Validity and reliability of 6-minute pegboard and ring test in patients with asthma.

OBJECTIVE: The 6-minute pegboard and ring test (6PBRT) is a test of upper-extremity functional capacity designed for and validated in chronic obstructive pulmonary disease. The aim of this study was to evaluate the validity and reliability of the 6PBRT in asthma patients. METHODS: Thirty-four adults (30 women, 4 men) with well-controlled asthma were included. Unsupported upper-extremity exercise capacity was assessed using 6PBRT, maximal arm exercise capacity using an arm ergometer, handgrip strength using a hand dynamometer, activities of daily living with the London Chest Activities of Daily Living Scale (LCADL), Milliken ADL scale (MAS) and health-related quality of life using the Asthma Quality of Life Questionnaire (AQLQ) and Health Assessment Questionnaire Disability Index (HAQ-DI). RESULTS: The 6PBRT showed moderate to excellent test-retest reliability with an intraclass correlation coefficient (ICC) value of 0.872 [95% confidence interval (CI) 0.702-0.941]. The 6PBRT was reproducible according to Bland-Altman analysis, with upper and lower limits of agreement of 53.51 and -25.08 rings moved, respectively. The 6PBRT score was significantly correlated with maximum workload (r = 0.514, p = 0.002) achieved in the arm ergometer test, change in dyspnea during 6PBRT (r = -0.402, p = 0.020), LCADL-self-care (r = -0.364, p = 0.037), MAS total (r = 0.483, p = 0.005), AQLQ-symptom domain (r = 0.420, p = 0.026) and HAQ-DI total scores (r = -0.390, p = 0.025). CONCLUSIONS: The 6PBRT can be used as a valid and reliable test to evaluate functional arm exercise capacity in patients with well-controlled asthma.

Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer.

BACKGROUND: The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer. METHODS: A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status. RESULTS: In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = -0.447, standard error (SE) = 0.050, p < 0.001; B = 15.666, SE = 4.542, p = 0.001, respectively). In model 3, performing shoulder-arm exercise for 30 min/day played a partial mediating role in the relationship of the severity of symptoms and QoL (R2 = 0.51, F = 5.41, p < 0.001). CONCLUSIONS: During 2 ~ 4 months after surgery, regular shoulder-arm exercise for 30 min/day could decrease the effect of the severity of symptoms on the QoL among women with breast cancer. Clinical healthcare providers may inform and educate patients as to the benefits of regular shoulder-arm exercise for 30 min/day.

Mechanical-ventilatory responses to peak and ventilation-matched upper- versus lower-body exercise in normal subjects.

