速度向量成像评价Valsalva动作对正常人左室扭转的影响

目的:应用速度向量成像(VVI)技术评价Valsalva动作对正常人左室扭转运动的影响,探讨其机理及临床意义。方法:应用VVI技术对30例正常人初始时与40 mmHg乏氏动作张力期10s时左室短轴心内膜及心外膜下心肌旋转(ROT)、扭转(TW)及扭矩(TOR)进行定量分析。结果:与初始时比较,40 mmHgValsalva动作张力期10s时左室舒张末容积(LVEDV)、收缩末容积(LVESV)及每搏量(SV)减低(P<0.001)而心率增快(P<0.001),射血分值(EF)没有变化(P>0.05);左室心尖部心内膜及心外膜下心肌收缩期峰值旋转均减低(P<0.05),而基底部ROT无明显变化(P>0.05),导致左室TW减低(P<0.05)而TOR没有变化(P>0.05)。结论:40 mmHg Valsalva动作可影响正常人左室ROT及TW。临床上Valsalva动作应尽量减少负荷压及持续时间,避免其对心脏功能的不利影响。     

The Metabolic and Performance Effects of Caffeine Compared to Coffee during Endurance Exercise

There is consistent evidence supporting the ergogenic effects of caffeine for endurance based exercise. However, whether caffeine ingested through coffee has the same effects is still subject to debate. The primary aim of the study was to investigate the performance enhancing effects of caffeine and coffee using a time trial performance test, while also investigating the metabolic effects of caffeine and coffee. In a single-blind, crossover, randomised counter-balanced study design, eight trained male cyclists/triathletes (Mean±SD: Age 41±7y, Height 1.80±0.04 m, Weight 78.9±4.1 kg, VO₂ max 58±3 ml•kg⁻¹•min⁻¹) completed 30 min of steady-state (SS) cycling at approximately 55% VO₂max followed by a 45 min energy based target time trial (TT). One hour prior to exercise each athlete consumed drinks consisting of caffeine (5 mg CAF/kg BW), instant coffee (5 mg CAF/kg BW), instant decaffeinated coffee or placebo. The set workloads produced similar relative exercise intensities during the SS for all drinks, with no observed difference in carbohydrate or fat oxidation. Performance times during the TT were significantly faster (∼5.0%) for both caffeine and coffee when compared to placebo and decaf (38.35±1.53, 38.27±1.80, 40.23±1.98, 40.31±1.22 min respectively, p<0.05). The significantly faster performance times were similar for both caffeine and coffee. Average power for caffeine and coffee during the TT was significantly greater when compared to placebo and decaf (294±21 W, 291±22 W, 277±14 W, 276±23 W respectively, p<0.05). No significant differences were observed between placebo and decaf during the TT. The present study illustrates that both caffeine (5 mg/kg/BW) and coffee (5 mg/kg/BW) consumed 1 h prior to exercise can improve endurance exercise performance.     

Acute Impact of Pacing at Different Cardiac Sites on Left Ventricular Rotation and Twist in Dogs

Objectives

We evaluated the acute impact of different cardiac pacing sites on two-dimensional speckle-tracking echocardiography (STE) derived left ventricular (LV) rotation and twist in healthy dogs.

Methods

Twelve dogs were used in this study. The steerable pacing electrodes were positioned into right heart through the superior or inferior vena cava, into LV through aorta across the aortic valve. The steerable pacing electrodes were positioned individually in the right atrium (RA), right ventricular apex (RVA), RV outflow tract (RVOT), His bundle (HB), LV apex (LVA) and LV high septum (LVS), individual pacing mode was applied at 10 minutes interval for at least 5 minutes from each position under fluoroscopy and ultrasound guidance and at stabilized hemodynamic conditions. LV short-axis images at the apical and basal levels were obtained during sinus rhythm and pacing. Offline STE analysis was performed. Rotation, twist, time to peak rotation (TPR), time to peak twist (TPT), and apical-basal rotation delay (rotational synchronization index, RSI) values were compared at various conditions. LV pressure was monitored simultaneously.

