4 Citations (Scopus)

Abstract

Background: To compare users of stimulant medications with matched nonusers on exercise outcomes during a maximal treadmill exercise test. Methods: A cross-sectional study of a community-based cohort comparing propensity-score-matched stimulant medication users (n=245) and nonusers (n=735) who underwent a maximal treadmill exercise test in the Cooper Center Longitudinal Study cohort from January 1, 1995 to December 31, 2013. Main Outcomes were peak systolic blood pressure (SBP), average rise in SBP, peak heart rate (HR), and estimated VO<inf>2</inf>max during exercise. A linear mixed model analysis was used to evaluate the effect of stimulant exposure on each of the exercise outcomes. In a sensitivity analysis, users were compared against nonusers for risk of chronotropic incompetence. Analyses were adjusted for relevant covariates and multiple testing. Results: Peak HR during exercise was significantly lower in stimulant medication users (least square mean estimate 170.2 beats/minute) compared to nonusers (174.4 beats/minute; p<0.0001). Moreover, stimulant medication users had an increased risk of chronotropic incompetence compared to nonusers (adjusted odds ratio 3.28, 95% confidence interval 1.70 to 6.34, p=0.0008). No significant differences were observed in the outcomes of peak SBP, average SBP rise, and estimated VO<inf>2</inf>max between matched groups. Conclusions: Stimulant medication use was associated with a significant decrease in peak HR and an increased risk of chronotropic incompetence. Further investigation is required to understand the clinical significance of chronotropic incompetence in stimulant medication users. Concerns that stimulant medication use may increase peak SBP and average SBP during exercise were not supported by this study.

Original languageEnglish (US)
Pages (from-to)32-39
Number of pages8
JournalJournal of Psychiatric Research
Volume64
DOIs
StatePublished - May 1 2015

Fingerprint

Blood Pressure
Exercise Test
Heart Rate
Propensity Score
Medication
Exercise
Least-Squares Analysis
Longitudinal Studies
Linear Models
Research Design
Cross-Sectional Studies
Cohort

Keywords

  • Amphetamine
  • Blood pressure
  • Chronotropic incompetence
  • Exercise
  • Heart rate
  • Methylphenidate
  • Stimulants

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Arts and Humanities (miscellaneous)

Cite this

Exercise outcomes in prevalent users of stimulant medications. / Westover, Arthur N.; Nakonezny, Paul A.; Barlow, Carolyn E.; Vongpatanasin, Wanpen; Adinoff, Bryon; Brown, E. Sherwood; Mortensen, Eric M.; Halm, Ethan A.; De Fina, Laura F.

In: Journal of Psychiatric Research, Vol. 64, 01.05.2015, p. 32-39.

Research output: Contribution to journalArticle

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title = "Exercise outcomes in prevalent users of stimulant medications",
abstract = "Background: To compare users of stimulant medications with matched nonusers on exercise outcomes during a maximal treadmill exercise test. Methods: A cross-sectional study of a community-based cohort comparing propensity-score-matched stimulant medication users (n=245) and nonusers (n=735) who underwent a maximal treadmill exercise test in the Cooper Center Longitudinal Study cohort from January 1, 1995 to December 31, 2013. Main Outcomes were peak systolic blood pressure (SBP), average rise in SBP, peak heart rate (HR), and estimated VO2max during exercise. A linear mixed model analysis was used to evaluate the effect of stimulant exposure on each of the exercise outcomes. In a sensitivity analysis, users were compared against nonusers for risk of chronotropic incompetence. Analyses were adjusted for relevant covariates and multiple testing. Results: Peak HR during exercise was significantly lower in stimulant medication users (least square mean estimate 170.2 beats/minute) compared to nonusers (174.4 beats/minute; p<0.0001). Moreover, stimulant medication users had an increased risk of chronotropic incompetence compared to nonusers (adjusted odds ratio 3.28, 95{\%} confidence interval 1.70 to 6.34, p=0.0008). No significant differences were observed in the outcomes of peak SBP, average SBP rise, and estimated VO2max between matched groups. Conclusions: Stimulant medication use was associated with a significant decrease in peak HR and an increased risk of chronotropic incompetence. Further investigation is required to understand the clinical significance of chronotropic incompetence in stimulant medication users. Concerns that stimulant medication use may increase peak SBP and average SBP during exercise were not supported by this study.",
keywords = "Amphetamine, Blood pressure, Chronotropic incompetence, Exercise, Heart rate, Methylphenidate, Stimulants",
author = "Westover, {Arthur N.} and Nakonezny, {Paul A.} and Barlow, {Carolyn E.} and Wanpen Vongpatanasin and Bryon Adinoff and Brown, {E. Sherwood} and Mortensen, {Eric M.} and Halm, {Ethan A.} and {De Fina}, {Laura F.}",
year = "2015",
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doi = "10.1016/j.jpsychires.2015.03.011",
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T1 - Exercise outcomes in prevalent users of stimulant medications

