Cardiovascular responses at the onset of static exercise in patients with dual-chamber pacemakers

Cardiac output (CO) responses to exercise can be altered by ventricular pacing in pacemaker-dependent patients. The relative contributions of CO and peripheral vascular resistance (PVR) toward the initial increase in blood pressure with the initiation of static exercise were investigated in eight otherwise healthy pacemaker-dependent subjects [age 24 +/- 2 yr (range 17-37 yr)]. Beat-by-beat measures of heart rate (HR; electrocardiography), mean arterial pressure (MAP), and CO derived from stroke volume (SV) (CO = HR.SV; 2-D echocardiography) were determined during the first 20 s of a one-legged static knee extension performed at 20% maximal voluntary effort by using three pacing modalities: dual pacing and sensing mode (DDD, i.e., normal physiological HR response), fixed at resting HR (DOO-R), and fixed at peak exercise HR (DOO-E), as previously achieved during 5 min of sustained contraction in the DDD mode. There were no differences in MAP, CO, or PVR (PVR = MAP/CO) between modes at rest (P > 0.05). With DOO-E pacing, SV was lower at rest compared with the other modes and increased with exercise (P < 0.05). Although there were no significant increase in MAP or CO during DOO-R pacing, both variables were elevated by leg contraction during DDD and DOO-E pacing (P < 0.05), with no significant change in PVR. Additionally, the CO and MAP increases were significantly greater with DOO-E pacing (P < 0.05). Thus the magnitude of the initial increase in arterial pressure at the onset of mild one-legged static exercise was dictated by the changes in CO as PVR remained unchanged.     

Two-year experience with rate-modulated pacing controlled by mixed venous oxygen saturation

Mixed venous oxy-hemoglobin saturation (MVO2) is a physiological variable with several features that might be desirable as a control parameter for rate adaptive pacing. Despite these desirable characteristics, the long-term reliability of the MVO2 sensor in vivo is uncertain. We, therefore, designed a study to prospectively evaluate the long-term performance of a permanently implanted MVO2 saturation sensor in patients requiring VVIR pacing. Under an FDA approved feasibility study, eight patients were implanted with a VVIR pulse generator and a right ventricular pacing lead incorporating an MVO2 sensor. In order to accurately assess long-term stability of the sensor, patients underwent submaximal treadmill exercise using the Chronotropic Assessment Exercise Protocol (CAEP) at 2 weeks, 6 weeks, and 3, 6, 9, 12, 18, and 24 months following pacemaker implantation. Paired maximal exercise testing using the CAEP was also performed with the pacing system programmed to the VVI and VVIR modes in randomized sequence with measurement of expired gas exchange after 6 weeks and 12 months of follow-up. During maximal treadmill exercise the peak exercise heart rate (132 +/- 9 vs 71.5 +/- 5 beats/min, P < 0.00001) and maximal rate of oxygen consumption (1,704 +/- 633 vs 1382 +/- 407 mL/min, P = 0.01) were significantly greater in the VVIR than in the VVI pacing mode. Similarly, the duration of exercise was greater in the VVIR than the VVI pacing mode (8.9 +/- 3.6 min vs 7.6 +/- 3.7 min, P = 0.04). The resting MVO2 and the MVO2 at peak exercise were similar in the VVI and VVIR pacing modes (P = NS). However, the MVO2 at each comparable treadmill exercise stage was significantly higher in the VVIR mode than in the VVI mode (CAEP stage 1 (P = 0.005), stage 2 (P = 0.04), stage 3 (P = 0.008), and stage 4 (P = 0.04). The correlation between MVO2 and oxygen consumption (VO2) was excellent (r = -0.93). Telemetry of the reflectance of red and infrared light and MVO2 in the right ventricle during identical exercise workloads revealed no significant change over the first 12 months of follow-up (ANOVA, P = NS). The chronotropic response to exercise remained proportional to VO2 in all patients over the first 12 months of follow-up. The time course of change in MVO2 during maximal exercise was significantly faster than for VO2. At the 18- and 24-month follow-up exercise tests, a significant deterioration of the sensor signal with attenuation of chronotropic response was noted for 4 of the 8 subjects with replacement of the pacing system required in one patient because of lack of appropriate rate modulation. Rate modulated VVIR pacing controlled by right ventricular MVO2 provides a chronotropic response that is highly correlated with VO2. This parameter responds rapidly to changes in workload with kinetics that are more rapid than those of VO2. Appropriate rate modulation provides a higher MVO2 at identical workloads than does VVI pacing. Although the MVO2 sensor remains stable and accurate over the first year following implantation, significant deterioration of the signal occurs by 18-24 months in many patients.     

