human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Peripheral vascular abnormalities contribute to compromised functional status in heart failure ( HF ) patients . The purpose of the present study was to test whether the intervention of moderate-intensity , resistance training could improve peripheral vascular responsiveness , that is , flow-mediated dilation ( FMD ) in HF . METHODS Baseline brachial artery FMD analysis ( 2 minutes of cuff occlusion and 5 minutes of reperfusion ) was measured in HF patients on intravenous inotropic support ( n = 9 ) awaiting cardiac transplantation .  Unilateral , upper-body resistance exercises ( moderate intensity , combination of isometric and isotonic exercises at 60%-80 % of maximum ) were performed 3 d/wk for 4 weeks . Follow-up FMD analysis was conducted after training . Central hemodynamics were defined via right-side-heart catheterization . RESULTS At baseline prior to training , HF patients elicited a significant hyperemic response 10 seconds following cuff occlusion ( mean increase in blood flow : 194 ± 44 mL/min , P < .05 ) . Despite this significant hyperemic response , HF patients demonstrated a mild , but paradoxical vasoconstriction of nearly 3 % at 1-minute after cuff release . Four weeks of resistance training corrected the paradoxical vasoconstriction observed at baseline and result ed in vasodilatation ( a positive increase in brachial artery diameter of 0.04 ± 0.04 mm , at 1 minute after cuff release ; P < .05 ) . Conversely , in a subset of 3 HF patients , studies in the untrained contralateral arm revealed no change in the FMD response . CONCLUSION Moderate-intensity upper-body resistance training  improved brachial artery FMD in end-stage HF patients on inotropic support . The reversal of the paradoxical vasoconstrictive response to reactive hyperemia following 4 weeks of training may be secondary to local improvements in vascular endothelial function rather than a quantitative change in the reactive hyperemic stimulus Background — Exercise training reduces the symptoms of chronic heart failure . Which exercise intensity yields maximal beneficial adaptations is controversial . Furthermore , the incidence of chronic heart failure increases with advanced age ; it has been reported that 88 % and 49 % of patients with a first diagnosis of chronic heart failure are > 65 and > 80 years old , respectively . Despite this , most previous studies have excluded patients with an age > 70 years . Our objective was to compare training programs with moderate versus high exercise intensity with regard to variables associated with cardiovascular function and prognosis in patients with postinfa rct ion heart failure . Methods and Results — Twenty-seven patients with stable postinfa rct ion heart failure who were undergoing optimal medical treatment , including & bgr;-blockers and angiotensin-converting enzyme inhibitors ( aged 75.5±11.1 years ; left ventricular [ LV ] ejection fraction 29 % ; & OV0312;o2peak 13 mL · kg−1 · min−1 ) were r and omized to either moderate continuous training ( 70 % of highest measured heart rate , ie , peak heart rate ) or aerobic interval training ( 95 % of peak heart rate ) 3 times per week for 12 weeks or to a control group that received st and ard advice regarding physical activity . & OV0312;o2peak increased more with aerobic interval training than moderate continuous training ( 46 % versus 14 % , P<0.001 ) and was associated with reverse LV remodeling . LV end-diastolic and end-systolic volumes declined with aerobic interval training only , by 18 % and 25 % , respectively ; LV ejection fraction increased 35 % , and pro-brain natriuretic peptide decreased 40 % . Improvement in brachial artery flow-mediated dilation ( endothelial function ) was greater with aerobic interval training , and mitochondrial function in lateral vastus muscle increased with aerobic interval training only . The MacNew global score for quality of life in cardiovascular disease increased in both exercise groups . No changes occurred in the control group . Conclusions — Exercise intensity was an important factor for reversing LV remodeling and improving aerobic capacity , endothelial function , and quality of life in patients with postinfa rct ion heart failure . These findings may have important implication s for exercise training in rehabilitation programs and future studies Background Optimal timing of cardiac transplantation in ambulatory patients with severe left ventricular dysfunction is often difficult . To determine whether measurement of peak oxygen consumption ( Vo2 ) during maximal exercise testing can be used to identify patients in whom transplantation can be safely