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RATIONALE: Exercise-induced dynamic hyperinflation contributes to decreased exercise tolerance in chronic obstructive pulmonary disease (COPD). It is unknown whether respiratory retraining (ventilation-feedback [VF] training) can affect exercise-induced dynamic hyperinflation and increase exercise tolerance. Objectives: To determine whether patients with COPD would achieve longer exercise duration if randomized to a combination of exercise training plus VF training than either form of training on its own. METHODS: A total of 64 patients randomized to 1 of 3 groups: VF plus exercise (n = 22), exercise alone (n = 20), and VF alone (n = 22). MEASUREMENTS AND MAIN RESULTS: Exercise duration before and after 36 training sessions and exercise-induced dynamic hyperinflation and respiratory pattern before and after training were measured. In the 49 patients who completed training, duration of constant work-rate exercise was 40.0 (+/- 20.4) minutes (mean +/- SD) with VF plus exercise, 31.5 (+/- 17.3) minutes with exercise alone, and 16.1 (+/- 19.3) minutes with VF alone. Exercise duration was longer in VF plus exercise than in VF alone (P < 0.0001), but did not reach predetermined statistical significance when VF plus exercise was compared with exercise alone (P = 0.022) (because of multiple comparisons, P

Hypogonadism, found in about one-third of patients with chronic obstructive pulmonary disease (COPD), has potential for decreasing muscle mass and muscle performance. Compared with eugonadal patients, we hypothesized that hypogonadal patients with COPD have decreased respiratory and skeletal muscle performance. Nineteen hypogonadal and 20 eugonadal men with COPD (FEV[1] 1.14 +/- 0.08 and 1.17 +/- 0.11 L [standard error], respectively) were studied. Diaphragmatic contractility, assessed as transdiaphragmatic twitch pressure generated by phrenic nerve stimulation, was similar in hypogonadal and eugonadal patients: 20.6 +/- 2.2 and 19.8 +/- 2.5 cm H2O, respectively. During progressive inspiratory threshold loading, hypogonadal and eugonadal patients had similar respiratory muscle endurance times (302 +/- 29 and 313 +/- 48 seconds, respectively) and airway pressure sustained during the last minute of loading (38.2 +/- 3.0 and 40.5 +/- 4.7 cm H2O, respectively) (similar to predicted values in healthy subjects). Hypogonadal and eugonadal patients had equivalent limb muscle strength and endurance. During cycle exercise to exhaustion, exercise performance, gas exchange, and respiratory muscle recruitment (estimated by esophageal and gastric pressure swings during tidal breathing) were similar in both groups. In conclusion, hypogonadism does not decrease respiratory or limb muscle performance and exercise capacity in men with moderate-to-severe COPD who, for the most part, are not underweight. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effects of applying transcutaneous electrical stimulation to paralyzed abdominal muscles during pulmonary function testing (PFT) of individuals with spinal cord injury (SCI). Ten male subjects with anatomical level of SCI between C5-T7 were studied. Subjects performed PFTs with and without electrical stimulation delivered to the abdominal muscles. Subjects with the lowest percentage of predicted expiratory volumes and flows demonstrated the greatest improvement when electrical stimulation was delivered during forced expiration. The overall increases seen in percent of predicted for the study sample were 23 percent for forced vital capacity (FVC), 16 percent for forced expiratory flow in 1 s (FEV1), and 22 percent for peak expiratory flow rate (PEF). Contractions of paralyzed expiratory muscles in response to electrical stimulation during the performance of PFT maneuvers can significantly improve FVC, FEV1, and PEF in some individuals with SCI. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if individuals with Parkinson's disease (PD) who completed an 8-week, supervised PoleStriding exercise program would undergo significant improvements in cognitive skills, activities of daily living, motor function, and quality of life. The Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39) were used to measure functional independence. Six male volunteers (72.7+/-3.7 years of age) performed PoleStriding exercise three times per week for 37+/-3 minutes. Differences in the participants' pre- and post-training scores on the UPDRS and PDQ-39 were analyzed using the Wilcoxin Signed Ranks Test. A statistically significant improvement occurred in the UPDRS (P<0.026) and PDQ-39 (P<0.028) scores following the moderate-intensity exercise intervention. The results of this nonrandomized clinical trial indicate that an 8-week individualized PoleStriding exercise program increases perceived functional independence and quality of life in individuals with PD. [ABSTRACT FROM AUTHOR]

