Search

Purpose: Clinicians often recommend using a 3-repetition maximum (3-RM) rather than 1-RM for strength testing, the assumption being that the lower weight associated with each repetition of a 3-RM will result in less stress on the cardiovascular system and therefore a safer test. However, there is limited data to support a 3-RM test being less stressful in terms of either cardiovascular or subjective responses associated with strength testing. Methods: Fifteen apparently healthy adults who were experienced in strength testing and training (6 M, 9 F) voluntarily participated in this study. They ranged in age from 23 to 41 years. A randomized counterbalanced experimental design was used in which subjects randomly underwent consecutive 1-RM or 3-RM testing on 4 separate days using the supine bench press. The method of Kraemer and Fry was employed for all strength testing. Heart rate, heart rhythm, blood pressure, and rating of perceived exertion were measured during both the 1-RM and 3-RM procedures, and rate pressure product was calculated. Results: Results indicate that the average heart rate and rate pressure product across both tests were significantly higher (p < 0.05) with 3-RM testing compared to 1-RM testing (heart rate: 1-RM = 128 +/- 21 beats * min[-1]; 3-RM = 139 +/- 20 beats* min[-1]; rate pressure product x 103: 1-RM = 16.3 +/- 3.7; 3-RM = 18.0 +/- 4.0). There were no significant differences for rating of perceived exertion or for systolic or diastolic blood pressure between 1-RM and 3-RM testing. Conclusions: Findings indicate that 1-RM testing may be performed with less cardiovascular strain than 3-RM testing in healthy adults in their 20s to early 40s. This evidence supports the use of 1-RM testing as a tool for determining optimal strength training exercise prescriptions in this population. [ABSTRACT FROM AUTHOR]

Stretching before performance is a common practice among athletes in hopes of increasing performance and reducing the risk of injury. However, cumulative results indicate a negative impact of static stretching and proprioceptive neuromuscular facilitation (PNF) on performance; thus, there is a need for evaluating other stretching strategies for effective warm-up. The purpose of this study was to compare the differences between two sets of ballistic stretching and two sets of a dynamic stretching routine on vertical jump performance. Twenty healthy male and female college students between the ages of 22 and 34 (24.8 +/- 3 years) volunteered to participate in this study. All subjects completed three individual testing sessions on three nonconsecutive days. On each day, the subjects completed one of three treatments (no stretch, ballistic stretch, and dynamic stretch). Intraclass reliability was determined using the data obtained from each subject. A paired samples t-test revealed no significant difference in jump height, force, or power when comparing no stretch with ballistic stretch. A significant difference was found on jump power when comparing no stretch with dynamic stretch, but no significant difference was found for jump height or force. Statistics showed a very high reliability when measuring jump height, force, and power using the Kistler Quattro Jump force plate. It seems that neither dynamic stretching nor ballistic stretching will result in an increase in vertical jump height or force. However, dynamic stretching elicited gains in jump power poststretch. [ABSTRACT FROM AUTHOR]

In a variety of occupational settings, poor balance or loss of balance on passively unstable surfaces can have substantial consequences with respect to safety or job performance. In the work described here, a quantitative approach for evaluating balance on a passively unstable wobble board has been developed and assessed. Quantitative measures were computed from kinematic data obtained during wobble board balance tasks that were performed on two wobble boards with inherently different difficulty levels. Results demonstrated that these measures were able to distinguish between the overall balance capacities associated with the different wobble boards, as well as to identify differences in balance strategies. [ABSTRACT FROM AUTHOR]

This article provides strategies for strength and conditioning professionals to assist in developing a complete and thorough core-training program for any client. [ABSTRACT FROM AUTHOR]

Peak aerobic power (VO2peak) is reduced for individuals with spinal cord injuries (SCI) in comparison to their able-bodied counterparts. In addition, SCI reduces the ability to respond to exercise training due to limiting factors specific to this condition. These limiting factors include reduced muscle mass available for exercise and impaired autonomic nervous system responses to exercise. Designing safe and effective exercise training programs for individuals with SCI depends in part on identifying the unique physiological factors that limit training adaptations of VO2 peak. This review discusses limitations of VO2peak for individuals with SCI as well as presenting benefits and accessibility of exercise programs for this population. [ABSTRACT FROM AUTHOR]

