title: Physical training in Syndrome X: physical training counteracts deconditioning and pain in Syndrome X.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiology, Huddinge University Hospital, Stockholm, Sweden.
authors.forename: B E
authors.initials: BE
authors.lastname: Eriksson
authors.forename: R
authors.initials: R
authors.lastname: Tyni-Lennè
authors.forename: J
authors.initials: J
authors.lastname: Svedenhag
authors.forename: R
authors.initials: R
authors.lastname: Hallin
authors.forename: K
authors.initials: K
authors.lastname: Jensen-Urstad
authors.forename: M
authors.initials: M
authors.lastname: Jensen-Urstad
authors.forename: K
authors.initials: K
authors.lastname: Bergman
authors.forename: C
authors.initials: C
authors.lastname: Selvén
mesh_terms: D005081:Exercise Therapy; D005260:Female; D006801:Humans; D017566:Microvascular Angina / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged