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• A prognostic scoring system for arm exercise stress testing

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  A prognostic scoring system for arm exercise stress testing

  Author(s)

  Yan Xie, Hong Xian, Pooja Chandiramani, Emily Bainter, Leping Wan, and Wade H Martin, III

  Date

  2016-01-12

  Source

  Open Heart

  Objective
  Arm exercise stress testing may be an equivalent or better predictor of mortality outcome than pharmacological stress imaging for the ≥50% for patients unable to perform leg exercise. Thus, our objective was to develop an arm exercise ECG stress test scoring system, analogous to the Duke Treadmill Score, for predicting outcome in these individuals.

  Methods
  In this retrospective observational cohort study, arm exercise ECG stress tests were performed in 443 consecutive veterans aged 64.1 (11.1) years. (mean (SD)) between 1997 and 2002. From multivariate Cox models, arm exercise scores were developed for prediction of 5-year and 12-year all-cause and cardiovascular mortality and 5-year cardiovascular mortality or myocardial infarction (MI).

  Results
  Arm exercise capacity in resting metabolic equivalents (METs), 1 min heart rate recovery (HRR) and ST segment depression ≥1 mm were the stress test variables independently associated with all-cause and cardiovascular mortality by step-wise Cox analysis (all p<0.01). A score based on the relation HRR (bpm)+7.3×METs−10.5×ST depression (0=no; 1=yes) prognosticated 5-year cardiovascular mortality with a C-statistic of 0.81 before and 0.88 after adjustment for significant demographic and clinical covariates. Arm exercise scores for the other outcome end points yielded C-statistic values of 0.77–0.79 before and 0.82–0.86 after adjustment for significant covariates versus 0.64–0.72 for best fit pharmacological myocardial perfusion imaging models in a cohort of 1730 veterans who were evaluated over the same time period.

  Conclusions
  Arm exercise scores, analogous to the Duke Treadmill Score, have good power for prediction of mortality or MI in patients who cannot perform leg exercise.

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• Arm exercise stress testing: diagnostic options in stable coronary artery disease

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  Arm exercise stress testing: diagnostic options in stable coronary artery disease

  Author(s)

  Rahul Bahl & Pascal Meierl

  Date

  2016-05-13

  Source

  Open Heart V3(1) 2016

  Diagnostic and prognostic testing in coronary artery disease (CAD) is a rapidly expanding field and now includes a range of functional tests, imaging modalities and combinations of the two (stress imaging). For patients suspected of having occlusive CAD, current European Society of Cardiology and National Institute for Health and Clinical Excellence guidance1 2 recommends an approach where the probability of obstructive disease and the risk of future events are estimated to determine the next steps. Those at low-risk on the basis of history, examination and basic investigations do not need further assessment, while those at high-risk can proceed directly to treatment, including invasive angiography, if needed. However, for intermediate risk patients, there are a number of options.

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• Arm exercise testing predicts clinical outcome

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  Arm exercise testing predicts clinical outcome

  Author(s)

  Nasreen A. Ilias, Hong Xian, Cindi Inman, Wade H. Martin

  Date

  2009-01-01

  Source

  Am Heart J. 2009 Jan;157(1):69-76. doi: 10.1016/j.ahj.2008.09.007. Epub 2008 Nov 1.

  Treadmill exercise testing provides prognostic and clinical information that is not available for patients with lower extremity disabilities who undergo pharmacologic stress tests. We sought to determine whether arm ergometer (AXT) exercise capacity in resting metabolic equivalents (METs) and hemodynamic and electrocardiographic responses to AXT are predictors of survival, myocardial infarction (MI), or coronary revascularization, individually or as a composite.

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• Comparison of Lower- vs. Upper-Body Cooling During Arm Exercise in Hot Conditions

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  Comparison of Lower- vs. Upper-Body Cooling During Arm Exercise in Hot Conditions

  Author(s)

  Price, Michael J.; Mather, Mark I.

