Effect of head-out water immersion on cardiorespiratory response to dynamic exercise.

Head-out water immersion is known to produce several cardiopulmonary adjustments at rest due to a cephalad shift in blood volume. The purpose of this study was to determine the effect of head-out water immersion on the cardiorespiratory response to graded dynamic exercise. Nineteen healthy middle-aged men performed upright cycling exercise at 40, 60 and 80% of maximal oxygen consumption on land and in water (31.0 +/- 1.0 degrees C) to the shoulders. Cardiac output (measured by the carbon dioxide rebreathing technique) was significantly greater in water at 40 and 80% maximal oxygen consumption. Stroke volume was significantly elevated at all stages of exercise. Heart rate did not differ significantly at 40 and 60% maximal oxygen consumption but was significantly lower in water at 80% maximal oxygen consumption. Total ventilation did not differ significantly in water and on land at any stage of exercise. The results suggest that the central redistribution of blood volume with head-out water immersion leads to an increase in stroke volume. Because there is not a proportional decrease in heart rate with the elevated stroke volume, cardiac output is regulated at a higher level during upright exercise in water compared with that on land. In conclusion, there are serious limitations of available, prerecorded rhythm data bases for designing and testing of automatic external defibrillators. Performance can be adequately assessed only by extensive clinical tests, which seem mandatory for this new and important type of defibrillator.

Effect of age and coronary artery disease on response to snow shoveling.

OBJECTIVES: The objective of this study was to evaluate the effect of age and coronary artery disease on responses to snow shoveling. BACKGROUND: Little information is available on the hemodynamic and metabolic responses to snow shoveling. METHODS: Sixteen men with asymptomatic coronary artery disease and relatively good functional work capacity, 13 older normal men and 12 younger normal men shoveled snow at a self-paced rate. Oxygen consumption, heart rate and blood pressure were determined. In nine men with coronary artery disease left ventricular ejection fraction was evaluated with an ambulatory radionuclide recorder. RESULTS: Oxygen consumption during snow shoveling differed (p < 0.05) among groups; it was lowest (18.5 +/- 0.8 ml/kg per min) in those with coronary artery disease, intermediate (22.2 +/- 0.9 ml/kg/min) in older normal men and highest (25.6 +/- 1.3 ml/kg/min) in younger normal men. Percent peak treadmill oxygen consumption and heart rate with shoveling in the three groups ranged from 60% to 68% and 75% to 78%, respectively. Left ventricular ejection fraction and frequency of arrhythmias during shoveling were similar to those during treadmill testing. CONCLUSIONS: During snow shoveling 1) the rate of energy expenditure selected varied in relation to each man's peak oxygen consumption; 2) older and younger normal men and asymptomatic men with coronary artery disease paced themselves at similar relative work intensities; 3) the work intensity selected represented hard work but was within commonly recommended criteria for aerobic exercise training; and 4) arrhythmias and left ventricular ejection fraction were similar to those associated with dynamic exercise.

Effect of enhanced preload with head-out water immersion on exercise response in men with healed myocardial infarction.

Head-out water immersion shifts venous blood to the central vasculature and heart and subsequently increases cardiac preload. In healthy men, cardiac output and stroke volume are greater during upright leg cycle exercise in water than on land. Heart rate is similar during work loads < 50% of peak oxygen consumption but is decreased in water at higher work intensities. To determine if men with myocardial infarction (MI) show a similar response, 15 men with a documented MI exercised upright on a leg cycle ergometer on land and immersed in water (31 +/- 1 degree C) to the level of the shoulders. Heart rate, cardiac output (carbon dioxide rebreathing procedure) and oxygen consumption were measured at rest and at work loads corresponding to approximately 40, 60 and 75% of peak oxygen consumption in both environments. At rest, cardiac output and stroke volume were elevated (p < 0.05) in water. During exercise, heart rate, cardiac output and stroke volume did not differ between water and land. When subjects were given beta-blocking medications (n = 8) and subjects with exercise-induced ST-segment depression (n = 5) were separately excluded from the analysis, water immersion still did not significantly change exercise responses. These results suggest that MI alters the normal cardiac response to increased preload during exercise. The alteration may involve reduced myocardial compliance or near-complete use of the Frank-Starling reserve, or both, during land exercise.

Cardiac response to combined moderate heat and exercise in men with coronary artery disease.

