974 resultados para Stress testing
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The ongoing global financial crisis has demonstrated the importance of a systemwide, or macroprudential, approach to safeguarding financial stability. An essential part of macroprudential oversight concerns the tasks of early identification and assessment of risks and vulnerabilities that eventually may lead to a systemic financial crisis. Thriving tools are crucial as they allow early policy actions to decrease or prevent further build-up of risks or to otherwise enhance the shock absorption capacity of the financial system. In the literature, three types of systemic risk can be identified: i ) build-up of widespread imbalances, ii ) exogenous aggregate shocks, and iii ) contagion. Accordingly, the systemic risks are matched by three categories of analytical methods for decision support: i ) early-warning, ii ) macro stress-testing, and iii ) contagion models. Stimulated by the prolonged global financial crisis, today's toolbox of analytical methods includes a wide range of innovative solutions to the two tasks of risk identification and risk assessment. Yet, the literature lacks a focus on the task of risk communication. This thesis discusses macroprudential oversight from the viewpoint of all three tasks: Within analytical tools for risk identification and risk assessment, the focus concerns a tight integration of means for risk communication. Data and dimension reduction methods, and their combinations, hold promise for representing multivariate data structures in easily understandable formats. The overall task of this thesis is to represent high-dimensional data concerning financial entities on lowdimensional displays. The low-dimensional representations have two subtasks: i ) to function as a display for individual data concerning entities and their time series, and ii ) to use the display as a basis to which additional information can be linked. The final nuance of the task is, however, set by the needs of the domain, data and methods. The following ve questions comprise subsequent steps addressed in the process of this thesis: 1. What are the needs for macroprudential oversight? 2. What form do macroprudential data take? 3. Which data and dimension reduction methods hold most promise for the task? 4. How should the methods be extended and enhanced for the task? 5. How should the methods and their extensions be applied to the task? Based upon the Self-Organizing Map (SOM), this thesis not only creates the Self-Organizing Financial Stability Map (SOFSM), but also lays out a general framework for mapping the state of financial stability. This thesis also introduces three extensions to the standard SOM for enhancing the visualization and extraction of information: i ) fuzzifications, ii ) transition probabilities, and iii ) network analysis. Thus, the SOFSM functions as a display for risk identification, on top of which risk assessments can be illustrated. In addition, this thesis puts forward the Self-Organizing Time Map (SOTM) to provide means for visual dynamic clustering, which in the context of macroprudential oversight concerns the identification of cross-sectional changes in risks and vulnerabilities over time. Rather than automated analysis, the aim of visual means for identifying and assessing risks is to support disciplined and structured judgmental analysis based upon policymakers' experience and domain intelligence, as well as external risk communication.
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Introduction: La surcharge de pression ventriculaire augmente à l’exercice chez les patients avec une sténose de valve aortique (SVA). Lorsqu’il n’y a aucun symptôme apparent, il est cependant difficile d’indiquer l’intervention chirurgicale en utilisant seulement les indices de surcharge de pression ventriculaire. D’autres paramètres, tels que la dispersion de la repolarisation ventriculaire (d-QT), qui augmentent avec le gradient de pression transvalvulaire (GPT), n’ont pas été étudiés dans la SVA. L’objectif de l’étude était de déterminer le modèle de réponse du segment QT et de la d-QT à l’épreuve d’effort chez des enfants avec une SVA congénitale modérée afin d’évaluer l’impact de la surcharge de pression ventriculaire selon une perspective électrophysiologique. Matériel et méthodes: 15 patients SVA modérés ont été comparés à 15 sujets contrôles appariés pour l’âge (14.8±2.5 ans vs. 14.2±1.5 ans) et pour le sexe (66,7% de sujets mâles). Tous les sujets ont fait une épreuve d’effort avec enregistrement électrocardiographique à 12 dérivations. Le segment QT a été mesuré à partir du début du complexe QRS jusqu’à l’apex de l’onde T (QTa) au repos, à l’effort maximal ainsi qu’après 1 et 3 minutes de récupération. La longueur du segment QT a été corrigée selon l’équation de Fridericia et la d-QT a été calculée. Résultats: La longueur du segment QT corrigée (QTc) était similaire au repos entre les groupes d’étude, mais était significativement élevée chez les SVA en comparaison avec le groupe contrôle à l’effort maximal (p=0.004) ainsi qu’après 1 (p<0.001) et 3 (p<0.001) minutes de récupération. Une interaction significative a été identifiée entre les groupes pour la d-QT (p=0.034) et les tests post hoc ont révélé une différence significative seulement au repos (p=0.001). Conclusions: Les anomalies de repolarisation ventriculaire peuvent être révélées par l’évaluation de la repolarisation électrique lors de l’épreuve d’effort chez les SVA modérées asymptomatiques. L’utilisation de la réponse du QT à l’effort pourrait être bénéfique pour l’optimisation de la stratification du risque chez ces patients.