NEW FINDINGS: What is the central question of this study? To what extent are the mechanical-ventilatory responses to upper-body exercise influenced by task-specific locomotor mechanics? What is the main finding and its importance? When compared with lower-body exercise performed at similar ventilations, upper-body exercise was characterized by tidal volume constraint, dynamic lung hyperinflation and an increased propensity towards neuromechanical uncoupling of the respiratory system. Importantly, these responses were independent of respiratory dysfunction and flow limitation. Thus, the mechanical ventilatory responses to upper-body exercise are attributable, in part, to task-specific locomotor mechanics (i.e. non-respiratory loading of the thorax). ABSTRACT: The aim of this study was to determine the extent to which the mechanical ventilatory responses to upper-body exercise are influenced by task-specific locomotor mechanics. Eight healthy men (mean ± SD: age, 24 ± 5 years; mass, 74 ± 11 kg; and stature, 1.79 ± 0.07 m) completed two maximal exercise tests, on separate days, comprising 4 min stepwise increments of 15 W during upper-body exercise (arm-cranking) or 30 W during lower-body exercise (leg-cycling). The tests were repeated at work rates calculated to elicit 20, 40, 60, 80 and 100% of the peak ventilation achieved during arm-cranking ( V̇E,UBE ). Exercise measures included pulmonary ventilation and gas exchange, oesophageal pressure-derived indices of respiratory mechanics, operating lung volumes and expiratory flow limitation. Subjects exhibited normal resting pulmonary function. Arm-crank exercise elicited significantly lower peak values for work rate, O2 uptake, CO2 output, minute ventilation and tidal volume (p < 0.05). At matched ventilations, arm-crank exercise restricted tidal volume expansion relative to leg-cycling exercise at 60% V̇E,UBE (1.74 ± 0.61 versus 2.27 ± 0.68 l, p < 0.001), 80% V̇E,UBE (2.07 ± 0.70 versus 2.52 ± 0.67 l, p < 0.001) and 100% V̇E,UBE (1.97 ± 0.85 versus 2.55 ± 0.72 l, p = 0.002). Despite minimal evidence of expiratory flow limitation, expiratory reserve volume was significantly higher during arm-cranking versus leg-cycling exercise at 100% V̇E,UBE (39 ± 8 versus 29 ± 8% of vital capacity, p = 0.002). At any given ventilation, arm-cranking elicited greater inspiratory effort (oesophageal pressure) relative to thoracic displacement (tidal volume). Arm-cranking exercise is sufficient to provoke respiratory mechanical derangements (restricted tidal volume expansion, dynamic hyperinflation and neuromechanical uncoupling) in subjects with normal pulmonary function and expiratory flow reserve. These responses are likely to be attributable to task-specific locomotor mechanics (i.e. non-respiratory loading of the thorax).

Prevalence and Predictors of Early Heart Failure With Preserved Ejection Fraction in Patients With Paroxysmal Atrial Fibrillation.

BACKGROUND: Patients with atrial fibrillation (AF) have an increased risk of diastolic dysfunction and heart failure. The purpose of this study was to identify independent predictors of early (ie, only exercise-induced) heart failure with preserved ejection fraction (HFpEF) and to describe the prevalence of early HFpEF among patients with paroxysmal AF. METHODS AND RESULTS: One hundred patients with paroxysmal AF and preserved left ventricular ejection fraction (LVEF) underwent catheterization for left atrial pressure (LAP) measurements at rest and at the peak of arm exercise (LAP-exe). Based on resting and exercise LAP values, the patients were divided into 3 groups. Sixty-one patients had no evidence of HFpEF (LAP at rest ≤15 mm Hg, LAP-exe <25 mm Hg). Twenty-five subjects had early HFpEF (LAP at rest ≤15 mm Hg, LAP-exe ≥25 mm Hg, prevalence 25%). Fourteen patients already had HFpEF at rest (LAP at rest >15 mm Hg). Multivariate exact logistic regression analysis identified age ≥58 years, LAP at rest ≥11 mm Hg, and peak systolic mitral annular velocity ≤9.3 cm/s to be independent predictors of early HFpEF. CONCLUSIONS: In patients with paroxysmal AF and preserved LVEF, there appears to be a clinically significant prevalence of early HFpEF.

Validation of an Arm Crank Ergometer Test for Use in Sedentary Adults.

The maximal oxygen uptake (V̇O2peak) test is an approved pre-operative examination tool, in a clinical setting: Both V̇O2peak and anaerobic threshold indicate a patient's physiological tolerance for major surgery and post-operative mortality, with cycle ergometry being routinely used for V̇O2peak tests in clinical settings, in many European countries. Nevertheless, the opportunities to assess populations with restricted mobility of the lower limbs are limited, as alternative methods (such as an arm-crank test protocol) to assess V̇O2peak are yet to be established. Twelve sedentary middle-aged adults (55.1 ± 5.0 years) performed two incremental protocols on an arm crank and cycle ergometer on separate occasions. During exercise, gas exchange was collected and analysed by an online breath-by-breath analysis system. Regression analysis showed that the model with dependent variable cycle ergometer V̇O2peak (CEV̇O2peak) in ml·kg-1·min-1 and independent variables arm crank V̇O2peak (ACEV̇O2peak) in ml·kg-1·min-1, lean body mass lower limbs (LBMLL) and total lean body mass (TLBM) fitted the population the best, with r2 = 0.87, adj. r2 = 0.82 and SEE = 3.14. The equation estimated with this model is: CE V̇O2peak = 11.776 + 1.418 X ACE V̇O2peak(ml·kg-1·min-) - 1.454 x TLBM + 3.967 X LLLBM. Our study suggests that arm cranking could be an alternative mode of exercise for sedentary middle-aged adults (and potentially in clinical settings) to assess the cardiorespiratory fitness of people with restricted lower-limb mobility.

