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University of Southern California Dissertations and Theses
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The Effect Of Exercise Training On Systolic Time Intervals In Elderly Men
(USC Thesis Other)
The Effect Of Exercise Training On Systolic Time Intervals In Elderly Men
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INFORMATION TO USERS This m a te ria l was produced from a microfilm copy of the original document. While the most advanced technological means to photograph and reproduce this document have bean used, the quality is heavily dependant upon the quality of the original submitted. The following explanation of techniques is provided to help you understand markings or patterns which may appear on this reproduction. 1. The sign or "target" for pages apparently lacking from the document photographed is "Missing Page(s)". If it was possible to obtain the missing pege(s) or section, they are spliced into the film along with adjacent pages. This may have necessitated cutting thru an image and duplicating adjacent pages to insure you complete continuity. 2. When an image on the film is obliterated with a large round Mack mark, it is an indication that the photographer suqsected that the copy may have moved during exposure and thus cause a blurred image. You will find a good image of the page in the adjacent frame. 3. When a map, drawing or chart, etc., was part of the material being photographed the photographer followed a definite method in "sectioning" the material. It is customary to begin photoing at the upper left hand comer of a large dieet and to continue photoing from left to right in equal sections with a smaH overlap. If necessary, sectioning is continued again — beginning below the first row and continuing on until complete. 4. The majority of users indicate that the textual content is of greatest value, however, a somewhat higher quality reproduction could be made from "photographs" if essential to the understanding of the dissertation. Silver prints of "photographs" may bo ordered at additional charge by writing the Order Department giving the catalog number, tide, author and specific pagaa you wish reproduced. 5. PLEASE NOTE: Some pages may have indistinct print. Filmed as received. Xerox University Microfilms 300 MofVt Z x b R tad A m Afbor. Mlchtgm 4S10S 74- 26,010 ADAMS, Gene M erle, 1939- THE EFFECT OF EXERCISE TRAINING O N SYSTOLIC TINE INTERVALS IN ELDERLY MEN. U n iv e rs ity o f S outhern C a lif o r n ia , P h .D ., 1974 E d u ca tio n , p h y sic a l University Microfilms, A X E R O X Company, Ann Arbor, Michigan THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED. TH E E F F E C T O F EX ER C ISE TRAINING ON SYSTO LIC TIM E IN TER V A LS IN E L D E R L Y M EN by G en e M e r le A dam e A D ie a er ta tio n P r e s e n te d to the F A C U L T Y O F TH E G R A D U A TE SCHOOL UNIVERSITY O F SO UTHERN C A LIFO R NIA In P a r tia l F u lfillm e n t o f the R eq u irem en t* fo r the D e g r e e DOCTOR O F PH ILO SO PH Y (P h y s ic a l E d u cation ) June 1974 UNIVERSITY O F SO U TH ERN CALIFORNIA T H IO K A D U A TI SCHOOL U N IV tM IT Y PARK LOS AM OCLU. CALIFORNIA MOOT This dissertation, written by under the direction of him. Dissertation Com mittee, and approved by all its members, has been presented to and accepted by The Graduate School, in partial fulfilm ent of requirements of the degree of D O C T O R OF P H IL O S O P H Y DISSERTATION COMM! T A B L E O F CO NTEN TS LIST O F T A B L E S...................................................................................................... iv LIST O F F IG U R E S ................................................................................................... C hapter P a g e I. IN TRO DUC TIO N..................................................................................... I S ta tem en t o f the P r o b le m .......................................................... 3 S ig n ific a n c e o f the S t u d y .......................................................... 3 D efin itio n * o f T e r m s .................................................................... 4 D e lim ita tio n s ..................................................................................... 6 II. REVIEW O F L IT E R A T U R E M eth od ology, D e sc r ip tio n and V a lid ity of ST1 . . . . F a c to r s A ffectin g L V E T .......................................................... 12 F a c to r s A ffectin g P E P .............................................................. 14 A cu te E ffe c t of E x e r c is e on S T I ........................................... 16 S ig n ific a n c e of P E P / L V E T ................................................... lfl E ffe c t of T rain in g on S T I ................. - ................................. 23 E ffe c t o f A ge on S T I .................................................................... 2S S u m m ary .................................................................................. 31 III. M ETHODS AND PR O C ED U R ES ................................................ 4C S u b j e c t s ............................................................................................... 4( E x p e r im e n ta l D e s i g n ................................................................. 42 In stru m en ta tio n and T e r m in o lo g y ..............* .................... 43 E x e r c is e P r o g r a m ................................................................. 53 IV. R E S U L T S ................................................................................................... 57 V. D IS C U S S IO N ............................................................................................ 73 ii C hapter P a g e VI. SUM M ARY AND C O N C L U S IO N S ................................................. 77 S u m m a r y ............................................................................................ 77 C o n c lu a io n a ..................................................................................... 79 F u tu re R e a e a r c h ........................................................................... 79 B IB L IO G R A P H Y ...................................................................................................... 83 A P P E N D IX E S I E x e r c ia e P r o g r a m - P h aaea 1 lc 3 .......................................... 98 II P r o g r a m -S e a a io n F o r m .................................................................. 101 III The A cu te E ffe c t of E x e r c ia e in O lder M alea on T otal S y a to le (QS2) 103 IV The A cute E ffe c t o f E x e r c ia e in O lder M alea on P r e -E je c tio n P e r io d ( P E P ) ................................................... 105 V The A cute E ffe c t of E x e r c ia e in O lder M alea on the R atio o f P r e -E je c tio n P e r io d to L eft V e n tr ic u la r E je ctio n T im e (P E P /L V E T ) ........................................... 107 i ii LIST O F T A B L E S T able P a g e 1. T rain in g E ffe c ts on R estin g S y s to lic T im e In te r v a ls of N o r m a l s ................................................................................... 32 2. T rain in g E ffe c ts on E x e r c is e R e c o v e r y S y s to lic T im e In te r v a ls o f N o r m a l s ........................................................... 35 3. C o m p a riso n o f S y s to lic T im e In te r v a ls in N o r m a ls and A b n o rm a ls a t R e st and a fte r A cu te E x e r c is e . . . 37 4. D e sc r ip tio n of the S u b jects ................................................. 41 5. T e s t -R e t e s t and S p lit-h a lv e s (B) E valu ation o f R e l i a b i l i t y ................................................................................... 45 6. S u m m ary of V ariou s S y s to lic T im e In ter v a l P r o c e d u r e s by P r e v io u s I n v e s t i g a t o r s ............................. 47 7. D e sc r ip tio n of S y s to lic T im e In ter v a ls (S T I )......................... 51 8. B ic y c le E r g o m e te r (C on stan t W ork T ype) P r o g r a m s , 54 9. P r e to 10 W eek C hanges in P h y s ic a l W ork C ap acity and A n th ro p o m etric V a lu es o f N o rm a l E ld e r ly M en . 60 10. P r e to 10 W eek C hanges in H ea rt Rate* and B lood P r e s s u r e at R est* du rin g E x e r c ise * and in R e c o v e r y ....................................................................................... 63 11. P r e to 10 W eek C hanges in S y s to lic T im e In te r v a ls C o r r e c te d fo r H eart R a t e .......................................................... 69 lv LIST O F ILLUSTR ATIO N S F ig u re P a g e 1. Illu str a tio n o f E le c tr o d e , P h o n o -s e n s o r , and C arotid P u ls e T ra n sd u c er P la c e m e n t on S u b ject . . . 49 2. A ctu al P o ly g r a p h ic T ra cin g fo r S y s to lic T im e In terv a l M ea su re m en t ........................................................................ 50 3. The A v e ra g e W ork Load at E ach W orkout and the A v e ra g e T otal W ork Output p er W orkout fo r E ach W eek o f the 10 W eek T rain in g P e r io d and the A v e ra g e H eart R ate fo r the W orkouts for Each W e e k ............................................................................................ 58 4. C hange in P h y s ic a l F itn e s s of M en A ged 5 7 -7 4 a fter 10 W eek s of B ic y c le E r g o m e t r y .............................. 59 5. P r e - p o s t M ean D iffe r e n c e s in H ea rt R ate at G iven W attages in the 3 M inute Step In terv a l P r o to c o l . . . 62 6. C hange in T otal S y sto le of M en A ged 5 7 -7 4 in the R estin g Supine P o s itio n and Seated on the B ic y c le E r g o m e te r a fte r 10 W eek s of B ic y c le E r g o m etry . . 64 7. The C hange in L eft V e n tr ic u la r E je ctio n T im e in M en A ged 5 7 -7 4 in the R estin g Supine P o sitio n and W hen S eated on the B ic y c le E r g o m e te r a fte r 10 W eek s of B ic y c le E r g o m e tr y ........................................................................ 66 8. The C hange in R atio o f P r e -e je c tio n P e r io d to L eft V e n tr ic u la r E je ctio n T im e o f M en A ged 5 7 -7 4 in the R estin g Supine P o s itio n and W hen S ea ted on the B ic y c le E r g o m e te r a fte r 10 W eeks of B ic y c le E r g o m e t r y .............................................................................. 67 v F ig u re P a g e 9. The C hange in L eft V e n tr ic u la r E je ctio n T im e C o r r e c te d fo r H eart R ate o f M en A ged 5 7 -7 4 W hile S ea ted on the B ic y c le E r g o m e te r a fte r 10 W eeks o f B ic y c le E r g o m e t r y ............................................ 70 vl C H A P T E R I INTRO DUCTIO N C a r d io v a sc u la r d is e a s e h as b een th e n u m b er on e c a u s e o f death in the U nited S ta te s (C o m m issio n fo r H ea rt D is e a s e R e s o u r c e s , 1970) and h a s b e e n la r g e ly r e s p o n s ib le fo r th e fa c t that the U nited S tates ran k s eig h tee n th am ong a w o r ld w id e l is t of lo n g e v ity in m a le s (C la rk e, 1972). T h u s, the sta tu s of A m e r ic a n s w ith r e s p e c t to c a r d io v a sc u la r d is e a s e h a s su g g e ste d that the m o d ern A m e rica n lif e - s t y l e has b een a co n trib u tin g fa cto r to th is " d eg en era tiv e" d is e a s e . P e r s o n s under 75 y e a r s of a g e have e x p e r ie n c e d the te c h n o lo g ic a l l if e - s t y l e for the g r e a te s t p o rtio n o f th eir y e a r s . The m o r ta lity s t a t is t ic s h ave sh ow n that m o r e than 40 p e r c e n t o f the c o r o n a r y h e a r t d is e a s e d eath s o c c u r r e d in p e r s o n s b etw een 55 and 74 y e a r s old (U nited S ta tes P u b lic H ealth S e r v ic e , 1969). One p r in c ip le c h a r a c te r is tic o f th is te c h n o lo g ic a lly in d u ced l if e - s t y l e h a s b e e n se d e n ta r y liv in g . E p id e m io lo g ic a l stu d ie s and r e v ie w s by c a r d io v a s c u la r s p e c ia lis t s h ave a s s o c ia te d p h y sic a l in a c tiv ity w ith h e a r t d is e a s e (B o y e r , 1972; F le tc h e r , 1971; F o x e t a l . , 1 2 1971; F ran k e t a l. , 1966; R aab, 1 9 6 6 ). V a rio u s in v e s tig a to r s h ave d e m o n stra te d a r ed u c tio n o f one or m o r e r is k fa c to r s a s s o c ia te d w ith h e a r t d is e a s e through p r o p e r ly a p p lied p h y sic a l a c tiv ity (B oyer e t a l. , 1970; C o o p er, 1967; F ra n k s, 1968; F r ic k et a l. , 1963). A nother c a r d io v a s c u la r b e n e f it-- in c r e a s e d c a r d ia c r e s e r v e - - g a in e d through p h y s ic a l train in g h a s b een m a n ife ste d o ften a s im p r o v ed c ir c u lo - r e s p ir a to r y en d u ran ce or sim p ly , im p ro v ed p h y sic a l f itn e s s . T h u s, e x e r c is e train in g h a s b een en co u ra g ed a s a m e a n s to im p r o v e c a r d io v a sc u la r h e a lth . In a c tiv e p e r s o n s the g r e a te r p h y sic a l w ork c a p a c ity h a s b een a ttrib u ted to an im p r o v ed c e n tr a l and p e r ip h e r a l c a r d io v a s c u la r s y s te m . W hile the im p r o v e m e n t at the p e r ip h e r a l le v e l h as b een a ttrib u ted to a g r e a te r m a x im a l a r te r io -v e n o u s oxygen d iffe r e n c e , the c e n tr a l le v e l o f im p r o v e m e n t h a s b een m a in ly a ttrib u ted to a g r e a te r c a r d ia c output, o r m o r e s p e c ific a lly , by a la r g e r str o k e v o lu m e (B e v eg a r d e t a l. , 1963; E kblom e t a l. , 1968; H anson e t a l . , 1968; J o k l, 1959). In v estig a tio n s in to the m e c h a n ism fo r im p r o v ed w ork c a p a c ity in o ld e r p e r so n s h a v e b een few and h a v e p ro v id ed so m e c o n tr o v e r s y w ith r e s p e c t to the s it e of c a r d io v a s c u la r im p r o v e m e n t w ith tra in in g . In o ld er p e r so n s J u liu s and h is c o -w o r k e r s (1967) found that th e a b ility to e x e r c is e w a s not lim ite d by the c e n tr a l le v e l of c a r d io v a s c u la r fu n ctio n , i. e . , c a r d ia c output and str o k e v o lu m e . The in v e s tig a to r s con clu d ed that lo c a l (p e rip h e ra l) c ir c u la to r y o r n e u r o m u sc u la r fa c to r s w e r e r e s p o n s ib le for the d e c lin e in a b ility to e x e r c is e in 3 the a g ed . S ta tem en t o f th e P r o b le m N o n -in v a siv e s y s t o lic tim e in te r v a l m eth o d o lo g y p e r m its e v a lu ation o f le ft v e n tr ic u la r fu n ction in e x p e r im e n ta l e x e r c is e p r o g r a m s E or n o r m a l o ld e r p e r s o n s w ith ou t in cu rrin g m a jo r r is k s . T h e r e fo r e , t w a s the p u rp o se of th is stu d y to in v e s tig a te the e ffe c t o f e x e r c is e train in g on le f t v e n tr ic u la r fu n ction in e ld e r ly m en a s m e a su r e d by n o n -in v a siv e s y s to lic tim e in te r v a ls . S p e c ific a lly , the p u rp o se w a s to ex a m in e the train in g e ffe c t on the m a jo r co m p o n en ts of the s y s t o lic tim e in t e r v a ls - - p r e - e j e c t io n p e r io d and le ft v e n tr ic u la r e je c tio n tim e --b o th at r e s t and a fter a cu te e x e r c is e . T h us, th is r e s e a r c h w a s d ir e c te d to the q u e stio n , "What is the e ffe c t of a ch an ge in p h y sic a l fitn e s s upon s y s t o lic tim e in te r v a ls in □Ider p e r s o n s ?" In q u a n tifia b le te r m s , the s t a t is t ic a l n u ll h y p o th e sis w as th e fo llo w in g : The m ean ch an ge fr o m p r e - t e s t to p o s t - t e s t s y s to lic tim e in te r v a l s c o r e s in the e x e r c is e group is n o t sig n ific a n tly d iffe r e n t ir o m the m ea n ch an ge in the c o n tr o l grou p . S ig n ific a n c e of the Study The im p o rta n t in d ic e s of c a r d ia c p e r fo r m a n c e w h ich a r e apt to con trib u te to en h an ced str o k e v o lu m e --s u c h a s m y o c a r d ia l c o n tr a c t il ity and e je c tio n fr a c t io n -- r e q u ir e e x p e n siv e , c o m p le x , and tra u m a tic 4 te a t p r o c e d u r e a w h en m e a s u r e d d ir e c tly , in ad d ition to req u irin g the p r e s e n c e of a p h y sic ia n . Thua, m an y in v e stig a to r a, e s p e c ia lly p h y s io lo g is ts and p h y sic a l e d u c a to r s, a r e d issu a d ed fr o m em b arin g upon e x p e r im e n ts u tiliz in g c a th e te r -ty p e m eth od s d e s p ite the im p o r tant in fo r m a tio n g a in ed . G rea ter r e s e r v a tio n e x is ts w h en the e x p e r im e n t c a lle a for p e r io d ic ev a lu a tio n on su b je cts w ho a r e n o r m a l and, th e r e fo r e , h ave litt le to gain p e r so n a lly fro m the tra u m a tic p r o c e d u r e s. V a rio u s in v e s tig a to r s have su b stitu ted n o n -in v a siv e s y s to lic tim e in te r v a l (STI) m e a s u r e m e n ts fo r c a th e te r iz a tio n tech n iq u es to e s tim a te c a r d ia c p e r fo r m a n c e . A s a r e s u lt , the r is k (e s p e c ia lly to the e ld e r ly ) h a s b e e n red u ced su b sta n tia lly and the t e s t m ay be a d m in iste r e d by p h y s io lo g is ts , p h y sic a l e d u c a to r s, o r p a r a -m e d ic a l p e r so n n e l. S in ce it h as b een su g g e s te d that STI v a lu e s r e la te to m y o c a r d ia l c o n tr a c tility , the p r e se n t stu d y h a s im p lic a tio n s reg a rd in g the tr a in a b ility o f the o ld e r m y o ca r d iu m . A ls o , the s it e of c a r d io v a sc u la r im p r o v e m e n t--c e n tr a l o r p e r ip h e r a l- - is e lu c id a te d by fo cu sin g d ir e c tly on le f t v e n tr ic u la r fu n ctio n a t th e c e n tr a l le v e l. D efin itio n s o f T e r m s S y s to lic tim e in te r v a ls (STI). - - T h e s e a r e the v a r io u s tim e 5 co m p o n en ts o f le f t v e n tr ic u la r c o n tr a c tio n m e a s u r e d in m illis e c o n d s . C y cle tim e (CT; R -R ; S z - S j l - - T h is is the tim e o f one c a r d ia c c y c le . It is u s e d to c a lc u la te h e a r t r a te (HR) a s fo llo w s: F orm u la: H ea rt R ate (HR) = 6 0 /R -R ; w h ere R -R is e x p r e s s e d in se c o n d s . T otal s y s to le (QS2 ; TS). - -T h is is the tim e p e r io d fr o m the o n s e t o f e x c ita tio n to the end of e je c tio n . It is the to ta l e le c t r o m e c h a n ic a l s y s t o le , w h ich in c lu d e s both e le c tr o m e c h a n ic a l lag (EM L) and m e c h a n ic a l s y s to le (MS; S^S^). It is m e a su r e d fro m the o n se t of Q (in itia l n e g a tiv e d e fle c tio n r e su ltin g fr o m v e n tr ic u la r d e p o la r iz a tion ) o f the e le c tr o c a r d io g r a m (ECG or EKG) to the f ir s t freq u en cy com p on en t o f the se co n d h a rt sound of the p h o n o ca rd io g ra m (PC G ). P r e -e je c tio n p e r io d (P E P ; T P ). - -T h is i s the tim e fro m the o n se t o f v e n tr ic u la r e x c ita tio n to th e b egin n in g of the e je c tio n of blood fr o m the le ft v e n tr ic le . It is the su m of EM L and is o v o lu m e tr ic c o n tr a c tio n tim e (IC T), and is c a lc u la te d by su b tra ctin g the le ft v e n tr ic u la r e je c tio n tim e (L V E T ) fr o m to ta l s y s t o le (QS^)< I s o v o lu m e tr ic c o n tr a c tio n tim e (IC T). - -T h is is the tim e p e r io d fr o m the o n s e t o f v e n tr ic u la r co n tra c tio n to the sta r t of e je ctio n o f b lood fr o m the le f t v e n tr ic le . It is c a lc u la te d by su b tr a ctin g L V E T fr o m m e c h a n ic a l s y s to le 6 L eft v e n tr ic u la r e je c tio n tim e (L V E T ; ET; E P ; IC P ). --T h ie is the tim e fr o m the o n s e t to the end o f e je c tio n of b lood . It is m e a s u r e d fro m the o n s e t o f the s te e p c a r o tid p u lse a s c e n t to the nad ir of the d ic r o tic n otch of the c a r o tid p u lse tra c in g (C P T ). R atio of p r e -e je c tio n p erio d to le f t v e n tr ic u la r e je c tio n tim e (P E P /L V E T ). - -T h is is a r a tio co m m o n ly u sed by c a r d io lo g is ts to ev a lu a te le f t v e n tr ic u la r fu n ction in n o r m a l and ab n orm al su b je c ts . C o r r e c te d in t e r v a ls . - - T h e s e a r e the v a lu e s of QS , P E P , »nd £ L V E T c o r r e c te d by the u s e o f a r e g r e s s io n eq u ation fo rm ed w ith h e a r t ra te and the r e s p e c tiv e in te r v a l {Shaw e t a l. , 1973) The fo r m u la s a r e a s fo llo w s: QS (m se c ) = (2. 