Article

Age-Predicted Maximal Heart Rate Revisited

February 2001
Journal of the American College of Cardiology 37(1):153-6

Source
PubMed

Authors:

University of Texas at Austin

We sought to determine a generalized equation for predicting maximal heart rate (HRmax) in healthy adults. The age-predicted HRmax equation (i.e., 220 - age) is commonly used as a basis for prescribing exercise programs, as a criterion for achieving maximal exertion and as a clinical guide during diagnostic exercise testing. Despite its importance and widespread use, the validity of the HRmax equation has never been established in a sample that included a sufficient number of older adults. First, a meta-analytic approach was used to collect group mean HRmax values from 351 studies involving 492 groups and 18,712 subjects. Subsequently, the new equation was cross-validated in a well-controlled, laboratory-based study in which HRmax was measured in 514 healthy subjects. In the meta-analysis, HRmax was strongly related to age (r = -0.90), using the equation of 208 - 0.7 x age. The regression equation obtained in the laboratory-based study (209 - 0.7 x age) was virtually identical to that obtained from the meta-analysis. The regression line was not different between men and women, nor was it influenced by wide variations in habitual physical activity levels. 1) A regression equation to predict HRmax is 208 - 0.7 x age in healthy adults. 2) HRmax is predicted, to a large extent, by age alone and is independent of gender and habitual physical activity status. Our findings suggest that the currently used equation underestimates HRmax in older adults. This would have the effect of underestimating the true level of physical stress imposed during exercise testing and the appropriate intensity of prescribed exercise programs.

[English translation] Maximum heart rate prediction equations fail key external validation test

Article

Full-text available

Apr 2025

Maximum heart rate equations (HRmax) have been used due to their easy availability and practicality, as compared to stress tests. However, the best-known equation, “220 – age”, shows low reliability and deviations of up to 12 beats/min. New formulae have been proposed, but they have not been correctly validated. The purpose of this study was to validate 7 prediction equations by using an independent data set. A data base of 634 subjects (474 men and 160 women) 18–85 years of age, obtained within a health service developed at the University of Michigan from 1990–1992, has been used. The subjects performed a VO2max test on a treadmill, following a free protocol. A linear regression technique was used in which the appropriate equations were those that met the two hypotheses: slope = 1 and constant = 0. According to the results, none of the equations analyzed for the full sample accepted both hypotheses. When doing the analysis by sex, six of the equations met the two hypotheses for the women, but none of them for the men; and when the analysis was done by age group, 4 of the equations met the hypotheses for the group 40 years old or younger, but not for those above 40. The HRmax seems to be difficult to predict through a single equation. Therefore, it is recommended that, when a valid measure for this variable is needed, a stress test be used.

Aging and Physiological Lessons from Master Athletes

Article

Full-text available

Dec 2019

Sedentary aging is often characterized by physical dysfunction and chronic degenerative diseases. In contrast, masters athletes demonstrate markedly greater physiological function and more favorable levels of risk factors for cardiovascular disease, osteoporosis, frailty, and cognitive dysfunction than their sedentary counterparts. In many cases, age‐related deteriorations of physiological functions as well as elevations in risk factors that are typically observed in sedentary adults are substantially attenuated or even absent in masters athletes. Older masters athletes possess greater functional capacity at any given age than their sedentary peers. Impressive profiles of older athletes provide insight into what is possible in human aging and place aging back into the domain of “physiology” rather than under the jurisdiction of “clinical medicine.” In addition, these exceptional aging athletes can serve as a role model for the promotion of physical activity at all ages. The study of masters athletes has provided useful insight into the positive example of successful aging. To further establish and propagate masters athletics as a role model for our aging society, future research and action are needed. © 2020 American Physiological Society. Compr Physiol 10:261‐296, 2020.

Advice to people with Parkinson's in my clinic: Get a cardiopulmonary exercise test

Article

Full-text available

Apr 2025

Aerobic (cardiopulmonary) exercise training improves fitness and limits the progression of motor signs in Parkinson's disease. Individualized development of exercise prescriptions relies upon accurately measured peak heart rate (HR). Cardiopulmonary exercise testing (CPET) is the only methodology to objectively confirm an individual's peak HR. This test is important in individuals who may have autonomic dysfunction, which may manifest as chronotropic incompetence. Without CPET's confirmation of maximal effort, there is no way of knowing whether exercise prescription in those with chronotropic incompetence is accurate. CPET also provides information regarding cardiorespiratory fitness, which can motivate patients to exercise to prolong health.

Reference values for arm ergometry cardiopulmonary exercise testing (CPET) in healthy volunteers

Article

Full-text available

Apr 2025

Introduction The performance of a cardiopulmonary exercise test (CPET) requires an individual to undertake a progressive, maximal exercise test to a symptom-limited end point. CPET is commonly performed using a treadmill or cycle ergometer (CE). Arm ergometry (AE) is an alternative exercise modality to CE; however, AE produces lower peak oxygen uptake (V̇O2) values as it involves smaller muscle groups and generates less cardiovascular stress. Current predicted equations for the interpretation of AE CPET are limited by small sample sizes, gender bias and limited age ranges. Aims To develop predicted equations and reference ranges for AE exercise testing. Design Incremental ramp protocol CPET, to a symptom-limited end point, via AE was performed in a group of 116 (62 F) healthy volunteers of median age 38 (IQR 29–48) years. Breath-by-breath gas analysis was performed using the Ultima CPX (Medical Graphics, UK) metabolic cart. Quantile regression analysis was used to develop regression equations for AE V̇O2, peak work rate (WR), anaerobic threshold, peak ventilation (VE), peak heart rate, oxygen pulse, V̇E/V̇CO2 slope and V̇O2/WR slope. Results Reference equations including upper and/or lower limits, based on quantile regression, were generated and verified using a validation cohort. Conclusions These findings represent the largest and most diverse set of predicted values and reference ranges for AE CPET parameters in healthy individuals to date. Implementation of these reference equations will allow AE to be more widely adopted, enabling the performance and interpretation of CPET in a wider population.

Control del rendimiento físico en futbolistas universitarios a través de la frecuencia cardiaca máxima

Chapter

Jan 2025

El deporte se desenvuelve en un mundo dinámico que se transforma constantemente, ante lo cual la innovación se erige como un factor fundamental para adaptarse con éxito a los desafíos de la sociedad globalizada, donde la creciente conciencia social exige liderazgo ante la diversidad. Más allá de la competencia, surge la necesidad de repensar el deporte desde una perspectiva inclusiva. Este libro, titulado “Estrategias innovadoras en el deporte: Liderazgo, inclusión y rendimiento”, tiene como objetivo explorar estas transformaciones y proporcionar una visión integral sobre cómo las nuevas formas de liderazgo y la inclusión pueden influir positivamente en el rendimiento deportivo y en las organizaciones deportivas.

Study protocol for the randomized controlled trial of EMBOLDEN: a multifaceted intervention aimed at Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design

Article

Full-text available

Apr 2025

Background Reduced physical mobility is common in older adults and is associated with adverse outcomes, including functional decline, depression, social isolation, and poor nutritional status. Group-based programs focusing on physical activity and nutrition to support healthier lifestyles have demonstrated benefits, particularly when paired with social engagement activities. This paper presents the protocol for a randomized controlled trial (RCT) to test a lifestyle intervention called EMBOLDEN: a multifaceted intervention aimed at Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design. EMBOLDEN is a co-designed 3-month intervention to improve quality of life by incorporating physical activity, healthy eating, social participation, and system navigation. Participants receiving the EMBOLDEN intervention plus usual care are expected to show improvement in physical activity and other health outcomes compared to receiving usual care alone. Methods This is a 2-arm Type II hybrid effectiveness-implementation pragmatic RCT. Eligibility criteria include older adults (55+ years), community-dwelling in urban neighborhoods facing health inequities, able to speak or understand English or Mandarin (or access to family/friend interpreters), and able to walk 10 m unassisted by another person (assistive devices permitted). Participants will be randomized to the intervention or control arm (1:1 ratio). The intervention arm is usual care plus: (1) 12 weekly group-based sessions to increase knowledge/skills and behavior activation related to physical activity, healthy eating, fostering social connections and community resources; and (2) up to three tailored individual system navigation sessions. The control arm is usual care, in which participants identify and access services without research support. The primary outcome is time spent doing moderate-to-vigorous physical activity. Secondary outcomes will also be explored, including quality of life, life space mobility, depressive symptoms, nutritional risk, and loneliness. Data will be collected at baseline, 3 months (post-intervention) and 6 months. Mixed effects models will be used to analyze outcomes, intention-to-treat analysis will be employed, and multiple imputation will address missing data. Descriptive and qualitative data from participants, interventionists, and research documentation will be used to examine adaptations and implementation barriers/facilitators. Discussion A community-based, co-designed lifestyle intervention may improve physical activity and other health outcomes in older adults living in neighborhoods with health inequities. Clinical trial registration ClinicalTrials.gov, NCT05008159.

The relationship between training and competition load characteristics of female boxers—a case study based on collegiate boxers

Article

Full-text available

May 2025

Introduction This study examines the relationships between external and internal loads in female collegiate boxers during training and competition, focusing on variations during menstruation and non-menstruation periods. It also evaluates the effectiveness of different monitoring techniques in these contexts, providing guidance for coaches and athletes in load management. Methods Twenty-one healthy female collegiate boxers participated, recording data across 18 training sessions and 6 competitions over six weeks. The metrics collected included session-RPE (sRPE), Banister’s Trimp, Stagno’s Trimp, moving distance, high-intensity moving distance, physical load, and the ratio of body weight loss. Pearson correlation analyses were applied. Results Correlation analysis revealed that internal and external loads are consistently positively correlated during training and competition. Apart from the training phase, where the correlation between sRPE and Stagno’s Trimp was not statistically significant ( r = 0.181, p > 0.05), correlations between sRPE and other indicators during both training and competition showed medium to high strength ( r = 0.426 ~ 0.880, p < 0.05). During menstruation, the correlations of all metrics were lower than in non-menstruation periods, except sRPE with Banister’s Trimp. Discussion The study highlights that the subjective load sRPE can effectively predict and assess the internal load of female boxers, and is more sensitive to internal loads regardless of menstruation status. However, its application to external loads is limited, and objective measurements are recommended during menstruation.

From Single Movement Behaviors to Complete 24‐h Behaviors Profiles and Multiple Health Outcomes—A Cross‐Sectional Study Using Accelerometry

Article

Full-text available

May 2025
SCAND J MED SCI SPOR

Movement behaviors research has evolved from focusing on single behaviors to multiple behaviors within a 24‐h perspective. However, it is unknown if 24‐h movement behavior profiles are consistently associated across multiple health outcomes. Thus, we aimed to investigate this. We used data from 807 adults who wore thigh accelerometers and recorded daily sleep/work times over 1–4 days and were categorized into four 24‐h movement behavior profiles: “Chimpanzees” (balanced distribution of movement behaviors in work and leisure; n = 226, reference), “Lions” (more active work and sleep, and less active leisure; n = 179), “Ants” (more active overall, less sedentary work and similar sleep, n = 244), and “Koalas” (more sedentary and sleep, and less active overall n = 158). Cardiorespiratory fitness and systolic blood pressure were measured, while low back pain and self‐rated health were self‐reported. Linear or ordinal logistic regression assessed the cross‐sectional associations between these profiles and outcomes, adjusting for age, sex, BMI, smoking, alcohol, occupational lifting/carrying, and work type. We found that referencing Chimpanzees, Lions were detrimentally associated with cardiorespiratory fitness (B = −2.70 mLO2/min/kg, p < 0.01), but beneficially associated with systolic blood pressure (B = −3.49 mmHg, p < 0.05) and low back pain (odds ratio, OR = 0.67, p = 0.03). Koalas were detrimentally associated with systolic blood pressure (B = 3.66 mmHg, p < 0.05) and cardiorespiratory fitness (B = −2.83 mLO2/min/kg, p < 0.01). Ants were detrimentally associated with self‐reported health (OR = 1.78, p < 0.01). We conclude that no 24‐h movement behavior profile was consistently (i.e., solely beneficial or detrimental) associated with the health outcomes. These findings indicate that research and practice about 24‐h movement behaviors need to consider multiple outcomes.