Constant infusion transpulmonary thermodilution for the assessment of cardiac output in exercising humans.

To determine the accuracy and precision of constant infusion transpulmonary thermodilution cardiac output (CITT-Q) assessment during exercise in humans, using indocyanine green (ICG) dilution and bolus transpulmonary thermodilution (BTD) as reference methods, cardiac output (Q) was determined at rest and during incremental one- and two-legged pedaling on a cycle ergometer, and combined arm cranking with leg pedaling to exhaustion in 15 healthy men. Continuous infusions of iced saline in the femoral vein (n = 41) or simultaneously in the femoral and axillary (n = 66) veins with determination of temperature in the femoral artery were used for CITT-Q assessment. CITT-Q was linearly related to ICG-Q (r = 0.82, CITT-Q = 0.876 × ICG-Q + 3.638, P < 0.001; limits of agreement ranging from -1.43 to 3.07 L/min) and BTD-Q (r = 0.91, CITT-Q = 0.822 × BTD + 4.481 L/min, P < 0.001; limits of agreement ranging from -1.01 to 2.63 L/min). Compared with ICG-Q and BTD-Q, CITT-Q overestimated cardiac output by 1.6 L/min (≈ 10% of the mean ICG and BTD-Q values, P < 0.05). For Q between 20 and 28 L/min, we estimated an overestimation < 5%. The coefficient of variation of 23 repeated CITT-Q measurements was 6.0% (CI: 6.1-11.1%). In conclusion, cardiac output can be precisely and accurately determined with constant infusion transpulmonary thermodilution in exercising humans.

Handcycling: training effects of a specific dose of upper body endurance training in females.

PURPOSE: This study aims to evaluate a handcycling training protocol based on ACSM guidelines in a well-controlled laboratory setting. Training responses of a specific dose of handcycling training were quantified in a homogeneous female subject population to obtain a more in depth understanding of physiological mechanisms underlying adaptations in upper body training. METHODS: 22 female able-bodied participants were randomly divided in a training (T) and control group (C). T received 7-weeks of handcycling training, 3 × 30 min/week at 65 % heart rate reserve (HRR). An incremental handcycling test was used to determine local, exercise-specific adaptations. An incremental cycling test was performed to determine non-exercise-specific central/cardiovascular adaptations. Peak oxygen uptake (peakVO2), heart rate (peakHR) and power output (peakPO) were compared between T and C before and after training. RESULTS: T completed the training sessions at 65 ± 3 % HRR, at increasing power output (59.4 ± 8.2 to 69.5 ± 8.9 W) over the training program. T improved on handcycling peakVO2 (+18.1 %), peakPO (+31.9 %), and peakHR (+4.0 %). No improvements were found in cycling parameters. CONCLUSION: Handcycling training led to local, exercise-specific improvements in upper body parameters. Results could provide input for the design of effective evidence-based training programs specifically aimed at upper body endurance exercise in females.

Circulating angiogenic biomolecules at rest and in response to upper-limb exercise in individuals with spinal cord injury.

