ECG Monitoring in Cardiac Rehabilitation: Is It Needed?

In brief: The need for expert supervision in cardiac rehabilitation exercise programs is generally accepted, but the use of ECG monitoring as a safety measure in such programs is controversial. No randomized controlled studies of monitoring vs supervision alone have been performed. Consequently, there is no uniform approach to the role of ECG monitoring in cardiac exercise programs.

Does Exercise Improve Coronary Collateralization? A New Look at an Old Belief.

In brief: An alternative route for blood supply in the heart-ie, coronary collateral vessels-can save the life of a person with coronary artery disease. Debate continues as to whether exercise training accelerates the growth of collateral vessels. Animal research has produced positive results, but studies of humans have been disappointing, largely because of problems in experimental design and methodology.

The Role of Diet, Exercise, and Medication in Blood Lipid Management of Cardiac Patients.

In brief: Results of clinical investigations clearly indicate that aggressive management of blood lipids and lipoproteins can significantly benefit cardiovascular health. This finding is particularly important for patients with diagnosed coronary heart disease and those at risk for developing it. Therapy comprises reduction of excess body fat, a diet low in cholesterol and saturated fats, endurance exercise, and medication.

Legal Aspects of Cardiac Rehabilitation Exercise Programs.

In brief: Cardiac rehabilitation as a distinct c health care service is of fairly recent origin, and existing programs are rather broad and nonstandardized. Consequently, the malpractice crisis that has engulfed the medical profession may well affect professionals who practice cardiac rehabilitation. Various legal issues and concerns face cardiac rehabilitation programs, as they do any other health care provider group.

Cardiac Rehabilitation: Then and Now.

In brief: Cardiac rehabilitation, born of cardiology in order to care for patients with coronary heart disease, has evolved into an accepted area of clinical practice. As more and more patients survive a coronary event, the need for state-of-the-art methods of rehabilitation will be increasingly needed. The author reviews the history of cardiac rehabilitation, discusses its current status, and predicts What courses of action will be needed as the field continues to evolve.

Does Cardiac Rehabilitation After Myocardial Infarction Favorably.

In brief: This review article discusses the limitations of 14 randomized controlled trials of exercise rehabilitation for patients who had sustained a myocardial infarction. Seven of nine major trials involved 3,222 patients, whose conditions were followed for one to nine years; total mortality was reduced by 20% to 50% in these studies. Although pooling this information to obtain statistical significance is difficult, the results are compatible with a substantial therapeutic benefit.

Simple ultraviolet calibration source with reference spectra and its use with the Galileo orbiter ultraviolet spectrometer.

We have developed a simple compact electron impact laboratory source of UV radiation whose relative intensity as a function of wavelength has an accuracy traceable to the fundamental physical constants (transitions probabilities and excitation cross sections) for an atomic or molecular system. Using this laboratory source, calibrated optically thin vacuum ultraviolet (VUV) spectra have been obtained and synthetic spectral models developed for important molecular band systems of H(2) and N(2) and the n(1)P(0) Itydberg series of He. The model spectrum from H(2) represents an extension of the molecular branching ratio technique to include spectral line intensities from more than one electronic upper state.

Relationship of stressful housing conditions to the onset of diabetes mellitus induced by multiple, sub-diabetogenic doses of streptozotocin in mice.

The effect of the stress of crowded housing conditions (10 mice/cage) on the onset of diabetes after multiple, sub-diabetogenic doses of streptozotocin (MSZ) in male C57BL/KsJ mice was investigated. Prior to MSZ treatment, the group-housed and individually-housed animals had similar plasma glucose levels, while the former group's plasma corticosterone (CS) levels were elevated (54 +/- 8 ng/ml, p less than 0.03; 166% of the latter group).

Biological differences in a rat insulinoma cell line obtained from different laboratories do not affect binding of human anti-islet immunoglobulins.

An insulin-producing clone of rat insulinoma cells (RINm5F) has been used by several investigators as target cells for studies of both humoral and cell-mediated anti-islet immunity in diabetic animals and humans. We noted that the rate of proliferation of RINm5F cells obtained from different laboratories varied considerably, and, in the present study, we have compared the proliferation rates of RINm5F cells obtained from 3 laboratories (Uppsala, Sweden [UPP], Chicago [CHI] and New York [NY]). The cells were plated at 0.

