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PubMed2006

Blood pressure rise with swimming versus walking in older women: the Sedentary Women Exercise Adherence Trial 2 (SWEAT 2).

OBJECTIVE: Swimming is often recommended in the prevention and treatment of hypertension. Few studies have investigated the effect of swimming training on blood pressure (BP). Our objective was to evaluate 6 months of supervised moderate swimming or walking on BP in previously sedentary, normotensive, older women. DESIGN: Women aged 50-70 years (n = 116) were randomly assigned to a supervised 6-month swimming or walking programme. They were further randomized to receive usual care or a behavioural intervention package. METHODS: Exercise comprised 3 sessions/week with a warm-up, cool down, and 30-min of moderate intensity walking or swimming. BP was recorded for 20 min supine, and 5 min standing. Assessments were made at 0 and 6 months. RESULTS: At baseline, mean supine BP (+/- SD) was 115.7 +/- 1.3/66.8 +/- 0.7 mmHg. Swimming improved swim distance by 78.1 m (29.3%) [95% confidence interval (CI); 66.7, 89.4] and walk time by 0.58 min (3.8%) (0.41, 0.74). Walking decreased walk time by 1.0 min (6.5%) (0.81, 1.19). After adjustment for initial BP, age, hypertension treatment status and change in weight, swimming increased supine and standing systolic BP relative to walking by 4.4 mmHg (1.2, 7.5) (P = 0.008) and 6.0 mmHg (2.6, 9.5) (P = 0.001), respectively. Supine and standing diastolic BP increased by 1.4 mmHg (-0.14, 3.0) (P = 0.07) and 1.8 mmHg (-0.02, 3.5) (P = 0.05), respectively. CONCLUSION: Relative to moderately paced walking, regular swimming significantly elevates BP in previously sedentary, normotensive, older women. This finding may have important implications for exercise prescription in older subjects.

Aged↗
PubMed1990

Below-knee amputee gait with dynamic elastic response prosthetic feet: a pilot study.

The purpose of this pilot study was to investigate some of the new dynamic elastic response (DER) prosthetic feet compared to the SACH foot and determine if any demonstrated trends of producing the most optimum gait. We investigated the gait of five below-knee amputees while wearing four different DER feet (Flex-Foot, Carbon Copy II, SEATTLE, STEN) and a standard SACH foot. Each subject used each foot for 1 month prior to in-depth gait analysis and energy expenditure testing at the Pathokinesiology Laboratory. Minimal differences in either free or fast walking were noted between the five feet. The Flex-Foot resulted in significantly different gait kinematics at the "ankle" compared to the other four feet, however, this foot did not produce an increased velocity nor an improved energy cost. The results of this pilot study indicated that during free or fast-paced walking on level ground there were no clinically significant advantages of any one of the feet tested. Based on this pilot data, recommendations are made for future studies including appropriate sample size.

Adult↗
PubMed2002

Development of dynamic knee stability after acute ACL injury.

Recently, a training program that includes perturbation of support surfaces has been shown to allow most active individuals with ACL injury who pass a screening examination to successfully return to high level activities. The purpose of this study was to identify the effect of this rehabilitation program on involved side muscle activation during walking in subjects with acute ACL rupture and to determine if the activation changes were coincident with improved function. Nine subjects with an acute, unilateral ACL injury or rupture of an ACL graft, who met the screening examination criteria, received ten sessions of rehabilitation that included perturbation training. Motion analysis of five self-paced walking trials were performed before and after training. Electromyographic (EMG) data were collected during stance. After training during walking, the vastus lateralis (VL) integral of activity increased, and relationships between muscles were significantly altered. During walking, VL activation variables were dependent on lateral hamstrings (LH) and/or the soleus (SOL) activation, while no relationships were found before training. Function improved after training, and all subjects returned to their pre-injury activities without experiencing instability. The relationships formed between muscles post-training suggests that perturbation training enhances dynamic knee stability by inducing a well-coordinated strategy among muscles that affect tibial translation.

Activities of Daily Living↗
PubMed1999

Velocity modulation and rhythmic synchronization of gait in Huntington's disease.

