Automated blood pressure measurement at rest and during exercise: evaluation of the motion tolerant CardioDyne NBP 2000.

PURPOSE: The purpose of this study was to validate the use of a motion tolerant blood pressure monitor (CardioDyne NBP 2000, Luxtec, Worcester, MA) ) against standard manual auscultation at rest and during exercise. METHODS: Nineteen subjects (men, N = 9; women, N = 10) participated in the study (mean: age 21+/-1.2 yr; height 172.5+/-8 cm; mass 69.4+/-14.5 kg). Standard Bruce protocol treadmill exercise tests with 12-lead ECG and metabolic measures were administered to the subjects, with blood pressure measures taken at rest before, during, and after the exercise tests. Blood pressure by manual auscultatory sphygmomanometry and the CardioDyne NBP 2000 was recorded simultaneously in the same arm. Manual auscultatory blood pressure measures obtained by one experimenter were used as the criterion measure, and the data of two NBP 2000 audio reviewers were averaged for each data point recorded. RESULTS: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) via manual auscultation and the NBP 2000 "automatic" values were not significantly different and were highly correlated at rest and during exercise. Resting intraclass correlation SBP values were high (range 0.95 to 0.98), as were DBP intraclass correlation values (range 0.83 to 0.95). Exercise intraclass correlation SBP values ranged from 0.94 to 0.99, and DBP intraclass correlation values from 0.88 to 0.93. CONCLUSION: We conclude that the NBP 2000 is simple to use at rest and during exercise stress testing and provides accurate and verifiable information.

Exercise with physically restrained nursing home residents: maximizing benefits of restraint reduction.

OBJECTIVE: To evaluate an exercise protocol designed to improve strength and mobility, and to decrease injury risk factors in physically restrained nursing home residents. DESIGN: A randomized controlled trial. PARTICIPANTS: Ninety-seven residents were randomized into either exercise or control groups. Thirty-five exercise and 37 control group residents completed all post-assessments after a 9-week trial. INTERVENTION: Walking or wheelchair movement training was supplemented by rowing exercise three times per week. Practice in behaviors related to safe movement was provided incidental to the exercise. MEASUREMENT: Endurance, speed, and injury risk measures relevant to walking, wheelchair propulsion, and standing were assessed by standardized protocols. Rowing endurance, rowing range of motion, and handgrip strength measures were collected to assess the effect of the rowing component of the exercise protocol. RESULTS: Fifty-four percent of the subjects who provided consent did not complete the protocol because of health status changes, lack of cooperation, or physical limitations that precluded exercise. The subjects who completed the exercise program showed significant improvement on injury risk and measures related to upper body strength (handgrip strength, rowing endurance, wheelchair endurance, and speed). Measures related to lower body strength did not significantly improve. CONCLUSION: Physically restrained residents are very frail, and it is difficult to implement a long-term exercise program with many residents because of the frailty. However, a substantial proportion of residents did cooperate well with the exercise program and showed improvement on measures correlated with decreased injury risk. The exercise program could be easily modified to include more lower body exercise, and the resultant protocol would be an important adjunct to restraint reduction programs.

Role of decreased carbohydrate oxidation on slower rises in ventilation with increasing exercise intensity after training.

In these studies, we examined whether the rightward shift in steady-state minute ventilation (VE) versus O2 uptake curves after training is more closely linked to the reduced CO2 production from carbohydrate oxidation (CHOOX) after training than to the attenuated increase in blood lactate concentration. Steady state VE values and gas exchange were measured in eight previously sedentary men who underwent exercise tests of 60 W + 40 W every 6 min before and after a 9 week training programme of cycling approximately 40 min a day. Following training, the slower rises in VE with increasing exercise intensities were associated with a reduced reliance on CHOOX, (P < 0.01). Both before and after training, VE values in litres per minute rose as a linear VE = 18.CHOOX + 14, function of rates of CHOOX in grams per minute (r = 0.99), irrespective of a marked shift to the right in arterialized venous blood lactate concentration versus CHOOX curves following training (P < 0.01). Thus, slower increases in steady-state VE values with increasing exercise intensities following endurance training appeared to be more closely linked to the decreased reliance on CHOOX than to the attenuated increase in blood lactate concentration.

Strength training effects on rearfoot motion in running.

The investigation examined isokinetic (IK) and nonisokinetic (NIK) strength training programs for the inversion (INV) and eversion (EV) muscles on pronation during running. Seventy-seven volunteers were videotaped running on a treadmill at 3.8 m.s-1 and total pronation (delta beta PRO) was computed. Eighteen heel-strike runners with the largest values of delta beta PRO (X = 16.7 degrees) were selected as subjects. During the pre- and posttests, isokinetic muscle strength at 20 and 180 degrees.s-1 was determined for the concentric (CON) and eccentric (ECC) actions of the INV and EV muscle groups. The subjects also were videotaped running on a treadmill (3.8 m.s-1). The IK training group performed three sets of eight CON and ECC repetitions at 20, 90, and 180 degrees.s-1 for both muscle groups; and the NIK subjects did exercises commonly used in ankle rehabilitation. Each group trained three times weekly for 8 wk. The IK group showed significantly (P < or = 0.05) CON and ECC strength increases for all INV test conditions and three of the four EV conditions (20 degrees.s-1 CON and ECC, and 180 degrees.s-1 CON). They also demonstrated significant decreases in the rearfoot (2.2 degrees) and pronation/supination (2.9 degrees) angles at heel strike and in delta beta PRO (-2.2 degrees).l The NIK group exhibited no change in rearfoot motion and only increased INV strength at the 180 degrees.s-1 ECC test condition. The findings suggest that pronation can be decreased by an isokinetic strength training program for the INV and EV muscles.

Effects of training on lactate production and removal during progressive exercise in humans.

To determine whether the reduced blood lactate concentrations [La] during submaximal exercise in humans after endurance training result from a decreased rate of lactate appearance (Ra) or an increased rate of lactate metabolic clearance (MCR), interrelationships among blood [La], lactate Ra, and lactate MCR were investigated in eight untrained men during progressive exercise before and after a 9-wk endurance training program. Radioisotope dilution measurements of L-[U-14C]lactate revealed that the slower rise in blood [La] with increasing O2 uptake (VO2) after training was due to a reduced lactate Ra at the lower work rates [VO2 less than 2.27 l/min, less than 60% maximum VO2 (VO2max); P less than 0.01]. At power outputs closer to maximum, peak lactate Ra values before (215 +/- 28 mumol.min-1.kg-1) and after training (244 +/- 12 mumol.min-1.kg-1) became similar. In contrast, submaximal (less than 75% VO2max) and peak lactate MCR values were higher after than before training (40 +/- 3 vs. 31 +/- 4 ml.min-1.kg-1, P less than 0.05). Thus the lower blood [La] values during exercise after training in this study were caused by a diminished lactate Ra at low absolute and relative work rates and an elevated MCR at higher absolute and all relative work rates during exercise.