The extreme difficulty with which persons with severe disabilities have been taught to maneuver a power wheelchair has been described in case studies, and anecdotal evidence suggests the existence of a patient population for whom mobility is severely limited if not impossible given currently available power wheelchair control interfaces. Since our review of the literature provided little evidence either in support or refutation of the adequacy of existing power wheelchair control interfaces, we surveyed 200 practicing clinicians, asking them to provide information about their patients and to give their impressions of the potential usefulness of a new power wheelchair navigation technology. Significant survey results were:* Clinicians indicated that 9 to 10 percent of patients who receive power wheelchair training find it extremely difficult or impossible to use the wheelchair for activities of daily living.* When asked specifically about steering and maneuvering tasks, the percentage of patients reported to find these difficult or impossible jumped to 40%.* Eighty-five percent of responding clinicians reported seeing some number of patients each year who cannot use a power wheelchair because they lack the requisite motor skills, strength, or visual acuity. Of these clinicians, 32% (27% of all respondents) reported seeing at least as many patients who cannot use a power wheelchair as who can.* Nearly half of patients unable to control a power wheelchair by conventional methods would benefit from an automated navigation system, according to the clinicians who treat them. [ABSTRACT FROM AUTHOR]

Seven subjects with chronic paralysis due to spinal cord injury completed a series of experiments to 1) determine and compare the metabolic cost of propelling the Handbike and Rowcycle, and 2) evaluate the potential of these upper body-powered devices for improving the cardiorespiratory fitness of persons with lower limb disabilities. Mean intrasubject differences between the Handbike and Rowcycle rides for heart rate, minute ventilation, oxygen uptake, and net locomotive energy cost were small and did not reach statistical significance for any of the ride conditions. Lower net locomotive energy cost (greater economy) during a 5.5 mi-hr(-1) ride condition predicted vehicle preference in all cases (P=0.008). The range of values for percent peak oxygen uptake suggests that all but one of the subjects were able to utilize either vehicle at an intensity sufficient for improving and maintaining cardiorespiratory fitness without undue fatigue. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the efficacy of a unique program of ventilation-feedback training combined with leg-cycle exercise to improve exertional endurance and decrease perceived dyspnea in patients with chronic obstructive pulmonary disease (COPD). Thirty-nine patients (67.5 +/- 8.1 yr of age) with moderate to severe COPD (42.6% of predicted forced expiratory volume in 1 s) were randomized to one of three 6-week experimental interventions: ventilation-feedback with exercise (V(+EX)), exercise only (EX(ONLY)), or ventilation-feedback only (VF(ONLY)). At baseline and at 6 weeks, patients completed a constant work-rate leg-cycle ergometer test at 85 percent of maximal power output. There were increases within the groups in exercise duration: 11.5 min (103%), 8.0 min (66%), and 0.4 min (4%) for the VF(+EX), EX(ONLY) and VF(ONLY) groups, respectively. The VF(ONLY) group experienced no significant within-group changes in selected gas exchange parameters. However, there were significant (p < 0.05) posttraining changes in minute ventilation, tidal volume, breathing frequency (f), and expiratory time (Te) in the VF(+EX) group, and in f and Te in the EX(ONLY) group. After completing the training, VF(+EX) and EX(ONLY) patients reported less breathlessness and perceived exertion (p < 0.05). The VF(ONLY) patients' ratings changed in the hypothesized direction but were not significant. Based on these preliminary data, VF(+EX) and EX(ONLY) were equally effective in improving leg-cycle exercise tolerance in patients with moderate to severe COPD. [ABSTRACT FROM AUTHOR]