An integrated dual sensor system automatically optimized by target rate histogram

The use of combined sensors and advanced algorithms using different principles can improve rate performance over a single sensor system. Combinations of sensors and more sophisticated algorithms, however, invariably increase the complexity of pacemaker programming. An automatically optimized combined minute ventilation and activity DDDR pacemaker was developed to minimize repeated sensor adjustment. The device used subthreshold (below cardiac stimulation threshold) lead impedance to detect lead configuration at implantation automatically, followed by "implant management," including setting of lead polarity and initiation of DDDR pacing. Automatic sensor adaptation was achieved by programming a "target rate histogram" based on the patient's activity level and frequency of exertion, and the rate profile optimization process matched the recorded integrated sensor response to the target rate histogram profile. In nine patients implanted with the DX2 pacemakers, the implant management gave 100% accuracy in the detection of lead polarity. Rate profile optimization automatically increased the pacing rate during exercise between discharge and 3-month follow-up (hall walk: 78 +/- 3 vs 98 +/- 3 beats/min, and maximal treadmill exercise: 89 +/- 6 vs 115 +/- 5 beats/min, P < 0.001) with a significant increase in exercise duration during maximal exercise (7.18 +/- 1 min vs 9.56 +/- 2 min, P = 0.05). The accuracy of rate profile optimization versus manual programming was assessed at 1 month, and there was no significant difference between pacing rate kinetics and maximal pacing rate between the two methods of programming. In conclusion, pacemaker automaticity can be initiated at implantation and the self-optimized rate adaptive response appeared to be comparable to that derived from a manual programming procedure, which may reduce the need to perform time consuming sensor programming.     

Mechanisms for increasing stroke volume during static exercise with fixed heart rate in humans

Ten patients with preserved inotropic function having a dual-chamber (right atrium and right ventricle) pacemaker placed for complete heart block were studied. They performed static one-legged knee extension at 20% of their maximal voluntary contraction for 5 min during three conditions: 1) atrioventricular sensing and pacing mode [normal increase in heart rate (HR; DDD)], 2) HR fixed at the resting value (DOO-Rest; 73 +/- 3 beats/min), and 3) HR fixed at peak exercise rate (DOO-Ex; 107 +/- 4 beats/min). During control exercise (DDD mode), mean arterial pressure (MAP) increased by 25 mmHg with no change in stroke volume (SV) or systemic vascular resistance. During DOO-Rest and DOO-Ex, MAP increased (+25 and +29 mmHg, respectively) because of a SV-dependent increase in cardiac output (+1.3 and +1.8 l/min, respectively). The increase in SV during DOO-Rest utilized a combination of increased contractility and the Frank-Starling mechanism (end-diastolic volume 118-136 ml). However, during DOO-Ex, a greater left ventricular contractility (end-systolic volume 55-38 ml) mediated the increase in SV.     

Stroke volume measurement during supine and upright cycle exercise by impedance cardiography

