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PubMed1996

Improvement in cardiovascular fitness after total knee arthroplasty.

Patients who have osteoarthrosis involving weight-bearing joints typically have a gradual decline in physical activity, which is often associated with cardiovascular deconditioning. After joint replacement, many patients resume routine walking and recreational activities, which may improve aerobic capacity. The purpose of the present study was to determine the effect of total knee arthroplasty on cardiovascular fitness. Nineteen patients who had had total knee arthroplasty (the arthroplasty group) performed an exercise test for cardiovascular fitness preoperatively. Sixteen of these patients were tested again at one year postoperatively and thirteen, at two years postoperatively. Sixteen patients in whom osteoarthrosis of the knee was being treated medically (the control group) were tested at the time of enrollment in the study and one year later. Nine of these patients also were tested two years after enrollment. All of the patients completed the Arthritis Impact-Measurement Scales (AIMS) at each examination. Fitness was assessed by the performance of a progressive maximum exercise test with use of a bicycle ergometer and a metabolic cart. All patients achieved the anaerobic threshold. One year postoperatively, the patients in the arthroplasty group demonstrated an increase, which approached significance, in maximum oxygen consumption (measured in milliliters of oxygen per minute) (p = 0.07), maximum oxygen consumption corrected for body weight (p = 0.08), and percentage of predicted maximum uptake of oxygen (p = 0.06). Two years after the total knee arthroplasty, the patients had a significant improvement with regard to all three parameters (p = 0.008, 0.005, and 0.005, respectively). The patients in the control group demonstrated a significant decrease in duration of exercise and in maximum workload at one year (p = 0.003 and 0.005, respectively) and at two years (p = 0.008 for both parameters). Physical activity had increased in the arthroplasty group but not in the control group, as demonstrated by the results of the Arthritis Impact-Measurement Scales. These findings demonstrate a trend toward improvement in cardiovascular fitness one year after total knee arthroplasty and a significant improvement two years postoperatively for patients who had been able to resume routine functional activities because of the arthroplasty. These improvements compared favorably with the static pattern or the decline in the measures of fitness that were observed in the control group. Our results should be considered preliminary because of the relatively small number of patients who were studied.

Aged↗
PubMedDate not supplied

The interactions of intensity, frequency and duration of exercise training in altering cardiorespiratory fitness.

This review has grouped many studies on different populations with different protocols to show the interactive effects of intensity, frequency and duration of training as well as the effects of initial fitness levels and programme length on cardiorespiratory fitness as reflected by aerobic power (VO2max). Within each level of exercise duration, frequency, programme length or initial fitness level, the greatest improvements in aerobic power occur when the greatest challenge to aerobic power occurs i.e., when intensity is from 90 to 100% of VO2max. The pattern of improvement where different intensities are compared with different durations suggests that when exercise exceeds 35 minutes, a lower intensity of training results in the same effect as those achieved at higher intensities for shorter durations. Frequencies of as low as 2 per week can result in improvements in less fit subjects but when aerobic power exceeds 50 ml/kg/min, exercise frequency of at least 3 times per week is required. As the levels of initial fitness improve, the changes in aerobic power decreases regardless of the intensity, frequency or duration of exercise. Although these pooled data suggest that maximal gains in aerobic power are elicited with intensities between 90 to 100% VO2max, 4 times per week with exercise durations of 35 to 45 minutes, it is important to note that lower intensities still produce effective changes and reduce the risks of injury in non-athletic groups.

Aerobiosis↗
PubMed2001

The relationship between aerobic fitness and recovery from high intensity intermittent exercise.