Depression is common in patients with heart failure (HF), prognostic for adverse outcomes and purportedly related to disease severity. Psychological and physiologic factors relevant to HF were assessed in HF-ACTION, a large randomized study of aerobic exercise training in patients with systolic HF. The relation of objective and subjective parameters was compared with scores on the Beck Depression Inventory (BDI) to examine the hypothesis that depressive symptoms are better associated with perception of disease severity than with objective markers of HF severity. At baseline, 2,322 of 2,331 subjects entered into HF-ACTION completed questionnaires to assess depression (BDI) and quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]). Objective markers of HF severity included ejection fraction, B-type natriuretic peptide, and peak oxygen consumption (using cardiopulmonary exercise testing, with evaluation of duration and respiratory exchange ratio also performed). Measures more likely to be affected by perceived functional status included New York Heart Association (NYHA) classification and the 6-minute walk test. Objective assessments of disease severity were slightly related (peak oxygen consumption) or not related (B-type natriuretic peptide and ejection fraction) to BDI scores. Using multivariate analysis (KCCQ not included), only age, gender, cardiopulmonary exercise testing duration, NYHA class, 6-minute walk distance, and peak respiratory exchange ratio independently correlated with BDI scores. In conclusion, depression was minimally related to objective assessments of severity of disease in patients with HF, but was associated with patient (and clinician) perceptions of disease severity. Addressing depression might improve symptoms in patients with HF. [ABSTRACT FROM AUTHOR]

Background: Prognosis in patients with heart failure (HF) is commonly assessed based on clinical characteristics. The association between partner status and socioeconomic status (SES) and outcomes in chronic HF requires further study., Methods: We performed a post hoc analysis of HF-ACTION, which randomized 2,331 HF patients with ejection fraction ≤35% to usual care ± aerobic exercise training. We examined baseline quality of life and functional capacity and outcomes (all-cause mortality/hospitalization) by partner status and SES using adjusted Cox models and explored an interaction with exercise training. Outcomes were examined based on partner status, education level, annual income, and employment., Results: Having a partner, education beyond high school, an income >$25,000, and being employed were associated with better baseline functional capacity and quality of life. Over a median follow-up of 2.5 years, higher education, higher income, being employed, and having a partner were associated with lower all-cause mortality/hospitalization. After multivariable adjustment, lower mortality was seen associated with having a partner (hazard ratio 0.91, 95% CI 0.81-1.03, P=.15) and more than a high school education (hazard ratio 0.91, CI 0.80-1.02, P=.12), although these associations were not statistically significant. There was no interaction between any of these variables and exercise training on outcomes (all P>.5)., Conclusions: Having a partner and higher SES were associated with greater functional capacity and quality of life at baseline but were not independent predictors of long-term clinical outcomes in patients with chronic HF. These findings provide information that may be considered as potential variables impacting outcomes., (Copyright © 2016 Elsevier, Inc. All rights reserved.)

Background: Although studies have shown that depression is associated with worse outcomes in patients with heart failure, most studies have been in white patients. The impact of depression on outcomes in blacks with heart failure has not been studied., Methods and Results: We analyzed 747 blacks and 1420 whites enrolled in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training, which randomized 2331 patients with ejection fraction ≤35% to usual care with or without exercise training. We examined the association between depressive symptoms assessed by the Beck Depression Inventory-II (BDI-II) at baseline and after 3 months with all-cause mortality/hospitalization. A race by baseline BDI-II interaction was observed (P=0.003) in which elevated baseline scores were associated with worse outcomes in blacks versus whites. In blacks, the association was nonlinear with a hazard ratio of 1.44 (95% confidence interval, 1.24-1.68) when comparing the 75th and 25th percentile of BDI-II (score of 15 and 5, respectively). No race interaction was observed for mortality (P=0.34). There was no differential association between BDI-II change and outcomes in blacks versus whites. In blacks, an increase in BDI-II score from baseline to 3 months was associated with increased mortality/hospitalization (hazard ratio, 1.33; 95% confidence interval, 1.12-1.57 per 10 point increase), whereas a decrease was not related to outcomes., Conclusions: In blacks with heart failure, baseline symptoms of depression and worsening of symptoms over time are associated with increased all-cause mortality/hospitalization. Routine assessment of depressive symptoms in blacks with heart failure may help guide management., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047437., (© 2015 American Heart Association, Inc.)

