102,255 research outputs found
WALKING SPEED AND WALKING PULSE: NOVEL INDICES TO QUANTIFY EFFICACY OF TRAINING IN CARDIAC SECONDARY PREVENTION
No full textIntroduction
Walking is the most common form of physical activity among adults, and is widely accessible and appealing to less fit subjects. Walking Speed (WS) is a strong predictor of survival and has been considered a vital sign (Cesari, 2011). We developed a moderate 1-km treadmill-walking test (1k-TWT) to estimate peak oxygen uptake (VO2peak) in cardiac outpatients (Chiaranda, 2012). WS during a 1k-TWT predicts survival; every 1-km/h increase in WS was associated with a 40% reduction in fully-adjusted 10-year risk of all-cause mortality (Chiaranda, 2013). This study aims to examine the utility of the 1k-TWT as a measure of cardiocirculatory response to a moderate walking program.
Methods
Fifty-four stable coronary artery disease patients were examined at baseline and after 8 weeks of perceptually-regulated walking training (11–13/20 Borg scale). Subjects performed 20-30 min supervised treadmill walking two times/week, and two additional 20-30 min sessions of self-guided exercise/week, for 8 weeks. Training effects were assessed by the determination of VO2peak and by the ratio of walking speed to heart rate (“Walking Pulse”, WP, m/h/bpm) during the 1k-TWT.
Results
VO2peak increased from 24.9±5.1 to 26.4±6.3 mL/kg/min (p<0.05). WS during 1k-TWT improved from 4.4±1.2 to 5.1±1.1 km/h (p<0.0001), whereas heart rate was unchanged (93±13 vs 93±12 bpm). A 19% improvement in WP was observed after training (from 47±13 to 56±12 m/h/bpm, p<0.0001).
Discussion and Conclusion
Eight weeks of moderate walking substantially improved cardiocirculatory fitness in cardiac outpatients, evidenced by an improvement in both VO2peak and WP (i.e. distance covered per bpm). After training, all patients were able to walk faster at the same heart rate. By extrapolating from our earlier results on survival benefits with improved WS (Chiaranda, 2013), the 0.7 km/h improvement corresponds to a 20% reduction in long-term risk of all-cause mortality. Given the clinical implications of a slow WS, these findings underscore the concept that a short, supervised and home based moderate walking program is effective in improving outcomes in cardiac outpatients. The 1k-TWT is a simple tool to assess training responses in secondary prevention programs. WP is a new index that appears to have utility for assessing the efficacy of training.
References
1. Cesari M. (2011) JAMA 305:93–4
2. Chiaranda G. et al. (2012) J Cardiopulm Rehabil Prev 32:262–9
3. Chiaranda G. et al. (2013) BMJ Open 3:e00344
Mirella Chiaranda docente. Ricordi di una ex studentessa
No full textMirella Chiaranda ha insegnato nell'Ateneo patavino per lungo tempo occupandosi di educazione dell'infanzia, storia della pedagogia e d educazione comparata
L'indagine emodinamica in Anestesia e Rianimazione
No full textIl libro è indirizzato agli Anestesisti-Rianimatori che desiderano approfondire gli aspetti fisiopatologici e tecnici dell'indagine emodinamica invasiva.
Gli Autori introducono l'argomento con una sintetica premessa fisiopatologica sulla funzione cardiovascolare e illustrano la tecnica del cateterismo del cuore destro con sonda di Swan-Ganz e le sue possibili complicanze.
Accanto all'elencazione dei parametri che si ottengono con la misura diretta ed alle formule matematiche necessarie per calcolare in via indiretta numerosi altri indici, viene descritto in modo analitico il significato dei singoli parametri discutendone l'interpretazione che va loro attribuita.
Nella seconda parte il lettore troverà le indicazioni all'applicazione dell'indagine emodinamica sia nell'ambito della pratica anestesica, sia nel vasto campo della patologia rianimativa, con riferimento a casi clinici esemplificativi
Aspetti emodinamici della anestesia ketaminica in perfusione continua nella chirurgia dell'età senile
No full textThe results obtained in a haemodynamic study carried out in 9 elderly patients subjected to ketaminic anaesthesia in continuous perfusion for visceral surgery operations are reported and compared with those observed, under the same conditions, in 9 patients aged less than 65. Stress is laid on the stimulating cardiovascular action observed during induction and the lower myocardial reactivity of elderly patients by comparison with younger ones. Mention is also made of the stability of haemodynamic values throughout the period of the operation. There was, however, a tendency to bradycardia and the constant onset of systemic arterial hypotension during the initial period. These are interpreted as phenomena due to the cardiovascular lability of senile age. The effectiveness of ketamine's cardiocirculatory action is, however, a positive factor in the light of the haemodynamic findings obtained during anaesthesia with Althesin and Fentanyl. It is concluded that the anaesthesia technique employed has some positive aspects that make it particularly indicated in states of acute or chronic cardiocirculatory lability, for visceral surgery operations also
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