A strong relationship between aerobic fitness and the aerobic response to repeated bouts of high intensity exercise has been established, suggesting that aerobic fitness is important in determining the magnitude of the oxidative response. The elevation of exercise oxygen consumption (VO2) is at least partially responsible for the larger fast component of excess post-exercise oxygen consumption (EPOC) seen in endurance-trained athletes following intense intermittent exercise. Replenishment of phosphocreatine (PCr) has been linked to both fast EPOC and power recovery in repeated efforts. Although 31P magnetic resonance spectroscopy studies appear to support a relationship between endurance training and PCr recovery following both submaximal work and repeated bouts of moderate intensity exercise, PCr resynthesis following single bouts of high intensity effort does not always correlate well with maximal oxygen consumption (VO2max). It appears that intense exercise involving larger muscle mass displays a stronger relationship between VO2max and PCr resynthesis than does intense exercise utilising small muscle mass. A strong relationship between power recovery and endurance fitness, as measured by the percentage VO2max corresponding to a blood lactate concentration of 4 mmol/L, has been demonstrated. The results from most studies examining power recovery and VO2max seem to suggest that endurance training and/or a higher VO2max results in superior power recovery across repeated bouts of high intensity intermittent exercise. Some studies have supported an association between aerobic fitness and lactate removal following high intensity exercise, whereas others have failed to confirm an association. Unfortunately, all studies have relied on measurements of blood lactate to reflect muscle lactate clearance, and different mathematical methods have been used for assessing blood lactate clearance, which may compromise conclusions on lactate removal. In summary, the literature suggests that aerobic fitness enhances recovery from high intensity intermittent exercise through increased aerobic response, improved lactate removal and enhanced PCr regeneration.

Adaptation, Physiological↗
PubMed2006

Temporal changes in the physical fitness of US Army recruits.

This article defines physical fitness and then reviews the literature on temporal trends in the physical fitness of new US Army recruits. Nineteen papers were found that met the review criteria and had published recruit fitness data from 1975 to 2003. The limited data on recruit muscle strength suggested an increase from 1978 to 1998 (20-year period). Data on push-ups and sit-ups suggested no change in muscular endurance between 1984 and 2003 (19-year period). Limited data suggested that maximal oxygen uptake (VO2max) [mL/kg/min] of male recruits did not change from 1975 to 1998 (23-year period), while there was some indication of a small increase in female recruit VO2max in the same period. On the other hand, slower times on 1-mile (1.6km) and 2-mile (3.2km) runs indicate declines in aerobic performance from 1987 to 2003 (16-year period). The apparent discrepancy between the VO2max and endurance running data may indicate that recruits are not as proficient at applying their aerobic capability to performance tasks, such as timed runs, possibly because of factors such as increased bodyweight, reduced experience with running, lower motivation and/or environmental factors. Recruit height, weight and body mass index have progressively increased between 1978 and 2003 (25-year period). Both the body fat and fat-free mass of male recruits increased from 1978 to 1998 (20-year period); however, body composition data on female recruits did not show a consistent trend. In this same time period, the literature contained little data on youth physical activity but there was some suggestion that caloric consumption increased. This article indicates that temporal trends in recruit fitness differ depending on the fitness component measured. The very limited comparable data on civilian populations showed trends similar to the recruit data.

Body Composition↗
PubMed1996

A comparative epidemiological study on the effects of physical fitness on health level.

Clinical tests, a questionnaire on life style and mental health, and physical fitness tests were conducted on 3,132 individuals (1,796 men and 1,336 women) to find the relationships between physical fitness level and life style, mental health, or cardiovascular risk factors among Japanese. Individuals with an advanced physical fitness level also exhibited optimum mental health: the odds ratio (OR) and 95% confidence interval (CI) for their sensation of fatigue (fast recovery) was 1.16 (95% CI = 1.00 to 1.35) and that for mood recovery (fast) was 1.29 (95% CI = 1.12 to 1.49). Among those with an advanced physical fitness level, the following were rare (OR): daily smoking [0.78]; obesity (over 120%) [0.73 (95% CI = 0.62 to 0.87)]; thick subcutaneous fat (over 20 mm on the back) [0.77 (95% CI = 0.66 to 0.90)]; high blood sugar level [0.64 (95% CI = 0.50 to 0.82)]; and hypertension [0.67 (95% CI = 0.49 to 0.91)]. These are risks for circulatory diseases. These data show that risk factors associated with cardiovascular disease are more common in those with a low physical fitness level.