This study evaluated impedance cardiography (ZCG) estimates of stroke volume (SV) during exercise. Seven subjects were studied at rest and during progressive cycle exercise in supine and upright positions. SV was determined by ZCG (SVZCG) during exercise and for the first 5 cardiac cycles following exercise. SVZCG was compared with separate measurements of SV by CO2 rebreathing (SVCO2). Static blood resistivity (p) was measured at each level of exercise. No significant differences were found between supine exercise and immediate post-exercise values for the peak of the first derivative of the impedance change (dZ/dtmax), left ventricular ejection time (LVET), or SVZCG. Small differences in dZ/dtmax and SVZCG, but not LVET, were found in exercise to post-exercise cycling in the upright position. Intra-individual SVZCG and SVCO2 were moderately correlated (upright mean r = 0.64, supine r = 0.42) from rest to 70% of peak VO2. Similar correlations were found between Pulse-O2 (VO2/heart rate, used as an index to SV) and both SVZCG (upright r = 0.73, supine r = 0.57) and SVCO2 (upright r = 0.8, supine r = 0.65). The ZCG parameters dZ/dtmax and LVET correlated better with Pulse-O2 (dZ/dtmax: upright r = 0.92, supine r = 0.73; LVET: upright r = -0.9, supine r = -0.9). SVZCG calculated with the Kubicek equation performed as well as SVCO2. ZCG might be a superior method if the inversely correlated parameters, dZ/dtmax and LVET, were not expressed as a product to calculate SV.     

AAIR versus DDDR pacing in patients with impaired sinus node chronotropy: an echocardiographic and cardiopulmonary study

The aim of this study was to compare AAIR and DDDR pacing at rest and during exercise. We studied 15 patients (10 men, age 65 +/- 6 years) who had been paced for at least 3 months with activity sensor rate modulated dual chamber pacemakers. All had sick sinus syndrome (SSS) with impaired sinus node chronotropy. The patients underwent a resting echocardiographic evaluation of systolic and diastolic LV function at 60 beats/min during AAIR and DDDR pacing with an AV delay, which ensured complete ventricular activation capture. Cardiac output (CO) was also measured during pacing at 100 beats/min in both pacing modes. Subsequently, the oxygen consumption (VO2AT) and VO2AT pulse at the anaerobic threshold were measured during exercise in AAIR mode and in DDDR mode with an AV delay of 120 ms. The indices of diastolic function showed no significant differences between the two pacing modes, except for patients with a stimulus-R interval > 220 ms, for whom the time velocity integral of LV filling and LV inflow time were significantly lower under AAI than under DDD pacing. At 60 beats/min, CO was higher under AAI than under DDD mode only when the stimulus-R interval was below 220 ms. For stimulus-R intervals longer than 220 ms, and also during pacing at 100 beats/min, the CO was higher in DDD mode. The stimulus-R interval decreased in all patients during exercise. The time to anaerobic threshold, VO2AT, and VO2AT pulse showed no significant differences between the two pacing modes. Our results indicate that, at rest, although AAIR pacing does not improve diastolic function in patients with SSS, it maintains a higher CO than does DDDR pacing in cases where the stimulus-R interval is not excessively prolonged. On exertion, the two pacing modes appear to be equally effective, at least in cases where the stimulus-R interval decreases in AAIR mode.     

Physiological and biomechanical responses during treadmill walking with graded loads

Eleven healthy men [mean (SD) for age, height, body mass and maximum oxygen consumption: 25.1 (3.0) years, 1.79 (0.06) m, 78.2 (10.5) kg and 56.9 (7.1) ml x kg(-1) x min(-1), respectively) completed two treadmill walking tests at their self-selected velocity while bilaterally carrying 15-kg and 20-kg loads (in a boxed container) for 4 min in front of the body. Each handle of the boxed container was fitted with a load cell so as to allow quantification of the load supported by each hand during load carriage. During the tests, oxygen uptake (VO2), heart rate (HR), and blood pressure (BP) were monitored using standardized procedures, and cardiac output (Qc) was measured using the carbon dioxide rebreathing method. Stroke volume (SV), arterio-venous oxygen difference (C(a-v)O2), rate pressure product (RPP) and total peripheral resistance (TPR) were calculated from the above measurements. The results showed that the two extremities sustained approximately 60% to 70% of the total load, with the balance being supported by the body. Significant increases (P < 0.05) in VO2, HR, Qc, and mean BP were observed during both of the load carriage walks compared to unloaded walking. However, SV, C(a-v)O2, RPP and TPR were unchanged (P > 0.05) during load carriage. Although VO2 was significantly higher during the 20-kg load carriage walk, no significant differences were observed between the two loads for any of the cardiovascular responses monitored. Contrary to our hypothesis, these results suggest that increasing the load from 15 kg to 20 kg during treadmill walking does not significantly increase the cardiovascular stress that occurs in healthy subjects.     