Experiments were undertaken to mechanistically define expiratory-muscle contribution to effectiveness of cough while controlling glottic movement. We hypothesized that electrical abdominal-muscle stimulation in patients with respiratory-muscle weakness produces effective coughs only when glottic closure accompanies coughs. In ten spinal-cord-injury patients, esophago-gastric pressure and airflow were recorded during solicited-coughs, coughs augmented by abdominal-muscle stimulation, and passive open-glottis exhalations. During solicited-coughs, patients closed the glottis initially; five were flow-limited, five non-flow-limited. Stimulations during solicited-coughs or open-glottis exhalations elicited similar driving pressures (changes in gastric pressure; p<0.001). Despite high driving pressures, stimulations induced flow-limitation only when patients transiently closed the glottis - not during open-glottis exhalations. That is, transient glottic closure enabled transmission of abdominal (driving) pressure to the thorax during cough, while impeding dissipation of intrathoracic pressure. In conclusion, transient glottic closure is necessary to render cough effective in patients with respiratory-muscle weakness, indicating that failure to close the glottis contributes to ineffective cough in weak tracheostomized patients and patients with bulbar disorders., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Helium-oxygen mixtures and pressure-support ventilation have been used to unload the respiratory muscles and increase exercise tolerance in COPD. Considering the different characteristics of these techniques, we hypothesized that helium-oxygen would be more effective in reducing exercise-induced dynamic hyperinflation than pressure-support. We also hypothesized that patients would experience greater increases in respiratory rate and minute ventilation with helium-oxygen than with pressure-support. The hypotheses were tested in ten patients with severe COPD (FEV(1) = 28 ± 3% predicted [mean ± SE]) during constant-load cycling (80% maximal workrate) while breathing 30% oxygen-alone, helium-oxygen, and pressure-support in randomized order. As hypothesized, helium-oxygen had greater impact on dynamic hyperinflation than did pressure-support (end-exercise; p = 0.03). For the most part of exercise, respiratory rate and minute ventilation were greater with helium-oxygen than with pressure-support (p ≤ 0.008). During the initial phases of exercise, helium-oxygen caused less rib-cage muscle recruitment than did pressure-support (p < 0.03), and after the start of exercise it caused greater reduction in inspiratory reserve volume (p ≤ 0.02). Despite these different responses, helium-oxygen and pressure-support caused similar increases in exercise duration (oxygen-alone: 6.9 ± 0.8 min; helium-oxygen: 10.7 ± 1.4 min; pressure-support: 11.2 ± 1.6 min; p = 0.003) and similar decreases in inspiratory effort (esophageal pressure-time product), respiratory drive, pulmonary resistance, dyspnea and leg effort (p < 0.03). In conclusion, helium-oxygen reduced exercise-induced dynamic hyperinflation by improving the relationship between hyperinflation and minute ventilation. In contrast, pressure-support reduced hyperinflation solely as a result of lowering ventilation. Helium-oxygen was more effective in reducing exercise-induced dynamic hyperinflation in severe COPD, and was associated with greater increases in respiratory rate and minute ventilation than pressure-support., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Introduction: The objectives of this descriptive study were (a) to determine the energy expenditure of activities commonly performed by individuals with a spinal cord injury (SCI) and summarize this information and (b) to measure resting energy expenditure and establish the value of 1 MET for individuals with SCI., Methods: One-hundred seventy adults with SCI were partitioned by gender, anatomical level of SCI, and American Spinal Injury Association designations for motor function. Twenty-seven physical activities, 12 recreational/sport and 15 daily living, were performed, while energy expenditure was measured continuously via a COSMED K4b portable metabolic system. In addition, 66 adult males with SCI completed 30 min of supine resting energy testing in a quiet environment., Results: Results for the 27 measured activities are reported in kilocalories per minute (kcal·min(-1)) and VO2 (mL·min(-1) and mL·kg(-1)·min(-1)). One MET for a person with SCI should be adjusted using 2.7 mL·kg(-1)·min(-1). Using 2.7 mL·kg(-1)·min(-1), the MET range for persons in the motor incomplete SCI group was 1.17 (supported standing) to 6.22 (wheeling on grass), and 2.26 (billiards) to 16.25 (hand cycling) for activities of daily living and fitness/recreation, respectively. The MET range for activities of daily living for persons in the group with motor complete SCI was 1.27 (dusting) to 4.96 (wheeling on grass) and 1.47 (bait casting) to 7.74 (basketball game) for fitness/recreation., Conclusions: The foundation for a compendium of energy expenditure for physical activities for persons with SCI has been created with the completion of this study. In the future, others will update and expand the content of this compendium as has been the case with the original compendium for the able-bodied.

