Effect of physical training on the recovery of acute exercise, among patients with cardiovascular disease

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array:1 [ 0 => array:2 [ "nombre" => "Alfredo" "apellidos" => "de Micheli" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1405994017300496?idApp=UINPBA00004N" "url" => "/14059940/0000008700000003/v1_201708020145/S1405994017300496/v1_201708020145/es/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Clinical Research" "titulo" => "Effect of physical training on the recovery of acute exercise, among patients with cardiovascular disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "199" "paginaFinal" => "204" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marianna García-Saldivia, Hermes Ilarraza-Lomelí, Jonathan Myers, Jorge Lara, Leopoldo Bueno" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Marianna" "apellidos" => "García-Saldivia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Hermes" "apellidos" => "Ilarraza-Lomelí" "email" => array:1 [ 0 => "hermes_ilarraza@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Jonathan" "apellidos" => "Myers" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Jorge" "apellidos" => "Lara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Leopoldo" "apellidos" => "Bueno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Rehabilitación Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, CA, United States" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Juan Badiano No. 1, Colonia sección XVI, Delegación Tlalpan, México, D.F., Mexico. Tel.: +52 5573 2911x1214; fax: +52 5573 0994." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto del entrenamiento físico en la recuperación del ejercicio agudo, en pacientes con enfermedad cardiovascular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1569 "Ancho" => 1649 "Tamanyo" => 143077 ] ] "descripcion" => array:1 [ "en" => "Abbreviations: Recovery of oxygen uptake (RVO2) and heart rate recovery (HRR). This scatter plot shows an absence of correlation between heart rate recovery and the recovery of oxygen uptake, (R2=0.002, p=ns)." ] ] ] "textoCompleto" => "IntroductionExercise testing has been widely used for decades as a diagnostic tool in patients with cardiovascular disease (CVD), but it has also a prognostic approach at intermediate and long term.<a class="elsevierStyleCrossRefs" href="#bib0120">1,2</a> Variables traditionally used for prediction models, are focused on the active part of this test (exercise), specifically on two items: maximal exercise tolerance (maximal oxygen uptake, VO2max) and chronotropic response.Nowadays, there are some recognized physiological disorders during the recovery phase among CVD patients, like a slow heart rate recovery (HRR) and an abnormal VO2 kinetics. These changes are associated with a poor survival, in patients with CVD.<a class="elsevierStyleCrossRefs" href="#bib0130">3–6</a> It has been reported, that individuals with heart failure have elevated both, oxygen debt and oxygen deficit. These phenomena are related with a slow recovery of the VO2 kinetics (RVO2) and also a reduced HRR. Some researching groups have reported that this could be mediated by several neuro-humoral and local mechanisms.<a class="elsevierStyleCrossRef" href="#bib0150">7</a>Physical training programs (PTP) have been associated with an increased on survival and better cardiovascular behavior among patients with heart disease. Particularly, it has been observed that PTP are linked to specific metabolic changes, such as a higher VO2max, and a reduced oxygen debt.<a class="elsevierStyleCrossRef" href="#bib0155">8</a>Some studies have shown that PTP are associated with an improvement of HRR (increase) in patients with CVD.<a class="elsevierStyleCrossRef" href="#bib0160">9</a> Nonetheless, this behavior has not yet been related with a reduction on oxygen debt.Thus, we hypothesize that PTP could modify both, HRR and RVO2 behavior, because of their effects on the autonomic nervous system regulation and some local processes. The aim of this study was to compare HRR and RVO2 after a physical training program.MethodsSelection criteria of this study included patients with cardiovascular disease, older than 18 years, who were referred to a hospital-outpatient cardiac rehabilitation program. Patients with any contraindication for exercising were excluded. Every patient was submitted into a risk stratification procedure that included: clinical examination, exercise testing and other evaluations as needed. Written consents were obtained from all patients.Exercise Testing. All patients performed a cardiopulmonary exercise test (CPET), before and after the PTP.<a class="elsevierStyleCrossRef" href="#bib0165">10</a> Every CPET was symptom's limited, and all CPET with more than 85% of the maximal predicted-heart rate (HRmax=220−age in years), or a respiratory quotient (RQ) greater than 1.10, were considered maximal.A SchillerCS-200© device with a treadmill was used. Electrocardiographic signal (ECG) was recorded throughout the test and blood pressure (BP) was measured every minute during exercise, and at the 1st, 3rd, 5th and 8th min of recovery using a calibrated aneroid sphygmomanometer. An automated medical gas analysis device (PowerCube©) was used to measure the volume, airflow and the fractional concentrations of oxygen and carbon dioxide in the exhaled air. Gas samples were printed every 10s. A face mask was used to collect expired air, taking care that it fitted properly and that there were no air leaks during exercise. A cardiac defibrillator and a fully stocked resuscitation cart were present at all times.The gas analyzer was calibrated according to the manufacturer specifications before each test was performed. ECG leads were placed according to the Mason–Likar method. Initially, skin was cleaned with an alcohol saturated cotton swab, and gentle abrasion of the skin's superficial layer was made with a fine abrasive paper.<a class="elsevierStyleCrossRef" href="#bib0170">11</a> A resting 12-lead ECG and spirometry were performed prior to the test. CPET began with a 3min resting period, and all subjects performed the same treadmill Balke ramp-protocol. Once maximal exercise was achieved, subjects continued to walk for 3min at 2km/h at 0% elevation. Following the 3min walking period, subjects rested in the supine position for an additional 5min.<a class="elsevierStyleCrossRef" href="#bib0175">12</a>All patients were instructed to express symptoms during exercise including chest pain, dyspnea or palpitations. Heart rate (HR) was obtained from the continuous ECG signal. HR at rest (HRrest) was measured when the patient was seated for at least 3min immediately prior to beginning exercise. Peak HR (HRpeak) and HR reserve (RHR) were used to evaluate the chronotropic response to exercise. RHR was the difference between HRrest and HRpeak. Heart rate recovery was obtained by subtracting HR at the first minute of recovery from the HRpeak.<a class="elsevierStyleCrossRef" href="#bib0135">4</a> The predicted maximal HR was calculated as follows: HRmaxpred=220−age in years.Myocardial oxygen uptake (MVO2) was estimated using the product of heart rate and systolic blood pressure (double product, DP). The presence of arrhythmias, ST-segment anomalies, or other ECG disturbances was recorded.The cardiopulmonary response to exercise was evaluated using expired gases, and the following variables were obtained: minute ventilation (VE), respiratory quotient (RQ), oxygen uptake (VO2) at the aerobic–anaerobic threshold (AT) and maximal effort (VO2peak), ventilator equivalent for carbon dioxide slope (VE/VCO2), oxygen pulse (PO2), and VO2 recovery (RVO2). RVO2 was identified measuring the time needed for returning oxygen uptake to half of its peak value.