Sensitivity to radiation treatment and changes in metallothionein synthesis in a transplanted murine tumor

OBJECTIVE: To examine the accuracy of the Caltrac accelerometer for estimating energy expenditure (EE) during three exercise modes. METHODS: A subset of 31 women (mean (SEM) age 22.6 (5) years) as selected from a training study comparing various physiological parameters during race walking, running, and stepping. Subjects each performed mode specific graded exercise tests to peak VO2. Regression equations for VO2 v heart rate (HR) were generated from each individual's test data. EE (kcal and kJ) was estimated for each VO2 value based on the respiratory exchange ratio, and kcal v HR regression equations were generated to predict EE from each subject's HR data (EE-HR). HR in the field was monitored by telemetry, and two Caltrac monitors, one set for EE and one to give counts, were attached to a belt over opposite hips. RESULTS: EE-HR was not significantly different across exercise modes. Caltrac overestimated EE (P < 0.01) in runners (14%) and walkers (19%) but underestimated EE in steppers by about 10% (P = 0.12). CONCLUSIONS: The Caltrac is a reliable instrument but it did not accurately distinguish EE in running, race walking, or stepping in a group of young women.     

Post-exercise changes in blood pressure, heart rate and rate pressure product at different exercise intensities in normotensive humans

To evaluate the effect of exercise intensity on post-exercise cardiovascular responses, 12 young normotensive subjects performed in a randomized order three cycle ergometer exercise bouts of 45 min at 30, 50 and 80% of VO2peak, and 12 subjects rested for 45 min in a non-exercise control trial. Blood pressure (BP) and heart rate (HR) were measured for 20 min prior to exercise (baseline) and at intervals of 5 to 30 (R5-30), 35 to 60 (R35-60) and 65 to 90 (R65-90) min after exercise. Systolic, mean, and diastolic BP after exercise were significantly lower than baseline, and there was no difference between the three exercise intensities. After exercise at 30% of VO2peak, HR was significantly decreased at R35-60 and R65-90. In contrast, after exercise at 50 and 80% of VO2peak, HR was significantly increased at R5-30 and R35-60, respectively. Exercise at 30% of VO2peak significantly decreased rate pressure (RP) product (RP = HR x systolic BP) during the entire recovery period (baseline = 7930 +/- 314 vs R5-30 = 7150 +/- 326, R35-60 = 6794 +/- 349, and R65-90 = 6628 +/- 311, P < 0.05), while exercise at 50% of VO2peak caused no change, and exercise at 80% of VO2peak produced a significant increase at R5-30 (7468 +/- 267 vs 9818 +/- 366, P < 0.05) and no change at R35-60 or R65-90. Cardiovascular responses were not altered during the control trial. In conclusion, varying exercise intensity from 30 to 80% of VO2peak in young normotensive humans did not influence the magnitude of post-exercise hypotension. However, in contrast to exercise at 50 and 80% of VO2peak, exercise at 30% of VO2peak decreased post-exercise HR and RP.     

Prediction of maximal aerobic power from a submaximal exercise test performed by paraplegics on a wheelchair ergometer

The aim of the present study was to verify the basic principles underlying the prediction of VO2 peak from a submaximal exercise test performed by paraplegics on a wheelchair ergometer and thus to propose regression equations of VO2 peak prediction. Forty-six paraplegic subjects (mean age = 33.2 +/- 8.7 years) with a traumatic lesion (T1-L3) performed a graded exercise test on a wheelchair ergometer until exhaustion. The test started with an initial workload of 0 watts, with an increment of 6 watts per 2 minutes. Measurements included power output (W), heart rate (HR) and oxygen consumption (VO2) throughout the test. Linear relationships were observed between VO2 and W (VO2 = 0.79 + 0.02 W, r = 0.80, SEE = 0.22 l min-1) as well as between %VO2 max and % maximal heart rate (% VO2 max = 8.7 + 0.83 %HR, r = 0.83 SEE = 10.5%). Combination of the two equations for estimating VO2 peak led to a linear relationship between the estimated and measured VO2 peak. Nonetheless, the strength and accuracy of the prediction were low (r = 0.49, SEE = 0.29 l min-1). Participation in aerobic exercise, body mass and lean body mass, introduced as correction factors in the regression equation, significantly improved the strength and the accuracy of the prediction (r = 0.85, SEE = 0.29 l min-1).(ABSTRACT TRUNCATED AT 250 WORDS)     