The effect of moderate heat stress on cardiac performance during sustained moderate physical work was evaluated in men greater than or equal to 6 weeks after a cardiac event. Subjects (n = 10) performed upright leg cycle ergometer exercise at approximately 50% of peak oxygen uptake for up to 60 minutes in warm (30.0 +/- 0.9 degrees C) and thermoneutral (21.5 +/- 0.3 degrees C) environments. Cardiac output (carbon dioxide rebreathing method), left ventricular ejection fraction and relative left ventricular end-diastolic volume (portable nuclear VEST monitor) were periodically determined. In both environments, heart rate increased (p less than 0.05), stroke volume decreased (p less than 0.05), and cardiac output remained unchanged with exercise time. In the warmer environment, heart rate was increased (p less than 0.05) and stroke volume tended to be decreased (p less than 0.08), with no difference in cardiac output. In both environments, left ventricular ejection fraction did not change from minute 6 to 60 of exercise, whereas relative left ventricular end-diastolic volume decreased (p less than 0.05) with exercise time. Arterial blood pressure was unchanged from minute 6 to 60 in the warm environment. Arrhythmias were not altered by exercise time or environment, and no subjects had evidence of myocardial ischemia. The data indicate that although heart rate increased and stroke volume and relative left ventricular end-diastolic volume decreased with exercise time, cardiac output and left ventricular ejection fraction remained unchanged in both thermoneutral and warm environments.(ABSTRACT TRUNCATED AT 250 WORDS)

Response of patients after myocardial infarction to carrying a graded series of weight loads.

Cardiovascular responses to carrying graded weight loads of 20 to 50 pounds were determined in 52 patients after myocardial infarction (MI) (greater than or equal to 2 months). Sixty percent of the patients were stopped before completing the heaviest weight load (50 pounds for 2 minutes) because of an increase in diastolic blood pressure (BP) to 120 mm Hg (end point) or arm fatigue. Compared with symptom-limited graded dynamic exercise, peak systolic and diastolic BP were significantly greater (p less than 0.05 and p less than 0.01, respectively) with weight carrying, while peak heart rate, pressure-rate product, ventilation and oxygen consumption were significantly lower (p less than 0.01). Ischemic responses were less frequent with weight carrying. Patients with severely reduced resting left ventricular ejection fraction (LVEF) (less than 35%) tolerated the weight carrying test as well as patients with normal resting LVEFs (greater than 50%). We conclude that (1) ischemic responses occur less frequently while carrying up to 50 pounds for 2 minutes than with symptom-limited dynamic exercise, (2) a significant number of patients have an increase in diastolic BP greater than or equal to 120 mm Hg while carrying objects that weigh 30 to 50 pounds for 2 minutes, and (3) a poor correlation exists between resting LVEF and tolerance for weight carrying.

Weight carrying versus handgrip exercise testing in men with coronary artery disease.

The clinical merits of handgrip and weight carrying tests were compared in 30 patients with documented coronary artery disease. The static loads in the 2 tests were matched by percentage of maximal static effort and corresponded to 25 and 45% of maximal voluntary handgrip contraction and 25 and 45% of maximal 1-hand lift capacity. Each static load in both tests was continued for less than or equal to 3 minutes. At the 25% maximal effort stage, 93 and 90% of patients were able to complete 3 minutes of handgrip and weight carrying, respectively. Only 13 and 10% were able to complete 3 minutes at the 45% maximal effort stage with handgrip and weight carrying, respectively. Arm fatigue and an increase in diastolic blood pressure greater than 120 mm Hg were the predominant endpoints. Weight carrying resulted in significantly higher (p less than 0.05) heart rate, systolic blood pressure, pressure-rate product, ventilation and oxygen consumption compared to handgrip. Diastolic blood pressure responses did not differ between the tests. None of the patients demonstrated ischemic responses to either handgrip or weight carrying and the incidence of arrhythmias was rare. The diastolic blood pressure response to static effort is equally evaluated by handgrip and weight carrying tests. However, the greater myocardial oxygen demand, reflected by the pressure-rate product, in addition to the greater total body oxygen consumption, imposed by weight carrying, enhances the clinical application of the weight carrying test.

Energy expenditure during household tasks in women with coronary artery disease.