<a class="elsevierStyleCrossRef" href="#bib0180">13</a>Physical Training Program. Once the first CPET was obtained, a trained cardiologist has prescribed all exercise parameters, based on each cardiovascular risk-stratification.<a class="elsevierStyleCrossRef" href="#bib0185">14</a> Every patient performed one indoor cycling session daily for 4 week (20 sessions) and lasting 30min each. All participants also performed general gymnastics twice a week. Ergometer workload was controlled using a heart rate feedback mechanism. Perceived exertion effort was moderate (Borg scale 12–13). Every session had three phases: warming up, main phase and cooling down. Cardiac Rehabilitation Program included also: education, exercise, nutrition and psychological advice.Statistical analysisStatistical analysis was performed using SPSS 19.0 software. Nominal and categorical variables were presented as frequencies and percentages, and compared using the chi square test or the Fisher exact test. Continuous variables are presented as mean and reference intervals (CI 95%). A two sample t-test for independent variables and one-way ANOVA were used to compare means of those variables with normal Gaussian distribution (Kolmogorov–Smirnov test), and the Mann–Whitney U test was used for numerical variables without normal distribution. Variables were plotted, bivariate analyses were performed, and all r and p values were derived using the Pearson test. Variables that demonstrated to be statistically significant were included in a multiple regression model (forward stepwise). All p values less than 0.05 were considered significant.ResultsA total of 215 patients and 430 CPET were analyzed. Demographic and PTP characteristics are shown in (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). After PTP, exercise time and VO2 peak increased in all patients (0.7±0.1min, p<0.001 and 2.2±5.2mlO2/kg/min, p<0.001 respectively), meanwhile heart rate and double product at rest decreased (2.7±12bpm, p<0.001 and 570±1700bpm/mmHg, p<0.001).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Cardiopulmonary exercise testing variables, before and after physical training are presented in (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Performance during recovery phase of acute exercise improved (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>); heart rate recovery augmented 1.6±10bpm (p<0.05) and RVO2 diminished 21±98s (p<0.01). Bivariate analysis showed that variables associated with an improvement on HRR or RVO2 were different. On one hand, those variables highly correlated with HRR were: spironolactone, chronotropic index, reserve heart rate, percentage of maximal predicted heart rate (PMPHR), DPmax, MVO2. On the other hand, variables associated with RVO2 were: diabetes mellitus, hypertension, sedentarism, age, METs, exercise time, oxygen pulse, Duke Treadmill Score and Veterans Affairs Score. All p values <0.05.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>These variables were included into two logistic regression models, one for HRR and another for RVO2. According to HRR, the only variable that remained significant after multivariable analysis was PMPHR. In contrast, those variables associated with RVO2 were: diabetes mellitus and sedentarism.On (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), it is presented the lack of correlation between HRR and RVO2 before and after PTP. (R2=0.002, p=ns).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>DiscussionOn this study we found that a four week physical training program is associated with an improvement of fitness. These findings complement those found in previous studies in patients with coronary artery disease.<a class="elsevierStyleCrossRefs" href="#bib0190">15–17</a>We identified that after training, 68% of patients increase their VO2peak, 54% augmented heart rate recovery, and 39% improved RVO2. Jolly et al., published that only 41% of patients increased HRR, and this change was associated with variables such as age, peripheral arterial disease, diabetes mellitus, heart failure and the use of nitrates.<a class="elsevierStyleCrossRef" href="#bib0205">18</a>In our studied population, after multivariate analysis we observed that only chronotropic response was highly associated with HRR improvement. It is remarkable that only 39 percent of our patients improved their RVO2 after physical training. This response was statistically associated with the presence of sedentarism and diabetes mellitus. We think that these changes in VO2kinetics, are probably due to several metabolic adaptations, promoted by changes of muscular tissue, either at myocardial or peripheral level.<a class="elsevierStyleCrossRefs" href="#bib0155">8,19</a> Furthermore, it has been reported that some patients with CVD, specifically those patients with heart failure have a slow oxygen uptake kinetics recovery.<a class="elsevierStyleCrossRef" href="#bib0165">10</a> We saw that patients who improved exercise recovery, did it regardless their left ventricle systolic function.Previous studies suggested that an inadequate RVO2 might be related with a slow supply energy at skeletal muscle, as reported by Cohen-Solal et al.<a class="elsevierStyleCrossRef" href="#bib0215">20</a>Another explanation to the lack of agreement among fitness, HRR and recovery of VO2 is that, physiological response to exercise training depends directly on the intensity of effort and the number of sessions. In our study, probably a training period of 4 weeks duration and moderate intensity was enough to improve fitness, but not to promote changes in the other two variables.<a class="elsevierStyleCrossRef" href="#bib0220">21</a>Some recognized mechanisms, related to RVO2 behavior are: re-synthesis of ATP, glycogen synthesis from blood lactate (Cori cycle); redistribution of oxygen content (blood, myoglobin and interstitial fluid), and the thermogenic effect of core temperature elevation, associated with the action of catecholamines.<a class="elsevierStyleCrossRef" href="#bib0225">22</a>Initially, HRR and recovery of VO2 seemed to be closely related. Nevertheless, our results pointed out that, factors associated with HRR improvement were different to those related to a better recovery of VO2. This evidence showed that both variables may be determinated by different physiological and pathophysiological processes, as suggested by Myers et al., about the role of the autonomic nervous regulation on the heart rate, regardless the metabolic state.