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El presente proyecto tiene como objeto identificar cuáles son los conceptos de salud, enfermedad, epidemiología y riesgo aplicables a las empresas del sector de extracción de petróleo y gas natural en Colombia. Dado, el bajo nivel de predicción de los análisis financieros tradicionales y su insuficiencia, en términos de inversión y toma de decisiones a largo plazo, además de no considerar variables como el riesgo y las expectativas de futuro, surge la necesidad de abordar diferentes perspectivas y modelos integradores. Esta apreciación es pertinente dentro del sector de extracción de petróleo y gas natural, debido a la creciente inversión extranjera que ha reportado, US$2.862 millones en el 2010, cifra mayor a diez veces su valor en el año 2003. Así pues, se podrían desarrollar modelos multi-dimensional, con base en los conceptos de salud financiera, epidemiológicos y estadísticos. El termino de salud y su adopción en el sector empresarial, resulta útil y mantiene una coherencia conceptual, evidenciando una presencia de diferentes subsistemas o factores interactuantes e interconectados. Es necesario mencionar también, que un modelo multidimensional (multi-stage) debe tener en cuenta el riesgo y el análisis epidemiológico ha demostrado ser útil al momento de determinarlo e integrarlo en el sistema junto a otros conceptos, como la razón de riesgo y riesgo relativo. Esto se analizará mediante un estudio teórico-conceptual, que complementa un estudio previo, para contribuir al proyecto de finanzas corporativas de la línea de investigación en Gerencia.
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La crisis que se desató en el mercado hipotecario en Estados Unidos en 2008 y que logró propagarse a lo largo de todo sistema financiero, dejó en evidencia el nivel de interconexión que actualmente existe entre las entidades del sector y sus relaciones con el sector productivo, dejando en evidencia la necesidad de identificar y caracterizar el riesgo sistémico inherente al sistema, para que de esta forma las entidades reguladoras busquen una estabilidad tanto individual, como del sistema en general. El presente documento muestra, a través de un modelo que combina el poder informativo de las redes y su adecuación a un modelo espacial auto regresivo (tipo panel), la importancia de incorporar al enfoque micro-prudencial (propuesto en Basilea II), una variable que capture el efecto de estar conectado con otras entidades, realizando así un análisis macro-prudencial (propuesto en Basilea III).
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Regional climate downscaling has arrived at an important juncture. Some in the research community favour continued refinement and evaluation of downscaling techniques within a broader framework of uncertainty characterisation and reduction. Others are calling for smarter use of downscaling tools, accepting that conventional, scenario-led strategies for adaptation planning have limited utility in practice. This paper sets out the rationale and new functionality of the Decision Centric (DC) version of the Statistical DownScaling Model (SDSM-DC). This tool enables synthesis of plausible daily weather series, exotic variables (such as tidal surge), and climate change scenarios guided, not determined, by climate model output. Two worked examples are presented. The first shows how SDSM-DC can be used to reconstruct and in-fill missing records based on calibrated predictor-predictand relationships. Daily temperature and precipitation series from sites in Africa, Asia and North America are deliberately degraded to show that SDSM-DC can reconstitute lost data. The second demonstrates the application of the new scenario generator for stress testing a specific adaptation decision. SDSM-DC is used to generate daily precipitation scenarios to simulate winter flooding in the Boyne catchment, Ireland. This sensitivity analysis reveals the conditions under which existing precautionary allowances for climate change might be insufficient. We conclude by discussing the wider implications of the proposed approach and research opportunities presented by the new tool.