Results

Anesthetic death occurred in 1 dog, and another dog was excluded because of bad imaging quality. Data from 10 dogs were analyzed. RVA, RVOT, HB, LVA, LVS, RARV (RA+RVA) pacing resulted in significantly reduced apical and basal rotation and twist, significantly prolonged apical TPR, TPT and RSI compared to pre-pacing and RA pacing (all P<0.05). The apical and basal rotation and twist values were significantly higher during HB pacing than during pacing at ventricular sites (all P<0.05, except basal rotation at RVA pacing). The apical TPR during HB pacing was significantly shorter than during RVOT and RVA pacing (both P<0.05). The LV end systolic pressure (LVESP) was significantly lower during ventricular pacing than during pre-pacing and RA pacing.

Conclusions

Our results show that RA and HB pacing results in less acute reduction on LV twist, rotation and LVESP compared to ventricular pacing.     

The Relationship between Adiponectin and Left Ventricular Mass Index Varies with the Risk of Left Ventricular Hypertrophy

Background

Adiponectin directly protects against cardiac remodeling. Despite this beneficial effect, most epidemiological studies have reported a negative relationship between adiponectin level and left ventricular mass index (LVMI). However, a positive relationship has also been reported in subjects at high risk of left ventricular hypertrophy (LVH). Based on these conflicting results, we hypothesized that the relationship between serum adiponectin level and LVMI varies with the risk of LVH.

Methods

A community-based, cross-sectional study was performed on 1414 subjects. LVMI was measured by echocardiography. Log-transformed adiponectin levels (Log-ADPN) were used for the analysis.

Results

Serum adiponectin level had a biphasic distribution (an increase after a decrease) with increasing LVMI. Although Log-ADPN did not correlate with LVMI, Log-ADPN was modestly associated with LVMI in the multivariate analysis (β = 0.079, p = 0.001). The relationship between adiponectin level and LVMI was bidirectional according to the risk of LVH. In normotensive subjects younger than 50 years, Log-ADPN negatively correlated with LVMI (r = −0.204, p = 0.005); however, Log-ADPN positively correlated with LVMI in ≥50-year-old obese subjects with high arterial stiffness (r = 0.189, p = 0.030). The correlation coefficient between Log-ADPN and LVMI gradually changed from negative to positive with increasing risk factors for LVH. The risk of LVH significantly interacted with the relationship between Log-ADPN and LVMI. In the multivariate analysis, Log-ADPN was associated with LVMI in the subjects at risk of LVH; however, Log-ADPN was either not associated or negatively associated with LVMI in subjects at low risk of LVH.

Conclusion

Adiponectin level and LVMI are negatively associated in subjects at low risk of LVH and are positively associated in subjects at high risk of LVH. Therefore, the relationship between adiponectin and LVMI varies with the risk of LVH.     

促红细胞生成素对血液透析患者血浆脂联素水平及左心室肥厚的影响

目的:促红细胞生成素(EPO)在维持性血液透析患者中具有保护心血管的作用,本文旨在探讨EPO在血液透析病人中对脂联素(ADPN)水平及左心室肥厚的影响。方法:46名维持性血液透析患者用EPO治疗8周,分别在治疗前,治疗第2、4、8周后测定血红蛋白(Hb),红细胞压积(Hct),血浆白蛋白(ALB),体重指数(BMI),C反应蛋白(CRP),血清铁蛋白(SF),血清铁饱和度(TAST),ELISA测定ADPN水平;彩色多普勒超声测定左心室心肌重量(LVM)及计算左心室心肌重量指数(LVMI)。结果:血液透析患者血清ADPN水平高于正常人;用EPO治疗2周后即出现ADPN水平升高,第4周后ADPN水平进一步升高,第8周与第4周比较无明显变化;应用EPO可降低CRP、SF水平;ADPN是LVMI的重要影响因子,EPO可改善左心室肥厚与功能。结论:EPO可提高血液透析患者ADPN水平,降低CRP、SF水平,减轻左心室肥厚。     

促红细胞生成素对血液透析患者血浆脂联素水平及左心室肥厚的影响

目的：促红细胞生成素（EPO）在维持性血液透析患者中具有保护心血管的作用,本文旨在探讨EPO在血液透析病人中对脂联素（ADPN）水平及左心室肥厚的影响。方法：46名维持性血液透析患者用EPO治疗8周,分别在治疗前,治疗第2、4、8周后测定血红蛋白（Hb）,红细胞压积（Hct）,血浆白蛋白（ALB）,体重指数（BMI）,C反应蛋白（CRP）,血清铁蛋白（SF）,血清铁饱和度（TAST）,ELISA测定ADPN水平;彩色多普勒超声测定左心室心肌重量（LVM）及计算左心室心肌重量指数（LVMI）。结果：血液透析患者血清ADPN水平高于正常人;用EPO治疗2周后即出现ADPN水平升高,第4周后ADPN水平进一步升高,第8周与第4周比较无明显变化;应用EPO可降低CRP、SF水平;ADPN是LVMI的重要影响因子,EPO可改善左心室肥厚与功能。结论：EPO可提高血液透析患者ADPN水平,降低CRP、SF水平,减轻左心室肥厚。     

