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Biomedical subjects

D R Pendergast

Publications and source records attributed to D R Pendergast.

At least 19 recordsLinked to original sources

A portable, easily performed muscle power test and its association with falls by elderly persoms.

This study developed and evaluated a simple, inexpensive, and safe screening test for assessment of falling risk in elderly persons. Subjects sat in chairs (hips and knees at 90 degrees) with their feet over a force transducer and stood as forcefully as possible. After standing for five seconds, they sat as fast as possible. The rate of change in force (dF/dT) for standing and sitting were calculated from data collected by computer. A group of nonfallers (n = 23, age = 23 to 72 years) and a group of fallers (n = 22, age = 63 to 92 years) were studied. Nonfallers' dF/dT for standing decreased linearly from 4kg.sec-1.kg-1 to 2.5kg.sec-1.kg-1. Values in fallers decreased linearly from 3kg.sec-1.kg-1 to 0.1kg.sec-1.kg-1. The dF/dT for sitting was not dependent on age in either group. Fallers had lower dF/dT than nonfallers (1.3 +/- .6kg.sec-1.kg-1 and 2.3 +/- .01kg.sec-1.kg-1, respectively). Seventeen of 22 fallers were identified by a reduced dF/dT and reduced overshoot force (kg).

Accidental Falls

Oxygen transport and peripheral microcirculation in long-term diabetes.

The purpose of this investigation was to evaluate the impact of long-term diabetes on muscle blood flow (MBF) and oxygen transport (vO2) during exercise. Twelve male patients (58 +/- 8 years, mean +/- SD), with at least a 10-year history of diabetes controlled by insulin, and seven age-matched controls (56 +/- 5 years, mean +/- SD) participated in this study. No patient had been clinically diagnosed as having peripheral vascular disease, and on the average resting ankle/arm systolic blood pressure ratios were normal. Following a baseline period, 5 min of cycle ergometer exercises at 75 W were performed in the upright position and, after 1-hr recovery, in the supine position. Continuous vO2 was determined via breath-by-breath analysis. MBF was measured in the vastus lateralis (VL) and tibialis anterior (TA) by 133Xe clearance. In the erect position, the diabetic group (compared with the control group, respectively) exhibited significantly (P less than 0.05) lower exercise MBF [ml. (100 g.min)-1] in both VL (19 +/- 2.5 vs 30.9 +/- 2) and TA (13.7 +/- 2 vs 22.0 +/- 4), a lower steady-state VO2 (1.3 +/- 0.3 vs 1.7 +/- 0.2 liters.min-1) during exercise including the values in the last 15 sec of exercise, and greater accumulation of blood lactate (35 +/- 2 vs 22.0 +/- 2 mg/100 ml). The same trends in the data were observed during supine exercise; however, the blood pressure of the diabetics was significantly elevated during exercise when compared with that of controls. The reduced exercise MBF in the TA and VL demonstrated that impaired microvascular flow, without clinically overt peripheral vascular disease, in long-term diabetics leads to reduced oxygen delivery and exercise tolerance.

Blood Pressure

Muscle rehabilitation in impaired elderly nursing home residents.

Based on observations of changes in muscle function associated with aging, and the exacerbation of these changes with frailty, a program of muscle strengthening has been developed to correct specific defects in muscles. This pilot study was undertaken on 18 functionally impaired nursing home residents (age range 60 to 90 years) with markedly deteriorated muscle function (50%) secondary to age, disuse, and multiple chronic illnesses. Fourteen of the subjects completed the six-week program without adverse effects. In 75% of the patients, there was improved muscle function, with endurance, strength, and speed increasing 35%, 15%, and 10%, respectively. After the program, many subjects increased their spontaneous activity and decreased their dependency. The improvements were still evident four months after rehabilitation. These results suggest that it may be possible, through a carefully supervised, short-term program of muscle rehabilitation, for nursing home residents to achieve an enhanced level of physical functioning.

Aged

Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis.

Muscle function and functional performance are limited in patients with osteoarthritis (OA). Although aerobic exercise can increase aerobic power and reduce fatigue, it does not appear to improve muscle function. The purpose of this study was to demonstrate the effect of a muscle rehabilitation program on muscle strength, endurance, speed, and function for patients with OA of the knees. Fifteen men (67.6 +/- 6.1 years) with OA of the knees underwent a four-month exercise program, three times per week. Muscle strength, endurance, and speed were 50% less in OA patients than in controls. After rehabilitation, there was a significant increase in strength (35%), endurance (35%), and speed (50%). Deficiencies and improvements in the muscles were greater at longer muscle lengths. Increases in muscle function were associated with decreased dependency (10%), difficulty (30%), and pain (40%). The average increase in all measured parameters was 10% and 25% after two and four months of rehabilitation, respectively. Improvements were sustained for eight months after rehabilitation. The muscle rehabilitation program was designed specifically to improve function; the improved muscle function was translated into improved functional performance.