Effects of 12 weeks of Head-Down Strong Abdominal Breathing Training on Gait and Cognitive Function in Patients with Chronic Obstructive Pulmonary Disease

Article

Full-text available

May 2025

Plain Language Summary Why was this study done? People with chronic obstructive pulmonary disease (COPD) often face challenges with movement and thinking skills as their condition worsens. Everyday tasks like walking around obstacles can become harder, and memory or focus may decline. This study tested whether simple breathing exercises—with or without body position changes—could improve walking ability and cognitive health in people with stable COPD. What did the researchers do? Researchers divided 63 adults with COPD into three groups for 12 weeks: Group 1 practiced breathing techniques while lying head-down. Group 2 did head-down positioning without breathing exercises. Group 3 did breathing exercises in normal sitting/standing positions. They measured changes in walking patterns (step length, speed) during regular and obstacle-filled paths, along with cognitive tests. What did they find? The head-down breathing group showed clearer improvements in stepping over obstacles compared to other groups. All groups scored better on cognitive tests after 12 weeks. Simple walking (without obstacles) showed no meaningful changes across groups. What do these results mean? Combining breathing practice with position changes may help people with COPD move more confidently in challenging situations like avoiding tripping hazards. The cognitive improvements across all groups suggest breathing exercises alone—whether lying down or upright—could support brain health in COPD. While longer studies are needed, these non-drug approaches show potential for helping people stay active and mentally sharp. Patients and healthcare teams might consider adding similar exercises to daily routines.

Tailoring exercise intensity: Acute and chronic effects of constant-speed and heart rate-clamped exercise in healthy, inactive adults

Article

Apr 2025
J SCI MED SPORT

Associations of Anthropometric and Strength Determinants With Walking and Running Economy in German Male and Female Police Officers

Article

Apr 2025
J STRENGTH COND RES

Effects of Acute Fatigue on Balance Control of Alpine Skiing Athlete

Article

Full-text available

Apr 2025

Background: Great physical requirements are necessary to maintain the entire body in a streamlined and aerodynamic position during downhill skiing. Balance control has an important role in alpine skiing and depends on muscle endurance and strength. The central processing of proprioception and the force capacity of muscle are altered by fatigue. The objective of this study was to assess the effects of fatigue and visual input on balance control in alpine skiing. Methods: Eleven male professional skiers participated in the study. Balance control with eyes open and eyes closed was assessed before and after performing a maximal effort specific alpine ski test. Variables: the total travel distance (TTD) (mm), radial area (RA) (mm2), ratio between TTD and RA (TTD/RA) (1/mm), mean center of pressure (COP) velocity (total length of the COP path per unit time) (mm/s), the mean mediolateral (ML) COP oscillation velocity (Lat_Vel) (mm/s), the mean anteroposterior (AP) COP oscillation velocity (AP_Vel) (mm/s), mean ML (MLD) (mm) and mean AP (APD) (mm) displacements of the COP and the distance from the ordinate origin (mean X and mean Y) (theoretical point where the COP should be) to the point at which the COP is located, and heart rate were measured. Results: The results showed differences in the variables related to postural control and balance before and after the stress test (p = 0.002–0.037). However, no differences were found when the results obtained with open and closed eyes were compared. Conclusions: The results showed that performance in alpine skiing could be negatively affected by fatigue. However, the dynamic parameters are not decreased by visual input during muscle fatigue.

Gait variability and fatigability during a simulated 10-km running race in trained runners

Article

Full-text available

Apr 2025
EUR J APPL PHYSIOL

Purpose Fatigue is an inevitable phenomenon during distance running, leading to the adoption of altered gait patterns by runners. Therefore, the aim of this study was to investigate the changes in gait variability and fatigability in distance runners over a 10-km running race. Methods For this aim, 12 runners (36.5 ± 5.4 y) completed a simulated 10-km running race. Throughout the trial, heart rate (HR) and rate perceived exertion (RPE, CR-10) were analyzed. In addition, kinematic/kinetic measurements: contact time (CT), flight time (FT), step length (SL), stride time (ST) leg (kvert) and vertical (kleg) stiffness, were recorded. Gait variability including phase coordination index (PCI) was calculated for each 2-km segment. Results HR increased (from 88.46 ± 5.84 to 93.87 ± 6.48 %HRMAX, P < 0.05) as well as RPE (6.58 ± 0.47–8.96 ± 0.40 a.u., P < 0.001) as the distance increased. Conversely, no differences between running segments for the kinematic/kinetic data (CT–FT–SL–ST–kvert–kleg) were observed over five 2 km. However, there was increase (P < 0.05) in gait variability (PCI), over the course of the running race. Furthermore, the determination coefficient (R²) was found as strong and very strong when compared five (0–10 km) and four (4–10 km) running segments between HR–RPE and PCI (R² = 0.623–0.845). Conclusion These results suggest that the gait variability is one mechanical determinant in assessing the neuromuscular output when the fatigability increases during a running race.

Anodal transcranial direct current stimulation combined with physical exercise increases postural sway in Parkinson’s disease: a double-blind and cross-over study

Article

Full-text available

Apr 2025
EXP BRAIN RES

Transcranial direct current stimulation (tDCS) has shown promising effects on postural control in people with Parkinson’s disease (PwPD). However, the characteristics of the stimulation, such as the specific cortical area targeted and combination with exercise, seem to influence the tDCS effects. Therefore, analyzing these factors is essential for identifying key characteristics and optimizing rehabilitation protocols for postural control in PD.We aimed to analyze the efficacy of tDCS over the primary motor (M1) and pre-frontal cortices (PFC) combined with aerobic exercise on postural control in PwPD. Twenty-one PwPD participated in this crossover, randomized, and double-blind study. The intervention consisted of exercising on a treadmill at moderate intensity for 30 min while receiving the stimulation. tDCS was applied during the central 20 min of exercise over M1, PFC, or sham on 3 different days. Three one-minute trials were conducted with participants standing still on a force platform to assess the center of pressure parameters in anteroposterior (AP) and mediolateral (ML) directions in pre- and post-intervention. Time*stimulation interaction was observed for sway area (p = 0.038) and sway mean amplitude in both the AP (p = 0.009) and ML directions (p = 0.059, marginal effect). Post-hoc analysis indicated a larger sway area and mean amplitude in both directions post-intervention compared to pre-intervention after tDCS application to the M1 and PFC. No significant differences were observed for the sham condition. Our findings suggest that the combination of exercise and tDCS, regardless of the area stimulated, modifies postural control in PwPD, leading to a larger sway.

Cytokine response to resistance exercise in children with excess adiposity and Prader‐Willi syndrome

Article

Full-text available

Apr 2025

Interleukin‐6 (IL‐6), tumor necrosis factor alpha (TNF‐α), and irisin (cytokines) are affected by excess body fat (obesity), skeletal muscle, and resistance exercise (RE). The purpose of this study is to determine whether Prader‐Willi Syndrome (PWS), a genetic cause for obesity (OB), or non‐syndromic OB influences these cytokine responses to RE. Nine children with PWS (11.4 ± 3.3 years, 45.6 ± 5.2% BF), 11 children without OB (9.2 ± 1.4 years, 18.6 ± 5.0% BF), and 12 children with OB (9.6 ± 1.3 years, 40.4 ± 5.4% BF) participated. Children stepped onto an elevated platform wearing a weighted vest for 6 sets of 10 repetitions per leg separated by 1 min of rest. Blood samples were obtained before exercise (pre), immediately post (IP), and during recovery (+15 and +60 min). There were no group‐by‐time interactions for any cytokine; and neither time nor group effects for TNF‐α or irisin (p ≥ 0.378). For IL‐6, 60+ was higher than pre, IP, and +15 (p < 0.001). Children with PWS and OB had increased IL‐6 than children without OB (p ≤ 0.038). Neither PWS nor OB affected IL‐6, TNF‐α or irisin responses to RE. However, excess body fat was associated with higher IL‐6 concentrations.

Intensity of Hatha yoga training for older adults

Article

Full-text available

Apr 2025

Małgorzata Grabara

The aim of this study was to assess the intensity of hatha yoga training for older adults in alignment with international physical activity recommendations. The sample included 26 participants (one male), aged 70 ± 5.7 years, with a mean BMI of 25.3 ± 3.2, recruited from a University of the Third Age. Heart rate (HR) was measured during a yoga session using the Polar Vantage V2 multisport GPS watch and the Polar H10 chest strap sensor. Results indicated that the mean HR during the most intensive phase of yoga reached 60% of participants’ HRmax and 31% of the heart rate reserve (HRR). On average, participants spent 16 min (15.9 ± 14.76) in the 64–76% HRmax range and nine minutes (9.4 ± 8.67) in the 40–59% HRR range, corresponding to moderate-intensity exercise. Four participants maintained moderate intensity for 30 min based on the 64 − 76% HRmax criterion, while only one participant sustained this intensity for at least 30 min according to the 40 − 59% HRR criterion. Participants reported a perceived exertion of 12, indicating a moderate level of effort. The study highlights that hatha yoga incorporates muscle-strengthening and endurance exercises for all major muscle groups, enhancing balance, coordination, flexibility, and range of motion, making it a comprehensive physical activity option for older adults. However, the session’s intensity remained predominantly below the moderate level.

Maximal oxygen uptake of master swimmers in incremental intermittent swimming test: effects of aging

Article

Full-text available

Apr 2025
Sport Sci Health

Maximal oxygen uptake (

\dot{V}{\text{O}}_{2\max }

) is one of the measures used to assess aerobic power, which is both negatively related to mortality and positively related to swimming performance. Aging acts directly on the decrease in

\dot{V}{\text{O}}_{2max}

, both in sedentary people and in athletes. Given the marked growth in the population of master swimmers and the lack of data on

\dot{V}{\text{O}}_{2\max }

in these swimmers, the present study aimed to compare the

\dot{V}{\text{O}}_{2\max }

parameters, in different age groups, of competitive master swimmers in swimming. The sample consisted of 22 master swimmers, divided into three groups by age (G1: 32.6 ± 2.9; G2: 44.8 ± 2.4; G3: 64.1 ± 8.0 years). Anthropometric and body composition measurements were taken prior to pool assessment. Oxygen uptake, heart rate (HR), blood lactate concentration ([La]), and rating of perceived exertion were recorded during an incremental intermittent n × 200 m front crawl test. Descriptive and inferential statistics were applied (alpha = 0.05). Although age demonstrated a large effect size on the variables, no significant differences were found between groups for

\dot{V}O_{2max}

(G1: 49.2 ± 6.2; G2: 43.4 ± 4.2; and G3: 39.6 ± 9.8 ml∙kg∙min⁻¹), and for maximal [La] (G1: 10.0 ± 4.0; G2: 9.2 ± 2.2; and G3: 7.4 ± 2.4 mmol∙l⁻¹). On the other hand, the maximal HR reached was lower in G3 (149.0 ± 9.5 bpm) than in G1 (177.1 ± 7.2 bpm) and G2 (168.6 ± 10.4 bpm). Despite the age-related decrease in physiological parameters affecting oxygen uptake, the dispersion of the

\dot{V}O_{2max}

data indicates the presence of other aspects to be considered beyond the age in these results, such as heterogeneity in swimming experience.