Background: The strength of race as an independent predictor of long-term outcomes in a contemporary chronic heart failure (HF) population and its association with exercise training response have not been well established. We aimed to investigate the association between race and outcomes and to explore interactions with exercise training in patients with ambulatory HF., Methods: We performed an analysis of HF-ACTION, which randomized 2331 patients with HF having an ejection fraction ≤35% to usual care with or without exercise training. We examined characteristics and outcomes (mortality/hospitalization, mortality, and cardiovascular mortality/HF hospitalization) by race using adjusted Cox models and explored an interaction with exercise training., Results: There were 749 self-identified black patients (33%). Blacks were younger with significantly more hypertension and diabetes, less ischemic etiology, and lower socioeconomic status versus whites. Blacks had shorter 6-minute walk distance and lower peak VO2 at baseline. Over a median follow-up of 2.5 years, black race was associated with increased risk for all outcomes except mortality. After multivariable adjustment, black race was associated with increased mortality/hospitalization (hazard ratio [HR] 1.16, 95% CI 1.01-1.33) and cardiovascular mortality/HF hospitalization (HR 1.46, 95% CI 1.20-1.77). The hazard associated with black race was largely caused by increased HF hospitalization (HR 1.58, 95% CI 1.27-1.96), given similar cardiovascular mortality. There was no interaction between race and exercise training on outcomes (P > .5)., Conclusions: Black race in patients with chronic HF was associated with increased prevalence of modifiable risk factors, lower exercise performance, and increased HF hospitalization, but not increased mortality or a differential response to exercise training., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Objectives: The goal of this study was to compare the prognostic efficacy of the 6-min walk (6MW) and cardiopulmonary exercise (CPX) tests in stable outpatients with chronic heart failure (HF)., Background: CPX and 6MW tests are commonly applied as prognostic gauges for systolic HF patients, but few direct comparisons have been conducted., Methods: Stable New York Heart Association (NYHA) functional class II and III systolic HF patients (ejection fraction ≤ 35%) from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial were studied. 6MW distance (6MWD) and CPX indices (peak oxygen consumption [VO(2)] and ventilatory equivalents for exhaled carbon dioxide [VE/VCO(2)] slope) were compared as predictors of all-cause mortality/hospitalization and all-cause mortality over 2.5 years of mean follow-up., Results: A total of 2,054 HF-ACTION participants underwent both CPX and 6MW tests at baseline (median age 59 years; 71% male; 64% NYHA functional class II and 36% NYHA functional class III/IV). In unadjusted models and in models that included key clinical and demographic covariates, C-indices of 6MWD were 0.58 and 0.65 (unadjusted) and 0.62 and 0.72 (adjusted) in predicting all-cause mortality/hospitalization and all-cause mortality, respectively. C-indices for peak VO(2) were 0.61 and 0.68 (unadjusted) and 0.63 and 0.73 (adjusted). C-indices for VE/VCO(2) slope were 0.56 and 0.65 (unadjusted) and 0.61 and 0.71 (adjusted); combining peak VO(2) and VE/VCO(2) slope did not improve the C-indices. Overlapping 95% confidence intervals and modest integrated discrimination improvement values confirmed similar prognostic discrimination by 6MWD and CPX indices within adjusted models., Conclusions: In systolic HF outpatients, 6MWD and CPX indices demonstrated similar utility as univariate predictors for all-cause hospitalization/mortality and all-cause mortality. However, 6MWD or CPX indices added only modest prognostic discrimination to models that included important demographic and clinical covariates., (Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The prognostic ability of a single measurement of peak oxygen uptake (VO(2)) is well established in patients with chronic heart failure. The relation between a change in peak VO(2) and clinical outcomes is not well defined., Methods and Results: This investigation determined whether an increase in peak VO(2) was associated with a lower risk of the primary end point of time to all-cause mortality or all-cause hospitalization and 3 secondary end points. In Heart Failure and a Controlled Trial to Investigate Outcomes of Exercise Training, an exercise training trial for patients with systolic heart failure, cardiopulmonary exercise tests were performed at baseline and ≈3 months later in 1620 participants. Median peak VO(2) in the combined sample increased from 15.0 (11.9-18.0 Q1-Q3) to 15.4 (12.3-18.7 Q1-Q3) mL·kg(-1)·min(-1). Every 6% increase in peak VO(2,) adjusted for other significant predictors, was associated with a 5% lower risk of the primary end point (hazard ratio=0.95; CI=0.93-0.98; P<0.001); a 4% lower risk of the secondary end point of time to cardiovascular mortality or cardiovascular hospitalization (hazard ratio=0.96; CI=0.94-0.99; P<0.001); an 8% lower risk of cardiovascular mortality or heart failure hospitalization (hazard ratio=0.92; CI=0.88-0.96; P<0.001); and a 7% lower all-cause mortality (hazard ratio=0.93; CI=0.90-0.97; P<0.001)., Conclusions: Among patients with chronic systolic heart failure, a modest increase in peak VO(2) over 3 months was associated with a more favorable outcome. Monitoring the change in peak VO(2) for such patients may have benefit in assessing prognosis.

