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Cardiovasculaire training is een be-langrijk middel in sportcentra en bij be-handeling in de (sport) fysiotherapeuti-sche praktijk. De laatste jaren is veel geschreven over rekenformules die een voorspelling geven van de maximale hartfrequentie. De eenvoudigste en meest gebruikte rekenformule is: 220 – leeftijd (1). Maar hoe nauwkeurig is deze berekening/schatting en welke formule is (wanneer) het beste? De maximale hartfrequentie is de hoogst mogelijke hartfrequentie bij een lichamelijke (sport)activiteit. Een for-mule voor het berekenen van Hfmax wordt gebruikt als je de Hfmax van een persoon niet weet en deze niet wilt of kunt meten maar moet schatten. Voor het berekenen, dus het schatten, van iemands maximale hartfrequentie zijn er vele formules in omloop. Voor dit artikel zijn, met behulp van geauto-matiseerde literatuurbestanden en zoekmachines, 12 verschillende reken-formules getraceerd en uitgekozen. Zonder te pretenderen dat deze lijst compleet is, geeft dit dus wel aan dat er vele verschillende formules bestaan 6 S p o r t g e r i c h t n r. 2 / 2 0 0 7 – j a a r g a n g 6 1 FYSIOLOGIE De intensiteit van cardiovasculaire training wordt vaak bepaald aan de hand van een percentage van de maximale hartfrequentie (Hfmax) of een afgeleide daarvan. In de trainingsliteratuur (en op Internet) zijn veel verschillende formules te vinden om de maximale hartfrequentie te bere-kenen. In dit artikel worden verschillende methoden voor het berekenen van de maximale hartfrequentie vergeleken en toegelicht, en worden de consequenties voor de praktijk weergegeven.
The two-minute walk test (2MWT) has been used in several health conditions, but the interpretation of its results is limited due to lack of reference values.
The aim of this study was to establish a reference equation to predict the distance walked (DW) in the 2MWT for healthy adults and the elderly, and to test its reproducibility.
We evaluated 390 healthy subjects (195 male), aged 18-89 years, with normal spirometry and no history of previous chronic diseases. Two 2MWTs were performed on the same day, 30 minutes apart. To test the reliability of the prediction equation, 70 subjects (35 male) were prospectively included in the study.
Males walked farther than females (221 [202-240] m vs. 199 [164-222] m, respectively; p <0.0001). Significant correlations were observed between DW and age (r = -0.50), weight (r = 0.23), height (r = 0.40), and gender (r = 0.35) (p <0.001 for all). Age and gender persisted in the model to predict DW (R(2): 0.51). There was no difference between the DW by the subjects (197 [182 -216]) and that estimated by the prediction equation (197 [179-222]) (p = 0.68).
We established a prediction equation that may be used as a reference to interpret performance on the 2MWT performed by adults and the elderly with different health conditions.
Do patients with chronic obstructive pulmonary disease (COPD) achieve a different distance on the sixminute walk test (6MWT) conducted on a 10m course versus on a 30m course? When assessing the distance on a 6MWT conducted on a 10m course, is it valid to use existing reference equations that were generated on longer courses?
A randomised double-crossover experimental study.
Forty-five patients with COPD in primary physiotherapy care.
All patients performed a 6MWT twice over a 10m course and twice over a 30m course. The 6MWTs were performed in accordance with the American Thoracic Society guidelines.
6MWD was assessed and predicted distance was calculated based on a range of reference equations.
The 6MWD on the 10m course was 49.5m shorter than on the 30m course, which was statistically significant (95% CI 39.4 to 59.6). By using existing reference equations for a 6MWT conducted on the 10m course, the predicted distance is highly overestimated (with a range of 30% to 33%) and the average distance as a percentage of the predicted value is 8%pred lower compared to a 6MWT conducted on the 30m course, resulting in a worse representation of a COPD patient's functional exercise capacity.