Objective: The objective of this study was to demonstrate improvement in nerve function with moderate exercise in patients with type II diabetic neuropathies., Research Design and Methods: Fives subjects with type II diabetes mellitus and distal, predominantly sensory polyneuropathies were studied. The subjects completed an 8-week program of a supervised moderate exercise program (40-75% of maximal 02 uptake reserve) with a subsequent 16-week program of monitored similar exercise. The same experienced electrophysiologist performed the electrodiagnostic studies both before and after the 24-week exercise period. These studies monitored physiological changes (conduction velocities, response amplitudes) in motor and sensory fibers as well as F-wave latencies., Results: The exercise program produced a documented increase in aerobic exercise capacity. Despite the small number of subjects studied and the relatively short exercise period, there was a statistically significant improvement in nearly all electrophysiological parameters evaluated post exercise including motor conduction velocities and amplitudes, sensory conduction velocities, and F-wave latencies. This improvement included a statistically significant improvement in absolute median motor evoked response amplitudes as well as the recording of sensory nerve action potentials not present prior to exercise. There were no adverse effects from the exercise., Conclusions: This study supports the hypothesis that exercise can be performed safely in patients with type II diabetic neuropathies and can produce improvement in their nerve function. This study also supports the hypothesis that ischemia may have a meaningful role in the pathogenesis of neuropathies in patients with type II diabetes mellitus.

Study Design: Survey research methods., Objectives: To assess patient satisfaction with the annual comprehensive preventative health evaluation (CPHE) and to determine if the patient's needs were being met., Setting: Department of Veterans Affairs National Survey, United States., Methods: A total of 853 subjects with spinal cord injuries participated in a mailed survey regarding the annual CPHE. Subjects were asked about satisfaction with the examination, preferences on how the examination is conducted and whether their needs were being met with the examination., Results: In all, 76% of the subjects that responded to the survey had completed a CPHE within the previous year. Subjects cited getting their medication and supplies refilled and talking to the doctor as the top two reasons for completing the evaluation. Subjects indicated that they would most like to discuss their muscle strength and weakness, bladder care, chronic pain, digestion and bowel care issues, and equipment problems during their evaluation. The majority of subjects (81%) indicated that they were satisfied with the CPHE. Subjects that were satisfied with the CPHE were also more satisfied with other aspects of care as well., Conclusion: The majority of respondents had completed a CPHE within the previous year. Most respondents cite health issues related to the spinal cord injury as areas they would most like to discuss during the evaluation. The majority of subjects were satisfied with the conduct of the CPHE.

Because individuals with claudication pain secondary to peripheral arterial disease (PAD) are limited in both walking speed and duration, the benefits of walking exercise may be insufficient to yield a cardiovascular training effect. The objectives of this analysis were to determine whether polestriding exercise training, performed by persons with PAD, would improve exercise endurance, elicit a cardiovascular training benefit, and improve quality of life (QoL). Persons (n = 49) whose claudication pain limited their exercise capacity were randomized into a 24-week polestriding training program (n = 25, 65.8 +/- 7.1 years of age) or a nonexercise attention control group (n = 24, 68.0 +/- 8.6 years of age). Those assigned to the polestriding group trained 3 times weekly. Control group subjects came to the laboratory biweekly for ankle blood pressure measurements. A symptom-limited ramp treadmill test, ratings of perceived leg pain, and QoL data (using the Short Form-36) were obtained at baseline and upon completion of training. After 24 weeks of polestriding training, subjects increased their exercise endurance from 10.3 +/- 4.1 minute to 15.1 +/- 4.5 minute. This was significantly greater than control group subjects whose exercise endurance declined (from 11.2 +/- 4.7 to 10.3 +/- 4.7 minute; P < .001). Relationships between systolic blood pressure (P < .001), heart rate (P = .04), rate pressure product (P = .05), oxygen uptake (P = .016), and perceived leg pain (P = .02) and exercise time improved from the baseline symptom-limited treadmill test to the 6-month symptom-limited treadmill test in the polestriding group compared to the control group. The improvement in the physical component summary score of the Short Form-36 was also greater in the polestriding group (P = .031). Polestriding training significantly improved the clinical indicators of cardiovascular fitness and QoL, and decreased symptoms of claudication pain during exertion.