This study analyzed the ability of patients with Huntington's disease (HD) to modulate gait velocity without external sensory cues and in response to an auditory rhythmic cue within a frequency entrainment design. Uncued gait patterns of 27 patients were first assessed during normal, slower, and faster self-paced walking. During rhythmic trials, metronome and musical beat patterns were delivered at rates 10% slower and 10-20% faster than baseline cadence to cue gait patterns. After the rhythmic trials, patients were retested at normal gait speed without rhythm. Gait velocities in the patients with HD were below normal reference values in all ranges. Patients were able to significantly (p <0.05) modulate their gait velocity during self-paced and rhythmic metronome cueing but not during music. The ability to modulate gait velocity was retained regardless of the severity of the disease. Gait velocity declined with an increase in disability and chorea score. The disability score differentiated better between gait velocity of moderately and severe patients than chorea score. Slowness of gait was significantly correlated only with disability score and not with chorea. Patients had more difficulty producing adequate step rates than stride lengths during normal and fast walking speeds. After the rhythmic trials, unpaced gait velocity remained significantly (p <0.05) higher than baseline. This carry-over effect was not seen after the uncued trials. Synchronization ability was deficient in all patients, deteriorated with severity of disease, and was already compromised in patients with soft disease signs. Rhythmic tracking of music declined more with severity of disease than metronome tracking. In summary, patients were able to modulate velocity with and without external cues. Velocity adaptations to the external rhythm in music and metronome were achieved without exact synchronization between step cadence and rhythmic stimulus.

Acoustic Stimulation↗
PubMed1993

Oxygen desaturation and breathlessness during corridor walking in chronic obstructive pulmonary disease: effect of oxitropium bromide.

BACKGROUND: Although exercise induced desaturation can occur in patients with chronic obstructive pulmonary disease (COPD), little is known about its frequency during everyday exercise, or how it relates to dyspnoea or prior drug treatment. METHODS: The effects of 200 micrograms inhaled oxitropium bromide, an anticholinergic bronchodilator drug, on spirometric values, dyspnoea score, and oxygen saturation during corridor walking and cycle ergometry were studied in a double blind, randomised, placebo controlled study. RESULTS: Oxitropium produced a small increase in forced expired volume in one second (FEV1) from 0.76 (0.28) 1 to 0.93 (0.69) 1 and in six minute walking distance from 311 (93) m to 332 (86) m, but did not change progressive cycle exercise duration. Resting and end exercise breathlessness levels were reduced in both forms of exercise after oxitropium. Resting oxygen saturation fell significantly after active bronchodilator from 92.9% (3.7%) to 92.0% (4.1%) but the nadir saturation during exercise was unchanged. The patients desaturated more during corridor walking than cycle ergometry [walking 7.8% (4.4%), cycle ergometry 2.1% (2.1%)]. Baseline walking distance was related to FVC, resting breathlessness and resting oxygen saturation (multiple r2 = 0.46) but only resting saturation correlated with end exercise breathlessness (r2 = -0.25). Improvements in symptoms or exercise performance after oxitropium could not be predicted by changes in spirometric indices or oxygen saturation. CONCLUSIONS: In patients with COPD arterial oxygen desaturation during self-paced walking is common, of greater severity than that during cycle ergometry, but is unaffected by inhaled oxitropium bromide. The factors that predict initial performance are not appropriate markers of functional improvement after an active bronchodilator drug.

Double-Blind Method↗
PubMed2006

Self-selected exercise intensity during household/garden activities and walking in 55 to 65-year-old females.

This study determined whether some of the more vigorous household and garden tasks (sweeping, window cleaning, vacuuming and lawn mowing) were performed at a moderate intensity (3-6 METs or metabolic equivalents) by a representative sample of 50, 55 to 65-year-old women (X +/- SD; 59.3 +/- 3.1 years, 161.5 +/- 5.2 cm, 69.4 +/- 12.4 kg, 38.4 +/- 7.3% BF). Data collection was conducted in a standardised laboratory environment and in the subjects' homes. Energy expenditure during self-perceived moderate paced walking around a quadrangle was also used as a marker of exercise intensity. Energy expenditure measured via indirect calorimetry was also predicted from: HR, CSA accelerometer counts, Quetelet's index and the Borg rating of perceived exertion. Ninety-six percent of the subjects walked at an intensity of >or= 3.0 METs. Except for vacuuming in the laboratory (X = 2.9 METs; P = 0.19), the intensity of each of the other activities was significantly (P or= 3.0 METs when the four household/garden activities were performed in the subjects' homes. These activities therefore have the potential to contribute to the 30 min day(-1) of moderate intensity physical activity required to confer health benefits but there was much inter-individual variability in the intensity at which these tasks were performed. Random intercept regression analyses yielded prediction equations with 95% confidence intervals of +/- 0.80 and +/- 0.84 METs for the laboratory and home based equations, respectively. Considering the means for the five activities ranged from 2.9 to 5.5 METs, these 95% confidence intervals lack predictive precision at the individual level. Nevertheless, the laboratory and home-based equations predicted with correct classification rates of 89 and 90%, respectively, whether energy expenditure was < 3.0 or >or= 3.0 METs.