AU - Westover, Arthur N.

AU - Nakonezny, Paul A.

AU - Barlow, Carolyn E.

AU - Vongpatanasin, Wanpen

AU - Adinoff, Bryon

AU - Brown, E. Sherwood

AU - Mortensen, Eric M.

AU - Halm, Ethan A.

AU - De Fina, Laura F.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background: To compare users of stimulant medications with matched nonusers on exercise outcomes during a maximal treadmill exercise test. Methods: A cross-sectional study of a community-based cohort comparing propensity-score-matched stimulant medication users (n=245) and nonusers (n=735) who underwent a maximal treadmill exercise test in the Cooper Center Longitudinal Study cohort from January 1, 1995 to December 31, 2013. Main Outcomes were peak systolic blood pressure (SBP), average rise in SBP, peak heart rate (HR), and estimated VO2max during exercise. A linear mixed model analysis was used to evaluate the effect of stimulant exposure on each of the exercise outcomes. In a sensitivity analysis, users were compared against nonusers for risk of chronotropic incompetence. Analyses were adjusted for relevant covariates and multiple testing. Results: Peak HR during exercise was significantly lower in stimulant medication users (least square mean estimate 170.2 beats/minute) compared to nonusers (174.4 beats/minute; p<0.0001). Moreover, stimulant medication users had an increased risk of chronotropic incompetence compared to nonusers (adjusted odds ratio 3.28, 95% confidence interval 1.70 to 6.34, p=0.0008). No significant differences were observed in the outcomes of peak SBP, average SBP rise, and estimated VO2max between matched groups. Conclusions: Stimulant medication use was associated with a significant decrease in peak HR and an increased risk of chronotropic incompetence. Further investigation is required to understand the clinical significance of chronotropic incompetence in stimulant medication users. Concerns that stimulant medication use may increase peak SBP and average SBP during exercise were not supported by this study.

AB - Background: To compare users of stimulant medications with matched nonusers on exercise outcomes during a maximal treadmill exercise test. Methods: A cross-sectional study of a community-based cohort comparing propensity-score-matched stimulant medication users (n=245) and nonusers (n=735) who underwent a maximal treadmill exercise test in the Cooper Center Longitudinal Study cohort from January 1, 1995 to December 31, 2013. Main Outcomes were peak systolic blood pressure (SBP), average rise in SBP, peak heart rate (HR), and estimated VO2max during exercise. A linear mixed model analysis was used to evaluate the effect of stimulant exposure on each of the exercise outcomes. In a sensitivity analysis, users were compared against nonusers for risk of chronotropic incompetence. Analyses were adjusted for relevant covariates and multiple testing. Results: Peak HR during exercise was significantly lower in stimulant medication users (least square mean estimate 170.2 beats/minute) compared to nonusers (174.4 beats/minute; p<0.0001). Moreover, stimulant medication users had an increased risk of chronotropic incompetence compared to nonusers (adjusted odds ratio 3.28, 95% confidence interval 1.70 to 6.34, p=0.0008). No significant differences were observed in the outcomes of peak SBP, average SBP rise, and estimated VO2max between matched groups. Conclusions: Stimulant medication use was associated with a significant decrease in peak HR and an increased risk of chronotropic incompetence. Further investigation is required to understand the clinical significance of chronotropic incompetence in stimulant medication users. Concerns that stimulant medication use may increase peak SBP and average SBP during exercise were not supported by this study.

KW - Amphetamine

KW - Blood pressure

KW - Chronotropic incompetence

KW - Exercise

KW - Heart rate

KW - Methylphenidate

KW - Stimulants

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DO - 10.1016/j.jpsychires.2015.03.011

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