Treadmill Cardio Workouts
Inositol nicotinate is licensed for use in the United Kingdom for patients with intermittent claudication. However,the evidence base for this compound is weak. Of the four double-blind, randomized, placebo-controlled trials, three were primary care based and used subjective or questionable objective criteria for assessment of IC without treadmill use. None showed clear evidence of improvement in symptoms with drug use. We suggest, therefore, that the drug may not be of value for patients with IC.
The participants in this study were young white and black men and women (ages 1830) who completed treadmill testing and then were followed from 1985 to 2001. Glucose, lipids, and blood pressures were measured and physical activity was assessed by interview and self-reporting. Outcome measurements included hypercholesterolemia, metabolic syndrome, hypertension, and type-2 diabetes. These results are similar to other studies where maximum oxygen uptake was used to measure fitness rather than treadmill-testing time. Nonetheless, it underscores the fact that suboptimal physical activity and fitness increase risk for cardiovascular disease, diabetes, lipid disorders, and metabolic syndrome.
Nineteen long-term (mean of 46 years) vegetarian and 12 non-vegetarian, healthy, physically active elderly women (mean age of 71 years) were compared on a variety of hematological, anthropometric, and metabolic factors.30 Although the vegetarian subjects had significantly lower blood glucose and cholesterol levels, no differences between groups were found for submaximal and maximal cardiorespiratory and electrocardio-graphic parameters measured during graded treadmill testing. The authors
The Duke treadmill score can provide an additional method of evaluating the patient that has received an exercise ECG. The treadmill score is the exercise time minus (5 x ST elevation in mm) minus (4 x exercise angina) where 0 no angina, 1 nonlimiting angina, and 2 exercise-limiting angina. Low risk is a score of 5 or higher, moderate risk is -10 to +4 and high risk is -11 or lower. (e.g., treadmill walking at the desired target heart rate for 30 min).
The answer is d. (Braunwald, 15 e, p 1402.) The most appropriate test would be a treadmill stress test with thallium imaging. A treadmill stress test has a lower sensitivity and specificity in patients with atypical or no chest pain. The overall sensitivity of exercise stress electrocardiography is about 75 . Therefore a negative treadmill stress test would not rule out coronary disease. Subsequent thallium imaging improves sensitivity and specificity.
This is a rheological agent that has been approved for the treatment of intermittent claudication. Only two of the double-blind, placebo-controlled studies of oxpentifylline that measured walking distance using treadmills showed any statistical improvement in such walking distance by patients on oxpentify-line. Furthermore, one of these was a retrospective subanalysis of short-distance claudicants, patients who could only walk short distances before claudication ocurred already included in another study. A meta-analysis of ten randomized, double-blind, controlled studies concluded that the limited amount and quality of data for this drug precluded an overall reliable estimate of its efficacy. We recommend, in the absence of any consistent clinical trial evidence,that oxpen-tifylline should not be prescribed for use in this indication.
In patients with symptoms consistent with claudication but relatively normal indices, exercise testing should be performed. A standard exercise test involves measuring the ABI at rest followed by walking on a treadmill at 2 miles hour at a 10 to 15 incline for 5 minutes. The ABI is recorded 1 minute after exercise. Normally, after exercise, there is a slight increase or no difference in the ABI. If the ABI decreases after exercise, this is consistent with claudication.
As you learned earlier in this chapter, ischemia is usually a changing, dynamic state that comes and goes, depending on the current balance or imbalance between oxygen supply and oxygen demand in the tissues. By the same token, ST depression is also often transient. It comes and goes with the ischemic state. Many patients with severe coronary artery disease display perfectly normal ECGs at rest and demonstrate ST depression only when ischemia is precipitated by exercise or occurs during an anginal episode. This fact gave rise to exercise stress testing as a means of detecting occlusive coronary artery disease in patients with normal resting ECGs. During stress testing, a 12-lead ECG is continuously monitored while the patient walks on a treadmill or peddles a stationary bicycle. Any ischemia provoked by exercise is then detected by observing for horizontal or downsloping ST depression of 1 mm. Care must be taken not to falsely interpret physiologic J point depression as representing...