Activities of Daily Living↗
PubMed2004

Estimation of gait cycle characteristics by trunk accelerometry.

This study reports on the novel use of a portable system to measure gait cycle parameters. Measurements were made by a triaxial accelerometer over the lower trunk during timed walking over a range of self-administered speeds. Signals from each trial were transformed to a horizontal-vertical coordinate system and analyzed by an unbiased autocorrelation procedure to obtain cadence, step length, and measures of gait regularity and symmetry. By curvilinear interpolation, speed-dependent gait parameters could be compared at a normalized speed. It was demonstrated that analysis of gait cycle parameters which previously required fixed laboratory equipment and paced walking procedures, now can be made from data obtained by a timing device and a portable sensor at free walking speeds.

Abdomen↗
PubMed2002

Ventilation threshold as a measure of impaired physical performance in adults with growth hormone excess.

OBJECTIVE: Fatigue is a prominent symptom among patients with GH excess and acromegaly. Identifying the physiological basis of such complaints and obtaining objective measures to quantify their severity remains an ongoing challenge. We investigated whether submaximal measures of aerobic performance can be used to assess GH excess-associated fatigue objectively. DESIGN AND PATIENTS: To investigate this possibility we examined the relation between physical function and physical capacity in 12 patients with active acromegaly and persistent fatigue before and after 3 and 6 months of treatment with the long-acting somatostatin analogue octreotide (LAR(R)). MEASUREMENTS: Heart rate (HR) and rating of perceived exertion (RPE using Borg's 10-point scale) were measured during a 160-metre self-paced walk test (SPW). Maximum oxygen uptake (VO2max) and ventilation threshold (VeT: a measure of work rate when breathlessness develops) were measured during a progressive treadmill test to fatigue or symptom-limited maximum. The Profile Of Mood States questionnaire (POMS) was used to quantify subjective feelings of fatigue and vigour. Morning fasting levels of GH and IGF-I were measured using immunoassay of serum samples. RESULTS: SPW speed at a fast pace of 1.69 +/- 0.18 m/s was achieved with higher than normal HR (112 +/- 15/min; normal = 102) and RPE (2.4 +/- 1.2). Similar to GH-deficient adults, VO2max (22.6 +/- 6.4 ml.kg-1.min-1; normal approximately 30 ml.kg-1.min-1) and VeT (13.1 +/- 2.9 ml.kg-1.min-1; predicted normal approximately 16 ml.kg-1(min-1) were low. However, VeT occurred at a normal fraction of VO2max (VeT/VO2max = 0.58). VeT was significantly increased and plasma IGF-I levels reduced following 3 and 6 months of octreotide LAR(R) treatment. Reduction in circulating IGF-I levels was correlated with improvement in reported vigour (r = 0.85) and VeT (r = 0.65) (P < 0.05). CONCLUSIONS: Our findings demonstrate impairment in physical function and physical capacity consistent with the perception of increased fatigue among acromegalic patients. These objective measures of compromised physical function are similar to the changes that we have reported previously in adults with GH deficiency. Taken together, these data suggest that a narrow window for GH/IGF-I levels is required to maintain optimal physical function.

Acromegaly↗
PubMed1999

Acute effects of thirty minutes of light-intensity, intermittent exercise on patients with chronic fatigue syndrome.