Efficacy of Yijinjing for Soft Tissue Improvement in Patients with Non-specific Chronic Neck Pain: Study Protocol for a Multicenter Randomized Controlled Trial

Article

Full-text available

Apr 2025

Introduction As a mind–body exercise, Yijinjing has shown benefits in enhancing the effects of manual therapy for the treatment of pain, disability and soft tissue status associated with non-specific chronic neck pain (NCNP). The efficacy of Yijinjing as an independent exercise regimen for the treatment of NCNP has not been established. This study is designed to assess the efficacy of Yijinjing in patients with NCNP, compared with cervical function training (CFT). Methods and analysis A total of 132 consenting NCNP participants will be randomly assigned in a 1:1 ratio to either the Yijinjing group or the CFT group (three times a week for 8 weeks). Both groups will undergo an 8-week intervention phase. Outcome variables will be assessed at baseline and at 4-week, 8-week and 12-week follow-up. The primary outcome measure is the change in visual analogue scale scores at week 8. Secondary outcomes include neck disability index, cervical range of motion and soft tissue status parameters. Ethics and dissemination This study has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki, local laws and regulations. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. Trial registration number ITMCTR2024000323.

Predicting experiences of paranoia and auditory verbal hallucinations in daily life with ambulatory sensor data – A feasibility study

Article

Full-text available

Apr 2025
PSYCHOL MED

Background Prediction models that can detect the onset of psychotic experiences are a key component of developing Just-In-Time Adaptive Interventions (JITAI). Building these models on passively collectable data could substantially reduce user burden. In this study, we developed prediction models to detect experiences of auditory verbal hallucinations (AVH) and paranoia using ambulatory sensor data and assessed their stability over 12 weeks. Methods Fourteen individuals diagnosed with a schizophrenia-spectrum disorder participated in a 12-day Ecological Momentary Assessment (EMA) study. They wore ambulatory sensors measuring autonomic arousal (i.e., electrodermal activity, heart rate variability) and completed questionnaires assessing the intensity/distress of AVHs and paranoia once every hour. After 12 weeks, participants repeated the EMA for four days for a follow-up assessment. We calculated prediction models to detect AVHs, paranoia, and AVH-/paranoia-related distress using random forests within nested cross-validation. Calculated prediction models were applied to the follow-up data to assess the stability of prediction models. Results Prediction models calculated with physiological data achieved high accuracy both for AVH (81%) and paranoia (69%–75%). Accuracy increased by providing models with baseline information about psychotic symptom levels (AVH: 86%; paranoia: 80%–85%). During the follow-up EMA accuracy dropped slightly throughout all models but remained high (73%–84%). Conclusions Relying solely on physiological data to detect psychotic symptoms achieved substantial accuracy that remained sufficiently stable over 12 weeks. Experiences of AVHs can be predicted with higher accuracy and long-term stability than paranoia. The findings tentatively suggest that psychophysiology-based prediction models could be used to develop and enhance JITAIs for psychosis.

mmHRR: Monitoring Heart Rate Recovery with Millimeter Wave Radar

Preprint

Mar 2025

Heart rate recovery (HRR) within the initial minute following exercise is a widely utilized metric for assessing cardiac autonomic function in individuals and predicting mortality risk in patients with cardiovascular disease. However, prevailing solutions for HRR monitoring typically involve the use of specialized medical equipment or contact wearable sensors, resulting in high costs and poor user experience. In this paper, we propose a contactless HRR monitoring technique, mmHRR, which achieves accurate heart rate (HR) estimation with a commercial mmWave radar. Unlike HR estimation at rest, the HR varies quickly after exercise and the heartbeat signal entangles with the respiration harmonics. To overcome these hurdles and effectively estimate the HR from the weak and non-stationary heartbeat signal, we propose a novel signal processing pipeline, including dynamic target tracking, adaptive heartbeat signal extraction, and accurate HR estimation with composite sliding windows. Real-world experiments demonstrate that mmHRR exhibits exceptional robustness across diverse environmental conditions, and achieves an average HR estimation error of 3.31 bpm (beats per minute), 71% lower than that of the state-of-the-art method.

Effects of 12-week combined interval running and resistance training on cardiac structure and performance in patients with type 1 diabetes

Article

Full-text available

Mar 2025
Ther Adv Endocrinol Metab

Background Exercise has been suggested to effectively improve cardiac performance in children with type 1 diabetes (T1D) by enhancing the glycemic control. The purpose of this study was to investigate (1) effects of a 12-week combined interval running and resistance training (CIRRT) and (2) 1 month of detraining on cardiac structure and myocardial performance in adolescent males with T1D. Methods A total of 72 participants, including 48 adolescent males with T1D (fasting blood glucose (FBG): 274.67 ± 52.99 mg/dL, age: 15.20 ± 1.78 years) and 24 healthy adolescents (FBG: 90.75 ± 5.47 mg/dL, age: 15.08 ± 1.67 years), were recruited to the study. Participants were allocated into diabetes exercise (DE), diabetes control (DC), and healthy controls (HC) groups. The DE group performed 12 weeks of a CIRRT program three times per week. Blood glucose profile, echocardiography (ECHO) indices, and peak oxygen consumption (VO 2peak ) were measured pre- and post-intervention and following 1-month detraining period. Repeated measures ANOVA was used for pre- and post-intervention comparisons within the DE group and across the three study groups. Significance level was set at p < 0.05. Results Exercise intervention resulted in decreased hemoglobin A1c (HbA1c% = Pre: 10.44 ± 2.03, Post: 9.38 ± 1.66, p < 0.05), FBG, left ventricular (LV) internal diameter, and both tricuspid and mitral deceleration time (DT) in the DE group. VO 2peak , ejection fraction (EF% = Pre: 62.38 ± 1.6, Post: 64.08 ± 1.18, p < 0.05), fractional shortening, early tricuspid diastolic inflow E velocity, and tricuspid velocity during atrial contraction were also increased following the exercise training. HbA1c (Pre vs Follow-up: 9.83 ± 1.73, p < 0.05), EF (Pre vs Follow-up: 62.97 ± 1.56, p < 0.05), LV, and DT tricuspid remained significantly improved after detraining period compared to the baseline. In the baseline, the glycemic index and ECHO variable significantly differed in the DE and DC groups with the HC group ( p < 0.05). However, after the intervention, the DC and HC groups did not change significantly ( p > 0.05). Conclusion The CIRRT intervention was associated with improved cardiac structure and performance in male adolescents with T1D potentially due to exercise-induced adaptations. Meanwhile, the results indicate that most cardiac morphological and functional changes are reversible following periods of inactivity in patients with T1D.

Real World Postural Transitions as Biomarkers of Functional Impairment in Duchenne Muscular Dystrophy

Article

Full-text available

Mar 2025

Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disorder that impairs daily functioning and results in premature death. Current clinical assessments are widely used for characterizing functional impairment but have limitations due to their subjective and effort-based nature and because they only capture a snapshot of symptoms at a single point in time. Digital health technologies, such as wearable devices, allow continuous collection of movement and physiological data during daily life and could provide objective measures of the impact of DMD symptoms on daily functioning. For example, measurement of the 95th centile of stride velocity has recently gained endorsement by European regulators as an endpoint for evaluating functional changes in DMD, but the use of wearables for this purpose is just beginning. In this study, we present preliminary investigations of candidate digital biomarkers of functional impairment using real-world data, and further explore the relationships between these parameters and established clinical assessments. We found nine candidate biomarkers for detecting DMD-related functional impairment, all exhibiting large to very large effect sizes in our sample of 14 boys with DMD and matched controls (9 DMD, 5 control, age 4-12 years). Each candidate biomarker was moderately or strongly associated with clinical measures of function in DMD. Six of the biomarkers are novel and/or understudied in DMD including objective measures of gait acceleration and variability; postural control immediately before and after a postural transition; and the smoothness of postural transitions. Notably, postural transition measures were more sensitive to DMD-related impairment than gait, activity, and cardiac measures. These results suggest that the quality of postural transitions could serve as a sensitive and objective measure of functional impairment in DMD and point toward the need for further exploration of these measures in DMD.

Investigating the relationship between aerobic fitness and lower-limb resistance vessel function before and after a bout of uninterrupted sitting

Article

Full-text available

Mar 2025

Prolonged sitting reduces lower-limb resistance vessel function (RVF), whereas increasing aerobic fitness levels enhance lower-limb RVF. However, it is unknown whether having higher aerobic fitness offers protection against prolonged sitting-induced declines in RVF. This study investigated the relationships between aerobic fitness versus reductions in lower-limb RVF following a 3 h bout of uninterrupted sitting. In 30 healthy young adults (19♀, 24 ± 6 years), aerobic fitness was assessed during a graded, maximal cycling test. Relative peak oxygen consumption (V̇O2peak) was determined via indirect calorimetry (37.5 ± 8.6 (24.7–60.7 mLO2/kg/min). Popliteal blood flow (PBF) was recorded via duplex ultrasonography. Lower-limb RVF was assessed in the seated posture and quantified as the peak PBF and area under the curve (PBFAUC, first minute of hyperemia) responses to 5 min of distal cuff-induced ischemia. The lower-limb RVF assessment was performed before and after a sitting. Peak PBF decreased following sitting (473 ± 254 to 387 ± 199 mL/min, P = 0.024), while PBFAUC remained unchanged (6145 ± 3063 versus 6446 ± 3826 mL, P = 0.758). Relative V̇O2peak was not associated with Pre-sitting peak PBF (R = 0.236, P = 0.210) or PBFAUC (R = −0.026, P = 0.889). Furthermore, relative V̇O2peak was also not associated with sitting-induced reductions in peak PBF (R = −0.145, P = 0.444). The reductions in peak PBF following sitting support previous work demonstrating that prolonged uninterrupted sitting negatively impacts lower-limb RVF. In contrast, prolonged sitting did not alter the PBFAUC response, suggesting that peak PBF responses may provide a more sensitive index of sitting-induced declines in RVF. In young, healthy individuals, aerobic fitness did not impact baseline or sitting-induced reductions in lower-limb RVF.

Influence of Intermittent Fasting on Body Composition, Physical Performance, and the Orexinergic System in Postmenopausal Women: A Pilot Study

Article

Full-text available

Mar 2025

Objective: This study aims to evaluate the effects of different nutritional strategies, specifically intermittent fasting (IF) combined with high-intensity interval training (HIIT) versus a low-calorie diet (LCD), on body composition, physical performance, and the orexinergic system in postmenopausal women. Methods: A randomized controlled trial involving thirty postmenopausal women (mean age 57.50 ± 6.50 years) was conducted over eight weeks, comparing the two dietary approaches alongside an 8-week HIIT program. Body composition was assessed using bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DEXA). Performance metrics included handgrip strength and the 6-min walking test (6MWT). Salivary samples were analyzed for Orexin-A (OX-A) levels pre- and post-intervention. Results: Significant improvements in health metrics, such as heart rate (HR) and endurance, were found, with mean HR changes showing a significant difference (F = 5.943, p = 0.033) between the groups at T1. Orexin-A levels reflected significant metabolic regulation shifts in relation to other variables, showing a change from baseline to post-intervention values at T1 (F = 10,931, p = 0.033). Flexibility (sit and reach) significantly improved by 6% (p < 0.05), as well as VO2 max (10%, p < 0.05), both highlighted as key predictors of overall health outcomes. Additionally, Cohen’s d analyses indicated that the dietary groups exhibited notable differences in endurance, with the LCD group showing a Cohen’s d of −0.90, suggesting a large effect size compared with the control group. Conclusions: The combination of IF and HIIT is an effective nutritional strategy for enhancing body composition and physical performance in postmenopausal women, potentially mediated by changes in the orexinergic system. Further research is warranted to explore long-term effects and underlying mechanisms.