27 x H ea rt R ate) + QS (m se c ) £ £ c P E P (m sec) = (0. 56 x H ea rt R ate) + P E P (m se c ) c L V E T (m se c ) » (1 ,7 1 x H eart R ate) + L V E T (m se c ) c D e lim ita tio n s The p r e s e n t stu d y w a s c o n c er n e d w ith to ta l s y s t o le (QS^), p r e e je c tio n p e r io d (P E P ), le ft v e n tr ic u la r e je c tio n tim e (L V E T ), and the r a tio o f P E P to L V E T . T h e r e fo r e , e le c tr o m e c h a n ic a l lag (EM L) and io s v o lu m e tr lc c o n tr a c tio n tim e (ICT) w e r e in c o r p o r a te d in to the sin g le m e a su r e d com p on en t o f d ie p r e -e je c tio n p e r io d and w e r e not m ea su r ed a s d is c r e te e n titie s . 7 The 26 su b je c ts o f th is study w e r e m a le v o lu n te e r s b e tw e en 54 and 74 y e a r s o f a g e . The su b je c ts w e r e fr e e fr o m d ia g n o slb le c a r d io v a s c u la r d is e a s e and any c o n tr a in d ic a tiv e co n d itio n s fo r e x e r c is e . C H A PT E R II REVIEW O F L IT E R A T U R E A lthough n o n -in v a siv e s y s t o lic tim e in te r v a l in v e stig a tio n s in e ld e r ly p e r s o n s , e s p e c ia lly e x e r c is e d s u b je c ts , h ave b een r a r e , stu d ie s on the you n ger and m id d le -a g e d p op u lation s h ave b een n u m e r o u s. T h e r e fo r e , the r e v ie w of the lite r a tu r e h a s been d iv id ed into s e c tio n s d ealin g w ith: (1) m eth o d o lo g y , d e s c r ip tio n , and v a lid ity o f s y s t o lic tim e in te r v a ls; (2) fa c to r s a ffe c tin g le ft v e n tr ic u la r e je c tio n tim e; (3) fa c to r s a ffe c tin g p r e -e je c tio n p eriod ; (4) acu te e ffe c t o f e x e r c is e on s y s t o lic tim e in te r v a ls; (5) s ig n ific a n c e of P E P /L V E T ; (6) e ffe c t o f train in g on STI; and (7) e ffe c t of a g e on s y s t o lic tim e in te r v a ls . M eth od ology, D e sc r ip tio n , and V a lid ity o f STI The sim u lta n eo u s rec o rd in g o f the e le c tr o c a r d io g r a m , the h ea rt so u n d s, and the a r te r ia l p u lse to m e a s u r e s y s t o lic tim e in t e r v a ls w a s in tro d u ced in 1923 by Kate and F e il (1923). The p r o c e d u r e for the m e a su r e m e n t o f the s y s t o lic p h a se s o f the c a r d ia c c y lc e had 8 9 b een m o d ified fr o m a study by W ig g ers (1921). In 1 9 2 6 -2 7 L om bard and C ope u se d the p o ly g ra p h ic m eth od on a la r g e p op ulation to com p are the s y s t o lic in te r v a ls of the s e x e s (1927). A lthough s y s to lic tim e in te r v a l m eth o d o lo g y had b een in itia te d in the 1920’s , r e la tiv e ly lit t le a tten tio n w a s g iv en to the m eth od due to the fo cu s upon m e a s u r e s o f flo w , p r e s s u r e , and c a r d ia c ch a m b er v o lu m e (W e is s le r , 1968). Only q u ite r e c e n tly , p a rtly due to the a d v a n ce s in the sta te o f the a r t o f e le c t r o n ic s , h a v e s y s t o lic tim e in te r v a ls retu rn ed to in c r e a s e d u s e and r ec o g n itio n . The two m a in com p on en ts o f the s y s t o lic tim e in t e r v a ls - - p r e - e je c tio n p e r io d and le f t v e n tr ic u la r e je c tio n t im e - -h a v e b een u se d to m e a s u r e v a r io u s p e r fo r m a n c e fa c to r s of the h e a r t. The le ft v e n tr ic u la r e je c tio n tim e (L V E T ) h a s b een r e fe r r e d to v a r io u sly a s the e j e c tio n p e r io d (E P ), e je c tio n tim e (E T ), and iso to n ic c o n tr a c tio n p erio d (IC P). The m e a s u r e m e n t o f L V E T , or the tim e a llo w ed fo r the e j e c tion of blood out of the le f t v e n tr ic le , h a s b een u sed to ev a lu a te the p e r fo r m a n c e o f the h e a r t. It h as b een co n clu d ed by so m e a u th o r itie s that a red u ced v e lo c ity o f m y o c a r d ia l fib e r sh o rten in g and , c o n s e q u en tly , a low str o k e v o lu m e or e je c tio n fr a c tio n m ay be r e fle c te d by a d im in ish e d le f t v e n tr ic u la r e je c tio n tim e (G arrard e t a l. , R u sh m er, 1964; Spodick e t a l . , 1969 (a); W e is s le r e t a l . , 1961). T his c o n c lu sio n has b een in te r p r e te d by J ea ek (1963) a s a p ertu rb a tio n o f c o n tr a c tility 10 a s s o c ia te d w ith a alow r is e of in tr a v e n tr ic u la r p r e a a u r e and an e a r lie r r e la x a tio n of the h e a r t m u a c le tonus tow ard s end of s y s t o le . T hus, the slo w r is e of in tr a v e n tr ic u la r p r e s s u r e , o r in c r e a s e d p r e -e je c tio n p e r io d , r e s u lts in a d e la y ed opening of the a o r tic v a lv e w h ic h , in turn, in fr in g e s upon the tim e fo r a ctu a l e je c tio n . H o w ev er, W ilh elm Raab (I960) h a s sta te d that the len g th o f e je c tio n p e r io d h as b een o f l e s s e r in te r e s t for the ev a lu a tio n of the n e u r o v e g e ta tiv e a c tio n on v e n tr ic u la r c o n tr a c tility sin c e L V E T has b een show n to be g r e a tly in flu en ced by h ea rt r a te and v e n tr ic u la r fillin g . R aab, w ho o r ig in a te d the co n cep t of " sy m p a th etic p r e p o n d e r a n ce" in in a c tiv e in d iv id u a ls, h as s t r e s s e d the im p o rta n ce o f the te n sio n p erio d or p r e -e je c tio n p e r io d (P E P ) fo r c a r d io v a s c u la r e v a lu a tio n . P E P in c lu d e s two se p a r a te co m p o n en ts: (1) the tim e r eq u ire d fo r the e le c t r ic a l stim u lu s to in itia te c o n tra c tio n of the le ft v e n tr ic le and (2) the tim e req u ired for the le ft v e n tr ic le to open the a o r tic v a lv e for the e je c tio n of b lood . The la tte r a lo n e (often c a lle d the i s o v o lu m e tr ic c o n tra c tio n tim e ) and the two to g eth er (P E P ) have b een a s s o c ia te d w ith the ra p id ity o f m y o c a r d ia l c o n tra c tio n o r ra te of p r e s s u r e r is e . In oth er w o r d s , the long P E P or long IC T r e f le c ts the slo w e r r is e o f le ft v e n tr ic u la r p r e s s u r e during is o v o lu m e tr ic c o n tr a c tio n . (B rau n w ald , 1955; K ate and F e il, 1923; M artin e t a l. , 1971; M etzg e r et a l. , 1967, 1969; R eitan e t a l. , 1972; S tafford e t a l . , 11 1970; T a lle y e t a l. , 1971). The v a lid ity o f the n o n -ln v a s iv e ly m e a s u r e d in te r v a ls , P E P and L V E T , h a s b een te ste d by a c o m p a r iso n w ith d ir e c t m a n o m e ter tec h n iq u es. In a ll c a s e s the c o r r e la tio n s h ave b een high . H igh c o r r e la tio n s for STI h ave b een rep o rted in d ogs that had b een c a th e te r - iz e d . A cute in te rv e n tio n p rod u ced ch a n g es that r e su lte d in a c o r r e la tio n of r * 0. 94 b etw een e x te r n a lly m e a su r e d P E P and in te r n a lly m e a s u r e d is o v o lu m e tr ic co n tra c tio n tim e (M etzg er e t a l. , 1969). In a s lig h tly m o r e r e c e n t stu d y the c o r r e la tio n o f d ir e c t and in d ir e c t m e a s u r e s o f L V E T w a s r a 0. 99 w hen ch a n g es w e r e in d u ced by a cu te in te r v e n tio n . The c o r r e la tio n w a s r = : 0. 94 b etw een n o n -in v a s iv e ly m e a s u r e d P E P and in te r n a lly m e a su r e d is o v o lu m e tr ic co n tra c tio n tim e . The in v e s tig a to r s co n clu d ed that the n o n -in v a siv e m e a s u r e m e n t o f s y s t o lic tim e in te r v a ls w a s a c o n v e n ien t a tr a u m a tic m eth od w h ich w a s a v a lid and s e n s it iv e m e a s u r e o f m y o c a r d ia l p e r fo r m a n c e (M artin e t a l. , 1971). T a lle y and h is c o lle a g u e s (1971) h ave show n th at the d ir e c t and in d ir e c t m e a s u r e s of P E P c o r r e la te d w e ll a s long a s le f t v e n tr ic u la r end d ia s to lic p r e s s u r e rem a in e d w ith in n o r m a l lim it s . W ilh elm R aab and c o -w o r k e r s (1958) h ave a tte s te d to the v a lid ity o f the " b lo o d less" n o n -in v a siv e m eth od w h ich w as r e fe r r e d to a s the " ch ron od yn ogram . " The a u th o rs b a sed the v a lid ity upon the c lo s e s im ila r ity b e tw e en the n o n -in v a siv e p r e -e je c tio n p e r io d v a lu e s 12 fr o m th e ir stu d y and the d ir e c tly m e a s u r e d P E P v a lu e s by E ugene B raunw ald and c o -w o r k e r s (1955). F a c to r s A ffectin g L V E T The co m p o n en ts o f s y s t o le - - P E P and L V E T --h a v e b een show n to be a ffe c te d by v a r io u s p h y sio lo g ic a l or p h y sic a l m e c h a n ism s a ctin g d ir e c tly o r in d ir e c tly on the h e a r t. In a study by B raunw ald and c o - in v e s tig a to r s (1958) th e e ffe c t of h e a r t r a te , blood p r e s s u r e , and str o k e v o lu m e upon le f t v e n tr ic u la r e je c tio n tim e w as ex a m in ed . The r e s u lts in d ica ted that w hen the str o k e v o lu m e w a s in c r e a s e d in the is o la te d h ea rt p re p a r a tio n the L V E T in c r e a s e d . When h e a r t rate w as in c r e a s e d at any g iv en stro k e v o lu m e , th e re w as a d e c r e a s e d L V E T . An in c r e a s e in m ean a o r tic p r e s s u r e a lo n e had little in flu e n c e u n til m a rk ed ly e le v a te d m ean a o r tic p r e s s u r e s w e r e r e a c h e d , w h ereu p on the L V E T then in c r e a s e d . The sa m e th r ee f a c t o r s - - h e a r t r a te , a o r tic blood p r e s s u r e , and str o k e v o lu m e - - a s r e la te d to L V E T w e r e d e te r m in e d by c a r d ia c c a th e te r iz a tio n in in ta c t m an in a stu d y by J o n es and F o s te r (1964). C o r r e la tio n s and a r e g r e s s io n equation w e r e fo r m u la te d fr o m data p oin ts at r e s t and at su p in e e x e r c is e . H ea rt r a te a lo n e p ro v id ed a fa ir in d ex o f the d u ration of e je c tio n (r » 0. 86). W hile str o k e v o lu m e and a o r tic d ia s to lic p r e s s u r e c o r r e la te d in s ig n i fic a n tly w ith v a lu e s of r * 0 .0 3 and - 0 .6 6 , r e s p e c tiv e ly . H o w ev er, both str o k e v o lu m e and p r e s s u r e su b sta n tia lly im p ro v ed the 13 r e g r e s s io n eq u ation w hen co m b in ed w ith h e a r t r a te , so that the e s t i m a te o f L V E T c o r r e la te d r a 0 .9 0 w ith the a ctu a l m e a s u r e m e n t. W e is s le r and c o -w o r k e r s (1961) found that L V E T w a s in v e r s e ly r e la te d to h e a r t ra te and p o s itiv e ly r e la te d to str o k e v o lu m e . In th eir la te r stu d ie s the r e la tio n sh ip b etw een h e a r t ra te and L V E T w a s put in to r e g r e s s io n fo r m and h as b e c o m e w id e ly u se d a s a c o r r e c tio n fa c to r (W e is s le r et a l. , 1968). R ecen tly a s im ila r r e g r e s s io n eq u a tion h a s b een d e r iv e d fr o m h e a r t ra te and L V E T o f a la r g e r sa m p le o f m a le s o f a g r e a te r a g e ra n g e (Shaw e t a l . , 1973). Raab and h is c o -in v e s tig a to r s (I9 6 0 ) co n clu d ed a fter e x te n s iv e n o n in v a siv e s tu d ie s , that L V E T w a s d e te r m in e d d ir e c tly by h e a r t ra te and v e n tr ic u la r fillin g . LV E T h as b een show n to be g r e a te r in c a s e s of a o r tic s te n o s is and sh o r te r w ith m itr a l in s u ffic ie n c y (M o sco w itz , 1965; B en ch im o l e t a l. , I9 6 0 ). V a rio u s p h y sic a l fa c to r s have b een e x a m in ed a s r e la te d to le f t v e n tr ic u la r e je c tio n tim e . P o stu r a l ch a n g es h a v e b een show n to a lte r L V E T . Stafford and c o lle a g u e s (1970) found that w ith a ste p w is e in c r e a s e in h ea d -u p tilt th e re w a s a p r o g r e s s iv e d e c r e a s e in L V E T -- an e ffe c t w h ich a ls o had b een d e m o n stra te d by W e is s le r and h is a s s o c ia t e s (1963) w h en L V E T w a s c o r r e c te d fo r h e a r t r a te . T h u s, h ea rt r a te a lo n e did not acco u n t for the o b se r v e d d e c r e a s e in L V E T a s a 14 m o re v e r t ic a l body p o sitio n w a s a s s u m e d . A n other study sh ow ed that w ith a ch an ge fr o m the su p in e to the se a te d p o sitio n L V E T d e c r e a s e d sig n ific a n tly . In the la tte r study n e ith e r h eig h t n or w e ig h t w e r e r e lated to L V E T or P E P (W iley, 1970). D e lib e r a te v o lu n ta ry a c ts su ch a s b rea th -h o ld in g and w a te r im m e r s io n have b een show n to a ffe c t L V E T . A p nea, or b r e a th -h o ld in g, h as b een sh ow n to sh o rten L V E T , w h ile fa c e im m e r s io n in w a te r w h ile b reath in g th rou gh a sn o r k e l len g th en ed LV E T (R od gers e t a l. , 1972). F a c to r s A ffectin g P E P M any o f the sa m e fa c to r s w h ich have been stu d ied w ith r e s p e c t to L V E T a ls o h ave b een stu d ied for the p r e -e je c tio n p e r io d . T h ere has b een so m e c o n tr o v e r s y r eg a rd in g the e ffe c t of h ea rt ra te upon the p r e -e je c tio n p e r io d . Raab did not f e e l that it w a s im p ortan t to c o r r e c t the p r e -e j e c t io n p erio d fo r h e a r t ra te (Raab, 1958, I9 6 0 ). V a r iou s stu d ie s h ave su p p orted the co n cep t that the p r e -e je c tio n p erio d w a s m a in ly r e la te d to the in o tr o p ic n e u r o v e g e ta tiv e e ffe c t on the le ft v e n tr ic le and not to h e a r t r a te , e s p e c ia lly w hen le ft v e n tr ic u la r end d ia s to lic p r e s s u r e w a s held co n sta n t (R aab, 1958; G o ld stein e t a l. , 1961; T a lle y e t a l. , 1971). T h u s, p o s itiv e in o tr o p ic (a d r e n e r g ic ) in flu e n c e s c h a r a c te r is t ic a lly h ave sh o rte n e d P E P w h ile n e g a tiv e in o tro p tic in flu e n c e s (c h o lin e r g ic a n d /o r sy m p a th o -in h ib ito r y ) have 15 len g th en ed P E P ; both in flu e n c e s w e r e in d ep en d en t of h e a r t r a te or p e r ip h e r a l r e s is ta n c e . P o stu r a l in flu e n c e s , in g e n e r a l, w e r e found to h ave a ffe c te d P E P o p p o site ly to L V E T . In the study by Stafford and c o lle a g u e s (1970) p a s s iv e h ea d -u p tilt c a u se d an in c r e a s e in P E P . The ste p w is e in c r e a s e o f p a s s iv e h ead -u p tilt r e su lte d in p r o g r e s s iv e in c r e a s e s of P E P . The in v e s tig a to r s p o stu la ted that the lo n g e r P E P r e su lte d fro m d e c r e a s e d le ft v e n tr ic u la r e n d -d ia s to lic v o lu m e and d e c r e a s e d m y o c a r d ia l fib e r len g th w h ich m o s t p rob ab ly r e su lte d in a slo w e r r is e of is o v o lu m e tr ic p r e s s u r e at a tim e w hen to ta l s y s to le fa ile d to len g th en . Two o th er stu d ie s have p rovid ed e v id en ce for in c r e a s e d P E P w ith a change fr o m the su p in e to the u p righ t p o sitio n (Raab e t a l. , I960; W iley , 1970). S in ce the con d u ction o f the e le c t r ic a l stim u lu s for v e n tr ic u la r c o n tr a c tio n h as b een in clu d ed a s a p a rt o f P E P , it is not su r p r isin g that le f t in tr a v e n tr ic u la r con d u ction d istu r b a n c e s h ave a cted to le n g th en P E P (W e is s le r e t a l . , 1971). D iu rn al v a r ia tio n in the v a r io u s s y s t o lic tim e in te r v a ls in d e p en d en t o f h e a r t r a te h as b e e n e x a m in ed by W e is s le r and h is c o l le a g u e s a ls o . A fter d e te r m in a tio n o f the STI at c o n tr o l, tw o, fo u r , and eig h t h o u rs there w a s a ten d en cy fo r the d u ration of the p h a se s o f s y s t o le to d im in ish s lig h tly , but not sig n ific a n tly (W e is sle r e t a l . , 1965). 16 A cu te E ffec t of E x e r c is e on STI In v e r y few stu d ie s h a v e a y a to lic tim e in te r v a la b een m e a s - ured during e x e r c ia e . The la ck h as been m a in ly due to the te c h n ic a l d iffic u ltie a of ob tain in g a r tif a c t-fr e e r e c o r d in g e in the p h o n o ca rd io - g r a m and the c a r o tid p u lae tr a c in g . H o w ev er, on e in v e a tig a to r waa ab le to m e a a u r e the in te r v a la w h ile the au b ject e x e r c is e d on a b ic y c le e r g o m e te r w h en a ea ted in a a p e c ia lly d ea ig n ed c h a ir . W ithout c o r r e c t ing for h e a r t r a te , the p r e -e je c tio n p e r io d and the le ft v e n tr ic u la r e je c tio n tim e w e r e found to d e c r e a a e during e x e r c ia e (W iley , 1970). C um m ing and E d w ard s (1963) u tiliz e d a p e c ia lly d eaign ed m icro p h o n ea to r e c o r d the s y s t o lic tim e in te r v a ls during e x e r c is e . At p r o g r e s s iv e ly in c r e a s e d w ork lo a d s it w aa found that the u n c o r r e c te d p r e - e je c tio n p e r io d d e c r e a s e d a c c o r d in g ly . The u n c o r r e c te d le ft v e n tr ic u la r e je c tio n tim e , h o w e v e r , in c r e a s e d at the in itia l low w ork lo a d s (100 and 180 K gM /m in ) a s co m p a red to the c o n tro l se a te d p o sitio n v a lu e and then s te a d ily d e c r e a s e d w ith h e a v ie r w ork lo a d s. The in v e s tig a to r s in te r p r e te d the in itia l in c r e a s e of L V E T a s an in c r e a s e in str o k e v o lu m e w ith the su b seq u en t d e c r e a s e in s e v e r e e x e r c is e o f L V E T due to in c r e a s e d e je c tio n v e lo c ity d e sp ite c o n sta n t o r in c r e a s e d atrok e v o lu m e . The la tte r stu d y a ls o o b s e r v e d the s y s t o lic tim e in t e r v a ls for a few m in u te s in to the e x e r c is e r e c o v e r y p e r io d . The in v e s t i g a to r s found that a fte r fiv e m in u tes o f r e c o v e r y that the p r e -e je c tio n 17 p erio d and le ft v e n tr ic u la r e je c tio n tim e had retu rn ed to the c o n tr o l v a lu e s d e sp ite a h ig h er h e a r t r a te . B ro d er and A m be (1972) fo llo w ed the u n c o r r e c te d in te r v a ls up to the fifte en th m in u te of r e c o v e r y a fter su p in e b ic y c le e x e r c is e . The n o r m a l r e s p o n s e c o n s is te d of a su b sta n tia l d e c r e a s e in a ll o f the in t e r v a ls at the in itia l r e c o v e r y p e r io d w hen co m p a red to the c o n tr o l su pin e v a lu e s . The v a lu e s then p r o g r e s s iv e ly retu rn ed to the lo n g e r c o n tro l v a lu e s a s the fifte e n th m inute o f r e c o v e r y w a s a p p ro a ch ed . S im ila r r e s u lts w e r e found up to the eig h th m in u te in a study by G ilb e r t and C an tw ell (1972). F rank and K inlaw (1962) rep o rted a d e c r e a s e d P E P im m e d i a te ly fo llo w in g 10 s it - u p s . S e v e r a l oth er in v e s tig a to r s have c o n fir m ed the sh o rte n e d u n c o r r e c te d in te r v a ls im m e d ia te ly a fte r e x e r c is e (C undiff, 1966; D u T oit, 1966; F ran k s and C u reton , 1968; G o ld ste in e t a l. , 1961; H ym an, 1964; L e v in e et a l. , 1962; P o u g e t e t a l. , 1971; S lo n ig e r , 1966; W h itsett and N aughton, 1971). N aughton and L ea ch (1971) found that the h ea rt ra te c o r r e c te d v a lu e s of P E P and L V E T fo llo w in g a t h r e e - m ile run w e r e sig n ific a n tly sh o r te n e d . By the fifth m in u te of r e c o v e r y the two co m p o n en ts o f s y s to le had retu rn ed to n e a r c o n tr o l v a lu e s . Thus the a c u te e ffe c t o f e x e r c is e upon the r e c o v e r y s y s t o lic tim e in te r v a ls in n o rm a l in d iv id u a ls h a s b een fir m ly e s ta b lis h e d . Im m e d ia te ly a fter e x e r c is e , s y s t o le a p p ea r s to be 18 sh o rten ed w ith both P E P end L V E T co m p o n en ts p e r tic ip e tin g in th e sh o r te n in g . A s r e c o v e r y c o n tin u es th e r e is a grad u al retu rn to p r e - e x e r c is e v a lu e s . S ig n ific a n c e o f P E P /L V E T The r e la tio n sh ip of the p r e -e je c tio n p e r io d and le ft v e n tr ic u la r e je c tio n tim e (P E P /L V E T ) h a s had a m ea n in g fu l p la c e in the e v a lu a tion o f s y s t o lic tim e in te r v a ls . G arrard and c o -w o r k e r s (1970) r e la te d P E P /L V E T to e je c tio n f r a c t io n - -s t r o k e v o lu m e d iv id ed by the end d ia s to lic v o lu m e . The c o r r e la tio n b etw een P E P /L V E T and e j e c tion fr a c tio n w a s r = -0 . 