deferred , we prospect ively performed exercise testing on all ambulatory patients referred for transplant between October 1986 and December 1989 . Methods and Results Patients were assigned into one of three groups on the basis of exercise data : Group 1 ( n = 35 ) comprised patients accepted for transplant ( Vo2<14 ml/kg/min ) ; group 2 ( n = 52 ) comprised patients considered too well for transplant ( Vo2 > 14 ml/kg/min ) ; and group 3 ( n = 27 ) comprised patients with low Vo2 rejected for transplant due to noncardiac problems . All three groups were comparable in New York Heart Association functional class , ejection fraction , and cardiac index ( p = NS ) . Pulmonary capillary wedge pressure was significantly lower in group 2 than in either group 1 or 3 ( p<0.05 ) , although there was wide overlap . Patients with preserved exercise capacity ( group 2 ) had cumulative 1- and 2-year survival rates of 94 % and 84 % , which are equal to survival levels after transplantation . In contrast , patients rejected for transplant ( group 3 ) had survival rates of only 47 % at 1 year and 32 % at 2 years , whereas patients awaiting transplantation ( group 1 ) had a survival rate of 790 % at 1 year ( both ( p < 0.005 versus patients with Vo2 > 14 ml/kg/min ) . All deaths in group 2 were sudden . By univariate and multivariate analyses , peak Vo2 was the best predictor of survival , with only pulmonary capillary wedge pressure providing additional prognostic information . Conclusions .These data suggest that cardiac transplantation can be safely deferred in ambulatory patients with severe left ventricular dysfunction and peak exercise Vo2 of more than 14 ml/min/kg . ( Circulation 1991;83:778–786 Background : Capacity to exercise may not be fully restored in patients with heart failure even in the long term after ventricular assist device ( VAD ) implantation . The benefits of exercise training in patients with VAD are unknown . Design and methods : Fifteen patients , aged 38.3 ± 15.9 years , bridged to heart transplantation with left ventricular assist device or biventricular assist device were r and omized at a ratio of 2 : 1 to a  training group  ( TG , n = 10 ) or a control group ( n = 5 ) , 6.3 ± 4 months after implantation . Both the groups were advised to walk 30–45 min/day . TG also underwent moderate-intensity aerobic exercise using a bike or treadmill for 45 min , three to five times a week , combined with high-intensity inspiratory muscle training using a computer- design ed software to respiratory exhaustion , two to three times a week for 10 weeks . The patients were tested using cardiopulmonary exercise testing , 6-min walk test , spirometry and electronic pressure manometer for inspiratory muscle strength ( Pimax ) and endurance ( sustained Pimax ) measurement . Quality of life was assessed with the Minnesota Living with Heart Failure question naire . Results : TG improved peak oxygen consumption ( 19.3 ± 4.5 vs. 16.8 ± 3.7 ml/kg per min , P = 0.008 ) and VO2 at ventilatory threshold ( 15.1 ± 4.2 vs. 12 ± 5.6 ml/kg per min , P = 0.01 ) , whereas the ventilation/carbon dioxide slope decreased ( 35.9 ± 5.6 vs. 40 ± 6.5 , P = 0.009 ) . The 6-min walk test distance increased ( 527 ± 76 vs. 462 ± 88 m , P = 0.005 ) and quality of life was improved ( 38.2 ± 11.6 vs. 48.9 ± 12.8 , P = 0.005 ) , as well as Pimax ( 131.8 ± 33 vs. 95.5 ± 28cmH2O , P = 0.005 ) , sustained Pimax ( 484 ± 195 vs. 340 ± 193cmH2O/s/10 3 , P = 0.005 ) , and inspiratoty lung capacity ( 2.4 ± 0.9 vs. 1.7 ± 0.7 L , P = 0.008 ) were improved . No significant changes were noted in the control group . Conclusion : Our findings indicate that exercise training may improve the functional status of VAD recipients  even at a later period after implantation and thus , may have additional importance in cases of destination therapy Background —The  maximal oxygen uptake ( peak & OV0312;o2 ) is used in risk stratification of patients with chronic heart failure ( CHF ) .  Peak & OV0312;o2 might be lower than maximally possible if exercise is stopped early because of lack of patient motivation or premature cessation by the investigator . In contrast , the anaerobic threshold ( & OV0312;o2AT ) and the ventilatory efficiency ( & OV0312;e versus & OV0312;co2 slope ) are less subject to these influences . Thus , we compared these parameters with peak & OV0312;o2 in identifying patients with CHF at increased risk for death within 6 months after evaluation . Methods and Results —We performed cardiopulmonary exercise tests with gas exchange measurements in 223 consecutive patients with CHF ( 114 coronary artery disease , 92 dilated cardiomyopathy , 17 others ) at the Herzzentrum Ludwigshafen