Preparing for the stress of total knee arthroplasty (TKA) surgery by exercise training (prehabilitation) may improve strength and function before surgery and, if effective, has the potential to contribute to postoperative recovery. Subjects with severe osteoarthritis (OA), pain intractable to medicine and scheduled for TKA were randomized into a usual care (UC) group (n = 36) or usual care and exercise (UC + EX) group (n = 35). The UC group maintained normal daily activities before their TKA. The UC + EX group performed a comprehensive prehabilitation program that included resistance training using bands, flexibility, and step training at least 3 times per week for 4-8 weeks before their TKA in addition to UC. Leg strength (isokinetic peak torque for knee extension and flexion) and ability to perform functional tasks (6-minute walk, 30 second sit-to-stand repetitions, and the time to ascend and descend 2 flights of stairs) were assessed before randomization at baseline (T1) and 1 week before the subject's TKA (T2). Repeated-measures analysis of variance indicated a significant group by time interaction (p < 0.05) for the 30-second sit-to-stand repetitions, time to ascend the first flight of stairs, and peak torque for knee extension in the surgical knee. Prehabilitation increased leg strength and the ability to perform functional tasks for UC + EX when compared to UC before TKA. Short term (4-8 weeks) of prehabilitation was effective for increasing strength and function for individuals with severe OA. The program studied is easily transferred to a home environment, and clinicians working with this population should consider prehabilitation before TKA.

This case report compared pre- and postoperative functional ability, knee strength, and pain of a female who underwent two separate total knee arthroplasty (TKA) procedures. The female patient was part of a larger research study. The first surgery on the right knee was preceded with usual care and the second surgery on the left knee was preceded by prehabilitation. Functional ability was assessed by a 6-minute walk, chair raises, and the time required to ascend and descend stairs. Knee extension and flexion isokinetic strength was assessed using the KinCom Isokinetic Dynamometer. Pain was assessed using the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC). Functional abilities, knee strength, and pain were assessed at baseline measurements 4 weeks before surgery, 1 week before surgery, and at 1 and 3 months post surgery during each TKA procedure. Results indicate that the prehabilitation intervention had a favorable impact on improving functional ability up to 30%, increasing knee strength by 50% and decreasing pain prior to the left knee TKA. For this patient, prehabilitation increased functional ability and strength prior to surgery. Gains in strength were maintained in the nonsurgical knee after surgery. These findings indicate that prehabilitation may be effective at facilitating the rehabilitation following a TKA.

This study assessed diurnal variation of hamstring and lumbar flexibility and also measured flexibility differences between men and women. Sixty-seven healthy, recreationally active college students (M=31 and F=36; age, M=22.9+/-3.5 and F=21.7+/-2.8 years old) participated. Hamstring and lumbar flexibility measurements were taken at waking (baseline measure) and every 2 hours through a 12-hour period using the active knee extension test and modified-modified Schober test. Hamstring flexibility (M: -53.1+/-2.3 degrees, F: -46.7+/-2.8 degrees) and lumbar flexion (M: 6.9+/-1.4 cm, F: 6.0+/-1.4 cm) were lowest at baseline. Hamstring flexibility was highest at the 12-hour time point (M: -48.6+/-2.7 degrees, F: -37.4+/-2.9 degrees), whereas lumbar flexion was highest at the 10-hour time point (M: 7.5+/-0.9 cm, F: 6.9+/-1.3 cm). Hamstring flexibility of the women was significantly greater at every time point than the men's (p<0.05). Lumbar flexibility for the men was significantly greater at every time point than women (p<0.05). Both sexes experienced similar increases in flexibility for hamstrings and lumbar spine over 12 hours. Findings of this study indicate that diurnal variation and gender differences in lumbar and hamstring flexibility should be considered and controlled for in flexibility testing, training, and research.

The hallmark characteristic of chronic heart failure (CHF) is exercise intolerance. This study evaluated a combined exercise program that would be consistent with current cardiac rehabilitation guidelines. The program consisted of progressive resistance training (intensity progressing from 50 to 80% maximum) and aerobic conditioning (70% of heart rate reserve). Outcomes included muscular strength measured as 8-repetition maximum and submaximal aerobic fitness indicators (measured at 50% of predicted maximal oxygen consumption) including heart rate, blood pressure, and rate pressure product. Subjects were taken retrospectively from a database of CHF patients who underwent cardiac rehabilitation between 1998 and 2004 with the Cardiac Rehabilitation Center of River Cities Cardiology in Jeffersonville, IN. The same data set was used to evaluate 2 research questions: to compare training outcomes between gender (men and women) and to compare outcomes between young (65 years) subjects. Forty-two subjects (15 women and 27 men; 19 were 65 years of age) met inclusion and exclusion criteria and underwent 36 sessions of cardiac rehabilitation over a 14-week time period. Repeated-measures analysis of variance was used to test whether strength and submaximal responses differed across gender or age. Analysis indicated that regardless of gender or age, subjects significantly increased their strength on each of 6 strength tests. Heart rate, systolic blood pressure, and rate pressure product were lower after training indicating increased aerobic efficiency. Progressive resistance training and aerobic conditioning prescribed in a manner consistent with cardiac rehabilitation guidelines resulted in similar improvements regardless of gender or age for individuals with CHF suggesting that no training program adjustments are necessary to accommodate age or gender.

