Relation Between Duration and Intensity of First Exercise and "warm Up" in Ischaemic Heart Disease

Overview

Journal Heart

Date 2000 Jan 5

PMID 10618328

Citations 3

Authors

P Kay

J Kittelson

R A Stewart

Affiliations

Soon will be listed here.

Abstract

Objective: To determine the importance of the duration and intensity of "warm up" exercise for reducing ischaemia during second exercise in patients with exertional angina.

Design: Randomised crossover comparison of three warm up exercise protocols.

Patients: 18 subjects with stable ischaemic heart disease and > 0.1 mV ST segment depression on treadmill exercise testing.

Interventions: The warm up protocols were 20 minutes of slow exercise at 2.7 km/h, symptom limited graded exercise for a mean of 7.4 (range 5.0 to 10.5) minutes, and three minutes of symptom limited fast exercise of similar maximum intensity.

Main Outcome Measures: ST segment depression during graded treadmill exercise undertaken 10 minutes after each warm up protocol or no warm up exercise.

Results: Compared with exercise with no warm up, the duration of graded exercise after earlier slow warm up increased by 4.9% (95% confidence interval (CI), -3.3% to 13.7%), after graded warm up by 10.3% (95% CI, 5.6% to 15.2%), and after fast warm up by 16% (95% CI, 6.2% to 26.7%). ST segment depression at equivalent submaximal exercise decreased after slow warm up by 27% (95% CI, 5% to 44%), after graded warm up by 31% (95% CI, 17% to 44%), and after fast warm up by 47% (95% CI, 27% to 61%). Compared with slow warm up exercise, the more intense graded and fast warm up protocols significantly increased the duration of second exercise (p = 0.0072) and reduced both peak ST depression (p = 0.0026) and the rate of increase of ST depression (p = 0.0069).

Conclusions: In patients with exertional angina the size of the warm up response is related to the maximum intensity rather than the duration of first exercise.

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References

Hambrecht R, Niebauer J, Marburger C, Grunze M, Kalberer B, Hauer K . Various intensities of leisure time physical activity in patients with coronary artery disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. J Am Coll Cardiol. 1993; 22(2):468-77. DOI: 10.1016/0735-1097(93)90051-2. View

Okazaki Y, Kodama K, Sato H, Kitakaze M, Hirayama A, Mishima M . Attenuation of increased regional myocardial oxygen consumption during exercise as a major cause of warm-up phenomenon. J Am Coll Cardiol. 1993; 21(7):1597-604. DOI: 10.1016/0735-1097(93)90374-a. View

Marber M, Joy M, Yellon D . Is warm-up in angina ischaemic preconditioning?. Br Heart J. 1994; 72(3):213-5. PMC: 1025501. DOI: 10.1136/hrt.72.3.213. View

Fletcher G, Balady G, Froelicher V, HARTLEY L, Haskell W, Pollock M . Exercise standards. A statement for healthcare professionals from the American Heart Association. Writing Group. Circulation. 1995; 91(2):580-615. DOI: 10.1161/01.cir.91.2.580. View

Stewart R, Simmonds M, WILLIAMS M . Time course of "warm-up" in stable angina. Am J Cardiol. 1995; 76(1):70-3. DOI: 10.1016/s0002-9149(99)80804-2. View

Jakicic J, Wing R, Butler B, Robertson R . Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women. Int J Obes Relat Metab Disord. 1995; 19(12):893-901. View

MAYBAUM S, Ilan M, Mogilevsky J, Tzivoni D . Improvement in ischemic parameters during repeated exercise testing: a possible model for myocardial preconditioning. Am J Cardiol. 1996; 78(10):1087-91. DOI: 10.1016/s0002-9149(96)90057-0. View

Niebauer J, Hambrecht R, Velich T, Hauer K, Marburger C, Kalberer B . Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation. 1997; 96(8):2534-41. DOI: 10.1161/01.cir.96.8.2534. View

Kloner R, Bolli R, Marban E, Reinlib L, Braunwald E . Medical and cellular implications of stunning, hibernation, and preconditioning: an NHLBI workshop. Circulation. 1998; 97(18):1848-67. DOI: 10.1161/01.cir.97.18.1848. View

10.

Willich S, Lewis M, Lowel H, Arntz H, Schubert F, Schroder R . Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group. N Engl J Med. 1993; 329(23):1684-90. DOI: 10.1056/NEJM199312023292302. View

11.

Siscovick D, Weiss N, Fletcher R, Lasky T . The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984; 311(14):874-7. DOI: 10.1056/NEJM198410043111402. View

12.

Yamamoto H, Tomoike H, Shimokawa H, Nabeyama S, Nakamura M . Development of collateral function with repetitive coronary occlusion in a canine model reduces myocardial reactive hyperemia in the absence of significant coronary stenosis. Circ Res. 1984; 55(5):623-32. DOI: 10.1161/01.res.55.5.623. View

13.

Joy M, Cairns A, Sprigings D . Observations on the warm up phenomenon in angina pectoris. Br Heart J. 1987; 58(2):116-21. PMC: 1277289. DOI: 10.1136/hrt.58.2.116. View

14.

Oldridge N, Guyatt G, Fischer M, Rimm A . Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials. JAMA. 1988; 260(7):945-50. View

15.

OConnor G, Buring J, Yusuf S, Goldhaber S, Olmstead E, Paffenbarger Jr R . An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation. 1989; 80(2):234-44. DOI: 10.1161/01.cir.80.2.234. View

16.

Blair S, Kohl 3rd H, Paffenbarger Jr R, Clark D, COOPER K, Gibbons L . Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989; 262(17):2395-401. DOI: 10.1001/jama.262.17.2395. View

17.

DeBusk R, Stenestrand U, Sheehan M, Haskell W . Training effects of long versus short bouts of exercise in healthy subjects. Am J Cardiol. 1990; 65(15):1010-3. DOI: 10.1016/0002-9149(90)91005-q. View

18.

Yamanishi K, Fujita M, Ohno A, Sasayama S . Importance of myocardial ischaemia for recruitment of coronary collateral circulation in dogs. Cardiovasc Res. 1990; 24(4):271-7. DOI: 10.1093/cvr/24.4.271. View

19.

Morris J, Clayton D, Everitt M, SEMMENCE A, Burgess E . Exercise in leisure time: coronary attack and death rates. Br Heart J. 1990; 63(6):325-34. PMC: 1024515. DOI: 10.1136/hrt.63.6.325. View

20.

Mittleman M, Maclure M, Tofler G, Sherwood J, Goldberg R, Muller J . Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. 1993; 329(23):1677-83. DOI: 10.1056/NEJM199312023292301. View