The Effect of an Acute Aerobic Exercise with Different Intensities on the Executive Functions of 9-10-year-old Children

Article

Full-text available

Jan 2025

Background: It is well-established that executive function can be affected by a session of aerobic training. Our study aimed to determine how acute aerobic exercise affect executive function at different intensities in 9-10-year-old children. Methods: The participants in this quasi-experimental study were 36 children (9.58 years±0.50) in Saqqez, Kurdistan Province, Iran in the first half of 2022. They were randomly assigned into 60% and 80% heart rate reserve (HRR) and a control group. All groups performed the Progressive Aerobic Cardiovascular Run (PACER) test in the first stage of study to ensure homogeneity. Then, in the pretest-posttest design, inhibitory control and working memory were assessed using the Stroop and N-back tests. During the 15-minute exercise session, participants exercised on a treadmill at different intensities of 60% and 80% of their HRR. One-way Analysis of Variance (ANOVA) and paired t-test were employed to analyze between-group and within-group differences in control and intervention groups. Results: According to the results, working memory scores of children improved significantly in 60% and 80% HRR groups (65.44±9.51 vs. 44.69±17.76) compared with the control group (31.00±2.02) (P<0.0001). Different exercise intensities; however, did not show any advantage over a control group in the interference score of correct answers, or reaction time (RT) of inhibition control (60% HRR: 4.08±3.77, 80% HRR: 1.16±3.32, Control: 4.25±3.62, P=0.074), (60% HRR: 52.00±65.91, 80% HRR: 85.66±59.75, Control: 27.16±106.46, P=0.215). Conclusions: The study findings revealed that working memory in pre-adolescents can be improved by a 15-minute session of moderate or high-intensity aerobic exercise. However, there were no significant differences between the groups in terms of inhibitory control.

Application of Exercise Snacks across Youth, Adult and Clinical Populations: A Scoping Review

Article

Full-text available

Mar 2025

Background Interest in ‘exercise snacks’ has increased, yet a comprehensive and holistic review of this novel concept is lacking. We aimed to map global research on ‘exercise snacks’, across youth, adult and clinical populations through a scoping review. Methods A systematic search was conducted in six databases. Grey literature searches were also conducted. Studies whereby participants were prescribed a structured bout of intense exercise dispersed across the day, or the exercise was explicitly defined as a form of ‘snacks’, in any setting were included. We used the Consensus on Exercise Reporting Template (CERT) to assess the completeness of exercise descriptions. Data were recorded into spreadsheets, then descriptively analyzed and summarized in graphic form. Results The 45 publications meeting our inclusion criteria represented 33 original studies. These 33 studies enrolled a total of 1118 participants, with a median sample size of 24. Studies were categorized as either acute (n = 12) or chronic (n = 21) trials with both trial types performed across a wide range of participant ages (range 8.7 to 78 years) but mostly conducted on healthy adults and older adults. The majority of studies (20/33) defined the concept as ‘exercise snacks’, with study context being predominantly the laboratory or home. A wide variety of exercise modes (e.g., cycling, stair climbing, body weight exercises) and comparator conditions (e.g., moderate intensity continuous exercise, prolonged sitting, non-exercise controls) were used. ‘Exercise snack’ intensity was prescribed more frequently than it was reported, and, of the available data, mean intensity was estimated at 76.9% of maximal heart rate and 5.2 Arbitrary Units (AU) on the Ratings of Perceived Exertion (RPE) CR10 scale. Study outcome measures were predominantly cardiovascular, metabolic, muscular, and psychological, with studies mostly adhering to the CERT, though there was underreporting of detail for the exercise provider, motivation strategies, adverse events and intervention fidelity. Conclusion The ‘exercise snack’ concept is being increasingly used to cover an array of exercise models. The most common protocols to date utilize body weight exercises or stair climbing. We recommend ‘exercise snacks’ terminology is consistently used to describe protocols whereby short, purposeful structured exercise is dispersed throughout the day. Future studies should provide detailed descriptions of their ‘exercise snacks’ model, through exercise and adverse event reporting checklists.

Fitness and Mortality Outcomes Associated with Supramaximal Peak Heart Rate on Treadmill Exercise Stress Testing

Article

May 2025
AM J CARDIOL

Exercício aeróbio influencia positivamente na redução da insatisfação corporal e na preocupação com a muscularidade em mulheres

Article

Full-text available

May 2025

Introdução: A imagem corporal é um conceito multidimensional elaborado a partir de aspectos fisiológicos, sociológicos e libidinais que pode ser influenciada por aspectos culturais e ambientais. Estudos tem buscado identificar os efeitos de algumas estratégias capazes de modular positivamente aspectos da imagem corporal, como a insatisfação e a preocupação com a muscularidade. Objetivo: Avaliar os efeitos de uma sessão de exercício aeróbico em diferentes intensidades sobre os componentes da imagem corporal em mulheres. Metodologia: Cinquenta e uma mulheres, jovens adultas insuficientemente ativas foram alocadas aleatoriamente para: a) 30 minutos de exercício aeróbio a 60-70% da frequência cardíaca de reserva (FCRes) ou b) 70-80% da FCRes. Medidas validadas foram utilizadas para avaliar a insatisfação corporal, preocupação com a muscularidade, checagem e a evitação corporal, internalização do ideal corporal e percepção da imagem corporal nos cinco momentos: pré-exercício, pós-exercício, 24, 48 e 72 horas pós-exercício. Resultados: Os principais resultados apresentaram efeito significativo de interação entre o protocolo (60-70% ou 70-80% da FCRes) e momentos de medida para a insatisfação corporal, indicando uma redução nos níveis de insatisfação corporal no momento pós em relação ao pré, e de momento de medida na preocupação com a muscularidade, com a média observada no momento 48h menor quando comparada aos momentos pré, mostrando que houve uma diminuição da preocupação com a muscularidade nas mulheres 48h após o exercício. Conclusões: Conclui-se que o exercício aeróbico influencia positivamente na redução da insatisfação corporal e na preocupação com a muscularidade em mulheres.

Sex differences in the work of breathing during exercise are independent of forced vital capacity in healthy adults

Article

Full-text available

May 2025
EXP PHYSIOL

During exercise, females have a higher work of breathing (ẆB) than males for a given minute ventilation (V̇E

\dot {V}_{\text {E}}

) ≥ 50–60 L min⁻¹, presumably due to sex differences in airway size. However, on average, males have greater forced vital capacity (FVC) than females, and the confounding effect of FVC on sex differences in ẆB is unknown. To determine the effects of FVC and sex on ẆB during exercise in healthy adults, 30 healthy adults (15 males, 15 females) completed spirometry and an incremental cycle exercise test to exhaustion. Throughout exercise, ẆB was calculated based on oesophageal pressure and open‐circuit spirometry. The ẆB–V̇E

\dot {V}_{\text {E}}

relationship was compared between the sexes across all participants and in seven males and seven females matched for FVC and age. Across all participants, FVC had no effect on the ẆB–V̇E

\dot {V}_{\text {E}}

relationship (P = 0.323), and females had a higher ẆB than males at a V̇E

\dot {V}_{\text {E}}

of 50 (P = 0.030), 60 (P = 0.023), 70 (P = 0.021) and 80 L min⁻¹ (P = 0.020). At a V̇E

\dot {V}_{\text {E}}

of 35 ± 2 L min⁻¹, FVC was not associated with ẆB (r2 = 0.042, P = 0.278). Conversely, at a V̇E

\dot {V}_{\text {E}}

of 70 ± 5 L min⁻¹, FVC was associated with ẆB across all participants (r2 = 0.164, P = 0.026), but not within each sex (males: r2 = 0.077, P = 0.317; females: r2 = 0.011, P = 0.714). In the males and females matched for FVC and age, females had a higher ẆB than males at a V̇E

\dot {V}_{\text {E}}

of 60 (P = 0.049), 70 (P = 0.019), 80 (P = 0.020) and 90 L min⁻¹ (P = 0.014). Overall, our findings indicate that sex differences in ẆB during exercise are not influenced by male–female differences in FVC.

Effects of Combining Shockwaves or Radiofrequency with Aerobic Exercise on Subcutaneous Adipose Tissue and Lipid Mobilization: A Randomized Controlled Trial

Article

Full-text available

May 2025

Reducing abdominal subcutaneous fat is a common concern among women, with evidence suggesting that combining aerobic exercise with external shock waves or radiofrequency may enhance fat reduction. This study aimed to assess the effects of six sessions of external shock wave therapy or radiofrequency combined with an aerobic exercise program on abdominal subcutaneous fat and lipid mobilization, compared to the effects of an aerobic exercise program alone. Thirty-one women (aged 18–60) were randomly assigned to three groups: EG1 (shockwave therapy + aerobic exercise), EG2 (radiofrequency + aerobic exercise), and CG (aerobic exercise only). Body composition measures, mean temperature, adipose tissue thickness, lipid profile, and glycerol and interleukin-6 levels were assessed before and after intervention. A significant decrease in the EG groups compared to the CG was observed in the subcutaneous abdominal thickness (p < 0.001, effect size of η2p = 0.446) and waist–hip ratio (p ≤ 0.001, effect size of η2p = 0.408). No significant changes were verified in the levels of lipolytic activity, lipid profile, and interleukine-6. Six sessions of shockwave or radiofrequency therapy combined with aerobic exercise reduced subcutaneous fat thickness and improved hip–waist ratio more effectively than aerobic exercise alone, without affecting lipid mobilization by changes in lipid profile, lipolytic activity, or interleukin-6 levels.

Physiological responses and physical performance of advanced and novice athletes in a specific MMA test

Article

Sep 2024

In Mixed Martial Arts (MMA), the evaluation of athletes’ performance is carried out mostly through non-specific tests. So far, there is only one specific test, the Anaerobic Specific Assessment for Mixed Martial Arts (ASAMMA). Thus, the objective of the present study was to apply ASAMMA to MMA athletes and compare their performance according to the competitive level. In the present study, 20 MMA athletes were involved, 10 advanced (ADV: 33.80± 4.80 years; height 179.40± 9.31 cm and 88.50± 20.83 kg) and 10 novices (NOV: 34.50± 5.81 years; 174.90± 5.99 cm and 86.00± 10.68 kg). In the first experimental session, anthropometric, resting heart rate (HR) and lactate (LA) measurements were performed. In the second session, ASAMMA was applied. Due to the physiological demand of the evaluation, ADV athletes performed three rounds, and the NOV only performed one round. At the end of each round, the following were recorded: i) HR values, ii) blood LA concentration, iii) total number of sequences performed per round and iv) fatigue index in ASAMMA. Regarding mean HR, differences were observed between groups (ADV: 167± 7.27 bpm and 89.2± 11.9% of maximum HR; NOV: 179± 3.8 bpm and 96.3± 3, 7% of maximum HR; p< 0.001). After the first round, LA concentration was 15.08± 2.86 mmol/L in ADV and 17.15± 1.36 mmol/L in NOV (p= 0.054). Among ADV, the LA increased throughout the rounds (F(2,10)= 5.81; p= 0.0111; η²= 0.39). ADV athletes performed a higher number of sequences in the first round (71.8± 7.87 versus 65.6± 2.87 repetitions; p= 0.003). However, in the analysis of repeated measures, a reduction in the number of sequences was observed throughout the rounds (F(2,10)= 14.37; p< 0.001). Negative correlations were found between body fat percentage and ASAMMA performance (p< 0.05) and between mean HR and ASAMMA performance (p< 0.01). ASAMMA can discriminate between advanced and novice athletes, both from a physiological (using heart rate as an indicator) and physical point of view, based on the number of sequences of movements.