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O presente trabalho visa propor uma metodologia para Teste de estresse e, consequentemente, cálculo do colchão adicional de capital em risco de crédito, conforme exigência do Comitê de Supervisão Bancária. A metodologia consiste em utilizar informações macroeconômicas para determinar o comportamento da taxa de inadimplência. Dessa forma, podemos simular possíveis cenários econômicos e, com isso, a taxa de inadimplência associada a esse cenário. Para cada cenário econômico é obtida uma taxa. Cada taxa de inadimplência fornece uma curva de perdas. Simulando diversos cenários econômicos foi possível obter diversas curvas de perda e, com elas, a probabilidade de ocorrência da perda esperada e inesperada. A metodologia foi aplicada a uma carteira de crédito pessoal para pessoa física. Os resultados se mostraram bastantes eficientes para determinar a probabilidade de ocorrência do Capital Alocado. Como consequência do teste, dado um nível de confiança, foi possível determinar qual deveria ser o Capital Alocado para fazer frente às perdas acima da perda inesperada.
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FUNDAMENTO: A Tolerância ao Esforço Físico (TEF) é uma medida de condicionamento cardiorrespiratório. A capacidade aeróbica é reduzida na Insuficiência Cardíaca (IC), embora não haja dados disponíveis sobre esse parâmetro em animais com disfunção ventricular e sem sinais de IC. OBJETIVO: Avaliar a TEF em ratos com disfunção ventricular diastólica isolada ou associada com disfunção sistólica induzida pela Estenose da Aorta ascendente (EAo). MÉTODOS: Ratos Wistar machos jovens (20-30 dias de idade) foram divididos em Grupo Controle (GC, n = 11) e Grupo EAo (n = 12). Os animais foram avaliados em 6 e 18 semanas após a cirurgia para EAo. O teste ergométrico foi feito até a exaustão e foram avaliadas a velocidade da esteira e a concentração de lactato [LAC] no limiar de lactato, velocidade da esteira e [LAC] na exaustão, e tempo total do teste. RESULTADOS: Dados ecocardiográficos revelaram remodelação do átrio esquerdo e hipertrofia concêntrica ventricular esquerda em 6 e 18 semanas. A fração de encurtamento endocárdico mostrou-se maior no grupo EAo do que no GC em 6 e 18 semanas. A fração de encurtamento da parede média mostrou-se maior no grupo EAo do que no GC em 6 semanas. O índice cardíaco mostrou-se semelhante no GC e no grupo EAo em 6 e 18 semanas, tendo diminuído entre 6-18 semanas em ambos os grupos. A razão entre a onda E a onda A foi maior no GC do que no grupo EAo em ambos os períodos e não se alterou em ambos os grupos entre a semana 6 e a semana 18. Os parâmetros do teste de esforço na esteira foram semelhantes nos dois grupos tanto na semana 6 quanto na semana 18. CONCLUSÃO: Embora a EAo promova a disfunção diastólica isolada ou associada à disfunção sistólica, em 6 ou 18 semanas, ela não é suficiente para alterar a tolerância ao esforço físico.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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The usefulness of stress myocardial perfusion scintigraphy for cardiovascular (CV) risk stratification in chronic kidney disease remains controversial. We tested the hypothesis that different clinical risk profiles influence the test. We assessed the prognostic value of myocardial scintigraphy in 892 consecutive renal transplant candidates classified into four risk groups: very high (aged epsilon 50 years, diabetes and CV disease), high (two factors), intermediate (one factor) and low (no factor). The incidence of CV events and death was 20 and 18, respectively (median follow-up 22 months). Altered stress testing was associated with an increased probability of cardiovascular events only in intermediate-risk (one risk factor) patients [30.3 versus 10, hazard ratio (HR) 2.37, confidence interval (CI) 1.693.33, P 0.0001]. Low-risk patients did well regardless of scan results. In patients with two or three risk factors, an altered stress test did not add to the already increased CV risk. Myocardial scintigraphy was related to overall mortality only in intermediate-risk patients (HR 2.8, CI 1.55.1, P 0.007). CV risk stratification based on myocardial stress testing is useful only in patients with just one risk factor. Screening may avoid unnecessary testing in 60 of patients, help stratifying for risk of events and provide an explanation for the inconsistent performance of myocardial scintigraphy.