Aged

Oxygen transport system before and after exposure to chronic hypoxia.

Maximal VO2 on the treadmill (VO2max) and on the bicycle ergometer (VO2peak), maximal cardiac output (Qmax), by a CO2 rebreathing method, maximal heart rate (HRmax), blood hemoglobin concentration (Hb), and hematocrit (Hct) were measured on six subjects before (B) and 3 weeks after (A) prolonged exposure to chronic hypoxia. It was observed that after high-altitude exposure VO2max, VO2peak, and Qmax were lower (P less than 005) than before [A: 4.13 +/- 0.67; 3.28 +/- 0.41 and 16.89 +/- 2.49 (l/min +/- SD); B: 4.39 +/- 0.39; 3.53 +/- 0.34 and 21.81 +/- 1.27, respectively], whereas Hb and Hct were larger (A: 162 +/- 8 g/l and 0.46 +/- 0.02; B: 142 +/- 7 and 0.41 +/- 0.02) and HRmax was unchanged (178 +/- 7 vs 175 +/- 9 bts/min). Thus, the calculated stroke volume of the heart and the Hb flow at VO2 peak were lower in A than in B (95 +/- 15 vs 124 +/- 7 ml and 2,723 +/- 307 vs 3,129 +/- 196 g/min) (P less than 0.05, respectively), whereas the arteriovenous O2 difference was greater in A than in B (195 +/- 16 vs 162 +/- 19 ml O2/l; P less than 0.05). At any given submaximal work load, VO2 and HR were the same in B and in A, whereas Q was lower in A by approximately 2-3 l/min. However, because of the increased Hb, leading to a higher arterial O2 content, at any work load the O2 flow remained unchanged.

Acclimatization

Morphologic and functional alterations in aging rat muscle.

To understand better the causes of reduced contractile force in aging skeletal muscle, we performed a physiologic and morphologic analysis of plantaris muscle in old rats. The peak twitch tension (Fmax) and rates of force development and relaxation were significantly lower in old (24 months old) rats than in young (six month old) rats. In teased muscle fiber preparations, there was a 5% reduction in the mean number of fibers in the aging plantaris muscle. Histologically, a net loss of fibers occurred only in the muscle belly. Histochemically, fewer Type I fibers were seen in the belly and proximal regions, whereas distally fewer Type IIa fibers were seen. The loss of Types I and IIa oxidative fibers suggested a conservation of fast-twitch Type IIb fibers in a fast-twitch muscle. The relatively small loss of muscle fibers does not explain the large decline in muscle contractile performance which, despite established doctrine, was independent of muscle mass, fiber number or size, or number of fast-twitch fibers. The reduced force production in aging rat muscle appears to be due to a defect in excitation, contraction performance or metabolic activity, rather than a purely anatomical abnormality of muscle.

Aging

Maximal isometric torque of knee extension as a function of muscle length in subjects of advancing age.

Many neuromuscular diseases are associated with muscle weakness. Assessment of this weakness by manual muscle testing or with hand-held equipment has been criticized. Furthermore, muscle length influences peak force development. One hundred fifty-three female and 116 male asymptomatic subjects between the ages of 20 and 80 (approximately 20 per decade) were studied. Maximal strength of the quadriceps group was determined isometrically, on a specially designed bench, at 3 hip angles (45 degrees, 90 degrees, and 180 degrees of extension), which represent three rectus femoris muscle lengths. Maximal strength was observed at a hip angle of 180 degrees and did not decrease significantly from 20 to 50 years of age, although the values for the male and female subjects over 50 years were significantly decreased (approximately 15% per decade). The increase in strength as the muscle was lengthened from 45 degrees to 180 degrees hip angle was about 80% (of the force at 45 degrees) in 20-year-olds; strength decreased progressively with age to a value of approximately 50% in the 70-year-olds. This greater reduction in maximal strength at longer quadriceps muscle lengths has functional significance in rising from a chair, climbing stairs, and eventually, walking and standing.