Prescripción de actividad física en el manejo de pacientes con distrofia muscular de DuchennePrescription of physical activity in the management of patients with Duchenne muscular dystrophyPrescrição de atividade física no tratamento de doentes com Distrofia Muscular de Duchenne

Article

Full-text available

Apr 2025

En los pacientes con DMD la habilidad para caminar se reduce gradualmente hasta la pérdida de la marcha, cerca de los 9 años. A pesar de que la progresión de la enfermedad es inevitable, con la rehabilitación integral se busca, prolongar la función motora gruesa y manual, minimizar las contracturas, promover la salud ósea, proteger el adecuado posicionamiento de la columna vertebral y prolongar la marcha; mejorando la calidad de vida y la transición a la adolescencia y a la vida adulta. Entre las intervenciones de rehabilitación de la DMD se contempla el uso de órtesis y sillas de ruedas. Materiales y métodos: Se conformó un panel de expertos con conocimiento y experiencia en el manejo de pacientes con distrofia muscular de Duchenne. Con base en la revisión de la evidencia disponible, su conocimiento, su experiencia clínica y las características del sistema de salud colombiano. Las recomendaciones fueron sometidas a votación (mayor al 85 % de favorabilidad en dos ciclos de votación). En caso de tener un porcentaje de acuerdo menor al establecido, se discutió de nuevo la recomendación y se realizó un segundo ciclo de votación. Resultados y discusión: Se emite una serie de recomendaciones sobre la prescripción de ayudas técnicas en rehabilitación (órtesis y sillas de ruedas) para pacientes con distrofia muscular de Duchenne. Se necesita desarrollar estudios adicionales con el fin de solucionar las preguntas que no han podido ser respondidas hasta el momento sobre la prescripción de ayudas técnicas en pacientes con esta enfermedad.

Effects of different types of badminton training on sleep quality, anxiety, and related baseline physiological markers in graduate students with sleep disorders: a randomized controlled trial

Article

Full-text available

Apr 2025
BMC PUBLIC HEALTH

Background The prevalence of sleep disorders and anxiety is on the rise among high-stress groups like graduate students. Physical activity interventions have revealed effectiveness in improving mental health, yet the effect of specialized badminton training on sleep-disordered populations remains under-researched. Besides, the effects of various forms of badminton training on sleep quality and anxiety in graduate students vary. Objective Our study aims to evaluate the effect of basic skill, advanced skill, and physical conditioning-focused badminton training on sleep quality, anxiety levels, and baseline physiological markers in graduate students with sleep disorders. Methods A randomized controlled trial (RCT) was conducted (Clinical Registry Number: TCTR20250119001, 16 January 2025), involving 160 graduate students randomly assigned to one of four groups: Badminton Basic Skills Training Group (BBSTG), Badminton Advanced Skills Training Group (BASTG), Badminton Specialized Physical Training Group (BSPTG), and a Control Group (CG), with 40 participants per group. The experimental groups trained three times weekly for one hour per session over 12 weeks, while the CG received only standard lifestyle guidance. Repeated measurements of sleep quality and anxiety levels were assessed at baseline, 4, 8, and 12 weeks using the Pittsburgh Sleep Quality Index (PSQI) and Self-Rating Anxiety Scale (SAS), with resting heart rate and blood pressure also recorded at each time point. Results (i) Baseline Measurements: Prior to the intervention, no statistically significant differences were uncovered among groups in terms of sleep quality, anxiety levels, basic physiological data (resting heart rate, blood pressure), or general characteristics (age, height, weight, BMI) (p > 0.05). Attrition rates of 8%- 11% were observed across groups, causing final group sizes of 36, 37, 35, and 36 for BBSTG, BASTG, BSPTG, and CG, respectively. This attrition had minimal impact on statistical analysis. (ii) PSQI Scores: Sleep quality enhanced significantly across all experimental groups over the 12-week period, with the BSPTG group showing the greatest improvement. At week 12, the BSPTG's PSQI score was 5.8 ± 0.8, significantly better than that of the CG (p < 0.001, 95% CI [- 2.7, - 1.4]). The BSPTG consistently outperformed the control group at all time points, with an F-value of 10.32 at week 12 (p < 0.001), stressing the positive effect of badminton training on sleep quality. (iii) SAS Scores: At week 12, the BSPTG’s SAS score was 36.3 ± 4.0, significantly lower than that of the CG (p < 0.001, 95% CI [- 6.1, - 3.2]). Anxiety levels reduced significantly across all experimental groups, with the BSPTG demonstrating the most notable reduction, further illustrating the significant effect of physical conditioning training on anxiety relief. (iv) Resting Heart Rate and Blood Pressure: Resting heart rate reduced significantly over the 12-week period, with the BSPTG achieving a final rate of 66.1 ± 4.8, significantly better than that of the CG (p < 0.001, 95% CI [- 6.9, - 3.2]). While blood pressure displayed some reduction post-intervention, differences were not statistically significant (p > 0.05), revealing limited short-term effect of badminton training on blood pressure. (v) Effect Sizes (Cohen’s d): In PSQI scores, BSPTG showed a large effect (d = 0.8), BASTG a medium effect (d = 0.5), and BBSTG a small effect (d = 0.3). For SAS scores, BSPTG demonstrated a medium-to-large effect (d = 0.7), BASTG a medium effect (d = 0.5), and BBSTG a small effect (d = 0.3). In resting heart rate, BSPTG showed the most significant improvement (d = 0.6), with BASTG showing a small-to-medium effect (d = 0.4) and BBSTG showing minimal improvement. Effect sizes for blood pressure were not significant. Conclusion Specialized badminton training, in detail, physical conditioning training, can significantly improve sleep quality and reduce anxiety levels in graduate students with sleep disorders and decrease resting heart rate. As a non-pharmacological intervention, specialized badminton training has underlying applications for enhancing mental health and cardiovascular health. Trial registration Randomized Controlled Trials, TCTR20250119001, 16 January 2025.

Validation of a Time-to-Exhaustion-Derived V̇O2max Prediction Equation and Secondary Criteria Agreement: The CARDIA Study

Article

Apr 2025

Introduction Measuring maximal oxygen consumption (V˙O 2max ) during a graded exercise test (GXT) poses challenges in population-based studies. We examined the relationship between GXT duration (GXTd) and V˙O 2max to create a prediction equation for estimating V˙O 2max from GXTd. We also assessed the agreement among secondary V˙O 2max criteria: respiratory exchange ratio (RER; ≥1.10), maximal heart rate (mHR; ≥85% age-predicted), and ratings of perceived exertion (RPE; >17). Methods Data include 580 Coronary Artery Risk Development in Young Adults (CARDIA) participants (55.9% female, 38.6% Black) who attended the year 35 exam (age 54–66 yr) and completed a GXT with gas analysis. Pearson correlation coefficients were computed between GXTd (seconds) and V˙O 2max (mL·kg ⁻¹ ·min ⁻¹ ). A regression equation was developed to predict V˙O 2max from GXTd. Secondary criteria agreement was assessed using percent agreement, kappa, sensitivity/specificity, and receiver operating characteristics (ROC) analysis, excluding 38 participants on beta-blockers. Results Mean (standard deviation) GXTd and V˙O 2max were 341.6 (137.0) s and 26.6 (7.1) mL·kg ⁻¹ ·min ⁻¹ , respectively, exhibiting a strong correlation ( r = 0.83) similar for male and female participants ( r = 0.81 and 0.80, respectively). The final prediction model included GXTd, body mass index, and physical activity status as significant V˙O 2max predictors ( R ² = 0.72; bias = 0.14 mL·kg ⁻¹ ·min ⁻¹ ; 95% confidence interval (CI), −1.24 to 1.52). RER, mHR, and RPE thresholds were met by 90.8%, 85.2%, and 42.8%, respectively. Agreement between mHR and RER was 82.9% (kappa = 0.178 (95% CI, 0.07–0.29); 34.0% sensitivity, 87.9% specificity). The agreement between RPE and RER was 45.3% (kappa = 0.018 (95% CI, −0.02 to 0.06); 62.5% sensitivity, 43.6% specificity). ROC analyses showed a larger area under the curve for mHR and RER (0.762 (95% CI, 0.705–0.820)) compared to RPE and RER (0.598 (95% CI, 0.522–0.674)). Conclusions GXTd serves as a reliable measure of cardiorespiratory fitness in the absence of gas analysis, and a corresponding V˙O 2max prediction equation can be effectively utilized. Discrepancies in secondary criteria highlight challenges in determining maximal effort, especially based on participant reports.

High-Intensity Gait Training for Patients After Stroke: A Feasibility Study

Article

Apr 2025
Physiother Res Int

Background and Purpose Approximately two‐thirds of stroke patients experience various levels of walking impairment that limit their participation in society. Mounting evidence suggests that gait training provided at high cardiovascular intensity with a focus on stepping practice improves gait function after stroke and is superior to lower intensity standard gait training. However, high intensity gait training (HIGT) is not widely applied. Purpose With this study, we wanted to examine the feasibility of HIGT in a XXX neurorehabilitation hospital. Methods A longitudinal cohort study with 15 patients participated in 2 weeks of HIGT with 3‐5 sessions per week. HIGT was provided as part of standard physical therapy. The results included feasibility measures such as adherence and fidelity to treatment, adverse events, and patient satisfaction. Furthermore, gait assessments were performed before and after the intervention and heart rate and number of steps were monitored during the training sessions. Results Eleven of the 15 patients were non‐ambulatory or dependent on the support of two people at the start of HIGT. Adherence to treatment was good, with almost all (14/15) completing 8 sessions or more. No serious adverse events occurred. The target heart rate of > 60% of HR max was achieved for a mean of 26.4, SD 7.4, min‐max 12.3–37.0 min per session. The number of steps increased from 245.44 (SD 223.12) in the first session to 676.75 (SD 376.83) in the last session. However, with a large variety, both within and between individuals. There was a significant improvement in all gait assessments. Patient satisfaction was high. Discussion HIGT was feasible, well tolerated by the patients and could be provided within existing staffing levels. There were no serious adverse events, and all patients confirmed that they would recommend HIGT to a friend in the same situation.

Assessment of sub-maximal aerobic capacity in North African patients with chronic hepatitis B: a pilot case-control study

Article

Full-text available

Apr 2025

Background Studies assessing sub-maximal aerobic capacity in non-cirrhotic chronic hepatitis B (CHB) patients are scarce. This study aimed to evaluate sub-maximal aerobic capacity in CHB patients compared to apparently healthy participants (control-group (CG)). Methods A 6-min walk test (6MWT) was performed. The 6-min walk distance (6MWD) was recorded, along with heart-rate (HR), oxy-hemoglobin saturation (SpO2), blood-pressure, and dyspnea ( ie ; visual analogue scale) at rest (Rest) and at the end (End) of the 6MWT. Additionally, the 6-min walk work (6MWW), and estimated cardiorespiratory and muscular chain age were calculated. Signs of physical intolerance were determined including abnormal 6MWD ( ie ; 6MWD < lower limit of normal), chronotropic insufficiency (ie ; HREnd < 60% of maximal predicted HR (MPHR)), high dyspnea ( ie ; dyspneaEnd > 5), and desaturation ( ie ; drop in SpO2 > 5 points). Results Compared to the CG (n=28), the CHB-group (n=26) exhibited significantly lower 6MWD by 61 meters (8%), lower 6MWW by 10%, and lower HREnd by 21% (when expressed in bpm) and 17% (when expressed in %MPHR). The CHB-group, compared to the CG, included higher percentages of participants with chronotropic insufficiency and abnormal 6MWD (23.08% vs. 3.57%, and 34.61% vs. 3.57%, respectively). The CHB-group was 8.1 and 14.3 times more likely to have chronotropic insufficiency and abnormal 6MWD than the CG, respectively. CHB accelerated the aging of the cardiorespiratory and muscular chain by 11 years. Conclusion Non-cirrhotic CHB may contribute to reduced submaximal aerobic capacity and acceleration of cardiorespiratory and muscular chain aging.

Short Bouts, Big Impact: The Cognitive Benefits of Brief Exercise

Article

Full-text available

Apr 2025

Acute bouts of exercise have been shown to have measurable positive impacts on cognition. Here participants either watched a movie (control), walked (moderate exercise), or ran (vigorous exercise) on a treadmill for 30 min while their heart rate was measured before completing a paired associative learning task in which they learned 40 word pairs over the course of 10 trials. We defined learning rate as how fast the participants correctly learned the word pairs. Two days later, all participants were given a surprise recall task, and we defined long-term memory as the number of word pairs correctly recalled. We also measured working memory capacity, anxiety, and sleep quality. We found that while there was no difference between exercise conditions in the rate of learning, participants in the vigorous condition recalled more word pairs 2 days later. Analyses revealed that average heart rate and condition were the only significant predictors of long-term recall. Potential mechanisms to explain the benefits of the vigorous exercise condition on long-term retention, but not on short-term retention, are discussed.