BACKGROUND AND PURPOSE: Currently, there is no consensus on exercise prescription for patients with chronic fatigue syndrome (CFS). This investigation examined whether light-intensity, intermittent physical activity exacerbated symptoms in patients with CFS immediately following exercise to 7 days following exercise. Subjects. Subjects were 9 women (mean age=44.2 years, SD=8.4, range=29-56; mean weight=74.2 kg, SD=18.8, range=56.36-110.91; and mean height=1.63 m, SD=0.8, range=1.55-1.78) and 1 man (age=48 years, weight=97.1 kg, and height= 1.98 m) who met the Centels for Disease Control and Prevention's criteria fi)r (FS. METHODS: Subjects performed 10 discontinuous 3-minute exercise bouts (separated by 3 minutes of recovery) at a self-selected, comfortable walking pace on a treadmill. Oxygen consumption, minute ventilation, respiratory exchange ratio, and heart rate were measured every minute during the exercise session. To assess degree of disability, general health status, activity level, symptoms, and mood, subjects completed various questionnaires before and after exercise. RESULTS: Results indicated that degree of disability, general health status, symptoms, and mood did not change immediately and up to 7 days following exercise. CONCLUSION AND DISCUSSION: Thirty minutes of intermittent walking did not exacerbate symptoms in subjects with CFS. The physiological data did not show any abnormal response to exercise. Although this study did not determine whether 30 minutes of continuous versus intermittent exercise would exacerbate symptoms, all 10 subjects felt that they could not exercise continuously for 30 minutes without experiencing symptom exacerbation. Despite this limitation, the results indicate that some individuals with CFS may be able to use low-level, intermittent exercise without exacerbating their symptoms.

Adult↗
PubMed1997

Walking performance and economy in chronic heart failure patients pre and post exercise training.

The effect of a 3-week exercise programme on performance and economy of walking was analysed in 16 male patients with chronic heart failure [mean age 51.8 (SD 6.9) years, height 174.9 (SD 6.3) cm, body mass 75.3 (SD 11.5) kg, ejection fraction 20.8 (SD 5.0)%]. They were submitted to a cardiopulmonary exercise test on a cycle ergometer and a 6-min walking test on a treadmill before and after the period of exercise training. The training programme consisted of interval cycle (five times a week for 15 min), and treadmill ergometer training (three times a week for 10 min) at approximately 70% cycling peak oxygen uptake (VO2peak) and supplementary exercises (three times a week for 20 min). Compared to the pre values cycling VO2peak [11.9 (SD 2.9) vs 14.0 (SD 2.3) ml. kg-1.min-1], maximal self paced walking speed [0.68 (SD 0.33) vs 1.16 (SD 0.30) m.s-1], and net walking power [2.16 (SD 0.89) vs 2.73 (SD 0.91) W.kg-1] had increased (P < 0.01) while net energy cost [3.31 (SD 0.66) vs 2.33 (SD 0.38) J.kg-1. m-1] had decreased (P < 0.001) after the training period. Approximately 42% of the increase of walking speed resulted from a higher walking power output, whereas approximately 58% corresponded to a positive effect on walking economy. The improvement in walking economy was a function of an increase in walking velocity itself and a result of a more efficient walking technique. These results would indicate that in patients with marked exercise intolerance, adequate exercise training programmes could contribute to favourable metabolic changes with positive effects on the economy of motion.

Cardiac Output, Low↗
PubMed1996

Cardiac response of elderly adults to normal activities and aerobic walking.

To assess the cardiac response of elderly adults, three sedentary men and six women (M = 68 years) with no known cardiovascular disease had their cardiac responses to activities done in a laboratory setting (walking, climbing stairs, carrying bags, shuffleboard); normal daily activities and aerobic walking (pace at 60% of the age-adjusted heart rate) were assessed by a 24-hour holter monitor. Supraventricular and ventricular ectopies were common during the 24 hours of monitoring, but none occurred during any of the activities. Bradycardia occurred at night, along with some supraventricular and ventricular ectopy, none clinically significant. Heart rate increased as the intensity of the activity increased (e.g., 68/ minute for carrying 5 pounds of groceries to 90/ minute during aerobic walking). When prescribing exercise or activity limitations, the chronotropic effects of usual daily activities must be considered in counseling sedentary, apparently healthy older adults.

Activities of Daily Living↗
PubMed2001

Utilization of the walking oximetry test to allow safe ambulation after pulmonary resection.