This study shows that the impact of course length on the 6MWD and on the use of reference equations in patients with COPD is substantial and clinically relevant (based on the most conservative published minimum clinically important difference). Therefore, existing reference equations established for a 6MWT conducted over a 30m (or longer) course cannot be applied to predict the distance achieved on the 6MWT on a 10m course, which is frequently used in primary care physiotherapy practices for patients with COPD.
This study compares the effects of 6 months resistance-type exercise training (three times per week) between healthy elderly women (n = 24; 71±1 years) and men (n = 29; 70±1 years). Muscle mass (dual-energy x-ray absorptiometry-computed tomography), strength (one-repetition maximum), functional capacity (sit-to-stand time), muscle fiber characteristics (muscle biopsies), and metabolic profile (blood samples) were assessed. Leg lean mass (3% ± 1%) and quadriceps cross-sectional area (9% ± 1%) increased similarly in both groups. One-repetition maximum leg extension strength increased by 42% ± 3% (women) and 43% ± 3% (men). Following training, type II muscle fiber size had increased, and a type II muscle fiber specific increase in myonuclear and satellite cell content was observed with no differences between genders. Sit-to-stand time decreased similarly in both groups. Glycemic control and blood lipid profiles improved to a similar extent in both women and men. A generic resistance-type exercise training program can be applied for both women and men to effectively counteract the loss of muscle mass and strength with aging. © 2012 © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected]
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This systematic review examines the effectiveness of current exercise interventions for the management of frailty. Eight electronic databases were searched for randomized controlled trials that identified their participants as "frail" either in the title, abstract, and/or text and included exercise as an independent component of the intervention. Three of the 47 included studies utilized a validated definition of frailty to categorize participants. Emerging evidence suggests that exercise has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review. Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults. There was a paucity of evidence to characterize the most beneficial exercise program for this population. However, multicomponent training interventions, of long duration (≥5 months), performed three times per week, for 30-45 minutes per session, generally had superior outcomes than other exercise programs. In conclusion, structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty.
This is a brief review of current evidence for the relationships between physical activity and exercise and the brain and cognition throughout the life span in non-pathological populations. We focus on the effects of both aerobic and resistance training and provide a brief overview of potential neurobiological mechanisms derived from non-human animal models. Whereas research has focused primarily on the benefits of aerobic exercise in youth and young adult populations, there is growing evidence that both aerobic and resistance training are important for maintaining cognitive and brain health in old age. Finally, in these contexts, we point out gaps in the literature and future directions that will help advance the field of exercise neuroscience, including more studies that explicitly examine the effect of exercise type and intensity on cognition, the brain, and clinically significant outcomes. There is also a need for human neuroimaging studies to adopt a more unified multi-modal framework and for greater interaction between human and animal models of exercise effects on brain and cognition across the life span.
The aim was to develop a standardised and externally paced field walking test, incorporating an incremental and progressive structure, to assess functional capacity in patients with chronic airways obstruction.
The usefulness of two different shuttle walking test protocols was examined in two separate groups of patients. The initial 10 level protocol (group A, n = 10) and a subsequent, modified, 12 level protocol (group B, n = 10) differed in the number of increments and in the speeds of walking. Patients performed three shuttle walking tests one week apart. Then the performance of patients (group C, n = 15) in the six minute walking test was compared with that in the second (modified) shuttle walking test protocol. Heart rate was recorded during all the exercise tests with a short range telemetry device.
The 12 level modified protocol provided a measure of functional capacity in patients with a wide range of disability and was reproducible after just one practice walk; the mean difference between trial 2 v 3 was -2.0 (95% CI -21.9 to 17.9) m. There was a significant relation between the distance walked in the six minute walking test and the shuttle walking test (rho = 0.68) but the six minute walking test appeared to overestimate the extent of disability in some patients. The shuttle test provoked a graded cardiovascular response not evident in the six minute test. Moreover, the maximal heart rates attained were significantly higher for the shuttle walking test than for the six minute test.