Purpose: The purpose of this study was to determine whether subjects with chronic heart failure, who completed a 12-week rehabilitation program, would have significantly greater quality of life, better aerobic fitness, less difficulty with symptoms of heart failure, greater self-efficacy for exercise, and higher daily activity levels when compared with subjects in a control group., Methods: Thirty-one males, aged 64 +/- 10 years with left ventricular ejection fraction of 29 +/- 7%, were randomized to a moderate intensity supervised aerobic exercise program (n = 15) or a control group (n = 16). Twenty-seven subjects completed at least 1 follow-up assessment., Results: After 12 weeks there were significant differences in the change scores for perceived physical function (using RAND Corporation's 36-item short form) (P =.025) and peak oxygen uptake (P =.019) between the exercise and control groups with the exercise group experiencing improved physical function and fitness., Conclusions: Exercise training in adults with heart failure increases exercise tolerance and perceived physical function. Improved heart failure symptoms, self-efficacy for exercise, or increased physical activity may not be associated with enhancement of exercise tolerance.

Objective: The efficacy of polestriding exercise (walking with modified ski poles with a movement pattern similar to cross-country skiing) to increase exercise tolerance of persons with intermittent claudication pain caused by peripheral arterial disease was tested in this 24-week prospective randomized clinical trial., Methods: The study was conducted in a Department of Veterans Affairs Hospital with 52 individuals who gave written informed consent and were randomized into either a polestriding exercise (n = 27; age, 65.5 +/- 7.0 years; ankle brachial index, 0.64 +/- 0.25) or nonexercise control (n = 25; age, 68.6 +/- 8.9 years; ankle brachial index, 0.69 +/- 0.14) group (P >.05 for all comparisons). The polestriding exercise program consisted of supervised training three times per week for 4 weeks, two times per week for 8 weeks, one time per week for 4 weeks, biweekly for 4 weeks and unsupervised training for 4 weeks. Starting in week 5, subjects took their poles home with instructions to repeat the most recent supervised training walk at an appropriate and convenient location near their residence. This was referred to as unsupervised but directed exercise. Subjects were provided with a personal log book for documenting unsupervised exercise sessions. With both supervised and unsupervised exercise, subjects were expected to complete a total of four 30-minute to 45-minute polestriding exercise sessions per week. The main outcome measures were exercise duration on symptom-limited incremental treadmill test, Walking Impairment Questionnaire, rating of perceived leg pain at baseline, 4, 8, 12, 16, and 24 weeks, and constant work-rate treadmill exercise tests at baseline and at 4, 12, and 24 weeks., Results: Polestriding significantly (P <.001) improved exercise tolerance on the constant work-rate and incremental treadmill tests. Ratings of perceived claudication pain were significantly less after the polestriding training program. Subject perceived distance and walking speed scores on the Walking Impairment Questionnaire improved in the polestriding trained group only (P <.001 and.022, respectively)., Conclusion: This randomized clinical trial provides empirical evidence that 24 weeks of polestriding training significantly improves quantitative and qualitative measures of the exercise tolerance of persons limited by intermittent claudication pain.

Breathing pattern retaining, in the form of pursed-lip breathing, has been used as one method in pulmonary rehabilitation to help alleviate the symptoms of dyspnea endured by people who suffer from airflow obstruction secondary to chronic obstructive pulmonary disease (COPD). Other techniques such as biofeedback also have been successfully used. This article describes the altered breathing patterns used by patients with COPD at rest and during physical activity. The literature is reviewed regarding techniques of breathing pattern retraining that have been developed to improve the capacity of persons with COPD to perform activities of daily living, a primarily rehabilitative outcome.

In patients with chronic obstructive pulmonary disease (COPD) the intensity of aerobic training is limited by dyspnea. Improving strength of the inspiratory muscles could enhance aerobic exercise training by reducing exercise-related dyspnea. We examined effects of home-based inspiratory muscle training (IMT) and cycle ergometry training (CET) in 53 patients with moderate to severe COPD (FEV(1)% pred, 50 +/- 17 [mean +/- SD]). Patients were randomly assigned to 4 mo of training in one of four groups: IMT, CET, CET + IMT, or health education (ED). Patients were encouraged to train to the limits of their dyspnea. Inspiratory muscle strength and endurance increased in IMT and CET + IMT groups compared with CET and ED groups (p < 0. 01). Peak oxygen uptake increased and heart rate, minute ventilation, dyspnea, and leg fatigue decreased at submaximal work rates in the CET and CET + IMT groups compared with the IMT and ED groups (p < 0. 01). There were no differences between the CET and CET + IMT groups. Home-based CET produced a physiological training effect and reduced exercise-related symptoms while IMT increased respiratory muscle strength and endurance. The combination of CET and IMT did not produce additional benefits in exercise performance and exercise-related symptoms. This is the first study to demonstrate a physiological training effect with home-based exercise training.