Refining Maximal Heart Rate Estimation to Enhance Exercise Recommendations for Persons With Parkinson Disease

Article

Apr 2025
ARCH PHYS MED REHAB

The relationship between 10meter walk test and 6minute walk test in subacute stroke patients

Article

Mar 2025

Eun-Joo Kim

Evaluation of cardiac autonomic nervous system activity and cardiopulmonary fitness in type 1 diabetes: A cross-sectional study

Article

Apr 2025

The autonomous nervous system (ANS) function is a valid parameter for evaluating cardiorespiratory efficiency index (VO2peak). ANS function is usually assessed through mean heart rate (HR) or heart rate variability (HRV). The aim of this study was to investigate the relationship between a range of cardiac autonomic function indices and VO2peak to assess the predictors of cardiopulmonary efficiency during rest, peak exercise performance, and recovery in adolescent males with type 1 diabetes (T1D). This cross-sectional study recruited 60 adolescent male participants with T1D (age, 15.3 ± 1.4; mean duration of diagnosis, 6.4 ± 1). A profile of cardiac autonomic indices related to HR and HRV was measured during rest, exercise, and recovery conditions. VO2peak was evaluated using Graded Exercise Testing (GXT). Simple linear regression models indicated a significant correlation between VO2peak and high-frequency power (HF) and ratio of low- to high-frequency power (LF/HF) indices at rest, peak exercise, and recovery; average HR and RMSSD at rest and recovery; and standard deviation of all normal R-R intervals (SDNN) at rest (R coefficients ranged from 0.90 to 0.32, p < 0.05). The multiple linear regression model indicated the HF during recovery as an independent predictor for VO2peak (R2 = 0.86, R = 0.93, p < 0.001). HF appears to be a more suitable predictor of the cardiorespiratory system efficiency in the resting and recovery stages of exercise than the HR factor. The quantification of selected HRV time and frequency factors may provide clinicians with more insightful information about the cardiovascular health status of adolescents with T1D during standard exercise and subsequent recovery period. Has been approved by the Iranian Registry of Clinical Trials at 2024–04-17. IRCT20211031052926N2. https://irct.behdasht.gov.ir/trial/75288

Análisis del rendimiento en jóvenes nadadores tras un entrenamiento de alto volumen de 12 semanas

Article

Full-text available

Apr 2025

Las prácticas tradicionales de entrenamiento en natación suelen implicar volúmenes de trabajo elevados. El presente estudio tiene como objetivo analizar el impacto de un programa de entrenamiento de 12 semanas de alto volumen y baja intensidad en el rendimiento deportivo de jóvenes nadadores que participan en competiciones oficiales, comparando los resultados obtenidos según las diferentes categorías de edad y por sexo. Un total de 144 nadadores menores de edad (68 hombres y 76 mujeres) participaron en este estudio. Se comenzó con un volumen inicial de 3.750-7.500 metros semanales según la categoría, aumentando un 5% por mesociclo. La intensidad se controló mediante el tiempo inicial para el estilo libre (65-75%) y la frecuencia cardiaca máxima en el resto de estilos (60-70%). Se registraron mejoras significativas en los tiempos de todas las categorías a lo largo de la intervención. Todas las categorías mejoraron las marcas pre-post (tanto considerando toda la muestra, como análisis diferenciado por sexo), sin embargo, no se encontraron diferencias significativas en las mejoras entre categorías. En conclusión, un entrenamiento de alto volumen de 12 ha demostrado tener efectos positivos en el rendimiento de los niños y adolescentes que compiten en natación, siendo más notables en las edades más tempranas. Aunque se registraron mejoras en ambos sexos al dividirlos por categorías, estas fueron más pronunciadas en las mujeres.

Autonomic Adjustments to Exercise in Humans

Article

Apr 2015

Autonomic nervous system adjustments to the heart and blood vessels are necessary for mediating the cardiovascular responses required to meet the metabolic demands of working skeletal muscle during exercise. These demands are met by precise exercise intensity‐dependent alterations in sympathetic and parasympathetic nerve activity. The purpose of this review is to examine the contributions of the sympathetic and parasympathetic nervous systems in mediating specific cardiovascular and hemodynamic responses to exercise. These changes in autonomic outflow are regulated by several neural mechanisms working in concert, including central command (a feed forward mechanism originating from higher brain centers), the exercise pressor reflex (a feed‐back mechanism originating from skeletal muscle), the arterial baroreflex (a negative feed‐back mechanism originating from the carotid sinus and aortic arch), and cardiopulmonary baroreceptors (a feed‐back mechanism from stretch receptors located in the heart and lungs). In addition, arterial chemoreceptors and phrenic afferents from respiratory muscles (i.e., respiratory metaboreflex) are also capable of modulating the autonomic responses to exercise. Our goal is to provide a detailed review of the parasympathetic and sympathetic changes that occur with exercise distinguishing between the onset of exercise and steady‐state conditions, when appropriate. In addition, studies demonstrating the contributions of each of the aforementioned neural mechanisms to the autonomic changes and ensuing cardiac and/or vascular responses will be covered. © 2015 American Physiological Society. Compr Physiol 5:475‐512, 2015.

Pulmonary Gas Exchange and Acid‐Base Balance During Exercise

Article

Apr 2013

As the first step in the oxygen‐transport chain, the lung has a critical task: optimizing the exchange of respiratory gases to maintain delivery of oxygen and the elimination of carbon dioxide. In healthy subjects, gas exchange, as evaluated by the alveolar‐to‐arterial P O 2 difference ( A ‐ a DO 2 ), worsens with incremental exercise, and typically reaches an A ‐ a DO 2 of approximately 25 mmHg at peak exercise. While there is great individual variability, A ‐ a DO 2 is generally largest at peak exercise in subjects with the highest peak oxygen consumption. Inert gas data has shown that the increase in A ‐ a DO 2 is explained by decreased ventilation‐perfusion matching, and the development of a diffusion limitation for oxygen. Gas exchange data does not indicate the presence of right‐to‐left intrapulmonary shunt developing with exercise, despite recent data suggesting that large‐diameter arteriovenous shunt vessels may be recruited with exercise. At the same time, multisystem mechanisms regulate systemic acid‐base balance in integrative processes that involve gas exchange between tissues and the environment and simultaneous net changes in the concentrations of strong and weak ions within, and transfer between, extracellular and intracellular fluids. The physicochemical approach to acid‐base balance is used to understand the contributions from independent acid‐base variables to measured acid‐base disturbances within contracting skeletal muscle, erythrocytes and noncontracting tissues. In muscle, the magnitude of the disturbance is proportional to the concentrations of dissociated weak acids, the rate at which acid equivalents (strong acid) accumulate and the rate at which strong base cations are added to or removed from muscle. © 2013 American Physiological Society. Compr Physiol 3:693‐739, 2013.

Exercise and Experiments of Nature

Article

Jul 2023

In this article, we highlight the contributions of passive experiments that address important exercise‐related questions in integrative physiology and medicine. Passive experiments differ from active experiments in that passive experiments involve limited or no active intervention to generate observations and test hypotheses. Experiments of nature and natural experiments are two types of passive experiments. Experiments of nature include research participants with rare genetic or acquired conditions that facilitate exploration of specific physiological mechanisms. In this way, experiments of nature are parallel to classical “knockout” animal models among human research participants. Natural experiments are gleaned from data sets that allow population‐based questions to be addressed. An advantage of both types of passive experiments is that more extreme and/or prolonged exposures to physiological and behavioral stimuli are possible in humans. In this article, we discuss a number of key passive experiments that have generated foundational medical knowledge or mechanistic physiological insights related to exercise. Both natural experiments and experiments of nature will be essential to generate and test hypotheses about the limits of human adaptability to stressors like exercise. © 2023 American Physiological Society. Compr Physiol 13:4879‐4907, 2023.

Exercise Physiology of Normal Development, Sex Differences, and Aging

Article

Oct 2011

The scientific study of human development has evolved from studies of children to studies of the full lifespan. Many physiological changes occur throughout the lifespan and unique changes occur during normal development compared to healthy aging. An enlarging body of data supports the idea that there exist critical periods of development during which physiological perturbations to the internal milieu (e.g., disease or physical activity) can alter the overall programming of developmental processes. Although different physiological functions decline with age with widely varying rates, the aging changes accumulated throughout the physiological systems reduce the capacity to cope with the stress and maintain homeostasis. The understanding of this process of development and aging is complicated by important physiologic sex differences with regard to nearly all physiological systems. Regular physical activity can favorably modulate this developmental and aging process and can have important health benefits. However, a physically inactive lifestyle can markedly impair normal development and lead to numerous diseases. Life‐long physical activity is essential for preserving or delaying the onset of functional disability and chronic cardiovascular and metabolic diseases. © 2011 American Physiological Society. Compr Physiol 1:1649‐1678, 2011.

Inhibition of sympathetic vasomotor outflow during low-intensity leg cycling is attenuated in healthy older females

Article

Apr 2025
J APPL PHYSIOL

The purpose of the present study was to elucidate the impact of age on muscle sympathetic nerve activity (MSNA) during dynamic leg exercise in females. Nine older females (71±2 years, mean±SD) and ten younger females (21±2 years) completed the study. The participants performed two 4 min leg cycling at 10% of their heart rate reserve using a cycle ergometer in a semirecumbent position [MSNA and estimated central venous pressure (eCVP) trials]. MSNA was recorded via microneurography of the left radial nerve. The CVP was estimated based on peripheral venous pressure, which was monitored using a cannula in the right antecubital vein. The magnitude of the change in mean arterial blood pressure during exercise was larger (P<0.001) in older females (+11.6±4.7 mmHg) compared with younger females (+4.1±3.2 mmHg). MSNA burst frequency (BF) was decreased during cycling in both groups, but the magnitude of the decrease in MSNA BF was smaller (P=0.004) in older females (−5.6±1.8 bursts/min) than in younger females (−9.1±2.5 bursts/min). The eCVP increased during exercise in both groups, and there was no difference in the changes in eCVP between the two groups (older, +0.80±0.27 vs. younger, +1.02±0.51 mmHg, P=0.462). From these results, it is possible that the cardiopulmonary baroreflex-mediated inhibition of sympathetic vasomotor outflow, elicited by the muscle pump, may be attenuated with advancing age in females.

The impact of a two-hour endurance run on brain activity monitored over 24 h

Article

Full-text available

Mar 2025
EXP BRAIN RES

Acute exercise has been shown to enhance cognitive abilities, particularly those governed by the prefrontal cortex, such as executive function. However, the effects of prolonged exercise on cognition and brain activity, especially over extended recovery periods, remain underexplored. This pilot study investigated the effects of two hours of moderate-intensity running on oscillatory brain activity and working memory performance, monitored across a 24-hour recovery period—an interval not previously studied. Using electroencephalography (EEG) and a 2-back task, resting-state brain activity and task-specific frontal theta power were assessed. While task accuracy and reaction times showed no significant changes, frontal theta power increased one hour post-exercise, reflecting heightened cognitive effort. Resting-state EEG demonstrated a sustained increase in high-alpha power, which persisted until the 24-hour mark and indicated cortical recovery processes. While limited by the lack of a control group, these findings suggest that prolonged moderate-intensity exercise may elicit complex and delayed neurophysiological responses, supporting recovery and neural resilience in trained individuals. Therefore, our research offers new insights into the interplay between exercise, cognition, and recovery, with implications for optimizing performance in physically demanding contexts.