OBJECTIVE: Individuals with spinal cord injury (SCI) show structural and functional vascular maladaptations and muscle loss in their lower limbs. Angiogenic biomolecules play important roles in physiological and pathological angiogenesis, and are implicated in the maintenance of muscle mass. This study examined the responses of angiogenic molecules during upper-limb aerobic exercise in patients with SCI and in able-bodied (AB) individuals. METHODS: Eight SCI patients with thoracic lesions (T6-T12, ASIA A) and eight AB individuals performed an arm-cranking exercise for 30 minutes at 60% of their VO2max. Plasma concentrations of vascular endothelial growth factor (VEGF-A165), VEGF receptor 1 (sVEGFr-1), VEGF receptor 2 (sVEGFr-2), metalloproteinase 2 (MMP-2), and endostatin were measured at rest, after exercise, and at 1.5 and 3.0 hours during recovery. RESULTS: The two-way analysis of variance showed non-significant main effects of "group" and significant main effects of "time/exercise" for all angiogenic biomolecules examined (P < 0.01-0.001). The arm-cranking exercise significantly increased plasma concentrations of VEGF, sVEGFr-1, sVEGFr-2, MMP-2, and endostatin in both groups (P < 0.001-0.01). The magnitude of the increase was similar in both patients with SCI and AB individuals, as shown by the non-significant group × time interaction for all angiogenic parameters. CONCLUSIONS: Upper-limb exercise (arm-cranking for 30 minutes at 60% of VO2max) is a sufficient stimulus to trigger a coordinated circulating angiogenic response in patients with SCI. The response of angiogenic molecules to upper-limb aerobic exercise in SCI appears relatively similar to that observed in AB individuals.

Effectiveness of upper arm and breathing exercises to improve inflammatory markers in severe COVID-19 patients.

Studies have suggested associations between inflammatory markers with the severity of coronavirus disease 2019 (COVID-19). Therefore, exercises that could reduce the level of inflammatory markers might be beneficial. The aim of this study was to determine the effect of upper arm and breathing exercises on inflammatory markers such as ferritin, lactate dehydrogenase (LDH), and C-reactive protein (CRP) in severe COVID-19 patients. A quasi-experimental with pre-test and post-test control group design was conducted among severe COVID-19 aged 18-70 years old, with or without comorbidities. Baseline data of inflammatory markers (ferritin, LDH, and CRP) were measured before the exercises and repeated post-exercise. The upper arm and breathing exercises were performed for ten days, twice a day (morning and evening) for ten minutes. A paired Student t-test was used to assess the changes in the inflammatory markers' levels. Our data indicated that levels of ferritin and CRP were not significantly different between pre- and post-exercise. However, the level of LDH decreased significantly from 481.35 U/L to 331.80 U/L (p=0.001). This study highlights that pulmonary rehabilitation exercises might be beneficial to enhance the recovery process in severe COVID-19 patients.

The contribution of "resting" body muscles to the slow component of pulmonary oxygen uptake during high-intensity cycling.

Oxygen uptake (VO2) kinetics during moderate constant-workrate (WR) exercise (>lactate-threshold (θL)) are well described as exponential. AboveθL, these kinetics are more complex, consequent to the development of a delayed slow component (VO2sc), whose aetiology remains controversial. To assess the extent of the contribution to the VO2sc from arm muscles involved in postural stability during cycling, six healthy subjects completed an incremental cycle-ergometer test to the tolerable limit for estimation of θL and determination of peak VO2. They then completed two constant-WR tests at 90% of θL and two at 80% of ∆ (difference between θL and VO2peak). Gas exchange variables were derived breath-by-breath. Local oxygenation profiles of the vastus lateralis and biceps brachii muscles were assessed by near-infrared spectroscopy, with maximal voluntary contractions (MVC) of the relevant muscles being performed post-exercise to provide a frame of reference for normalising the exercise-related oxygenation responses across subjects. Above supra-θL, VO2 rose in an exponential-like fashion ("phase 2), with a delayed VO2sc subsequently developing. This was accompanied by an increase in [reduced haemoglobin] relative to baseline (∆[Hb]), which attained 79 ± 13 % (mean, SD) of MVC maximum in vastus lateralis at end-exercise and 52 ± 27 % in biceps brachii. Biceps brachii ∆[Hb] was significantly correlated with VO2 throughout the slow phase. In contrast, for sub- L exercise, VO2 rose exponentially to reach a steady state with a more modest increase in vastus lateralis ∆[Hb] (30 ± 11 %); biceps brachii ∆[Hb] was minimally affected (8 ± 2 %). That the intramuscular O2 desaturation profile in biceps brachii was proportional to that for VO2sc during supra-θL cycle ergometry is consistent with additional stabilizing arm work contributing to the VO2sc.