The shuttle walking test constitutes a standardised incremental field walking test that provokes a symptom limited maximal performance. It provides an objective measurement of disability and allows direct comparison of patients' performance.
The six minute walking distance (6MWD) test is a commonly used test to estimate functional exercise capacity in patients with chronic diseases including chronic obstructive lung disease. Surprisingly, no attempt has been made to establish normal values for the 6MWD. The aim of this study, therefore, was to evaluate the 6MWD in healthy elderly volunteers and to evaluate its determining factors. Fifty-one healthy subjects aged 50-85 yrs volunteered to participate in the trial. All subjects were free of diseases that could interfere with performance in a walking test. Tests were performed in a quiet 50-m long hospital corridor. Patients were encouraged every 30 s to continue walking as quickly as possible. Walking distance averaged 631+/-93 m and was 84 m greater in the male compared to female subjects (p<0.001). The 6MWD showed significant correlations with age (r=-0.51, p<0.01) and height (r=0.54, p<0.01). Stepwise multiple regression analysis showed that age, height, sex and weight were independent contributors to the 6MWD in healthy subjects, thus explaining 66% of the variability. It is concluded that the six minute walking distance can be predicted adequately using a clinically useful model in healthy elderly subjects. Its variability is explained largely by age, sex, height and weight. Results of the six minute walking distance may be interpreted more adequately if expressed as a percentage of the predicted value.
A combination of aerobic activity, strength training, and flexibility exercises, plus increased general daily activity can reduce medication dependence and health care costs while maintaining functional independence and improving quality of life in older adults. However, patients often do not benefit fully from exercise prescriptions because they receive vague or inappropriate instructions. Effective exercise prescriptions include recommendations on frequency, intensity, type, time, and progression of exercise that follow disease-specific guidelines. Changes in physical activity require multiple motivational strategies including exercise instruction as well as goal-setting, self-monitoring, and problem-solving education. Helping patients identify emotionally rewarding and physically appropriate activities, contingencies, and social support will increase exercise continuation rates and facilitate desirable health outcomes. Through patient contact and community advocacy, physicians can promote lifestyle patterns that are essential for healthy aging.
The incremental shuttle walking test (ISWT) is used to assess exercise capacity in patients with chronic obstructive pulmonary disease (COPD) and is employed as an outcome measure for pulmonary rehabilitation. This study was designed to establish the minimum clinically important difference for the ISWT.
372 patients (205 men) performed an ISWT before and after a 7-week outpatient pulmonary rehabilitation programme. After completing the course, subjects were asked to identify, from a 5-point Likert scale, the perceived change in their exercise performance immediately upon completion of the ISWT. The scale ranged from "better" to "worse".
The mean (SD) age was 69.4 (8.4) years, forced expiratory volume in 1 s (FEV(1)) 1.06 (0.53) l and FEV(1)/forced vital capacity (FVC) ratio 50.8 (18.1)%. The baseline shuttle walking test distance was 168.5 (114.6) m which increased to 234.7 (125.3) m after rehabilitation (mean difference 65.9 m (95% CI 58.9 to 72.9)). In subjects who felt their exercise tolerance was "slightly better" the mean improvement was 47.5 m (95% CI 38.6 to 56.5) compared with 78.7 m (95% CI 70.5 to 86.9) in those who reported that their exercise tolerance was "better" and 18.0 m (95% CI 4.5 to 31.5) in those who felt their exercise tolerance was "about the same".
Two levels of improvement were identified. The minimum clinically important improvement for the ISWT is 47.5 m. In addition, patients were able to distinguish an additional benefit at 78.7 m.