<a class="elsevierStyleCrossRef" href="#bib0230">23</a>A limitation on this research could be that our study-cohort was conducted at only one institution, and it was self-controlled (before–after). It is worth to mention that looking for a control group on this kind of therapy is ethically questionable. We believe that this topics need to be further studied, using more specific and long-term designs.In conclusion the physical exercise in patients with cardiovascular disease is associated with improved recovery of heart rate and oxygen consumption recovery. These variables separately were significantly associated with heart rate reserve in the stress test.However, a linear correlation between HRR and RVO2 was not observed. This lack of association may be because they are different factors that determine the behavior of each of these two variables.Ethical disclosuresProtection of human and animals subjectsThe authors state that no experiments have been performed on humans or animals for this research.Confidentiality of dataThe authors state that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors state that no patient data appears in this article.FundingThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Conflict of interestThe authors declare that there is no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres877226" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec865015" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres877225" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec865016" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of human and animals subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 11 => array:2 [ "identificador" => "xack292721" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-09-28" "fechaAceptado" => "2016-11-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec865015" "palabras" => array:6 [ 0 => "Cardiac rehabilitation" 1 => "Cardiovascular disease" 2 => "Recovery heart rate" 3 => "Cardiopulmonary exercise testing" 4 => "Oxygen uptake recovery" 5 => "México" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec865016" "palabras" => array:6 [ 0 => "Rehabilitación cardiaca" 1 => "Enfermedad cardiovascular" 2 => "Recuperación de la frecuencia cardiaca" 3 => "Prueba de esfuerzo cardiopulmonar" 4 => "Cinética de recuperación del consumo de oxigeno" 5 => "México" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionPhysical training programs (PTP) have shown several beneficial effects for patients with cardiovascular disease (CVD), particularly by increasing survival and quality of life. Physiological response during the effort and recovery phases of an exercise testing, is one of the strongest prognostic markers among patients with CVD. A reasonable mechanism that explains those training effects on survival is through the adaptations seen on heart rate recovery (HRR) and oxygen uptake kinetics at the post-exertional phase (RVO2). ObjectiveCompare the HRR and RVO2 values before and after a PTP in patients with CVD. MethodsWe studied a cohort of patients included in a cardiac rehabilitation program, whom performed a cardiopulmonary exercise testing (CPX). Then, risk stratification and an individualized exercise training program were performed. The exercise training program included 20 sessions of aerobic exercise, 30min a day, five times a week, at moderate intensity. Finally, a second CPX was performed. ResultsA total of 215 patients were included. Peak oxygen uptake values rose 2.2±5.2ml/kg/min (p<0.001), HRR increased 1.6±10bpm (p<0.05) and RVO2 improved −21±98s (p<0.001). A post-hoc analysis show that the percentage of maximum heart rate remained statistically associated with HRR increment. Furthermore, diabetes and sedentarism were strongly related to RVO2 improvement.No correlation between HRR and RVO2 was found (R2=0.002). ConclusionPhysical exercise was associated with a beneficial effect on HRR and RVO2. Nevertheless, both variables were statistically unrelated." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLos programas de entrenamiento físico han demostrado efectos benéficos en pacientes con enfermedad cardiovascular, particularmente debido al aumento de la supervivencia y calidad de vida. La respuesta fisiológica durante la prueba de esfuerzo cardiopulmonar tanto en las fases de ejercicio como de recuperación son de los principales marcadores pronósticos debido a la adaptación en la recuperación de la frecuencia cardiaca (RFC) y la cinética de recuperación de oxígeno en la fase de postesfuerzo (RVO2). ObjetivoComparar los valores de RFC y RVO2 antes y después de un programa de entrenamiento físico. MétodosSe estudió una cohorte de pacientes incluidos en un programa de rehabilitación cardiaca, que hayan realizado una prueba de esfuerzo cardiopulmonar. El programa de entrenamiento consistió en 20 sesiones de ejercicio aeróbico de 30min diarios, 5 veces a la semana de intensidad moderada. Por último, se realizó una segunda prueba de esfuerzo cardiopulmonar. ResultadosSe incluyeron 215 pacientes. El consumo pico de oxígeno aumentó en 2.2±5.2ml/kg/min (p<0.001), la RFC se incrementó 1.6±10lpm (p<0.05) y mejoró la RVO2 −21±98 seg (p<0.001). En el análisis post-hoc se observó que el porcentaje de la frecuencia cardiaca máxima se mantuvo asociado con el incremento de la RFC. Por otra parte, la diabetes y el sedentarismo estuvieron fuertemente asociados con la mejora de la RVO2. No se observó correlación entre RFC y RVO2 (R2=0.002). ConclusionesEl ejercicio físico se asoció con un efecto benéfico sobre la RFC y la RVO2. Sin embargo, ambas variables no se relacionaron estadísticamente." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1131 "Ancho" => 2791 "Tamanyo" => 92874 ] ] "descripcion" => array:1 [ "en" => "Abbreviations: beats per minute (bpm). Cardiopulmonary recovery behavior improved after a physical training program (a) shows a significant increase of heart rate recovery (p<0.05), and (b) a reduction of oxygen uptake kinetics recovery time (p<0.01)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1569 "Ancho" => 1649 "Tamanyo" => 143077 ] ] "descripcion" => array:1 [ "en" => "Abbreviations: Recovery of oxygen uptake (RVO2) and heart rate recovery (HRR). This scatter plot shows an absence of correlation between heart rate recovery and the recovery of oxygen uptake, (R2=0.002, p=ns)." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: F, female; M, male; BMI, body mass Index; LVEF, left ventricle ejection fraction; ACE–ARB, angiotensin-converting enzyme inhibitors–angiotensin-II receptor blocker; CCB, calcium channel blocker; W, watts; HR, heart rate; bpm, beat per minute. Demographic variables and physical training characteristics of patients are displayed." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">215 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57±13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F=47 (22%), M=168 (78%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27±5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (15%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">125 (58%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic heart disease (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">178 (83%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valvular heart disease (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Congenital heart disease (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Idiopathic cardiomyopathy (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other pathologies (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEF (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44±14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bet-blockers (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">188 (87%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nitrates (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (25%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Digoxin (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 (24%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACE–ARB (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">187 (87%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CCB (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 (18%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antiarrhythmic (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Training sessions (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20±4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Load increase (W) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29±15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Training HR (bpm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">103±15 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1480744.