Adult↗
PubMed2003

Cardiorespiratory fitness and the incidence of type 2 diabetes: prospective study of Japanese men.

OBJECTIVE: To investigate the association between cardiorespiratory fitness and the incidence of type 2 diabetes among Japanese men. RESEARCH DESIGN AND METHODS: This prospective cohort study was conducted in 4747 nondiabetic Japanese men, aged 20-40 years at baseline, enrolled in 1985 with follow-up to June 1999. Cardiorespiratory fitness was measured using a cycle ergometer test, and Vo(2max) was estimated. During a 14-year follow-up, 280 men developed type 2 diabetes. RESULTS: The age-adjusted relative risks of developing type 2 diabetes across quartiles of cardiorespiratory fitness (lowest to highest) were 1.0 (referent), 0.56 (95% CI 0.42-0.75), 0.35 (0.25-0.50), and 0.25 (0.17-0.37) (for trend, P < 0.001). After further adjustment for BMI, systolic blood pressure, family history of diabetes, smoking status, and alcohol intake, the association between type 2 diabetes risk and cardiorespiratory fitness was attenuated but remained significant (1.0, 0.78, 0.63, and 0.56, respectively; for trend, P = 0.001). CONCLUSIONS: These results indicate that a low cardiorespiratory fitness level is an important risk factor for incidence of type 2 diabetes among Japanese men.

Adult↗
PubMed1986

Physical fitness: a buffer against stress.

The purpose of this study was to determine the extent to which physically fit and unfit persons differ regarding levels of stress in their lives. The six Kraus-Weber tests were employed to assess minimal muscular function and fitness among 4,628 adult males, and a 10-item Likert-type inventory was administered to measure perceived stress. Analysis of covariance was utilized with age statistically controlled, and the results indicated that the unfit subjects perceived significantly more distress in their lives than did the adequately fit subjects. It was concluded that physical fitness may fortify the body against the demands of life and provide increased strength and hardiness. Physical fitness may act as a buffer against stress.

Adult↗
PubMed1991

Physical fitness, body image, and locus of control in college women dancers and nondancers.

This study assessed the correlations among measures of physical fitness, body image and locus of control in college freshman women dancers and nondancers. 39 students enrolled in courses in modern, ballet, and jazz dance, and 120 students enrolled in an introductory personal health course were administered the Hall Physical Fitness Test Profile, the Winstead and Cash 54-item short-form Body Self-relations Questionnaire (BSRQ), and the Adult Nowicki-Strickland Locus of Control Scale. Analysis showed dancers were more physically fit, scored more positively on the BSRQ physical fitness and health domains, and were more internal in their locus of control than the nondancers. There was no significant difference between dancers and nondancers on the BSRQ appearance domain. The significant positive correlation between BSRQ health and physical fitness among dancers was not observed among nondancers. The significant positive correlation for BSRQ appearance and health was noted for nondancers but not for dancers.

Adolescent↗
PubMed1991

Role of fitness in mediating stress: a correlational exploration of stress reactivity.

Researchers have investigated the effect of exercise on reducing subjects' responsiveness to stress. Results from the initial studies were positive, yet these studies often did not use objective measures of fitness. This investigation applied more rigorous methodology than past experiments to assess the relationship between fitness and reactivity to stress. Maximal oxygen consumption was measured to indicate the fitness of recreational cyclists who were then exposed to three stressful situations (mental subtraction, speech preparation, and the cold pressor test). Heart rate, frontalis electromyographic (EMG) levels, and self-report of tension were monitored during the stress-inducing tasks. Physical fitness was significantly related to heart rate taken during the subtraction and cold pressor tasks, with EMG during subtraction, and with self-report during all three stressor tasks. These results further support the hypothesized association of physical fitness and reducing response to stress.

Adaptation, Psychological↗
PubMed1993

Leisure-time physical activity as a determinant of self-perceived fitness.

