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Objective: To emphasize the potentially harmful effects of high-intensity exercise on cardiac health and the fine line between physiologic and pathologic adaptation to chronic exercise in the elite athlete. This case also highlights the crucial need for regular evaluation of symptoms that suggest cardiac abnormality in athletes., Background: Sudden cardiac death (SCD) of young athletes is always a tragedy because they epitomize health. However, chronic, high-intensity exercise sometimes has harmful effects on cardiac health, and pathologic changes, such as myocardial fibrosis, have been observed in endurance athletes. In this case, a highly trained 30-year-old cyclist reported brief palpitations followed by presyncope feeling while exercising. Immediate investigations revealed nonsustained ventricular tachycardia originating from the left ventricle on a stress test associated with myocardial fibrosis of the left ventricle as shown with magnetic resonance imaging. Despite complete cessation of exercise, life-threatening arrhythmia and fibrosis persisted, leading to complete restriction from competition. Differential Diagnosis: Hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, myocarditis, postmyocarditis, use of drugs and toxic agents, doping, and systemic disease., Treatment: The arrhythmia could not be treated with catheter ablation procedure or drug suppression. Therefore, the athlete was instructed to withdraw completely from sport participation and to have a medical follow-up twice each year., Uniqueness: To our knowledge, no other report of left ventricle exercise-induced fibrosis associated with life-threatening arrhythmia in a living young elite athlete exists. Only postmortem evidence supports such myocardial pathologic adaptation to exercise., Conclusions: To prevent SCD in young athletes, careful attention must be paid to exercise-related symptoms that suggest a cardiac abnormality because they more often are linked to life-threatening cardiovascular disease.

Introduction: A new clinical entity, exercise-induced bronchoconstriction (EIB), has been recently defined which describes bronchoconstriction occurring in association with exercise in susceptible non-asthmatic persons., State of Art: There is considerable evidence that the pathogenesis of this condition is related to airway injury, due to prolonged hyperventilation and aggressive environmental factors. If the objective diagnostic tests are identical for the diagnosis of exercise induced asthma and EIB, the diagnoses are established differently, according to the high sensitivity of provocation by exercise "in the field" or the eucapnic voluntary hyperventilation provocation test., Perspectives: Current pharmacological treatment is based upon the inhalation of ß2-agonists prior to exercise, but to be granted permission to use them, athletes are required to provide documentation of objective evidence of EIB. Therefore, the diagnostic pathway in athletes is essential and respiratory physicians need to know the specific features of this new clinical entity., Conclusions: EIB distinct from the presence of asthma is prevalent in elite athletes and its determinants should be well known by their health care providers to assure an optimal management of this peculiar disease, in respect to drug doping regulations., (Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

The aim of this study was to identify some of the mechanisms that could be involved in blunted ventilatory response (VE) to exercise in the supine (S) position. The contribution of the recruitment of different muscle groups, the activity of the cardiac mechanoreceptors, the level of arterial baroreceptor stimulation, and the hemodynamic effects of gravity on the exercising muscles was analyzed during upright (U) and S exercise. Delayed rise in VE and pulmonary gas exchange following an impulselike change in work rate (supramaximal leg cycling at 240 W for 12 s) was measured in seven healthy subjects and six heart transplant patients both in U and S positions. This approach allows study of the relationship between the rise in VE and O2 uptake (VO2) without the confounding effects of contractions of different muscle groups. These responses were compared with those triggered by an impulselike change in work rate produced by the arms, which were positioned at the same level as the heart in S and U positions to separate effects of gravity on postexercising muscles from those on the rest of the body. Despite superimposable VO2 and CO2 output responses, the delayed VE response after leg exercise was significantly lower in the S posture than in the U position for each control subject and cardiac-transplant patient (-2.58 +/- 0.44 l and -3.52 +/- 1.11 l/min, respectively). In contrast, when impulse exercise was performed with the arms, reduction of ventilatory response in the S posture reached, at best, one-third of the deficit after leg exercise and was always associated with a reduction in VO2 of a similar magnitude. We concluded that reduction in VE response to exercise in the S position is independent of the types (groups) of muscles recruited and is not critically dependent on afferent signals originating from the heart but seems to rely on some of the effects of gravity on postexercising muscles.

Introduction/Background Gliomas are the most common primary brain tumors in adults. Physical activity is proposed as an associated care in multiple cancers with proven benefits but has not been often and specifically evaluated for gliomas. The main objective of our study was to assess the feasibility and the potential effectiveness of exercise training in patients with high and low-grade gliomas. Material and method Twenty-eight patients (mean age 49 years, 16 high grades and 12 low-grades, minimal Karnofksy Performance Status at 70%) were addressed by the neuro-oncology for fatigue complaint. They were first screened by a physiatrist and then included a program of individual exercise training. A Six-Minute-Walking-Test was realized before and after the training. Results On the 17 patients included, 14 finished the program (7 high grade and 7 low-grade gliomas). Only 2 patients were excluded for a clinical degradation and only 1 patient did not finish it for a reason linked to his tumor. Mean number of sessions was 8; no major sides effects were reported. After the program, a statistically significant increase of the 6-Minute-Test was found ( P = 0.0007). Conclusion In this population, this kind of program seems to be feasible and efficient. However, our results cannot be extended to all gliomas patients due to the good general state of our population and the inner limits of the Six-Minute-Walking-Test. Further studies are needed to assess the possible benefits in larger sample. [ABSTRACT FROM AUTHOR]

Objective Exercise behavior has shown its interest in cancers and may have a prognosis value in brain tumors [1] . The aim of this prospective study is to show the effectiveness of a guided personalized rehabilitation-reconditioning program in brain tumors. Patients Inclusion criteria: patients over 18; complain of fatigue and decrease or interruption of a physical activity; histological diagnosis of brain tumor; Karnofsky Performance Status > 60. Exclusion criteria: major neurological or cognitive impairment; cardiac or pulmonary contraindication; high risk of tumor progression. Methods Patients underwent an incremental, physician-supervised cardiopulmonary exercise test (CPET) before including the personalized rehabilitation reconditioning program. The program included 5 to 10 individualized sessions, supervised by a physiotherapist; from 30 to 45 minutes per session; 1 to 2 times per week; altered or continuous on walking treadmill or bicycle. The endurance phase was calculated depending on results of the CPET. The objectives of the sessions were personalized; the physical therapist gave the patient therapeutic advices to continue physical activity after the reconditioning program, with a written notebook of follow-up for self- sessions provided at home. The primary outcome was a 6-minute walk test (6MWT) [2] . Results Nineteen patients, mean aged of 53 years old (standard deviation 14.2) were proposed by the neurologist to follow the program; 11 had high-grade glioma and 8 of them low-grade glioma. Fourteen patients were included; 9 completed the program, 3 are currently following it. At follow up, all patients who had completed the program increased their walking speed from 1.68 m/sec (6 km/h) to 1.92 m/sec (6.9 km/h) ( p = 0.022). Discussion Brain tumor survivors can improve walking function after a personalized and guided rehabilitation reconditioning program. This study is a preliminary study before a controlled study measuring the effects of such a program on quality of life and survey in glioblastoma. [ABSTRACT FROM AUTHOR]