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic and exercise training characteristics." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Abbreviations: CPET, cardiopulmonary exercise test; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; DP, double product; RHR, reserve heart rate; PMPHR, percentage of maximal predicted heart rate; VA, Veterans Affairs risk score; VO2AT, oxygen uptake at aerobic–anaerobic threshold; VO2, oxygen uptake; MVO2, myocardial oxygen uptake; HRR, heart rate recovery; RVO2, recovery of oxygen uptake. These are the data obtained from cardiopulmonary exercise testing, before and after a physical training program." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CPET 1 (x±DE) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CPET 2 (x±DE) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference (x±DE) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HR rest (bpm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.7±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP rest (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116±17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">113±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.3±1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP rest (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.3±0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DP rest (bpm/mmHg)*1000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.78±1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.57±1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Exercise time (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2±2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.9±2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HR peak (bpm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">128±23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132±25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4±19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP peak (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">147±27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">146±26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1±21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP peak (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DP peak (lpm/mmHg)*1000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.9±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PMPHR (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79±13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RHR (bpm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59±22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65±24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6±19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ST segment depression (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01±0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulse of oxygen (ml/beat) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77±22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85±22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1±26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VA score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.3±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.7±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.4±3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duke score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2±5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RQ peak \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.11±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.13±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VO2AT (ml/kg/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1±4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">< 0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VO2peak (ml/kg/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VE/VCO2slope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MVO2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HRR (bpm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.6±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RVO2 (seg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">249±97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">228±81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−21±98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1480743.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Values were calculated for differences before and after training program." ] ] ] "descripcion" => array:1 [ "en" => "Cardiopulmonary response before and after physical training program." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise testing in the clinical evaluation of patients with heart and lung disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. 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Clinical Research

Efecto del entrenamiento físico en la recuperación del ejercicio agudo, en pacientes con enfermedad cardiovascular

Marianna García-Saldiviaa, Hermes Ilarraza-Lomelía,

Corresponding author

hermes_ilarraza@yahoo.com

Corresponding author at: Juan Badiano No. 1, Colonia sección XVI, Delegación Tlalpan, México, D.F., Mexico. Tel.: +52 5573 2911x1214; fax: +52 5573 0994.

, Jonathan Myersb, Jorge Laraa, Leopoldo Buenoa

a Servicio de Rehabilitación Cardiaca, Instituto Nacional de Cardiología Ignacio Chávez, Mexico

b Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, CA, United States

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Exercise testing has been widely used for decades as a diagnostic tool in patients with cardiovascular disease &#40;CVD&#41;&#44; but it has also a prognostic approach at intermediate and long term&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#44;2</span></a> Variables traditionally used for prediction models&#44; are focused on the active part of this test &#40;exercise&#41;&#44; specifically on two items&#58; maximal exercise tolerance &#40;maximal oxygen uptake&#44; VO<span class="elsevierStyleInf">2</span>max&#41; and chronotropic response&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nowadays&#44; there are some recognized physiological disorders during the recovery phase among CVD patients&#44; like a slow heart rate recovery &#40;HRR&#41; and an abnormal VO<span class="elsevierStyleInf">2</span> kinetics&#46; These changes are associated with a poor survival&#44; in patients with CVD&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#8211;6</span></a> It has been reported&#44; that individuals with heart failure have elevated both&#44; oxygen debt and oxygen deficit&#46; These phenomena are related with a slow recovery of the VO<span class="elsevierStyleInf">2</span> kinetics &#40;RVO<span class="elsevierStyleInf">2</span>&#41; and also a reduced HRR&#46; Some researching groups have reported that this could be mediated by several neuro-humoral and local mechanisms&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical training programs &#40;PTP&#41; have been associated with an increased on survival and better cardiovascular behavior among patients with heart disease&#46; Particularly&#44; it has been observed that PTP are linked to specific metabolic changes&#44; such as a higher VO<span