Ghrelin对改善心衰大鼠左室功能紊乱的作用研究

目的:慢性心力衰竭(CHF)患者终末期阶段常发生左室(LV)重塑和心脏性恶病质,有研究称Ghrelin可能对CHFLV功能和能量代谢产生保护作用。本文旨在探讨Ghrelin对CHF大鼠LV功能紊乱和心源性恶病质的作用。方法:建立左冠状动脉结扎术和假手术组,手术后4周,给予大鼠Ghrelin或生理盐水3周。用超声心动图和心脏导管术监测结果。结果:与给予安慰剂组相比,用Ghrelin治疗的CHF和假手术组,血浆GH和胰岛素样生长因子1明显升高(t=1.49,t=0.71,P0.05)。与Sham-Placebo组相比,CHF-Placebo组大鼠体重明显减轻(t=2.18,P0.05)。然而与CHF-Placebo组相比,CHF-Ghrelin组大鼠,体重(t=3.89,P0.05),心输出量(t=3.28,P0.05),LV dP/dtmax(t=3.90,P0.05)明显增加。Ghrelin增加了CHF大鼠心脏舒张压,抑制LV扩大,增加LV缩短分数。结论:长期注射Ghrelin可改善CHF大鼠LV功能紊乱,减缓LV重构和心脏性恶病质的发展,有望为CHF的治疗提供新的途径和方法。     

Relationship of Exercise Capacity and Left Ventricular Dimensions in Patients with a Normal Ejection Fraction. An Exploratory Study

Objectives

Extreme endurance exercise is known to be associated with an enlargement of the left ventricular (LV) chamber, whereas inactivity results in inverse changes. It is unknown if these dimensional relationships exist in patients.

Methods

We analyzed the relationship of exercise capacity and LV dimension in a cohort of sequential patients with a normal ejection fraction undergoing stress echocardiography. In a total of 137 studies the following questions were addressed: (a) is there a difference in LV dimensions of patients with an excellent exercise capacity versus patients with a poor exercise capacity, (b) how is LV dimension and exercise capacity affected by LV wall thickness and (c) how do LV dimensions of patients who are unable to walk on a treadmill compare to the above groups.

Results

Patients with a poor exercise capacity or who are unable to physically exercise have a 34 percent smaller LV cavity size when compared to patients with an excellent exercise capacity (p<0.001). This reduction in LV chamber size is associated with concentric LV hypertrophy and a reciprocal increase in resting heart rate. In addition, cardiac output reserve is further blunted by chronotropic incompetence and a tachycardia-induced LV volume reduction. In conclusion the relationship of exercise capacity and cardiac dimensions described in extreme athletes also applies to patients. Our exploratory analysis suggests that patients who cannot sufficiently exercise have small LV cavities.     

The Functional State of Athletes Addicted to Exercises during Exercise Deprivation

The objective of this study is to identify markers of the addictive condition developing in athletes during exercise deprivation by analyzing electroencephalograms (EEGs), electromyograms (EMGs), skin temperature measurements, sympathetic nervous system activity, levels of anxiety and depression (by psychological tests). A cohort of professional football players (N = 50) voluntarily participated in the study. The athletes were tested under two test conditions: during active training sessions and during exercise deprivation (for seven days). The analyzed results have shown that the functional state of athletes with exercise addiction (due to exercise deprivation), compared with athletes showing no addictive behavior, was characterized by lower brain bioelectric activity (a decrease in the α-rhythm amplitude and power), growth in the muscular tension, increased sympathetic activity, and elevated levels of anxiety and depression. We have concluded that an athlete’s functional state during exercise deprivation is an important predictor for exercise dependence. A prolonged exercise deprivation causes intense psychophysiological changes in the body of athletes inclined to exercise addiction. The obtained results may be useful for experts in the field of sports medicine, as well as for further studies in different types of addictions.     