Differences in Rate of Perceived Exertion and Workload Intensity in Males and Females during Submaximal Arm and Leg Ergometry.

Purpose: Arm ergometry (AE) is necessitated for individuals unable to perform leg ergometry (LE) exercise. This study explored gender differences in RPE and workload (WL) during AE and LE at submaximal target heart rates (THR). Methods: 35 healthy college-aged individuals were randomly allocated to begin exercise on either AE or LE. Participants exercised on both modes with increasing WL to achieve submaximal THRs of 110, 120, 130, 140 and 150 beats per minute (bpm). Factorial ANOVAs tested for differences in RPE and WL. Results: No significant differences were found in RPE between genders, as well as between arm and leg exercise (p > 0.001). For WL, a significant main effect was found for mode with LE greater than AE (p < 0.001), and gender, with males greater than females (p < 0.001). A significant interaction effect was also found for HR and mode, with a greater increase in WL during LE compared to AE in both genders (p = 0.001). Conclusions: Exercise specialists typically prescribe exercise based on a chosen THR. The results of this study provide meaningful data on mean RPE and WL responses that a given THR elicits for ergometry. The finding of no differences in RPE between AE and LE informs the clinician that at any given submaximal THR, similar RPE scores can be expected during AE and LE. Further research is warranted to investigate differences in wider populations.

Effects of chronic decaffeinated green tea extract supplementation on lipolysis and substrate utilization during upper body exercise.

BACKGROUND: Decaffeinated green tea extract (dGTE) can increase fat oxidation during leg exercise, but dGTE is unsuitable for many people (e.g., those with injuries/disabilities), and its effects on arm exercise and women are unknown. METHODS: Eight adults (23-37 years old, 4 women) performed an incremental arm cycle test to measure peak oxygen uptake (VO2peak), followed by four 1-h trials at 50% VO2peak. Subjects were randomly assigned to 650 mg of dGTE or placebo (PLA) for 4 weeks followed by a 4-week washout and crossover trial. Blood samples were obtained pre-exercise and post-exercise for glycerol and free fatty acid analysis. Respiratory gases were collected continuously. RESULTS: VO2 showed no differences across trials ((0.83-0.89) ± (0.19-0.25) L/min, p = 0.460), neither did energy expenditure ((264-266) ± (59-77) kcal, p = 0.420) nor fat oxidation (dGTE = 0.11 to 0.12 g/min vs. PLA = 0.10 to 0.09 g/min, p = 0.220). Fat oxidation as percentage of energy expenditure was not different for dGTE vs. PLA (23% ± 12% to 25% ± 11% vs. 23% ± 10% to 21% ± 9%, p = 0.532). Glycerol concentration increased post-exercise in all trials, independent of treatments (pre = (3.4-5.1) ± (0.6-2.6) mg/dL vs. post = (7.9-9.8) ± (2.6-3.7) mg/dL, p = 0.867, η2 = 0.005 for interaction), as did free fatty acid ((3.5-4.8) ± (1.4-2.2) mg/dL vs. (7.2-9.1) ± (2.6-4.5) mg/dL, p = 0.981, η2 = 0.000). CONCLUSION: Chronic dGTE supplementation had no effect on lipolysis and fat oxidation during arm cycle exercise in men and women.

The effect of early arm exercise on drainage volume after total mastectomy and tissue expander insertion in breast cancer patients: a prospective study.