class="elsevierStyleInf">2</span>max&#44; and a reduced oxygen debt&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Some studies have shown that PTP are associated with an improvement of HRR &#40;increase&#41; in patients with CVD&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> Nonetheless&#44; this behavior has not yet been related with a reduction on oxygen debt&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Thus&#44; we hypothesize that PTP could modify both&#44; HRR and RVO<span class="elsevierStyleInf">2</span> behavior&#44; because of their effects on the autonomic nervous system regulation and some local processes&#46; The aim of this study was to compare HRR and RVO<span class="elsevierStyleInf">2</span> after a physical training program&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Selection criteria of this study included patients with cardiovascular disease&#44; older than 18 years&#44; who were referred to a hospital-outpatient cardiac rehabilitation program&#46; Patients with any contraindication for exercising were excluded&#46; Every patient was submitted into a risk stratification procedure that included&#58; clinical examination&#44; exercise testing and other evaluations as needed&#46; Written consents were obtained from all patients&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exercise Testing&#46;</span> All patients performed a cardiopulmonary exercise test &#40;CPET&#41;&#44; before and after the PTP&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> Every CPET was symptom&#39;s limited&#44; and all CPET with more than 85&#37; of the maximal predicted-heart rate &#40;HRmax<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>220<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>age in years&#41;&#44; or a respiratory quotient &#40;RQ&#41; greater than 1&#46;10&#44; were considered maximal&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A SchillerCS-200<span class="elsevierStyleSup">&#169;</span> device with a treadmill was used&#46; Electrocardiographic signal &#40;ECG&#41; was recorded throughout the test and blood pressure &#40;BP&#41; was measured every minute during exercise&#44; and at the 1st&#44; 3rd&#44; 5th and 8th min of recovery using a calibrated aneroid sphygmomanometer&#46; An automated medical gas analysis device &#40;PowerCube<span class="elsevierStyleSup">&#169;</span>&#41; was used to measure the volume&#44; airflow and the fractional concentrations of oxygen and carbon dioxide in the exhaled air&#46; Gas samples were printed every 10<span class="elsevierStyleHsp" style=""></span>s&#46; A face mask was used to collect expired air&#44; taking care that it fitted properly and that there were no air leaks during exercise&#46; A cardiac defibrillator and a fully stocked resuscitation cart were present at all times&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The gas analyzer was calibrated according to the manufacturer specifications before each test was performed&#46; ECG leads were placed according to the Mason&#8211;Likar method&#46; Initially&#44; skin was cleaned with an alcohol saturated cotton swab&#44; and gentle abrasion of the skin&#39;s superficial layer was made with a fine abrasive paper&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> A resting 12-lead ECG and spirometry were performed prior to the test&#46; CPET began with a 3<span class="elsevierStyleHsp" style=""></span>min resting period&#44; and all subjects performed the same treadmill Balke ramp-protocol&#46; Once maximal exercise was achieved&#44; subjects continued to walk for 3<span class="elsevierStyleHsp" style=""></span>min at 2<span class="elsevierStyleHsp" style=""></span>km&#47;h at 0&#37; elevation&#46; Following the 3<span class="elsevierStyleHsp" style=""></span>min walking period&#44; subjects rested in the supine position for an additional 5<span class="elsevierStyleHsp" style=""></span>min&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">All patients were instructed to express symptoms during exercise including chest pain&#44; dyspnea or palpitations&#46; Heart rate &#40;HR&#41; was obtained from the continuous ECG signal&#46; HR at rest &#40;HRrest&#41; was measured when the patient was seated for at least 3<span class="elsevierStyleHsp" style=""></span>min immediately prior to beginning exercise&#46; Peak HR &#40;HRpeak&#41; and HR reserve &#40;RHR&#41; were used to evaluate the chronotropic response to exercise&#46; RHR was the difference between HRrest and HRpeak&#46; Heart rate recovery was obtained by subtracting HR at the first minute of recovery from the HRpeak&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a> The predicted maximal HR was calculated as follows&#58; HRmaxpred<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>220<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>age in years&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Myocardial oxygen uptake &#40;MVO<span class="elsevierStyleInf">2</span>&#41; was estimated using the product of heart rate and systolic blood pressure &#40;double product&#44; DP&#41;&#46; The presence of arrhythmias&#44; ST-segment anomalies&#44; or other ECG disturbances was recorded&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The cardiopulmonary response to exercise was evaluated using expired gases&#44; and the following variables were obtained&#58; minute ventilation &#40;VE&#41;&#44; respiratory quotient &#40;RQ&#41;&#44; oxygen uptake &#40;VO<span class="elsevierStyleInf">2</span>&#41; at the aerobic&#8211;anaerobic threshold &#40;AT&#41; and maximal effort &#40;VO<span class="elsevierStyleInf">2</span>peak&#41;&#44; ventilator equivalent for carbon dioxide slope &#40;VE&#47;VCO<span class="elsevierStyleInf">2</span>&#41;&#44; oxygen pulse &#40;PO<span class="elsevierStyleInf">2</span>&#41;&#44; and VO<span class="elsevierStyleInf">2</span> recovery &#40;RVO<span class="elsevierStyleInf">2</span>&#41;&#46; RVO<span class="elsevierStyleInf">2</span> was identified measuring the time needed for returning oxygen uptake to half of its peak value&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Physical Training Program&#46;</span> Once the first CPET was obtained&#44; a trained cardiologist has prescribed all exercise parameters&#44; based on each cardiovascular risk-stratification&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a> Every patient performed one indoor cycling session daily for 4 week &#40;20 sessions&#41; and lasting 30<span class="elsevierStyleHsp" style=""></span>min each&#46; All participants also performed general gymnastics twice a week&#46; Ergometer workload was controlled using a heart rate feedback mechanism&#46; Perceived exertion effort was moderate &#40;Borg scale 12&#8211;13&#41;&#46; Every session had three phases&#58; warming up&#44; main phase and cooling down&#46; Cardiac Rehabilitation Program included also&#58; education&#44; exercise&#44; nutrition and psychological advice&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS 19&#46;0 software&#46; Nominal and categorical variables were presented as frequencies and percentages&#44; and compared using the chi square test or the Fisher exact test&#46; Continuous variables are presented as mean and reference intervals &#40;CI 95&#37;&#41;&#46; A two sample <span class="elsevierStyleItalic">t</span>-test for independent variables and one-way ANOVA were used to compare means of those variables with normal Gaussian distribution &#40;Kolmogorov&#8211;Smirnov test&#41;&#44; and the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used for numerical variables