90. The r e s e a r c h e r s r e a so n e d that the p h y sio lo g ic a l m e c h a n ism r e s p o n s ib le fo r the high in v e r s e r e la tio n sh ip o f P E P /L V E T to e je c tio n fr a c tio n w a s the m y o c a r d ia l c o n tr a c til ity w h ich is r e s p o n s ib le fo r le ft v e n tr ic u la r p r e s s u r e r is e and str o k e v o lu m e . The m y o ca r d iu m w ith su p e r io r c o n tr a c tility p r o d u ce s a fa s te r r a te of p r e s s u r e r is e and a g r e a te r str o k e v o lu m e , w h ich r e su lts in a r e la tiv e ly lo w e r P E P v a lu e and a r e la tiv e ly g r e a te r L V E T v a lu e , r e s p e c t iv e ly . In o th er w o r d s , a su p e r io r m y o c a r d ia l c o n tr a c til ity p e r m its l e s s tim e sp en t in a c h iev in g the p r e s s u r e n e c e s s a r y for the opening o f the a o r tic v a lv e w h ich is r e q u ir e d b e fo r e b lood can be e je c te d fr o m the le f t v e n tr ic le . The c o n se q u e n c e , th e r e fo r e , o f a fa s te r r a te o f p r e s s u r e r is e is a sh o r te r p r e -e je c tio n p e r io d . A s m en tio n ed p r e v io u s ly , the g r e a te r m y o c a r d ia l c o n tr a c tility is 19 r e s p o n s ib le a ls o fo r a g r e a te r str o k e v o lu m e . T his is due to m o r e b lood b ein g e je c te d fr o m the p r e ce d in g d ia s to lic v o lu m e , i . e . , e j e c tion fr a c tio n . T h e r e fo r e , the r e la tiv e ly lo n g e r p e r io d o f a o r tic o p e n ing p r o d u c e s a lo n g e r le ft v e n tr ic u la r e je c tio n tim e . The au th o rs co n clu d ed that P E P /L V E T w as a s e n s itiv e m e a s u r e o f the a b ility of the h e a r t to e je c t b lood . L o g ic a lly , if the fa ilin g h ea rt h as a red u ced r a te of p r e s s u r e r is e r e su ltin g in an in c r e a s e d P E P , w h ile L V E T e ith e r r e m a in s the sa m e or is r e d u c e d , then the P E P /L V E T ra tio sh ou ld be la r g e r . In d e e d , th is h as b een the c a s e in m any stu d ie s w h ich h ave m ad e c o m p a r is o n s of the P E P /L V E T , L V E T /P E P , or L V E T /IC T r a tio s b e tw e ei fa ilin g and n o n -fa ilin g h e a r ts . S e v e r a l in v e stig a tio n s h a v e show n that r e stin g n o n -in v a siv e ly m e a s u r e d s y s t o lic tim e in te r v a ls d iffe r e n tia te d b etw een fa ilin g and n o n fa ilin g h e a r ts . A hm ed and h is c o lle a g u e s (1970) sh ow ed that p a tie n ts w ith le ft v e n tr ic u la r d is e a s e had g r e a tly in c r e a s e d P E P /L V E T r a tio s c o m p a re d w ith n o r m a ls . In an oth er study 50 a c u te m y o c a r d ia l in fa r c t p a tie n ts w e r e fo llo w ed s e r ia lly fo r 20 d a y s. A lthough th ere w a s no ch an ge in P E P , th e re w a s a s ig n ific a n t red u ctio n in L V E T (th u s, in c r e a s e d P E P /L V E T ) o f th o se w ho d ied co m p a red w ith the s u r v iv o r s (H elk k ila e t a l. , 1971). A s im ila r ch an ge w a s found in a study in w h ich the r a tio had 20 been In verted to L V E T /P E P . The c o r o n a r y p atien t* had sig n ific a n tly Lower L V E T /P E P v a lu e s (M a r g o lis, 1964). S e v e r a l o th er in v e s t ig a to rs h a v e c o n firm e d the in c r e a s e d P E P /L V E T v a lu e s in fa ilin g h e a r ts when stu d ied at r e s t (Spodick e t a l. , 1969a; Stafford e t a l . , 1970; W ayne, 1968; W e is s le r e t a l. , 1968). V a rio u s in v e stig a tio n s have len t su p p ort to the th e s is that p o s t e x e r c is e s y s t o lic tim e in te r v a ls s u c c e s s f u lly d iffe r e n tia te d b etw een fa ilin g and n o n -fa llin g h e a r ts . A ronow and h is c o -in v e s tig a t o r s (1971) found that the L V E T /IC T r a tio c o r r e la te d w e ll w ith e je c tio n fr a c tio n at r e s t , im m e d ia te ly a fter b ic y c le e r g o m e tr y , and th r e e m in u te s p o st e r g o m e tr y . B ro d er and A m be (1972) a ls o sh ow ed that e x e r c is e r e c o v e r y STI t e s ts add fu rth er d ia g n o stic d is c r im in a tio n fo r c o r o n a r y a r te r y d is e a s e a s co m p a red to r e stin g v a lu e s a lo n e. At the fifte en th m in u te o f r e c o v e r y fr o m su p in e e x e r c is e the P E P /L V E T r a tio w a s w ithin a c c e p ta b le lim it s o f the p r e - e x e r c is e valu e in a n g io g r a p h lc a lly d e te r m in e d n o r m a ls . H o w ev er, in the p a tien ts w ith a n g io g ra p h ic e v id e n c e of c o ro n a ry a r te r y d is e a s e th e r e w a s an a b n o rm a l in c r e a s e of P E P /L V E T a t the tenth or fifte en th m in u te of r e c o v e r y co m p a red to the r e stin g v a lu e s . S om e o f the p a tie n ts had show n no S T -T d e p r e s sio n on the p r o g r e s s iv e e x e r c is e e le c tr o c a r d io g r a m . The a b o v e r e s u lts w e r e v e r y s im ila r to an oth er stu d y on h e a r t r a te c o r r e c te d 5T1 ev a lu a tio n fo r eig h t m in u te s of e x e r c is e r e c o v e r y . In th is stu dy 21 by G ilb er t and C an tw ell (1972) c o ro n a ry p atien ta ex h ib ited s ig n ific a n t ly d iffe r e n t h e a r t ra te c o r r e c te d STI v a lu e s both a t r e s t and p o st e x e r c is e . The c o ro n a ry p a tie n ts sh ow ed l e s s in c r e a s e in c o r r e c te d L V E T a the fifth and eig h th m in u te than the n o r m a ls . P E P had a s i g n ific a n tly g r e a te r d e c r e a s e in the n o r m a ls than the a b n o r m a ls. Thus P E P /L V E T w a s s m a lle r in the n o r m a ls than th e a b n o rm a ls in p o s t e x e r c is e s y s to lic tim e in te r v a ls c o r r e c te d fo r h e a r t r a te . H o w ev er, P o u g et and h is c o -w o r k e r s (1971) found the o p p o site e ffe c t w hen m e a su r e d im m e d ia te ly (1/2 m in u te) a fte r a sh o r t e x e r c is e bout on a g e -m a tc h e d n o r m a ls and a b n o r m a ls. The a b n o rm a ls in c r e a s e d the p o s t - e x e r c is e c o r r e c te d le f t v e n tr ic u la r e je c tio n tim e (L V E T ), w h ile the n o r m a ls sh ow ed no ch a n g e. The c o r r e c te d p r e - c e je c tio n p e r io d (P E P ^ ) had d e c r e a s e d a ls o in the a b n o rm a ls at 1 /2 m in u te a fte r e x e r c is e . T h u s, the P E P /L V E T ra tio w a s red u ced to a g r e a te r ex ten t in the a b n o rm a ls than the n o r m a ls at 1/2 m in u te p o s t e x e r c is e . At the se c o n d , fifth , and tenth m in u te o f r e c o v e r y , h o w e v e r , th e re w a s no sig n ific a n t d iffe r e n c e in any of the STI v a lu e s b etw een the n o r m a l and a b n o rm a l g r o u p s. S in ce the r e s u lts of the la tte r stu d y d iffe r e d fr o m the e x p e cted P E P /L V E T c h a n g e, the in v e s tig a to r s h y p o th e sise d that the im m e d ia te p o s t - e x e r c is e in c r e a s e in P E P /L V E T w a s due to the in a b ility o f the fa ilin g o r is c h e m ic v e n tr ic le to han dle n o r m a lly the en h an ced v en o u s r e tu r n of e x e r c is e . 22 T h u s, in s te a d o f the co m m o n ly r e c o g n ise d long P E P and sh o r t L V E T c c at r e s t in a b n o rm a ls w hen c a r d ia c output and str o k e v o lu m e a r e lo w , the P E P w a s slig h tly d e c r e a s e d and L V E T w a s m a rk ed ly in c r e a s e d c c w hen c a r d ia c output w a s high im m e d ia te ly fo llo w in g e x e r c is e . The in v e s tig a to r s a ss u m e d that the in o tro p ic r e s p o n s e in the a b n o rm a l h e a r t w a s l e s s ad eq u ate than in the n o r m a l h e a r t. T h us, c a r d ia c output w a s r a is e d at the e x p e n se of a lo n g e r e je c tio n tim e . At the sa m e tim e , the la r g e r e n d -d ia s to lic v o lu m e of the m alfu n ction in g v e n tr ic le and the e x p o su r e to h igh er le v e ls of c ir c u la tin g c a te c h o la m in e s , both o f w h ich h elp ed to a c c e le r a te the iso v o lu m ic r is e of p r e s s u r e and the g r e a te r e n d -d ia s to lic p r e s s u r e m ay have in c o m b in a tio n a cco u n ted fo r the n o r m a l or g r e a te r than n o r m a l sh o rten in g of the p r e -e je c tio n p e r io d . T h ere a p p ea r s to be so m e d iffe r e n c e in op in ion w ith r e s p e c t to the p h y sio lo g ic a l sig n ific a n c e o f the P E P /L V E T r a tio . Indeed the d ir e c tio n of the train in g e ffe c t is in q u e stio n . One sc h o o l of th o u g h t-- p r e se n te d a b o v e --h o ld s to the th eo ry that im p ro v ed c a r d ia c fu n ction m ea n s red u c ed P E P /L V E T v a lu e s . The bulk of the e v id en ce in s u p p o rt of th is th eory is b a sed m o s tly on n o r m a ls v e r s u s a b n o r m a ls. The o th er sc h o o l h a s p r e se n te d e v id en ce w h ich h as su p p orted a p a r a sy m p a th e tic p rep o n d era n ce in the m o r e fit in d ivid u al w h ich has tended to in c r e a s e P E P to a g r e a te r ex ten t than L V E T , thus an 23 in c r e a s e d P E P /L V E T v a lu e has r e su lte d . In a study by Raab and h is a s s o c ia t e s (1958), a s the c la s s if ie d grou p s b e c a m e m o r e a c tiv e , the P E P /L V E T v a lu e p r o g r e s s iv e ly in c r e a s e d . In a ll in s ta n c e s th e h igh er r a tio w a s a r e s u lt o f r e la tiv e ly g r e a te r p r e -e j e c t io n p e r io d s r a th er than a d e c r e a s e in L V E T . Raab h as in te r p r e te d the h ig h er P E P v alu e in the a th le te a s a p o s itiv e c h a r a c te r is tic . The e m in en t c a r d io v a s c u la r r e s e a r c h e r h as c la im e d that sy m p a th e tic a d r e n e r g ic p r e p o n d e r a n ce (thus sh o r te r r e stin g P E P v a lu e s ), e ith e r fr o m e x c e s s iv e c a t e ch o la m in e d is c h a r g e s or inad eq u ate v a g a lc h o lin e r g ic cou n ter r e g u la tion , h a s c o n stitu te d a th r ea t to m y o c a r d ia l, fu n ctio n a l, and s t r u c tu ra l in te g r ity (Raab e t a l. , I9 6 0 ). D ir e c t c o m p a r is o n s of the data fr o m the two d iffe r e n t s c h o o ls is often d iffic u lt s in c e one s c h o o l (" p a ra sy m p a th etic p rep o n d era n ce" ) h a s c h o se n not to c o r r e c t the STI fo r h e a r t r a te , w h e r e a s the oth er sc h o o l h a s. E ffe c t of T rain in g on STI S e v e r a l e p id e m io lo g ic a l or c o m p a r a tiv e stu d ie s (c o m p a riso n of sa m p le s o f d iffe r in g p h y sic a l a c tiv ity le v e ls ) h ave not show n c o n c lu s iv e ly any d e fin ite a s s o c ia tio n b etw een h ab itu al p h y sic a l a c tiv ity and r e stin g s y s t o lic tim e in te r v a ls . Two o f the stu d ie s c o r r e c te d the in te r v a ls for h e a r t ra te w h ile the r e s t did not. A m ong the fo r m e r , Mon toy e and h is c o -w o r k e r s (1972), found no r e la tio n sh ip b etw een e ith e r P E P or L V E T and habitual p h y sic a l a c tiv ity a s c la s s if ie d fro m 24 a q u e stio n n a ir e or h e a r t r a te r e s p o n s e to e x e r c is e . W h itsett and N aughton (1971) ex a m in ed r e stin g and r e c o v e r y s y s t o lic tim e in te r v a ls in se d e n ta r y a b n o r m a ls, se d e n ta r y h ea lth y , a c tiv e a b n o r m a ls, and a c tiv e h ea lth y lis te d in a sc e n d in g o r d e r o f m a x im a l o x y g en c o n su m p tion . The in v e s tig a to r s found that th e r e stin g p r e -e je c tio n p e r io d u n c o r r e c te d fo r h e a r t r a te w a s sig n ific a n tly lo n g e r in both " card iac" g ro u p s than the h ea lth y g r o u p s, and that P E P sh o rte n e d sig n ific a n tly a fte r a cu te e x e r c is e to a co m p a ra b le d e g r e e in a ll four g r o u p s. How - le v e r , the le ft v e n tr ic u la r e je c tio n tim e w h ich w a s c o r r e c te d for h ea rt r a te w a s sig n ific a n tly sh o r te n e d in r e sp o n s e to a cu te e x e r c is e in a c tiv e h ea lth y and the a c tiv e c a r d ia c s , w h ile L V E T w a s p ro lo n g ed in c the sen d en ta ry c a r d ia c s . Thus the le ft v e n tr ic u la r e je c tio n tim e in d ex in r e c o v e r y d epend ed on the r e la tiv e sta te of p h y sic a l a c tiv ity and h ea lth . The two in v e s tig a to r s sta te d that the r e s u lts su g g e s te d a d e c r e a s e d ra te o f m y o c a r d ia l fib e r sh o rten in g in se d e n ta r y c a r d ia c s w h ile the c o n tr a c tility w a s in c r e a s e d in a c tiv e h ea lth y and a c tiv e c a r d ia c s in r e s p o n s e to a cu te e x e r c is e . A n other stu d y c o m p a re d h igh ly tra in ed a th le te s w ith o ld e r m en and w o m e n , and h y p e r te n siv e and is c h e m ic h e a r t d is e a s e p a tien ts (D eck m an e t a l . , 1972). The e v id e n c e a tte s te d to the d ile m m a s u r rounding th e in te r p r e ta tio n of P E P and L V E T . In deed , the h ig h ly tra in ed young r u n n ers in the stu d y by D eck m a n 's grou p and the 25 p a tie n ti w ith h e a r t fa ilu r e r e p o r te d by W e is s le r 's group (W ela a ler e t a l. , 1971) had a im ila r ly h ig h er P E P /L V E T v a lu e a than n o r m a l. N o rm a l e ld e r ly p e r so n a , h o w e v e r , in D eck m an 'a stu d y did not h ave a high P E P /L V E T r a tio . The in v e a tig a to r a In the la tte r stu d y did not se p a r a te the e ld e r ly into tra in ed and u n train ed c a te g o r ie s . The la c k o f a young u n tra in ed group to c o m p a re w ith the h ig h ly tra in ed young group did not p e r m it c o n c lu sio n s co n cern in g P E P o r L V ET c h a r a c te r i s t i c s w ith r e s p e c t to tra in in g . It a p p e a r s then that the la tte r stu dy d o e s not e lim in a te e ith e r th eo ry r eg a rd in g the d ir e c tio n o f ch an ge in P E P /L V E T w ith tra in in g . Tharp (1969) found a s m a ll, but in s ig n ific a n t, c o r r e la tio n (r = 0 . 21 ) b etw een a p h y sic a l w ork c a p a c ity t e s t and the p r e -e je c tio n p e r io d in 31 m a le s . F ard y (1971) co m p a red h ig h ly tra in ed c r o s s co u n try ru n n ers w ith n o n -tr a in e d m a le s . He found a sig n ific a n tly lo w e r h e a r t r a te , and s ig n ific a n tly lo n g e r to ta l s y s t o le , P E P , and is o v o lu m e tr ic c o n tr a c tio n tim e , a ll u n c o r r e c te d for h e a r t r a te , in the tra in ed r u n n e r s. A r e c e n t stu d y c o r r e la te d m a x im a l o x y g en c o n su m p tio n w ith v a r io u s c a r d ia c tim e co m p o n en ts m e a s u r e d at r e s t , d u rin g, and im m e d ia te ly a fte r e x e r c is e . The in v e s tig a to r s found lit t le or no c o r r e la tio n b e tw e en the v a r ia b le s in the young u n train ed m en (M olnar e t a l. , 1973). T h u s, fiv e c o m p a r a tiv e -ty p e stu d ie s h a v e n o t o ffe r e d p o s itiv e 26 e v id e n c e fo r the s u c c e s s f u l u s e o f STI for fitn e s s d is c r im in a tio n . The id e a l r e q u ir e m e n t of v e r y la r g e n u m b ers or a c tu a l t e s t p e r fo r m a n c e -- n ot q u e s tio n n a ir e --fo r e p id e m io lo g ic a l s tu d ie s , h o w ev e r, m ean that th e ab o ve stu d ie s h ave not to ta lly r e s o lv e d the q u estio n of the r e la tio n sh ip b etw een s y s t o lic tim e in te r v a ls and p h y sic a l a c tiv ity le v e l. V a rio u s in v e stig a tio n s have b een m ad e co n cern in g the e ffe c ts o f p h y sic a l tra in in g in te rv e n tio n upon the v a r io u s co m p o n en ts of the s y s t o lic tim e in te r v a ls . C undiff (1966) rep o rted that a group of m id d le -a g e d m en w ho tra in ed fo r fiv e m on th s th r ee tim e s p er w eek d e c r e a s e d the is o v o lu m e tr ic c o n tr a c tio n tim e during r e c o v e r y fr o m a m o d e ra te w ork lo a d . The en h an ced sy m p a th o -a d r e n e r g ic a c tiv ity a s r e p r e se n te d by IC T, h o w e v e r , w a s in c o n tr a st to the g e n e r a l p r e d o m in a n ce o f v a g a l tone a fter train in g a s m a n ife ste d by a slo w e r r is e in h e a r t ra te during e x e r c is e . Two stu d ie s on m id d le -a g e d m en r e v e a le d lo n g e r is o v o lu m e tr ic c o n tr a c tio n tim e s in r e c o v e r y fr o m a cu te e x e r c is e a fte r s e v e r a l w e e k s o f en d u ran ce tra in in g . The in v e s tig a to r s in te r p r e te d the r e la x e d sy m p a th e tic stim u la tio n to the le ft v e n tr ic le a s a p o s itiv e ad ap tation of tra in in g (D u T oit, 1966; F ran k s and C u reton , 1969). No sig n ific a n t ch a n g es in r e stin g P E P or L V ET w e r e found in two se p a r a te stu d ie s by F ard y (1967; 1973) on a group of c o lle g e s o c c e r p la y e r s and m id d le -a g e d m en a fte r tra in in g . H o w ev er, the P E P and L V E T sig n ific a n tly in c r e a s e d in p o s t-tr a in in g r e c o v e r y 27 v a lu e s w h ich w e r e m e a s u r e d in l e s s than two m in u te s a fter a fix ed e x e r c is e lo a d . F ran k s (1967), on the o th e r hand, found an in c r e a s e in is o v o lu m e tr ic c o n tr a c tio n tim e a fter train in g o f m id d le -a g e d m a le s both at r e s t and at r e c o v e r y fr o m su b m a x im a l e x e r c is e . In none o f the ab ove tra in in g stu d ie s had the s y s to lic tim e in te r v a ls b een c o r r e c te d for h e a r t r a te although in m o st in s ta n c e s h e a r t r a te had ch an ged s ig n ific a n tly . A s sta te d e a r lie r , Raab con clu d ed that the su sta in e d sta te of train in g w a s c h a r a c te r iz e d by an a n tia d r e n e r g ic (vagal p lu s a y m - p a th o in h ib ito r y ) p r e p o n d er a n c e . He m a in ta in ed that the sta te w a s m a n ife ste d by a slo w h e a r t ra te and a p ro lo n g ed p r e -e j e c t io n p e r io d . The a c q u isitio n o f an au gm en ted a n tia d r e n e r g ic p ow er fr o m train in g w a s d e m o n str a te d in a grou p o f stu d en ts w h o se a v e r a g e r e stin g h ea rt ra te f e ll by fiv e b e a ts and w h o se p r e -e je c tio n p e r io d in c r e a se d fr o m 90 to 97 m illis e c o n d s a fte r s ix to 12 w e e k s of running and g y m n a s tic s . The ab ove w a s in te r p r e te d a s a fa v o ra b le r e s p o n s e b e c a u se of the r ed u ced m y o c a r d ia l oxygen c o s t (R aab, I9 6 0 ). In an oth er study Raab (1966) p o stu la ted that h yp oxic d e g e n e r a tiv e h e a r t d is e a s e w a s not c a u se d s o le ly by c o ro n a ry a t h e r o s c le r o s is but by a d isp r o p o r tio n a te a u g m en ta tio n o f m y o c a r d ia l o x y g en con su m p tion u n d er sy m p a th e tic n e r v o u s and a d r e n o -m e d u lla r y in flu e n c e . Thus a lo n g e r P E P w a s in d ic a tiv e of a l e s s in flu e n tia l sy m p a th e tic sta te . A d iffe r e n t r e s u lt 28 w a i ob tain ed by T erjung and h is c o -w o r k e r s (1973) w ho e x a m in ed the e ffe c ts of s ix w e e k s o f tra in in g on m id d le -a g e d m en . B oth the h e a r t ra te c o r r e c te d and u n c o r r e c te d v a lu e s o f r e s tin g P E P and L V E T d e c r e a s e d a s a r e s u lt o f the two d a ily s ix -m in u te tra in in g p e r io d s. Only r e s tin g v a lu e s w e r e o b s e r v e d and no m en tio n w a s m ad e o f the d ir e c tion of c h a n g e , if an y, in h e a r t r a te . The in v e s tig a to r s sta te d that the r e s u lts su g g e s te d an im p ro v ed m y o c a r d ia l c o n tr a c tility b a sed on a stu d y by H anson and c o -w o r k e r s (1988) w h ich sh ow ed an in c r e a se d m a x im u m d p /d t and an in c r e a s e d m a x im u m ra te of le f t v e n tr ic u la r e je c tio n a fte r tra in in g . W iley (1971) ev a lu a ted the e ffe c ts o f train in g on the u n c o r r e c t ed s y s t o lic tim e in te r v a ls at r e s t , during e x e r c is e and a fte r e x e r c is e in a grou p of m a le s fr o m a w id e a g e ran ge (2 4 -6 2 y e a r s ). Ten w e e k s o f en d u ra n ce train in g r e su lte d in s ig n ific a n tly lo n g e r L V ET at r e s t , during e x e r c is e , and r e c o v e r y in the tra in ed su b je c ts co m p a red to the c o n tr o ls . The p r e -e je c tio n p e r io d w a s not sig n ific a n tly lo n g e r at r e s t but w a s lo n g e r du rin g e x e r c is e and r e c o v e r y . The in v e stig a to r in t e r p r e te d the ch an ge a s an in h ib itio n o f the c a r d ia c rhythm . The la tte r stu d y , am ong o th e r s , h as p ro v id ed su p p ort for the d e s ir a b ility o f h e a r t r a te c o r r e c t io n s . The stu d y by W iley a ls o su g g e ste d that th e in c lu s io n of a few o ld e r su b je c ts in a tra in in g stu d y did n o t a tten u a te th e fre q u en tly o b s e r v e d d e c r e a s e in h e a r t r a te and co n co m ita n t e ffe c t on s y s t o lic tim e in te r v a ls . 