  Date

  2004-03-01

  Source

  Aviation, Space, and Environmental Medicine, Volume 75, Number 3, March 2004 , pp. 220-226(7)

  Introduction: Studies examining cooling strategies and exercise have generally employed lower-body exercise despite the fact that arm exercise is an important mode for many industrial tasks and disabled populations. The aim of this study was to determine the effects of two cooling strategies during arm exercise in the heat. Methods: There were eight male subjects (mean ± SD age 24.5 ± 4.0 yr, weight 81.0 ± 7.8 kg, upper-body [V-dot]O2peak 3.13 ± 0.50 L • min−1) who volunteered for this study. Subjects undertook arm crank exercise for 30 min (50% [V-dot]O2peak) in a hot environment (40.2 ± 0.4°C, 38.7 ± 7.4% RH) on three occasions (no cooling control, CON; lower-body cooling, LC; upper-body cooling, UC). Results: No differences were observed between trials for oxygen consumption, respiratory exchange rate (RER), or blood lactate. Heart rate (HR) was greatest during CON (151 ± 11 bpm) when compared with UC and LC (148 ± 16 and 138 ± 13 bpm; p < 0.05). Mean skin temperature was warmer during CON (36.3 ± 0.5°C) when compared with UC (31.2 ± 1.4°C, p < 0.05), which was warmer than during LC (28.5 ± 1.3°C, p < 0.05). No differences were observed for rectal or aural temperatures between trials. At the end of exercise, heat storage was hyperthermic (3.04 ± 0.68 J • g−1), thermoneutral (0.18 ± 1.21 J • g−1), and hypothermic (−2.37 ± 0.81 J • g−1) during CON, UC, and LC, respectively (p < 0.05). Perceived exertion was lowest during LC and greatest during CON (p < 0.05).Conclusions: The results of this study suggest that cooling the lower body during arm exercise in hot conditions is more effective in reducing physiological and thermal strain than cooling the upper body.

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• Effects of Arm-Cranking Exercise in Cutaneous Microcirculation in Older, Sedentary People

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  Effects of Arm-Cranking Exercise in Cutaneous Microcirculation in Older, Sedentary People

  Author(s)

  MARKOS KLONIZAKIS, EDWARD WINTER

  Date

  2011-09-12

  Source

  Microvascular Research, 2011 – Elsevier

  Objectives: Microvascular integrity is compromised by several diseases and conditions as well as age. Exercise can reverse these effects but it is unclear whether these are systemic or localised, or which mechanisms are responsible for observed improvements Therefore, the primary objective of this study was to assess whether arm-cranking exercise had a systemic or localised cutaneous, microcirculatory effect in an older, healthy population and compare these findings with our previous work on patients with chronic venous disease. A secondary objective was to see if improvements were greater in the lower- or in the upper-limb.
  Methods: Endothelial dependent- and independent- vasodilation were assessed on the forearm and the perimalleolar region in 14 older (59 ± 4.5 years), sedentary, healthy participants using LDF and incremental doses of acetylcholine (ACh) and sodium nitroprusside (SNP), before and after a session of arm-cranking exercise. Cutaneous blood flux data were expressed as cutaneous vascular conductance (CVC).
  Results: Endothelial-dependent vasodilation increased both in the upper- (p=0.04, d=0.59) and lower-limb (p=0.03, d=0.52), after exercise. Endothelial-independent vasodilation did not
  change either in the lower- and upper-limb (p>0.05 on both occasions). “Between-limbs”
  comparison showed that pre-exercise differences between the forearm and the lower-leg
  (p=0.04, d=0.47) disappeared after ACh-induced vasodilation, following arm-cranking exercise (p>0.05). Conversely, SNP-induced did not change.
  Conclusion: Our results suggest that in a healthy, sedentary population (and in contrast to postsurgical varicose vein patients), acute arm-cranking exercise leads to an improvement of
  microvascular endothelial function in the extremities.

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• Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events

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  Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events

  Author(s)