The energy expenditure for and heart rate responses to common household tasks were determined in 26 older (mean age 62 +/- 2 years) women with coronary artery disease (CAD). Each activity was performed at a self-determined pace for 6 or 8 minutes. The average oxygen uptake (ml/kg/min) for each task evaluated was 6.5 for washing dishes, 6.8 for ironing, 7.2 for scrubbing pans, 8.6 for unpacking groceries, 9.5 for vacuuming, 9.8 for sweeping, 10.1 for mopping, 12.0 for changing bed linens, and 12.4 for washing the floor (hands and knees). None of the subjects reported angina. Mean relative oxygen uptake (i.e., percentage of peak response with treadmill testing) ranged from 31 +/- 2% for washing dishes to 62 +/- 3% for changing the bed linens and washing the floor. Percentage of peak treadmill heart rate ranged from 62 +/- 2% for washing dishes to 73 +/- 2% for washing the floor. In 4 of the more physically demanding household activities (i.e., vacuuming, mopping, washing the floor, and changing bed linens), the responses of 10 age-matched normal women were evaluated. The absolute and relative demands of the tasks were similar between the CAD and normal groups. Results indicate that the mean energy expenditure rate of common household tasks evaluated in this study range from 2 to 4 METs, suggesting that most women with CAD who are able to achieve > or = 5 METs during a treadmill exercise test without adverse signs or symptoms should be able to resume these activities.

Comparison of adaptations and compliance to exercise training between middle-aged and older men.

OBJECTIVE: To compare the rate and magnitude of physiologic and psychologic adaptations to aerobic training between middle-age and older men, to assess their interest in continued participation (> 6 months) in a supervised high-intensity training program, and to evaluate the safety of high-intensity training for older people. DESIGN: Before-after intervention trial. SETTING: Medical center in a Midwestern metropolitan city. PARTICIPANTS: Thirteen middle-age (35-50 years) and 14 older (60-71 years) normal men. INTERVENTION: Subjects trained on treadmills and leg cycle ergometers for 40 minutes 3 times per week. The intensity was increased to 85% of peak heart rate (HR) within the first 3 weeks of training. MEASUREMENT: Peak oxygen consumption, HR at submaximal work rates, three psychological tests, and election to continue in the supervised program. RESULTS: At 6 months of training, peak oxygen consumption had increased by 12% and 11% in the middle-aged and older groups, respectively, with 86% and 100% of this increase occurring within the first 3 months. Both groups showed comparable decreases in HR at submaximal work rates after 3 months of training with no further significant change from 3 to 6 months. None of the psychologic parameters evaluated changed significantly with 3 or 6 months of training in either group. More of the older (71%) than middle-aged (45%) men elected to continue in the supervised program after 6 months. CONCLUSIONS: The results of this study involving small groups of carefully screened middle-aged and older men suggest that the time course and magnitude of physiologic adaptations to aerobic training are similar between age groups when the training regimen is the same. Neither age group showed alterations in psychologic parameters nor experienced orthopedic injuries with training. The older group showed greater interest in continued participation in a supervised exercise program.

Effect of aerobic training on baroreflex regulation of cardiac and sympathetic function.

To investigate the effect of aerobic exercise training on baroreflex regulation of muscle sympathetic nerve activity (MSNA) and cardiac R-R intervals in a middle-aged to older population, 10 healthy men > 40 yr of age underwent tests of autonomic function before and after 12 wk of high-intensity training. Cardiac and peripheral baroslopes were determined from the R-R interval vs. mean arterial pressure (MAP) and peroneal MSNA vs. diastolic pressure relationships, respectively, during sequential bolus injections of nitroprusside and phenylephrine. Maximal oxygen uptake increased (P < 0.05) 17% with training. Resting R-R interval increased (881 +/- 23 to 956 +/- 38 ms, P < 0.05), MAP decreased (96 +/- 2 to 91 +/- 3 mmHg, P < 0.05), and MSNA was unaltered (23.1 +/- 2.3 to 23.6 +/- 1.9 bursts/min) with training. Before and after training, respectively, cardiac baroslopes determined with decreasing (8.7 +/- 0.9 to 9.9 +/- 5.5 ms/mmHg) and increasing MAP (9.6 +/- 2.1 to 9.9 +/- 2.2 ms/mmHg) and the peripheral sympathetic baroslope (-3.3 +/- 0.4 to -3.5 +/- 0.6 bursts.min-1 x mmHg-1) did not differ. The results suggest that short-term aerobic training does not alter resting MSNA or neurocirculatory responses to baroreceptor challenges in middle-aged and older men.