29 E ffe c t of A ge on STI S e v e r a l in v e stig a tio n s h ave b een m ad e on the s y s to lic c o m p o n en ts o f the e ld e r ly . Only the stu dy by W iley , h o w ev e r, h as in clu d ed o ld e r p e r s o n s in stu d ie s w h ich have d e a lt w ith the e x e r c is e train in g e ffe c t on the in te r v a ls . H a r r iso n and h is c o -w o r k e r s (1964) sh ow ed that no s p e c ific tren d e x is te d in the r e la tio n sh ip b etw een a g e and the f ir s t com p on en t of the p r e -e je c tio n p e r io d --th e e le c tr o m e c h a n ic a l lag (Q Sj). H o w e v er , th e r e w a s a slig h t in c r e a s e in the se co n d com p on en t of P E P - - t h e is o v o lu m e tr ic c o n tra c tio n tim e (IC T )--in d ep en d en t of h e a r t r a te w ith agin g a d u lts (r = 0. 4 2 3 ). A ls o , a slig h t in c r e a s e in the le f t v e n tr ic u la r e je c tio n tim e w ith age w a s o b s e r v e d (r = 0 . 316 ) but a p p ea red to be r e la te d to a slo w e r a v e r a g e h e a r t r a te in the o ld er su b je c ts . M ontoye and c o lle a g u e s (1967) found that P E P in c r e a s e d w ith in c r e a s e d y e a r s . W ith r e s p e c t to L V E T , W ille m s and h is c o - in v e s tig a to r s (1970) found a s m a ll but s ig n ific a n t in c r e a s e of L V E T w ith age in d ep en d en t o f h e a r t ra te and blood p r e s s u r e . W hile D e c k m an and h is c o lle a g u e s (1972) c o n fir m e d the find in g of lo n g e r le ft v e n tr ic u la r e je c tio n tim e a s s o c ia te d w ith a g e , sh o r te r P E P v a lu e s w e r e o b s e r v e d in the o ld e r m en and w om en . An e x te n s iv e stu d y w ith r e s p e c t to the e ffe c t o f a g e on the r e stin g s y s t o lic tim e in te r v a ls w a s con d u cted by Shaw and h is c o -w o r k e r s (1973). M ore than 300 m a le s 30 ranging in a g e fr o m 20 to 89 y e a r s w e r e e v a lu a ted in the r e stin g sta te . In the n o r m o te n s iv e s , a sig n ific a n t but s m a ll p ro lo n g a tio n o f P E P , both u n c o r r e c te d and c o r r e c te d fo r h e a r t ra te w a s o b s e r v e d . The in c r e a s e am ou n ted to fou r m illis e c o n d s per d eca d e fro m the th ird to six th d eca d e w ith a d e c r e a s e in the se v e n th and eigh th d e c a d e . The sa m e w a s tru e o f to ta l s y s t o le ( Q ^ ) e x c e Pt that t* le in c r e a s e w a s fiv e m illis e c o n d s p er d e c a d e . No sig n ific a n t r e la tio n sh ip w a s found b e tw een L V E T and a g e . Slodki and h is c o lle a g u e s (1969) a ls o found a ten d en cy tow ard p ro lo n g ed to ta l s y s to le in the o ld e r p e r s o n s w hen co m p a red to y o u n g er p e r so n s fr o m an e a r lie r study (Shah and S lod k i, 1964). The in v e s tig a to r s con clu d ed that the in c r e a s e d QS^ w ith a g e w a s a co m b in a tio n of in c r e a s e d P E P and L V E T w h ich su g g e ste d a co m b in a tio n of is c h e m ia and e ffe c ts of aging on the le f t v e n tr ic le . A lso , it w a s thought that m y o c a r d ia l f ib r o s is r e la te d to agin g m ay have con trib u ted to p ro lo n g ed v e n tr ic u la r s y s to le . A n oth er study w h ich did not u tiliz e the p u lse tra cin g o b se r v e d the m e c h a n ic a l s y s t o le (S S ) in young and old p e r so n s not on ly at X H r e s t but during and a fte r e x e r c is e . The r e g r e s s io n lin e o f m e c h a n ic a l s y s to le on h e a r t ra te w a s found to be s lig h tly but sig n ific a n tly h ig h er in the old than in the young alth ou gh the slo p e w a s s im ila r . T h u s, at any g iv en h e a r t ra te m e c h a n ic a l s y s t o le w a s lo n g e r in the e ld e r ly (S tra n d ell, 1964). A ronow (1970) ex a m in ed the is o v o lu m e tr ic 31 c o n tr a c tio n tim e u n c o r r e c te d for h e a r t ra te a t r e s t , im m e d ia te ly a fte r e x e r c is e and th r e e m in u te s a fte r e x e r c is e in m en of v a r io u s a g e s . A lthough no s ig n ific a n t d iffe r e n c e s w e r e o b s e r v e d im m e d ia te ly a fter e x e r c is e , the is o v o lu m e tr ic c o n tra c tio n tim e s w e r e sig n ific a n tly lo n g e r at r e s t and at th r e e m in u te s p o st e x e r c is e in the o ld e r g r o u p s. In g e n e r a l, w ith the e x c e p tio n of D eck m a n 's stu d y w ith r e s p e c t to P E P , lo n g e r P E P and L V E T v a lu e s have b een o b s e r v e d in o ld e r p e r s o n s . It w ould ap p ear that sin c e both P E P and L V E T in c r e a s e th e r e w ould be lit tle e ffe c t on the r a tio of P E P and L V E T in o ld e r p e r s o n s . The s c a r c ity o f stu d ie s w ith r e s p e c t to both the a cu te and c h r o n ic e ffe c t o f e x e r c is e on s y s t o lic tim e in te r v a ls in o ld e r p e r so n s a tte s ts to the n eed fo r su ch s tu d ie s . The im p o rta n ce o f su ch a study in the a g ed is in c r e a s e d by the p o s s ib ility that e x e r c is e m a y r e ta r d or r e v e r s e the aging of the le ft v e n tr ic u la r m y o ca rd iu m . S u m m ary T ab le 1 s u m m a r is e s the train in g e ffe c ts on r e stin g s y s t o lic tim e in te r v a ls in n o r m a l p e r s o n s . The tab le d iv id e s p r e v io u s stu d ie s in to th o se w h ich have c o r r e c te d the s y s t o lic tim e in te r v a ls fo r h e a r t r a te and th o se w h ich h a v e not m ad e h e a r t ra te c o r r e c tio n s . It is d iv id ed fu r th e r in to th r e e g e n e r a l ty p e s o f train in g stu d ie s . The f ir s t o f th e se is the tra in in g in te rv e n tio n s tu d ie s , i . e . , th o se stu d ie s _ TABLE 1 Training Effects on Resting Systolic Time Intervals of Normels Invest igetors Heart Rate PEP LVET Uncorrected for Heart Rate A. Training-Intervention: Raab, W. et al., 1960 Decrease Increase Increase— NS Cundiff, D., 1966 Decrease NS change NS change DuToit, S., 1966 Decrease— NS Increase NS change Fardy, P., 1967, 1973 Decrease— NS Decrease— NS Decrease— NS Franks, B. etal., 1969 Decrease NS change NS change Wiley, J., 1971 Decrease Increase— NS Increase Terjung, R. etal., 1973 Unreported Decrease Decrease— NS B. Comparative Studies: Fardy. P., 1971 Decrease Increase NS difference Montoye, H. et al., 1972 NS difference Shorter— NS Equal C. Correlative Studies: Tharp, G., 1969 (PWC- Test) NS correlation NS correlation Molnar, S. et al., 1973 (Max VO j, mile run) NS correlation NS correlation Heart Rate PEP LVETe Corrected for Heart Rate: A. Train ing-1 ntervention: Terjung, R. et al., 1973 Unreported Decrease Decrease— NS B. Comparative Studies: Montoye, H. et al., 1972 NS difference Shorter— NS Longer— NS Whitaett, T. et al., 1971 (Normals) Lower-NS Equal Longer— NS C. Correlative Studies: Montoye, H. et at., 1972 (Submaximal ex. HR) No significant correlation No significant correlation NS ■ Not tignif icsnt 33 w h ich c o m p a re d p r e -tr a in in g syatoH c tim e in te r v a le w ith the e y a to lic tim e in te r v a le m e a s u r e d a fte r an in te rv e n in g train in g p e r io d . The aecon d c a te g o r y o f atudiea ia the c o m p a ra tiv e type w h ereb y the e y a to lic tim e in te r v a le o f tra in ed per cone a r e co m p a red w ith th oee of u n tra in ed p e r a o n e . The fin a l c a te g o r y ia the c o r r e la tiv e type w h ereb y the a y e to lic tim e in te r v a le of in d ivid u ala a r e r e la te d to p e r fo r m a n c e on a p h y a ica l fitn ea a te a t auch aa m a x im a l oxygen c o n su m p tio n , P W C150, or the m ile run. Of the atu d iea H ated a ll have rep o rted e ith e r a d e c r e a a e or no a ig n ific a n t ch an ge in h ea rt ra te aa a r e a u lt of tra in in g . The u n c o r r e c te d p r e -e je c tio n p e r io d in tw o atudiea (Raab et a l . , I960; D u T oit, 1966 ) haa show n a a ig n ific a n t in c r e a s e w h ile on ly one study h a s show n a a ig n ific a n t d e c r e a s e (T erjung e t a l. f 1973). The la tte r study did not r e p o r t w h eth er o r not h ea rt ra te had ch an ged . B aaed on the atudiea lis t e d it a p p ea r s that any in c r e a s e in P E P ia a sa o c ia te d w ith a c o n c o m ita n t d e c r e a s e in h ea rt r a te aa a r e s u lt o f tra in in g . L eft v e n tr ic u la r e je c tio n tim e (L V E T ) h a s been r e p o r te d to in c r e a s e s ig n ific a n tly due to tra in in g in te r v e n tio n in on ly one atudy (W iley, 1971). No atudy haa r e p o r te d a a ig n ific a n t d e c r e a s e in L V E T , w h ile s ix s tu d ie s h a v e rep o rted no sig n ific a n t ch an ge (C undiff, 1966; D u T oit, 1966; F a r d y , 1967, 1973; F ran k s and C u reton , 1969; R aab et a l. , 1966; T erju ng e t a l. , 1973). The one stu d y w h ich c o r r e c te d for 34 h e a r t r a te in d ic a te d a d e c r e a s e d P E P w h ile L V E T did not sig n ific a n tly ch an ge (T erjun g e t a l . , 1973). The c o m p a r a tiv e stu d ie s do not in d ic a te any c le a r ten d en cy for elo n g a tio n or sh o rten in g o f P E P or L V E T w ith r e s p e c t to train in g sta tu s (M ontoye e t a l. , 1972; W h itsett and N aughton, 1971) e x c e p t for one study w h ich did n ot c o r r e c t fo r h e a r t ra te and found a lo n g e r P E P in the m o r e tra in ed p e r s o n s (F a rd y , 1971). N one o f the c o r r e la tiv e s t u d ie s - - e it h e r h e a r t r a te c o r r e c te d or u n c o r r e c te d --s h o w e d any r e la tio n sh ip b etw een the P E P or LVET and v a r io u s p h y s ic a l f it n e s s m e a s u r e m e n ts (T h arp , 1969; M olnar e t a l. , 1973; M ontoye e t a l . , 1972). T ab le 2 s u m m a r iz e s the e ffe c ts o f train in g on the a c u te e x e r c is e r e c o v e r y s y s t o lic tim e in te r v a ls o f n o r m a ls. In g e n e r a l, the r e c o v e r y h e a r t r a te s a fter a su b m a x im a l e x e r c is e w ork lo a d w e r e d e c r e a s e d by tra in in g o r lo w er in p r e v io u s ly tra in ed p e r so n s (C undiff, 1966; F a rd y , 1967; F ran k s and C u reton , 1969; W iley , 1971). In m o s t in s ta n c e s , P E P a n d /o r e ith e r on e o f its c o m p o n e n ts --is o v o lu m e tr ic c o n tr a c tio n tim e (ICT) or e le c tr o m e c h a n ic a l lag (E M L )--w a s found to in c r e a s e in th e tra in ed p e r so n s in the stu d ie s w h ich did n o t c o r r e c t for h e a r t r a te . In one stu d y IC T in c r e a s e d a fte r tra in in g (D u T oit, 1966) w h ile in two stu d ie s no sig n ific a n t ch an ge w a s found (F a rd y , 1967, 1973). The L V E T w a s found to in c r e a s e a fte r train in g in two stu d ie s 35 TABLE 2 Training Effects on Exercise Raoovary Systolic Tima Intervals of Normals Investigators m a n r a n PEP LVET Uncorrected for Heart Rata Training-Intervent ion: Cundrff, D., 1966 Decrease ICT decrease NS change DuToit, S., 1966 Decrease— NS ICT increase NS change Fardy, P., 1967 Decrease (sub max. exercise) NS change Increase Increase (max.) NS change Decrease 1973 Decrease EM L decrease NS change Franks, B. et al., 1969 Decrease ICT increase NS change Wiley, J., 1971 Decrease Increase Increase Corrected for Heart Rate Comparative Study: Heart Rate PEP Study ciMd did not LVETC Whitsatt, T. et al., 1971 Lower— NS Equal Shorter (Normals) NS “ Not significant 36 F a rd y , 1967; W iley , 1971) and found to m a k e no a ig n ific a n t ch an ge in four atudiea (C undiff, 1966; D u T oit, 1966; F ard y, 1973; F ranka and C u reto n , 1969). T ab le 3 c o m p a r e s the s y s t o lic tim e in te r v a ls in n o r m a ls and a b n o rm a ls both at r e s t and a fte r a cu te e x e r c is e . The stu d ie s c le a r ly in d ica ted lo n g er p r e -e je c tio n p e r io d s and sh o r te r le ft v e n tr ic u la r e je c tio n tim e s . Thus the P E P /L V E T r a tio w as c o n s is te n tly found to be larger in the a b n o rm a ls than the n o r m a ls (Ahm ed e t a l. , 1970; H eikk ila et a l . , 1971; M a r g o lis, 1964; S tafford et a l. , 1970; W ayne, 1968; W e is s le r e t a l . , 1968; B ro d er and A m b e, 1972; G ilb ert and C an tw ell, 1972). In lig h t of the p r e v io u s s tu d ie s , the n o n -in v a slv e m e a s u r e m e n t o f s y s t o lic tim e in te r v a ls r e fle c t v a r io u s p h y sio lo g ic a l co n d itio n s. B r ie fly , it w a s se e n that the le ft v e n tr ic u la r e je c tio n tim e is a good in d ic a to r o f str o k e v o lu m e (B raunw ald e t a l. , 1958), w h ile the r e la tio n sh ip b etw een LV E T and the p r e -e je c tio n p eriod is r e la te d to the e je c tio n fr a c tio n (G arrard e t a l. , 1970) and IC T --a com p on en t of P E P - - h a s b een su g g e s te d a s a d ir e c t e x p r e s s io n of m y o c a r d ia l c o n tr a c tility (Spodick and K um ar, 1968b). T h e r e fo r e the s y s t o lic tim e in te r v a ls have b e e n u s e d to d i s c r im in a te b etw een n o r m a l and a b n o rm a l h e a r ts . To in c r e a s e d i s c r im in a to r y s e n s itiv it y , STI h ave b een a d m in iste r e d a fter a cu te TABLE 3 Comparison of Systolic Tima Intervals In Normals and Abnormals at Rast and after Acuta Exarciss Investigator PEP LVET PEP/LVET Resting Ahmed, S., et al., 1970 Not repot d Not reported Larger— Abn Heikkila, J. et al., 1971 NS difference Shorter— Abn Larger— Abn Margolis, C., 1964 NS difference NS difference Larger— Abn Spodick, D. et al., 1969 Not examined Shorter— Abn Not examined Stafford, R. et al., 1970 Longer— Abn Shorter— Abn Larger— Abn Wayne, H., 1968 Longer— Abn Shorter— Abn Larger— Abn Weissler, A. et al., 1968 Longer— Abn Shorter— Abn Larger— Abn Acute Exercise Recovery fHeert Rate Corrected) Broder, G. et al., 1972 (Post 10-15 minutes) Longer— Abn Shorter— Abn Larger— Abn Gilbert, C. etal., 1972 Longer— Abn (Post 2-5 min.) Short er-A bn (Post 5-8 min.) Larger— Abn Pouget, J. et al., 1971 Post % minute Post 2-10 minutes Shorter-A bn NS difference Longer— Abn NS difference Smaller— Abn NS difference N “ Normals; Abn - Abnormals; NS * No significant difference 38 e x e r c is e . F in a lly , the s y s t o lic tim e in te r v a ls h ave b een u se d to m e a s u r e le ft v e n tr ic u la r ch a n g es a s a r e s u lt of e x e r c is e tra in in g . In g e n e r a l, the b e n e fic ia l e ffe c ts of an im p ro v ed c a r d io v a s c u la r c o n d ition a re an in c r e a s e in both P E P and LV E T a s a r e s u lt o f a d e c r e a se in r e stin g or r e c o v e r y h e a r t r a te . U su a lly P E P h a s b een show n to in c r e a s e r e la tiv e ly m o r e than L V E T due to it s p u rp orted g r e a te r s e n s itiv ity to sy m p a th e tic a d r e n e r g ic a c tiv ity , or the la ck of su ch a c c e le r a tin g -ty p e a c tiv ity . H o w e v er , in v e r y few of the stu d ie s d e a l ing w ith the n o r m a l p op ulation w a s th e r e a c o r r e c tio n fo r h ea rt r a te . On the o th er hand, m o st o f the stu d ie s w h ich d e a lt w ith a b n o rm a ls did c o r r e c t the in te r v a ls fo r h ea rt r a te . P e r h a p s, th is h as led to the d iffe r e n t find in g o f the "abnorm al stu d ie s" w h ich a p p e a r s to be in c o n s is te n t w ith the r a tio n a le behind the r e s u lts fo r the "n orm al s tu d ie s . " The "abnorm al stu d ie s" in com p arin g n o r m a ls w ith a b n o rm a ls have c o n s is te n tly found a s h o r te r P E P r e la tiv e to L V E T (d ir e c tio n op p o s ite to tra in ed e ffe c t in n o r m a l s tu d ie s ) in n o r m a l p e r s o n s , thus r e su ltin g in s m a lle r P E P /L V E T v a lu e s . The ra tio n a le fo r the r e s u lts of th e se stu d ie s w h ich co m p a red a b n o rm a ls w ith n o r m a ls has been that the g r e a te r m y o c a r d ia l c o n tr a c tility o f the n o r m a l h e a r t c a u s e s a sh o r te r P E P and the g r e a te r str o k e v o lu m e o f the n o r m a l h e a r t c a u s e s a lo n g er L V E T . It r e m a in s to be s e e n w h eth er or not the aged m y o ca rd iu m m a y be e x p e c te d to p rod u ce an e ffe c t s im ila r to p r e v io u s n o r m a l stu d ie s or s im ila r to p r e v io u s a b n o rm a l stu d ie s . 39 A n o n -in v a a iv e m eth o d , euch a.a the a y a to lic tim e in te r v a l m e a a u r e m e n t, id e a lly m e e te the n eed for u tilis in g a n o n -tr a u m a tic tea t to ev a lu a te th e le f t v e n tr ic u la r fu n ction o f o ld e r p e r so n a u n d e r going a c a r d io v a s c u la r con d ition in g p r o g r a m . C H A PT E R III M ETHODS AND PR O C ED U R ES S u b ject! T w en ty -fo u r of the 26 m a le v o lu n te e r s w e r e r e s id e n ts o f the r e tir e m e n t co m m u n ity o f Laguna H ills , C a lifo rn ia . M ed ical h is to r y , r e stin g 12 lea d e le c tr o c a r d io g r a m a n a ly z e d by a p h y sic ia n , and blood p r e s s u r e in d ic a ted that a ll su b je c ts a p p ea red c lin ic a lly to be fr e e of d ia g n o sa b le c a r d io v a s c u la r or o th er d is o r d e r s w h ich m igh t c o n tr a in d ic a te v ig o r o u s e x e r c is e for th is a g e grou p . In d ivid u als w ith s y s t o lic b lood p r e s s u r e o v e r 160 or d ia s to lic e x c e e d in g 95 m m Hg w e r e s c r e e n e d fr o m the p r o g r a m , In a d d itio n , p e r so n s w ho ex h ib ited path - o lo g ic a l m u r m u r s, freq u en t p r e m a tu re v e n tr ic u la r c o n tr a c tio n s, or is c h e m ia at r e s t , du rin g or a fter e x e r c is e w e r e e lim in a te d fr o m the stu d y. The 13 e x p e r im e n ta l su b je c ts ran ged in age fr o m 57 to 74 y e a r s w ith a m ean a g e o f 6 6 . 6 . T ab le 4 p r e s e n ts the v ita l data fo r the su b je c ts in clu d in g the p h y sic a l w ork c a p a c ity at 85 p e r c e n t o f a g e - p r e d ic te d m a x im u m h e a r t r a te . A ll su b je c ts a p p ea red to be in the m id d le and u p p e r -m id d le s o c io e c o n o m ic c l a s s e s , ju d ged fr o m the c o s t o f liv in g a c c o m m o d a tio n s in the L e is u r e W orld r e tir e m e n t c o m m u n ity . 