Objective: The purpose of this study was to examine the effect of a preoperative exercise intervention on knee pain, functional ability, and quadriceps strength among patients with knee osteoarthritis before and after total knee arthroplasty (TKA) surgery., Design: A repeated-measures design was used to compare 2 groups over 4 data collection points., Setting and Patients: Community-dwelling subjects with osteoarthritis of the knee who were scheduled for a unilateral TKA were recruited from a single orthopedic surgeon's office and were randomized into control (n = 28) or prehab groups (n = 26)., Interventions: The control patients maintained usual care before their TKA. The exercisers performed prehabilitation exercises, which included resistance training, flexibility, and step training, 3 times per week before their TKA., Outcome Measures: Knee pain, functional ability, quadriceps strength, and strength asymmetry were assessed at baseline (T1), at 1 week before the patients' TKA (T2), and again at 1 (T3) and 3 (T4) months after TKA., Results: The exercisers improved their sit-to-stand performance at T2, whereas the control group did not change their performance of functional tasks and had increased pain at T2. At T3 the exercisers demonstrated improved sit-to-stand performance. The control patients at T3 exhibited decreases in pain, their 6-minute walk, surgical leg strength and an increase in their nonsurgical leg strength and leg strength asymmetry. At T4 the exercisers improved in their performance of 3 of the 4 functional tasks, decreased all of their pain measures, and increased their surgical and nonsurgical quadriceps strength. At T4 the control group improved their performance on 2 of the 4 functional tasks, decreased all of their pain measures, increased their nonsurgical leg strength, and exhibited greater leg strength asymmetry., Conclusion: These findings appear to indicate the efficacy of prehabilitation among TKA patients and support the theory of prehabilitation.

Osteoarthritis (OA) is a common health problem affecting more than 7 million Americans. Declines in strength, flexibility, and knee joint pain reduce functional ability and contribute to decisions for total knee arthroplasty (TKA). This study describes predictors of functional ability among knee patients scheduled for TKA and proposes a preoperative exercise program to improve functional ability. A total of 82 knee OA patients (average age = 62.7 +/- 7.48 years, 70% women) were recruited from a single orthopedic surgeon's office. Muscular fitness assessments included knee flexion, extension strength, and range of motion (ROM) of the surgical and nonsurgical knees. Functional ability was assessed by 6-minute walk, number of chair rises in 30 seconds, and time required to ascend and descend 2 flights of stairs. Perceived functional ability and pain were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Correlation matrices determined which measures of muscular fitness, pain, and perceptions were associated with measures of functional ability. Significant correlates were entered into regression equations that determined the significant predictors of the functional tasks. These regression equations identified flexion strength of the nonsurgical knee as predicting 24-45% of the variance of functional ability assessments that involved independent or consecutive knee movement. Other variables that, to a lesser degree, predicted performance of the functional ability assessments included knee joint ROM and body mass index. Because functional ability after TKA is strongly dependent on presurgical functional ability, future investigators may wish to examine the impact of improving presurgical functional ability of TKA patients through resistance training, particularly closed-kinetic chain exercises that transfer fewer forces through the knee joint.

Conditioning the body to undergo physical stress such as joint arthroplasty has been termed prehabilitation. This case study examined the effect of a 4-week prehabilitation intervention on functional outcomes after total knee arthroplasty (TKA). Two female subjects completed baseline strength and functional assessments before TKA. Subjects were randomized to either a 4-week prehabilitation intervention (ES) aimed at increasing strength and range of motion or a usual care condition (CS). After 4 weeks of training, subjects were reassessed and underwent TKA. Subjects completed a final assessment 12 weeks after TKA. Functional outcomes included 6-minute walk, number of times up from a chair in 30 seconds, proprioception, and self-reported function and pain using the Western Ontario and McMaster Universities Osteoarthritis Index. The data suggest that 4 weeks of prehabilitation had a positive effect on functional task performance and knee proprioception before surgery. After surgery, the ES continued to exhibit higher levels of functioning and less pain compared with the CS. Prehabilitation before TKA may contribute to improved recovery after surgery.

Treatment for breast cancer patients includes surgical removal of the tumor followed by chemotherapy. Chemotherapy frequently results in difficult to manage symptoms that threaten compliance with the therapy. Symptoms include fatigue, declines in functional ability, muscle wasting, and a decreased quality of life. Preparing the body to tolerate a stressful event such as chemotherapy has been termed "prehabilitation". This case study determined the efficacy of introducing aerobic training 1 week prior to and continuing through 8 weeks of chemotherapy on fatigue and functional ability in a 42-year-old newly diagnosed breast cancer patient. The patient participated in a supervised and home-based walking program. Fatigue during daily activities and functional ability (12-minute walk, ascending and descending stairs, sit to stand, getting to and rising from the floor, 30-second bicep curl) were measured before and after exercise training. Results indicate that 5 of 7 functional measures demonstrated improvement, ranging from 23.4- 54.5%. In addition, fatigue while performing activities of daily living, as well as following the performance of the functional tasks, was reduced. The findings of this case study indicate that fatigue can be decreased and functional ability can be improved as a result of aerobic training initiated 1 week before and continued throughout chemotherapy. This case study presents a novel approach to introducing exercise prior to and continued during 8 weeks of chemotherapy in a way that may reduce the cumulative effects of this stressor.

