Multi-site study of outpatient cardiac rehabilitation programs utilizing transtelephonic exercise monitoring

D.S. Shaw¹, K.E. Sparks², H.S. Jennings³, L.M. Quinn^4
1Department of Physical Therapy, East Carolina University, Greenville, NC, ²Department of HPERD, Cleveland State University, Cleveland, OH, ³Saint Thomas Hospital, Nashville, TN, and ⁴Consultant, Cleveland State University, Cleveland, OH

Objective. The purpose of this study was to summarize transtelephonic exercise monitoring (TEM) data obtained from all outpatient cardiac rehabilitation programs utilizing simultaneous voice and ECG transmission technology.
Experimental Design. Survey data from all TEM sites (n = 14) were obtained via questionnaire and were analyzed using standard descriptive methods.
Participants. All patients (492 males, 294 females) were cardiac rehabilitation program participants (age: 56 ± 3.8 yrs) who amassed a total of 23,551 patient-exercise hours.
Measures. Participation profiles were quantified by age, risk category, and site of program participation (home or rural tandem medical facility). Frequency, site, and type of cardiovascular complication was also studied. Chi Square tests were used evaluate occurrence differences between: 1) home vs rural tandem facilities, 2) age (<65 yrs vs. = 65 yrs), and 3) high vs low risk categories.
Results. Ages ranged from 13-85 years; 420 patients (53%) were = 65 years of age. Ninety-three patients (12%) were considered high-risk. Nine facilities (75%) were monitoring patients at home only, two facilities (17%) were monitoring patients from tandem sites, and one hospital (8%) was conducting both home and tandem sessions. Twenty-nine cardiovascular complications were observed; 21 at rural tandem sites and eight at home. There were no fatalities and only one patient required emergency transport.
Conclusions. High-risk patients = 65 yrs who exercise at rural tandem medical facilities are most likely to experience cardiovascular complications. However, given the absence of fatalities, TEM appears to be safe regardless of risk stratification.

The effects of a short-term high-volume resistive training program on muscular strength, body composition, and serum glucose and insulin levels in heart patients

J.J. Schluck, K.R. Ecker, J.L. Boehler, M. Al-Omari
Human Performance Labortory, Department of Human Performance, Mankato State University, Mankato, MN

Objective. The purpose of this study was to determine therole resistive training may contribute in reducing the risks of coronary artery disease in cardiac patients by favorably altering serum glucose and insulin levels, body composition, and muscular strength.
Experimental Design. The subjects completed 12 weeks of biweekly bouts of high-volume resistive training on 12 Badger-Magnum resistance training machines.
Participants. Seven (3 females and 4 males) heart patients (age: 54.4 ± 2.4 years) volunteered for the study.
Measures. A repeated measures ANOVA was used to compare changes in baseline levels of insulin and glucose. A dependent t-test was used to monitor changes in pretest vs. post-test levels of strength and body composition.
Results. Glucose and insulin levels were not found to be significantly different from baseline values. Significant differences were obtained in body composition with average lean body weight increasing 4.4% (p < 0.05) and body fat decreasing 9.3% respectively (p < 0.05). Strength significantly increased from 23% to 76%, with an average increase of 45% (p < 0.05).
Conclusions. Increases in overall strength as well as desirable changes in body composition can be safely attained in properly screened cardiac populations. Although favorble alterations in glucose levels were evidenced in this investigation, significant changes may require a longer training period.

