Physical training in Syndrome X - Physical training counteracts deconditioning and pain in Syndrome X

OBJECTIVES The aim of this study was to evaluate the effects of exercise tr aining and body-awareness training in female patients with Syndrome X. BACKGROUND Patients with Syndrome X, defined as effort-induced angina pecto ris, a positive exercise test and a normal coronary angiogram, suffer from a chronic pain disorder. We hypothesized that this disorder results in phys ical 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 meas urements, with eight weeks of body-awareness training followed by eight wee ks of exercise training on a bicycle ergometer three times a week for 30 mi n 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 withou t any intervention whatsoever. The effects on exercise performance, hormona l secretion, vascular function, adenosine sensitivity and quality of life w ere evaluated. RESULTS Body-awareness training did not change the pain response. The two t raining groups did not differ in effects of exercise training. Exercise cap acity before training was below the gender- and age-matched reference range and improved by 34% with training to a level not different from the refere nce 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-ex ercise curve was shifted to the right. Syndrome X patients showed a hyperse nsitivity to loll-dose adenosine infusion compared to healthy age- and gend er-matched controls (p < 0.0001) that did not change with exercise training . Endothelium-dependent blood flow increase was at baseline within referenc e range and tended to increase (p < 0.06) following training. In Group A th e 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 exercis e training (Group B). CONCLUSIONS Physical deconditioning with lower exertional threshold for pai n is a prominent feature in Syndrome X. Physical training in Syndrome X res ults in an increased exercise capacity with lesser anginal pain. We suggest physical training as an effective treatment in Syndrome X. (C) 2000 by the American College of Cardiology.