40 TABLE 4 Description of the Subjects 41 Age Height Weight PWC 86% S u b let (yrs) (inch) (lbs) (watt-min.) Experimental Subjects WB 57 68.26 136.50 830 DG 67 66.00 156.00 947 MK 65 64.75 173.00 628 PL 63 67.75 153.50 798 EL 65 63.00 122.50 258 ML 68 66.25 150.00 115 GO 64 71.00 215.00 2234 NO 71 67,00 183.75 928 KP 70 67.00 145.50 595 BR 65 66.50 180.25 1191 DR 74 68.75 169.50 883 EV 65 70.25 141.50 556 CW 68 64.25 138.50 244 Mean 66.3 67.0 158.9 785.2 Range 57-74 63-71 122.5-215 115-2234 S.D. 4.03 2.19 23.82 515.56 Control Subjects MA 57 66.50 136.50 1452 NO 71 65.75 148.50 678 KG 59 71.50 191.75 1171 JH 70 68.75 137.50 842 FK 64 69.50 158.25 493 RK 68 67.00 157.50 1085 RM 64 68.50 144.00 850 CS 71 63.00 162.00 822 JSt 73 62.00 122.00 156 JS 64 68.00 172.50 890 WW 65 68.25 190.50 777 HW 69 68.50 182.00 692 RW 71 65.25 142.75 662 Mean 66.6 67.1 167.4 812.3 Range 57-73 62-71.5 122-191.75 156-1452 S.D. 4.73 2.52 20.92 306.44 42 E x p er im e n ta l D e sig n A ll su b ject* w e r e ranked a cco r d in g to the P E P /L V E T ra tio d e te r m in e d by the p r e - t e s t and then d iv id ed into tw o m a tch ed g r o u p s. The d e c is io n a s to w h ich group c o n stitu te d the e x p e r im e n ta l or c o n tr o l w a s d e c id ed by ch a n ce. T h u s, the e x p e r im e n ta l d e sig n u tilis e d e x p e r im e n ta l and c o n tro l grou p s w h ich w e r e m a tch ed w ith r e s p e c t to the P E P /L V E T v a lu e . A fter the p o st 10 w eek data w e r e ob tain ed a ll p a r a m e te r s w e r e a n a ly se d by t e s t s (d o u b le -ta ile d ) fo r the s ig n ific a n c e o f the d iffe r e n c e s in c h a n g es b etw een the e x p e r im e n ta l and c o n tro l s u b je c ts . The fo rm u la u sed fo r the t t e s t for u n c o r r e la te d m ea n s in two s a m p le s o f eq u al s i s e w a s a c co r d in g to G u ilford (1965): D - D w h ere: D - the m ea n ch an ge (D iffe r e n c e ) of the e x p e r im e n ta l g ro u p , D * the m ean ch an ge (D iffe r e n c e ) of the c o n tro l g ro u p , and c crd^ = > the stan d ard e r r o r of the d iffe r e n c e b etw een the d iffe r e n c e s . A lso , a t te s t for c o r r e la te d data w a s run on the m a tch ed v a r ia b le , P E P /L V E T . The fo rm u la w a s a s fo llo w s: m d N (N — 1) 43 w h ere: = the m e in o f the d iffe r e n c e s b etw een the d iffe r e n c e s of the e x p e r im e n ta ls and the d iffe r e n c e s o f the c o n tr o ls , 2 x = the su m of the sq u a red d e v ia tio n s fr o m the m ean of the the d iffe r e n c e s b etw een ch a n g es in e x p e r im e n ta l and c o n tr o ls , and N * the n u m b er o f su b je c ts . R e jec tio n of the nu ll h y p o th e sis w a s e s ta b lis h e d at the 0. 05 le v e l of c o n fid e n c e . In stru m en ta tio n and T e rm in o lo g y A ll te stin g o c c u r r e d at the F oundation fo r R e se a r c h in A gin g, E x e r c is e , and P r e v e n tiv e M ed icin e at the M ed ica l C enter in the r e tir e m e n t com m u n ity at Laguna H ills , C a lifo rn ia . T e m p e ra tu r e w as m a in ta in ed b etw een 7 0 - 7 5 ° F w ith h u m id ity b elo w 50 p e r c e n t. The t e s t s w e r e sc h e d u led fo r at le a s t four h ou rs a fte r a lig h t m e a l. The su b je c ts w e r e in s tr u c te d to a b sta in fr o m c o ffe e , te a , a lc o h o lic b e v e r a g e s , and n ic o tin e du rin g the h ou rs p r e c e d in g the te s t fo r that day. A ls o , the v o lu n te e r s w e r e a sk ed to r e fr a in fr o m any p h y sic a l a c tiv ity p r e ce d in g the te s t w h ich w a s m o r e v ig o r o u s than n o r m a l w a lk in g . To m in im is e any e ffe c t o f d iu rn a l v a r ia tio n , su b je c ts w ho w e r e te s te d in th e m orn in g on the se c o n d v is it w e r e te s te d a ls o in the m o rn in g for the th ird and fou rth v is it . E ach su b je c t m ad e th r e e tr ip s to the la b o r a to r y b e fo r e m atch ed 44 a ss ig n m e n t w a s m ad e to the e x p e r im e n ta l or c o n tr o l situ a tio n . On the f ir s t v is it a b r ie f m e d ic a l h is to r y w a s taken along w ith the 12 -le a d r e stin g e le c tr o c a r d io g r a m and the a u sc u la to r y blood p r e s s u r e . The seco n d v is it , alon g w ith the f ir s t , s e r v e d to fa m ilia r iz e the su b je ct w ith the in v e stig a to r , b ic y c le e r g o m e te r , ECG le a d s , p h o n o -tr a n s d u c e r , p u lse tr a n sd u c e r , and v a r io u s oth er ap p aratu s and p r o c e d u r e s. A n th ro p o m etric m e a s u r e m e n ts w h ich in clu d ed sk in fo ld s , a lso w e r e taken on the se co n d v is it . A ll t e s ts w h ich w e r e p e r fo r m e d on the se co n d v is it w e r e rep ea ted on the third v is it w ith in a on e w eek p erio d . The data fr o m th e se two te s ts w e r e a n a ly zed fo r r e lia b ility . T ab le 5 sh ow s the c o e ffic ie n ts fo r the t e s t - r e t e s t r e lia b ility b a sed on p r e te s ts ; it sh o w s a ls o the s p lit-h a lf r e lia b ility b a sed on eig h t c o n s e c u tiv e c a r d ia c c y c le s a t r e s t. The s p lit-h a lv e s te s t co m p a red the odd c y c le s (1, 3, 5, and 7) w ith the ev en c y c le s (2, 4, 6 , and 8 ) in o r d e r to m e a s u r e the r e lia b ility of the in v e stig a to r in the m e a s u r e m e n t and c a lc u la tio n o f the v a r io u s s y s t o lic tim e in te r v a ls . The t e s t - r e t e s t r e lia b ility c o e ffic ie n ts sh ow ed that th e re w a s c o n sid e r a b le b io lo g ic a l v a r ia b ility , w h ile the s p lit-h a lv e s c o e ffic ie n ts d e m o n str a te d that the m e a s u r e m e n ts w e r e m e a s u r e d and c a lc u la te d r e lia b ly fo r that g iv e n r ec o rd in g p e r io d . O nly the data fr o m the third v is it , w h ich r e p r e se n te d the se co n d e x e r c is e t e s t , se r v e d a s the p r e -d a ta for the p u r p o s e o f c o m p a r iso n w ith the fou rth (final) v is it to the la b o r a to r y a fte r ---- 45 TABLE 6 Test-Retest and Spttt-halvw (B) Evaluation of Raliability (Correlation Coefficient In Box) A. Test-Retast Reliability Pre-exareiaa Raoovary Aftar Exercise Parameter Supine Seated 2m in. 5m in. 10 min. 15 min. Heart Rate 0.71 0.71 0.60 0.68 0.68 0.75 Systolic BP 0.63 0.54 0.52 0.75 0.72 0.76 Diastolic BP 0.66 0.53 0.85 0.86 0.69 0.67 o s 2 LVET 0.70 0.65 0.70 0.73 0.75 0.75 0.73 0.56 0.67 0.74 0.74 0.78 PEP 0.75 0.70 0.76 0.79 0.75 0.74 Physical Work Capacity 85%: r *0.92 Haight: r - 0.996 Weight: r » 0.995 B. Split-Halves (Odd-Even) Raliability Pre-exercise Supine Q Sj (Total Systole) 0.99 LVET (Left Ventricular Ejection Time 0.99 PEP (Pre-Ejection Period) 0.98 PEP/LVET 0.98 46 the train in g o r c o n tr o l p e r io d . The p o st te a t w aa a d m in is te r e d to both grou p s at the end o f the 10 w eek e x e r c is e p r o g r a m . T h us, c o n tr o ls and e x p e r im e n ta ls w e r e te s te d o v e r the sa m e p e r io d of tim e . At an o r ie n ta tio n m ee tin g ju st p r io r to the f ir s t e x e r c is e c la s s the su b je c ts w e r e taught to take th e ir ow n h e a r t r a te s e ith e r by p a l- patation o r w ith a ste th o s c o p e . The c o n tr o ls w e r e r eq u e sted not to change the n o rm a l le v e l o f p h y sic a l a c tiv ity and both g ro u p s w e r e r eq u e sted not to ch an ge d ie ta r y h a b its. The c o n tr o ls m e t a g a in at the fourth w e e k w h ereu p on the r e q u e st w a s r e p e a te d . On the b a s is o f fiv e y e a r s o f p r e v io u s la b o r a to ry e x p e r ie n c e w ith th is sa m e p op u lation , it w a s b e lie v e d that e v e r y o n e c o o p e r a te d fu lly . S y s to lic tim e in te r v a ls . ST1 w e r e m e a su r e d by the sim u lta n eou s r e c o r d in g of e le c tr o c a r d io g r a m , p h o n c a rd io g ra m , and c a ro tid p u lse w a v e . T ab le 6 p r e s e n ts a su m m a ry o f v a r io u s ST1 p r o c e d u r e s by oth er in v e s tig a to r s . A fou r ch a n n el E lem a -S ch o n a n d e r M ingograph r e c o r d e r and p u lse tr a n sd u c e r w a s u s e d to ob tain the p o lo g ra p h ic tra c in g . A p ap er sp ee d of 100 m m /s e c w a s u s e d w ith sy n ch ro n y o f r e s p o n s e fo r the fou r c h a n n els ch e ck ed d a ily and the sp eed ch e ck ed w ith a 60 c y c le s o u r c e fo r c a lib r a tio n ju s t p r e v io u s to and im m e d i a te ly a fte r the r e s e a r c h p r o g r a m . T he e le c tr o c a r d io g r a m c o n s is te d o f a lea d s y s te m w h ich u tilis e d a CM^ b ip o la r le a d m a in ly for e x e r c is e m o n ito rin g (B lack b u rn 4 7 TABLES Summary of Various Systolin Tima InUrval Procedures by Previous Investigators Investigator ECO Laad Phono Site and Fraquaney Speed (mm/sec) Cardiac Cyoias Aronow, 1970 Apax: 60*400 76,100 10 Back, 1968 I I Apax 100 Benchlmol, 1900 75 Braunwald, 1965 I I CUmming, 1903 V 6 Apax too 6 Frank, 1902 Earliast Q Ltft S-A-6 100 10 Franki, 1968 II 6 H arr i ion, 1904 1 . M Jazek, 1903 II 35-260 Hz Naughton, 1971 V5 LSB-2 10 Pbugat, 1971 LSB-3 100 10 Spodick, 1909 I I 76,100 26,200 5 Stafford, 1970 10 Strandall, 1964 4th Laft intar costal 100400 Hz 100 Tavel, 1967 Apax; PA-2 100300 Hz 100 Wsissler, 1968 1969 Earliast Q 2 mics optional Uppar praoordlum 100 10,20,30 Whitsttt, 1971 Bast S2 100 10 Wilay, 1971 II 60 6 48 e t a l. , 1966) and th r ee o th er b ip o la r v e c to r lea d a in r ig h t-le ft, in fe r io r - s u p e r io r , and p o s te r io r -a n te r io r p la n e s. The ECG lea d w h ich y ie ld e d .th e e a r lie s t Q or R w a v e d e fle c tio n at 100 m m /s e c rec o rd in g sp eed w a s s e le c te d for the p o ly g ra p h ic s y s t o lic tim e in t e r v a l tra c in g . The p h o n o ca rd io g ra m u tiliz e d a Schon and er EM T 25C phono tr a n sd u c e r a tta ch ed to the le f t ste r n a l b o r d e r at the fourth in te r s p a c e (LSB 4 ). The fre q u en cy se ttin g for the tw o ch an n el p h o n o ca rd io g ra m w a s 50 and 200 c y c le s p er seco n d (H z). F ig u re 1 illu s t r a t e s the p o s i tio n s o f the tr a n sd u c e r and the fiv e e le c tr o d e s on the su b ject. The c a r o tid p u lse tra cin g (C PT ) w a s m ad e w ith an E le m a - Schonander EM T 510 c r y s t a l tr a n sd u c e r ap p lied e x te r n a lly and h eld in p la c e m a n u a lly on the le ft c a r o tid a r te r y . The C P T w a s r e c o r d e d on the E lem a -S ch o n a n d e r fou r ch an n el r e c o r d e r sim u lta n e o u sly w ith the s e le c te d ECG le a d and the two p h o n o ca rd io g ra m fr e q u e n c ie s a s se e n in F ig u r e 2. At le a s t fiv e c y c le s w e r e r e c o r d e d at the end poin t o f e x p ir a tion . F ig u r e 2 d e fin e s the m e a su r in g p o in ts fo r the P E P , and L V E T co m p o n en ts of the s y s to lic tim e in te r v a ls . T ab le 7 d e s c r ib e s the v a r io u s s y s t o lic tim e in te r v a ls . The a b b re v ia tio n s in clu d e oth er te r m s fo r that p a r tic u la r in te r v a l often found in the lite r a tu r e . S y sto lic tim e In ter v a ls and b lood p r e s s u r e w e r e r e c o r d e d in 49 AOTID PUL8E TRANSOUCER RA PHONO LL LA RL F ig . 1. Illu str a tio n of E le c tr o d e , P h o n o -s e n s o r , and C arotid P u ls e T ra n sd u cer P la c e m e n t on Subject (E le c tr o d e le a d s: R A -rig h t arm ; R L - righ t leg ; L L -le ft le g ; L A -le ft arm ; C -c h e s t e le c tr o d e p la c e d n ear tip o f sc a p u la ) F ig. 2. A ctual P olygraph ic T racing for S y sto lic T im e Interval M easurem ent U l S . 51 TABLE 7 Daaarlptten of tyatoUe Time Interval* (STI) Interval Abbreviations Computation Explanation Primary Componantt Cyclt Tima t l j R-R; $2*^2 R to R (msac) One complete cardiac cycle: systole + diastole Total Systole QSj; TS Q to Sj (msac) Onset of excitation to end of ven tricular election Pre-ejection Period PEP; TP QSj minus LVET (msac) Onset of excitation to beginning of ventricular ejection Laft Vantricular Ejection Tima LVET; ET; E P Carotid pulse ascent to dicrotic notch Onset of ejection to end of ejection Ratio PEP/LVET; P/L; PEP divided by LVET or vice versa Relation of PEP to LVET Corractad Total Systole Pre-ejection Period OS-j PEPC QSj + (2.27 x HR) PEP + (0.56 k HR) Conversion of QS2. PEP, and LVET based on regression equation form ed with heart rate and the respec tive interval (Shew, O.etel., 19731 Laft Vantricular Enaction Tima LVETC ; ET, LVET + 0.71 x HR) Sacondary Compooanta Elactromachan ical Lag QS^EML Q to S, (msac) Onset of excitation to first heart sound Iso volumetric Con traction Tima ICT (S1 to S2> - LVET “Onset" of contraction to onset of ejection Machanfcal Systole SjSj ; M S Sj to Sj "Onset" of contraction to end of ejection Ratio ICT/LVET; LVET/ICT ICT divided by LVET or vice versa Relation of ICT to LVET 52 the su p in e p o sitio n a fte r the su b je c t had b een lyin g co m fo rta b ly for a p p r o x im a te ly 15 m in u te s. The m e a s u r e m e n ts w e r e r e p e a te d w h ile se a te d on the b ic y c le e r g o m e te r p r e v io u s to e x e r c is e and 2, 5 , 10, and 15 m in u te s p o s t - e x e r c ls e in the su p in e p o sitio n . B lood p r e s s u r e w as taken by the u su a l cu ff m eth od (K orotkow sou n d s) u sin g the f ir s t and fifth p h a se s at r e s t and the fourth p h a se on o c c a s io n during e x e r c is e . B ic y c le e r g o m e tr y . The e x e r c is e bout c o n s is te d of con tin u ou s e x e r c is e on an e le c tr o n ic a lly p r o g r a m m e d C ollin s b ic y c le e r g o m e te r on w h ich the su b je c t p e d a lled for 3 m in u te s a t 50 W atts and in e a ch s u c c e s s iv e 3 m in u te p e r io d the w ork load w a s r a ise d by 25 W atts u n til h e a r t r a te on the c a r d io ta c h o m e te r r e a c h e d 85 p e r c e n t o f the age p r e d ic te d m a x im a l h e a r t ra te a s e n d o r se d by the M y rtle B ea ch C on fe r e n c e (P a r m le y e t a l . , 1969). The e a r p leth y sm o g ra p h w a s c a l i b rated w ith th e c a rd io ta c h r e c o r d e r d a ily at 0, 90, and 150 b e a ts p er m in u te w h ile the C o llin s b ic y c le e r g o m e te r w as c a lib r a te d p r e and p o s t e x p e r im e n ta l p e r io d by the P ro n y b ra k e m ethod w ith a Q uinton In stru m en ts B ic y c le C a lib r a to r. A n th ro p o m etry . A n th ro p o m etric data fo r h eigh t and w e ig h t w e r e ob tain ed w ith a freq u en tly c a lib r a te d p h y sic ia n s s c a le . S k in fold s at the t r ic e p s , su b sca p u la , and c h e s t w e r e m e a su r e d w ith L ange 53 ■kinfold c a lip e r s a c c o r d in g to the m eth od * o f B ro zek and K ey* (1951), snd then c a lc u la te d fo r p e r c e n t fa t. The b icep * and a u p r a -ilia c w e r e m ea su r ed a c c o r d in g to the m ethod* of D urnin and R aham an (1967). Both the p e r c e n t fat and th e su m o f the fiv e sk in fo ld m e a su r e m e n t* w ere a n a ly zed s t a t is t ic a lly fo r ch an ge* due to tra in in g . E x e r c is e p r o g r a m . The e x e r c is e p r o g r a m c o n s is te d of th ree p h a ses and w a s le d by the in v e s tig a to r . The f ir s t p h a se d e s c r ib e d in A ppendix 1 in clu d ed v a r io u s c a lis th e n ic e x e r c is e s s p e c ific a lly d e sig n e d to m a in ta in low h e a r t r a te s . Thus the c a lis th e n ic s w e r e m a in ly str e tc h in g and b a la n cin g e x e r c is e s w h ich la ste d for on ly 5 m in u te s. T he se co n d p h a s e --t h e a e r o b ic e x e r c is e - - w a s d e sig n e d to c o n stitu te the e x p e r im e n ta l v a r ia b le o f the e x e r c is e p r o g r a m . The a e r o b ic e x e r c is e c o n s is te d o f an in te r v a l train in g type o f b ic y c le e r g o m e tr y a* d e s c r ib e d in T ab le 8. The e n tir e d u ration o f the b ic y c le e r g o m e tr y p ortion o f the e x e r c is e p r o g r a m w a s 30 m in u te* w ith only two 1 m in u te r e s t in te r v a ls e v e r y 10 m in u te s w h ereu p on h e a r t r a te w a s r e c o r d e d (h ea rt r a te fo r m in A p pend ix II). The a b so lu te in te n sity of the b ic y c le p ro g ra m v a r ie d w ith the h e a r t r a te o b s e r v e d for the in d iv id u a l. Thus v a r io u s p ro g ra m * or " p r e sc r ip tio n s" w e r e a s s ig n e d to the p a r t ic i pants in a c c o r d a n c e w ith th e h e a r t ra te of the In d ivid u al. The v a r io u s bike p r o g r a m s w e r e p r e s c r ib e d to e li c i t h e a r t r a te s a b o v e 70 p e r c e n t of the p r e d ic te d m a x im a l h e a r t ra te but n ot a b o v e the 85 p e r c e n t le v e l 54 TABLE t Btcyala Erfometer (ConMHit Work Typi) P tvfnm Ttma (Min) Conttnuotw Interval MW RPM M H#t 0— 6th 6 14 50 1.16 6th— 10th 6 17 60 1.41 10th— 11th 1 (HR) 11th— 16th 6 19 70 1.66 16th-21 »t 6 22 80 1.83 21 tt— 22nd 1 (HR) 22nd-27th 6 19 70 1.68 27th— 30th 3 14 60 0.70 Total M II m 8.26 A B C D E F G H 1 KGM/MIN 160 160 160 300 300 300 460 460 460 160 300 300 300 460 460 460 600 600 Heart Rata: Count and Record 160 160 300 300 300 460 460 460 600 160 300 300 300 460 450 460 600 600 Heart Rata: 1 Count and Record 160 150 160 300 300 300 460 460 460 160 160 160 300 300 300 300 300 460 KGM -M IN 4,200 6,700 6,460 8,400 9,900 10,060 12,150 13.660 14360 J K L M N O P Q R KGM/MIN 460 460 460 460 460 460 600 600 600 600 600 600 760 750 760 B O O 1,060 1,060 Heart Rata: Count and Record 600 600 750 760 900 900 900 B O O 1,060 600 760 760 B O O 900 1,060 1,060 1,050 1,060 Heart Rata: Count and Record 600 600 760 760 900 B O O B O O B O O B O O 460 460 460 460 460 460 450 460 460 KGM -M IN 16,000 16,360 17.860 10,360 20,860 21,600 23,100 23360 24,600 55 (P a r m le y e t a l . , 1969). Ae ju d ged by p r e v io u s tra in in g stu d ie s on o ld e r a g e g rou p s (d e V r ie s , 1971; A dam s e t a l. , 1973) the ab ove th r esh o ld le v e l w a s d e e m e d ad eq u ate for a tra in in g e ffe c t. The b i c y c le p r o g r a m s w e r e q u an tified a c co r d in g to the to ta l w ork a c c u m u la te d in the 30 m in u te c y c lin g p e r io d . The lig h te s t p r o g r a m w a s "A" w h ich am ou n ted to a to ta l w ork load o f 4200 k ilo g r a m m e te r s (or an a v e r a g e of 150 k ilo g r a m -m e t e r s /m in . ) or 700 W a tt-m in u te s (or an a v e r a g e o f 25 W atts). The p r o g r a m s w e r e p r o g r e s s iv e ly in c r e a s e d to b e a b le to a c co m m o d a te a p e r so n ca p a b le of p r o g r a m "N" w h ich to ta led 2 0 ,8 5 0 k ilo g r a m -m e te r s (or 745 K gM /m in ) or about 3 ,4 7 5 c u m u la tiv e W a tt-m in . (or an a v e r a g e w ork load of a p p r o x im a te ly 125 W ). The in itia l 5 to 10 m in u te s of the 30 m in u te p e r io d w a s a w a r m -u p c y c lin g p e r io d , w h ile the la s t 3 to 8 m in u te s se r v e d a s a c o o l dow n. R ev o lu tio n s p er m in u te w e r e p ro g ra m m ed into the p r e s c r ib e d p r o g r a m s for the fiv e Schw inn co n sta n t w ork load type o f b ic y c le e r g o m e te r s , but rem a in e d co n sta n t at 50 R PM for the tw o M onark e r g o m e te r s . P r e v io u s c a lib r a tio n s w ith a d ig ita l v o lt m e te r had sh ow n that a ll the Schw inn e r g o m e te r s have a fla t c u r v e fr o m 5 0 -9 0 R P M . Two se p a r a te e x e r c is e s e s s io n s w e r e n e c e s s a r y to a c c o m m o d a te the 13 p e r s o n s on the s e v e n e r g o m e te r s . The m a jo r ity o f the su b je c ts took h e a r t r a te w ith the s te th o s c o p e s p ro v id ed and w e r e e n c o u r a g e to u s e it during the la s t 15 se c o n d s o f the w o rk lo a d 56 a s long a s a c c u r a c y w a s n ot je o p a r d ise d . O th erw ise* h e a r t r a te w a s r e c o r d e d during a m in im a l w ork load and v e r y slo w RPM w ith in 10 se c * onds o f the p r e ce d in g w ork lo a d . The in v e stig a to r sp o t-c h e c k e d h e a r t r a te s fo r a c c u r a c y w ith a ste th o s c o p e du rin g e a c h train in g w ork ou t and on o c c a s io n s o m e su b je c ts w e r e ch e ck ed w ith the e a r p le th y s m o - grap h . The te m p e r a tu r e of the e x e r c is e ro o m w a s m a in ta in ed b etw een 6 9 - 7 4 ° F in o r d e r to m in im iz e e n v iro n m en ta l te m p e r a tu r e e ffe c t on the h e a r t r a te . The th ird p h a se o f the e x e r c is e p ro g ra m c o n s is te d o f 5 m in u tes of sta tic str e tc h in g e x e r c i s e s . The th ird p h a se s e r v e d two p u r p o se s: (1) to im p r o v e jo in t m o b ility * and (2) to p rev en t a n d /o r r e lie v e m u s c le s o r e n e s s (d e V r ie s, 1966). P h a s e s on e and th r ee w e r e in clu d ed to add v a r ie ty , in t e r e s t , and sa fe ty w ith ou t in te r fe r e n c e to the e x p e r im e n ta l v a r ia b le -- th e e r g o m e tr y p r o g r a m of p h a se tw o. CH APTER IV R E SU L T S A d e sc r ip tio n o f the a v e r a g e h e a r t r a te s a c h ie v e d , a v e r a g e w o rk lo a d s p e r fo r m e d , and the a v e r a g e c a lo r ie s sp en t for e a ch w eek of the 10 w e ek e x e r c is e p r o g r a m is p r e se n te d in F ig u r e 3. S in ce the m ile a g e for e a ch p e r so n w a s fix e d ea ch day at 8. 