  Richard V. Milani, Carl J.Lavie MD, Mark M. Cassidy MD

  Date

  1996-10-01

  Source

  American Heart Journal, Volume 132, Issue 4, October 1996, pages 726 – 732

  To evaluate the effect of cardiac rehabilitation and exercise training on depression after major cardiac events, we studied 338 consecutive patients in whom a major cardiac event had occurred 4 to 6 weeks previously and who were participating in phase II cardiac rehabilitation consisting of 36 sessions over a 3-month period. Depressive symptoms and other behavioral characteristics and quality-of-life parameters were analyzed by validated questionnaire. Depression was prevalent in patients with coronary heart disease, occurring in 20% of the patients evaluated. At baseline, depressed patients had lower exercise capacity, reduced high-density lipoprotein cholesterol level, and higher triglyceride levels; had lower scores for mental health, energy or fatigue, general health, pain, overall function, well-being, and total quality of life; and had greater scores for somatization, anxiety, and hostility than those of nondepressed patients. After cardiac rehabilitation, depressed patients had marked improvements in depression scores and other behavioral parameters (anxiety, somatization, and hostility) and quality of life. Depressed patients also showed improved exercise capacity, percentage of body fat, and levels of triglycerides and high-density lipoprotein cholesterol. Depressed patients exhibited statistically greater improvements in certain behavioral and quality-of-life parameters than did nondepressed patients. Two thirds of the patients who were initially depressed resolved their symptoms by study completion. In conclusion, depression is reduced in patients with symptomatic coronary heart disease patients enrolled in cardiac rehabilitation. Greater emphasis is needed to ensure that depressed patients are referred to and attend formal cardiac rehabilitation programs after major cardiac events.

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• Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals (video article)

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  Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals (video article)

  Author(s)

  Joelle L. Flueck1

  Date

  2017-08-06

  Source

  Journal of Visualized Experiments

  Reliable exercise protocols are required to test changes in exercise performance in elite athletes. Performance improvements in these athletes may be small; therefore, sensitive tools are fundamental to exercise physiology. There are currently many exercise tests that allow for the examination of exercise capacity in able-bodied athletes, with protocols mainly for lower-body or whole-body exercise. There is a trend to test athletes in a sport-specific setting that closely resembles the actions that the participants are used to performing. Only a few protocols test short-term, high-intensity exercise capacity in participants with an impairment of the lower body. Most of these protocols are very sportspecific and are not applicable to a wide range of athletes. One well-known test protocol is the 30 s Wingate test, which is well-established in cycling and in arm crank exercise testing. This test analyzes high-intensity exercise performance over a 30 s time duration. In order to monitor exercise performance over a longer duration, a different method was modified for application to the upper body. The 3 min, all-out arm crank ergometer test allows athletes to be tested in a manner specific to 1,500 m wheelchair racing (in terms of exercise duration), as well as to upper body exercises such as rowing or hand-cycling. In order to increase the reliability with identical test conditions, it is crucial to precisely replicate settings such as the resistance (i.e., torque factor) and the position of the participants (i.e., the height of the crank, the distance between the crank and the participant, and the fixation of the participant). Another important issue concerns the beginning of the exercise test. Fixed revolutions per minute are required to standardize the test conditions for the start of the exercise test. This exercise protocol shows the importance of accurate operations to reproduce identical test conditions and settings.

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• Influence of training status and exercise modality on pulmonary O2 uptake kinetics in pre-pubertal girls

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  Influence of training status and exercise modality on pulmonary O2 uptake kinetics in pre-pubertal girls

  Author(s)

  Melitta A. Winlove, Andrew M. Jones, Joanne R. Welsman

  Date

  2010-04-05

  Source

  European Journal of Applies Physiology. April 2010, Volume 108, Issue 6, pp 1169-1179

  The limited available evidence suggests that endurance training does not influence the pulmonary oxygen uptake ( V˙O2 ) kinetics of pre-pubertal children. We hypothesised that, in young trained swimmers, training status-related adaptations in the V˙O2 and heart rate (HR) kinetics would be more evident during upper body (arm cranking) than during leg cycling exercise. Eight swim-trained (T; 11.4 ± 0.7 years) and eight untrained (UT; 11.5 ± 0.6 years) girls completed repeated bouts of constant work rate cycling and upper body exercise at 40% of the difference between the gas exchange threshold and peak V˙O2 . The phase II V˙O2 time constant was significantly shorter in the trained girls during upper body exercise (T: 25 ± 3 vs. UT: 37 ± 6 s; P < 0.01), but no training status effect was evident in the cycle response (T: 25 ± 5 vs. UT: 25 ± 7 s). The V˙O2 slow component amplitude was not affected by training status or exercise modality. The time constant of the HR response was significantly faster in trained girls during both cycle (T: 31 ± 11 vs. UT: 47 ± 9 s; P < 0.01) and upper body (T: 33 ± 8 vs. UT: 43 ± 4 s; P < 0.01) exercise. The time constants of the phase II V˙O2 and HR response were not correlated regardless of training status or exercise modality. This study demonstrates for the first time that swim-training status influences upper body V˙O2 kinetics in pre-pubertal children, but that cycle ergometry responses are insensitive to such differences.