Physiological changes during 33 years of exercise training

F. W. Kasch and R. Pyes
San Diego State University , San Diego, CA

Objective. The purpose of this research was to evaluate the role of exercise training on circulatory function from middle to old age.
Experimental Design. Fifteen men with mean initial age of 45 years were periodically measured nine times at rest and at maximum effort over a period of 33 years. At first, physical training consisted of 14 joggers and 1 swimmer. As the years progressed, some men changed to walking and cycling. Training increased from 3.0 to 4.6 frequencies per week, while duration per frequency remained at one hour. Intensity of training declined from 84 to 77% of heart rate reserve.
Results. Body weight declined 4 kg, height 3 cm, and HR rest 6 beats per min. Resting blood pressure remained normotensive, with no subject developing hypertension. HR max declined from 177 to 153, while O₂ pulse changed from 19.3 to 17.9 ml per HR. Mean arterial pressure at maximum changed slightly, from 111 to 112 mmHg. Peripheral vascular resistance increased from 4.9 to 6.2 units in the exercisers, compared to a control group which doubled from 5.8 to 11.1 units. V0₂ max declined 5% per decade, from 44.4 to 37.0 ml×min^-1×kg^-1, or 0.22 ml×min^-1×kg^-1×yr^-1. V0₂ max decline was nonlinear, occurring at ages 55, 66 and 76 years.
Conclusions. It was concluded that the usual decline in circulatory function from middle to old age can be minimized by adequate exercise training.

Analyses of predicted and actual metabolic equivalents in the frail older adult with chronic disease

C.W. Cortes¹, T.W. Findley¹, T. Cavalieri², and T. Morley^3
1Institute for Disability Prevention and Wellness and the ²Departments of Geriatric and ³Pulmonary Medicine, University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine, Stratford, NJ

Objective. The metabolic equivalent of 3.5 ml/kg/min is based on the healthy normal male weighing 70 kilograms aged 20-30 years. Risk stratification classifications uses the standard multiplier of 3.5 ml/kg/min, it has much clinical utility in cardiac rehabilitation. However, MET norms are not available for older adults.
Experimental Design. MET levels were determined using four different methods: 1) ACSM walking equation; 2) peak VO₂ divided by 3.5 (MC_3.5); 3) peak VO₂ divided by 2.3 (MC_2.3); and 4) actual peak VO₂ divided by the actual resting VO₂ response (I_REST).
Participants. We studied resting and peak VO₂ in 15 frail adults age 73-85 years on 3 separate occasions using a cardiopulmonary exercise protocol. Recently, we reported that 2.3 ml/kg/min was an average resting VO₂ response in older frail adults.
Results. ANOVA with repeated measures showed significant MET level differences between ACSM and measured constant (MC_3.5) compared to MC_2.3 and I_REST [r = .60 was statistically significantly (p < .05)]. Group means for MET level at maximum exercise: 1) ACSM 9.0 ± 3.1; 2) MC_3.5 7.4 ± 2.3; 3) MC_2.3 11.2 ± 3.5; and 4) I_REST 11.8 ± 4.7. ACSM, MC_3.5, MC_2.3 were highly correlated with each other (r = .69 - .85). Group mean data indicate the inadequacy of using the standard multiplier (i.e., 3.5 ml/kg/min). Mean responses were 2.4 - 3.8 METS lower for ACSM and MC_3.5 compared to MC_2.3. I_REST MET gives greater variability in MET level results than using group means.
Conclusions. This suggests that establishing new standard MET levels in the older adult by use of a group mean is desirable for predicting submaximal exercise capacity. There is a need to assess the cardiopulmonary responses of frail older adults with chronic disease to accurately establish age and risk stratification for METS.

Acute effects of caffeine intake on maximal anaerobic power during the 30s Wingate cycling test

Hyunsik Kang¹, Hyuntae Kim², and Byungroh Kim^2
1School of Exercise, Leisure & Sport Kent State University, Kent, Ohio and ²Department of Physical Education Changwon National University, Changwon, S. Korea

Objective. The purpose of this study was to investigate the effects of caffeine (99.5% purity) on maximal anaerobic power.
Experimental Design. A double-blind research design was employed. Maximal anaerobic power output, including total power (TP), mean power (MP), and peak power (PP), was determined using the 30s Wingate cycling test. In addition, fingertip blood samplings were collected to analyze lactate concentrations before and after the test.
Participants. A group of 14 subjects (7 professional cyclists and 7 PE students) ingested 2.5, 5.0 mg/kg of caffeine and a placebo (lemon juice) in a counterbalanced order.
Results. A 2 x 3 ANOVA (group x treatment) with repeated measures on the time factor, followed by the Student-Newman Keuls post-hoc, showed that maximal anaerobic power outputs (TP, MP, PP) in both groups were significantly increased with caffeine (p < .05). For example, the cyclists increased TP (4919 ± 340 and 4785 ± 634 w), MP (819 ± 87 and 826 ± 92 w), PP (969 ± 67 and 947 ± 93 w) with both 2.5 and 5.0 mg of caffeine vs. TP (4288 ± 509 w), MP (715 ± 85 w), PP (845 ± 120 w) with the placebo. Likewise, the PE students increased TP (4047 ± 471 and 4053 ± 410 w), MP (660 ± 62 and 676 ± 68 w), PP (823 ± 45 and 837 ± 94 w) with both 2.5 mg and 5.0 mg of caffeine vs. TP (3748 ± 440 w), MP (625 ± 79 w), PP (784 ± 79 w) with the placebo.
Conclusions. Maximal blood lactate concentrations in both groups were not significantly different with caffeine compared to with the placebo. Therefore, it was concluded that caffeine could increase maximal anaerobic power during cycling.