BACKGROUND: In prosthesis-based breast reconstruction patients, the drain tends to be kept in place longer than in patients who undergo only mastectomy. Postoperative arm exercise also increases the drainage volume. However, to preserve shoulder function, early exercise is recommended. In this study, we investigated the effect of early exercise on the total drainage volume and drain duration in these patients. METHODS: We designed a prospective randomized trial involving 56 patients who underwent immediate breast reconstruction following mastectomy using tissue expanders. In each group, the patients were randomized either to perform early arm exercises using specific shoulder movement guidelines 2 days after surgery or to restrict arm movement above the shoulder height until drain removal. The drain duration and the total amount of drainage were the primary endpoints. RESULTS: There were no significant differences in age, height, weight, body mass index, or mastectomy specimen weight between the two groups. The total amount of drainage was 1,497 mL in the early exercise group and 1,336 mL in the exercise restriction group. The duration until complete removal of the drains was 19.71 days in the early exercise group and 17.11 days in the exercise restriction group. CONCLUSIONS: Exercise restriction after breast reconstruction did not lead to a significant difference in the drainage volume or the average time until drain removal. Thus, early exercise is recommended for improved shoulder mobility postoperatively. More long-term studies are needed to determine the effect of early exercise on shoulder mobility in prosthesis-based breast reconstruction patients.

Can the fistula arm be used to lift heavy items? Six-pound dumbbells versus handgrip exercise in a 6-month follow-up secondary analysis of a randomized controlled trial.

INTRODUCTION: Patients with arteriovenous fistulas are advised to avoid carrying heavy objects draped over the fistula arm. Awareness gradually leads to overprotection and a reduction in the use of the fistula arm. However, restricting motion in the fistula arm leads to decreased quality of life and diminished muscle strength. The current safety recommendations regarding lifting heavy items with the fistula arm are primarily based on experience. Few studies have provided evidence clarifying the scope of safe activity and the influence of load bearing on the continued patency of arteriovenous fistulas. METHODS: This prospective observation was based on a long-term follow-up study in which 86 hemodialysis recipients with arteriovenous fistulas were randomized into either a dumbbell group or a handgrip group. The dumbbell group exercised with 6-lb dumbbells, while the handgrip group squeezed rubber balls. Postintervention primary patency and adverse events at the 6-month follow-up were analyzed. RESULTS: No significant difference in postintervention primary patency was observed between the dumbbell group and the handgrip group at 6 months (97.4% vs 95.0%). There were two participants with high-flow fistulas in the dumbbell group and three in the handgrip group, with no significant difference between the two groups (5.3% vs 7.5%). In both groups, there were no other adverse events reported regarding cardiac failure, aneurysm, puncture site hematoma, or hemorrhage. CONCLUSION: Hemodialysis patients can safely use their fistula arm to lift objects weighing less than 6 lb, which encourages increased motion and helps preserve the functionality of the fistula arm.

Effect of early pendulum exercise on shoulder function after cardiac rhythm management device implantation.

PURPOSE: Patients who are post-implantation of cardiac rhythm management devices (CRMDs) are commonly instructed to restrict ipsilateral arm movement to reduce risk of lead dislodgement. This immobilization practice increases risk of shoulder-related pain leading to limited shoulder function. We aimed to assess effect of pendulum exercise on shoulder function in patients after CRMD implantation. METHODS: This study was a prospective, randomized, open-blinded end point study conducted with 200 patients undergoing CRMD implantation. They were randomized into two groups, standard care (control) and pendulum exercise (experimental) groups. The shoulder function was assessed using QuickDASH-TH scores and measurement of the range of motion (ROM) of shoulder abduction and flexion before and 1 month after implantation. RESULTS: Baseline characteristics did not differ between the two groups. The lower incidence of shoulder ROM reduction after CRMD implantation was demonstrated in the pendulum exercise group compared to the control group in both flexion (16.8% vs. 40.4%, P < 0.001) and abduction (9.9% vs. 32.3%, P < 0.001). A lower disability of shoulder function after implantation assessed by QuickDASH-TH scores was also noted in the exercise group compared to control (15.2 ± 16.4 vs. 23.4 ± 18.1, P = 0.001). Two patients in the control group and one in the exercise group had atrial lead dislodgement on the day following the procedure. CONCLUSIONS: Early pendulum exercise with ipsilateral arm after CRMD implantation was safe and resulted in lower incidence of limited shoulder ROM and less disability of shoulder function compared to control group. TRIAL REGISTRATION: The study was registered in clinicaltrials.in.th , and the identification number is TCTR20180612003.