Purpose: Physical activity has been associated with reduced blood pressure in observational epidemiologic studies and individual clinical trials. This meta-analysis of randomized, controlled trials was conducted to determine the effect of aerobic exercise on blood pressure. Data Sources: English-language articles published before September 2001. Study Selection: 54 randomized, controlled trials (2419 participants) whose intervention and control groups differed only in aerobic exercise. Data Extraction: Using a standardized protocol and data extraction form, three of the investigators independently abstracted data on study design, sample size, participant characteristics, type of intervention, follow-up duration, and treatment outcomes. Data Synthesis: In a random-effects model, data from each trial were pooled and weighted by the inverse of the total variance. Aerobic exercise was associated with a significant reduction in mean systolic and diastolic blood pressure (-3.84 mm Hg [95% Cl, -4.97 to -2.72 mm Hg] and -2.58 mm Hg [CI, -3.35 to -1.81 mm Hg], respectively). A reduction in blood pressure was associated with aerobic exercise in hypertensive participants and normotensive participants and in overweight participants and normal-weight participants. Conclusions: Aerobic exercise reduces blood pressure in both hypertensive and normotensive persons. An increase in aerobic physical activity should be considered an important component of lifestyle modification for prevention and treatment of high blood pressure.
As primary care practice space is mostly limited to 10 m, the 6-minute walk test (6MWT) over a 10 m course is a frequently used alternative to evaluate patients' performance in COPD. Considering that course length significantly affects distance walked in 6 minutes (6MWD), this study aims to develop appropriate reference equations for the 10 m 6MWT.
181 healthy subjects, aged 40-90 years, performed two standardised 6MWTs over a straight 10 m course in a cross-sectional study.
Average distance achieved was 578±108 m and differed between males and females (p<0.001). Resulting sex-specific reference equations from multiple regression analysis included age, body mass index and change in heart rate, explaining 62% of the variance in 6MWD for males and 71% for females.
The presented reference equations are the first to evaluate 6MWD over a 10 m course and expand the usefulness of the 6MWT.
ACSM Position Stand on the Appropriate Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults. Med. Sci. Sports Exerc., Vol. 33, No. 12, 2001, pp. 2145–2156. In excess of 55% of adults in the United States are classified as either overweight (body mass index = 25–29.9 kg·m−2) or obese (body mass index ≥ 30 kg·m−2). To address this significant public health problem, the American College of Sports Medicine recommends that the combination of reductions in energy intake and increases in energy expenditure, through structured exercise and other forms of physical activity, be a component of weight loss intervention programs. An energy deficit of 500–1000 kcal·d−1 achieved through reductions in total energy intake is recommended. Moreover, it appears that reducing dietary fat intake to <30% of total energy intake may facilitate weight loss by reducing total energy intake. Although there may be advantages to modifying protein and carbohydrate intake, the optimal doses of these macronutritents for weight loss have not been determined. Significant health benefits can be recognized with participation in a minimum of 150 min (2.5 h) of moderate intensity exercise per week, and overweight and obese adults should progressively increase to this initial exercise goal. However, there may be advantages to progressively increasing exercise to 200–300 min (3.3–5 h) of exercise per week, as recent scientific evidence indicates that this level of exercise facilitates the long-term maintenance of weight loss. The addition of resistance exercise to a weight loss intervention will increase strength and function but may not attenuate the loss of fat-free mass typically observed with reductions in total energy intake and loss of body weight. When medically indicated, pharmacotherapy may be used for weight loss, but pharmacotherapy appears to be most effective when used in combination with modifications of both eating and exercise behaviors. The American College of Sports Medicine recommends that the strategies outlined in this position paper be incorporated into interventions targeting weight loss and the prevention of weight regain for adults.
Background:
Physical activity is beneficial for healthy ageing. It may also help maintain good cognitive function in older age. Aerobic activity improves cardiovascular fitness, but it is not known whether this sort of fitness is necessary for improved cognitive function. Studies in which activity, fitness and cognition are reported in the same individuals could help to resolve this question.
Objectives:
To assess the effectiveness of physical activity, aimed at improving cardiorespiratory fitness, on cognitive function in older people without known cognitive impairment.