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BACKGROUND: Left anterior hemiblock (LAHB) is the most frequent conduction abnormality, but its impact on the diagnostic accuracy of the exercise ECG has not been studied. The aim of our study was to determine the diagnostic accuracy of ST depression for predicting ischaemia in the presence of LAHB. PATIENTS: Consecutive patients with known or suspected coronary heart disease undergoing exercise ECG and 99mTc-sestamibi single photon emission computed tomography (SPECT) were included in the analysis. Patients with left bundle branch block, with changes in QRS morphology related to myocardial infarction, and patients who had undergone pharmacological stress testing were excluded. RESULTS: Of 1532 patients assessed, 567 patients qualified for the analysis. In 69 patients with LAHB, ECG stress testing had lower sensitivity (38% vs 86%) and lower negative predictive value (82% vs 92%) than in patients with normal baseline ECG. The reduction of sensitivity appeared to be similar in patients with isolated LAHB (n=43), in patients with right bundle branch block (n=39), and with bifascicular block (n=26). In contrast, the positive predictive value of the test was excellent. CONCLUSION: The diagnostic accuracy of the exercise ECG for prediction of ischaemia is reduced in patients with LAHB.
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BACKGROUND: Exercise capacity after heart transplantation (HTx) remains limited despite normal left ventricular systolic function of the allograft. Various clinical and haemodynamic parameters are predictive of exercise capacity following HTx. However, the predictive significance of chronotropic competence has not been demonstrated unequivocally despite its immediate relevance for cardiac output. AIMS: This study assesses the predictive value of various clinical and haemodynamic parameters for exercise capacity in HTx recipients with complete chronotropic competence evolving within the first 6 postoperative months. METHODS: 51 patients were enrolled in this exercise study. Patients were included when at least >6 months after HTx and without negative chronotropic medication or factors limiting exercise capacity such as significant transplant vasculopathy or allograft rejection. Clinical parameters were obtained by chart review, haemodynamic parameters from current cardiac catheterisation, and exercise capacity was assessed by treadmill stress testing. A stepwise multiple regression model analysed the proportion of the variance explained by the predictive parameters. RESULTS: The mean age of these 51 HTx recipients was 55.4 +/- 13.2 yrs on inclusion, 42 pts were male and the mean time interval after cardiac transplantation was 5.1 +/- 2.8 yrs. Five independent predictors explained 47.5% of the variance observed for peak exercise capacity (adjusted R2 = 0.475). In detail, heart rate response explained 31.6%, male gender 5.2%, age 4.1%, pulmonary vascular resistance 3.7%, and body-mass index 2.9%. CONCLUSION: Heart rate response is one of the most important predictors of exercise capacity in HTx recipients with complete chronotropic competence and without relevant transplant vasculopathy or acute allograft rejection.
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BACKGROUND: The incidence of coronary artery disease (CAD) in totally asymptomatic patients with myocardial ischemia during stress testing is unknown. METHODS: 54 patients with asymptomatic myocardial ischemia participated in the Swiss Interventional Study on Silent Ischemia type I (SWISSI I). Asymptomatic myocardial ischemia was verified by bicycle ergometry and stress imaging (echocardiography or scintigraphy). Findings from coronary angiographies in the course of the study constituted the main outcome. RESULTS: Of the 54 study participants, 29 patients (53.7%) underwent coronary angiography. CAD was found in 27 of 29 patients (93.1%). In those 27 patients with CAD, 9 patients (33.3%) suffered from single vessel disease, 9 patients (33.3%) from two vessel disease, and 9 patients (33.3%) from triple vessel disease. Two patients showed left main coronary artery stenosis. CONCLUSION: This study shows a high incidence of relevant CAD among totally asymptomatic patients with myocardial ischemia during stress testing. Previously healthy subjects with exercise-induced ST-segment depression at check-up examinations, even if asymptomatic, should have further diagnostic evaluation.
