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Who actually remembers anything about the Offices, Shops and Railway Premises Act? It came into operation in 1964 and was introduced to the NHS by Circular HM(64)46. The Health and Safety at Work Act is intended eventually to replace the OSRPA together with other earlier safety legislation. A. Smith jogs our memories.
Regular physical activity is essential for the optimal function of many vital organs and tissues, and for general function. I am less sure about its direct and significant effects in the area of preventive medicine, but I can mention much indirect evidence to justify a whole-hearted promotion of physical exercise. Information about diet and exercise should be tied together. My present prescription for exercise is as follows: Daily -- at least 60 minutes of physical activity, not necessarily vigorous, nor all at the same time. During your daily routine, moving, walking, climbing stairs, etc., whether for one minute 60 times per day, 12 minutes 5 times a day, or any combination totalling 60 minutes, will burn up approximately 300 kcal (1.2MJ). Weekly -- at least two or three periods of 30 minutes of intermittent or sustained activity at submaximal rate of work (brisk walking, jogging, cycling, swimming, cross-country skiing, gymnastics etc.) are necessary for maintaining good cardiovascular fitness, and will consume an additional 750 kcal per week (3MJ).
OBJECTIVE: To provide updated, evidence-based recommendations for health care professionals concerning the effects of regular physical activity on the prevention and control of hypertension in otherwise healthy adults. OPTIONS: People may engage in no, sporadic or regular physical activity that may be of low, moderate or vigorous intensity. For sedentary people with hypertension, the options are to undertake or maintain regular physical activity and to avoid or moderate medication use; to use another lifestyle modification technique; to commence or continue antihypertensive medication; or to take no action and remain at increased risk of cardiovascular disease. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1997 with the terms exercise, exertion, physical activity, hypertension and blood pressure. Both reports of trials and review articles were obtained. Other relevant evidence was obtained from the reference lists of these articles, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. VALUES: A high value was placed on avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: Physical activity of moderate intensity involving rhythmic movements with the lower limbs for 50-60 minutes, 3 or 4 times per week, reduces blood pressure and appears to be more effective than vigorous exercise. Harm is uncommon and is generally restricted to the musculoskeletal injuries that may occur with any repetitive activity. Injury occurs more often with jogging than with walking, cycling or swimming. The costs include the costs of appropriate shoes, garments and equipment, but these were not specifically measured. RECOMMENDATIONS: (1) People with mild hypertension should engage in 50-60 minutes of moderate rhythmic exercise of the lower limbs, such as brisk walking or cycling, 3 or 4 times per week to reduce blood pressure, (2) Exercise should be prescribed as an adjunctive therapy for people who require pharmacologic therapy for hypertension, especially those who are not receiving beta-blockers. (3) People who do not have hypertension should participate in regular exercise as it will decrease blood pressure and reduce the risk of coronary artery disease, although there is no direct evidence that it will prevent hypertension. VALIDATION: These recommendations agree with those of the World Hypertension League, the American College of Sports Medicine, the report of the US Surgeon General on physical activity and health, and the US National Institutes of Health Consensus Development Panel on Physical Activity and Cardiovascular Health. These guidelines have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada.
Exaggerated blood pressure reactivity to behavioral stress has been observed in the African-American population, and such a pressor response is believed to play a role in hypertension. Regular aerobic exercise has been shown to exert an anti-hypertensive effect, and this may alter the blood pressure hyperreactivity observed in African Americans. To test the hypothesis that aerobic exercise attenuates pressor reactivity in African Americans, we studied eight healthy aerobically-trained normotensive African-American females and five similar sedentary females. The stress stimuli consisted of the cold pressor test with the foot immersed in ice water for two minutes. The aerobic exercise training protocol consisted of six weeks of jogging at 60-70% of peak oxygen uptake (VO2peak), three days/week for 35 min/exercise session. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, heart rate, cardiac output, total peripheral resistance, and forearm blood flow were measured. Manifestation of a training effect was illustrated by a 24.1 +/- 0.2% increase in VO2peak (26.9 +/- 1.2 mL x kg(-1) min(-1) vs 35.4 +/- 1.6 mL x kg(-1) min(-1)) (P<.05). Within the exercise-trained group there was a 6.3 +/- .15% decrease in systolic pressure (129 +/- 4.6 mm Hg vs. 121 +/- 5.4 mm Hg) (P<.05), and a 5.0 +/- .05% decrement in mean arterial blood pressure (99 +/- 3.3 mm Hg vs 94 +/- 3.6 mm Hg) (P<.05) during the cold pressor test. Pressor reactivity to cold stress did not change in the untrained group. Measures of heart rate, cardiac output, total peripheral resistance, and forearm blood flow were unaltered during conditions of the cold pressor test. We conclude that aerobic exercise attenuates the blood pressure reactivity to behavioral stress in young, adult normotensive African-American females. A lifestyle change such as exercising may play a role in reducing the risk of hypertension in African-American women.