Supplemental oxygen therapy after pulmonary resection can generally be tapered according to arterial blood gases at rest or pulse oximetry (SpO2). However, detecting exercise-induced oxygen desaturation can be difficult. We developed the walking oximetry test (WOT) so that thoracotomy patients could be rehabilitated without the risk of undetected ambulatory hypoxemia. The subjects were 58 patients who had undergone pulmonary resection and could walk at the bedside, with oxygen at 3 l/min via a nasal cannula. Patients with a value of more than 100 torr were allowed to walk with assistance for 6 min in the corridor. The oxygen flow rate was kept at 3 l/min and the walking pace was less than 50 m/min. SpO2 was determined using a wristwatch pulse oximeter. The test was stopped if the SpO2 fell below 90% or there was a score of 5 or more on the Borg scale (range 1-10). Oxygen desaturation occurred in six patients (10%) during the WOT. These patients underwent ambulatory training with sufficient oxygen supplementation and were then tested again. Patients whose SpO2 values remained higher than 90% and who showed no more than 5% desaturation were permitted to walk in the corridor with oxygen at 3 l/min via a nasal cannula. All these patients had a Borg score of 4 or lower. The WOT is a reliable, nonvasive method for detecting exercise-induced oxygen desaturation during ambulation after pulmonary resection.

Exercise Test↗
PubMed2000

Field test of self-paced work capacity: Ifugao rice farmers.

This article reports results of a field test of work capacity on 30 male farmers ranging in age from 15-54. It involved a self-paced walk from the valley floor, up the mountain wall, and return, with heart rate monitoring. The route was 2.21 km long with a vertical rise of about 200 m. At its steepest, the grade was about 34 degrees, requiring long runs of steps cut into the mountain face. The purpose of this research was to determine whether biological and behavioral traits of individual men help to explain household economic productivity to which they contribute. The traits included anthropometry and a new measure of self-paced, voluntary work capacity (heart rate x time). Income per productive adult increased as did the relative fitness index (heart rate increase above resting x min taken to finish the course). However, the number of rice bundles earned per family, expected to increase with more fit workers, increased with the number of household adults and sitting height (adjusted R(2) = 0.392), but not with self-paced fitness markers. Am. J. Hum. Biol. 12:192-200, 2000. Copyright 2000 Wiley-Liss, Inc.

Journal Article↗
PubMed2004

Longitudinal study of determinants of dependence in an elderly population.

OBJECTIVES: To describe those factors, from the host of initial measures in ambulatory, independent older men and women, that were determinants of becoming dependent over an 8-year follow-up. DESIGN: Initial measures in a cohort of independent older adults were used in logistic regression to describe the determinants of becoming dependent at the 8-year follow-up. SETTING: London, Ontario. PARTICIPANTS: Three hundred seventy-three men and women aged 55 to 86. MEASUREMENTS: Initial variables included body size, presence of chronic disease, maximal oxygen uptake (VO2max), strength, flexibility, walking pace, and leisure time physical activity. RESULTS: An 8-year follow-up of 297 participants identified 43 as dependent. Logistic regression showed age, presence of disease, and VO2max (cardiorespiratory fitness) at baseline to have significant odds ratios related to the outcome of becoming dependent. Controlling for other factors, a lower VO2max increased the odds of dependence by 14% for each mL/kg.min. CONCLUSION: Lower cardiorespiratory fitness was a significant determinant of becoming dependent in an 8-year follow-up of older adults. Initiatives to encourage physical activity in older adults should emphasize exercise, such as brisk walking, to maintain or improve cardiorespiratory fitness.

Activities of Daily Living↗
PubMed1994

Entrained breathing and oxygen consumption during treadmill walking.

Entrainment of the breathing rhythm to that of the rhythm of limb movement during exercise has been shown to decrease oxygen consumption for cycling at a moderate workload. This study examined the effect of entrainment on oxygen consumption during treadmill walking at two workloads. For each workload, 8 subjects performed two exercise protocols consisting of walking on a treadmill for 8 min. For the first protocol they received no instructions, but for the second protocol they were instructed to coordinate one breath per auditory cue which was provided during the last 4 min of exercise. The auditory cue was transmitted as a click via headphones. It was derived from a foot switch and was designed to synchronize breathing to the walking pace at a respiratory frequency close to that observed in the first protocol. Entrainment and oxygen consumption were compared between the protocols for the last 4-min segments for each workload. These comparisons showed that the presence of the auditory cue significantly increased entrainment from 29 to 74%, but oxygen consumption was not significantly changed.