Adult

Spatial and temporal variability of blood flow in stimulated dog gastrocnemius muscle.

The distribution of blood flow in skeletal muscle stimulated to rhythmic isotonic contractions was studied by injections of radioactive microspheres into the arterial supply of gastrocnemius muscles (mean weight 88 g) subsequently cut into 0.5 g pieces for determination of radioactivity. The coefficient of variation (CV = SD/mean) of the ratio of simultaneously injected 10 microns and 15 microns microspheres, 0.12, was taken as the inherent scatter of the method. The average spatial distribution inequality of 10-15 microns microspheres corresponded to a CV of 0.45 and the specific local blood flow inhomogeneity to a CV = 0.43 (= square root of 0.45(2) - 0.12(2)), but there were marked differences between muscles. The temporal variability of blood flow in individual muscle pieces was obtained from the comparison of fractional trapping of 4 to 5 differently labeled microspheres injected at intervals of 2 minutes into steadily stimulated muscles. The mean CV for the variations in time was 0.23 and that corrected for methodological scatter, 0.19. There were large differences between muscle pieces within a muscle and between muscles. The presence of considerable spatial and temporal variations of blood flow in exercising muscle during apparent steady state may be important in limiting and/or modulating tissue O2 supply.

Animals

The effect of decreased muscle energy stores on the VO2 kinetics at the onset of exercise.

The kinetics of adjustment of oxygen uptake (VO2) at the onset of a square wave of exercise in man has been shown to be variable and related mainly to factors located distal to the capillary. The present study examined the effects of decreasing oxygen and high energy phosphates (approximately P) stores, by blood flow occlusion (BFO) and/or preceding exercise, on the half time of the VO2 on-response (t1/2 VO2 on-) during arm exercise. Twelve male subjects performed an arm exercise test at a standard intensity of 75 W (75 WA) following six procedures designed progressively to decrease O2 and/or approximately P stores. Breath-by-breath VO2 and lactic acid accumulation in blood (delta [1ab]) during the VO2 transient were measured. Preceding the 75 WA by 5 min of 125 W leg exercise decreased significantly the t1/2 VO2 on- (63-47 s). Preceding the 75 WA with either arm BFO and isometric exercise (1 min), no-load or 25 W (25WA) arm cranking (5 min) did not significantly affect t1/2 VO2 on- or delta [1ab]. Preceding 75 WA with 5-10 min BFO or BFO plus 25 WA resulted in a significant decrease in t1/2 VO2 on- (20% and 50%, respectively). The delta [1ab] increased linearly with t1/2 VO2 on-responses greater than 24 s. These data suggest that the local depletion of O2 and/or approximately P stores play an important role in determining the kinetics of adjustment of VO2 to exercise.

Adult

Energetics of kayaking.

The metabolic cost of paddling at low speeds (v) was measured from oxygen uptake (VO2) and anaerobic glycolysis in an annular pool or calculated from submaximal VO2 measured at higher speeds when the kayaker was assisted in overcoming water resistance. Also calculated were the total drag (D) and the net mechanical efficiency (e). Each of the above variables was determined in male (n = 17) and female (n = 7) kayakers ranging in experience from beginners to elite. The VO2 increased with v to a peak of approximately 3.4 l.min-1 (80%-100% of peak VO2 during running) in men and of approximately 2.8 l.min-1 in women, while at higher speeds the additional energy was accounted for by anaerobic glycolysis. In all subjects the energy cost to paddle a given distance (C) increased according to a power function with increasing v. The C was lower for the elite male paddlers than for the unskilled group, while that for elite women was slightly less than that for the elite men. Also the rates of increase of C appeared to be inversely proportional to the subjects' skill. Total D for elite men increased from approximately 15 to 60 N over a range of speeds from 1 to 2.2 m.s-1 while those of unskilled men and skilled women for the same speed range were 10-20 N greater and slightly less, respectively. The e increased linearly, but at a different rate, with increases in v for the unskilled and the elite kayakers (males and females) being 4.2% and 6%, respectively, at v = 1.2 m.s-1.

Adult

Cardiovascular, respiratory, and metabolic responses to upper body exercise.