Gestational diabetes: impact of home glucose monitoring on neonatal birth weight.

Two groups of 58 gestational diabetic women matched for age, prepregnancy weight, height, and parity were studied. The home glucose monitoring study group performed fasting and 1-hour postprandial capillary blood glucose testing after every meal. The control group was followed by conventional treatment.

Validity of skinfold thickness measures of formerly obese adults.

Unlabelled: To assess the validity of skinfold thickness estimates of body fatness in formerly morbid obese adults, 23 patients (17 women, 6 men) who had completed a protein-sparing modified fast were studied. Mean +/- SD weight loss was 60.7 +/- 20.

Triad of markers for identifying children at high risk of developing insulin-dependent diabetes mellitus.

A longitudinal investigation was conducted from 1977 to 1984 on 178 families in which one or more of the children had insulin-dependent diabetes mellitus. Of 351 nondiabetic sibs followed up for an average of 54 months, ten have, thus far, become diabetic. Eight sibs were HLA identical to their diabetic proband and nine had HLA-DR3 and/or HLA-DR4.

Exercise testing, training and arm ergometry.

Standard exercise testing and training methods require leg work, but alternative methods involving arm work appear to be particularly applicable for selected subjects. An understanding of the physiology of upper extremity exercise and of the implications for arm exercise testing and training will assist in the diagnostic and functional evaluation and prescription of exercise. The cardiorespiratory and haemodynamic responses to submaximal and maximal arm and leg exercise are reviewed and practical information and guidelines for the recommendation of arm exercise testing and training in wheelchair-confined individuals, normal subjects, and patients with coronary heart disease are provided.

Very low-density lipoprotein metabolism in an unusual case of lipoatrophic diabetes.

Complete acquired lipoatrophic diabetes (LD) is characterized by nonketotic insulin-resistant diabetes, elevated very low-density lipoprotein (VLDL) triglyceride (TG) levels, and absent subcutaneous fat. We studied a young child in whom LD atypically developed after the onset of type 1 diabetes mellitus. On uncontrolled home diet the patient had triglyceride levels over 1,000 mg/dL on multiple occasions.

Cardiac exercise programs: role of continuous electrocardiographic monitoring.

The purpose of the present study was to determine the value of telemetry monitoring for detection of new and significant electrocardiographic (ECG) or blood pressure abnormalities during outpatient cardiac exercise therapy. Following preliminary graded exercise testing, 177 cardiac patients underwent a four-week monitored exercise program three days per week. During 2248 training sessions, 12 of the 177 patients (7%) showed significant ECG or blood pressure abnormalities not evident on initial exercise testing, eight (5%) requiring change in medical therapy.

Physiological profile of national-class National Collegiate Athletic Association fencers.

Selected physiological characteristics of seven national-class fencers (1983 National Collegiate Athletic Association Division I champions) were studied and the results compared with those for normal persons and athletes of similar age. Evaluation included maximal oxygen uptake during arm and leg ergometry, serum lipids, body composition, and standard spirometry. Maximal oxygen uptake during arm work (34.

Evaluating the cardiac patient for exercise therapy. Role of exercise testing.

Several types of exercise tests and their use are reviewed. Suggestions are made for modification of tests to enhance their value in the counseling of normal individuals and patients with cardiac problems regarding occupational, recreational, and training activity. Also discussed are indications and contraindications to testing, end points in testing, and evaluation of test results.

Chronic adaptations to physical conditioning in cardiac patients. Implications regarding exercise trainability.

Physical conditioning in patients with coronary heart disease can result in increased functional capacity, symptomatic relief of angina pectoris, favorable reduction of risk factors, enhanced psychological status, and improved quality of life. The mechanisms underlying the adaptations to training are poorly understood, but it is clear that several factors affect exercise trainability. Guidelines are available that suggest the appropriate intensity, frequency, and duration of exercise needed to obtain beneficial physiologic adaptations.

Metabolic cost of extremely slow walking in cardiac patients: implications for exercise testing and training.

To assess metabolic cost of extremely slow walking, nine patients with coronary heart disease (means age, 56.1 yr) underwent multistage treadmill testing using standard open circuit calorimetry techniques. Heart rate, blood pressure, minute ventilation, and oxygen uptake in METS (1MET = 3.