A theoretical analysis of factors determining VO2 MAX at sea level and altitude

When maximal VO2 (VO2 MAX) is limited by O2 supply, it is generally thought that cardiac output (QT) is mostly responsible, but other O2 transport conductances [ventilation (VA); [Hb]; pulmonary (DLO2) and muscle (DMO2) diffusion capacities] may also influence VO2 MAX. A numerical analysis interactively linking the lungs, circulation and muscles was designed to compare the influences of each conductance component on VO2 MAX at three altitudes: PB = 760, 464 and 253 Torr. For any given set of conductances the analysis simultaneously solved six equations for alveolar, arterial, and venous PO2 and PcO2. The equations represent pulmonary mass balance, pulmonary diffusion, and muscle diffusion for both gases. At PB = 760, [Hb], DLO2 and DMO2 were as influential as QT in limiting VO2 MAX. With increasing altitude, the influence of QT and [Hb] fell while that of VA, DLO2 and DMO2 progressively increased until at PB = 253, VO2 MAX was independent of QT and [Hb]. Neither the fall in maximal QT nor rise in [Hb] with chronic hypoxia therefore appear to affect VO2 MAX. However, high values of ventilation, DLO2 and DMO2 appear to be advantageous for exercise at altitude.     

Age alters regional distribution of blood flow during moderate-intensity exercise

During dynamic exercise in warm environments, requisite increases in skin and active muscle blood flows are supported by increasing cardiac output (Qc) and redistributing flow away from splanchnic and renal circulations. To examine the effect of age on these responses, six young (Y; 26 +/- 2 yr) and six older (O; 64 +/- 2 yr) men performed upright cycle exercise at 35 and 60% of peak O2 consumption (VO2peak) in 22 and 36 degrees C environments. To further isolate age, the two age groups were closely matched for VO2peak, weight, surface area, and body composition. Measurements included heart rate, Qc (CO2 rebreathing), skin blood flow (from increases in forearm blood flow (venous occlusion plethysmography), splanchnic blood flow (indocyanine green dilution), renal blood flow (p-amino-hippurate clearance), and plasma norepinephrine concentration. There were no significant age differences in Qc; however, in both environments the O group maintained Qc at a higher stroke volume and lower heart rate. At 60% VO2peak, forearm blood flow was significantly lower in the O subjects in each environment. Splanchnic blood flow fell (by 12-14% in both groups) at the lower intensity, then decreased to a greater extent at 60% VO2peak in Y than in O subjects (e.g., -45 +/- 2 vs. -33 +/- 3% for the hot environment, P < 0.01). Renal blood flow was lower at rest in the O group, remained relatively constant at 35% VO2peak, then decreased by 20-25% in both groups at 60% VO2peak. At 60% VO2peak, 27 and 37% more total blood flow was redistributed away from these two circulations in the Y than in the O group at 22 and 36 degrees, respectively. It was concluded that the greater increase in skin blood flow in Y subjects is partially supported by a greater redistribution of blood flow away from splanchnic and renal vascular beds.     