This study evaluated a possible anticipation bias when ratings of perceived exertion (RPE) were obtained during submaximal progressive exercise testing. Perceptual estimates were obtained using the CR-10 category-ratio scale. 13 subjects, 7 men and 6 women (M age = 26.8 +/- 6.4 yr., height = 2.7 +/- .17 m, weight = 73.0 +/- 18.2 kg, VO2 peak = 46.7 +/- 5.6 ml x kg(-1) x min(-1) for men and 47.8 +/- 7.3 ml x kg(-1) x min(-1) for women) recruited from the university student population participated. Each subject underwent two submaximal progressive exercise tests separated by at least 48 hr. using the cycle as test mode and the YMCA protocol. Power outputs established during the first test were presented in random order during the second test. Differentiated RPE for the Peripheral, Respiratory-Metabolic, and the undifferentiated signals, and heart rate, were measured during the last 15 sec. of each of the four stages of exercise. In comparing responses between the two tests, significant differences were observed for both heart rate and the Respiratory-Metabolic signal during power output 4, using repeated-measures analysis of variance. However, a 95% limit of agreement test was significant only for heart rate as the 95% confidence interval for the Respiratory-Metabolic signal overlapped zero and thus was not significantly different. No significant differences were found for the undifferentiated or peripheral signals between the two tests. Results indicate that both undifferentiated and differentiated RPE are given without significant anticipation bias during submaximal progressive cycle exercise.

Suitability for safe participation in aerobic exercise is typically determined by a cardiopulmonary exercise test, using a treadmill or cycle. With increased participation in strength training by healthy clients as well as rehabilitation patients, there is a need to develop a test for determining suitability for safe participation in strength training. This investigation describes a strength stress test that may be used for determining safety of participation in strength training. Ten healthy subjects (28.3 +/- 5.9 years and 75.3 +/- 14.4 kg) with strength training experience participated. Following a resting echocardiogram, subjects performed 3 sets of leg presses at an 8 repetition maximum. Resting and exercise end-diastolic and end-systolic volumes were obtained during the last repetition of each set and were indexed for body surface area (ESV(I), EDV(I)). Ejection fraction, cardiac output, and stroke volume were calculated. Cardiac output increased significantly (p < 0.05) for each set in comparison to rest and also during the third set in comparison to sets 1 and 2. Ejection fraction increased, whereas ESV(I) and EDV(I) decreased significantly for each set compared to rest, and also during sets 2 and 3 when compared to set 1. Responses to sets 2 and 3 indicate increased cardiac stress with increasing sets to exhaustion analogous to changes observed during tests designed to assess anaerobic and aerobic power. Thus, this protocol may be used as a test for evaluating the ability to participate in modest strength training consistent with exercise prescriptions developed for participants of health clubs and rehabilitation facilities. Strength testing protocol described may be adapted and modified for evaluating other lifts such as arm work and job-related tasks.

Position stands from the American College of Sports Medicine and the Surgeon General site a need for strategies capable of enhancing the effectiveness of stretching on flexibility and joint range of motion. One strategy for enhancing flexibility that has received anecdotal support but lacks substantial experimental evidence is the impact of prior exercise. This study compared 5 minutes of static stretching and proprioceptive neuromuscular facilitation (PNF) on hamstring flexibility performed with and without exercise. Forty undergraduate student-athletes participated in a repeated measure, counterbalanced experimental design. Within-group comparisons indicated that PNF resulted in a significant (p < 0.05) increase in flexibility after 60 minutes of exercise when compared with baseline (9.6%) and without exercise (7.8%). No differences were observed with static stretching across time. In addition, no differences were observed between the groups at any time point. Results demonstrated that PNF performed after exercise enhanced acute hamstring flexibility, and implementing a PNF stretching routine following exercise may augment current stretching practices among athletes.