Effect of head-out water immersion on response to exercise training.

During spaceflight and head-out water immersion (WI) there is a cephalad shift in blood volume. We have recently shown that left ventricular end-diastolic dimension is significantly greater during moderate cycling exercise with WI compared with on land. The purpose of this study was to determine whether the cephalad shift in blood volume and accompanying increase in cardiac preload with WI alters the normal cardiovascular adaptations to aerobic exercise training. Nine middle-aged healthy men trained on cycle ergometers in water, nine trained on land, and four served as controls for 12 wk. Following training, both training groups showed similar increase (P less than 0.05) in stroke volume and similar decreases in heart rate (P less than 0.01) and blood pressure (P less than 0.05) at a given submaximal exercise O2 consumption (VO2). Maximal VO2 increased (P less than 0.01) similarly for both training groups. The control group did not demonstrate any significant changes in submaximal or maximal exercise responses. We conclude that the cephalad shift in blood volume with WI does not alter the normal cardiovascular adaptation to aerobic exercise training.

Effect of increased central blood volume with water immersion on plasma catecholamines during exercise.

To examine the influence of an increase in central blood volume with head-out water immersion (WI) on the sympathoadrenal response to graded dynamic exercise, nine healthy men underwent upright leg cycle exercise on land and with WI. Plasma norepinephrine and epinephrine concentrations were used as indexes of overall sympathoadrenal activity. Oxygen consumption (VO2), heart rate, systolic blood pressure, and plasma concentrations of norepinephrine, epinephrine, and lactate were determined at work loads corresponding to approximately 40, 60, 80, and 100% peak VO2. Peak VO2 did not differ on land and with WI. Plasma norepinephrine concentration was reduced (P less than 0.05) at 80 and 100% peak VO2 with WI and on land, respectively. Plasma epinephrine and lactate concentrations were similar on land and with WI at the three submaximal work stages, but both were reduced (P less than 0.05) at peak exertion with WI. Heart rate was lower (P less than 0.05) at the three highest work intensities with WI. These results suggest that the central shift in blood volume with WI reduces the sympathoadrenal response to high-intensity dynamic exercise.

Cardiovascular regulation during head-out water immersion exercise.

Head-out water immersion is known to increase cardiac filling pressure and volume in humans at rest. The purpose of the present study was to assess whether these alterations persist during dynamic exercise. Ten men performed upright cycling exercise on land and in water to the suprasternal notch at work loads corresponding to 40, 60, 80, and 100% maximal O2 consumption (VO2max). A Swan-Ganz catheter was used to measure right atrial pressure (PAP), pulmonary arterial pressure (PAP), and cardiac index (CI). Left ventricular end-diastolic (LVED) and end-systolic (LVES) volume indexes were assessed with echocardiography. VO2max did not differ between land and water. RAP, PAP, CI, stroke index, and LVED and LVES volume indexes were significantly greater (P less than 0.05) during exercise in water than on land. Stroke index did not change significantly from rest to exercise in water but increased (P less than 0.05) on land. Arterial systolic blood pressure did not differ between land and water at rest or during exercise. Heart rates were significantly lower (P less than 0.05) in water only during the two highest work intensities. The results indicate that indexes of cardiac preload are greater during exercise in water than on land.

Special ergometric techniques and weight reduction.

Several physiological and psychological benefits can be achieved with exercise training provided an adequate exercise threshold is reached. In recommending exercise regimens to obese individuals, it is important to consider the exercise intensity, frequency, and duration that is most likely to lead to the desired benefits of exercise training. The special problems that some obese individuals may encounter with exercise training should also be considered. Walk/jog and stationary cycling are the two most commonly recommended modes of exercise. Aquatic exercise, due to the buoyancy and thermal properties of water, may be especially suitable as a method of exercise for obese individuals. In addition to swimming, cycling exercise and aerobic dance can be performed in a water environment.

Physiologic responses to shoveling and thermal stress in men with cardiac disease.