Oxygen therapy improves submaximal exercise tolerance in hypoxemic patients with chronic obstructive pulmonary disease (COPD). This study compared the standard nasal cannula, reservoir nasal cannula, and a demand flow device in 15 male hypoxemic patients with COPD. On six separate occasions each subject used, in a randomized order, all three systems while completing incremental cycle ergometry and a test circuit composed of tasks that simulate activities of daily living. Oxygen flow required during exercise was 1.8 +/- 0.9 and 2.8 +/- 0.7 L/min for reservoir nasal cannula and standard nasal cannula use, respectively (p < 0.0001). The effect of the three oxygen delivery systems on oxygen saturation (Spo2) during the last 30 s of exercise varied with type of activity. Only during demand flow device use while undressing and dressing was the subjects' Spo2 (90 +/- 3%) significantly lower (p = 0.019). There was a trend toward lower Spo2 with the demand flow device (p = 0.103) during arm work above shoulder level. Although not statistically significant, reservoir nasal cannula use resulted in consistently lower tidal volume and minute ventilation during test circuit activities. Exercise tolerance was not significantly different between the three oxygen delivery systems.

Objective: This study was conducted to develop a new equation for predicting oxygen uptake (VO2) during counterclockwise arm crank ergometry (ACE) in men with lower limb disabilities, cross-validate the new equation in a similar group of men, and compare the predictive accuracy of the new equation to previously published equations for clockwise ACE., Patients: The metabolic responses of 55 men, 17 to 69 years of age, with spinal cord injuries (n = 50) or lower limb fractures (n = 5) were recorded during maximal ACE-graded exercise tests. Participants were volunteers from area hospital rehabilitation centers, and wheelchair sport teams., Design: Subjects were partitioned by level of injury and randomly assigned to a prediction (PRE) or validation (VAL) group., Results: No differences were found between the PRE and VAL groups for age, anthropometric or peak exercise variables. Using stepwise regression, a prediction equation (EXP) was derived from the PRE group data. The resulting model: VO2 (mL/min) = 127.06 + 7.201 (Watts) + 4.502 (weight in kg) + 0.033 (Watts2) explained 89.8% of the variance in the PRE group VO2, standard error of estimate (SEE) = 151.9 mL/min. The equation performed similarly in the VAL group (SEE = 144.0mL/min)., Conclusions: In this sample, the EXP equation had less prediction error than equations derived for clockwise ACE. Accuracy was not substantially influenced by level of injury. Comparison of the data to that published previously for clockwise ACE by men with paraplegia suggests greater metabolic economy for counterclockwise as compared with clockwise ACE.

Several reports indicate that dyslipidemia, primarily depressed high density lipoprotein cholesterol, is common in persons with spinal cord injury. The purpose of this study was to assess the relationships between anthropometric and near infrared interactance measurements to the serum lipoprotein profiles of 46 men with spinal cord injury of > 6 months duration. Mean age (+/- SD) was 49.5 +/- 15.0 y and duration of injury was 17.5 +/- 13.0 y. Forty-one percent of the subjects had low high density lipoprotein cholesterol (< 35 mg dl-1) and 57% had elevated total cholesterol to high density lipoprotein cholesterol ratios (> 4.5). Abdominal circumference was most closely associated with the overall lipid profile and abdominal circumference/height ratio was the second strongest correlate. Body mass index, conicity index, and percent body fat estimated by near infrared interactance were significantly related to some lipid parameters; however, the relationships were weaker than for abdominal circumference or abdominal circumference/height. Significant correlations were found between abdominal circumference and serum high density lipoprotein cholesterol (r = -0.421, P < 0.01) and log10 triglyceride (r = 0.587, P < 0.001) concentrations as well as the total cholesterol:high density lipoprotein cholesterol (r = 0.482, P < 0.01) and low density lipoprotein cholesterol-to-high density lipoprotein cholesterol (r = 0.387, P < 0.05) ratios. Based on these findings, the sample was partitioned by abdominal circumference into low (< 95 cm), moderate, and high (> or = 102 cm) risk subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this initial study was to evaluate a new wheelchair ergometer (WCE) and exercise test protocol for the detection of coronary artery disease in men with lower limb disabilities. Forty-nine patients (63 +/- 9 yr) completed WCE tests without complications. Peak heart rate was 84 +/- 15% (mean +/- SD) of age-predicted maximum and peak double product was 223 +/- 62 x 10(2). The specified target heart rate (> or = 80% age-predicted maximal) or a positive result was achieved in 76% of tests. Fourteen tests were rated positive, 21 as negative and 14 as nondiagnostic for exercise-induced ischemia. In 18 patients who underwent coronary angiography, the predictive value was 100% (10/10) for a positive, and 50% (2/4) for a negative WCE test result. These results suggest that WCE is a viable initial diagnostic option for some persons who cannot adequately perform treadmill or cycle ergometry exercise.

As a result of the improved medical treatment of infectious diseases, these formerly leading causes of mortality in the United States have been supplanted in rank by chronic events as the major causes of death. The major causes include coronary artery disease, respiratory disease, and cancer. Static and dynamic pulmonary functions in the apparently healthy wheelchair user population were measured and then modelled using stepwise regression. One hundred and nine wheelchair users (97 males, 12 females) with paraplegia (n = 77) or quadriplegia (n = 32) gave informed consent and participated in this study. Subjects ranged from being Olympic caliber wheelchair marathon racers to those who live sedentary life styles. Subjects performed three slow vital capacity (SVC) tests, three forced vital capacity (FVC) tests, and three maximal voluntary ventilation (MVV) tests while seated in their standard wheelchair. The order of the pulmonary function tests was randomized. Subjects also completed two functional residual capacity (FRC) measurements. Analysis of variance revealed significant differences in several pulmonary functions based on gender (FEVC, p = 0.0001, FEV1, p = 0.0001, FEVC 25-75%, p = 0.005, PEF, p = 0.002, FIVC, p = 0.002, RV, p = 0.0001, MVV, p = 0.0001, SVC, p = 0.001). The women's unforced prediction equations using age, height, weight did yield some significant correlations with predictions based upon ambulatory subjects. The men's unforced adapted prediction equations did reveal significant correlations with the validation group for FEVC (r = 0.66, p = 0.007), FEV1 (r = 0.62, p = 0.015), PIF (r = 0.95, p = 0.015), MVV (r = 0.57, p = 0.067), SVC (r = 0.69, p = 0.019), and RV (r = 0.67, p = 0.009). Pulmonary function in male wheelchair users should be predicted using equations which incorporate years with disability and level of impairment. Additional study is required to make any recommendations regarding women wheelchair users. However, study of pulmonary function in women should be made a priority. Pulmonary function is affected by the extent of physical impairment, and tends to decline as years with disability increase.

This paper describes the evolution of the Wheelchair Aerobic Fitness Trainer (WAFT), a wheelchair ergometer developed for determination of aerobic capacity and the diagnosis of coronary artery disease in lower limb disabled persons whose mobility depends primarily on the manual wheelchair. The device was originally developed for use in research studies to determine peak exercise capacity in persons with spinal cord injuries and other lower limb disabilities and to formulate associated graded exercise stress test protocols. In subsequent research, the device was incorporated into a specially designed testing station for the detection of coronary artery disease in persons who cannot adequately undergo treadmill or cycle ergometry testing because of lower limb disabilities. Based on the usefulness of the device for both rehabilitation and diagnostic purposes, the WAFT has been brought into the technology transfer process of the Department of Veterans Affairs Rehabilitation Research and Development Service. Under a contract with Packer Engineering, Inc., Naperville, IL, development of a preproduction version of the device and six units for field evaluation has commenced. The preproduction prototype of the WAFT has incorporated numerous improvements over the original device and promises to expand the potential for future research, rehabilitation, and diagnostic applications.