BACKGROUND: To describe anthropometric and match performance profiles of international Rugby Sevens players and explore correlations between anthropometric characteristics and work-rates in matches. METHODS: Profiles were compared by means of multivariate analysis and correlation techniques. SETTINGS: measurements were made on players participating in the 1996 International Rugby Sevens tournament in Uruguay. SUBJECTS: Thirty male players. MEASURES: work-rate analysis during matches (n = 30) and a comprehensive anthropometry profile of 27 of the 30 players. RESULTS: Forwards had more mass (whole-body, adipose tissue, muscle) than backs, jogged more frequently and paused more often. High intensity activity was negatively correlated with muscle mass and with mesomorphy. CONCLUSIONS: Anthropometric features are related to components of match play in Rugby Sevens but do not necessarily determine whether a game is won or lost.
Counseling for the resumption of sexual activity deserves as much attention in a cardiac rehabilitation program as walking or jogging. Research findings enable the counselor to give specific sexual advice. The energey expenditure during coitus for long-married couples is equivalent to that of climbing stairs, and consequently the risk of heart attack is low. However, clustering of psychosocial and physiologic demands, such as illicit affairs, outbursts of anger, alcohol, and hearty meals, may precipitate reinfarction or death. A sexual activities program is successful only if each partner is committed to give and receive pleasure. Knowledgeable and sensitive counseling will enable the couple to explore extra-coital options for lovemaking prior to the resumption of intercourse. This writer has observed that once couples are "turned on" to the pleasuring exercises, coital activity is attempted at an earlier date without untoward side effects in the cardiac patient.
Dietary therapy and physical activity are cornerstones for lipid lowering and prevention of cardiovascular disease. The efficacy of dietary therapy has been established in several primary and secondary prevention studies. Exercise is believed to be useful to prevent atherosclerosis, but there has been no mega trial performed. The beneficial effect of physical activity may be mediated in several ways, such as reduction in VLDL, increase in HDL, reduction in body weight and reduction in blood pressure. According to the guideline of Japan Atherosclerosis Society, dietary modification is recommended to perform in three steps and practical use of the guideline was described. For exercise, aerobic activity, such as brisk walking, jogging, swimming and bicycling are recommended. Intensity, amount and frequency of exercise were described.
BACKGROUND: This study was undertaken to evaluate if possible changes in stretch- and H-reflexes could be related to the changes in the EMG activity of the cooled lower leg muscles observed during a stretch-shortening cycle exercise. METHODS: Eight subjects wearing shorts and jogging shoes were exposed once to 27 degrees C and twice to 10 degrees C for 60 min each. During the second exposure to 10 degrees C, the subject's lower legs were kept warm (10 degrees Clw) with electrical pillows. After the exposures Achilles tendon reflex (stretch reflex) was induced and the EMG activity of the triceps surae was measured. Immediately after reflex measurements the EMG activity of the triceps surae and tibialis anterior during a drop-jump (stretch-shortening cycle) was measured. After similar thermal exposures electrically induced H-reflex from the calf was measured. RESULTS: During the preactivity and stretch phases the EMG activity of the triceps surae increased after the exposure to 10 degrees C, whereas during the shortening phase it decreased. During the shortening phase cooling, on the contrary, increased the activity of tibialis surae anterior. These changes disappeared at 10 degrees Clw. At 10 degrees C the maximum EMG-amplitude of triceps surae during stretch reflex decreased (p<0.05), reflecting suppressed muscle spindle activity. Suppressed spindle activity causes the agonist to be unfacilitated and the antagonist muscle contraction to be uninhibited, which was seen in the present study as decreased agonist and increased antagonist EMG activity during the shortening phase at 10 degrees C. The Hmax/Mmax-ratio, H-reflex latency and amplitude increased at 10 degrees C (p<0.05), reflecting increased motoneuron pool excitability. This in part may explain the increased EMG activity during the preactivity and stretch phases. CONCLUSION: Cooling-induced increase in the excitability of the motoneuron pool and suppression of muscle spindle activity seem to be responsible of the EMG activity changes during the stretch-shortening cycle, consequently decreasing muscular performance.