To investigate the effect of temperature stress on responses to static-dynamic work in patients with ischemic heart disease (IHD), 10 men with IHD shoveled gravel for 30 min in a warm (29 degrees C), neutral (24 degrees C), and cold (-8 degrees C) environment (on separate days). A pace of 15 lifts.min-1 was set, and the load per lift approximated 5.5 kg. Heart rate (HR), oxygen consumption (VO2), and systolic (SBP) and diastolic blood pressures (DBP) were evaluated at 5-min intervals. Arrhythmias and ST-segment depression were evaluated by ambulatory electrocardiographic monitoring. At 30 min, VO2, SBP, and DBP were higher (P < 0.05) in the cold environment, and HR was higher (P < 0.05) in the warm environment compared with the neutral environment. HR increased (P < 0.05) from 5 to 30 min in all three conditions. The increase in HR was greater (P < 0.05) in the warm environment. None of the subjects reported angina or demonstrated electrocardiographic ST-segment changes during shoveling in any environment. The results indicate that low-risk patients with stable IHD show modest temperature-induced alterations in hemodynamic and VO2 responses during 30 min of moderate intensity (50-60% of peak VO2) static-dynamic work without adverse electrocardiographic responses or symptomatology.

Snow blowing and shoveling in normal and asymptomatic coronary artery diseased men.

We evaluated the oxygen uptake and heart-rate responses to self-paced snow blowing and snow shoveling in 10 men with asymptomatic coronary artery disease, 10 older normal men, and six younger normal men. Mean peak treadmill oxygen uptake in the three groups ranged from 26.4 +/- 1.1 to 47.3 +/- 3.9 ml/kg per min (P < 0.05). Oxygen uptake during snow blowing did not differ significantly among subject groups; values were 17.1 +/- 1.3, 17.7 +/- 1.1, and 17.2 +/- 0.9 ml/kg per min in the coronary artery disease, older normal, and younger normal groups, respectively. Oxygen uptake with snow shoveling was lower (P < 0.05) in those with coronary artery disease (18.4 +/- 1.0 ml/kg per min) than in the normal groups. In comparison with snow shoveling, oxygen uptake and heart rate did not differ (P = NS) from snow blowing in the coronary artery disease group but were lower (P < 0.05) with snow blowing in the two normal groups. The results indicate that men with asymptomatic coronary artery disease and relatively good functional work capacity perform snow blowing and snow shoveling at similar levels of oxygen uptake and heart rate.

Static versus dynamic exercise: effects on Doppler echocardiographic indices of left ventricular performance.

In order to compare the effects of static exercise with those of dynamic exercise on the Doppler echocardiographic measurements of ascending aortic blood flow velocity and acceleration, Doppler echocardiography was performed with sustained handgrip exercise and with supine bicycle exercise in 12 normal subjects, 12 patients with coronary artery disease, and 7 patients with heart failure. In normal subjects: peak velocity decreased by 16 +/- 11% with handgrip from the resting value and increased by 49 +/- 19% with bicycle exercise (p less than 0.01); mean acceleration decreased by 6 +/- 30% with handgrip and increased by 162 +/- 83% with bicycle exercise (p less than 0.01). In patients with coronary artery disease: peak velocity declined by 9 +/- 14% with handgrip and increased by 19 +/- 18% with bicycle exercise (p less than 0.01); mean acceleration increased by 13 +/- 27% with handgrip and by 41 +/- 33% with bicycle exercise (NS). In patients with congestive heart failure: peak velocity decreased by 19 +/- 13% with handgrip and increased by 5 +/- 17% with bicycle exercise (p less than 0.01); mean acceleration decreased by 12 +/- 23% with handgrip and by 4 +/- 37% with bicycle exercise. A marked increase in afterload stress induced by static exercise presumably offsets the moderately increased contractility and accounts for the decline of peak velocity and mean acceleration with static exercise both in normals and cardiac patients. In contrast, marked increase in contractile state along with little change in afterload with dynamic exercise results in markedly increased peak velocity and mean acceleration in normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of simulated work testing in cardiac rehabilitation: a case report.

A significant percentage of patients do not return to work after myocardial infarction or coronary artery bypass surgery for nonmedical reasons. These reasons include unwarranted medical restrictions, patient anxiety concerning ability to meet job demands, apprehensive family members, and fearful employers. A case study is presented to illustrate how occupational therapists can enhance a patient's work potential by using skills in activity analysis to develop simulated work evaluations. Satisfactory performance on a test that closely simulates work demands can help the physician, patient, family, and employer gain confidence in the patient's ability to return to work.

Physiological comparison of walking among bilateral above-knee amputee and able-bodied subjects, and a model to account for the differences in metabolic cost.