心电图左心室劳损和左心室肥厚对主动脉瓣狭窄患者预后的影响

目的:探讨心电图左心室劳损(LV)和左心室肥厚(LVH)对无症状主动脉瓣狭窄患者预后的影响。方法:到我院治疗的主动脉瓣狭窄患者766例,心电图左心室劳损和左心室肥厚的预测值用Sokolow-Lyon(SL)电压标准和Cornell电压-时间(CVDP)标准评估,通过对其他预后协变量调整并进行评价。结果:心电图左心室劳损患者的心肌梗死的累计发生率显著高于非心电图劳损的患者(HR=2.7,95%CI:1.4-5.3,P=0.006)。与非心电图左心室肥厚的患者比较,SL标准与CVDP标准联用诊断的左心室肥厚患者心力衰竭的风险显著增加(95%CI:4.7-26.4,P0.001);行主动脉瓣置换术风险显著增加(95%CI:1.6-3.2,P0.001);非致死性梗死、心力衰竭或心血管死亡的复合终点风险也显著增加(95%CI:1.2-3.7,P0.05)。结论:心电图LV和LVH是无症状主动脉瓣狭窄患者预后不良的独立预测因子。     

The Single-Bout Forearm Critical Force Test: A New Method to Establish Forearm Aerobic Metabolic Exercise Intensity and Capacity

No non-invasive test exists for forearm exercise that allows identification of power-time relationship parameters (W′, critical power) and thereby identification of the heavy-severe exercise intensity boundary and scaling of aerobic metabolic exercise intensity. The aim of this study was to develop a maximal effort handgrip exercise test to estimate forearm critical force (fCF; force analog of power) and establish its repeatability and validity. Ten healthy males (20–43 years) completed two maximal effort rhythmic handgrip exercise tests (repeated maximal voluntary contractions (MVC); 1 s contraction-2 s relaxation for 600 s) on separate days. Exercise intensity was quantified via peak contraction force and contraction impulse. There was no systematic difference between test 1 and 2 for fCF_{peak force} (p = 0.11) or fCF_impulse (p = 0.76). Typical error was small for both fCF_{peak force} (15.3 N, 5.5%) and fCF_impulse (15.7 N⋅s, 6.8%), and test re-test correlations were strong (fCF_{peak force}, r = 0.91, ICC = 0.94, p<0.01; fCF_impulse, r = 0.92, ICC = 0.95, p<0.01). Seven of ten subjects also completed time-to-exhaustion tests (TTE) at target contraction force equal to 10%<fCF_{peak force} and 10%>fCF_{peak force}. TTE predicted by W′ showed good agreement with actual TTE during the TTE tests (r = 0.97, ICC = 0.97, P<0.01; typical error 0.98 min, 12%; regression fit slope = 0.99 and y intercept not different from 0, p = 0.31). MVC did not predict fCF_{peak force} (p = 0.37), fCF_impulse (p = 0.49) or W′ (p = 0.15). In conclusion, the poor relationship between MVC and fCF or W′ illustrates the serious limitation of MVC in identifying metabolism-based exercise intensity zones. The maximal effort handgrip exercise test provides repeatable and valid estimates of fCF and should be used to normalize forearm aerobic metabolic exercise intensity instead of MVC.     

Effects of Exercise Intensity on Physical Fitness and Risk Factors for Coronary Heart Disease

Objective: To determine whether “low‐intensity” exercise (walking) and “high‐intensity” exercise (aerobic dance), when added to a weight loss diet, have different effects on coronary heart disease (CHD) risk factors and physical fitness. Research Methods and Procedures: Ninety obese women were divided into diet only (DO), diet plus walking (DW), and diet plus aerobic dance (DA) groups. DXA was used to evaluate segmental body composition. Leg‐extension strength and maximal oxygen uptake (V?o _2max) were the indicators of physical fitness. Blood pressure, lipoproteins, and fasting glucose were used as indices for CHD risk factors. These items were measured before and after a 14‐week intervention period. Results: Whole‐body plus all segmental fat masses were significantly reduced (p < 0.001). Reductions in whole‐body and lower‐limb fat‐ and bone‐free masses were significantly less (p < 0.01) in the DA group (?1.5 and ?0.1 kg, respectively) compared with the DO (?2.1 and ?0.4 kg, respectively) and DW (?2.5 and ?0.5 kg, respectively) groups. Improvements in leg‐extension strength and V?o _2max were significantly greater (p < 0.05) in the DA group compared with the DO group. The CHD risk factors clearly improved (p < 0.05) within each group. Reductions in low density lipoprotein‐cholesterol and fasting glucose were significantly greater (p < 0.05) in the DA group compared with the DO and DW groups. Discussion: Adding higher intensity aerobic dance to a weight‐loss diet program may help maintain fat‐ and bone‐free mass and may be more effective in improving CHD risk factors compared with low‐intensity walking.     