Relationship between nitric oxide and prostaglandins in carrageenin pleurisy

PURPOSE: To examine the effects of repeated bouts of exercise on the blood lactate [HLa]-ratings of perceived exertion (RPE) relation. METHODS: Six moderately trained males were studied on two occasions: a sequential exercise bouts day (SEB: 1000 h, 1130 h, and 1300 h) and a delayed exercise bouts day (DEB: 1000 h, 1400 h, and 1800 h). Each of the three exercise bouts within a given condition were 30 min in duration at the power output (PO) associated with 70% of VO2peak on a cycle ergometer. A standardized meal was provided at 0600 h. VO2, PO, HR, and RER were recorded every min during exercise and blood [HLa] and RPE were measured every 5 min during exercise. RESULTS: A 2 x 3 analysis of variance with repeated measures revealed that blood [HLa] decreased significantly with each repeated exercise bout (X +/- SEM: bout 1: SEB = 3.5 (0.3), DEB = 3.8 (0.4); bout 2: SEB = 2.6 (0.3), DEB = 2.8 (0.3); bout 3: SEB = 2.0 (0.2), DEB = 2.1 (0.4); mM). No differences were observed in the blood [HLa] response to repeated bouts of exercise between SEB and DEB. RPE-peripheral (legs, RPE-L) was higher during bout 3 compared with bout 1 (P <0.05) (bout 1: SEB = 11.8 (0.8), DEB = 12.3 (0.2); bout 2: SEB = 12.3 (0.5), DEB = 13.3 (0.4); bout 3: SEB = 13.5 (0.8), DEB = 14.0 (0.7); RPE-central (chest and breathing, RPE-C) was not affected by repeated bouts of exercise, whereas RPE-Overall (RPE-O) was higher during bout 3 compared with bouts 1 and 2 (P < 0.05) (bout 1: SEB = 12.5 (0.2), DEB = 12.3 (0.4); bout 2: SEB = 12.8 (0.4), DEB = 12.7 (0.4); bout 3: SEB = 13.7 (0.7), DEB = 13.2 (0.3)). No interaction for RPE x condition was observed. HR increased with repeated bouts of exercise with HR during exercise bout 3 being higher than HR during exercise bout 1 (164 vs. 156 bpm, P < 0.05). There was also a strong trend for HR during exercise bout 3 to be higher than HR during exercise bout 2 (P < 0.06). A trend for a reduction in VO2 with repeated exercise was observed (P < 0.07), with the reduction apparently related to the SEB condition (P < 0.12 for VO2 x condition). PO and kcal.min-1 were not affected by repeated bouts of exercise. RER decreased significantly with each repeated bout of exercise (from RER = 0.96 to RER = 0.89, P < 0.05) with no difference observed between SEB and DEB. CONCLUSIONS: We conclude that the blood [HLa]-RPE relation is altered by repeated bouts of exercise and that this alteration does not appear to be affected by recovery time between exercise bouts (up to 3.5 h of recovery). These data suggest that, after the first exercise bout, RPE should not be used to produce a specific blood [HLa] on subsequent exercise bouts.     

Striatal dopamine dynamics are altered following an intranigral infusion of iron in adult rats

Exercise has a noted effect on skin blood flow and temperature. We aimed to characterize the normal skin temperature response to exercise by thermographic imaging. A study was conducted on ten healthy and active subjects (age=25.8+/-0.7 years) who were exposed to graded exercise for determination of maximal oxygen consumption (VO2 max), and subsequently to constant loads corresponding to 50%, 70%, and 90% of VO2 max. The skin temperature response during 20 min of constant load exercise is characterized by an initial descending limb, an ascending limb and a quasi-steady-state period. For 50% VO2 max, the temperature decrease rate was - 0.0075+/-0.001 degrees C/s during a time interval of 390+/-47 s and the temperature increase rate was 0.0055+/-0.0031 degrees C/s during a time interval of 484+/-99 s. The level of load did not influence the temperature decrease and increase rates. In contrast, during graded load exercise, a continuous temperature decrease of -0.0049+/-0.0032 degrees C/s was observed throughout the test. In summary, the thermographic skin response to exercise is characterized by a specific pattern which reflects the dynamic balance between hemodynamic and thermoregulatory processes.     

Is the response to cardiac pacing controlled by central venous temperature physiological?