This paper examined the extent to which a reliable measure of leisure-time physical activity is predictive of self-perceived fitness among 40 British university students (mean age = 20.6 yr.). Spearman's rank-order correlations indicated that self-perceived fitness, on an ordinal scale of 1 through 5, was positively correlated 0.48 with Total activity score and 0.54 with one of its subfractions, Very Hard activity. An additional association of 0.52 with an estimate of cardiorespiratory endurance capacity meant that 35.4% of the variation in self-perceived fitness was accounted for by leisure-time physical activity and fitness variables (R = 0.60). These findings provide support that notions of perceived fitness are not inaccurate and are influenced by the amount and types of leisure-time physical activity undertaken.

Adolescent↗
PubMed1976

Correlation of maternal physical fitness during pregnancy with maternal and fetal pH and lactic acid at delivery.

The physical fitness of 120 healthy primigravidae was determined two weeks before term using first the standardized three-stage submaximal work test on the following day the voluntarily maximal pulse-conducted work test on a bicycle ergometer. After the first test the level of lactic acid in the capillary circulation of 115 mothers was examined. Immediately after delivery the pH and the level of lactic acid in the maternal artery, umbilical vein and umbilical artery were determined. The level of lactic acid after the work test was negatively correlated with the physical performance of the mother. The level of lactic acid in the mother after the work test and the levels of lactic acid in the umbilical vessels were positively correlated. The mean pH value in physically fit women after delivery was almost significantly higher than in the women of below average performance. The pH level in the umbilical artery was also almost significantly higher in the mothers with above average performance. The physically fit women appear to work more during delivery than the less fit mothers, as the level of lactic acid after the delivery was as high as or higher than in mothers with a physical performance below average. The physical fitness of six mothers, who delivered an asphyxiated baby, was almost significantly lower than the performance of the mothers. Five mothers with an exceptionally high pH after delivery had a significantly higher performance than the other mothers.

Adult↗
PubMed1996

Adaptive fitting of hearing instruments by category loudness scaling (ScalAdapt).

The introduction of programmable as well as non-linear hearing instruments has shown that audiogram-based fitting procedures are inappropriate for meeting the individual needs of hearing aid users with sensorineural loss. Particularly the present and future development of hearing instruments with advanced analog and digital signal processing requires suitable fitting procedures. In this context, we developed an adaptive fitting strategy (ScalAdapt) using category loudness scaling. In this paper the procedure is described and tested using programmable 3-channel AGC instruments. However, it can be modified for any other hearing aid design. The underlying idea is to normalize the aided loudness perception for two input levels, one around the most comfortable level (MCL) and the other just below the uncomfortable level (UCL), as anchor points in each channel by interactive fine-tuning of the fitting parameters (channel gain, compression onset, compression ratio, etc.). The benefits of ScalAdapt have been evaluated by a field test study in 17 experienced hearing aid users. The results showed that ScalAdapt provides consistently higher objective (speech recognition in noise) and subjective benefits (self-assessment inventory) than for instance NAL-based fittings.

Hearing Aids↗
PubMed1998

Development and evaluation of a procedure for fitting multi-channel compression hearing aids.

Hearing aids with multi-channel compression are often fitted on the basis of loudness scaling data obtained using narrow bands of noise or tones. Here, we report the development and evaluation of an alternative fitting procedure based on the use of speech signals. The parameters of the hearing aid (the gains in each channel for high and low input levels) are adjusted adaptively under computer control on the basis of the listener's responses. The goal is that speech at 85 dB SPL should be judged as 'loud', speech at 60 dB SPL should be judged as 'quiet', and speech at both levels should be judged as 'neither tinny nor boomy'. The procedure was evaluated using a two-channel compression hearing aid, the remote control of which allowed two programs to be stored. One program was based on our fitting procedure. The other was either based on the manufacturer's recommended full fitting procedure (which included loudness scaling with bands of noise), or was based on the audiogram alone, using the manufacturer's algorithm. After an acclimatization period of at least two weeks, subjects were then asked to fill in a questionnaire about their experiences with the two programs in different listening situations. The results generally indicated a preference for the program based on our adaptive fitting procedure. We also conducted laboratory measurements of speech intelligibility, in quiet and in a background of a single competing talker. These showed no clear difference between programs, although scores overall were very high. We conclude that our adaptive procedure gives very satisfactory results in everyday life. Parameter values giving good comfort also give good intelligibility. The procedure typically takes between five and 10 minutes per ear, which is quicker than most loudness scaling procedures.