Stretching exercise is effective for increasing joint range of motion (ROM). However, the Surgeon General's Report and the American College of Sports Medicine cite a lack of studies identifying strategies capable of increasing the effectiveness of stretching exercise. This investigation evaluated adding modest weight (0.45-1.35 kg) to a stretching exercise routine (Body Recall [BR]) on joint ROM. Forty-three subjects ages 55-83 years participated in 1 of 2 training groups, BR, BR with weights (BR+W), or a control group (C). ROM was evaluated at the neck, shoulder, hip, knee, and ankle before and after 10 weeks of exercise. Using ANCOVA, significant differences (p < 0.01) were observed for right and left cervical rotation, hip extension, ankle dorsiflexion, ankle plantar flexion, and shoulder flexion. Post hoc analysis revealed that cervical rotation (left and right), hip extension, and ankle dorsiflexion for BR+W subjects differed significantly from BR and C (p < 0.01). Significant differences with shoulder flexion and ankle plantar flexion were found for both BR and BR+W in comparison to C (p < 0.01). Results indicate that addition of weights enhanced the effectiveness of stretching exercise for increasing joint ROM with 4 of the 6 selected measurements. Thus, a modest intensity exercise program that is within the reach of most elderly may significantly affect joint ROM and flexibility.

In this investigation we studied the effect of manipulating the acid-base balance through sodium bicarbonate (NaHCO(3)) ingestion on ratings of perceived exertion for the overall body (RPE-O) and on differentiated ratings for the leg and chest (RPE-L, RPE-C) during exercise recovery. Six women of college age underwent 3 experimental conditions in which NaHCO(3) was ingested in either a single (bolus) or periodic (distributed throughout the exercise) dosage, with calcium carbonate serving as a placebo control. Each subject pedaled a cycle ergometer at 90% Vo(2)peak for three 5-minute exercise sessions, each separated by 10 minutes of recovery. Repeated-measures analysis of variance with Tukey post hoc analysis was performed for acid-base and perceptual variables. Results indicate that a gradient of acid-base balance was established such that pH and bicarbonate concentration were significantly greater (p < 0.05) for the single condition in comparison with periodic and placebo conditions, and the periodic condition was significantly greater (p < 0.05) than placebo. The average percentage of recovery for RPE-L and RPE-C was 8% greater (p < 0.05) for the single condition than for the periodic and placebo conditions, at the first and second minutes of recovery. During the first minute of recovery, the average percentage of recovery for RPE-O was 10% greater (p < 0.05) for the single condition than for the placebo condition. During the second minute of recovery, the percentage of recovery for RPE-O for the single condition was significantly greater than those for both the periodic and placebo conditions by an average of 9%. These results strengthen the relationship between the acid-base balance and the subjective perception of exertion. In addition, this study provides preliminary data in support of RPE as an adjunct measure to quantify the extent of recovery from exercise.

This study determined the reliability and validity of a branching treadmill protocol in predicting VO2max. Thirty-seven, apparently healthy individuals (19 women and 18 men); volunteered to participate. On 2 separate testing days, each subject underwent maximal exercise testing using the protocol developed. Stepwise regression analysis indicated that the percentage of age-predicted maximum heart rate (APMHR) achieved at stage 3, speed and grade at stage 3, and APMHR accounted for 89% of the variance in VO2max. The 4 predictor variables were statistically significant (p < 0.01), and the standard error of the estimate was 4.56 ml x kg(-1) min(-1). Results indicate that health and fitness professionals can incorporate this protocol into their practices for the purpose of predicting VO2max for their clients outside the laboratory environment. Furthermore, our results indicate that using the proposed regression model is reliable and has received preliminary construct validity support.

Inadequate flexibility is a contributing factor to muscle injury, especially with respect to the hamstring muscle group. Simple therapeutic regimens capable of increasing hamstring flexibility may reduce the injury potential of athletes with below-average hamstring flexibility or history of injury. This study compared 30 seconds of static stretching with 20 minutes of heat application on hamstring flexibility. A secondary purpose was to determine the relationship between the subjects attitude toward each treatment and the efficacy of treatment. Thirty undergraduate student athletes who were current members of a Midwestern collegiate football team participated in a 2 (treatment: heat vs. stretching) by 2 (coun-terbalanced order: heat first vs. stretching first) repeated-measures design. Results indicated that significant benefits to increase hamstring flexibility could be gained by using moist heat packs in comparison with static stretching despite a perceived attitudinal bias in favor of stretching. These findings may have implications for orthopedic fitness as well as injury prevention for an athlete with prior hamstring injury or inadequate flexibility.

Purpose: The safety of one repetition maximum (1RM) testing for patients with chronic obstructive pulmonary disease (COPD) has not been determined. Therefore, this study was conducted to determine the prevalence of abnormal cardiopulmonary responses, muscle soreness, and muscle injury of patients with moderate to severe COPD in response to 1RM testing., Methods: Twenty pulmonary rehabilitation patients (11 women and 9 men) with moderate or severe COPD participated in this investigation. The 1RM testing was performed using the parallel squat and incline press. Blood pressure, heart rate dyspnea ratings, and oxygen saturation responses were measured immediately following the 1RM procedure. Ratings of muscle soreness and injury were measured immediately after 1RM testing and on days 2 and 7., Results: No injury, significant muscle soreness, or abnormal cardiopulmonary responses occurred as a result of 1RM testing. No gender differences were found for any variable measured in response to 1RM testing., Conclusions: A properly supervised and screened pulmonary rehabilitation population can be 1RM tested without significant muscle soreness, injury, or abnormal cardiopulmonary responses.