Slow loaded breathing training improves blood pressure, lung capacity and arm exercise endurance for older people with treated and stable isolated systolic hypertension.

BACKGROUND: Hypertension and reduced lung function are important features of aging. Slow loaded breathing training reduces resting blood pressure and the question is whether this can also improve lung function. METHODS: Thirty-two people (67 ±â€¯5 years, 16 male) with controlled isolated systolic hypertension undertook an eight weeks randomised controlled training trial with an inspiratory load of 25% maximum inspiratory pressure (MIP) at 6 breaths per minute (slow loaded breathing; SLB) or deep breathing control (CON). Outcome measures were resting blood pressure (BP) and heart rate; MIP; lung capacity; chest and abdominal expansion; arm cranking exercise endurance at 50% heart rate reserve. RESULTS: Home based measurement of resting systolic BP decreased by 20 mm Hg (15 to 25) (Mean and 95%CI) for SLB and by 5 mm Hg (1 to 7) for CON. Heart rate and diastolic BP also decreased significantly for SLB but not CON. MIP increased by 15.8 cm H2O (11.8 to 19.8) and slow vital capacity by 0.21 L (0.15 to 0.27) for SLB but not for CON. Chest and abdominal expansion increased by 2.3 cm (2.05 to 2.55) and 2.5 cm (2.15 to 2.85), respectively for SLB and by 0.5 cm (0.26 to 0.74) and 1.7 cm (1.32 to 2.08) for CON. Arm exercise time increased by 4.9 min (3.65 to 5.15) for SLB with no significant change for CON. CONCLUSION: Slow inspiratory muscle training is not only effective in reducing resting BP, even in older people with well controlled isolated systolic hypertension but also increases inspiratory muscle strength, lung capacity and arm exercise duration.

Low-Volume Intense Exercise Elicits Post-exercise Hypotension and Subsequent Hypervolemia, Irrespective of Which Limbs Are Exercised.

INTRODUCTION: Exercise reduces arterial and central venous blood pressures during recovery, which contributes to its valuable anti-hypertensive effects and to facilitating hypervolemia. Repeated sprint exercise potently improves metabolic function, but its cardiovascular effects (esp. hematological) are less well-characterized, as are effects of exercising upper versus lower limbs. The purposes of this study were to identify the acute (<24 h) profiles of arterial blood pressure and blood volume for (i) sprint intervals versus endurance exercise, and (ii) sprint intervals using arms versus legs. METHODS: Twelve untrained males completed three cycling exercise trials; 50-min endurance (legs), and 5(*)30-s intervals using legs or arms, in randomized and counterbalanced sequence, at a standardized time of day with at least 8 days between trials. Arterial pressure, hemoglobin concentration and hematocrit were measured before, during and across 22 h after exercise, the first 3 h of which were seated rest. RESULTS: The post-exercise hypotensive response was larger after leg intervals than endurance (AUC: 7540 ± 3853 vs. 3897 ± 2757 mm Hg·min, p = 0.049, 95% CI: 20 to 6764), whereas exercising different limbs elicited similar hypotension (arms: 6420 ± 3947 mm Hg·min, p = 0.48, CI: -1261 to 3896). In contrast, arterial pressure at 22 h was reduced after endurance but not after leg intervals (-8 ± 8 vs. 0 ± 7 mm Hg, p = 0.04, CI: 7 ± 7) or reliably after arm intervals (-4 ± 8 mm Hg, p = 0.18 vs. leg intervals). Regardless, plasma volume expansion at 22 h was similar between leg intervals and endurance (both +5 ± 5%; CI: -5 to 5%) and between leg and arm intervals (arms: +5 ± 7%, CI: -8 to 5%). CONCLUSIONS: These results emphasize the relative importance of central and/or systemic factors in post-exercise hypotension, and indicate that markedly diverse exercise profiles can induce substantive hypotension and subsequent hypervolemia. At least for endurance exercise, this hypervolemia may not depend on the volume of post-exercise hypotension. Finally, endurance exercise led to reduced blood pressure the following day, but sprint interval exercise did not.