Allometric scaling of knee extension strength in youths: Examination of gender differences

Joseph P. Weir¹, T.J. Housh², D.J. Housh³, G.O. Johnson², K.T. Ebersole², and S.R. Perry^2
1Program in Physical Therapy, University of Osteopathic Medicine & Health Sciences, Des Moines, IA, ²Department of Health & Human Performance, University of Nebraska, Lincoln, NE, ³Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE

Objective. In youths, muscle strength has been shown to exhibit an age effect, in which increases in age are associated with increases in strength independent of differences in body size. To date, the effect of gender on the age effect has not been examined. In this study, we examined age effects for isokinetic strength between genders using multivariate allometric scaling to control for differences in body size.
Participants. The subjects were 72 competitive female gymnasts (mean age ± SD = 15.7 ± 1.2 years) and 150 male high school wrestlers (mean age ± SD = 16.6 ± 1.0 years).
Measures. The subjects were tested for isokinetic knee extension peak torque at 30, 180, and 300 degrees/sec. The body size variable was fat-free weight (FFW) determined with hydrostatic weighing. The allometric analyses were performed using multiple regression. The dependent variables were log of isokinetic torque (one each for each velocity) and the independent variables were log of FFW, log of age, and log of gender (gender dummy codes: 2 = female, 3 = male).
Results. the analyses showed significant main effects for FFW, ange, and gender. There were no significant interactions, indicating that common scaling exponents for age and FFw were appropriate for both genders. All FFW scaling exponents included 1.0 in the 95% confidence intervals, indicating a response consistent with dimensionality theory, which suggests that muscle torque should scale to mass to the 1.0 power. The significant main effects for age indicated that, after accounting for differences in body size, older subjects exhibited greater peak torque. The significant sex effects indicated that, after controlling for FFW and age, male subjects on average had higher peak torque than the females. The FFW and age corrected gender differences were 14.9, 16.7 and 13.6% at 30, 180, and 300 degrees/sec, respectively.
Conclusions. These results indicate that: 1) the age effect is similar for males and females (non-significant interactions), and 2) even after correcting for differences in FFW and age, males were stronger than the females. The causes of the gender differences require further study.

The effects of association and positive self-talk on 40K time trial performance in trained male cyclists

Paul J. Ayres and M.D. Becque
Department of Physical Education, Southern Illinois University, Carbondale, Illinois

Objective. The purpose of this study was to determine the effects of a cognitive strategy using association and positive self-talk on a 40K cycling time trial in trained male cyclists.
Experimental Design. All subjects performed two 40K time trials, immediately followed by an interview to assess cognitive orientations. During the pretest 40K time trial, all subjects were instructed to do their best. The pretest time trial results were employed to match the subjects and assign them to either a Control (n = 5) or Treatment (n = 7) group. The Treatment Group practiced a cognitive strategy during at least five hours of cycling prior to the posttest time trial. The cognitive strategy consisted of positive self-talk and association. The subjects in the Control Group were instructed to do their best during the posttest ride.
Participants. Twelve trained male cyclists (age: 22.6 ± 2.4 yrs) volunteered for participation in this study.
Measures. Repeated measures ANOVA was used to analyze 40K times, average heart rate, and ratings of perceived exertion (RPE). Cognitive orientations were analyzed using a Wilcoxon test and a Mann-Whitney U test.
Results. The RPE of the Treatment Group was significantly higher during the posttest compared to the pretest time trial. There were no significant differences in 40K time. The Treatment Group described their posttest ride with significantly more associative keywords and imagery vividness than during the pretest ride.
Conclusions. Trained cyclists can increase their internal attentional focus using a cognitive strategy which utilizes association and positive self-talk. Although the cognitive strategy did not result in a mean increase in performance, 5 of the 7 subjects increased performance by at least 1 minute. This strategy assures that the athlete is focused on his participation and may result in performance benefits.