Pulmonary capillary blood volume and diffusing membrane capacity during exercise in humans: role of pulmonary artery pressure

Article

Mar 2025
AM J PHYSIOL-LUNG C

During exercise, lung diffusing capacity for carbon monoxide (DL CO ), pulmonary capillary blood volume (V c ), and diffusing membrane capacity (D M ) increase secondary to a rise in pulmonary artery pressure (PAP) and central blood volume mobilization. While the role of central blood volume on DL CO is well established, the impact of PAP on DL CO , V c , and D M during exercise is less clear. Based on previous work, we tested the hypothesis that acute increases in PAP will potentiate exercise DL CO via increases in D M . Fifteen healthy young adults (7 females; age: 24±4 years) completed two bouts of cycling exercise at 60W, with (CUFF) or without (CON) bilateral thigh cuff inflation pressurized to 90 mmHg. The multiple fractions of inspired O 2 -DL CO method was used to determine DL CO , V c and D M at baseline and during both exercise conditions alongside estimates of cardiac output (Q̇ c ; impedance cardiography), and right ventricular systolic pressure (RVSP; echocardiography). CUFF exercise resulted in a larger increase in RVSP (CUFF: 44.7±6.1 vs. CON: 38.9±5.5 mmHg; P=0.036), but not Q̇ c ( P=0.644) or V̇O 2 ( P=0.976) compared to CON. DL CO was higher during CUFF exercise (CUFF: 41±6 vs. CON: 38±6 ml/min/mmHg; P=0.001), and was mediated by increases in D M (CUFF: 138±55 vs. CON: 90±39 ml/min/mmHg; P=0.032), not V c (CUFF: 85±18 vs. CON: 98±27 ml/min/mmHg; P=0.820). Increases in RVSP were positively related with D M (r rm =0.82; P=0.024) but inversely related with V c (r rm =-0.80, P=0.029). Collectively, these data indicate that PAP primarily contributes to DL CO during low intensity exercise via increases in capillary recruitment (i.e., D M ).

Universal Proteomic Signature After Exercise‐Induced Muscle Injury in Muscular Dystrophies

Article

Full-text available

Mar 2025

Objective Several neuromuscular disorders (NMDs) are characterized by progressive muscle damage and are marked by the elevation of circulating muscle proteins from activity‐related injury. Despite a diverse array of genetic drivers, many NMDs share similar patterns of exercise intolerance and higher concentrations of muscle injury proteins relative to unaffected individuals. While the interplay between the nature of the muscle injury and the specific genetic driver is poorly understood, the similarities exhibited by various NMDs suggest that a common proteomic signature of muscle injury may exist. Methods We used an established exercise challenge and the SOMAscan proteomics platform to study the baseline and post‐exercise proteomic profiles in a cross‐sectional study of three different muscular dystrophies: Becker muscular dystrophy (BMD) and limb girdle muscular dystrophy types R9 and R12. Results Our Results Uncover a Common Signature of Circulating Proteins That Are Elevated in all Three Myopathies, Some of Which Are Further Elevated by Exercise in Becker Muscular Dystrophy and Limb Girdle Muscular Dystrophy Type R9, and Others That Are Not Responsive to Exercise. Interpretation Interestingly, these two signatures exhibit opposing trajectories with age in a larger cross‐sectional cohort of BMD individuals. This research represents a first step toward defining an annotated protein signature coupled with activity‐injury, a defining pathophysiological feature of many myopathies.

Exploring physiological and emotional responses to exercise with additional body mass: an experiential learning activity

Article

Mar 2025
ADV PHYSIOL EDUC

Gregory N. Ruegsegger

Many Exercise and Sport Science (EXSS) undergraduate students enter their programs with weight bias, which can hinder their ability to empathize and effectively work with overweight individuals. This experiential learning activity explored the physiological and emotional responses to exercise with additional mass. Further, this experience sought to address weight bias among EXSS students by promoting a deeper understanding of the difficulties faced by individuals with excess body weight during exercise. Twelve students enrolled in an Exercise for Special Populations course participated in treadmill walking and cycling exercise with and without 15% additional body mass. During exercise, the effect of additional mass on cardiometabolic (e.g., heart rate, blood pressure, VO 2 , caloric expenditure) and psychological (e.g., perceived exertion, affective response) measures were evaluated. Before the experiential activity, students engaged in a lecture reviewing preparticipation screening, body composition assessment, and exercise testing procedures. Students reported significant differences in physiological and affective responses to exercise between the two modalities, with treadmill walking with additional mass showing increased exertion. Interestingly, student predictions of psychological responses to walking with additional mass were less negative than their actual experiences, highlighting the difficulty of exercising with additional body mass. Post-activity feedback indicated that students felt highly confident in administering exercise tests and reported enhanced awareness of the challenges faced by overweight individuals. These observations support that incorporating practical activities involving altered body weight can improve practical skills and foster greater empathy towards overweight populations, enhancing student preparedness for careers in allied health fields.

Relationship of Left Ventricular Structure to Maximal Heart Rate During Exercise

Article

Full-text available

Mar 1995

Previous investigators using clinical, hemodynamic, or exercise parameters to predict maximal exercise heart rate (HRmax) have demonstrated age to be the major determinant. Regression coefficients have ranged from -0.3 to -0.6, leaving approximately two thirds of the variance in HRmax unexplained. Because cardiac size and function are directly related to stroke volume and should influence HRmax, we studied 114 male subjects (aged 19 to 73 years) with two-dimensional and M-mode echocardiography who underwent maximal treadmill testing with respiratory gas analysis. Seventy-three were normotensive (diastolic BP < 95 mm Hg) and 41 were hypertensive. As in previous studies, HRmax was inversely related to age (HRmax = 199-0.63[age], r = -0.47, p < 0.001). M-mode left ventricular (LV) diastolic dimension (LVD) added significantly to the explanation of the variance in HRmax (r = -0.57, p < 0.001) (HRmax = 236 - 0.72 [age]-6.8 [LVD]). Thus, the larger the heart, the lower the HRmax. No other echocardiographic measurement or derived parameter added significantly to the explanation of the variance in HRmax. To evaluate the effects of hypertension on HRmax, we studied hypertensives and normotensives separately. Only age was significantly related to HRmax in the normotensives (r = -0.50, p < 0.001). In the hypertensive subjects, however, both age and relative wall thickness (RWT) (which describes LV wall thickness in relation to LV chamber size) were significantly related to HRmax. Age explained 45% of the observed variance in HRmax (r = 0.67, p < 0.001) and RWT added modestly (9%) but significantly to the relationship (HRmax = 173-0.96[age]+94 [RWT], p < 0.001), together explaining 54% of the variance observed in HRmax. Thus, HRmax is inversely related to LVD and patients with larger ventricles achieve lower HRmax. In hypertensives, the amount of LV muscle mass in relation to chamber size is an additional predictor of HRmax. However, despite controlling for age, sex, and cardiovascular disease, and the inclusion of echocardiographic indices of cardiac size and function, a large portion of the variance in HRmax could not be explained. The unexplained variance in HRmax is most likely due to intersubject variability in resting cardiac size, volume, function, and other as yet undefined factors.

Article

Full-text available

Aug 1997

Our purpose was to determine the relationship between habitual aerobic exercise status and the rate of decline in maximal aerobic capacity across the adult age range in women. A meta-analytic approach was used in which mean maximal oxygen consumption (VO2 max) values from female subject groups (ages 18-89 yr) were obtained from the published literature. A total of 239 subject groups from 109 studies involving 4,884 subjects met the inclusion criteria and were arbitrarily separated into sedentary (groups = 107; subjects = 2,256), active (groups = 69; subjects = 1, 717), and endurance-trained (groups = 63; subjects = 911) populations. VO2 max averaged 29.7 +/- 7.8, 38.7 +/- 9.2, and 52.0 +/- 10.5 ml . kg-1 . min-1, respectively, and was inversely related to age within each population (r = -0.82 to -0.87, all P < 0.0001). The rate of decline in VO2 max with increasing subject group age was lowest in sedentary women (-3.5 ml . kg-1 . min-1 . decade-1), greater in active women (-4.4 ml . kg-1 . min-1 . decade-1), and greatest in endurance-trained women (-6.2 ml . kg-1 . min-1 . decade-1) (all P < 0.001 vs. each other). When expressed as percent decrease from mean levels at age approximately 25 yr, the rates of decline in VO2 max were similar in the three populations (-10.0 to -10.9%/decade). There was no obvious relationship between aerobic exercise status and the rate of decline in maximal heart rate with age. The results of this cross-sectional study support the hypothesis that, in contrast to the prevailing view, the rate of decline in maximal aerobic capacity with age is greater, not smaller, in endurance-trained vs. sedentary women. The greater rate of decline in VO2 max in endurance-trained populations may be related to their higher values as young adults (baseline effect) and/or to greater age-related reductions in exercise volume; however, it does not appear to be related to a greater rate of decline in maximal heart rate with age.

Greater rate of decline in maximal aerobic capacity with age in physically active vs. sedentary healthy women

Article

Full-text available

Jan 1998

Using a meta-analytic approach, we recently reported that the rate of decline in maximal oxygen uptake (VO2 max) with age in healthy women is greatest in the most physically active and smallest in the least active when expressed in milliliters per kilogram per minute per decade. We tested this hypothesis prospectively under well-controlled laboratory conditions by studying 156 healthy, nonobese women (age 20-75 yr): 84 endurance-trained runners (ET) and 72 sedentary subjects (S). ET were matched across the age range for age-adjusted 10-km running performance. Body mass was positively related with age in S but not in ET. Fat-free mass was not different with age in ET or S. Maximal respiratory exchange ratio and rating of perceived exertion were similar across age in ET and S, suggesting equivalent voluntary maximal efforts. There was a significant but modest decline in running mileage, frequency, and speed with advancing age in ET. VO2 max (ml . kg-1 . min-1) was inversely related to age (P < 0.001) in ET (r = -0.82) and S (r = -0.71) and was higher at any age in ET. Consistent with our meta-analysic findings, the absolute rate of decline in VO2 max was greater in ET (-5.7 ml . kg-1 . min-1 . decade-1) compared with S (-3.2 ml . kg-1 . min-1 . decade-1; P < 0. 01), but the relative (%) rate of decline was similar (-9.7 vs -9. 1%/decade; not significant). The greater absolute rate of decline in VO2 max in ET compared with S was not associated with a greater rate of decline in maximal heart rate (-5.6 vs. -6.2 beats . min-1 . decade-1), nor was it related to training factors. The present cross-sectional findings provide additional evidence that the absolute, but not the relative, rate of decline in maximal aerobic capacity with age may be greater in highly physically active women compared with their sedentary healthy peers. This difference does not appear to be related to age-associated changes in maximal heart rate, body composition, or training factors.

The exercise stress test: Needs for standardization

Article

Jan 1970

ACC/AHA 2002 guideline update for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing)

Article

Jan 2002
J AM COLL CARDIOL

Physical Activity and Primary Prevention

Article

Jan 2003

The degree of physical fitness demands on the extent, frequency and intensity of physical activity. In primary prevention there is an inverse relation between a high physical capacity and total mortality or cardiac events. The optimal amount of physical activity to decrease mortality or cardiovascular diseases is in literature stated to range between 1,000 and 3, 500 motoric kcal per week principally independent from the intensity of physical exercise. Only a few data exist concerning the optimal intensity of preventive physical activity. There is some indication that only "vigorous" but not "non-vigorous" physical activities are associated with decreased mortality, but there is no study comparing the two types of intensity revealing a different outcome in total mortality or cardiovascular diseases. On the other hand it has been documented, that "physical fitness" (endurance capacity) is a decisive factor for a decreased mortality. Therefore, it may be assumed, that physical activities are only efficient for health benefits, if they also result in increased physical fitness. The recommendations from the American College of Sports Medicine are based on these considerations; they call for regular physical exercise of intermediate or higher intensity. Following this assumption, quality and quantity of training in primary prevention has to be adjusted to the individual requirements (performance, age, gender, health) of the subjects.