Effects of Obesity on Substrate Utilization during Exercise

Objective: The capacity for lipid and carbohydrate (CHO) oxidation during exercise is important for energy partitioning and storage. This study examined the effects of obesity on lipid and CHO oxidation during exercise. Research Methods and Procedures: Seven obese and seven lean [body mass index (BMI), 33 ± 0.8 and 23.7 ± 1.2 kg/m², respectively] sedentary, middle‐aged men matched for aerobic capacity performed 60 minutes of cycle exercise at similar relative (50% Vo _2max) and absolute exercise intensities. Results: Obese men derived a greater proportion of their energy from fatty‐acid oxidation than lean men (43 ± 5% 31 ± 2%; p = 0.02). Plasma fatty‐acid oxidation determined from recovery of infused [0.15 μmol/kg fat‐free mass (FFM) per minute] [1‐¹³C]‐palmitate in breath CO₂ was similar for obese and lean men (8.4 ± 1.1 and 29 ± 15 μmol/kg FFM per minute). Nonplasma fatty‐acid oxidation, presumably, from intramuscular sources, was 50% higher in obese men than in lean men (10.0 ± 0.6 versus 6.6 ± 0.8 μmol/kg FFM per minute; p < 0.05). Systemic glucose disposal was similar in lean and obese groups (33 ± 8 and 29 ± 15 μmol/kg FFM per minute). However, the estimated rate of glycogen‐oxidation was 50% lower in obese than in lean men (61 ± 12 versus 90 ± 6 μmol/kg FFM per minute; p < 0.05). Discussion: During moderate exercise, obese sedentary men have increased rates of fatty‐acid oxidation from nonplasma sources and reduced rates of CHO oxidation, particularly muscle glycogen, compared with lean sedentary men.     

超声心动图评价左室舒张性心力衰竭患者左心形态及舒张功能的应用价值

目的:研究超声心动图对左室舒张性心力衰竭(LVDHF)患者左心形态及舒张功能的评估价值。方法:选择2014年3月至2016年3月我院收治的LVDHF患者78例记为观察组,另选择同期健康志愿者80例记为对照组,两组受试者均进行血压、心率检查,并利用超声心动图技术检测两组受试者的心脏相关指标。结果:观察组的舒张压(DBP)、收缩压(SBP)、心率(HR)、左房内径(LAD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、综合指标(E/Ea)及反向血流速度(Ar)水平均明显高于对照组,而早、晚期的运动速度比(Ea/Aa)、血流传播速度(Vp)及峰速比(S/D)水平明显低于对照组,差异均有统计学意义(P0.05)。结论:超声心动图能准确地反应LVDHF患者的左心形态以及舒张功能,可在临床进行推广。     

不同强度的体育运动对糖尿病大鼠骨密度及骨代谢的影响

目的:探讨运动强度对糖尿病大鼠骨密度及骨代谢的影响,为糖尿病骨质疏松的预防和治疗提供实验依据。方法:采用一次性腹腔注射链服佐菌素建立糖尿病大鼠模型,随机分为糖尿病对照组、小强度运动组(10 m/min)、中强度运动组(20 m/min)和高强度运动组(30 m/min)。分别于运动前后测定各组大鼠的血糖、骨密度、血清骨钙素(BGP)、碱性磷酸化酶(AKP)、血钙(S-Ca)及血磷(S-P)含量。结果:运动组大鼠血糖均低于训练前和对照组(P0.05)。小强度运动组和高强度运动组大鼠骨密度低于对照组,中强度运动组大鼠骨密度显著高于对照组、小强度运动组和高强度运动组(P0.05);小强度运动组与高强度运动组大鼠骨密度无显著性差异(P0.05)。运动组大鼠BGP和S-P显著升高,AKP下降,差异具有统计学意义(P0.05)。小强度运动组和高强度运动组大鼠S-Ca无显著变化(P0.05);中强度运动组大鼠S-Ca显著升高,且高于小强度运动组和高强度运动组(P0.05)。结论:运动强度对骨密度和骨代谢有一定影响,采取适当的体育运动可提高血清骨钙素含量,改善骨代谢状况,有利于糖尿病骨质疏松症的预防。     

Metabolic, thermoregulatory, and perceptual responses during exercise after lower vs. whole body precooling.