without normal distribution&#46; Variables were plotted&#44; bivariate analyses were performed&#44; and all r and <span class="elsevierStyleItalic">p</span> values were derived using the Pearson test&#46; Variables that demonstrated to be statistically significant were included in a multiple regression model &#40;forward stepwise&#41;&#46; All <span class="elsevierStyleItalic">p</span> values less than 0&#46;05 were considered significant&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 215 patients and 430 CPET were analyzed&#46; Demographic and PTP characteristics are shown in &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; After PTP&#44; exercise time and VO<span class="elsevierStyleInf">2</span> peak increased in all patients &#40;0&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 and 2&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2<span class="elsevierStyleHsp" style=""></span>mlO2&#47;kg&#47;min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 respectively&#41;&#44; meanwhile heart rate and double product at rest decreased &#40;2&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>bpm&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 and 570<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1700<span class="elsevierStyleHsp" style=""></span>bpm&#47;mmHg&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Cardiopulmonary exercise testing variables&#44; before and after physical training are presented in &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Performance during recovery phase of acute exercise improved &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#59; heart rate recovery augmented 1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>bpm &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and RVO<span class="elsevierStyleInf">2</span> diminished 21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>98<span class="elsevierStyleHsp" style=""></span>s &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; Bivariate analysis showed that variables associated with an improvement on HRR or RVO<span class="elsevierStyleInf">2</span> were different&#46; On one hand&#44; those variables highly correlated with HRR were&#58; spironolactone&#44; chronotropic index&#44; reserve heart rate&#44; percentage of maximal predicted heart rate &#40;PMPHR&#41;&#44; DPmax&#44; MVO<span class="elsevierStyleInf">2</span>&#46; On the other hand&#44; variables associated with RVO<span class="elsevierStyleInf">2</span> were&#58; diabetes mellitus&#44; hypertension&#44; sedentarism&#44; age&#44; METs&#44; exercise time&#44; oxygen pulse&#44; Duke Treadmill Score and Veterans Affairs Score&#46; All <span class="elsevierStyleItalic">p</span> values &#60;0&#46;05&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">These variables were included into two logistic regression models&#44; one for HRR and another for RVO<span class="elsevierStyleInf">2</span>&#46; According to HRR&#44; the only variable that remained significant after multivariable analysis was PMPHR&#46; In contrast&#44; those variables associated with RVO<span class="elsevierStyleInf">2</span> were&#58; diabetes mellitus and sedentarism&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">On &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; it is presented the lack of correlation between HRR and RVO<span class="elsevierStyleInf">2</span> before and after PTP&#46; &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>ns&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">On this study we found that a four week physical training program is associated with an improvement of fitness&#46; These findings complement those found in previous studies in patients with coronary artery disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">15&#8211;17</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">We identified that after training&#44; 68&#37; of patients increase their VO<span class="elsevierStyleInf">2</span>peak&#44; 54&#37; augmented heart rate recovery&#44; and 39&#37; improved RVO<span class="elsevierStyleInf">2</span>&#46; Jolly et al&#46;&#44; published that only 41&#37; of patients increased HRR&#44; and this change was associated with variables such as age&#44; peripheral arterial disease&#44; diabetes mellitus&#44; heart failure and the use of nitrates&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In our studied population&#44; after multivariate analysis we observed that only chronotropic response was highly associated with HRR improvement&#46; It is remarkable that only 39 percent of our patients improved their RVO<span class="elsevierStyleInf">2</span> after physical training&#46; This response was statistically associated with the presence of sedentarism and diabetes mellitus&#46; We think that these changes in VO<span class="elsevierStyleInf">2</span>kinetics&#44; are probably due to several metabolic adaptations&#44; promoted by changes of muscular tissue&#44; either at myocardial or peripheral level&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#44;19</span></a> Furthermore&#44; it has been reported that some patients with CVD&#44; specifically those patients with heart failure have a slow oxygen uptake kinetics recovery&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> We saw that patients who improved exercise recovery&#44; did it regardless their left ventricle systolic function&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Previous studies suggested that an inadequate RVO<span class="elsevierStyleInf">2</span> might be related with a slow supply energy at skeletal muscle&#44; as reported by Cohen-Solal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Another explanation to the lack of agreement among fitness&#44; HRR and recovery of VO<span class="elsevierStyleInf">2</span> is that&#44; physiological response to exercise training depends directly on the intensity of effort and the number of sessions&#46; In our study&#44; probably a training period of 4 weeks duration and moderate intensity was enough to improve fitness&#44; but not to promote changes in the other two variables&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Some recognized mechanisms&#44; related to RVO<span class="elsevierStyleInf">2</span> behavior are&#58; re-synthesis of ATP&#44; glycogen synthesis from blood lactate &#40;Cori cycle&#41;&#59; redistribution of oxygen content &#40;blood&#44; myoglobin and interstitial fluid&#41;&#44; and the thermogenic effect of core temperature elevation&#44; associated with the action of catecholamines&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Initially&#44; HRR and recovery of VO<span class="elsevierStyleInf">2</span> seemed to be closely related&#46; Nevertheless&#44; our results pointed out that&#44; factors associated with HRR improvement were different to those related to a better recovery of VO<span class="elsevierStyleInf">2</span>&#46; This evidence showed that both variables may be determinated by different physiological and pathophysiological processes&#44; as suggested by Myers et al&#46;&#44; about the role of the autonomic nervous regulation on the heart rate&#44; regardless the metabolic state&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">A limitation on this research could be that our study-cohort was conducted at only one institution&#44; and it was self-controlled &#40;before&#8211;after&#41;&#46; It is worth to mention that looking for a control group on this kind of therapy is ethically questionable&#46; We believe that this topics need to be further studied&#44; using more specific