OBJECTIVE: To compare the metabolic cost for prosthetic ambulation among persons with bilateral above-knee amputation with that for able-bodied ambulation, and to test a model that differentiates the metabolic cost of walking into three components. DESIGN: Cross-sectional comparison. SETTING: Community-dwelling subjects studied at an academic medical center. PARTICIPANTS: Five bilateral above-knee amputee subjects with mean (+/-SD) age of 22 +/- 3 years, and five able-bodied control subjects matched for gender, height, weight, and age. INTERVENTION: Subjects performed 6-minute bouts of walking at three paced speeds and their chosen walking speed with oxygen uptake being determined during the last 2 minutes of each bout. MAIN OUTCOME MEASURES: Chosen walking speed and oxygen uptake during each walking condition. RESULTS: The chosen walking speed was 21% slower and induced aerobic demands 49% higher for the amputee subjects. Across specified paced speeds, aerobic demands were 55% to 83% higher for the amputee subjects than for the able-bodied subjects. The described model suggests that the higher metabolic costs for the amputee subjects resulted from greater demands for maintenance of balance and posture and for performing the walking movement. CONCLUSIONS: Prosthetic ambulation by young healthy persons with bilateral above-knee amputation induces significantly greater metabolic demands than walking by able-bodied individuals. Although the chosen walking speed of persons with bilateral above-knee amputation is slower, the reduction in speed is insufficient to equalize their metabolic cost with that of able-bodied individuals walking at their chosen walking speed.

Effects of exercise in cool water on body weight loss.

Seven obese women (greater than 30 per cent body fat, mean = 43 per cent) performed moderate exercise (30 to 40 per cent of maximal oxygen consumption) for 90 min during head-out immersion in cool water (17 to 22 degrees C) five times per week for eight weeks to determine if cold exposure and the attendant caloric deficit in body heat stores would lead to body weight loss. Exercise was on a cycle ergometer that was modified for underwater use. Body weight, body fat, fat-free body weight, and caloric intake did not change significantly as a result of the exercise program in cool water. The significant heat debts incurred were presumably repaid without an increase in energy expenditure. The caloric balance and the thermal data obtained suggest that body heat stores were slowly repaid during recovery by resting metabolic heat production associated with a reduced rate of body heat loss. Maximal oxygen uptake did not increase significantly. No metabolic or thermal evidence was found to support cold adaptation in the obese women. Ergometer exercise in water as well-tolerated, as evidenced by no exercise-related injuries and an adherence rate of 93 per cent. It was concluded that, while cold exposure does not increase caloric expenditure significantly in obese individuals, exercising regularly in cool water may be beneficial as it may motivate obese people to exercise at higher intensity for thermal comfort and the water environment may help prevent injuries.

Determination of stroke volume and cardiac output during exercise: comparison of two-dimensional and Doppler echocardiography, Fick oximetry, and thermodilution.

Simultaneous estimates of cardiac output were made during graded upright maximal exercise in 10 male subjects by means of Doppler velocity spectrum of ascending aortic flow, apical two-dimensional echocardiograms, thermodilution, and Fick oximetry. In 15 subjects, aortic annular and root diameters were measured during similar exercise from parasternal two-dimensional echocardiograms. The linear correlation between Doppler, two-dimensional echocardiography, and the invasive estimates ranged from r = .78 to r = .92. Both echocardiographic techniques were able to predict changes in invasive flow estimates with reasonable accuracy. Two-dimensional echocardiographic flow estimates underestimated invasive values by about 60%. The accuracy of Doppler flow estimates varied with the method of estimating aortic cross-sectional area. Greatest accuracy was obtained with areas calculated from diameters measured at the aortic value anulus with the leading edge-to-leading edge method of measurement. Correlation coefficients comparing Doppler and thermodilution flow estimates were generally higher (r = .75 to .96, mean .86) for individuals than for the group, but accuracy of the Doppler estimates in single subjects was quite variable. Aortic diameters did not increase from rest to moderate levels of upright exercise. A 3% to 5% increase in resting aortic diameter was noted in the upright posture as compared with the supine. Doppler flow estimates were obtained in all subjects to maximal exertion but in only a minority of subjects with two-dimensional echocardiography or thermodilution. Thus two-dimensional and Doppler echocardiography offer a noninvasive means of estimating cardiac output during vigorous exercise. The Doppler technique is technically more suitable to the study of exercise than two-dimensional echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)