The present study was conducted to test the effects of exercise stress on the ECG of the congenitally deaf children from school for deaf, in view of the occurrence of the Jervell-Lange Neilsen (Surdo Cardiac) variant of the Long QT Syndrome (LQTS) in them. An ECG Lead II was recorded at rest and after two minutes of static jogging. For comparison, the same protocol was repeated in normal healthy children from another school. ECG were analysed for the calculation of corrected QT interval (QTc) by Bazett's equation QTc = QT/square root of R-R and also for the evidence for other abnormalities. Both in the normal and deaf children, exercise did not produce significant (P > 0.05) change in QTc from their resting values. However, when pre and post exercise QTc values of deaf children were compared with normal children, the female deaf had significantly longer QTc (P < 0.01) both at rest and after exercise than normal female children. Normal children did not show significant ECG abnormality either at rest or on exercise. On the contrary many of their counter part (deaf) exhibited occasional ECG abnormality at rest but plethora of abnormalities after exercise viz., sinus arrhythmias, sinus pauses, ST depression, T-inversion, biphasic-T, notched-T, T-alternans, nodal ectopics and junctional rhythm. These results lend credence to the hypothesis of sympathetic imbalance and repolarisation defects in deaf children's heart, which in more severe form could pass into frank Jervell-Lange Neilsen variant of the Long: QT Syndrome.
BACKGROUND: The aim of the current investigation was to determine the movement profiles of elite South American soccer players during international competition and examine the relationship between anthropometric profile and work-rate variables. METHODS: Seventeen full-time professional soccer players were filmed while competing for their countries. Anthropometric profiles were obtained for eleven of these players. Six full-time professional players from the English Premier League were also filmed for comparative purposes. RESULTS: The South American international players covered significantly less (p<0.05) total distance during match-play than English Premier League players (International, 8638+/-1158 m; English Premier League, 10104+/-703 m). The total distance covered during the second half of the game was significantly reduced (p<0.05) compared to the first half distance for both groups of players (mean+/-SD first half 4605+/-625 m; mean+/-SD second half 4415+/-634 m). The data for both groups of players were combined to evaluate positional differences in the workrate profile. Midfield players covered a significantly greater (p<0.05) distance than forward players (midfield, 9826+/-1031 m; forwards, 7736+/-929 m) and defenders covered a greater (p<0.05) distance jogging backwards than forward players (defenders, 276+/-155 m; forwards, 68+/-25 m). Forwards sprinted a greater distance (p<0.05) than defensive players (defenders, 231+/-142 m; forwards, 557+/-142 m). Mean somatotype was a balanced mesomorph (2-5 1/2-2). Body mass and muscle mass was related to the total distance covered (r=0.43, r=0.53, p<0.05). CONCLUSIONS: Based on these data, it seems that an individual's work-rate profile is dependent upon the type of competition and the playing position. Relationships between anthropometric profile and work-rate are complex due to the interaction between the variables that determine work-rate.
Interval training is theoretically attractive as a means of training the postcoronary patient, since by appropriate choice of exercise and recovery intervals substantial cardiac training can be achieved without the accumulation of anaerobic metabolities and associated increases of blood pressure and cardiac work load. Six patients with frequent exercise-induced anginal attacks coped well with a program based upon running or jogging (1/2 to 1 minute) followed by 1 to 1-1/2 minutes of slow walking. Despite a poor previous response to several months of continuous training, they showed a substantial gain of aerobic power with one year on the interval regimen. The ST segmental response to a fixed increment of pulse rate remained unimproved, but probably because of the enhanced cardiorespiratory fitness, the ST depression at a fixed work load was lessended. Twenty other patients who had also followed a continuous exercise regimen for up to one year were switched to interval-type work. Over the next year they failed to progress as fast as a group of 15 patientswho persisted with continuous effort training. While interval work is helpful to the severely disabled anginal patient, it apparently leads to slower progress in the average postcoronary patient.