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Background: Cardiac shock wave therapy (CSWT) delivered to the myocardium increases capillary density and regional myocardial blood flow in animal experiments. In addition, nonenzymatic nitric oxide production and the upregulation of vascular growth factor's mRNA by CSWT have been described. The aim of the study was therefore to test its potential to relieve symptoms in patients with chronic stable angina pectoris. Methods: Twenty-one patients (mean age 68.2 ± 8.3 years, 19 males) with chronic refractory angina pectoris and evidence of inducible myocardial ischemia during MIBI-SPECT imaging, were randomized into a treatment (n = 11) and a placebo arm (n = 10). The region of exercise-induced ischemia was treated with echocardiographic guidance during nine sessions over a period of 3 months. One session of CSWT consisted of 200 shots/spot (9--12 spots/session) with an energy intensity of 0.09 mJ/mm2. In the control group acoustic simulation was performed without energy application. Medication was kept unchanged during the whole treatment period. Results: In the treatment group, symptoms improved in 9/11 patients, and the ischemic threshold, determined by cardiopulmonary exercise stress testing, increased from 80 ± 28 to 95 ± 28 W (P= 0.036). In the placebo arm, only 2/10 patients reported an improvement and the ischemic threshold remained unchanged (98 ± 23 to 107 ± 23 W; P= 0.141). The items “physical functioning” (P= 0.043), “general health perception” (P= 0.046), and “vitality” (P= 0.035) of the SF-36 questionnaire significantly improved in the treatment arm, whereas in the placebo arm, no significant change was noted. Neither arrhythmias, troponin rise nor complications were observed during treatment. Conclusions: This placebo controlled trial shows a significant improvement in symptoms, quality of life parameters and ischemic threshold during exercise in patients with chronic refractory angina pectoris treated with CSWT. Thus, CSWT represents a new option for the treatment of patients with refractory AP.
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BACKGROUND Traumatic knee dislocation represents a rare but devastating injury. Several controversies persist regarding type of treatment, surgical timing, graft selection, repair versus reconstruction of the medial and lateral structures, surgical techniques and postoperative rehabilitation. A new technique for primary ACL stabilization, dynamic intaligamentary stabilization (DIS) was developed at the authors' institution. The purpose of this study was to analyze the clinical and radiological outcomes of surgically treated traumatic knee dislocations by means of the DIS technique for the ACL, primary suturing for PCL, MCL and LCL. METHODS Between 2009 and 2012, 35 patients treated surgically for traumatic knee dislocation with primary anterior cruciate ligament (ACL) reconstruction with DIS, suturing of the posterior cruciate ligament (PCL) and primary complete repair of collaterals, were evaluated clinically (IKDC score, SF12 health survey, Lysholm score, Tegner score) and radiologically with a mean follow up of 2.2 years (range 1.00-3.50 years) years. Instrumented anterior-posterior translation was measured (KT-2000). RESULTS Anterior/posterior translation (KT-2000) for the healthy and injured limb was 4.8mm (range 3-8mm) and 7.3mm (range 5-10) (89N) respectively. Valgus and varus stress testing in 30° flexion was normal in 26 (75%) and 29 (83%) patients, respectively. The IKDC score was B in 29 (83%) and C in 6 (17%) patients, while the mean Tegner score was 6 (range 4-8). The mean Lysholm score was 90.83 (range 81-95) and mean SF-12 physical and mental scores were 54.1 (range 45-60) and 51.0 (range 39-62) respectively. In 2 patients, a secondary operation was performed. CONCLUSIONS Early, one stage reconstruction with DIS can achieve good functional results and patient satisfaction with overall restoration of sports and working capacity without graft requirements.