Hearing Aids↗
PubMedDate not supplied

Worksite fitness and exercise programs: a review of methodology and health impact.

PURPOSE: To examine the methodology of worksite fitness and exercise programs and to assess their effect on health-related fitness, cardiac risk factors, life satisfaction and well-being, and illness and injury. SEARCH METHODS: The 52 studies reviewed cover English-language literature for the period from 1972 to 1994, as identified by a search of the Cumulative Index Medicus, Medline, the Canadian Sport Documentation Centre's "Sport Discus," computerized bibliography, and my own files. Reports were divided into five controlled experimental studies, 14 quasi-experimental studies with matched controls (one reported in abstract), and 33 other interventions of varied quality. SUMMARY: Methodologic problems include difficulty in allowing for Hawthorne effects, substantial sample attrition, and poor definition of the intervention (exercise or broad-based health promotion). Findings are analyzed by specific fitness and health outcomes. Program participants show small but favorable changes in body mass, skinfolds, aerobic power, muscle strength and flexibility, overall risk-taking behavior, systemic blood pressure, serum cholesterol, and cigarette smoking. Claims of improved mood state are based heavily on uncontrolled studies. Quasi-experimental studies suggest reduced rates of illness and injury among participants, but seasonal and year-to-year differences in health weaken possible conclusions. CONCLUSIONS: Participation in worksite fitness programs can enhance health-related fitness and reduce risk-taking behavior, but population effect is limited by low participation rates.

Cardiovascular Diseases↗
PubMedDate not supplied

Relationship of trait, Type A behavior, and physical fitness variables to cardiovascular reactivity and coronary heart disease risk potential.

PURPOSE: This research investigated the effects of individual characteristics on cardiovascular reactivity, and in turn on the potential for developing coronary heart disease. DESIGN: Path analysis was performed using LISREL, a structural equation modeling program providing maximum likelihood estimators and goodness-of-fit measures. SETTING: Data were collected during a health assessment program, from participants attending a Department of Defense senior service school. SUBJECTS: Participants were 134 senior-ranking male military and civilian employee volunteers, representing approximately 84% of all students in training. MEASURES: Five individual characteristics, four measures of cardiovascular reactivity, and one coronary heart disease risk potential variable were investigated. These included Physical Fitness, Type A behavior, Trait Anger and Trait Anxiety, Diastolic and Systolic Blood Pressure measures, and Coronary Heart Disease Risk. RESULTS: Significant path coefficients (critical ratios > 2) indicated that the mean diastolic blood pressure under a video stress condition was predictive of increased potential of developing coronary heart disease (.51), while hard driving Type A behavior was a cardiovascular reactivity antecedent associated with an increase in coronary heart disease risk directly (.14) and indirectly (.39). Physical fitness, on the other hand, had a positive affect in that increased fitness was related to lower cardiovascular reactivity when participants were stressed (-.58). CONCLUSIONS: Physical fitness is indirectly beneficial in reducing coronary heart disease risk potential by reducing an individual's diastolic blood pressure response, while scoring high as a Type A Hard Driving personality increases cardiovascular reactivity and coronary heart disease risk. This study is limited to middle-aged males who were generally healthy and displayed concern for their health.

Adult↗
PubMedDate not supplied

The association between physical fitness and diagnosed chronic disease in health maintenance organization members.