As Alzheimer's disease becomes the most extensive and expensive disease in the world, the need to broaden the definition of treatment becomes more and more necessary. Medication is presently the first, and often the last, step in "treatment." But medication alone offers meager solace for the millions of people who live daily with this degenerative disease. The world they live in becomes increasingly strange and their behavior increasingly erratic. In order for most people with this disease to live lives that tend toward normalcy, a combination of pharmacological and non-pharmacological remedies is necessary. Therapeutic settings, activities that make up for cognitive deficits, family involvement, and caregiver approaches must augment medication. One non-pharmacological treatment modality is a physical environment that helps people find their way, jogs their memory, and keeps them safe. This paper recounts an investigative journey to discover what are the components of a multi-approach treatment for Alzheimer's disease, what role the physical environment plays in treatment, and what effects the physical environment has on the behavior of people with Alzheimer's disease. This paper describes and links the work of a small group of investigators and practitioners over the last decade of the 20th century (Zeisel, Hyde, Levkoff 1994; Hyde 1987; Zeisel, 1999; Zeisel and Raia, 2000; Zeisel, Silverstein, Hyde, Powell, and Holmes, 2001).
The cardiovascular response to an aerobic cycloergometer exercise test (ACET, 15 min at 60 W, 60 rpm) and the maximally attainable muscle power output, assessed by a stair climbing test (SCT), were evaluated in 60 obese patients (41 females and 19 males; age: 18-68 yr; body mass index, BMI: 40.8+/-4.8 kg/m2) before and after a 3-week body mass reduction (BMR) program, entailing integrated energy-restricted diet (1200-1500 kcal/day), low-grade aerobic exercise conditioning and individual and/or group psychological therapy. The daily conditioning protocol (5 days/week) consisted of: 1) 30 min of indoor jogging and dynamic aerobic standing and floor exercises performed with arms and legs, under the guidance of a therapist; 2) 30 min of cycloergometer exercise at 60 W; and/or 3) 4-km outdoor leisure walking on flat terrain. Three weeks of BMR program induced a significant weight loss (-4.5 %; p<0.001), a reduction of systolic (-11+/-14 mmHg, -7.3%,p<0.001) and diastolic (-7+/-9 mmHg, -7.3%,p<0.001) resting arterial blood pressure, as well as a reduction of heart rate at rest (-18.6%,p<0.001), during ACET (-11.3%,p<0.001) and 5 min thereafter (-14.8%,p<0.001). The subjective rating of perceived exertion in terms of breathlessness and general fatigue during ACET, scored on a 0-100 visual analogic scale, was significantly reduced (p<0.001) after BMR program. A 11.2% decrease in SCT time (p<0.001) was also observed, corresponding to a 9.6% increase (p<0.001) in average muscle power (W) and 14.6% increase (p<0.001) in specific muscle power (W.kg(-1)). In conclusion, a combination of energy restricted diet, low intensity aerobic exercise and psychological counselling appears to significantly improve both aerobic and anaerobic performance in morbidly obese subjects. Different factors (ie, reduction of body mass, shift in the balance between parasympathetic and sympathetic activity, a weight-loss dependent shift toward a more favourable region of the muscle power-velocity curve, acquisition of a certain degree of motor skillfulness during the conditioning program, improvement of self-esteem and motivation) might be responsible, alone or in combination, for these short-term positive effects of BMR program.
The purpose of this investigation was to assess the adaptations of middle-aged women and men to a ten-week physical training program. Before and after training on a treadmill maximal oxygen uptake (VO2 max), heart rates and blood lactate were measured. Also, heart rates during submaximal exercise were observed. Additional measurements were made for body fat (skinfold method), resting blood pressure, heart rate and vital capacity. The training program consisted of a 30-minute walking and jogging exercise, three to four days per week. As a result of the training, oxygen consumption at exhaustion increased from 1.72 to 2.18 liters-min (29.2 to 37.4 ml/kg times min) for the women; 2.78 to 3.42 liters-min (33.7 to 41.8 ml/kg times min) for the men. The mean weight loss for the groups (0.7 kg and 0.8 kg) was negligible. Estimates of body fat (skinfold method) showed a significant loss of maximal exercise decreased significantly. No significant decreases in basal heart rate, blood pressure or vital capacity were observed. These data suggest that sedentary middle-aged women respond to vigorous physical training much like sedentary middle-aged men do.