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• Left ventricular mechanical limitations to stroke volume in healthy humans during incremental exercise

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  Left ventricular mechanical limitations to stroke volume in healthy humans during incremental exercise

  Author(s)

  Eric, J. Stöhr, José González-Alonso, Rob Shave

  Date

  2011-08-01

  Source

  American Journal of Physiology – Heart August 1, 2011 vol. 301 no. 2 H478-H487

  During incremental exercise, stroke volume (SV) plateaus at 40–50% of maximal exercise capacity. In healthy individuals, left ventricular (LV) twist and untwisting (“LV twist mechanics”) contribute to the generation of SV at rest, but whether the plateau in SV during incremental exercise is related to a blunting in LV twist mechanics remains unknown. To test this hypothesis, nine healthy young males performed continuous and discontinuous incremental supine cycling exercise up to 90% peak power in a randomized order. During both exercise protocols, end-diastolic volume (EDV), end-systolic volume (ESV), and SV reached a plateau at submaximal exercise intensities while heart rate increased continuously. Similar to LV volumes, two-dimensional speckle tracking-derived LV twist and untwisting velocity increased gradually from rest (all P < 0.001) and then leveled off at submaximal intensities. During continuous exercise, LV twist mechanics were linearly related to ESV, SV, heart rate, and cardiac output (all P < 0.01) while the relationship with EDV was exponential. In diastole, the increase in apical untwisting was significantly larger than that of basal untwisting (P < 0.01), emphasizing the importance of dynamic apical function. In conclusion, during incremental exercise, the plateau in LV twist mechanics and their close relationship with SV and cardiac output indicate a mechanical limitation in maximizing LV output during high exercise intensities. However, LV twist mechanics do not appear to be the sole factor limiting LV output, since EDV reaches its maximum before the plateau in LV twist mechanics, suggesting additional limitations in diastolic filling to the heart.

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• Physical Fitness of Lower Limb Amputees

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  Physical Fitness of Lower Limb Amputees

  Author(s)

  Chin, Takaaki MD, PhD; Sawamura, Seishi MD; Fujita, Hisao MD; Nakajima, Sakuya MD; Oyabu, Hiroko RPT; Nagakura, Yuji RPT; Ojima, Isao RPT; Otsuka, Hiroshi PO; Nakagawa, Akio

  Date

  2002-05-13

  Source

  American Journal of Physical Medicine & Rehabilitation: May 2002 – Volume 81 – Issue 5 – pp 321-325

  Objective: To investigate the cardiorespiratory endurance of the physical fitness of amputees and able-bodied subjects of the same ages and to demonstrate deterioration of the physical fitness of the amputees.
  Design: The test subjects were 31 amputees. Eighteen able-bodied persons served as controls. The incremental exercise test was performed to evaluate physical fitness. Sixteen of 31 amputees underwent endurance training by using a cycle ergometer driven by the intact leg, and their physical fitness was evaluated after completion of the endurance training program.
  Results: The V̇o2max, anaerobic threshold, and maximum workload for the amputees were significantly lower than those of the able-bodied group. The equivalent values for the endurance training group before exercise treatment were 18.0, 12.1, and 63.9, respectively. After exercise treatment, these values significantly increased, and there was no significant difference from the able-bodied subjects.
  Conclusions: This study showed that the physical fitness of amputees was clearly lower than that of the able-bodied subjects and that the amputees were able to recover from a poorly conditioned status after endurance training.

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• Studying the cutaneous microcirculatory response during upper-limb exercise in healthy, older, sedentary people

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  Studying the cutaneous microcirculatory response during upper-limb exercise in healthy, older, sedentary people

  Author(s)

  Markos Klonizakis∗

  Date

  2011-07-01

  Source

  Clinical Hemorheology and Microcirculation 48 (2011) 1–7

  This study investigated changes incurred in cutaneous skin blood flux (SKBF) in the superficial veins of the lower limb by upper limb exercise training in the form of arm-cranking in 14 healthy participants over the age of 50 years. Changes in cutaneous microvascular function of the lower leg were assessed using laser Doppler Flowmetry (LDF) during a 30-minute exercise session undertaken over 4-exercise periods. Both SKBF and Time to reach Peak Perfusion (Tmax) were improved significantly during the 2nd (e.g. 121 (±107.2) vs 280 (±269.1) and 171 (±34.4) vs. 247 (±38.3) respectively) when compared to the first exercise period, while values approaching initial levels in the following stages. The results indicate that the thermoregulatory and vasodilation mechanisms observed during exercise in middle-aged and older healthy people are different to the one appearing in younger age groups, suggesting a more extensive effect of the age-related structural changes than it was previously thought.