PURPOSE: The purpose of this investigation was to determine the relationship between predicted cardiorespiratory fitness (predicted VO2max) and diagnosed chronic disease. DESIGN: A stratified random sample of individuals was surveyed. SETTING: Large Health Maintenance Organization (HMO) in the upper Midwest. SUBJECTS: HMO members (N = 8000), age 40 and over, with none, one, or two or more of the following diagnosed chronic conditions: hypertension, diabetes, dyslipidemia, and heart disease. MEASURES: Predicted VO2max was estimated for those respondents who completed the survey providing all critical data elements (n = 4121; representing 51.5% of total sample). Predicted VO2max was compared across chronic conditions using analysis of variance. The proportion of subjects across fitness quintiles by number of chronic conditions was tested using the chi 2 test. RESULTS: Subjects without chronic conditions showed higher predicted VO2max values (29.8 +/- 7.7 ml/kg/min) than those with one (25.9 +/- 7.8 ml/kg/min) or two or more conditions (25.7 +/- 7.9 ml/kg/min) (p < .0001). Subjects with diabetes, hypertension, and heart disease reported lower predicted VO2max than their healthier counterparts (p < .0001), but this was not the case for dyslipidemia subjects (27.6 +/- 7.6 vs. 27.4 +/- 8.2 ml/kg/min, respectively; p > .58). A larger proportion of diseased subjects was in the lowest fitness quintile for diabetes, hypertension, and heart disease, but not for dyslipidemia. CONCLUSIONS: As a group, chronic disease patients appear to have lower levels of physical fitness than subjects without chronic disease. Physical fitness improvement in diseased populations should be supported in the clinical setting.

Adult↗
PubMedDate not supplied

Sports and fitness activities: the negative consequences.

Participation in sports and fitness activities offers potential health benefits for individuals of all ages, such as combating obesity and osteoporosis, as well as enhancing cardiovascular fitness. Negative consequences of musculoskeletal injuries sustained during sports participation in childhood and adolescence may compromise function in later life, limiting the ability to experience pain-free mobility and engage in fitness-enhancing activity. Increasingly successful management of sports-related injuries has allowed more athletes to return to participation. However, even effective early management of meniscal or anterior cruciate ligament injury does not minimize or preclude the increased likelihood of developing subsequent osteoarthritis. In addition, even in the absence of injury, vigorous participation in sports and fitness activities during childhood and adolescence increases the likelihood of developing osteoarthritis. It is ironic that return to vigorous sports participation has been adopted as an important measure of success of treatment, yet few efforts have been made to document long-term consequences of continued participation. Awareness of the long-term consequences of intensive sport and fitness activities allows the physician to help patients make informed decisions about the types and levels of activity they choose.

Athletic Injuries↗
PubMed1996

Addressing a neglected coronary heart disease risk factor in an HMO: exercise counseling and fitness testing at group health cooperative.

Group Health Cooperative, following the lead of the American Heart Association (AHA), the Centers for Disease Control (CDC), and the US Preventive Services Task Force (USPSTF), has identified inactivity as one of the most significant risk factors for the prevention of coronary heart disease (CHD). This paper reports on the programs being developed at Group Health Cooperative to address inactivity. A clinical tool designed to make fitness testing and comprehensive exercise counseling practical in routine primary care was designed and piloted. The fitness test was based on the One-Mile Walk Test, with computerization of the results analysis and reporting. The test helped the physician assess the patient's current exercise habits and physical fitness in terms of Vo2max (maximal oxygen consumption). The computer program showed the patient and the physician how the individual's Vo2max compared to norms for the patient's age and gender. The program provided comprehensive written exercise counseling and individualized advice about activity and fitness based on the patient's current exercise habits. The test cost little to administer, and helped reduce the time and effort of the primary physician in providing exercise counseling, while making optimal use of the physician's power to motivate. Exercise counseling is a very cost-effective preventive intervention. We believe that an organized and systematic exercise counseling program, together with a program for measuring fitness, would be the most effective intervention. Evidence indicates that effective exercise counseling should result in substantial reduction in disease in our population.

Adult↗