26 m ile s , the total d ista n c e c o v e r e d w a s 247. 8 m ile s fo r the 10 w eek p e r io d . The a v e r a g e w ork load in the 28 m in u te s o f a c tu a l e r g o m e tr y w a s about 450 K gM /m in u te. The w ork output o f the e x e r c is e p r o g r a m r e p r e s e n te d a to ta l c a lo r ic ex p en d itu re o f a p p ro x im a te ly 4 ,8 6 3 k ilo c a lo r ie s . E x e r c is e h e a r t r a te s w e r e c o n s is te n tly ab ove 120 but b elow 125 b e a ts p er m in u te a fte r the th ird w e ek of e x e r c is e . T he a v e r a g e w ork out p r o g r e s s iv e ly in c r e a s e d e a ch w e ek w h ile the a v e r a g e h e a r t ra te p la tea u ed and then f e ll slig h tly a fte r the se v en th w eek . The ch an ge in p h y sic a l fit n e s s a s a r e s u lt of train in g a s m e a su red by PW C 85% is sh ow n in F ig u re 4 and T ab le 9. W hile the e x p e r im e n ta l! and c o n tr o ls sta r te d at a p p ro x im a te ly the sa m e le v e l o f o f fitn e s s (785 W a tt-m in and 812 W a tt-m in , r e s p e c tiv e ly ) the 57 l ^ j | |N y M r M = TUN. M l £200 O E A R T R A T E WATTS/VMM (n M b a n ) 1 4 0 0 00 200 -20 C O N O L A IV V E K ol: 231 €33 1M4 M O O 2 1 2 7 2055 3 1 9 2 373142034003 1 2 3 4 5 6 7 8 9 I B WEEKS Fig. 3. The Average Work Load (Watts; solid bar) at Each Workout and the Average Total Work Output (Watt-min. ; total bar) p er Workout for Each Week of the 10 Week Training P eriod and the Average H eart Rate (solid line) for the Workouts for Each Week (Cumulative kilocalories (horizontal axis) of the 10 week training period is based on a m echanical efficiency of approxim ately 23%. ) O l oo 59 1.000 P W C 85% (WATT-MIN) iqq EXPERIMENTAL O CONTROL P R E P O S T PRE P O ST Fig. 4. Change (P<0.001) in P h y s ic a l F itn e s s of Men Aged 57-74 a fte r 10 W eeks of Bicycle E rg o m e try (Standard E r r o r of the m e a n in b r a c k e ts . ) 60 TABLE 9 Pre to 10 Weak Changes in Physical Work Capacity and Anthropometric Values of Normal Elderly Man Exercised Subjects (N-13) Unaxercised Subjects (N-13) Parameter Pra Test Post Test Pra Test Post Test PWC 85%* (Watt-min) 785 1093 812 770 Weight (lbs.) 158.9 158.1 157.4 156.5 Fat (% ) 22.7 21.7 22.0 21.5 Skinfold Sum (mm) 98.4 92.5 93.4 91.1 •Between group difference significant at P < .001 level. 61 e x p e rim en ta l* In c r e a se d by 39 p e r c e n t to 1093 W a tt-m in w h ile the c o n tr o ls d e c r e a s e d by about 2 p e r c e n t to 770 W a tt-m in . The d iff e r en c e in gain* b etw een the two group* w a s h igh ly sig n ific a n t (F <. 001). F ig u re 5 and T ab le 10 show how the two g ro u p s ch an ged in h e a r t ra te a fte r the 10 w e e k s o f e x e r c is e . H eart r a te s of the su b je c ts w e r e co m p a red w hen se a te d on the b ic y c le e r g o m e te r ju s t p r io r to e x e r c is e and at th r e e of the w ork lo a d s w h ich p ro v id ed adequate sa m p le n u m b e r s. The d iffe r e n c e s b etw een grou p s in h e a r t ra te at 50, 75, and 100 W atts w e r e h igh ly sig n ific a n t (P<. 01). The h ea rt rate d e c r e a s e d by 7, 4 , and 10 b e a ts p er m in u te at the r e s p e c tiv e w ork lo a d s. The c o m p a ra tiv e red u ctio n in ra te in the e x p e r im e n ta l* w h ile se a te d on the b ic y c le e r g o m e te r w a s s ig n ific a n t (P<. 05) w ith a d e c r e a s e o f 6 b e a ts p er m in u te in the e x p e r im e n ta l* and an in c r e a s e of 5 b e a ts in the c o n tr o ls . It w a s lik e ly that a train in g e ffe c t had o c c u r r e d b a sed on the red u ced h e a r t ra te at the m o d e ra te w ork lo a d s and the in c r e a s e d am oun t of w ork a ccu m u la ted at 85 p e r c e n t of p r e d ic ted m a x im a l h e a r t ra te by the e x p e r im e n ta l s u b je c ts . The s y s t o lic tim e in te r v a l c o m p o n e n ts, total s y s to le and le ft v e n tr ic u la r e je c tio n tim e u n c o r r e c te d for h e a r t ra te w e r e in c r e a s e d s ig n ific a n tly both in the r e s tin g su p in e p o sitio n and at r e s t w h ile se a te d on the bik e (P<. 05 and <. 01, r e s p e c tiv e ly ). It is sh ow n in F ig u re 6 that to ta l s y s to le (QS^) r e s t in the su pin e p o sitio n H R (B/MIN) EXPERIMENTAL CONTROL • - O.- - - ~o M*t o - - - 1 2 1 - 75W 75W 1MW S E A T E I N EM M ET El S E A T E I M EKM ETEI T IM E (MIN.) Fig. 5. P re -p o s t Mean Differences in H eart Rate at Given Wattage s in the 3 Minute Step Interval Protocol (Experimental group changes w ere significant at P<0. 05 and the difference in changes between groups was significant at all workloads (P<0. 05, P<0, 01). ) 63 TAM.1 10 Ptete 10 Weak Ckanfti in Heart Rate, and Hand Ptatawra X Rett, O w riw f Im tM n, and in W iw iw r Unancrcimd Central O w fcfeete (N-13) tiia rilitt 1iQ |w > i IN-131 10 Week 10 Week M T m 8 0 N T m I riiMiKMi Prt T an ID Pom T an 04 4 8 02 fte-ax mptne H ttn Rata 06 10.7 80 120 10.0 132 S y n d ic SP 131 12.6 127 77 4 8 00 Diaatdic Of 80 6.9 74 73 0.2 07 P rH R Mk* Haart Rata* 74 11.4 08 121 14.2 128 SyMOlk: 0 0 120 1 2 8 119 70 0.9 70 D iandic BP 70 0.9 70 101 1 1 8 07 00 Watt* Haart Rata** 102 148 90 too 18.2 104 Siritolic BP 149 18.1 141 03 0.0 81 DiaMolic BP 70 10.8 71 (N- 110 12) 7.0 107 78 Watt* Haart Rata** (N-10) 108 11.1 (M-12) 102 170 10.0 180 S y n d ic BP** 106 13.7 148 81 10.0 83 D iandic BP 73 9.3 71 1N-0I 121 0.4 120 (N -1 1) 100 Watt* Haart Rata* (N-0) 121 06.1 (N-10) 110 ISO 20.7 ISO (N-10) S y n d ic BP (N-7) 172 13.4 160 83 10.4 83 (N-10) Diattolic BP (N-7) 78 4.3 72 <N « 182 ■ 13) 18.4 181 NakW orfc Load Synolic BP 174 22.9 (N-13) 170 83 1 0 8 04 Diattolic BP 78 11.0 78 80 0.1 80 2 min. Poat h , Haart Rata 83 12.1 79 100 20.7 103 S y n d ic BP 149 13.7 157 73 7 8 77 Diattolic BP 72 7.7 74 78 0.2 70 8 min. R an Ex Haart Rata 76 9 8 71 128 1 0 8 130 S y ttd ic BP 132 13.3 131 72 0.1 70 Diattolic BP 72 7 8 72 72 5 8 73 10 min. Pom In Heart Rata 73 7.9 09 122 1 1 8 124 S y n d ic BP 122 9 8 127 74 0 8 77 Diattolic BP 74 7.0 70 71 0 8 71 18 min. toM l a Heart Rata 71 7.7 07 122 128 124 S yaidieB P 128 12.1 125 77 8.7 78 D ie n d ic OP 78 7 8 77 ' l i m i w pwjp dtfhm w Mgntflcant at IU> I m I ** 0.01 iM tl q s 2 (■tte) EXPERI M ENTAL PIE POST PRE POST R E S T (SUPINE) 4 1 0 4 0 0 390 380- 3 70 3 6 0 □ C O NTRO L PRE POST PRE POST RESTftEATEO O N ERGOMETER) Fig, 6. Change in Total Systole (QS2 ) of Men Aged 57-74 in the Resting Supine Position (P<0.05) and Seated on the Bicycle E rgom eter (P<0. 01) after 10 Weeks of Bicycle E rgom etry (The standard e r r o r of the m ean is within the bracket. ) 65 in c r e a s e d fr o m 4 1 0 to 426 m illis e c o n d s in the e x p e r im e n t a l w h ile it d e c r e a s e d fr o m 4 1 2 to 407 in the c o n tr o ls . The sa m e d ir e c tio n o f ch an ge o c c u r r e d a t the b ic y c le - s e a t e d p o sitio n w ith an in c r e a s e fr o m 381 to 395 m s e c in the e x p e r im e n ta ls and a d e c r e a s e fr o m 390 to 375 m s e c in the c o n tr o ls . F ig u re 7 sh o w s that w h ile the e x p e r im e n ta ls in c r e a s e d fr o m 302 m illis e c o n d s to 313 m illis e c o n d s , the c o n tr o ls d e c r e a s e d fr o m 305 to 297 m illis e c o n d s at the r e stin g su p in e p o sitio n . The L V E T in the e x p e r im e n ta ls in c r e a s e d at the b ic y c le - s e a t e d p o s i tion fr o m 255 to 266 m s e c w h ile the c o n tr o ls d e c r e a s e d fro m 266 to 251 m s e c . A lthough the p r e -e je c tio n p e r io d did not ch an ge s ig n ific a n t ly in e ith e r g ro u p , the ratio P E P /L V E T u n c o r r e c te d for h e a r t ra te w a s red u ced in a r e la tiv e s e n s e in the e x p e r im e n ta l grou p (P<. 05). F ig u re 8 sh o w s that the ch an ge at the r e stin g su p in e p o sitio n w a s a cco u n ted fo r by the in c r e a s e in the c o n tr o l group r a th er than any ch an ge in the e x p e r im e n ta ls . T hus the e x p e r im e n ta ls in c r e a s e d fr o m 0. 361 to 0. 364 w h ile the ra tio in the c o n tr o ls w a s r a is e d fr o m 0. 351 tc 0. 371. T he P E P /L V E T ra tio w h ile se a te d on the b ic y c le w a s red u ced fr o m 0. 494 to 0. 487 in the e x p e r im e n ta ls w h ile that of the c o n tr o ls w a s r a is e d fro m 0 .4 6 8 to 0. 502. N one o f the r e c o v e r y s y s t o lic tim e in te r v a ls , e ith e r u n c o r r e c te d or c o r r e c te d fo r h e a r t r a te , w e r e sig n ific a n tly d iffe r e n t a fter the 10 w e e k tra in in g p e r io d . T he le f t v e n tr ic u la r e je c tio n tim e L V E T (■see) □ EXPEMENTM. 271 CtNTML 2 (1 251 249 239 m m m m r e s t ( s u p in e ) PIE POST PIE POST R E S T (ON E K IM E T E l) Fig. 7. The Change in Left V entricular Ejection Time (LVET) in Men Aged 57- in the Resting Supine Position (P<0. 05) and When Seated on the Bicycle E rgom eter (P<0. 01) after 10 Weeks of Bicycle E rgom etry (The standard e r r o r of the m ean is within the bracket. ) EXPERIM ENTAL CONTROL □ L V E T 5 2 0 5M 400 441 PIE POST PIE POST R E S T (SU PIN E) PIE POST PIE POST R E S T (ON ENOM ETEI) Fig. 8. The Change in Ratio of P re-ejectio n P eriod to Left V entricular Ejection Time (FE P/L V E T ) of Men Aged 57-74 in the Resting Supine Position (P<0. 05) and When Seated on the Bicycle E rgom eter (P<0. 05) after 10 Weeks of Bicycle E rgom etry __________________(The standard e r r o r of the m ean is within the bracket. ) 68 c o r r e c te d fo r h e a r t r a te m e a s u r e d w ith the su b je ct se a te d on the bike show ed a sig n ific a n t ch an ge (P <. 05). The L.VET in c r e a s e d fr o m 381 c to 383 m s e c in the e x p e r im e n t a l w h ile the c o n tr o ls d e c r e a s e d fr o m 381 to 375 m s e c . The la tte r r e s u lt w a s the on ly sig n ific a n t ch an ge in any o f the c o r r e c te d s y s t o lic tim e in te r v a ls a s can b e s e e n in T ab le 11. B oth s y s t o lic and d ia s to lic p r e s s u r e at the r e stin g su p in e and se a ted p o s itio n tended to d e c r e a s e in both g ro u p s a s show n in T ab le 10. B lood p r e s s u r e in the su p in e p o sitio n w a s 1 3 1 /8 0 and 1 3 2 /8 0 in the e x p e r im e n ta l and c o n tr o l grou p , r e s p e c t iv e ly , at the s ta r t o f the p r o gram . B oth g r o u p s, th e r e fo r e , e n ter ed w ith blood p r e s s u r e b elow the a v e ra g e o f 1 4 3 /8 3 fo r a m ea n age o f 66 g iv e n by L a s s e r and M a ster (1959) in th e ir c la s s ic a l stu d y. Thus it w a s p o s sib le that the p a r a m e te r s had l e s s fr e e d o m to m o v e fu rth er tow ard lo w er v a lu e s . A lthough s y s to lic blood p r e s s u r e w a s not s ig n ific a n tly d iffe r e n t fo llo w in g tr a in ing at 50 W atts, 100 W atts, or at the peak w o rk load , n or during r e c o v e r y , s y s t o lic p r e s s u r e w a s sig n ific a n tly red u ced a t 75 W atts From 155 to 146 m m Hg in the e x p e r im e n ta ls com p ared to the in c r e a s e of 165 to 170 m m Hg in the c o n tr o ls (P<. 01). E x cep t fo r the sig n ific a n t ch a n g es in e x e r c is e h e a r t r a te s , th ere w e r e no sig n ific a n t d iffe r e n c e s in ch a n g es in h e a r t rate e ith e r at the r e s tin g su p in e p o s itio n or at any o f the r e c o v e r y tim e s . The a n a ly s is of the a n th ro p o m etr ic d ata a s show n in T ab le 11 69 T A 8L E 11 h h ♦ A l a ( u ^ | U V l ^ u *--■— ^ n a A . " '1 IQ IV M K bM H pi H I V fPM t I M l W lrv fl vOfTMNi T O C n W I M w UnanaralatO Control «uOt»«t» <N-1J» ExarMwU liO |» H (N-13) lOMtaafc lOWaak oat Taat 9 0 h a Taat h ram atar Pra TaM SO P natT a H I 16.6 663 Pra-ax tuplna O S j (m ac) LVET 667 13.1 662 406 16.7 411 412 10.4 416 146 7.6 142 PEP 146 6.6 146 .366 .020 .346 PEP/LVET .362 .018 .364 640 13.1 643 Pra-ax Mfca OS* (maae) LVET* 649 13.8 560 376 10.7 381 381 13.3 363 166 9.6 162 PEP 108 6.6 167 .440 .026 .424 PEP/LVET .440 .026 .430 639 21A 641 2m fn. Pom Ex. QSjImaac) LVET 642 15.7 640 406 16.9 410 411 17.2 406 134 16.6 131 PEP 130 9.2 134 .330 .046 .320 PEP/LVET .317 .031 .330 664 19.3 666 6 mhv Pom Ex. QSj (m ac) LVET 669 12.3 669 410 17.0 414 414 15.4 416 143 7.5 141 PEP 146 10.6 143 .349 .018 .340 PEP/LVET .362 .034 .347 666 17.8 668 10 mfc*. h a t Ex. O S j (m ac) LVET 660 12.6 686 409 17.0 414 412 13.0 416 160 7.0 144 PEP 148 11.9 161 .396 .023 .348 PEP/LVET .361 .035 366 667 16.0 666 16 ntin. Paat Ex. 0 9 * (m ac) LVET 668 9 J 662 404 16.6 407 406 13.4 410 163 7.0 149 PEP 163 9.2 152 .390 0 2 3 .367 PEP/LVET .377 0 3 2 .370 ' l i w w r group dlHiwntt algniftaant at 0 . 0 1 Im I. ^ E X P E R I M E N T A L □ CONTROL 390 - LVET PRE POST PRE POST REST ( SEATED ON ERGOMETER) Fig. 9. The Change in Left V e n tric u la r E jection T im e C o r r e c te d for H eart Elate (L V E T C) of Men Aged 57-74 W hile Seated on the Bicycle E r g o m e te r (P<. 05) a fte r 10 W eeks of Bicycle E rg o m e te ry (The sta n d a rd e r r o r of the m ean (±1) is w ithin the b ra c k e t. ) 71 r e v e a le d no sig n ific a n t d iffe r e n c e s in ch a n g es b etw een the two g r o u p s. Both grou p s ten ded to d e c r e a s e w e ig h t, p e r c e n t fa t, and to ta l s k in - fo ld s , but none w a s sig n ific a n t. The d e c r e a s e in p e r c e n t fat in the ex p e rim en ta l^ r e p r e se n te d 1. 5 pounds w h ich a p p ro x im a ted the c a lo r ic eq u iv a len t of the e x e r c is e p r o g r a m . The a cu te e ffe c t of e x e r c is e on a ll of the su b je c ts is d e p ic ted in the fig u r e s in the A ppendix (Ill-V I). T otal s y s to le (QS^) and le f t v e n tr ic u la r e je c tio n tim e (L V E T ) d e c r e a s e d upon a ch an ge fr o m the su p in e to the se a te d p o sitio n due to the com b in ed e ffe c t of in c r e a s e d h e a r t ra te and d e c r e a s e d str o k e v o lu m e a s p o stu la ted by o th er stu d ie s w ith s im ila r fin d in g s (Raab e t a l. , I960; S tafford e t a l. , 1970; W iley , 1970). Both QS and L V E T p r o g r e s s iv e ly in c r e a s e d tow ard the p r e - C f e x e r c is e r e stin g su p in e le v e l during r e c o v e r y in the su p in e p o sitio n as h e a r t ra te retu rn ed to n o r m a l and the in o tro p ic in flu e n c e of e x e r c is e w a s d im in ish e d . The p r e -e je c tio n p e r io d (P E P ) and P E P /L V E T in c r e a s e d upon a ch an ge fr o m the su pin e to the s e a te d p o sitio n , w h ich w a s in a g r e e m e n t w ith p r e v io u s stu d ie s (Stafford e t a l. , 1970; Raab e t a l. , I960; W iley , 1970) and h a s b e e n p o stu la ted by Stafford and h is c o lle a g u e s a s due to d e c r e a s e d le f t v e n tr ic u la r end d ia s to lic v o lu m e and d e c r e a s e d m y o c a r d ia l fib e r len gth w h ich r e s u lts in a s lo w e r r is e o f iso v o lu m ic p r e s s u r e (1970). The P E P and P E P /L V E T v a lu e s then d e c r e a s e d b elow the p r e - e x e r c is e r e stin g su p in e v a lu e s at the se c o n d m in u te of r e c o v e r y fr o m e x e r c is e p r e su m a b ly due to the r e s id u a l in o tr o p ic in flu e n c e o f e x e r c is e (Raab e t a l. f I9 6 0 ), w ith a g ra d u a l retu rn to the r e stin g v a lu e by the fifte en th m in u te a s the in o tr o p ic e ffe c t d im in ish e d . C H A PT E R V DISCUSSION The a tten d a n ce r e c o r d fo r the 13 e x p e r im e n ta l su b je c ts w a s e x c e lle n t a s a tte s te d by the fo llo w in g fig u r e s : One su b je ct atten d ed 87 p e r c e n t, two su b je c ts atten d ed 97 p e r ce n t and 10 su b je c ts atten ded 100 p e r c e n t o f the r e q u e ste d th r e e s e s s io n s p e r w eek for th e 10 w eek p e r io d . The d e c r e a s e d c a r d ia c s t r e s s in te r m s of lo w e r e d h e a r t ra te a s s o c ia te d w ith a g iv en w ork lo a d c o n fir m e d p r e v io u s fin d in g s of in c r e a s e d p h y sic a l w ork c a p a c ity at a g iv en h e a r t r a te or im p ro v ed c ir c u lo - r e s p ir a t o r y en d u ran ce in o ld er p e r so n s (A dam s e t a l . , 1973; B a r ry e t a l . , 1966; d e V r ie s , 1970; S tam ford , 1972). The data of the p r e s e n t stu d y a ls o su g g e ste d that the m agn itu d e o f the c a p a c ity for train in g w a s n o t g r e a tly d iffe r e n t fro m that o f the y o u n g er in d ivid u al w h en c o m p a re d on a p e r c e n ta g e b a s is (Shephard, 1965). The fin d in g s of the p r e s e n t study ten ded to su p p o rt the v a r io u s stu d ie s w h ich h a v e r e p o r te d a sh ift tow ard g r e a te r v a g a l ton e a fte r tra in in g . The a n tia d r e n e r g ic e ffe c t of train in g w a s m a n ife ste d in the p r e s e n t stu d y by a d e c r e a s e d h e a r t r a te , alon g w ith the in c r e a s e d 73 74 tim e o f to te l s y s t o le and le ft v e n tr ic u la r e je c tio n in the r e stin g p o s i tio n s. T his w a s in d ir e c t a g r e e m e n t w ith the stu d y by W iley (1971) and a p p ea red to a g r e e w ith the study by Raab and h is c o lle a g u e s (19601 C on trary to the la tte r stu d y, h o w ev e r, no train in g change o c c u r r e d in the r e stin g p r e -e j e c t io n p e r io d - -th e com p on en t p r e su m e d to be the m o st s e n s it iv e to a n tia d r e n e r g ic in flu e n c e s . The la ck o f a ch an ge in P E P a g r e e d w ith stu d ie s by F ard y (1967, 1973), D u T oit (1966), and C undiff (1966) on y o u n g er p e r s o n s . The p r e s e n t data did not su p p ort the r e c e n t study by T erju ng and h is c o -w o r k e r s (1973) who found a d e c r e a s e of both P E P and LV E T (c o r r e c te d and u n c o r r e c te d fo r h e a r t r a te ) in the su p in e p o s itio n a fte r train in g in te rv e n tio n . The s ig n ific a n tly lo n g e r L V E T a fte r train in g in the e x p e r i m en ta l group in the b ik e -s e a te d p o sitio n o b se r v e d in the p r e s e n t stu dy w a s not lik e ly to be a ttrib u ted s o le ly to the d e c r e a s e d h e a r t r a te , s in c e the L V E T com p on en t w hen c o r r e c te d for h e a r t rate s t i l l sh ow ed a sig n ific a n t in c r e a s e a s a r e s u lt of tra in in g . The in c r e a s e d L V ET in both r e s tin g p o s itio n s in the tra in ed m en su g g e ste d that an in c r e a s e d str o k e v o lu m e w a s the m e c h a n ism r e sp o n s ib le fo r su ch an in c r e a s e s in c e L V E T and str o k e v o lu m e have b een show n to be d ir e c tly r e la te d (B raunw ald e t a l. , 1958). A lthough v a r io u s stu d ie s h ave rep o rted tra in in g c h a n g e s in the v a r io u s s y s t o lic tim e in te r v a ls during r e c o v e r y fro m e x e r c is e , 75 n a m e ly in c r e a s e d tim e co m p o n en ts w ith co n co m ita n t d e c r e a s e d h e a r t r a te , the p r e se n t stu d y fa ile d to sh ow any s ig n ific a n t c h a n g e s. The d iffe r e n t r e s u lts m a y be attrib u ted p a r tly , a t le a s t , to the fa c t that the fo r m e r stu d ie s u tiliz e d a fix ed e x e r c is e w ork lo a d in te stin g and did not c o r r e c t for h e a r t ra te (F a rd y , 1967, 1963; D u T oit, 1966; F ra n k s, 1967). T h e r e fo r e the b ra d y ca rd ia e ffe c t of train in g r e su lte d in lo w e r p eak e x e r c is e h e a r t r a te s and c o r r e sp o n d in g ly lo w e r r e c o v e r y h ea rt r a te s , w h ich lik e ly co n trib u ted to the in c r e a s e d s y s t o lic tim e in t e r v a ls in the fo r m e r s tu d ie s . The p r e s e n t stu d y , h o w e v e r , u tiliz e d a fix e d h e a r t r a te (85% o f a g e p r e d ic te d m a x im a l h e a r t ra te) w h ich d ic ta te d that both p r e -tr a in in g and p o s t-tr a in in g e x e r c is e b ou ts r e m a in e d at the s a m e le v e l of c a r d io v a sc u la r s t r e s s d e sp ite the in c r e a s e d w ork output at th is le v e l in the tr a in ed grou p . It w a s o f in te r e s t to c o m p a re the p r e s e n t data w ith th o se o f Shaw and h is c o lle a g u e s (1973) fo r the sa m e a g e grou p . The 38 s u b j e c t s aged 60 to 69 o f the la tte r stu d y w e r e p r a c tic a lly id e n tic a l to the su b je c ts fr o m the p r e s e n t stu d y w hen c o r r e c te d for h e a r t r a te . N e ith er to ta l s y s t o le , p r e -e je c tio n p e r io d , nor le ft v e n tr ic u la r e j e c tion tim e d iffe r e d by m o r e than one m illis e c o n d , w h ile P E P /L V E T w a s v ir tu a lly the s a m e . The c o r r e c te d v a lu e s and the sta n d a rd e r r o r of the m e a n s fo r th e s e co m p o n en ts in the e a r lie r stu d y by Shaw and h is c o lle a g u e s and the p r e s e n t stu d y , r e s p e c tiv e ly , w e r e : QS^i 555±3 and 556*3; P E P : 143*2 and 144*1; L V E T : 411 * 2 and 412*2; P E P / L V E T : . 