Exercise videos allow patients to improve overall fitness in the comfort of their own homes. But cutting through the Hollywood glitz and hype that surround this lucrative fitness market is difficult. Here are one exercise physiologist's recommendations for exercise videos for patients at various fitness levels.

This study investigated the effects of acute bouts of both exercise and smoking on high-density lipoprotein-cholesterol subfractions, HDL2-C and HDL3-C in black females. During two testing trials, seven subjects were exposed to either acute exercise or smoking. Treadmill exercise was performed at 70% of heart rate reserve for 15 minutes. Blood samples were taken before, immediately after, and 10 minutes after exercise. The smoking trial consisted of subjects smoking two cigarettes followed by 30 minutes of nonsmoking. Blood samples were taken before smoking, after each cigarette, and after two 15-minute intervals of nonsmoking. The exercise protocol resulted in a 10.8% increase in total HDL-C, primarily through an increase in the HDL2-C subfraction. The values returned to baseline within 10 minutes after exercise. Smoking one cigarette decreased total HDL-C by 10%. Neither subfraction was significantly effected by smoking; however, the HDL3-C subfraction was decreased 11% and HDL2-C subfraction was decreased 14.7% from resting values. The maximum reduction in HDL3-C subfraction occurred after the smoking of the first cigarette, while the maximum reduction in the HDL2-C subfraction occurred after the first 15-minute nonsmoking period. Acute cigarette smoking was associated with a decrease in total HDL-C that was maintained through 15 minutes of nonsmoking. It is suggested that the adverse effect on HDL-C by acute smoking is a significant contributor to coronary heart disease (CHD) risk in black females. Results further indicate that low-intensity exercise is capable of transiently increasing the total HDL-C via an increase in the anti-atherogenic HDL2-C subfraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Ten male subjects underwent exercise testing in three modes, arms (A), legs (L), and arms + legs (A + L), after ingesting 0.3 g X kg-1 body weight of either NaHCO3 to induce alkalosis or CaCO3 as a placebo (i.e., six exercise trials). Ratings of perceived exertion (RPE: Borg, 15-pt scale) for the arms (RPE-A), legs (RPE-L), chest (REP-C), and overall body (RPE-O) did not differ between acid-base conditions at 20, 40, or 60% VO2max for all three exercise modes. At 80% VO2max, 1) RPE-A was lower (P less than 0.01) during A; 2) RPE-L was lower (P less than 0.01) during L; and 3) RPE-A and RPE-L were lower (P less than 0.01) during A + L under the NaHCO3 as compared to the CaCO3 condition. Differences were not found for RPE-L during A or for RPE-A during L. RPE-C and RPE-O were lower (P less than 0.01) under NaHCO3 during A, L, and A + L. Blood acid-base, VO2, and cardiorespiratory responses were not differentially influenced by exercise mode. Blood pH was significantly higher under NaHCO3 than CaCO3 at pre-exercise and 80% VO2max. VO2, heart rate, and tidal volume did not differ between acid-base conditions at any exercise intensity. VE and respiratory rate did not differ between acid-base conditions at 20, 40, or 60% VO2max but were significantly lower under NaHCO3 at 80% VO2max. RPE-A and L were positively related to blood [H+], and RPE-C was positively related to VE for all exercise modes.

The effect of an acute exercise session on high density lipoprotein-cholesterol (HDL-C) and the subfractions HDL2-C and HDL3-C was determined for 9 healthy females (VO2max = 46.62 +/- 4.82 ml X kg-1 min-1). Each subject underwent a continuous 40-min run on a treadmill at a workload corresponding to 70% of VO2max. A venous blood sample was obtained immediately prior to exercise and 5 min, 24, 48 and 96 h after the exercise. Pre-exercise values were: HDL-C (61.7 +/- 3.7 mg X dl-1); HDL2-C (22.4 +/- 2.1 mg X dl-1); HDL3-C (39.3 +/- 2.0 mg X dl-1). At 5 min after exercise, HDL-C (66.2 +/- 4.4 mg X dl-1) and HDL3-C (44.5 +/- 2.8 mg X dl-1) were significantly elevated (P less than 0.01) when compared to pre-exercise values. HDL-C and HDL3-C were not significantly different from pre-exercise at the remaining time points. In comparison with pre-exercise, HDL2-C showed no significant change at any of the post-exercise time points. Results indicated that the rise in HDL-C following acute exercise was due to an increase in the subfraction HDL3-C. The change in total HDL-C and HDL3-C was transient in that pre-exercise values were re-attained within 24 h following acute submaximal exercise.