In Cardiology: Current Topics and Progress

Article

Effect of Age and Other Factors on Maximal Heart Rate

Article

Feb 2013

In an attempt to reduce the confusion regarding reported effects of age upon maximal exercise heart rate (HR max), a comprehensive review of the English literature was conducted to obtain descriptive statistical data representing over 23,000 independent subjects from 5 to 81 years old. The data were split randomly into two data sets for independent regression analyses. HR max was the dependent variable while independent variables include: age, age2, age3, age4, sex, level of fitness, type of ergometer, exercise protocol, continent of residence, and race. After cross validation the data were pooled and reanalyzed. Additional validation was accomplished on identifiable subsets of the data, e.g., cross sectional, longitudinal, training, comparative ergometry, and comparative sex studies. Results identified negative linear and non-linear age factors, an ergometry factor, a fitness factor and a continent factor. Age accounted for about 70–75% of the variability. Generalized equations were proposed. Even with all factors accounted for, the 95% confidence interval of individual HR max was about 45 beats/min. Tables of HR max derived from the equations are included.

Historical note: The normal range and determinants of the intrinsic heart rate in man.

Article

Maximal heart rate and treadmill performance of healthy women in relation to age

Article

Feb 1978

Maximal treadmill exercise heart rate, work capacity and electrocardiographic response were studied in 95 asymptomatic, predominantly sedentary women between the ages of 19 and 69 years. Average maximal heart rate (MHR) was found inversely related to age, such that MHR = 216 -0.88 (years of age) +/- 10 beats/min (X +/- 1 SD). Treadmill exercise endurance was 7.64 min +/- 1.99. The reduction of treadmill endurance with advancing age was not statistically significant. Asymptomatic ST-segment depression occurred in 6% of subjects. In 5% the ST segment sloped upward, and in 1% it was flat. Mean age of women with ST depression was 52 years, compared with 39 years mean age of all subjects. Premature beats during exercise were found in 20 of 95 subjects, and were not related to age. Graded exercise testing of women employing target heart rates should use heart rate tablets developed especially for women. These tables do not require correction for athletically trained for sedentary life-style.

Predictors of over- and underachievement age-predicted maximal heart rate

Article

Nov 1992

The age-predicted maximal heart rate (PMHR) formula, 220--age, is frequently used for identifying exercise training intensity, as well as determining endpoints for submaximal exercise testing. This study was designed to identify variables discriminating those with actual maximal heart rates considerably above or below that predicted from the 220--age equation. Subjects included 2010 men and women ranging in age from 14 to 77 yr. Stepwise discriminant analysis was performed using maximal heart rate error groups as the dependent variable, and selected preexercise test characteristics as predictors. The HR error groups were based on the difference between the measured and PMHR as follows: below (> or = 15 beats.min-1 below PMHR), within (+/- 14 beats.min-1 of PMHR), and above (> or = 15 beats.min-1 above PMHR). A contrast of the below and above groups identified age, resting HR, body weight, and smoking status as predictors of group membership (P < 0.01) for both men and women. The overall canonical correlation was 0.282 and 0.294 for the men and women, respectively. Older age, higher resting HR, lower weight, and non-smoking were related to the above group, while the inverse was related to the below group. Standardized coefficients suggest that age and resting heart rate for the men, and age and smoking status for the women were the most potent variables for discriminating extreme deviations between measured and PMHR.(ABSTRACT TRUNCATED AT 250 WORDS)

Variations of normal sinus node function in relation to age: Role of autonomic influence

Article

Sep 1986

An electrophysiological study of sinus node function, including measurements of resting heart rate, maximal corrected sinus node recovery time and sinoatrial conduction time, was performed in 30 patients, 12–79 years of age, without any clinical, electro car diographic or electrophy siological evidence of sinus node disease. To analyse autonomic influences, variables were measured before and after sympathetic and parasympathetic blockade. No significant correlations were observed between age and electrophysiological measurements of sinus node function at the control study or after sympathetic blockade. In contrast, the electrophysiological parameters of intrinisic sinus node activity were correlated with age and showed a progressive lengthening of mean sinus cycle length, of maximal corrected sinus node recovery time and of sinoatrial conduction time. In addition, measurements after vagolysis suggest a progressive decrease of parasympathetic activity with increasing age. These data also indicate that the respective role of the two components of the autonomic nervous system vary with increasing age: parasympathetic activity predominates in younger subjects; sympathetic and parasympathetic tones are equilibrated in older subjects. The normal sinus node function represents an equilibrated system: in parallel with ageing of the intrinsic properties of the sinus node, parasympathetic activity decreases so that basal properties remain stable throughout life.

Acute response to submaximal and maximal exercise consequent to beta-adrenergic blockade: Implications for the prescription of exercise

Article

May 1985
AM J CARDIOL

Forty-seven healthy male subjects, 17 to 34 years old, completed a test to exhaustion on a motor-driven treadmill to determine their maximal oxygen uptake. A second test was administered 2 days later during which the subject walked for 20 to 25 minutes at a steady-state level representing 60% of the maximal oxygen uptake as determined in the first test. The grade was then increased every 2 minutes until the subject reached the state of exhaustion. After the second test, the subjects were randomly assigned, in a double-blind manner, to either placebo, propranolol (160 mg/day), or atenolol (100 mg/day) treatment for 7 days. Exactly 1 week from the time of the second test, and 3 hours after the last medication, the subjects completed the final exercise test using the same treadmill protocol administered in the second test. Heart rate and systolic blood pressure at rest and during submaximal steady-state exercise were significantly reduced by both drugs, whereas diastolic pressure was unaffected. During submaximal steady-state exercise, cardiac output was reduced in both the placebo and atenolol groups, stroke volume was increased in both atenolol and propranolol groups, oxygen uptake was reduced in the atenolol group, pulmonary ventilation was reduced in both propranolol and atenolol groups, and the respiratory exchange ratio remained unchanged. With maximal exercise, treadmill time was significantly reduced with propranolol, pulmonary ventilation and heart rate were reduced significantly with both drugs, but maximal oxygen uptake remained unchanged. Thus, beta blockade does not appear to limit ability to exercise. However, there appears to be a significant advantage to using a cardioselective rather than a nonselective beta-blocking agent.

The normal range and determinants of the intrinsic heart rate in man

Article

May 1970

Authors' synopsis: Normal standards for the intrinsic heart rate (IHR) were measured in 432 healthy adult subjects aged 16 to 70 years. At rest, with normal body temperature, the IHR was highly reproducible. In different subjects, age was the only important determinant. Differences in IHR between individuals may correspond to differences in functional capacity of the myocardium, whether determined genetically, by age, or by disease.

Physical activity and prevention of coronary heart disease

Article

Jan 1972
Ann Clin Res

Physical activity and the prevention of coronary heart disease

Article

Apr 1972

Data suggest, but fall short of proving, that an increase in habitual physical activity is beneficial. Likely benefits may be as much or more in the area of an improved quality of life as in life extension-quantity. If levels of acceptance of preventive regimens can be categorized as the possible, the prudent, and the proved, there appears sufficient reason to place physical activity as being among the prudent actions to be recommended at present. More studies are urgently needed, particularly concerning whether increased physical activity will contribute to cardiovascular and general health enhancement, increased total human performance and a vigorous creative society.While studies develop better definition, it seems possible with exercise stress testing to “clear” individuals relative to the intensity of exertion that involves an acceptably low hazard of acute cardiac catastrophe yet will provide a predictable improvement in physiologic capability. It appears possible to prescribe the intensity of activity from recently developed information concerning heart rate responses. It is possible also to make useful recommendations as to the type, frequency, and duration of various activities on an individual basis that will fit in with the interests and desired life style of individuals.

Criteria for maximal oxygen uptake: Review and commentary

Article

Oct 1995

Historically, the achievement of maximal oxygen uptake (VO2max) has been based on objective criteria such as a leveling off of oxygen uptake with an increase in work rate, high levels of lactic acid in the blood in the minutes following the exercise test, elevated respiratory exchange ratio, and achievement of some percentage of an age-adjusted estimate of maximal heart rate. These criteria are reviewed relative to their history, the degree to which they have been achieved in published research, and how investigators and reviewers follow them in current practice. The majority of the criteria were based on discontinuous protocols, often carried out over several days. Questions are raised about the applicability of these criteria to modern continuous graded exercise test protocols, and our lack of consistency in the terminology we use relative to the measurement of maximal oxygen uptake.

Autonomic nervous system control of the heart: Endurance exercise training

Article

Oct 1995

The purpose of this study was to assess hemodynamic responses to lower body negative pressure (LBNP) to -45 torr with selective cardiac parasympathetic (using atropine sulphate), sympathetic efferent (using metoprolol tartrate), and combined (atropine+metoprolol) blockade prior to and following 8 months of endurance exercise training in eight young men. Training resulted in significant increases of maximal oxygen uptake (27%) and blood volume (16%) and a decrease of baseline heart rate (HR, from 66 +/- 4 to 57 +/- 4 bpm). This training related bradycardia was exclusively determined by an enhanced vagal tone as there was no significant difference in intrinsic HR pre- to post-training and only atropine (pre: 100 +/- 3 vs post: 101 +/- 3 bpm), not metoprolol (pre: 56 +/- 3 vs post: 49 +/- 4 bpm), abolished the HR difference. The reflex tachycardia in the control experiment was significantly diminished following training. However, the increase in HR at LBNP -45 torr between pre- and post-training was similar after either atropine (+13 +/- 2 vs +14 +/- 1 bpm) or metoprolol (+8 +/- 1 vs +8 +/- 1 bpm). Reflex tachycardia was greater during atropine than metoprolol blockade and the sum of the HR increase during selective blockade (21 and 22 bpm) was greater when compared with the control (no blockade, 16 +/- 2 vs 11 +/- 2 bpm). There was no difference pre- to post-training in SV or Qc response to -45 torr LBNP during the control condition. However, selective beta 1-receptor blockade resulted in a greater decrease in SV to -45 torr LBNP post-training compared to pre-training (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing)

Article

Aug 1997
J AM COLL CARDIOL

How to Implement Physical Activity in Primary and Secondary Prevention : A Statement for Healthcare Professionals From the Task Force on Risk Reduction, American Heart Association

Article

Aug 1997

Gerald F. Fletcher

Substantial data exist on the benefits of physical activity in both primary and secondary prevention of cardiovascular disease. These data are well documented in American Heart Association position statements,1 2 the current Surgeon General’s report,3 and population studies.4 5 6 7 8 The purpose of this “how-to” statement is to delineate the fundamentals of implementation of physical activity in both primary and secondary prevention of cardiovascular disease. The recommendations and rationale of earlier scientific statements1 2 on exercise have been translated into practical suggestions that can be implemented in the physician’s office. Physical activity in primary prevention should begin in the early school years and continue throughout an individual’s lifetime. Schools must specifically designate physical education programs with aerobic activities for children at early ages. Programs should include recreational sports such as running, dancing, swimming, and selected types of resistance exercises using free weights and/or specific equipment. There also should be support for an active lifestyle for children at home. In the patient-visit setting, physicians and their staff should discuss physical activity and provide exercise prescriptions for patients and their families. In some instances, suggestions could be made about implementing physical activity recommendations at the worksite. Intensity, duration, and frequency as well as mode and progression should be considered in all types of physical activity programs. As children and adolescents become adults and discontinue the athletic endeavors of school and college, primary prevention must include a plan for a lifetime of appropriate physical activity. Ideally this activity should be done for at least 30 to 60 minutes four to six times weekly1 or 30 minutes on most days of the week.3 The frequency, duration, and intensity of the activity should be individualized to personal satisfaction as well as mode and progression. Subjects may use …

ACSM's Guidelines for Exer-cise Testing and Prescription

Jan 2000

American College
Sports Medicine

American College of Sports Medicine. ACSM's Guidelines for Exer-cise Testing and Prescription. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins, 2000.

ACC/AHA guidelines for exercise testing