347 and . 349. Thua the data In the p r e a e n t atudy a p p ea red to a g r e e c lo a e ly w ith th o ee of Shaw e t a l. (1973). CH APTER VI SUM M ARY AND CONCLUSIONS S u m m ary The p u r p o se of the p r e se n t stu d y w a s to in v e stig a te the e ffe c t o f e x e r c is e train in g on le ft v e n tr ic u la r fun ction in e ld e r ly m en a s m e a s u r e d by n o n -in v a s iv e s y s t o lic tim e in te r v a ls . A lthough p r e v io u s in v e s tig a to r s h ave ex a m in ed the e ffe c ts of train in g on young and m id d le -a g e d p e r s o n s , none h a s d e a lt w ith the o ld e r p e r so n . N or h ave any stu d ie s c o n c e n tr a te d on the a c u te e ffe c t o f e x e r c is e on the s y s to lic tim e in te r v a ls in su b je c ts ov er 60 y e a r s o f a g e . A lso , v e r y few tra in in g stu d ie s h ave c o n sid e r e d the ch an ge in s y s t o lic tim e c o m p o n en ts c o r r e c te d fo r h e a r t r a te . In th is in v e stig a tio n the tim e fo r to ta l s y s t o le (QS^), le ft v e n tr ic u la r e je c tio n tim e (L V E T ), and p r e -e je c tio n p e r io d (P E P ) w e r e c a lc u la te d a c co r d in g to stan d ard g ra p h ic m eth o d s. The STI m e a s u r e m en ts w e r e taken on the su b je c t in the su p in e and se a te d p o s itio n p r e ced in g e x e r c is e e r g o m e tr y and in the su p in e p o sitio n at 2, 5, 10, and 15 m in u te s p o s t - e x e r c is e . The 26 n o r m a l m a le su b je c ts w e r e m atch ec 77 78 a c co rd in g to P E P /L V E T and th en the p a ir e d m e m b e r s w e r e ran d om ly ■ e le c te d fo r e x p e r im e n ta l o r c o n tr o l grou p . The 13 e x p e r im e n ta l su b je c ts ran ged in a g e fr o m 57 to 74 w ith a m ea n a g e o f 66. 3 w h ile the 13 c o n tr o ls ran ged in a g e fr o m 57 to 73 w ith a m ea n a g e of 6 6 . 6 y e a r s . The e x e r c is e p r o g r a m c o n s is te d o f 30 m in u te s of b ic y c le e r g o m e tr y th ree tim e s p e r w e e k for 10 w e e k s . E x e r c is e w a s p r e c e d e d by a 5 m in u te b a llis t ic str e tc h in g p e r io d and fo llo w ed by a 5 m in u te sta tic str e tc h in g p e r io d . B oth g ro u p s w e r e p r e te s te d a s to p h y sic a l fitn e s s and s y s t o lic tim e in te r v a ls and then r e te s te d at the end of the 10 w eek e x p e r im e n ta l or c o n tr o l p e r io d . The r e s u lts o f the stu d y sh ow ed sig n ific a n t im p r o v e m e n t in p h y sic a l f it n e s s due to tra in in g a s m e a su r e d by w ork a c c o m p lish e d to 85 p e r c e n t o f a g e p r e d ic te d m a x im a l h e a r t ra te {PWC 85%). In the r e stin g p o s itio n th e tra in ed grou p a ls o s ig n ific a n tly in c r e a s e d to ta l s y s to le and le f t v e n tr ic u la r e je c tio n tim e u n c o r r e c te d fo r h e a r t r a te , w h ile the r a tio of P E P to L V E T d e c r e a s e d . O nly one h e a r t ra te c o r r ec te d com p on en t sh ow ed any sig n ific a n t c h a n g e --in c r e a s e d le ft v e n tr ic u la r e je c tio n tim e o f the tra in ed grou p w h ile at r e s t in the se a te d p o s itio n . N one of the s y s t o lic tim e in te r v a ls , e ith e r c o r r e c te d or u n c o r r e c te d , during r e c o v e r y fr o m a cu te e x e r c is e sh ow ed any sig n ific a n t c h a n g e s due to en d u ran ce tra in in g . 79 C o n clu sio n s The finding* su g g e s te d that under the e x p e r im e n ta l con d ition * of thi* in v e stig a tio n : 1. O lder p e r so n s w e r e cap ab le of im p rovin g th e ir p h y sic a l w ork c a p a c ity . 2 . The ch an ge in le ft v e n tr ic u la r fu n ction a s a r e s u lt of train in g w a s s im ila r to y o u n g er a g e g r o u p s. 3. The b ra d y ca rd ia e ffe c t of train in g w a s la r g e ly r e sp o n s ib le for the o b se r v e d in c r e a s e of to ta l s y s to le and le ft v e n tr ic u la r e je c tio n tim e u n c o r r e c te d for h ea rt r a te . 4. In c r e a se d str o k e v o lu m e , ind uced by in c r e a se d m y o c a r d ial c o n tr a c tility a n d /o r en h an ced v en o u s retu r n , m ay h ave b een se c o n d a r ily r e s p o n s ib le for the in c r e a s e in le ft v e n tr ic u la r e je c tio n tim e in the tra in ed grou p a s ded u ced fr o m the p r e v io u sly d ir e c t r e la tio n sh ip b etw een str o k e v o lu m e and L V E T for a g iv en h e a r t r a te (B raunw ald e t a l. , 1958). F u tu re R e se a r c h The m eth o d o lo g y u se d in th is stu d y w a s found to be a u se fu l to o l fo r m e a su r in g the d y n a m ic s of le ft v e n tr ic u la r fu n ction in o ld er p e r so n * . The b io lo g ic a l v a r ia b ility o f s y s t o lic tim e in te r v a l* w ith in in d iv id u a ls, h o w ev e r, d ic ta te s that e x tr e m e c a r e for a c h ie v in g 80 id e n tic a l e n v ir o n m e n ta l, p s y c h o lo g ic a l, and p o stu r a l s e ttin g s be m ad e w h en ev e r s e r ia l te stin g is e m p lo y ed . The n o n -in v a siv e s y s to lic tim e in te r v a l m eth o d o lo g y is r e c o m m e n d e d fo r fu rth er u s e in both the r e s e a r c h and the c lin ic a l se ttin g fo r a n a ly s is of le ft v e n tr ic u la r fu n ction . R e se a r c h m ay p o s s ib ly im p r o v e the m eth od by a tten tio n to the fo llo w in g th r e e a r e a s : 1. B e tte r d e lin e a tio n o f the ste e p r is e of the c a r o tid p u lse tr a c in g , p erh a p s b y u s e of an oth er ch an n el tr a n sc r ib in g the p u lse w ave d e r iv a tiv e (d p /d t). 2 . Im p ro v em en t in the a b ility to r e c o r d a r tifa c t- fr e e ca ro tid p u lse tr a c in g s and phono c a r d io g r a m s during e x e r c is e , m a in ly by b u ilt-in f ilt e r s in the tr a n sd u c e r s ra th er than in ch a n g es m ad e to ;'quiet" the e x e r c is e d e v ic e . 3. Im p ro v em en t in the a b ility to te le m e te r the h ea rt sou nd s and p u lse tra cin g w ith o u t undue a r tifa c t. f a r t h e r r e s e a r c h is n eed ed to: 1. E lu cid a te p o s s ib le c h a n g e s in s y s to lic tim e in te r v a ls o f a b n o rm a ls a s a r e s u lt o f e x e r c is e therap y. 2. D e te r m in e p o s s ib le d iffe r e n c e s in s y s to lic tim e in te r v a ls b etw een n o r m a l o ld e r m en and w om en . 3. E x a m in e the e ffe c ts o f e x e r c is e train in g on s y s t o lic tim e in te r v a ls in o ld er w o m en . 4. E xam in e the a c u te e ffe c ts o f is o m e tr ic m u s c le c o n tr a c tio n du rin g b reath h old in g (V a lsa lv a ) on the s y s t o lic tim e In te r v a ls in n o r m a ls and a b n o r m a ls. 5. E xam in e the r e la tio n sh ip b etw een s y s to lic tim e in te r v a ls and r e la x a tio n a b ility (as m e a su r e d by e le c tr o m y o g r a p h y ) under o p tim a l r ela x in g co n d itio n s and v a r io u s s t r e s s co n d itio n s. 6 . D e te r m in e b e s t e x e r c is e p r e s c r ip tio n s (typ e, in te n sity , d u ra tio n , and freq u en cy of e x e r c is e ) for e lic itin g the m o s t fa v o ra b le s y s t o lic tim e in te r v a l c h a n g e s. B I B L I O G R A P H Y 82 BIBLIO G RAPH Y A d a m s, G ene M. & d e V r ie s , H erb ert A. P h y s io lo g ic a l e ffe c ts o f an e x e r c is e tra in in g r e g im e n upon w o m en aged 5 2 -7 9 , J ou rn al o f G e r o n to lo g y , 1973, 28 (1 ), 5 0 -5 5 . A d am s, G ene M. The r e lia b ility of s y s to lic tim e in te r v a ls b e fo r e and a fte r e x e r c is e . U n p u blished pap er p r e p a r e d fo r P h y s ic a l E d u cation 790 at the U n iv e r sity of S ou thern C a lifo r n ia , 1972. A hm ed, S. S . , L e v in so n , G. E, , S ch w a rtz, C. J . , e t a l. C o m p a r i so n o f s y s t o lic tim e in te r v a ls (ST1) w ith d ir e c t m e a s u r e s o f m y o c a r d ia l c o n tr a c tility in m an. C lin ic a l R e s e a r c h , 1970, 18, 294. (A b stra ct) A ronow , W. S. Iso v o lu m ic c o n tr a c tio n and le ft v e n tr ic u la r e je c tio n tim e s - -e x te r n a l m e a s u r e m e n ts at r e s t and a fte r e x e r c is e in n o r m a l m en . A m e r ic a n Jou rn al o f C a r d io lo g y , 1970, 26, 2 3 8 -2 4 0 . A ronow , W ilb ert S. , B o w y e r, A llen F . , & K aplan, M arvin A. Ex ter - n al is o v o lu m ic c o n tra c tio n tim e s and le f t v e n tr ic u la r e je c tio n tim e /e x te r n a l is o v o lu m ic c o n tr a c tio n tim e r a tio s a t r e s t and a fte r e x e r c is e in c o ro n a ry h e a r t d is e a s e . C ir c u la tio n , 1971, 4 3 , 5 9 -6 5 . B a n n iste r , E. W. , C u reton , T. K. , A bbott, B. C. , fc P o lla r d , J. W. A c o m p a r a tiv e study o f the b r a c h ia l p u ls e w ave and its tim e d e r iv a tiv e s am ong a th le tic , n o r m a l, and p a th o lo g ic a l su b je c ts . Jou rn al o f S p o rts M ed icin e and P h y s ic a l F it n e s s , 1966, 6_(2), 9 2 -9 9 . B a r r y , A lan J. , D a ly , J. W. , P r u e tt, E . D. R. , S te in m e tz , J. R. , P a g e , H. F . , B irk h ea d , N . C. , fc R od ahl, K. The e ffe c ts of p h y sic a l con d ition in g in o ld e r in d iv id u a ls. J ou rn al of G e r o n to lo g y , 1966, 21, 1 8 2 -1 9 1 . 83 84 B e ck , W. , It S c h r ir e , V. An a ttem p t at the a s s e s s m e n t of m y o c a r * d ia l c o n tr a c tility fro m p h o n o c a rd io g ra p h ica lly m ea a u re d tim e com p on en ta of v e n tr ic u la r c o n tr a c t aa a ca u a e o f d im in ia h ed v e lo c ity o f c o n tra c tio n . C ir c u la tio n , 1968, 38, 4 8 9 -5 0 4 . B e n c h im o l, A lb e r to , D im ond, G rey E . , It Shen, Y en. E je ctio n tim e in a o r tic aten oaia and m itr a l a te n o sia . The A m e r ic a n Jou rn al o f C a r d io lo g y , I9 6 0 , 5, 7 2 8 -7 4 3 . B en eatad , A rne M. T r a in a b ility of old m en . A cta M ed ica S c a n d in a v ic a , 1965, 178, 3 2 1 -3 2 7 . B e v eg a r d , S. , H o lm g ren , A. , & Jon aaon , B. C ir c u la to r y atudiea in w e ll-tr a in e d a th le tea at r e a t and during h e a v y e x e r c ia e , w ith a p e c ia l r e fe r e n c e to atrok e v o lu m e and the in flu en ce of body p o a itio n . A cta P h y a io lo g ic a S ca n d in a v ia , 1963, 57. 2 6 -5 0 . B lack b u rn , H en ry, T a y lo r , H enry L. , V aaq u ez, C. L u ia, it F u c h n er , Thom aa C. The e le c tr o c a r d io g r a m during e x e r c ia e . C ir c u la tio n , 1966, 34, 1 0 3 4 -1 0 4 3 . B o y e r , John L. , It K aach, F red W. E x e r c ia e th erap y in h y p er te n - a iv e m en . Jou rn al of A m e r ic a n M ed ica l A a a o cia tio n , 1970, 211 . 1668. B o y e r , John M. E ffe c ts of ch r o n ic e x e r c ia e on c a r d io v a s c u la r fu n c tion , P h y s ic a l F itn e s s R e se a r c h D ig e s t, 1972, 2J3), 1 -6 . B rau n w ald , E. , M o sc o v itz , H. L-,, A m ra m , S. S, e t a l. T im in g of e le c t r ic a l and m e c h a n ic a l e v e n ts o f the le ft aid e o f the hum an h e a r t. Jou rn al o f A pplied P h y s io lo g y , 1955, 8, 3 0 9 -3 1 4 . B rau n w ald , E . , S arn off, C. J. It Stain a by, W. N. D e ter m in a n ts o f d u ra tio n and m ea n r a te o f v e n tr ic u la r e je c tio n . C ir cu la tio n R e s e a r c h , 1958, 6 , 3 1 9 -3 2 5 . B r o d e r , G eo r g e, It A m b e, K ish o re S. E x e r c ia e r e c o v e r y s y s t o lic tim e in te r v a l tea t fo r c o r o n a r y a r te r y d is e a s e . C lin ic a l R e s e a r c h , 1972, 2 0 (3 ), 365. B r o z e k , J o a e f, It K e y s, A n ce l. The ev a lu a tio n o f le a n n e s s - f a t n e s s in m an : N orm a and in te r r e la tio n s h ip s . B r itis h Jou rn al o f N u tritio n . 1951, 5, 1 9 4 -2 0 6 . 85 B u yuk ozturk, K em a lettin , K im b ir is, D e m e tr io s , k S e g a l, B ern a rd L. S y s to lic tim e in te r v a ls : R ela tio n to s e v e r ity o f c o ro n a ry a r te ry d is e a s e , in te r c o r o n a r y c o lla te r a liz a tio n and le ft v e n tr ic u la r d y s k in e sia . C ir cu la tio n , 1971, 28, 1 8 3 -1 9 0 . C la rk e, H a r r iso n , F o x , S am u el M. , k B o y e r , John L . P h y s ic a l a c tiv ity and c o r o n a r y h e a r t d is e a s e . P h y s ic a l F itn e s s R e s e a r c h D ig e s t, 1972, 2 (2), n. p. C o m m issio n fo r H eart D is e a s e R e s o u r c e s . P r im a r y p r e v e n tio n of the a th e r o s c le r o tic d is e a s e s . C ir cu la tio n , 1970, 4 2 , 5 5 -9 5 . C um m ing, G. R. , k E d w a rd s, A. H. In d ir e c t m e a s u r e m e n t of le ft v e n tr ic u la r fu n ction du rin g e x e r c is e . C anadian M ed ica l A s so c ia tio n J o u r n a l, 1963, 2 1 9 -2 2 1 . C undiff, D. E . T rain in g ch a n g es in the sym p ath o -a d r e n a l s y s te m d e te r m in e d by c a r d ia c c y c le h em o d y n a m ic o x y g en intak e and e o sin o p e n ia . U npublished d o c to r a l d is s e r ta tio n . U n iv e r sity of I llin o is , 1966. C u reton , T h om as K. In terp reta tio n of the oxygen intak e t e s t--w h a t is it? A m e rica n C o r r e c tiv e T herapy J o u rn a l, 1973, 27 (1 ), 1 7 -2 3 . C u reton , T h om as K. The p h y s io lo g ic a l e ffe c ts of e x e r c is e p r o g r a m s on a d u lts. S p r in g fie ld , 111. : C h a rle s C. T h o m a s, 1969. D eck m an , C h a r le s, B a r r y , A lan, K e lly , John, k D a ly , J a m e s . E ffe c ts o f a g e , tra in in g and h e a r t d is e a s e on s y s t o lic tim e in te r v a ls . M ed icin e and S c ie n c e o f S p o r ts, 1972, 4{1), 56. (A b stra ct) d e V r ie s , H. A. Q u an titative e le c tr o m y o g r a p h ic in v e stig a tio n of the sp a sm th eo ry o f m u s c le p ain . A m e rica n J o u rn a l o f P h y s ic a l M e d ic in e . 1966, 45, 1 1 9 -1 3 4 . . P h y s io lo g ic a l e ffe c ts of an e x e r c is e tra in in g r e g im e n upon m en a g ed 5 2 -8 8 . J ou rn al of G ero n to lo g y , 1970, 25(4), 3 2 5 -3 3 6 . __________ . E x e r c is e in te n sity th r esh o ld fo r im p r o v e m e n t of c a r d io v a s c u la r - r e s p ir a to r y fu n ction in o ld e r m en . G e r ia tr ic s . 1971, 2 6 , 9 4 -1 0 1 . 86 D urnin, J. V. G. A. , it R aham an, M. M. The k a ie a a m e n t o f the am ou n t of fa t in the hum an body fr o m m ea a u re m en ta o f a k in - fo ld th ic k n e s s . B r itia h J ou rn al of N u tritio n , 1967, 21, 6 8 1 -6 8 9 . Du T o it, Stephanua F . Running and w e ig h t train in g e ffe c ts upon the c a r d ia c c y c le . U npubliahed d o c to r a l d ia a e r ta tio n , U n iv era ity o f Illin o ia , 1966. E k b lom , B . , A atran d , P . O. , Sal tin , B. , S ten b erg , J. , it W a ll- a tro m , B. E ffec t o f train in g on c ir c u la to r y reap on ae to e x e r c ia e . Jou rn al o f A pplied P h y a io lo g y , 1968, 2 4 . 518. F a rd y , P au l S. The in flu en ce of p h y sic a l a c tiv ity on a e le c te d c a r d ia c c y c le tim e com p on en ta. Jo u rn a l o f S p orts M ed icin e and P h y s ic a l F it n e s s , 1971, 2 2 7 -2 3 3 . __________ , The e ffe c ts of s o c c e r train in g and d etra in in g upon a e le c te d c a r d ia c and m eta b o lic m e a s u r e s . U n published d o c to r a l d is s e r ta tio n , U n iv e r sity o f I llin o is , 1967. __________ . L eft v e n tr ic le tim e com p on en t changea in m id d le -a g e d m en fo llo w in g a tw e lv e w e e k p h y sic a l train in g in te rv e n tio n p r o g r a m . Jou rn al of S p o rts M ed icin e and P h y s ic a l F it n e s s , 1973, in p r e s s . F o x , S am u el M. , N aughton, J. P . , It H a sk e ll, W illia m L. P h y s ic a l a c tiv ity and the p r e v en tio n of c o r o n a r y h e a r t d is e a s e . A nnals o f C lin ica l R e a e a r c h , 1971, 3, 4 0 4 -4 3 2 . F ran k , M. N. It K inlaw , W. B. In d ir e c t m e a su r e m e n t of iso v o lu ^ m e tr ic c o n tr a c tio n tim e and te n sio n p e r io d in n o r m a l su b je c ts . A m e rica n J o u rn a l o f C a r d io lo g y , 1962, 10, 8 0 0 -8 0 6 . F ran k , C h a r le s W ., W ein blatt, E. , S h ap iro, S. It S a g e r , R. V. P h y s ic a l in a c tiv ity a s a le th a l fa c to r in m y o c a r d ia l in fa r c tio n am ong m en . C ir c u la tio n , 1966, 34, 1 0 2 2 -1 0 3 3 . F ra n k s, Don B. E ffecta o f tra in in g on s e le c te d c a r d io v a s c u la r p a r a m e te r s . O AH PER J o u r n a l, C onven tion I s s u e , 1968, 1 3 -1 4 . F r a n k s, B. D. E ffe c ts of tra in in g on c a r d ia c in te r v a ls and o th e r f i t n e s s m e a s u r e s . U n published d o c to r a l d is s e r ta tio n , U n iv e r sity o f I llin o is , 1967. 87 F r a n k s, B. D. , b C u reton , T. K. E ffe c ts o f train in g on tim e com p o - n en ts o f the le f t v e n tr ic le . 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A. , b C an tw ell, J. The r e s p o n s e o f s y s t o lic tim e in t e r v a ls fo llo w in g e x e r c is e in p a tie n ts w ith c o ro n a ry a t h e r o s c le r o tic h e a r t d is e a s e . M ed icin e and S c ie n c e in S p o r ts, 1972, 4 (1 ), 56. (A b stra ct) G lick , G. , S on n en b lick , E . H ., b B rau n w ald , E. M y o ca rd ia l f o r c e - v e lo c ity r e la tio n s stu d ied in Intact u n a n e sth e tise d m en . Jou rn al C lin ic a l In v e stig a tio n , 1965, 4 4 . 9 7 8 -9 8 8 . G o ld ste in , 1. M. , e t a l. In flu en ces o f e x e r c is e and au to n o m ic tone on the d u ra tio n of le ft v e n tr ic u la r is o m e tr ic c o n tr a c tio n . C ir c u la tio n , 1961, 2 4 , 942. (A b stra ct) G u ilford , J . P . F u n d am en tal s t a t is t ic s in p sy ch o lo g y and e d u c a tio n . (4th ed. ) N ew Y ork: M cG ra w -H ill, 1965. * H anson, J. S. , T ab akin, B. S . , L e v y , A. M. e t a l. L o n g term p h y sic a l tra in in g and c a r d io v a s u la r d y n a m ics in m id d le -a g e d m a n . C ir c u la tio n , 1968, 38, 7 8 3 -7 9 9 . H a r r is , W. S. , S c h o e n fie ld , C. D. , b W e is s le r , A. M. E ffe c ts of a d r e n e r g ic r e c e p to r a c tiv a tio n and b lo ck a g e on the s y s t o lic p r e in je c tio n p e r io d , h e a r t r a te , and a r te r ia l p r e s s u r e in m an. 88 Jou rn al C lin ic a l In v e stig a tio n , 1967, 4 6 , 1 7 0 4 -1 7 1 4 . H a r r is , W. S. , W e is s le r , A. M. , It B r o o k s, P . H. V agal in flu e n c e on le ft v e n tr ic u la r c o n tr a c tio n in m an : A c a u se fo r p r o lo n g a tio n of the p r e -in je c tio n p e r io d . C lin ic a l R e s e a r c h , 1966, 14. 4 2 6 . (A b stra ct) H a r r iso n , T. R. , D ixon , K. , R u s s e ll, R. O. , B ib w ai, P . S. , b C o lem a n , H. N e a l. The r e la tio n of a g e to the d u ration o f c o n tr a c tio n , e je c tio n , and r e la x a tio n o f the n o rm a l hum an h e a r t. A m e r ic a n H ea rt J o u rn a l, 1964, 6 7 . 1 8 9 -1 9 9 . H e ik k ila , Juh ani, L u o m a n m ik i, K im m o, , b P y o r a la , K a lev i. S e r ia l o b s e r v a tio n s on le ft v e n tr ic u la r d ysfu n ction in a c u te m y o c a r d ia l in fa r ctio n : 11 s y s t o lic tim e in te r v a ls in p ow er fa ilu r e . C ir c u la tio n , 1971, 4 4 . 