The most common cause of acute MI, occurring in 90 to 95 percent of cases, is total occlusion of a major coronary artery. This mechanism is similar to that which occurs in unstable angina, except that in unstable angina, occlusion of the coronary artery is not complete. It is now known that acute MI most often develops in a vessel with a lesser grade occlusion.23 This surprising finding is linked to the instability of the lipid-laden, thinly capped atherosclerotic plaque, which is more susceptible to rupture and subsequent formation of an occluding thrombus. A plaque with less lipid and a stronger cap is more resistant to rupture. Because a majority of infarcts develop from nonocclusive plaques, it is difficult to identify patients at risk for MI with exercise treadmill testing, which typically screens for patients with flow-limiting lesions.
It is helpful to educate the patient about how many calories are spent in an individual exercise activity. Most tables of caloric expenditure with given levels of activity have been compiled to reflect total caloric expenditure, not the amount over the resting metabolic rate. As a result, the caloric contribution of exercise must be calculated as the difference between the calories expended per minute during the exercise and the calories that a person would have expended just sitting. It is instructive and often disappointing to patients to discover just how much exercise they must do to expend a significant number of calories. For instance, if an overweight woman's basal metabolic rate is 1400 kcal d, lying down awake she expends 1.1 kcal min sitting, about 1.2 kcal min walking slowly, about 1.9 kcal min and walking a treadmill at 4.0 miles per hour, 7.2 kcal min. Thus, the difference in caloric expenditure between sitting quietly and walking fast on a treadmill (at 4.0 miles per...
Exercise stress test is a noninvasive study that is performed to evaluate cardiac function during physical activity. Electrocardiography is conducted during stress testing and the patient's heart rate and blood pressure are monitored. There are three types of exercise associated with this test stair climbing, walking a treadmill with the grade of incline gradually increasing, and pedaling a stationary bike with the pedaling tension slowly increasing.
The patient is prepared for this exam by having an ECG monitor attached to the chest and a blood pressure cuff placed on the arm. The patient is then placed on a treadmill and exercises until obtaining a maximum heart rate. At that time, the radionuclide thallium is injected intravenously, the patient is placed in a supine position, and the scan is performed. The scan is usually repeated approximately four hours later to assess the redistribution of the radionuclide. The scans are then analyzed by computer and appropriate photographic records are developed. SPECT scanning, which provides a three-dimensional image of the physiology of the heart, may also be performed. Chemical stress testing is available for individuals with physical limitations that prevent them from doing the treadmill exercises. Medications are administered that stress the heart in the same manner as exercise, and
When Robert Freuhauf was admitted to the coronary care unit, you learned during your nursing evaluation that Robert was unfortunate enough to have had a myocardial infarction seven years previously at the age of 33. Robert had a cardiac catheterization shortly thereafter, the results of which are unclear to you. He can only remember that they told him he had a tear in a vessel wall. After 7years free of chest pain, or other symptoms, Robert had been readmitted 2 weeks ago with a several week history of exertional chest discomfort relieved by rest, and then, finally, an episode of pain at rest, leading to admission. After several days in the CCU, Robert had had a treadmill stress test performed, which was negative, and he was discharged on aspirin and simvastatin.
Algorithm for a suggested approach to cost-effective, risk-stratification and management after acute myocardial infarction (MI). This approach entails risk stratification and initiation of preventive therapy in all patients before discharge, including those without symptoms. Patients with persistent or recurrent symptoms of cardiac failure, ischemia, or ventricular arrhythmias (unstable condition) should undergo direct coronary angiography, followed by myocardial revascularization (percutaneous transluminal coronary angioplasty PTCA or coronary artery bypass graft surgery CABG when appropriate). Patients who appear clinically stable after an acute MI may or may not have evidence of left ventricular (LV) dysfunction. Patients with no evidence of LV dysfunction should undergo submaximal treadmill exercise testing (ET). Patients with evidence of LV dysfunction should undergo echocardiography to assess LV function. If ejection fraction is 40 percent, ET should be performed to detect...
The Donts of Treadmill Buying
Though competitive runners are advised to run on the road, there are several reasons why you should buy treadmills anyway. You might have a family which means that your schedule does not have the flexibility it once had.