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• Subjective Measures of Exercise Intensity to Gauge Substrate Partitioning in Persons With Paraplegia

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  Subjective Measures of Exercise Intensity to Gauge Substrate Partitioning in Persons With Paraplegia

  Author(s)

  Jochen Kressler, PhD, Rachel E. Cowan, PhD, Kelly Ginnity, MS, Mark S. Nash, PhD

  Date

  2012-08-08

  Source

  Topics in Spinal Cord Injury Rehabilitation. Volume 18, Number 3 / Summer 2012

  Background: The Borg Rating of Perceived Exertion (RPE) Scale and talk test (TT) are commonly recommended for persons to gauge exercise intensity. It is not known whether they are suitable to estimate substrate partitioning between carbohydrate and fat in persons with SCI. Objective: Investigate substrate partitioning/utilization patterns associated with RPE and TT. Methods: Twelve participants with chronic paraplegia underwent 2 arm crank exercise tests on nonconsecutive days within 2 weeks. Test 1 was a graded exercise test (GXT) to volitional exhaustion. Test 2 was a 15-minute self-selected steady state (SS) voluntary arm exercise bout simulating a brief, yet typical exercise session. Results: For the GXT, very light intensity exercise (RPE < 9) and TT stage before last positive were associated with highest contribution of fat oxidation (~35%-50%) to total energy expenditure (TEE). Fat oxidation was low at all stages, with the highest rate (0.13 ± 0.07 g/min) occurring at stage 1 (10 W). Corresponding average RPE was 7 ± 2 and the TT was positive for all participants at this stage. For the SS, fuel partitioning throughout exercise was dominated by carbohydrate oxidation (1.47 ± 0.08 g/min), accounting for almost all (~94%) of TEE with only a minute contribution from fat oxidation (0.02 ± 0.004 g/min). A positive TT was associated with an average contribution of fat oxidation of ~10%. Conclusions: RPE but not the TT appears suitable to predict exercise intensities associated with the highest levels of fat oxidation. However, such intensities are below authoritative intensity thresholds for cardiorespiratory fitness promotion, and therefore the applicability of such a prediction for exercise prescriptions is likely limited to individuals with low exercise tolerance.

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• The influence of crank configuration on muscle activity and torque production during arm crank Ergometry

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  The influence of crank configuration on muscle activity and torque production during arm crank Ergometry

  Author(s)

  Paul M. Smith, Mark L. Chapman, Kathryn E. Hazlehurst, Mark A. Goss-Sampson

  Date

  2008-08-11

  Source

  Journal of Electromyography and Kinesiology. Volume 18, Issue 4, Pages 598-605, August 2008

  This study investigated the effect of crank configuration on muscle activity and torque production during submaximal arm crank ergometry. Thirteen non-specifically trained male participants volunteered. During the research trials they completed a warm-up at 15 W before two 3-min exercise stages were completed at 50 and 100 W; subjects used either a synchronous or asynchronous pattern of cranking. During the final 30-s of each submaximal exercise stage electromyographic and torque production data were collected. After the data had been processed each parameter was analysed using separate 2-way ANOVA tests with repeated measures. The activity of all muscles increased in line with external workload, although a shift in the temporal pattern of muscle activity was noted between crank configurations. Patterns of torque production during asynchronous and synchronous cranking were distinct. Furthermore, peak, minimum and delta (peak-minimum) torque values were different (P < 0.05) between crank configurations at both workloads. For example, at 100 W, peak torque using synchronous [19.6 (4.3) Nm] cranking was higher (P < 0.05) compared to asynchronous [16.8 (1.6) Nm] cranking. In contrast minimum torque was lower (P < 0.05) at 100 W using synchronous [4.8 (1.7) Nm] compared to asynchronous [7.3 (1.2) Nm] cranking. There was a distinct bilateral asymmetry in torque production during asynchronous cranking with the dominant transmitting significantly more force to the crank arm. Taken together, these preliminary data demonstrate the complex nature of muscle activity during arm crank ergometry performed with an asynchronous or synchronous crank set-up. Further work is required to determine how muscle activity (EMG activity) and associated patterns of torque production influence physiological responses and functional capacity during arm crank ergometry.