3 4 3 -3 5 4 . H ym an, A. S. The Q - fir s t h e a r t sound in te r v a l in a th le te s at r e s t and a fte r e x e r c ia e . Jou rn al S p o rts M ed icin e and P h y sic a l F itn e s s , 1964, 4 , 199-203” J e z e k , V. C lin ic a l v a lu e o f the p o ly g ra p h ic tra cin g in the stu d y of the se q u e n c e of e v e n ts during c a r d ia c c o n tr a c tio n . C a r d io lo g ia , 1963, 4 3 , 2 9 8 -3 1 6 . Jok l, E r n st. E ffe c t o f sp o r ts and a th le tic s on the c a r d io v a s c u la r s y s te m . In A. A . L u isa d a , C a rd io lo g y . New York: M cG raw - H ill, 1959. J o n e s, W. B . , b F o s te r , G. L. D eterm in a n ts o f d u ration of le ft v e n tr ic u la r e je c tio n tim e in n o r m a l young m en . Jou rn al o f A p p lied P h y s io lo g y , 1964, 19, 2 7 9 -2 8 3 . J u liu s , S te v o , A m e ry , A ntdon, W h itlock , L eig h S . , b C onw ay, J a m e s . In flu en ce o f a g e on the h em o d y n a m ic r e s p o n s e to e x e r c is e . C ir c u la tio n , 1967, 36. 2 2 2 -2 3 0 . K atz, L. N. , b F e il, H. S. C lin c ia l o b s e r v a tio n s on the d y n a m ics o f v e n tr ic u la r s y s t o le : 1. a u r ic u la r fib r illa tio n . A r c h iv e s o f In tern a l M ed ic in e, 1923, 32, 6 7 2 . L a s s e r , R ich ard P . , b M a ste r , A rthur M. O b serv a tio n o f fre q u en cy d istr ib u tio n c u r v e s of blood p r e s s u r e in p e r so n s a g ed 2 0 -1 0 6 y e a r s . G e r ia t r ic s , 1959, 14, 3 4 5 -3 6 0 . 89 L e v in e , H. J. , N e ill, W. A. , W eg m e n , R. J. e t a l. The e ffe c t of e x e r c is e on m ea n le ft v e n tr ic u la r e je c tio n r a te in m an. Jou rn al of C lin ic a l In v e stig a tio n , 1962, 4 1 , 1 0 5 0 -1 0 5 8 . L om b ard , W. P . , fit C ope, O. M. The d u ration of the s y s to le of the le ft v e n tr ic le of m an . A m e rica n Jou rn al of P h y sio lo g y , 1926, 7 7 , 263. ___________ S ex d iffe r e n c e s in h e a r t a ctio n ; d u ration o f s y s to le . A m e r ic a n Jou rn al of P h y s io lo g y , 1927, 83, 3 7 -4 2 . L u isa d a , A ldo A. , fit Z a lte r , Rudolph. P h o n o ca rd io g ra p h y . In A m e r ic a n C o lle g e o f C h est P h y s ic ia n s , C lin ic a l C a rd io p u l m o n a r y . N ew Y ork: G rune It S tra tto n , I9 6 0 . L u isa d a , A ldo A. , fit M ac Cannon, D onald M. The p h a se s o f the c a r d ia c c y c le . A m e r ic a n H eart J o u r n a l, 1972, 83<5), 7 0 5 -7 1 1 . M a r g o lis, C. S ig n ific a n c e of e je c tio n p e r io d /te n s io n p e r io d a s a fa c to r in the a s s e s s m e n t o f c a r d ia c fu n ction and a s a p o s s ib le d ia g n o stic to o l fo r the u n co v erin g of s ile n t c o r o n a r y h ea rt d is e a s e : Study o f 111 c a s e s . D is C h est, 1964, 4 6 /6 ), 7 0 6 -7 1 3 . M artin , E. C. , S h a v er, J a m e s A. , T h om p son , M ark E, , R eddy, P . Sudhakar, & L eon ard , J a m e s J. D ir e c t c o r r e la tio n o f e x te r n a l s y s t o lic tim e in te r v a ls w ith in te rn a l in d ic e s of le ft v e n tr ic u la r fu n ction in m an . C ir c u la tio n , 1971, 4 4 , 4 1 9 -4 3 1 . M e tz g e r , C. C. , C hough, C. B . , K r o e tz , F. W ., fit L eo n a rd , J a m es J, T ru e is o v o lu m ic c o n tr a c tio n tim e and its c o r r e la tio n w ith e a s ily m e a s u r e d e x te r n a l in d ic e s of v e n tr ic u la r c o n tr a c tility . C ir c u la tio n , 1967, 35 (su p p lem en t 2 ), 1 -1 8 7 . __________ . T rue Iso v o lu m ic c o n tr a c tio n tim e; Its c o r r e la tio n w ith tw o e x te r n a l in d e x e s o f v e n tr ic u la r p e r fo r m a n c e . A m e rica n Jou rn al of C a r d io lo g y , 1969, 24, 4 3 4 . M oln ar, San d or, F r a n k s, B. D on, J e tte , M a u r ic e, fit C u reton , T. K. C ard iac tim e co m p o n en ts o f b o y s 7 -1 4 y e a r s o f a g e . M ed icin e and S c ie n c e in S p o r ts, 1971, 3_(1), 1 2 -1 7 . M oln ar, San d or, W ile y , Jack F . , fit C reton , T h om as K. P r e d ic tio n o f en d u ran ce p e r fo r m a n c e and oxygen co n su m p tio n fro m 90 c a r d ia c tim e co m p o n en ts. R e se a r c h Q u a r ter ly , 1973, 4 4 (3 ), 2 7 8 -2 8 9 . M on toye, H en ry J . , W illis , P a rk W ., III, k H ow ard, G ordon E . C ard iac is o m e tr ic p e r io d : R ela tio n to a g e , s e x , d a ily p h y sic a l a c tiv ity and r isk fa c to r s a s s o c ia te d w ith c o ro n a ry h e a r t d is e a s e . N e w s le tte r , 1967, 2_(2), 5. M on toye, H en ry J. , W illis , P a rk W. , 111, K e lle r , Jacob B . , k M etzn er , H elen L . S y s to lic p r e e je c tio n p erio d : R ela tio n to h ab itu al p h y sic a l a c tiv ity . M ed icin e and S c ie n c e in S p o r ts, 1972, 4 (2 ), 7 7 -8 4 . M o sk o w itz, R ob ert. L eft v e n tr ic u la r e je c tio n tim e in a o r tic and m itr a l v a lv e d is e a s e . A m e r ic a n Jou rn al of C a rd io lo g y , 1965, 15, 809. N aughton, John, k L ea ch , W illia m . The e ffe c t of a sim u la te d w a r m up on v e n tr ic u la r p e r fo r m a n c e M ed icin e and S c ie n c e in S p o r ts, 1971, 3_{4), 1 6 9 -1 7 1 . N a z a ro v , 1. L. , k M u siich u k , Y. I. In flu en ce o f body p o sitio n on p h a se s of c a r d ia c c y c le in h ealth y su b je c ts . T e r a p e v ic h e s k ii A rk h iv , 1965, 37, 106. O llen d o rff, F . , V a sh , R. , k V a le r o , A. E ffe c t o f e x e r c is e and a c c lim a tiz a tio n on d is p la c e m e n t ap ex c a r d io g r a m in n o rm a l young s u b je c ts . B r itis h H eart J o u r n a l, 1971, 33, 3 7 -4 5 . P a r m le y , L. F. , Jr. , B la ir , S. , G a z e s, P . C. G ie s e , W. K. , S u m m er a ll, C. P . , k S a u n d ers, D. E. (E d s. ) P r o c e e d in g s o f the n a tio n a l w o rk sh o p on e x e r c is e in the p r e v e n tio n , in the e v a lu a tio n , in the tr e a tm e n t of h e a r t d is e a s e . 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A d r e n e r g ic and c h o lin e r g in in flu e n c e s on the d yn am ic c y c le o f the n o r m a l hum an h e a r t. C a r d io lo g la , 1958, 33, 3 5 0 -3 6 4 . R aab, W ., de P au la E S ilv a , P . , M a rch et, H. , K im u ra, E . , k S ta r c h e sk a , Y. K. C ard iac a d r e n e r g ic p rep o n d era n ce due to la c k of p h y sic a l e x e r c is e and its p ath ogen ic im p lic a tio n s. A m e r ic a n Jou rn al o f C a rd io lo g y , I9 6 0 , 33, 3 0 0 -3 2 0 . R aab, W. T r a in in g , p h y sic a l in a c tiv ity and the ca rd ia c dyn am ic c y c le , Jou rn al o f S p orts M ed icin e and P h y s ic a l F itn e s s , 1966, 6, 38-47" R ap aport, E llio t. E x e r c is e r e s p o n s e s in p a tie n ts w ith h e a r t fa ilu r e or c o n g e n ita l h e a r t d is e a s e . Jou rn al of the South C arolin a M e d ic a l A s s o c ia tio n , 1969 (su p p lem en t), 6 5 (1 2 ), 6 1 -6 4 . R eita n , John A. , S m ith , N. T . , B o r is o n , V. S co tt, k K ad is, L e s lie B The c a r d ia c p r e -e je c tio n p e r io d : A c o r r e la te of peak a s c e n d ing a o r tic b lo o d -flo w a c c e le r a tio n . A n e s th e sio lo g y , 1972, 36 (1 ). 7 6 -8 0 . R em in g to n , J. W. , H am ilton , W. F . , k A h lq u ist, R. P . I n te r r e la tio n b etw een the len g th of s y s t o le , str o k e v o lu m e and le ft v e n tr ic u la r w ork in the d og. A m e r ic a n Jou rn al of P h y s io lo g y , 1948, 154, 6 -1 5 . R o d g e r s, K en, L yn ch , P . , k F r a n k s, B. D. E ffe c ts of apnea and fa c e im m e r s io n in w a te r on the tim e com p on en ts of the c a r d ia c c y c le . M ed icin e and S c ie n c e o f S p o r ts , 1972, 4 (1 ), 56. (A b stra ct) R u sh m er , R ob ert F . In itia l v e n tr ic u la r im p u lse : A p o te n tia l k ey to c a r d ia c ev a lu a tio n . C ir c u la tio n , 1964, 2 9 , 2 6 8 -2 8 3 . Saw ayaw a, T o sh ita m i, N ik i, Isa o , M atsu u ra, T e tsu , k Ic h in o se , S u su m u . E x e r c is e p h o n o c a r d io g r a m --s ig n ific a n c e o f the th ird and a tr ia l so u n d s. J a p a n e se C ir cu la tio n J o u rn a l, 1966, 30j(9), 1 1 5 3 -1 1 5 9 . Saah, P . M. , k S lo d k i, S. J. The Q -Il in te r v a l. A stu d y of the 92 se c o n d h e a r t sound in n o r m a l a d u lts and in s y s te m ic h y p e r te n sio n . C ir c u la tio n , 1964, 29, 551. S h a v er, J. A. , K r o e tz , F. W. , L eo n a rd , J. J. e t a l. The e ffe c t o f ste a d y sta te in c r e a s e s in s y s te m ic a r te r ia l p r e s s u r e on the d u ra tio n o f le f t v e n tr ic u la r e je c tio n tim e . Jou rn al of C lin ica l I n v e stig a tio n , 1968, 4 7 . 2 1 7 -2 3 0 . Shaw , D avid J. , R othbaum , D onald A , , A n g ell, C h a rle s S . , It Sh ock , N athan W. The e ffe c ts o f a g e and b lood p r e s s u r e upon the s y s t o lic tim e in te r v a ls in m a le s aged 2 0 -8 9 y e a r s . Jou rn al of G e r o n to lo g y , 1973, 28_(2), 1 3 3 -1 3 9 . Shep hard, R. J. The d e v e lo p m en t of c a r d io -r e s p ir a to r y f it n e s s . M ed ica l S e r v ic e s J o u rn a l, C anada, 1965, 21. 5 3 3 -5 4 4 . S h k h vatsab aya, Y. K. In v estig a tio n of the len g th o f p h a se s of the c a r d ia c c y c le during m u sc u la r e x e r c is e . K a rd io lo g iy a , 1964, 4, 62. S ie g e l, W ayne, B lo m q u ist, G unnar, It M itc h e ll, J e r e H. E ffe c ts o f a q u an titated p h y sic a l tra in in g p r o g r a m on m id d le -a g e d s e d e n ta r y m en . C ir c u la tio n , 1970, 41. 19. S lo d k i, Sheldon J. , H u ssa in , A hm ed T. , fe L u isa d a , A ldo A. The Q -ll in te r v a l. 111. A study of the se c o n d h e a r t sound in o ld a g e . Jou rn al of the A m e r ic a n G e r ia tr ic s S o c ie ty , 1969, 17(7), 6 7 3 -6 7 9 . S lo n ig e r , E. L. The r e la tio n sh ip o f s t r e s s in d ic a to r s to p r e -e j e c t io n c a r d ia c in te r v a ls . U n published d o c to r a l d is s e r ta tio n , U n iv e r s ity of I llin o is , 1966. S p od ick , D avid H. , It K um ar, S u d arsh an . A tra u m a tic m e a s u r e m e n t o f the is o m e tr ic r e la x a tio n p e r io d o f the le ft v e n tr ic le . A e r o sp a c e M e d ic in e , 1968, 39 (9 ), 9 6 8 -9 6 9 . . Is o v o lu m e tr ic c o n tr a c tio n p e r io d of the le f t v e n tr ic le . A m e r ic a n H ea rt J o u rn a l, 1968, 76 (4 ), 4 9 8 -5 0 3 . __________ . R apid fillin g o f the le f t v e n tr ic le : M ea su re m en t by a p e x - c a rd io g r a p h y . A e r o sp a c e M e d ic in e , 1968, 3 9 (12), 1 3 5 1 -1 3 5 3 . S p od ick , D avid H. , D o r r , C o n sta n ce A. , It C a la b r e se , B ern a d in e F. -----------------------------------------------------------------------------------------------------------------------9* D e te c tio n o f c a r d ia c a b n o rm a lity by c lin ic a l m e a s u r e m e n t o f le f t v e n tr ic u la r e je c tio n tim e . Jou rn al o f A m e r ic a n M ed ica l A s s o c ia tio n , 1969, 2 0 9 (2 ). 2 3 9 -2 4 2 . S p od ick , D avid H. , K um ar, S u d arsh an , F le s s a s , A th a n a ssio s P . , S rira ta n a b a n , Ach&ra D. , S o s le r , G era ld , K lin ts, R a sm a V. , It M uench, H ugo. R ela tio n sh ip o f p ap er sp eed to p r e c is io n of p u lse w a v e m e a s u r e m e n ts . A m u ltip le o b s e r v e r stu d y of le ft v e n tr ic u la r e je c tio n tim e . A e r o sp a c e M ed ic in e, 1969, 4 0 (7 ). 7 0 7 -7 0 9 . S ta ffo rd , R. W. , H a r r is , W. S. , tt W e is s le r , A. M . L eft v e n tr ic u la r s y s t o lic tim e in te r v a ls a s in d ic e s o f p o stu r a l c ir c u la to r y s t r e s s in m an . C ir cu la tio n , 1970, 41, 4 8 5 -4 9 2 . S tam ford , B ryan t A. P h y s io lo g ic a l e ffe c ts of train in g upon in s titu tio n a liz e d g e r ia t r ic m en . Jou rn al o f G ero n to lo g y , 1972, 2 7 (4 ), 4 5 1 -4 5 5 . St rand e ll, T. M ech a n ica l s y s to le at r e s t , during and a fter e x e r c is e in su p in e and sittin g p o sitio n in young and old m en . A cta P h y s io lo g ic a S c a n d in a v ica , 1964, M , 2 7 9 -2 9 8 . T afur, E. , C ohen, L. S. , & L e v in e, H. D. The n o r m a l a p e x c a r d io - g ra m : Its te m p o ra l r e la tio n sh ip to e le c t r ic a l, a c o u s tic , and m e c h a n ic a l c a r d ia c e v e n ts . C ir c u la tio n , 1964, 30, 3 8 1 -3 8 9 . T a lle y , R. C. , M e y e r , J. F . , I* M cK ay, J. L. E valu ation o f the p r e -e je c tio n p e r io d a s an e s tim a te of m y o c a r d ia l c o n tr a c tility in d o g s. A m e r ic a n Jou rn al of C a r d io lo g y , 1971, 27, 384. T a v el, M orton E. C lin ic a l p h on ocard iograp h y and e x te r n a l p u lse r e c o r d in g . C h icago: Y earb ook M ed ica l P u b lis h e r s , 1967. T erju n g , R. L. , B ald w in , K. M. , C o o k sey , J . , S a m so n , B. , It S u tter , R. A. C a r d io v a sc u la r ad ap tation to tw e lv e m in u te s of m ild d a ily e x e r c is e in m id d le -a g e d se d e n ta r y m en . Journal o f the A m e r ic a n G e r ia tr ic s S o c ie ty , 1973, 2 1 (4 ), 1 6 4 -1 6 8 . T harp, G erald D. C ard iac fu n ction te s ts a s in d e x e s o f f it n e s s . The R e se a r c h Q u a r te r ly , 1969, 4 0 (4 ), 8 1 8 -8 2 2 . U nited S ta te s P u b lic H ealth S e r v ic e . V ita l s t a t is t ic s o f the U nited S ta te s , 1967. In M o rta lity 2: A ltB . W ash ington, D. C. : D ep a rtm en t of H ealth , E d u cation , It W e lfa r e , 1969. 94 W a lla c e , A. G. , M itc h e ll, J. H. , S k in n er, N. S. e t a l. D u ration of p h a se s of le ft v e n tr ic u la r s y s to le . C ircu la tio n R e se a r c h , 1963, 12, 6 1 1 -6 1 9 . W ayne, H. H. S e r ia l a p e x c a r d io g r a m s, p h o n o c a r d io g r a m s, and c a r o tid tr a c in g s in m y o c a r d ia l in fa r c tio n . C ir c u la tio n , (su p p lem en t), 1968, 6, 203. (A b stra ct) W e is s le r , A rnold M ., & G a rra rd , C liffo rd L. S y s to lic tim e in te r v a li in c a r d ia c d is e a s e 111. M odern C on cord an ce of C ard iac D is e a s e , 1971, 40 (2 ), 5^ T W e is s le r , A. M. , P e e le r , R. G. , & R o e h ill. R e la tio n sh ip s b etw een le f t v e n tr ic u la r e je c tio n tim e , str o k e v o lu m e , and h e a r t ra te in n o r m a l in d iv id u a ls and p a tie n ts w ith c a r d io v a s c u la r d is e a s e A m e rica n H ea rt J o u r n a l, 1961, 6 2 , 367. W e is s le r , A. M. , H a r r is , L, C. , it W aite, G. D. L eft v e n tr ic u la r e je c tio n tim e in d ex in m an. Jou rn al o f A m e rica n P h y sio lo g y , 1963, 18, 919. W e is s le r , A. M. , K am en, A. R. , B o r n ste in , R. S. , e t a l. The e ffe c t o f d e s la n o s id e on the d u ration o f the p h a se s of v e n tr ic u la r s y s t o le in m an . A m e r ic a n Jou rn al of C a rd io lo g y , 1965, 15, 153. W e is s le r , A. M. , H a r r is , W. S. , it S ch o en feld , C. D. S y s to lic tim e in te r v a ls in h e a r t fa ilu r e in m an . C ir cu la tio n , 1968, 37, 149. . B e d sid e te c h n ic s fo r the ev a lu a tio n o f v e n tr ic u la r fu n ction in m an . A m e r ic a n J ou rn al o f C a r d io lo g y , 1969, 23, 5 7 7 -5 8 3 . W e is s le r , A rnold M. The p r e se n t a p p lic a tio n of s y s to lic tim e in te r v a ls in c lin ic a l p r a c tic e . P a p er p r e s e n te d in sy m p o siu m . C lin ic a l A p p lica tio n s in C ard iac T e stin g , at M em o ria l H o sp ita l o f Long B e a ch , C a lifo rn ia , 1970. W h itse tt, T. L . , It N aughton, J. The e ffe c t of e x e r c is e on s y s to lic tim e in te r v a ls in se d e n ta r y and a c tiv e in d iv id u a ls and r e h a b il ita ted p a tie n ts w ith h e a r t d is e a s e . A m e r ic a n Jou rn al o f C a r d io lo g y , 1971, 2 7 , 352. W ig g e r s, C. J. , It K atz, L . N . The s p e c if ic in flu e n c e o f the a c c e l e r a to r n e r v e s on the d u ration of v e n tr ic u la r s y s t o le . A m e r i can Jou rn al of P h y s io lo g y , 1920, 5 3 , 4 9 -6 4 . 95 W ig g e r s, C. J. S tu d ies on the c o n se c u tiv e p h a se s o f the c a r d ia c c y c le . 11. The la w s g o v ern in g the r e la tiv e d u ration o f v e n tr ic u la r s y s t o le and d ia s to le . A m e rica n J o u rn a l o f P h y sio lo g y , 1921, 56, 4 3 9 -4 5 9 . W iley , Jack F . E ffe c ts o f 10 w e ek s of en d u ran ce train in g on le f t v e n tr ic u la r in te r v a ls . Jou rn al of S p orts M ed icin e and P h y sic a l F it n e s s , 1971, 11.(2), 1 0 4 -1 1 1 . ___________ E ffe c ts o f body p o s itio n and e x e r c is e on le ft v e n tr ic u la r in te r v a ls . M ed icin e and S c ie n c e in S p o rts, 1970, 2j(3), 1 3 2 -1 3 6 . W ile y , J. F. , F ra n k s, B. D. , & M oln ar, S. T im e com p on en ts o f the le ft v e n tr ic le during w o rk . New Z ealand Jou rn al o f H ealth , P h y s ic a l E d u cation, and R e c r e a tio n , (annual r e s e a r c h is s u e ) 1969, 2 , 6 7 -7 4 . W ille m s , J. L. , R oelan d t, J. , D e G e e st, H. , K e ste lo o t, H ugo, tc J o o s s e n s , J. V. L eft v e n tr ic u la r e je c tio n tim e in e ld e r ly su b je c ts . C ir c u la tio n , 1970, 4 2 , 3 7 -4 2 . A P P E N D I X E S A P P E N D IX I E X E R C ISE PRO GRAM - PH A SES 1 k 3 97 A P P E N D IX I EX ER C ISE PRO GRAM - P h a se s 1 1 3 I. P h a se 1 "W arm -up" (5 -1 0 m in u te s) A. Standing up e x e r c is e s - p e r fo r m e d s lo w ly 1. N eck c ir c le s 2 . S h ou ld er sh ru g s 3. A rm c ir c l e s 4. H ip c ir c le s 5. H alf k n ee b en d s* 6 . S id e body b e n d er s 7. D iv e r 's sta n c e * 8 . One le g b a la n ce - b ack , s id e , fo rw a rd 9. Standing k n ee r a is e r * 10, G roin s tr e tc h e r B. L ying dow n e x e r c is e s - p e r fo r m e d slo w ly 1. L ying down k n ee r a is e r (to c h e st)* 2 . S ittin g a lte r n a te toe tou ch er 3. H u r d le r 's e x e r c is e 4 . M ule k ick * 5. S id e le g b ic y c le * 6 . S id e le g r a is e r * 7. F oot c ir c le s II. P h a se 3 "C ool dow n" (5 -1 0 m in u te s) A . S ta tic str e tc h in g e x e r c is e s (hold sa m e p o sitio n fo r 1 m in u te) 1. P r a is e a lla h (low b ack str e tc h e r 2 . H eel s itte r 98 99 3. S ittin g fo rw a rd s tr e tc h e r 4 . Shouldar s tr e tc h e r 5. C alf s tr e tc h e r 6 . Trunk tw is te r (rig h t and le ft) *No m o r e than 10 r e p e titio n s (NO N- CARDIOVASCUL.ARLY STIM ULATING EXERCISES) A P P E N D IX II PR O G R A M -SESSIO N FORM 100 A P P E N D IX II NAME PR O G R A M -SESSIO N FORM TRAINING H.R. LIMITING H.R. SESSION PROGRAM 1 2 3 PROGRAM 1 2 3 PROGRAM 1 2 3 SESSION SESSION 1 2 3 4 5 6 7 8 9 10 HEART RATES 11 12 13 14 15 16 17 18 IB 20 HEART RATES 21 22 23 24 26 28 29 30 HEART RATES 101 A P P E N D IX III TH E A C U T E E F F E C T O F EX ER C ISE IN O LDER M A L E S ON TO TA L SY ST O L E (Q S ^ 102 qs2 ( ■ N C ) 440 430 420 410 400 390 380 370 360 350 340 Supine Bike 2.0 Beet Reet r 5.0 10.0 Recovery Supine (Min.) N - 28 The Acute E ffect of E x e rc is e in O lder M ales on Total Systole (QS2 } -r 15.0 EOT A P P E N D IX IV THE A C U T E E F F E C T O F E X E R C ISE IN O LD ER M A LES ON P R E -E JE C T IO N PER IO D (P E P ) 104 PEP [msec) 130 120 100 90 80 Supine Bike 2.0 10.0 15.0 5.0 Rest Rest Recovery Supine (Hin.) N - 28 The Acute E ffect of E x e rc ise in O lder M ales on P re -E je c tio n P e rio d (PE P) A P P E N D IX V THE A C U T E E F F E C T O F E X ER C ISE IN O LDER M A L E S ON THE RATIO O F P R E -E JE C T IO N PER IO D TO L E F T V EN TR IC U LA R EJEC TIO N TIM E (P E P /L V E T ) 106 PEP/ LVET .520 .500 .480 .460 .440 .420 .400 .380 .360 .340 .320 .300 .280 Supine Bike 2.0 5.0 10.0 15.0 Rest Rest Recovery Supine (Min.) M - 28 The Acute E ffect of E x e r c ise in O lder M ales on the Ratio of P r e -E je c tio n P er io d to L eft V en tricular E jection Tim e (P E P /L V E T ) A P P E N D IX VI A C U T E E F F E C T O F E X ER C ISE ON O LDER M A LES (N « 28) 108 330 31S LVST 300 285 270 255 240 Supine R est Bike Rest 2.0 10.0 15.0 RECOVERY SUPIHE (MIN) Acute E ffect of E x e r c ise on O lder M ales (N =28) 109
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Adams, Gene Merle
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Core Title
The Effect Of Exercise Training On Systolic Time Intervals In Elderly Men
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Doctor of Philosophy
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Physical Education
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