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En un ejercicio no extenuante la frecuencia cardíaca (FC) guarda una relación lineal con el consumo máximo de oxígeno (V O2max) y se suele usar como uno de los parámetros de referencia para cuantificar la capacidad del sistema cardiovascular. Normalmente la frecuencia cardíaca puede remplazar el porcentaje de V O2max en las prescripciones básicas de ejercicio para la mejora de la resistencia aeróbica. Para obtener los mejores resultados en la mejora de la resistencia aeróbica, el entrenamiento de los individuos se debe hacer a una frecuencia cardíaca suficientemente alta, para que el trabajo sea de predominio dinámico con la fosforilación oxidativa como fuente energética primaria, pero no tan elevada que pueda suponer un riesgo de infarto de miocardio para el sujeto que se está entrenando. Los programas de entrenamiento de base mínima y de base óptima, con ejercicios de estiramientos para prevenir lesiones, son algunos de los programas más adecuados para el entrenamiento de la resistencia aeróbica porque maximizan los beneficios y minimizan los riesgos para el sistema cardiovascular durante las sesiones de entrenamiento. En esta tesis, se ha definido un modelo funcional para sistemas de inteligencia ambiental capaz de monitorizar, evaluar y entrenar las cualidades físicas que ha sido validado cuando la cualidad física es la resistencia aeróbica. El modelo se ha implementado en una aplicación Android utilizando la camiseta inteligente “GOW running” de la empresa Weartech. El sistema se ha comparado en el Laboratorio de Fisiología del Esfuerzo (LFE) de la Universidad Politécnica de Madrid (UPM) durante la realización de pruebas de esfuerzo. Además se ha evaluado un sistema de guiado con voz para los entrenamientos de base mínima y de base óptima. También el desarrollo del software ha sido validado. Con el uso de cuestionarios sobre las experiencias de los usuarios utilizando la aplicación se ha evaluado el atractivo de la misma. Por otro lado se ha definido una nueva metodología y nuevos tipos de cuestionarios diseñados para evaluar la utilidad que los usuarios asignan al uso de un sistema de guiado por voz. Los resultados obtenidos confirman la validez del modelo. Se ha obtenido una alta concordancia entre las medidas de FC hecha por la aplicación Android y el LFE. También ha resultado que los métodos de estimación del VO2max de los dos sistemas pueden ser intercambiables. Todos los usuarios que utilizaron el sistema de guiado por voz para entrenamientos de 10 base mínima y de base óptimas de la resistencia aeróbica consiguieron llevar a cabo las sesiones de entrenamientos con un 95% de éxito considerando unos márgenes de error de un 10% de la frecuencia cardíaca máxima teórica. La aplicación fue atractiva para los usuarios y hubo también una aceptación del sistema de guiado por voz. Se ha obtenido una evaluación psicológica positiva de la satisfacción de los usuarios que interactuaron con el sistema. En conclusión, se ha demostrado que es posible desarrollar sistemas de Inteligencia Ambiental en dispositivos móviles para la mejora de la salud. El modelo definido en la tesis es el primero modelo funcional teórico de referencia para el desarrollo de este tipo de aplicaciones. Posteriores estudios se realizarán con el objetivo de extender dicho modelo para las demás cualidades físicas que suponen modelos fisiológicos más complejos como por ejemplo la flexibilidad. Abstract In a non-strenuous exercise, the heart rate (HR) shows a linear relationship with the maximum volume of oxygen consumption (V O2max) and serves as an indicator of performance of the cardiovascular system. The heart rate replaces the %V O2max in exercise program prescription to improve aerobic endurance. In order to achieve an optimal effect during endurance training, the athlete needs to work out at a heart rate high enough to trigger the aerobic metabolism, while avoiding the high heart rates that bring along significant risks of myocardial infarction. The minimal and optimal base training programs, followed by stretching exercises to prevent injuries, are adequate programs to maximize benefits and minimize health risks for the cardiovascular system during single session training. In this thesis, we have defined an ambient intelligence system functional model that monitors, evaluates and trains physical qualities, and it has been validated for aerobic endurance. It is based on the Android System and the “GOW Running” smart shirt. The system has been evaluated during functional assessment stress testing of aerobic endurance in the Stress Physiology Laboratory (SPL) of the Technical University of Madrid (UPM). Furthermore, a voice system, designed to guide the user through minimal and optimal base training programs, has been evaluated. Also the software development has been evaluated. By means of user experience questionnaires, we have rated the attractiveness of the android application. Moreover, we have defined a methodology and a new kind of questionnaires in order to assess the user experience with the audio exercise guide system. The results obtained confirm the model. We have a high similarity between HR measurements made of our system and the one used by SPL. We have also a high correlation between the VO2max estimations of our system and the SPL system. All users, that tried the voice guidance system for minimal and optimal base training programs, were able to perform the 95% of the training session with an error lower than the 10% of theoretical maximum heart rate. The application appeared attractive to the users, and it has also been proven that the voice guidance system was useful. As result we obtained a positive evaluation of the users' satisfaction while they interacted with the system. In conclusion, it has been demonstrated that is possible to develop mobile Ambient Intelligence applications for the improvement of healthy lifestyle. AmIRTEM model is the first theoretical reference functional model for the design of this kind of applications. Further studies will be realized in order to extend the AmIRTEM model to other physical qualities whose physiological models are more complex than the aerobic endurance.