Joseph F. Norman

Comparison of the energy expenditure index and oxygen consumption index during self-paced walking in children with spastic diplegia cerebral palsy and children without physical disabilities.

The aim of this study was to assess whether the Energy Expenditure Index (EEI), based on heart rate (HR) adjusted for speed, was a clinical indicator of the Oxygen Consumption Index (OCI), oxygen consumption (VO2) adjusted for speed, during self-paced walking in children with spastic diplegia cerebral palsy (CP) and children without physical disabilities (ND). Ten children with spastic diplegia CP and 15 children who are ND participated. VO2 and HR were measured at rest and during self-paced ambulation using an AeroSport KB1-C portable metabolic system, and the EEI and OCI were calculated. A fair to good correlation (r = 0.61) between EEI and OCI was found for children with spastic diplegia CP ambulating at self-paced speeds while only a moderate correlation (r = 0.40) was found for children who are ND. The results suggest that the EEI may be a useful clinical indicator of OCI at self-paced ambulation speeds in children with spastic diplegia CP and warrants further investigation.

Maternal atherogenic diet in swine is protective against early atherosclerosis development in offspring consuming an atherogenic diet post-natally

Atherosclerosis found early in life suggests that it may arise from fetal adaptations during development in utero. We evaluated the effect of a maternal atherogenic diet on atherosclerosis development in offspring. Aortic fat deposition was evaluated by Sudan IV staining and coronary atherosclerosis was assessed histologically. Sows were fed an atherogenic diet (ath) or standard diet (std) throughout gestation. Twelve neonates (six per maternal diet group) were evaluated with no significant differences noted (P>0.05) in serum lipids or aortic fat deposition and there was no evidence of coronary atherosclerosis. Twenty offspring (10 per maternal diet group) were followed for 5 months forming the pubertal age group. Half of these swine received an atherogenic (ATH) diet (std-ATH and ath-ATH) and half received a standard (STD) diet (std-STD and ath-STD). Pubertal age swine on the ATH diet had significantly greater (P<0.05) serum lipids and aortic fat deposition compared with those on the STD diet, with significantly greater fat deposition (P<0.05) occurring in the std-ATH versus ath-ATH group. Coronary atherosclerosis was exhibited only in the std-ATH diet group. Our findings suggest that gestational diet may alter the bodys management of cholesterol later in life, possibly providing a protective effect from atherosclerosis.

Validity of the counting talk test in comparison with standard methods of estimating exercise intensity in young healthy adults.

PURPOSE The Talk Test is a method for recommending exercise intensity on the basis of the ability of an individual to carry on a conversation during exercise and has been associated with defining the upper recommended limits of exercise intensity for cardiorespiratory training. The purpose of this study was to assess the validity of a novel variation of the Talk Test method, the “Counting Talk Test” (CTT), as a semiquantitative approach for estimating exercise intensity in healthy individuals. METHODS Forty young adults (22.5 ± 2.3 years) participated in 2 maximal treadmill tests on separate days. The first test was performed to determine maximum heart rate (HR) and oxygen uptake (VO2) and to allow participants to habituate to the testing protocol. During the second session, participants were instructed in the CTT method. HR, rating of perceived exertion (RPE), blood pressure, and CTT were recorded at rest and at each test stage. Correlation analyses were conducted among the variables. RESULTS Correlation coefficients values, r = −0.93, −0.92, and −0.86, were found between the %CTT and percentage of heart rate reserve (%HRR), percentage of VO2-reserve (%VO2R), and RPE, respectively. CONCLUSIONS The CTT has concurrent validity with the criterion measure of VO2R as well as to the more commonly utilized measures of HRR and RPE for estimating relative exercise intensity in young adults. Exercising at a level at which individuals could count to half to one third of their resting CTT value corresponded with American College of Sports Medicines recommendations for moderate to vigorous exercise intensity.

Consistency of the Counting Talk Test for Exercise Prescription

Abstract Loose, BD, Christiansen, AM, Smolczyk, JE, Roberts, KL, Budziszewska, A, Hollatz, CG, and Norman, JF. Consistency of the counting talk test for exercise prescription. J Strength Cond Res 26(6): 1701–1707, 2012—The purpose of this study was to assess the consistency of the counting talk test (CTT) method for estimating exercise intensity across various modes of exercise in healthy young adults. Thirty-six individuals completed the study, which required participation in 3 separate sessions within a 2-week time period. During the first session, the individuals completed a maximal effort treadmill test from which each individuals heart rate reserve (HRR) was calculated. During the second and third sessions, the subjects participated in 2 modes of exercise in each session for a total of 4 different modes of exercise. The individuals exercised at 40% HRR, 50% HRR, 60% HRR, 75% HRR, and 85% HRR. The heart rate (HR), CTT, and rating of perceived exertion (RPE) were recorded at each workload. Based on the individuals resting CTT (CTTrest), the %CTT for each exercise stage was then calculated. Pearson correlations demonstrated moderate to good correlations between the CTT and HRR methods and the CTT and RPE methods for estimating exercise intensity. This study found that for the individuals with CTTrest <25, moderate to vigorous intensity exercise as recommended by the American College of Sports Medicine HRR guidelines could be achieved by exercising at a level of 40–50% CTTrest. Individuals with a CTTrest ≥25, exercising at a level of 30–40% CTTrest would place them in the moderate to vigorous exercise intensity range. A high degree of reliability was demonstrated using the CTT method across the various modes of aerobic exercise. As such, independent of the exercise mode, the CTT was found to be an easy and consistent method for prescribing moderate to vigorous aerobic exercise intensity.