Cardiovascular control during whole body exercise.

It has been considered whether during whole body exercise the increase in cardiac output is large enough to support skeletal muscle blood flow. This review addresses four lines of evidence for a flow limitation to skeletal muscles during whole body exercise. First, even though during exercise the blood flow achieved by the arms is lower than that achieved by the legs (∼160 vs. ∼385 ml·min(-1)·100 g(-1)), the muscle mass that can be perfused with such flow is limited by the capacity to increase cardiac output (42 l/min, highest recorded value). Secondly, activation of the exercise pressor reflex during fatiguing work with one muscle group limits flow to other muscle groups. Another line of evidence comes from evaluation of regional blood flow during exercise where there is a discrepancy between flow to a muscle group when it is working exclusively and when it works together with other muscles. Finally, regulation of peripheral resistance by sympathetic vasoconstriction in active muscles by the arterial baroreflex is critical for blood pressure regulation during exercise. Together, these findings indicate that during whole body exercise muscle blood flow is subordinate to the control of blood pressure.

Effects of non-paretic arm exercises using a tubing band on abdominal muscle activity in stroke patients.

BACKGROUND: Abdominal strengthening exercises are important for stroke patients; however, there is a lack of research on therapeutic exercises for increasing abdominal muscle activity in stroke patients. OBJECTIVE: We investigated the effects of non-paretic arm exercises using a tubing band on abdominal muscle activity in stroke patients. METHODS: In total, 18 hemiplegic subjects (13 males, 5 females) were recruited. All subjects performed non-paretic arm exercises involving three different shoulder movements (extension, flexion, and horizontal abduction) using an elastic tubing band. Surface electromyography (EMG) signals were recorded from the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles bilaterally during non-paretic arm exercises. RESULTS: EMG activities of abdominal muscles during non-paretic arm extension and horizontal abduction were increased significantly versus shoulder flexion when subjects performed the arm exercise in a seated position. Muscle activity of the EO was significantly greater in the paretic than the non-paretic side during non-paretic arm extension and horizontal abduction. CONCLUSIONS: We suggest that non-paretic arm extension and horizontal abduction exercises using an elastic tubing band may be effective in increasing abdominal muscle activity.

Stability Ball Sitting versus Chair Sitting During Sub-maximal Arm Ergometry.

It was predicted that sitting on a stability ball during arm ergometry would elevate cardiovascular parameters when compared to sitting on a chair and that this would be associated with greater recruitment of trunk and leg skeletal muscles. METHODS: Open-circuit spirometry, videotaping, blood pressure, heart rate, and EMG were conducted during rest and four minute stages of 15 W, 30 W, and 45 W using a Monark arm ergometer. Twenty-six apparently healthy adults exercised twice, once sitting on a stability ball and the other sitting on a chair (order randomized), with 45 to 60 minutes of rest between. ANOVA for repeated measures and paired-t testing were used for analysis. RESULTS: Oxygen consumption was significantly 10 to 16% higher during exercise while sitting on the stability ball. There were no significant differences between sitting modes for heart rate, SBP, and DBP. Also, resting and exercise rectus femoris and 45 W external oblique EMGs were significantly higher on the stability ball. Finally, the knee was significantly more extended with the feet farther apart and more forward on the stability ball. CONCLUSION: The stability ball significantly elevates oxygen consumption during sub-maximal arm cranking without significantly increasing heart rate or blood pressure and this is associated with increased thigh muscle activation and lower leg repositioning.