Acoustic Stimulation↗
PubMed2004

Differences in normal and perturbed walking kinematics between male and female athletes.

OBJECTIVE: To identify differences in lower extremity kinematic movement patterns between genders during walking through the application of an expected perturbation. DESIGN: Randomized limb kinematics were compared between healthy active males and females. BACKGROUND: Lower extremity kinematics during jump landing and cutting have been implicated as a potential source of the discrepancy in anterior cruciate ligament injury rates between genders. Kinematic differences between genders have been identified during tasks that are not provocative of anterior cruciate ligament injury but do result in increased ligament strain. Repetition of movement patterns that increase anterior cruciate ligament strain may increase the likelihood they will be reproduced during athletic tasks that produce force loads that exceed anterior cruciate ligament tensile strength. METHODS: Twenty subjects (10 women, 10 men) classified as a level I or II athlete underwent motion analyses while performing self-paced walking trials. Five trials were undisturbed, and five each with a platform translating either laterally or anteriorly at heel contact. Sagittal, frontal, and transverse hip angles as well as sagittal and frontal knee angles were collected during stance. RESULTS: Excursions in the frontal and transverse planes were greater at the hip and knee for females compared to males in each walking condition. The rate of these excursions also occurred more rapidly for females than males. There was no difference for joint angles at initial contact between genders, and there was no difference in the amount of sagittal plane excursion for the hip and knee when comparing genders. CONCLUSIONS: Females demonstrate characteristics during both normal and perturbed gait that may potentially contribute to increased anterior cruciate ligament strain. Repetition of these potentially harmful movement patterns during provocative athletic maneuvers may lead to anterior cruciate ligament injury. RELEVANCE: Females exhibit lower extremity kinematic patterns that differ from males. Female kinematic patterns may contribute to an increased risk for anterior cruciate ligament injury.

Adaptation, Physiological↗
PubMed1996

"Lifestyle" interventions for promoting physical activity: a kilocalorie expenditure-based home feasibility study.

The Centers for Disease Control and Prevention and the American College of Sports Medicine in cooperation with the President's Council of Physical Fitness and Sports recommended short periods of daily kilocalorie (calorie) expenditure with moderate-intensity physical activities to complement the currently existing recommendations. In this study the feasibility (adherence and safety) of employing calorie expenditure as the basis for prescribing a home-based walking program to healthy, community-dwelling men and women was examined. This was a 16-week pretest-posttest feasibility study of a home-based calorie-expenditure walking program conducted in an outpatient clinic in an academic medical center. Participants included 20 healthy, elderly, community-dwelling men and women. A 16-week home-based walking program was individually prescribed as a weekly amount of calorie expenditure increasing from an initial 300 calories per week to 1,200 calories per week (approximately 30 minutes of walking daily) during the final 6 weeks of the study. Adherence to the program was recorded individually in a diary (kept daily and reviewed at each visit), body weight, and walking pace. All but one participant were able to complete this 16-week program (95 percent adherence). That a calorie-based approach to promote physical activity among the elderly has a high adherence rate is suggested by these findings. Additional studies are necessary to define the potential role for this approach in promoting physical activity and improving health outcomes among the elderly.

Aged↗
PubMedDate not supplied

Six-minute walk by people with chronic renal failure. Assessment of effort by perceived exertion.

The ability to exercise among 20 people with chronic renal failure was assessed on three tests by measuring the distance walked in 6 min, heart rate change from pre-exercise to postexercise and perceived exertion. Test 1 was conducted to minimize practice effects. Ten participants received exercise coaching for 3 mo between Tests 2 and 3, and 10 individuals were in a control group. Distance walked was highly correlated on the three tests; heart rate change and perceived exertion were only slightly less consistent. Three people changed their perceived exertion by more than one point between Tests 2 and 3, and these changes obscured differences between the exercise and control groups. Exclusion of data for those who changed by more than one point equalized perceived exertion changes in the two groups and revealed a significant (P < 0.05) increase in distance in the exercise group (+21.8 m) but not in the control group (+1.5 m). The study demonstrates that, although perceived exertion ratings are intended for use in incremental exercise testing, they are also valuable for assessing consistency v change in the effort of individual participants in single-intensity testing, such as a self-paced walk.

Adult↗