Physical Demands of Vacuuming in Women Using Different Models of Vacuum Cleaners

PURPOSE Women continue to have the primary responsibility for housekeeping, even after a cardiac event. Vacuuming is one housekeeping task that is often reported as difficult to perform due to angina symptoms. The aim of this study was to evaluate the energy expenditure and hemodynamic responses associated with vacuuming using five different models of vacuum cleaners. METHODS Thirty-six healthy women 50-59 yr of age (54.5 +/- 3.1 yr) participated in this study. Energy expenditure was measured by indirect calorimetry using an Aerosport KB1-C portable metabolic system. After collection of baseline HR, blood pressure (BP), and oxygen consumption ( VO2 ) data, subjects performed vacuuming and treadmill walking in one of six different sequences. Vacuuming consisted of using five different models of vacuum cleaners, three upright models (heavy-duty, self-propelled, and lightweight) and two canister models (standard and compact) for 6 min each. Treadmill walking was conducted at 2.0 mph (0% grade) for 6 min. VO2, HR, BP, and RPE were recorded during each task. The rate-pressure product (RPP) was calculated to estimate myocardial oxygen demand. RESULTS Vacuuming with the self-propelled upright model resulted in significantly lower VO2, RPE, HR, systolic BP, and RPP responses compared with some of the other models.(2) CONCLUSION Significant differences in oxygen consumption and myocardial oxygen demand are associated with vacuuming using different models of vacuum cleaners. When making recommendations to individuals regarding the least physiologically demanding models, the power assist features of the machine should be the greatest consideration. This important characteristic should be taken into account when making recommendations for patients with limited capacity, or those wanting to limit physiological stress due to a disease state.

Predictors of Cognitive/Affective and Somatic Depression in Heart Failure Patients:

The effects of depression on patients with heart failure (HF) are substantial, yet the predictors remain unclear. The predictors of cognitive/affective and somatic depression in stable HF patients were studied. Using a cross-sectional design, 150 HF outpatients were recruited at two mid-Western HF clinics. Predictors included dyspnea with activities of daily living, family and friend social support, and loneliness; age and gender were control variables. All constructs were measured using standardized instruments. Structural equation modeling (SEM) showed that cognitive/affective depression was predicted by greater dyspnea and loneliness, whereas somatic depression was predicted by more dyspnea and friend support. Also, greater dyspnea was related to more loneliness and less friend support; less friend support was related to loneliness. Women reported more dyspnea and loneliness. Since cognitive/affective and somatic depression have different predictors, further study is warranted to identify HF patients at risk for depression and to establish interventions targeted at improving depression.

A self-directed adherence management program for patients with heart failure completing combined aerobic and resistance exercise training

This study measured the impact of the Exercise Adherence Management Program (EAMP) provided to 20 patients with heart failure (HF) who participated in a combined resistance and aerobic exercise training program during two 12-week phases. The EAMP included strategies designed to support exercise self-efficacy and adherence. Results indicate that an improvement in exercise self-efficacy occurred during the study period, whereas exercise adherence declined during the unsupervised phase. The highest rated adherence strategy for helpfulness and self-efficacy was group sessions. The study supports the use of adherence strategies based on self-efficacy in exercise programs for patients with HF.

Effects of partners together in health intervention on physical activity and healthy eating behaviors: a pilot study.

Background:Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. Objective:The objective of this feasibility study was to test the Partners Together in Health (PaTH) intervention versus usual care in improving physical activity and healthy eating behaviors in coronary artery bypass graft surgery patients and their spouses. Methods:An experimental, 2-group (n = 17 couples/group), repeated-measures design was used. Coronary artery bypass surgery patients in both groups participated in phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients did. Spouses in the usual care attended educational classes with patients. It was theorized that “2 persons would be better than 1” at making changes and sticking with them in the long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), at 3 months (post-CR), and at 6 months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. Results:The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and usual care patients or spouses at 3 or 6 months in the number of minutes per week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥150 min/wk at >3 metabolic equivalents). Conclusions:The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR.

Team-based Care for Cardiac Rehabilitation and Exercise Training in Heart Failure

The estimated cost of treating patients with HF in the United States is expected to more than double by 2030.65 This forecast of the impact of HF in the United States should serve as a call to action. Despite well-documented benefits, participation in exercise training and CR programs by patients with HF remains low. In this article, standards and guidelines for exercise and CR in HF were reviewed. Although traditional CR had core components, it lacked care management specific for HF. Chronic stable HF patients can safely exercise; however, there are many unique needs that are not currently addressed at the patient, system, and provider levels. As we face economic and political forces that are expected to require major change to the health care delivery system, it becomes even more important to capitalize on the advantages that come with team-based care. CR has always served as a model of team-based care; however, the model must now include professionals with HF expertise to guide patients in safe exercise and self-management strategies appropriate for this chronically ill population.

Psychological responses and adherence to exercise in heart failure.

Purpose: The purpose of this study was to describe psychological effects and exercise adherence during a multicomponent exercise training intervention. Methods: A sample of 42 patients with heart failure were randomized into an exercise (INV) group (n = 22) and an attention control (AC) group (n = 20). The exercise protocol included two 12‐week phases, a structured phase and a self‐managed phase. The psychological responses assessed were mood states and exercise self‐efficacy. To meet the second purpose of the study, the exercise group was dichotomized based on the number of sessions completed to create two adherence subgroups. Findings: Results indicate self‐efficacy improved for the INV group and was maintained during the self‐management phase. The adherence subgroups demonstrated different patterns for weekly exercise. Depression and confusion scores improved for the high‐adherence group in contrast to worsening for the low‐adherence group. Conclusions: Results suggest a need for further study of the psychological responses of exercise adherence for patients with heart failure. Clinical Relevance: The study indicates the importance of continuous assessment of exercise participation and longer term adherence support for patients with heart failure.