Many studies have suggested that arm exercise, particularly in the supine position or with arms elevated, is more stressful than leg exercise. Arm exercise at a given workload is typified by cardiac output and oxygen consumption values slightly higher and heart rate, blood pressure, ventilatory and blood lactic acid responses that are significantly higher than those observed during leg exercise. Part of the increased physiological stress during arm exercise may be due to sluggish kinetics of oxidative metabolism and increased glycolysis leading to lactic acid production and accumulation in blood. This physiological state would lead to a cardiovascular and respiratory pressor effect. The limitations of VO2 adjustment in the arms are not due to cardiac or muscle blood flow limitations as these are quick to adjust and reach higher absolute levels than during leg exercise. Specific arm training increases the VO2 adjustment, and the physiological values in these subjects during arm exercise are similar to those observed during leg exercise.

Arm

Blood flow distribution and its temporal variability in stimulated dog gastrocnemius muscle.

The distribution of blood flow in skeletal muscle stimulated to rhythmic isotonic contractions was studied by injections of radioactive microspheres into the arterial supply in 8 gastrocnemius muscles (mean weight 84 g) of 6 anesthetized dogs (20-25 kg body weight). The distribution of 10 micron microspheres in regions of about 0.5 g was very similar to that of the standard 15 micron microspheres, whereas that of 25 micron microspheres was more uneven. The coefficient of variation (CV = SD/mean) of the ratio of simultaneously injected 10 micron and 15 micron microspheres, 0.12, was taken as the inherent scatter of the method. The average spatial distribution inequality of 10-15 micron microspheres corresponded to a CV of 0.45 and the specific local blood flow inhomogeneity to a CV = 0.43 ( = square root 0.45(2) - 0.12(2], but there were marked differences between muscles. At equal blood flow levels, the inhomogeneity during reactive hyperemia was similar to that observed during stimulation. The temporal variability of blood flow in individual muscle pieces was obtained from the comparison of fractional trapping of 4 to 5 differently labeled microspheres injected at intervals of 2 min into steadily stimulated muscles. The mean CV for the variations in time was 0.23 and that corrected for methodological scatter, 0.19, but the differences in the extent of temporal blood flow changes among muscle pieces within a muscle and between different muscles were large. The presence of considerable spatial and temporal variations of blood flow in exercising muscle during apparent steady state may be important in limiting and/or modulating tissue O2 supply.

Animals

The effect of body cooling on oxygen transport during exercise.

The capability to transport oxygen to muscle limits the ability to exercise. The purpose of this review is to consider the effects of body cooling on the oxygen transport and therefore exercise capacity. Body cooling results in an increase in resting metabolism that is proportional to the decrease in core temperature (Tc). Furthermore, the energy cost of exercise is increased (10-40%) by a 0.5-1.5 degrees C decrease in Tc. The capability to supply oxygen to meet the increased cost of activity is also reduced by 10-40% for a decrease in Tc of 0.5-1.5 degrees C. The reduced oxygen delivery is a result of a combination of decreased respiratory effectiveness, cardiac function, and muscle blood flow. Other than at rest, cardiac output in air or water with and without body cooling increases similarly with oxygen consumption (6 1/1 O2). Body cooling does result in a reduction of maximal heart rate and cardiac output. We postulate that the primary limitation to oxygen transport is a persistent vasoconstriction mediated by the sympathetic system, to increase body insulation, that blunts the local metabolically mediated exercise hyperemia.

Adaptation, Physiological

Effect of head-out immersion on plasma atrial natriuretic factor in man.

This study was conducted to examine the role of atrial natriuretic factor (ANF) in the development of diuresis and natriuresis in response to the head-out immersion in 35 degrees C water. Six male subjects were hydrated (0.5% body wt), sat for 1 hr in air (preimmersion), were immersed in water to the neck for 3 hr, and then sat for 1 hr in air (postimmersion). In another series they were similarly hydrated and then sat for 5 hr in air for the time control. Urine and venous blood samples were collected hourly for creatinine and electrolyte measurements. In addition, the concentration of ANF was determined in unextracted plasma by a radioimmunoassay. The pattern of electrolyte excretion was evaluated on the basis of fractional excretion of filtered load. In the time control series, urine flow and fractional excretion of Na and K remained low throughout the 5-hr experimental period. On the other hand, urine flow increased significantly from the preimmersion level of approximately 2 to approximately 7 ml/min during the first hour of immersion (P less than 0.05), after which it decreased to approximately 5 ml/min during the second hour of immersion (P less than 0.05) and to approximately 2 ml/min during the third hour of immersion. Fractional excretion of Na increased continuously from preimmersion level of approximately 1.0 to approximately 1.8% during the second and third hours of immersion (P less than 0.05) and then decreased to 1.2% during the 1-hr postimmersion period. The plasma ANF remained low (approximately 75 pg/ml) during the 5-hr time control period. In the immersion series, plasma ANF increased significantly from the preimmersion level of approximately 80 to approximately 120 pg/ml during the entire 3-hr immersion period and then returned to the preimmersion level during 1 hr postimmersion. These results indicate that the immersion diuresis and natriuresis are indeed associated with the increased ANF release. However, it can not be ascertained from the present study if the increased ANF contributes directly to these renal responses to immersion or in concert with other mediators.