Rate responsive cardiac pacemakers are capable of adapting their pacing rate according to metabolic demands in the physical effort and some of the sensors in use even according to such physiological stimuli in which the level of metabolism remains unchanged. Central blood temperature (CVT) could possibly represent a much-needed and searched ideal sensor, which truly reflects physiological processes. In order to verify the response of the thermistor sensor under various physiological conditions, 10 single-chamber VVIR pacemakers Thermos M 02 (Biotronik) were implanted since 1993 through 1995. Our group of patients consisted of 9 men and 1 women. 8 patients had chronic atrial fibrillation with bradycardia and ventricular chronotropic incompetence, 2 patients suffered from the 3rd degree atrioventricular block. The mean age at the time of implant was 62.4 (52-72) years, the mean follow-up period has amounted to 23 (2-32) months. The CVT response to physical exercise was proportional and smooth, especially in the strenuous physical effort. In contrast to some other sensors, CVT exhibited the physiological reaction also in situations in which the metabolic level did not change. It displayed a physiological circadian fluctuation of the pacing rate. Nevertheless, a markedly prolonged reaction time at the onset of physical exercise in the patients who were still "cold" was a shortcoming of this principle. The special sensor lead is a must and only the ventricular pacing is possible. Isolated CVT is not the ideal sensor but it be combined with fast sensors. It will undoubtedly be one of the sensors within the automatic multisensor pacemaker in the forseeable future. (Tab. 1, Fig. 1, Ref. 15.)     

Respiratory responses to exercise in divers at 0.4 MPa ambient air pressure

OBJECT: This study was carried out to evaluate changes in the breathing pattern of divers during exercise at an elevated ambient air pressure equivalent to a depth of 30 m of seawater. METHODS: A total of 22 healthy male subjects performed graded bicycle exercise in a dry hyperbaric chamber up to a maximum of 3.5 W kg(-1) body weight at normal (0.1 MPa) and at elevated ambient air pressure (0.4 MPa). The exercise ventilation (VE), tidal volume (VT), breathing frequency (BF), oxygen uptake (VO2), carbon dioxide elimination (VCO2), and heart rate (HR) were measured. Perceived dyspnea was assessed by Borg scale ratings. RESULTS: Comparison of respiratory indices between conditions (0.1 versus 0.4 MPa) revealed a significant reduction in VE, VT, BF, and HR during exercise at 0.4 MPa. VO2 and VCO2 did not differ significantly between conditions. Likewise, no significant difference between conditions emerged in perceived dyspnea. CONCLUSION: Ventilation is significantly impaired during heavy bicycle exercise at 0.4 MPa. This is obviously not apparent with regard to subjective perception of dyspnea.     

Cardiorespiratory kinetics during exercise of different muscle groups and mass in old and young

The purpose was to compare cardiorespiratory kinetics during exercise of different muscle groups (double-leg cycling vs treadmill walking and single-leg ankle plantar flexion) in old and young subjects. Oxygen uptake (VO2) during exercise transitions was measured breath by breath, and the phase 2 portion of the response was fit by a monoexponential for determination of the time constant (tau) of VO2. Two separate studies were performed: in study 1, 12 old (age 66.7 yr) and 16 young (aged 26.3 yr) subjects were compared during cycling and ankle plantar flexion exercise, and in the study 2, five old (aged 69.6 yr) and five young (24.4 yr) subjects were compared during cycling and treadmill walking. VO2 transients during square-wave cycling exercise were significantly slower in the old compared with the young groups. In contrast, VO2 kinetics did not differ between old and young groups during plantar flexion exercise. Heart rate (HR) kinetics followed the same pattern, with tau HR being significantly slower in the old vs young groups during transitions to cycling but not to plantar flexion. In study 2 tau VO2 and tau HR during on-transients to treadmill square-wave exercise were significantly slower in the old group compared with the young group, but tau VO2 was significantly faster during treadmill exercise than during cycling in the old group. The differences with aging between the modes of exercise may be related to the muscle mass involved and the circulatory demands. On the other hand, slowed VO2 kinetics with age appear to occur in a mode (cycling) in which the muscles are not accustomed to the activity, whereas in a mode of normal activity (walking) and with the muscle groups (plantar flexors) accustomed to the activity, VO2 kinetics are not slowed to the same degree with age.     