Search strategy:
We searched MEDLINE, EMBASE, PEDro, SPORTDiscus, PsycINFO, CINAHL, Cochrane Controlled Trials Register (CENTRAL), Dissertation abstracts international and ongoing trials registers on 15 December 2005 with no language restrictions.
Selection criteria:
All published randomised controlled trials comparing aerobic physical activity programmes with any other intervention or no intervention with participants older than 55 years of age were eligible for inclusion.
Data collection and analysis:
Eleven RCTs fulfilling the inclusion criteria are included in this review. Two reviewers independently extracted the data from these included studies.
Main results:
Eight out of 11 studies reported that aerobic exercise interventions resulted in increased cardiorespiratory fitness of the intervention group (an improvement on the maximum oxygen uptake test which is considered to be the single best indicator of the cardiorespiratory system) of approximately 14% and this improvement coincided with improvements in cognitive capacity. The largest effects on cognitive function were found on motor function and auditory attention (effect sizes of 1.17 and 0.50 respectively). Moderate effects were observed for cognitive speed (speed at which information is processed; effect size 0.26) and visual attention (effect size 0.26).
Authors' conclusions:
There is evidence that aerobic physical activities which improve cardiorespiratory fitness are beneficial for cognitive function in healthy older adults, with effects observed for motor function, cognitive speed, auditory and visual attention. However, the majority of comparisons yielded no significant results. The data are insufficient to show that the improvements in cognitive function which can be attributed to physical exercise are due to improvements in cardiovascular fitness, although the temporal association suggests that this might be the case. Larger studies are still required to confirm whether the aerobic training component is necessary, or whether the same can be achieved with any type of physical exercise. At the same time, it would be informative to understand why some cognitive functions seem to improve with (aerobic) physical exercise while other functions seem to be insensitive to physical exercise. Clinicians and scientists in the field of neuropsychology should seek mutual agreement on a smaller battery of cognitive tests to use, in order to render research on cognition clinically relevant and transparent and heighten the reproducibility of results for future research.
It is hypothesized that the intensity of physical activity habits, rather than the time spent on those activities, might mediate cognitive function. This study tested a possible association between changes in the time spent on or the average intensity of weekly physical activities and changes in cognitive function in healthy men and women.
This longitudinal cohort study with 1,904 healthy men and women (45-75 years of age) assessed physical activity by a questionnaire and cognitive function with a neuropsychological test battery twice with an interval of 5 years.
Multiple linear regression analyses showed that changes in the time spent on physical activities were not associated with changes in cognitive function over a 5-year period. By contrast, changes in average intensity of weekly activities were significantly and positively associated with processing speed (beta = 0.063; p < 0.05).
In this longitudinal cohort study, an increase or smaller decline in average intensity was associated with a smaller age-related decline in processing speed, estimated at 6 years of aging.
The 12-minute walking test is a useful and reproducible measure of exercise tolerance. It provides a simple, practical guide to everyday disability and does not require expensive apparatus. Nevertheless, it is both time consuming for the investigator and exhausting for the patient. We therefore explored the possibility of using walking tests of shorter duration to assess exercise tolerance.
This symposium summarizes current knowledge and serves to illustrate the many questions which must be considered and answered before the mechanisms which govern the cardiovascular adjustments to static exercise are understood. These include: What is the degree of mechanical hindrance to blood flow in statically contracting muscles? What are the characteristics of the receptors in muscle which are activated as a consequence of muscle contraction, the mechanism(s) of their activation, and the afferent fibers and central connections? What is the distribution of these receptors in different muscles and fiber types? What are the metabolic changes in muscles that accompany their contraction, and the relation of these to fiber type? To what degree do the higher centers in the brain dictate or mediate the cardiovascular responses? What is the role of muscle mass and tension in determining the responses to static exercise? What hemodynamic changes cause the increase in arterial pressure? What mechanisms cause the increase in heart rate? How do the arterial baroreceptors and cardiopulmonary vagal afferents modulate the primary hemodynamic changes caused by the muscle reflex and the higher centers? Do the same mechanisms control the cardiovascular responses during static and dynamic exercise with only quantitative differences, or do qualitative differences exist? What are the consequences of disease or physical training on the mechanisms responsible for the cardiovascular adjustments? In this paper the authors have tried to emphasize points of agreement, differences of viewpoints, and areas of ignorance.