Nasal dilators supposedly aid recovery from exercise by reducing nasal airway resistance. Research has focused on the effectiveness of nasal dilators during exercise. The purpose of this study was to examine the effects of nasal dilators on heart rate (HR), minute ventilation (VE), and oxygen consumption (Vo2) during recovery from anaerobic exercise. Fourteen subjects (19-32 years) performed a modified Cunningham-Faulkner anaerobic treadmill test (1-minute walk at 2.0 miles per hour [mph], 0% grade; 1-minute jog at 5 mph, 0% grade; and sprint at 8 mph, 20% grade) under 3 randomly assigned conditions: (a) control, (b) nasal strip, and (c) placebo nasal strip. A 10-minute recovery period consisting of 5 minutes of walking (2 mph, 0% grade) and 5 minutes of passive recovery (seated) was completed. During the test and recovery periods, the participant wore a fireman's face mask to allow for simultaneous sampling of nose and mouth breathing. Vo2 and VE were monitored by a TEEM 100 metabolic analyzer. Each subject wore a Polar Heart Watch to monitor HR every minute during recovery. Mean time to exhaustion was 48.4 seconds (+/-14.9). One-way repeated-measures analyses of variance (ANOVAs) indicated no significant nasal dilator effect on 5-minute recovery HR or 10-minute recovery HR, 5-minute recovery Vo2 or 10-minute recovery Vo2, and 5-minute recovery VE or 10-minute recovery VE. Nasal strips appear to have no significant impact during recovery from anaerobic exercise.
We are reporting on a 46-year-old man who has suffered of muscle cramps for 4 years, occurring immediately after jogging and playing tennis and lasting for 7-8 hours. Repeated neurological, orthopedic, internal medical and endocrinological examinations showed no pathological findings. Physiotherapy, supplementation of fluids and electrolytes had no effect, nor did medication therapy with muscle relaxants. During spiroergometry without medication, there was an overproportional increase of heart rate and respiratory rate with delayed pCO2 increase after exercise with otherwise normal blood gas levels. This reaction was considerably reduced during spiroergometry under beta-blockade (metoprolol 100 mg); at the same time, the muscle cramps could no longer be induced. Both excessive respiratory regulation and direct hyperadrenergic stimulation should be discussed as the primary cause of the muscle cramps. According to recent findings, b-blockers with intrinsic sympathocomimetic activity should be avoided in therapy.
Physical exercise has a beneficial effect to the humans. Sudden death in healthy persons engaged in physical exercise is extremely rare since healthy heart is protected from complications. The records of five elderly men who died during or immediately after exercise in the period between 1988-2001 in our region have been given, out of 23 men (and no one woman) aged 14-68 who died due to physical exercise in that time. They have been engaged in tennis, jogging and swimming recreatively. In all of them coronary heart disease has been found by the forensic autopsy. Only one has had arterial hypertension, symptoms of chest pain few years before accident and acute myocardial infarction has been found. The other four have been without symptoms. In three of them myocardial scars have been found of past myocardial infarctions. In all of them the thickness of the left ventricle wall was 15 mm or more (from 15 to 25 mm). It seems that the thickness of the wall of the left ventricle increases cardiovascular risk in persons without symptoms. In Croatia about 7% of the whole population are engaged in recreation. In this population 13% are elderly: 40,950. The reported five deaths due to recreational physical exercise in the elderly reached 1/114,660 persons every three years, or 1/573,300 persons during fourteen years.
BACKGROUND: The precise pathophysiological basis of exercise-related vasodepressor syncope is not well understood. PURPOSE: The diagnostic values of head-up tilt and modified treadmill tests with abrupt termination were tested in patients with exercise-related syncope and compared with those of patients with situational or vasovagal syncope. PATIENTS AND METHODS: Diagnostic accuracies of head-up tilt and modified treadmill exercise tests were examined in 44 patients with unexplained syncope (26 men, 18 women, aged 46 19 years) and in 20 control subjects. Results for 18 patients with syncope during exercise (short-distance dash [n=7], jogging [n=3], going up stairs [n=6], swimming [n=1] or cycling [n=1]), defined as exercise-related syncope, were compared with those for 26 patients with exercise-unrelated syncope (including situational [n=7] and vasovagal [n=14] syncope). RESULTS: No differences were found between the clinical backgrounds of subjects with and those without exercise-related syncope. Head-up tilt testing had good diagnostic sensitivities, specificities and accuracies in both exercise-related and exercise-unrelated groups (84% versus 77%, 84% versus 85%, 84% versus 80%, respectively). The corresponding values of modified treadmill tests in the two groups were 78% versus 19% (P<0.05), 95% versus 95% and 86% versus 52% (P<0.05), respectively. The results of exercise tests were of limited diagnostic value for exercise-unrelated syncope. Beta-blockade had good short term efficacy in subjects with exercise-related syncope (nine of 15, 60%) as well as in subjects with exercise-unrelated syncope (seven of 10, 70%). CONCLUSIONS: Modified treadmill exercise testing is thought to be useful for diagnosing exercise-related syncope.