between 1995 and 1998 . We measured peak & OV0312;o2 , & OV0312;o2AT and & OV0312;e versus & OV0312;co2 slope . We selected peak & OV0312;o2 of ≤14 mL/kg per minute , & OV0312;o2AT of < 11 mL/kg per minute , and & OV0312;e versus & OV0312;co2 slope of > 34 as threshold values for high risk of death . The median follow-up time was 644 days . Patients with peak & OV0312;o2 of ≤14 mL/kg per minute had a > 3-fold-increased risk ( OR=3.4 ; CI , 1.3 to 9.1 ) , with & OV0312;o2AT < 11 mL/min per kg or & OV0312;e versus & OV0312;co2 slope > 34 a 5-fold increased risk for early death ( OR=5.3 ; CI , 1.5 to 19.0 ; OR=4.8 ; CI , 1.7 to 13.8 , respectively ) . In patients with both & OV0312;o2AT < 11 mL/kg per minute and & OV0312;e versus & OV0312;co2 slope > 34 , the risk of early death was 10-fold higher ( OR=9.6 ; CI , 2.1 to 44.7 ) . After correction for age , sex , left ventricular ejection fraction , and New York Heart Association class in a multivariate analysis , the combination of & OV0312;o2AT < 11 mL/kg per minute and & OV0312;e versus & OV0312;co2 slope > 34 was the best predictor of 6-month mortality ( RR=5.1 , P = 0.001 ) . Conclusions —&OV0312;o2AT of < 11 mL/kg per minute and slope of & OV0312;e versus & OV0312;co2 > 34 , combined , better identified patients at high risk for early death from CHF than did peak & OV0312;o2 and should therefore be considered when prioritizing patients for heart transplantation BACKGROUND Interval ( IT ) and continuous training ( CT ) represent well-established exercise modalities in patients with moderate to severe chronic obstructive pulmonary disease ( COPD ) . However , their effects and feasibility in patients with end-stage COPD remain unclear . METHODS Sixty patients ( 53 ± 6 years , 53 % women ) being evaluated for lung transplantation where r and omly assigned either to IT ( n = 30 , cycling at 100 % peak work rate for 30 seconds alternating with 30 seconds of rest ) or CT ( n = 30 , cycling at 60 % of peak work rate ) during a 3-week inpatient rehabilitation program . Both exercise protocol s yielded an equivalent amount of total work . Patients had a mean forced expiratory volume at 1 second ( FEV(1 ) ) of 25 % ± 8 % of predicted value . RESULTS Patients in both groups achieved similar clinical ly relevant improvements in 6-minute walking distance of 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Peripheral vascular abnormalities contribute to compromised functional status in heart failure ( HF ) patients . The purpose of the present study was to test whether the intervention of moderate-intensity , resistance training could improve peripheral vascular responsiveness , that is , flow-mediated dilation ( FMD ) in HF . METHODS Baseline brachial artery FMD analysis ( 2 minutes of cuff occlusion and 5 minutes of reperfusion ) was measured in HF patients on intravenous inotropic support ( n = 9 ) awaiting cardiac transplantation .  Unilateral , upper-body resistance exercises ( moderate intensity , combination of isometric and isotonic exercises at 60%-80 % of maximum ) were performed 3 d/wk for 4 weeks . Follow-up FMD analysis was conducted after training . Central hemodynamics were defined via right-side-heart catheterization . RESULTS At baseline prior to training , HF patients elicited a significant hyperemic response 10 seconds following cuff occlusion ( mean increase in blood flow : 194 ± 44 mL/min , P < .05 ) . Despite this significant hyperemic response , HF patients demonstrated a mild , but paradoxical vasoconstriction of nearly 3 % at 1-minute after cuff release . Four weeks of resistance training corrected the paradoxical vasoconstriction observed at baseline and result ed in vasodilatation ( a positive increase in brachial artery diameter of 0.04 ± 0.04 mm , at 1 minute after cuff release ; P < .05 ) . Conversely , in a subset of 3 HF patients , studies in the untrained contralateral arm revealed no change in the FMD response . CONCLUSION Moderate-intensity upper-body resistance training  improved brachial artery FMD in end-stage HF patients on inotropic support . The reversal of the paradoxical vasoconstrictive response to reactive hyperemia following 4 weeks of training may be secondary to local improvements in vascular endothelial function rather than a quantitative change in the reactive hyperemic stimulus Background — Exercise training reduces the symptoms of chronic heart failure . Which exercise intensity yields maximal beneficial adaptations is controversial . Furthermore , the incidence of chronic heart failure increases with advanced age ; it has been reported that 88 % and 49 % of patients with a first diagnosis of chronic heart failure are > 65 and > 80 years old , respectively . Despite this , most previous studies have excluded patients with an age > 70 years . Our objective was to compare training programs with moderate versus high exercise intensity with regard to variables associated with cardiovascular function and prognosis in patients with postinfa rct ion heart failure . Methods and Results — Twenty-seven patients with stable postinfa rct ion heart failure who were undergoing optimal medical treatment , including & bgr;-blockers and angiotensin-converting enzyme inhibitors ( aged 75.5±11.1 years ; left ventricular [ LV ] ejection fraction 29 % ; & OV0312;o2peak 13 mL · kg−1 · min−1 ) were r and omized to either moderate continuous training ( 70 % of highest measured heart rate , ie , peak heart rate ) or aerobic interval training ( 95 % of peak heart rate ) 3 times per week for 12 weeks or to a control group that received st and ard advice regarding physical activity . & OV0312;o2peak increased more with aerobic interval training than moderate continuous training ( 46 % versus 14 % , P<0.001 ) and was associated with reverse LV remodeling . LV end-diastolic and end-systolic volumes declined with aerobic interval training only , by 18 % and 25 % , respectively ; LV ejection fraction increased 35 % , and pro-brain natriuretic peptide decreased 40 % . Improvement in brachial artery flow-mediated dilation ( endothelial function ) was greater with aerobic interval training , and mitochondrial function in lateral vastus muscle increased with aerobic interval training only . The MacNew global score for quality of life in cardiovascular disease increased in both exercise groups . No changes occurred in the control group . Conclusions — Exercise intensity was an important factor for reversing LV remodeling and improving aerobic capacity , endothelial function , and quality of life in patients with postinfa rct ion heart failure . These findings may have important implication s for exercise training in rehabilitation programs and future studies Background Optimal timing of cardiac transplantation in ambulatory patients with severe left ventricular dysfunction is often difficult . To determine whether measurement of peak oxygen consumption ( Vo2 ) during maximal exercise testing can be used to identify patients in whom transplantation can be safely deferred , we prospect ively performed exercise testing on all ambulatory patients referred for transplant between October 1986 and December 1989 . Methods and Results Patients were assigned into one of three groups on the basis of exercise data : Group 1 ( n = 35 ) comprised patients accepted for transplant ( Vo2<14 ml/kg/min ) ; group 2 ( n = 52 ) comprised patients considered too well for transplant ( Vo2 > 14 ml/kg/min ) ; and group 3 ( n = 27 ) comprised patients with low Vo2 rejected for transplant due to noncardiac problems . All three groups were comparable in New York Heart Association functional class , ejection fraction , and cardiac index ( p = NS ) . Pulmonary capillary wedge pressure was significantly lower in group 2 than in either group 1 or 3 ( p<0.05 ) , although there was wide overlap . Patients with preserved exercise capacity ( group 2 ) had cumulative 1- and 2-year survival rates of 94 % and 84 % , which are equal to survival levels after transplantation . In contrast , patients rejected for transplant ( group 3 ) had survival rates of only 47 % at 1 year and 32 % at 2 years , whereas patients awaiting transplantation ( group 1 ) had a survival rate of 790 % at 1 year ( both ( p < 0.005 versus patients with Vo2 > 14 ml/kg/min ) . All deaths in group 2 were sudden . By univariate and multivariate analyses , peak Vo2 was the best predictor of survival , with only pulmonary capillary wedge pressure providing additional prognostic information . Conclusions .These data suggest that cardiac transplantation can be safely deferred in ambulatory patients with severe left ventricular dysfunction and peak exercise Vo2 of more than 14 ml/min/kg . ( Circulation 1991;83:778–786 Background : Capacity to exercise may not be fully restored in patients with heart failure even in the long term after ventricular assist device ( VAD ) implantation . The benefits of exercise training in patients with VAD are unknown . Design and methods : Fifteen patients , aged 38.3 ± 15.9 years , bridged to heart transplantation with left ventricular assist device or biventricular assist device were r and omized at a ratio of 2 : 1 to a  training group  ( TG , n = 10 ) or a control group ( n = 5 ) , 6.3 ± 4 months after implantation . Both the groups were advised to walk 30–45 min/day . TG also underwent moderate-intensity aerobic exercise using a bike or treadmill