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• The influence of crank rate on peak oxygen consumption during arm crank ergometry

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  The influence of crank rate on peak oxygen consumption during arm crank ergometry

  Author(s)

  Paul M. Smith, Michael J. Price, Mike Doherty

  Date

  2001-11-19

  Source

  Journal of Sports Sciences, Volume 19, Issue 12, 2001

  The aim of this study was to assess the influence of three imposed crank rates on the attainment of peak oxygen consumption ( V O 2peak ) and other physiological responses during incremental arm crank ergometry. Twenty physically active, although non-specifically trained, males volunteered for the study. They completed an exercise protocol using an electrically braked arm ergometer (Lode Angio, Groningen, Netherlands) at crank rates of 60, 70 and 80 rev•min -1 . The order of tests was randomized and they were separated by at least 2 days. Peak V O 2 was significantly higher ( P 0.05) at 70 and 80 rev•min -1 than at 60 rev•min -1 . Peak ventilation volume increased as a function of crank rate and was higher ( P 0.05) at 80 than at 60 rev•min -1 . Peak heart rate was higher ( P 0.05) at 70 and 80 rev•min -1 than at 60 rev•min -1 . Furthermore, 70 and 80 rev•min -1 resulted in an extended test time compared with 60 rev•min -1 . The greater physiological responses observed during the tests at the two faster crank rates might have been the result of a postponement of acute localized neuromuscular fatigue, allowing for more work to be completed. We recommend, therefore, that an imposed crank rate between 70 and 80 rev•min -1 should be used to elicit V O 2peak and other physiological responses in arm crank ergometry.

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• The Influence of Step and Ramp Type Protocols on the Attainment of Peak Physiological Responses During Arm Crank Ergometry

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  The Influence of Step and Ramp Type Protocols on the Attainment of Peak Physiological Responses During Arm Crank Ergometry

  Author(s)

  P. M. Smith, M. Doherty, D. Drake, M. J. Price

  Date

  2004-12-13

  Source

  International Journal of Sports Medicine 2004; 25(8): 616-621

  The present study examined the impact of two exercise protocols on the attainment of peak physiological responses during arm crank ergometry (ACE). Fourteen physically active, although non-specifically trained male subjects completed two V•O2 peak tests using an electrically braked arm ergometer (Lode Angio, Groningen, Netherlands). The tests consisted of a stepwise or rampwise increase in external workload. The order of tests was randomised and each test was separated by at least two days. Respiratory data were collected continuously using an on-line gas analysis system with sample time set at 30 s. Fingertip capillary blood samples (∼ 20 µL) were collected at volitional exhaustion and at minute intervals for 7 min of passive recovery for the determination of peak whole blood lactate concentration. Time on the test (Tlim; s), peak minute power (PMP; W), and total work done (TWD; kJ) were also recorded. In addition to determining systematic bias using separate independent t-tests, the level of agreement was also examined by way of calculating the 95 % limits of agreement. Sub-maximal values of V•O2, V•E, and HR were similar (p > 0.05) between test when the amount of external work completed was taken into consideration. There was no systematic bias (p > 0.05) for mean (± s) peak values of V•O2 (3.12 [0.37] vs. 3.04 [0.38] L • min-1) or any other parameter between the step and ramp tests, respectively. Mean values of Tlim, PMP, and TWD were also similar (p > 0.05) between tests. However, the level of agreement for peak values of all test parameters was low. It is therefore concluded that while either test can be considered as being suitable for the purpose of eliciting V•O2 peak and other physiological responses using ACE, they should not be used interchangeably for the purpose of assessing parameters linked to the aerobic capacity of the upper-body.

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• The Relation of Arm Exercise Peak Heart Rate to Stress Test Results and Outcome

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  The Relation of Arm Exercise Peak Heart Rate to Stress Test Results and Outcome

  Author(s)

  Xian H, Liu W, Marshall C, Chandiramani P, Bainter E, Martin WH 3rd.

  Date

  2016-09-01

  Source

  Medicine and Science in Sports and Exercise

  PURPOSE:
  Arm exercise is an alternative to pharmacologic stress testing for >50% of patients unable to perform treadmill exercise, but no data exist regarding the effect of attained peak arm exercise heart rate on test sensitivity. Thus, the purpose of this investigation was to characterize the relationship of peak arm exercise heart rate responses to abnormal stress test findings, coronary revascularization, and mortality in patients unable to perform leg exercise.