The purpose of this investigation was to compare the thermoregulatory, metabolic, and perceptual effects of lower body (LBI) and whole body (WBI) immersion precooling techniques during submaximal exercise. Eleven healthy men completed two 30-min cycling bouts at 60% of maximal O(2) uptake preceded by immersion to the suprailiac crest (LBI) or clavicle (WBI) in 20 degrees C water. WBI produced significantly lower rectal temperature (T(re)) during minutes 24-30 of immersion and lower T(re), mean skin temperature, and mean body temperature for the first 24, 14, and 16 min of exercise, respectively. Body heat storage rates differed significantly for LBI and WBI during immersion and exercise, although no net differences were observed between conditions. For WBI, metabolic heat production and heart rate were significantly higher during immersion but not during exercise. Thermal sensation was significantly lower (felt colder) and thermal discomfort was significantly higher (less comfortable) for WBI during immersion and exercise. In conclusion, WBI and LBI attenuated T(re) increases during submaximal exercise and produced similar net heat storage over the protocol. LBI minimized metabolic increases and negative perceptual effects associated with WBI.     

Delayed Treatment Effects of Xanthine Oxidase Inhibition on Systolic Overload-Induced Left Ventricular Hypertrophy and Dysfunction

The nonpurine selective xanthine oxidase (XO) inhibitor febuxostat attenuates development of left ventricular (LV) hypertrophy and dysfunction in mice when treatment is initiated within 1 hour of transverse aortic constriction (TAC). This study investigated whether a 7-day delay of treatment with the XO inhibitors febuxostat or allopurinol would reverse TAC-induced changes after onset of heart failure (HF). Neither treatment significantly affected TAC-induced LV hypertrophy; only febuxostat caused a modest improvement in LV function (～10% increase in LV ejection fraction). However, the purine analog allopurinol tended to increase mortality compared with vehicle or febuxostat in HF mice.     

High Intensity Exercise in Multiple Sclerosis: Effects on Muscle Contractile Characteristics and Exercise Capacity,a Randomised Controlled Trial

Introduction

Low-to-moderate intensity exercise improves muscle contractile properties and endurance capacity in multiple sclerosis (MS). The impact of high intensity exercise remains unknown.

Methods

Thirty-four MS patients were randomized into a sedentary control group (SED, n = 11) and 2 exercise groups that performed 12 weeks of a high intensity interval (H_ITR, n = 12) or high intensity continuous cardiovascular training (H_CTR, n = 11), both in combination with resistance training. M.vastus lateralis fiber cross sectional area (CSA) and proportion, knee-flexor/extensor strength, body composition, maximal endurance capacity and self-reported physical activity levels were assessed before and after 12 weeks.

Results

Compared to SED, 12 weeks of high intensity exercise increased mean fiber CSA (H_ITR: +21±7%, H_CTR: +23±5%). Furthermore, fiber type I CSA increased in H_CTR (+29±6%), whereas type II (+23±7%) and IIa (+23±6%,) CSA increased in H_ITR. Muscle strength improved in H_ITR and H_CTR (between +13±7% and +45±20%) and body fat percentage tended to decrease (H_ITR: -3.9±2.0% and H_CTR: -2.5±1.2%). Furthermore, endurance capacity (W_max +21±4%, time to exhaustion +24±5%, VO_2max +17±5%) and lean tissue mass (+1.4±0.5%) only increased in H_ITR. Finally self-reported physical activity levels increased 73±19% and 86±27% in H_CTR and H_ITR, respectively.

Conclusion

High intensity cardiovascular exercise combined with resistance training was safe, well tolerated and improved muscle contractile characteristics and endurance capacity in MS.

Trial Registration

ClinicalTrials.gov NCT01845896