Atrial Natriuretic Factor

Fluid conservation in athletes: responses to water intake, supine posture, and immersion.

The roles of antidiuretic hormone (ADH) and aldosterone in the elicited diuretic responses of trained and untrained men to seated, supine, and head-out water immersed conditions were studied. Volunteers were comprised of groups of six untrained individuals, six trained swimmers, and six trained runners. Each subject underwent three protocols, six hours in a seated position, supine position, or immersion (35 degrees C water). The last two protocols were preceded and followed by 1 h of seated position. After 10 h of fasting, 0.5% body wt of water was drunk. One hour later the trained groups had higher urine osmolalities (P less than 0.05) and urinary excretion rates of ADH (P less than 0.05) and lower urine flow rates (P less than 0.05) than untrained subjects. Throughout the sitting protocol, urinary ADH was also higher in both trained groups (P less than 0.05). Both supine posture and immersion resulted in significant decreases in urinary ADH in the untrained subjects (P less than 0.05) but no changes wer noted in swimmers and only during the second hour of immersion in the runners (P less than 0.05). The natriuresis and kaliuresis were greater during immersion than in the supine position but plasma renin activity, measured only in trained groups, and plasma aldosterone, measured in the untrained group, were decreased similarly with both protocols. The increases in urinary sodium excretion and urine flow rate were lower in trained than untrained subjects during the supine and immersion protocols (P less than 0.05). The data are compatible with an increased osmotic but decreased volume sensitivity of ADH control in trained men.

Adult

Cardio-renal responses to a stimulated gravity-free state induced by water immersion.

HOI induces a significant increase in the cardiac output, which is accompanied by increases in the urinary excretion of water, Na and K. However, the renal responses are not always associated with the cardiac response, suggesting a possible dissociation of two events. Although the urinary excretion of both ADH and aldosterone decreases during HOI, the mechanism for these changes is not clearly understood. The renal responses to HOI, especially the natriuresis, is considerably attenuated in endurance-trained athletes, which may be related to the more moderate inhibition of both ADH and renin-aldosterone systems. The exact role of the cardiac receptors in inducing the renal responses to HOI is still not defined, although the latter receptors are involved in inducing the natriuresis. Finally, important diurnal variations have been demonstrated for the renal responses to HOI, and elucidation of the mechanism for this interesting phenomenon may help understand the overall mechanisms for the development of cardiorenal-endocrine responses to HOI.

Aldosterone

Vein valve transplantation.

The vein valve transplantation has, in our experience, subjectively relieved symptoms in the majority of patients. More importantly, elevated venous pressure has been decreased in most patients. Thus, patients exhibiting signs of venous insufficiency syndrome as well as elevated venous pressure and proved valvular incompetence should be considered candidates for vein valve transplantation after an unsuccessful trial of medical management.

Follow-Up Studies

Cardiac output and muscle blood flow in exercising dogs.

Average blood flow (q) was determined by trapping of 15 micron radioactive microspheres in the vastus lateralis, the gastrocnemius-flexor digitorum superficialis and the triceps brachii of five 18 kg untrained mongrel dogs at rest and during graded treadmill running. Oxygen uptake (VO2) and cardiac output (Qco) were simultaneously determined. q leveled off in all investigated muscles at 60-100 ml X 100 g-1 X min-1 when VO2 was ca. 70% of peak VO2. Qco increased linearly with VO2 up to peak VO2. The regional blood flow (qR) distribution pattern within the muscle was found to be extremely scattered around q, both at rest and at heavy exercise. qR ranged from approximately 5 to approximately 55 ml X 100 g-1 X min-1 at rest and from approximately 10 to approximately 200 ml X 100 g-1 X min-1 at maximal exercise. No significant topographic pattern was observed in the qR distribution of the gastrocnemius muscle which was essentially similar to that previously found for the isolated-perfused muscle preparation. The results indicate that maximal limb muscle blood flow and/or its uneven distribution may be the primary limiting factor to peak VO2 in untrained running dogs.

Animals