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.
authors.affiliation: Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA. Electronic address: arthur.westover@utsouthwestern.edu.
authors.forename: Arthur N
authors.initials: AN
authors.lastname: Westover
authors.affiliation: Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nakonezny
authors.affiliation: The Cooper Institute, Dallas, TX, USA.
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Barlow
authors.affiliation: Hypertension Section, Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
authors.forename: Wanpen
authors.initials: W
authors.lastname: Vongpatanasin
authors.affiliation: Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; VA North Texas Health Care System, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX 75216, USA.
authors.forename: Bryon
authors.initials: B
authors.lastname: Adinoff
authors.affiliation: Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
authors.forename: E Sherwood
authors.initials: ES
authors.lastname: Brown
authors.affiliation: VA North Texas Health Care System, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX 75216, USA; Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.affiliation: The Cooper Institute, Dallas, TX, USA.
authors.forename: Laura F
authors.initials: LF
authors.lastname: DeFina
mesh_terms: D000328:Adult; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012111:Residence Characteristics; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000697:Central Nervous System Stimulants
keywords: Amphetamine; Blood pressure; Chronotropic incompetence; Exercise; Heart rate; Methylphenidate; Stimulants
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