for 45 min , three to five times a week , combined with high-intensity inspiratory muscle training using a computer- design ed software to respiratory exhaustion , two to three times a week for 10 weeks . The patients were tested using cardiopulmonary exercise testing , 6-min walk test , spirometry and electronic pressure manometer for inspiratory muscle strength ( Pimax ) and endurance ( sustained Pimax ) measurement . Quality of life was assessed with the Minnesota Living with Heart Failure question naire . Results : TG improved peak oxygen consumption ( 19.3 ± 4.5 vs. 16.8 ± 3.7 ml/kg per min , P = 0.008 ) and VO2 at ventilatory threshold ( 15.1 ± 4.2 vs. 12 ± 5.6 ml/kg per min , P = 0.01 ) , whereas the ventilation/carbon dioxide slope decreased ( 35.9 ± 5.6 vs. 40 ± 6.5 , P = 0.009 ) . The 6-min walk test distance increased ( 527 ± 76 vs. 462 ± 88 m , P = 0.005 ) and quality of life was improved ( 38.2 ± 11.6 vs. 48.9 ± 12.8 , P = 0.005 ) , as well as Pimax ( 131.8 ± 33 vs. 95.5 ± 28cmH2O , P = 0.005 ) , sustained Pimax ( 484 ± 195 vs. 340 ± 193cmH2O/s/10 3 , P = 0.005 ) , and inspiratoty lung capacity ( 2.4 ± 0.9 vs. 1.7 ± 0.7 L , P = 0.008 ) were improved . No significant changes were noted in the control group . Conclusion : Our findings indicate that exercise training may improve the functional status of VAD recipients  even at a later period after implantation and thus , may have additional importance in cases of destination therapy Background —The  maximal oxygen uptake ( peak & OV0312;o2 ) is used in risk stratification of patients with chronic heart failure ( CHF ) .  Peak & OV0312;o2 might be lower than maximally possible if exercise is stopped early because of lack of patient motivation or premature cessation by the investigator . In contrast , the anaerobic threshold ( & OV0312;o2AT ) and the ventilatory efficiency ( & OV0312;e versus & OV0312;co2 slope ) are less subject to these influences . Thus , we compared these parameters with peak & OV0312;o2 in identifying patients with CHF at increased risk for death within 6 months after evaluation . Methods and Results —We performed cardiopulmonary exercise tests with gas exchange measurements in 223 consecutive patients with CHF ( 114 coronary artery disease , 92 dilated cardiomyopathy , 17 others ) at the Herzzentrum Ludwigshafen between 1995 and 1998 . We measured peak & OV0312;o2 , & OV0312;o2AT and & OV0312;e versus & OV0312;co2 slope . We selected peak & OV0312;o2 of ≤14 mL/kg per minute , & OV0312;o2AT of < 11 mL/kg per minute , and & OV0312;e versus & OV0312;co2 slope of > 34 as threshold values for high risk of death . The median follow-up time was 644 days . Patients with peak & OV0312;o2 of ≤14 mL/kg per minute had a > 3-fold-increased risk ( OR=3.4 ; CI , 1.3 to 9.1 ) , with & OV0312;o2AT < 11 mL/min per kg or & OV0312;e versus & OV0312;co2 slope > 34 a 5-fold increased risk for early death ( OR=5.3 ; CI , 1.5 to 19.0 ; OR=4.8 ; CI , 1.7 to 13.8 , respectively ) . In patients with both & OV0312;o2AT < 11 mL/kg per minute and & OV0312;e versus & OV0312;co2 slope > 34 , the risk of early death was 10-fold higher ( OR=9.6 ; CI , 2.1 to 44.7 ) . After correction for age , sex , left ventricular ejection fraction , and New York Heart Association class in a multivariate analysis , the combination of & OV0312;o2AT < 11 mL/kg per minute and & OV0312;e versus & OV0312;co2 slope > 34 was the best predictor of 6-month mortality ( RR=5.1 , P = 0.001 ) . Conclusions —&OV0312;o2AT of < 11 mL/kg per minute and slope of & OV0312;e versus & OV0312;co2 > 34 , combined , better identified patients at high risk for early death from CHF than did peak & OV0312;o2 and should therefore be considered when prioritizing patients for heart transplantation BACKGROUND Interval ( IT ) and continuous training ( CT ) represent well-established exercise modalities in patients with moderate to severe chronic obstructive pulmonary disease ( COPD ) . However , their effects and feasibility in patients with end-stage COPD remain unclear . METHODS Sixty patients ( 53 ± 6 years , 53 % women ) being evaluated for lung transplantation where r and omly assigned either to IT ( n = 30 , cycling at 100 % peak work rate for 30 seconds alternating with 30 seconds of rest ) or CT ( n = 30 , cycling at 60 % of peak work rate ) during a 3-week inpatient rehabilitation program . Both exercise protocol s yielded an equivalent amount of total work . Patients had a mean forced expiratory volume at 1 second ( FEV(1 ) ) of 25 % ± 8 % of predicted value . RESULTS Patients in both groups achieved similar clinical ly relevant improvements in 6-minute walking distance of 
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