CLINICAL STUDY
Physical training in Syndrome X
Physical training counteracts deconditioning and pain in Syndrome X
Björn E. Eriksson, MD, PhD*,
Raija Tyni-Lennè, PhD, PT ,
Jan Svedenhag, MD, PhD ,
Rolf Hallin, MD, PhD ,
Kerstin Jensen-Urstad, MD, PhD||,
Mats Jensen-Urstad, MD, PhD*,
Kristina Bergman, PT,** and
Christer Sylvén, MD, PhD, FACC, FESC*
* Cardiology, at Huddinge University Hospital, Stockholm, Sweden of
Physiotherapy, at Huddinge University Hospital, Stockholm, Sweden of
Clinical Physiology, at Huddinge University Hospital, Stockholm, Sweden and of
Neurophysiology at Huddinge University Hospital, Stockholm, Sweden
|| Department of Clinical Physiology at South Hospital, Stockholm, Sweden
Manuscript received August 5, 1999;
revised manuscript received April 19, 2000,
accepted June 19, 2000.
Reprint requests and correspondence: Dr. Björn E. Eriksson, Dept. of Cardiology, Huddinge University Hospital, 141 89 Stockholm, Sweden
OBJECTIVES
The aim of this study was to evaluate the effects of exercise training and body-awareness training in female patients with Syndrome X.
BACKGROUND
Patients with Syndrome X, defined as effort-induced angina pectoris, a positive exercise test and a normal coronary angiogram, suffer from a chronic pain disorder. We hypothesized that this disorder results in physical deconditioning with decreased exertional pain threshold.
METHODS
Twenty-six patients were randomly assigned to two training groups (A, B) and a control group (C). Group A (n = 8) started, after baseline measurements, with eight weeks of body-awareness training followed by eight weeks of exercise training on a bicycle ergometer three times a week for 30 min at an intensity of 50% of peak work rate. Group B (n = 8) performed only eight weeks of exercise training. Group C (n = 10) acted as controls without any intervention whatsoever. The effects on exercise performance, hormonal secretion, vascular function, adenosine sensitivity and quality of life were evaluated.
RESULTS
Body-awareness training did not change the pain response. The two training groups did not differ in effects of exercise training. Exercise capacity before training was below the gender- and age-matched reference range and improved by 34% with training to a level not different from the reference range. Onset of pain was delayed by 100% from 3 ± 2 to 6 ± 3 min (p < 0.05) while maximum pain did not change. Thus the pain-response-to-exercise curve was shifted to the right. Syndrome X patients showed a hypersensitivity to low-dose adenosine infusion compared to healthy age- and gender-matched controls (p < 0.0001) that did not change with exercise training. Endothelium-dependent blood flow increase was at baseline within reference range and tended to increase (p < 0.06) following training. In Group A the concentration of cortisol in urine decreased by 53% after body-awareness training (p < 0.05), and this change from baseline remained after physical exercise training (p < 0.05). A similar decrease occurred with only exercise training (Group B).
CONCLUSIONS
Physical deconditioning with lower exertional threshold for pain is a prominent feature in Syndrome X. Physical training in Syndrome X results in an increased exercise capacity with lesser anginal pain. We suggest physical training as an effective treatment in Syndrome X.
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Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | Borg CR-10 | = Borg Category Ratio Scale | | FMD | = Flow mediated dilation | | NTG | = Nitroglycerine |
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