  METHODS:
  From 1997 until 2002, arm cycle ergometer stress tests were performed in 443 consecutive veterans age 64.1 yr (11.0 yr) (mean (SD)), of whom 253 also underwent myocardial perfusion imaging (MPI). Patients were categorized by frequency distributions of quartiles of percentage age-predicted peak heart rate (APPHR), heart rate reserve (HRR), and peak heart rate-systolic blood pressure product (PRPP). Exercise-induced ST-segment depression, abnormal MPI findings, coronary revascularization, and 12.0-yr (1.3 yr) Kaplan-Meier all-cause and cardiovascular mortality plots were then characterized by quartiles of APPHR, HRR, and PRPP.

  RESULTS:
  A reduced frequency of abnormal arm exercise ECG results was associated only with the lowest quartile of APPHR (≤69%) and HRR (≤43%), whereas higher frequency of abnormal MPI findings exhibited an inverse relationship trend with lower APPHR (P = 0.10) and HRR (P = 0.12). There was a strong inverse association of APPHR, HRR, and PRPP with all-cause (all P ≤ 0.01) and cardiovascular (P < 0.05) mortality. The frequency of coronary revascularization was unrelated to APPHR or HRR.

  CONCLUSIONS:
  Arm exercise ECG stress test sensitivity is only reduced at ≤69% APPHR or ≤43% HRR, whereas arm exercise MPI sensitivity and referral for coronary revascularization after arm exercise stress testing are not adversely affected by even a severely blunted peak heart rate. However, both all-cause mortality and cardiovascular mortality are strongly and inversely related to APPHR and HRR

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• Validity and Reliability of Skill-Related Fitness Tests for Wheelchair-Using Youth With Spina Bifida.

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  Validity and Reliability of Skill-Related Fitness Tests for Wheelchair-Using Youth With Spina Bifida.

  Author(s)

  Manon A. Bloemen, MSc; Tim Takken, PhD; Frank J. Backx, PhD; Marleen Vos, MSc; Cas L. Kruitwagen, MSc; Janke F. de Groot, PhD

  Date

  2017-06-01

  Source

  Archives of Physical Medicine and Rehabilitation 2017;98:1097-103

  Abstract
  Objectives: To determine content validity of the Muscle Power Sprint Test (MPST), and construct validity and reliability of the MPST, 10
  5
  Meter Sprint Test (10
  5MST), slalom test, and One Stroke Push Test (1SPT) in wheelchair-using youth with spina bifida (SB).
  Design: Clinimetric study.
  Setting: Rehabilitation centers, SB outpatient services, and private practices.
  Participants: A convenience sample of children and adolescents (NZ53; 32 boys, 21 girls; age range, 5e19y) with SB who use a manual
  wheelchair. Participants were recruited through rehabilitation centers, SB outpatient services, pediatric physical therapists, and the BOSK
  (Association of Physically Disabled Persons and their Parents).
  Interventions: Not applicable.
  Main Outcome Measures: Construct validity of the MPST was determined by comparing results with the arm-cranking Wingate Anaerobic Test
  (WAnT) using paired t tests and Pearson correlation coefficients, while content validity was assessed using time-based criteria for anaerobic
  testing. Construct validity of the 10
  5MST, slalom test, and 1SPT was analyzed by hypothesis testing using Pearson correlation coefficients and
  multiple regression. For reliability, intraclass correlation coefficients (ICCs) and smallest detectable changes (SDCs) were calculated.
  Results: For the MPST, the mean  SD exercise time of 4 sprints was 28.16.6 seconds. Correlations between the MPSTand arm-crankingWAnT
  were high (r>.72, P<.01). Excellent correlations were found between the 10
  5MSTand slalom test (rZ.93, P<.01), while correlations between the
  10
  5MSTor slalom test and MPSTand 1SPTwere moderate (rZ.56 to.70; rZ.56, P<.01). The variation of the 1SPTwas explained for 38% by
  wheelchair mass (bZ.489) and total upper muscle strength (bZ.420). All ICCs were excellent (ICCs>.95), but the SDCs varied widely.
  Conclusions: The MPST is a valid and reliable test in wheelchair-using youth with SB for measuring anaerobic performance. The 10
  5MST and
  slalom test are valid and reliable for measuring agility. For the 1SPT, both validity and reliability are questionable.

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