The plasma norepinephrine (NE) and epinephrine (E) responses to a variety of stressors are influenced by age, adiposity, and exercise training status. The objectives of this study were to 1) compare basal levels as well as posture- and exercise-induced changes in plasma NE and E concentrations in young [25 +/- 1 (SE) yr; n = 24] and older (64 +/- 1 yr; n = 106) people and examine the associations of the responses with adiposity and maximal O2 uptake (VO2max) and 2) determine the extent to which the NE and E responses are altered by exercise training in older people. We found no significant differences in basal NE and E levels between young and older subjects. However, the NE response to standing was exaggerated in older people (696 +/- 39 vs. 512 +/- 61 pg/ml; P < 0.05), whereas NE and E responses to exercise requiring approximately 78% of VO2max were attenuated in older people (NE: 1,444 +/- 74 vs. 1,983 +/- 222 pg/ml; E: 109 +/- 10 vs. 228 +/- 29 pg/ml; both P < 0.01). Increments in NE and E during exercise were more closely associated with age (NE: r = -0.38; E: r = -0.46; both P < 0.05) and VO2max (NE: r = 0.43; E: r = 0.52; both P < 0.05) than with adiposity (NE: r = -0.29; E: r = -0.25; both P < 0.05). In 48 older subjects who completed 9 mo of exercise training, the increases in NE and E during exercise at the same absolute intensity were 39 and 57% lower, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Physical activity has been associated with reduced blood pressure in observational epidemiologic studies and individual clinical trials. This meta-analysis of randomized, controlled trials was conducted to determine the effect of aerobic exercise on blood pressure.
English-language articles published before September 2001.
54 randomized, controlled trials (2419 participants) whose intervention and control groups differed only in aerobic exercise.
Using a standardized protocol and data extraction form, three of the investigators independently abstracted data on study design, sample size, participant characteristics, type of intervention, follow-up duration, and treatment outcomes.
In a random-effects model, data from each trial were pooled and weighted by the inverse of the total variance. Aerobic exercise was associated with a significant reduction in mean systolic and diastolic blood pressure (-3.84 mm Hg [95% CI, -4.97 to -2.72 mm Hg] and -2.58 mm Hg [CI, -3.35 to -1.81 mm Hg], respectively). A reduction in blood pressure was associated with aerobic exercise in hypertensive participants and normotensive participants and in overweight participants and normal-weight participants.
Aerobic exercise reduces blood pressure in both hypertensive and normotensive persons. An increase in aerobic physical activity should be considered an important component of lifestyle modification for prevention and treatment of high blood pressure.
The aging vasculature and its effects on the heart
- Fcp Yin
Nederlandse vertaling: Poel G van der. Inspannings- en sportfysiologie. 2e herz. druk
- J H Wilmore
- D Costill
- W L Kenney
Handleiding Fysiotherapeuten BeweegKuur: een interventie voor de (eerstelijns) zorg om mensen met (een hoog risico op) diabetes type 2 te begeleiden naar een actievere leefstijl
- Handleiding Fysiotherapeuten BeweegKuur
Development of a shuttle walking test of disability in patients with chronic airways obstruction
- S J Singh
- M D Morgan
- S Scott
- SJ Singh
KNGF-standaard Beweeginterventie oncologie. Amersfoort: Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF)
- M M Stuiver
- H M Wittink
- M J Velthuis
- N Kool
- Wam Jongert
- MM Stuiver
Hypertrophic and degenerative changes in human hearts with aging
- P B Baker
- A R Arn
- D V Unverferth
- PB Baker