Effects of endurance training and heat acclimation on psychological strain in exercising men wearing protective clothing

Two experiments examined the influences of endurance training and heat acclimation on ratings of perceived exertion (RPE) and thermal discomfort (RTD) during exercise in the heat while wearing two types of clothing. In experiment 1, young men underwent 8 weeks of physical training [60-80% of maximal aerobic power (VO2max) for 30-45 min day-1, 3-4 days week-1 at 20-22 degrees C dry bulb (db) temperature] followed by 6 days of heat acclimation [45-55% VO2max for 60 min day-1 at 40 degrees C db, 30% relative humidity (rh)] (n = 7) or corresponding periods of control observation followed by heat acclimation (n = 9). In experiment 2, young men were heat-acclimated for 6 or 12 days (n = 8 each). Before and after each treatment, subjects completed bouts of treadmill exercise (1.34 m s-1, 2% grade in experiment 1 and 0% grade in experiment 2) in a climatic chamber (40 degrees C db, 30% rh), wearing in turn normal light clothing (continuous exercise at 37-45% VO2max for a tolerated exposure of 116-120 min in experiment 1 and at 31-34% VO2max for 146-150 min in experiment 2) or clothing protective against nuclear, biological, and chemical agents (continuous exercise at 42-51% VO2max for a tolerated exposure of 47-52 min in experiment 1 and intermittent exercise at 23% VO2max for 97-120 min in experiment 2). In experiment 1, when wearing normal clothing, endurance training and/or heat acclimation significantly decreased RPE and/or RTD at a fixed power output. There were concomitant reductions in relative work intensity (% VO2max) [an unchanged oxygen consumption (VO2) but an increased VO2max, or a reduced VO2 with no change of VO2max], rectal temperature (Tre), mean skin temperature (Tsk), and/or heart rate (HR). When wearing protective clothing, in contrast, there were no significant changes in RPE or RTD. Although training and/or acclimation reduced %VO2max or Tre, any added sweat that was secreted did not evaporate through the protective clothing, thus increasing discomfort after training or acclimation. Tolerance times were unchanged in either normal or protective clothing. In experiment 2, when wearing normal clothing, heat acclimation significantly decreased RPE and RTD at a fixed power output, with concomitant reductions in Tre, Tsk, and HR; the response was greater after 12 than after 6 days of acclimation, significantly so for RPE and HR. When wearing protective clothing, the subjects exercised at a lower intensity for a longer duration than in the moderate exercise trial. Given this tactic, either 6 or 12 days of heat acclimation induces significant reductions RPE and/or RTD, accompanied by reductions in Tre, Tsk, and/or HR. Tolerance times in protective clothing were also increased by 11-15% after acclimation, despite some increase of sweat accumulation in the protective clothing. The results suggest that (1) neither endurance training nor heat acclimation reduce psychological strain when protective clothing is worn during vigorous exercise, because increased sweat accumulation adds to discomfort, and (2) in contrast to the experience during more vigorous exercise, heat acclimation is beneficial to the subject wearing protective clothing if the intensity of effort is kept to a level that allows permeation of sweat through the clothing. This condition is likely to be met in most modern industrial applications.     

Duration of QT interval in clinically normal dogs

The QT interval is the period from onset of the QRS complex to the end of the T wave. The QT interval is useful for monitoring drug (eg, quinidine) and electrolyte (eg, calcium) effects on the heart. It depends principally on heart rate (HR), and the relationship between QT interval and HR has been expressed for human beings and for dogs. The purpose of the study reported here was to quantify that relationship for dogs and to assess whether body weight also influenced QT interval. The ECG was recorded from 17 dogs, ranging in weight between 7 and 25 kg. Dogs were anesthetized with fentanyl/droperidol/ketamine, and HR was accelerated by administration of graded doses of atropine. A significant relationship was not found between QT interval and body weight. Despite changes in HR during sinus arrhythmia, a significant relationship was not found between QT and RR intervals. The QT interval vs HR accelerated by atropine was analyzed for all dogs and for small (7 to 10 kg, n = 5), medium (10 to 20 kg, n = 7), and large dogs (20 to 25 kg, n = 5). Equations relating QT interval to mean HR were calculated for each group. Our data may serve as a baseline with which to compare QT intervals from dogs with heart disease and/or electrolyte imbalance.