and long-term designs&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion the physical exercise in patients with cardiovascular disease is associated with improved recovery of heart rate and oxygen consumption recovery&#46; These variables separately were significantly associated with heart rate reserve in the stress test&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">However&#44; a linear correlation between HRR and RVO<span class="elsevierStyleInf">2</span> was not observed&#46; This lack of association may be because they are different factors that determine the behavior of each of these two variables&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of human and animals subjects</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors state that no experiments have been performed on humans or animals for this research&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidentiality of data</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors state that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to privacy and informed consent</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors state that no patient data appears in this article&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">This research received no specific grant from any funding agency in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Physical training programs &#40;PTP&#41; have shown several beneficial effects for patients with cardiovascular disease &#40;CVD&#41;&#44; particularly by increasing survival and quality of life&#46; Physiological response during the effort and recovery phases of an exercise testing&#44; is one of the strongest prognostic markers among patients with CVD&#46; A reasonable mechanism that explains those training effects on survival is through the adaptations seen on heart rate recovery &#40;HRR&#41; and oxygen uptake kinetics at the post-exertional phase &#40;RVO<span class="elsevierStyleInf">2</span>&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Compare the HRR and RVO<span class="elsevierStyleInf">2</span> values before and after a PTP in patients with CVD&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We studied a cohort of patients included in a cardiac rehabilitation program&#44; whom performed a cardiopulmonary exercise testing &#40;CPX&#41;&#46; Then&#44; risk stratification and an individualized exercise training program were performed&#46; The exercise training program included 20 sessions of aerobic exercise&#44; 30<span class="elsevierStyleHsp" style=""></span>min a day&#44; five times a week&#44; at moderate intensity&#46; Finally&#44; a second CPX was performed&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 215 patients were included&#46; Peak oxygen uptake values rose 2&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;min &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; HRR increased 1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>bpm &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and RVO<span class="elsevierStyleInf">2</span> improved &#8722;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>98<span class="elsevierStyleHsp" style=""></span>s &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; A post-hoc analysis show that the percentage of maximum heart rate remained statistically associated with HRR increment&#46; Furthermore&#44; diabetes and sedentarism were strongly related to RVO<span class="elsevierStyleInf">2</span> improvement&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">No correlation between HRR and RVO<span class="elsevierStyleInf">2</span> was found &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Physical exercise was associated with a beneficial effect on HRR and RVO<span class="elsevierStyleInf">2</span>&#46; Nevertheless&#44; both variables were statistically unrelated&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
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            "identificador" => "abst0015"
            "titulo" => "Methods"
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          3 => array:2 [
            "identificador" => "abst0020"
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            "titulo" => "Conclusion"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los programas de entrenamiento f&#237;sico han demostrado efectos ben&#233;ficos en pacientes con enfermedad cardiovascular&#44; particularmente debido al aumento de la supervivencia y calidad de vida&#46; La respuesta fisiol&#243;gica durante la prueba de esfuerzo cardiopulmonar tanto en las fases de ejercicio como de recuperaci&#243;n son de los principales marcadores pron&#243;sticos debido a la adaptaci&#243;n en la recuperaci&#243;n de la frecuencia cardiaca &#40;RFC&#41; y la cin&#233;tica de recuperaci&#243;n de ox&#237;geno en la fase de postesfuerzo &#40;RVO<span class="elsevierStyleInf">2</span>&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Comparar los valores de RFC y RVO<span class="elsevierStyleInf">2</span> antes y despu&#233;s de un programa de entrenamiento f&#237;sico&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; una cohorte de pacientes incluidos en un programa de rehabilitaci&#243;n cardiaca&#44; que hayan realizado una prueba de esfuerzo cardiopulmonar&#46; El programa de entrenamiento consisti&#243; en 20 sesiones de ejercicio aer&#243;bico de 30<span class="elsevierStyleHsp" style=""></span>min diarios&#44; 5 veces a la semana de intensidad moderada&#46; Por &#250;ltimo&#44; se realiz&#243; una segunda prueba de esfuerzo cardiopulmonar&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 215 pacientes&#46; El consumo pico de ox&#237;geno aument&#243; en 2&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;min &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; la RFC se increment&#243; 1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>lpm &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; y mejor&#243; la RVO<span class="elsevierStyleInf">2</span> &#8722;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>98 seg &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; En el an&#225;lisis post-hoc se observ&#243; que el porcentaje de la frecuencia cardiaca m&#225;xima se mantuvo asociado con el incremento de la RFC&#46; Por otra parte&#44; la diabetes y el sedentarismo estuvieron fuertemente asociados con la mejora de la RVO<span class="elsevierStyleInf">2</span>&#46; No se observ&#243; correlaci&#243;n entre RFC y RVO<span class="elsevierStyleInf">2</span> &#40;R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El ejercicio f&#237;sico se asoci&#243; con un efecto ben&#233;fico sobre la RFC y la RVO<span class="elsevierStyleInf">2</span>&#46; Sin embargo&#44; ambas variables no se relacionaron estad&#237;sticamente&#46;</p></span>"
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            "titulo" => "Introducci&#243;n"
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            "titulo" => "Objetivo"
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          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "M&#233;todos"
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          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
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          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; beats per minute &#40;bpm&#41;&#46; Cardiopulmonary recovery behavior improved after a physical training program &#40;a&#41; shows a significant increase of heart rate recovery &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and &#40;b&#41; a reduction of oxygen uptake kinetics recovery time &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p>"