Step training with and without light extremity loading: Effect on knee, elbow, and shoulder muscle endurance

H.-J. Engels, J. Currie, C. Lueck, and J.C. Wirth
HPR/Exercise Science, Wayne State University, Detroit, MI and Department of Physical Therapy, Mount Clemens General Hospital, Mount Clemens, MI

Objective. The purpose of this study was to examine the effects of a 12 week step training program (3 days/week, 50 min/session, 60-90% HRmax) with and without additional light extremity loading on knee, shoulder, and elbow muscle endurance capacity in adult females.
Experimental Design. Analysis of variance on pre-post change scores including planned comparison post-hoc tests.
Participants. Thirty-two healthy adult females (age: 21-51 years) were randomly assigned to two exercise groups that trained regularly with (n=16) and without (n=16) 1.36 kg/hand-held and 0.68 kg/ankle attached extremity loads while 12 subjects served as non-training controls.
Measures. Before and after the intervention, muscle endurance capacity was determined from the total work performed over 20 consecutive, reciprocal concentric contractions at angular test velocities of 180E/sec (knee, shoulder) and 120E/sec (elbow) using computerized isokinetic dynamometry (Biodex).
Results. Pre-post change scores for total work (in NM) performed for knee flexion and extension, elbow flexion and extension, and shoulder abduction and adduction were not significantly different among the 3 study groups.
Conclusions. Twelve weeks of step training, performed with and without additional light extremity loads, is not adequate to affect isokinetically determined muscular endurance capacity in healthy adult females.

Sitting versus standing isokinetic trunk extension and flexion work

B.W. Findley and L.E. Brown
Central Palm Beach Physicians, West Palm Beach, FL

Objective. Trunk extension and flexion work has been traditionally measured in either the sitting or standing position. However, these positions may produce dissimilar levels of work output. The purpose of this investigation was to determine if differences in work output exist between standing and sitting isokinetic trunk extension and flexion exercise.
Experimental Design. Subjects performed three maximal repetitions of isokinetic concentric trunk extension and flexion at 60 and 120 d/s in the sitting and standing positions.
Participants. Sixteen subjects (8 males & 8 females), age 30.8 ± 6.4 yrs, ht 170.2 ± 11.1 cm, wt 68.1 ± 13.8 kg) volunteered for this study.
Measures. Repeated measures ANOVA was used to analyze work per repetition data.
Results. Standing flexion produced significantly greater work than sitting at both speeds tested [116.9(11.1)* stand vs. 86.4(6.7) sit at 60 d/s and 106.7(8.3)* stand vs. 77.7(4.9) sit at 120 d/s] while no differences were noted in extension [165.6(14.2) stand vs. 173.1(18.8) sit at 60 d/s and 154.7(14.6) stand vs. 146.9(17.0) sit at 120 d/s]. *Significantly greater than sitting (p < 0.05). The results are in joules (mean ± SEM).
Conclusions. Distinct muscle length tension ratios between the sitting and standing positions elicit unique work outputs during flexion. Therefore, caution should be exercised when interpreting position-specific isokinetic test results that measure trunk flexion work.