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        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; Recovery of oxygen uptake &#40;RVO<span class="elsevierStyleInf">2</span>&#41; and heart rate recovery &#40;HRR&#41;&#46; This scatter plot shows an absence of correlation between heart rate recovery and the recovery of oxygen uptake&#44; &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>ns&#41;&#46;</p>"
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        "identificador" => "tbl0005"
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; F&#44; female&#59; M&#44; male&#59; BMI&#44; body mass Index&#59; LVEF&#44; left ventricle ejection fraction&#59; ACE&#8211;ARB&#44; angiotensin-converting enzyme inhibitors&#8211;angiotensin-II receptor blocker&#59; CCB&#44; calcium channel blocker&#59; W&#44; watts&#59; HR&#44; heart rate&#59; bpm&#44; beat per minute&#46; Demographic variables and physical training characteristics of patients are displayed&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">215 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47 &#40;22&#37;&#41;&#44; M<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>168 &#40;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">125 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic heart disease &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">178 &#40;83&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valvular heart disease &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Congenital heart disease &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Idiopathic cardiomyopathy &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other pathologies &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bet-blockers &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">188 &#40;87&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nitrates &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Digoxin &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;24&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACE&#8211;ARB &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">187 &#40;87&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CCB &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antiarrhythmic &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Training sessions &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Load increase &#40;W&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Training HR &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">103<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Demographic and exercise training characteristics&#46;</p>"
        ]
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        "etiqueta" => "Table 2"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; CPET&#44; cardiopulmonary exercise test&#59; HR&#44; heart rate&#59; SBP&#44; systolic blood pressure&#59; DBP&#44; diastolic blood pressure&#59; DP&#44; double product&#59; RHR&#44; reserve heart rate&#59; PMPHR&#44; percentage of maximal predicted heart rate&#59; VA&#44; Veterans Affairs risk score&#59; VO<span class="elsevierStyleInf">2</span>AT&#44; oxygen uptake at aerobic&#8211;anaerobic threshold&#59; VO<span class="elsevierStyleInf">2</span>&#44; oxygen uptake&#59; MVO<span class="elsevierStyleInf">2</span>&#44; myocardial oxygen uptake&#59; HRR&#44; heart rate recovery&#59; RVO<span class="elsevierStyleInf">2</span>&#44; recovery of oxygen uptake&#46; These are the data obtained from cardiopulmonary exercise testing&#44; before and after a physical training program&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CPET 1<br>&#40;<span class="elsevierStyleItalic">x</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CPET 2<br>&#40;<span class="elsevierStyleItalic">x</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference<br>&#40;<span class="elsevierStyleItalic">x</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HR rest &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP rest &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP rest &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DP rest &#40;bpm&#47;mmHg&#41;&#42;1000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Exercise time &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HR peak &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">132<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP peak &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">146<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP peak &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DP peak &#40;lpm&#47;mmHg&#41;&#42;1000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PMPHR &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RHR &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ST segment depression &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulse of oxygen &#40;ml&#47;beat&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VA score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duke score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RQ peak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VO<span class="elsevierStyleInf">2</span>AT &#40;ml&#47;kg&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VO<span class="elsevierStyleInf">2</span>peak &#40;ml&#47;kg&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 14059940
Original language: English

DOI:10.1016/j.acmx.2016.11.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	3	0	3
2024 October	15	7	22
2024 September	19	9	28
2024 August	16	4	20
2024 July	16	5	21
2024 June	9	1	10
2024 May	8	2	10
2024 April	29	5	34
2024 March	47	5	52
2024 February	22	4	26
2024 January	26	7	33
2023 December	23	9	32
2023 November	22	8	30
2023 October	34	5	39
2023 September	21	3	24
2023 August	12	7	19
2023 July	21	7	28
2023 June	16	2	18
2023 May	15	5	20
2023 April	23	2	25
2023 March	13	0	13
2023 February	26	1	27
2023 January	17	2	19
2022 December	40	6	46
2022 November	37	7	44
2022 October	25	37	62
2022 September	22	16	38
2022 August	29	8	37
2022 July	28	7	35
2022 June	40	8	48
2022 May	56	7	63
2022 April	68	11	79
2022 March	96	6	102
2022 February	112	4	116
2022 January	51	8	59
2021 December	40	10	50
2021 November	54	12	66
2021 October	33	8	41
2021 September	22	11	33
2021 August	35	5	40
2021 July	31	9	40
2021 June	33	7	40
2021 May	54	7	61
2021 April	109	6	115
2021 March	67	8	75
2021 February	59	4	63
2021 January	49	14	63
2020 December	41	9	50
2020 November	31	9	40
2020 October	30	10	40
2020 September	36	14	50
2020 August	33	7	40
2020 July	43	16	59
2020 June	44	10	54
2020 May	44	11	55
2020 April	28	8	36
2020 March	44	9	53
2020 February	42	5	47
2020 January	37	7	44
2019 December	75	9	84
2019 November	20	3	23
2019 October	17	12	29
2019 September	19	12	31
2019 August	22	9	31
2019 July	24	9	33
2019 June	44	28	72
2019 May	132	14	146
2019 April	61	19	80
2019 March	22	16	38
2019 February	32	7	39
2019 January	34	8	42
2018 December	31	11	42
2018 November	26	13	39
2018 October	59	32	91
2018 September	52	7	59
2018 August	10	7	17
2018 July	13	10	23
2018 June	18	6	24
2018 May	32	21	53
2018 April	34	6	40
2018 March	22	7	29
2018 February	13	10	23
2018 January	18	3	21
2017 December	31	4	35
2017 November	35	11	46
2017 October	87	18	105
2017 September	67	18	85
2017 August	92	9	101
2017 July	5	5	10
2017 June	1	21	22
2017 May	3	14	17
2017 April	2	54	56
2017 March	5	47	52
2017 February	8	22	30
2017 January	8	57	65
2016 December	0	20	20

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