A comparative study of various mathematical models for critical velocity of juvenile swimmers

J.C. Lin, C. F. Wu, and S. J. Wang
Department of Physical Education, National Taiwan Normal University, Taipei, TAIWAN

Objective. The purpose of this study was to assess and compare the critical velocity (CV) in swimming derived from velocity-time (V-T) nonlinear model, velocity-1/time (V-1/T) linear model, distance-time (D-T) linear model and 3-parameter (3-P) nonlinear model.
Experimental Design. Subjects used the front crawl stroke to swim five distances (25 m, 50 m, 100 m, 200 m and 400 m, in balanced order) at maximal effort; and the time to complete each distance was recorded to assess CV by the various mathematical models.
Participants. Subjects were 18 male juvenile swimmers (age: 15.4 ± 1.64 yr; height: 167.9 ± 6.48 cm; weight: 58.2 ± 8.20 kg).
Measures. One-way repeated measures ANOVA was used to compare critical velocity derived from different mathematical models. Pearson product-moment correlation was applied to examine the association between performance of all distances and CV from the various mathematical models.
Results. Significant differences were found among the CVs derived from the different mathematical models (CV_V-T = 1.39 m/s; CV_V-1/T = 1.49 m/s; CV_D-T = 1.42 m/s; CV_3-P = 1.35 m/s). The data showed a high coefficient of correlation (r = 0.90~0.99) between performance at all distances and CV from the various mathematical models. The longer the swimming distance, the higher the coefficient of correlation between the critical velocity and the swimming performance was indicated.
Conclusions. Since there is a high coefficient of correlation between swimming performance and the CV for all models, and the D-T linear model is the easiest to use, the D-T linear model is the best choice for CV estimation for juvenile swimmers.

Gender and anthropometric effects on acceleration during knee extension exercise on an isokinetic device

L.E. Brown and B.W. Findley
Florida Atlantic University, Boca Raton, FL

Objective. The purpose of this study was to investigate the relationship bwtween acceleration range of motion (ACCROM) prior to sustained isokinetic velocity (load range), gender and the anthropometric variables of height, weight, limb weight and limb length during isokinetic knee extension exercise.
Experimental Design. Subjects performed three maximal concentric knee extension repetitions at 60 through 450 degrees per second (d/s).
Participants. Thirty-five subjects (15 male, 20 female, age 27.5 ± 6.5 yrs) volunteered for this study.
Measures. Linear multiple regression was used to analyze ACCROM, gender and anthropometric variables.
Results. Actual, multiple r, r² and standard error values are listed below:

*Significant at p < 0.05

Conclusions. These results demonstrate a strong relationship between ACCROM, gender and the anthropometric variables of HT, WT, LW and LL. This suggests that males and taller and heavier individuals with heavier and longer lower limbs may produce greater amounts of load range during knee extension exercise under isokinetic conditions. Therefore, gender and anthropometric influences may positively effect the load range associated strength training benefits and muscle adaptations that occur during knee extension exercise at medium to high isokinetic velocities.

Health fitness screening in an underserved African-American community

N.W. Pollock, D.K. Shaw¹, W.L. Jenkins¹, and G.S. Poehlman².
Human Performance Laboratory, ¹Physical Therapy Department, and ²Department of Family Medicine, East Carolina University, Greenville, NC

Objective. The purposes of this study were to: 1) provide health-fitness screening for a rural, underserved, low socioeconomic status community; 2) evaluate the need for community-based preventive and rehabilitative intervention programs; and 3) determine the efficacy of integrating health-fitness and medical clinics.
Experimental Design. We evaluated anthropometrics, resting electrocardiography, static lung volumes and dynamic flows, fasted blood values, musculoskeletal strength, flexibility and joint function to augment a free medical clinic program. A total of 165 measures were obtained on each participant.
Participants. Forty-three residents (29 females, 14 males) volunteered (age = 56.0 ± 13.6 and 52.7 ± 17.3 y [mean ± SD], BMI = 34.0 ± 5.4 and 30.8 ± 5.1 kg.m^-2, WHR = 0.94 ± 0.10 and 0.99 ± 0.07, respectively).
Results. Diabetes was relatively common in this group (29% of females, 21% of males) and regular exercise uncommon (31% of females, 29% of males). Variable abnormalities were found in musculoskeletal function (in 70% of subjects), pulmonary function (in 63% of subjects), and fasting blood values (in up to 69% of subjects for select measures).
Conclusions. This pilot study identified a high incidence of some degree of dysfunction in the subjects evaluated. Many of the problems may not be identified or easily managed during typical drop-in medical clinic programs. We suggest that a need exists for implementation of health-fitness evaluation and preventive and rehabilitative programs in conjunction with routine medical care in underserved communities.