Kyle J. McInnis

Recommendations for Clinical Exercise Laboratories A Scientific Statement From the American Heart Association

The present statement provides a guide to initiating and maintaining a high-quality clinical exercise testing laboratory for administering graded exercise tests to adults. Pediatric testing has been addressed separately.1 It is a revision of the 1995 American Heart Association (AHA) “Guidelines for Clinical Exercise Testing Laboratories”2 and is designed to complement several other AHA documents related to exercise testing, including the AHA/American College of Cardiology (ACC) guidelines for exercise testing,3 the AHA’s “Exercise Standards for Testing and Training,”4 the AHA’s “Clinical Competence Statement on Stress Testing,”5 and the AHA’s “Assessment of Functional Capacity in Clinical and Research Settings.”6 Exercise testing is a noninvasive procedure that provides diagnostic and prognostic information and evaluates an individual’s capacity for dynamic exercise. Exercise testing facilities range from the sophisticated research setting to more conventional equipment in the family practitioner’s or internist’s office. Regardless of the range of testing procedures performed in any given laboratory, basic equipment, personnel, and protocol criteria are necessary to ensure the comfort and safety of the patient and to conduct a meaningful test. ### Environment Exercise testing equipment varies in size. The testing room should be large enough to accommodate all the equipment necessary, including emergency equipment and a defibrillator, while maintaining walking areas and allowing adequate access to the patient in emergency situations. It is also important that the laboratory comply with local fire standards and with procedures for other types of emergencies (eg, earthquake, hurricane). The laboratory should be well lighted, clean, and well ventilated, with temperature and humidity control. A wall-mounted clock with a sweep second hand or a digital counter is useful. The examining table should have space for towels, tape, and other items needed for patient preparation and testing. A curtain for privacy during patient preparation is useful. Minimization of interruptions …

Comparison of cardiopulmonary responses in obese women using ramp versus step treadmill protocols

The purpose of this study was to evaluate whether individual ramp protocol treadmill testing is superior to frequently used step protocols in eliciting peak cardiopulmonary responses in obese women. The main findings indicate that protocol selection based on predicted pretest individual exercise capacity is more important than whether a ramp or step protocol is used.

Cardiovascular screening and emergency procedures at health clubs and fitness centers.

A survey of 110 fitness centers in Massachusetts reveals that many do not follow generally accepted guidelines for administering preparticipation cardiovascular screening, obtain physician consent for individuals with known cardiovascular disease, and prepare for emergency situations should they occur. Thus, the promotion of physical activity to the general public now underway in the United States must also coincide with better screening at all fitness centers to maximize the potential for safe exercise participation at fitness centers.

Accuracy of a pretest questionnaire in exercise test protocol selection

Proper exercise test protocol selection is essential to allow adequate time for observation of subjective and physiologic responses to exercise, as well as provider-patient interaction and patient comfort. This study evaluates the accuracy of a pretest questionnaire in predicting exercise capacity for exercise test protocol selection and compares the accuracy of this questionnaire when ramp versus step protocols are used.

State of the Art Reviews: Using the Internet to Promote Physical Activity and Healthy Eating in Youth

The prevalence of overweight children and adolescents is increasing at alarming rates. Since 1980, the prevalence of overweight among children aged 6 to 11 years has more than doubled and more than tripled among adolescents aged 12 to 19. Innovative, effective weight loss strategies that effectively promote healthy eating and physical activity are needed to address this obesity epidemic. The Internet may prove to be an effective means of reaching youth to reduce overweight and, ideally, prevent weight gain. This article reviews the available literature of Internet-based interventions promoting healthy eating, physical activity, and/ or weight loss in school, home, camp, and medical settings. Findings show that few examples of well-designed trials exist in the youth literature. However, several studies show promise for the use of the Internet. It is recommended that future trials use adequate sample sizes, randomized designs, objective measures, boys and girls, health disparity youth, longer intervention periods (at least 16 weeks), long-term follow-up, theory-based skill building (eg, tracking of behavior, goal setting, feedback, increasing social support), the involvement of parents or caretakers, and improved means for sustaining interest and use in the site over time.

Effect of Body Composition on Oxygen Uptake during Treadmill Exercise: Body Builders versus Weight-Matched Men

Oxygen uptake (VO2) during treadmill exercise is directly related to the speed and grade, as well as the participants body weight. To determine whether body composition also affects VO2 (ml.kg-1.min-1) during exercise, we studied 14 male body builders (M weight = 99 kg, SD = 7; M height = 180 cm, SD = 8; M body fat = 8%, SD = 3; M fat free mass = 91 kg, SD = 7) and 14 weight-matched men (M weight = 99 kg, SD = 9; M height = 179 cm, SD = 5; M body fat = 24%, SD = 5; M fat free mass = 73 kg, SD = 9). Percentage of body fat, t(13) = 8.185, p < .0001, and fat free mass, t(13) = 5.723, p < .0001, were significantly different between groups. VO2 was measured by respiratory gas analysis at rest and during three different submaximal workrates while walking on the treadmill without using the handrails for support. VO2 was significantly greater for the lean, highly muscular men at rest: 5.6 +/- 1 vs. 4.0 +/- 1 ml.kg-1.min-1, F(1, 26) = 21.185, p < .001; Stage 1: 1.7 mph/10%, 18.5 +/- 2 vs. 16.1 +/- 2 ml.kg-1.min-1, F(1, 26) = 6.002, p < .05; Stage 2: 2.5 mph/12%, 26.6 +/- 3 vs. 23.1 +/- 2 ml.kg-1.min-1, F(1, 26) = 7.991, p < .01; and Stage 3:3.4 mph/14%, 39.3 +/- 5 vs. 33.5 +/- 5 ml.kg-1.min-1, F(1, 26) = 7.682, p < .01, body builders versus weight-matched men, respectively. However, net VO2 (i.e., exercise VO2 - rest VO2) was not significantly different between the two groups at any of the matched exercise stages. The findings from this study indicate that VO2 during weight-bearing exercise performed at the same submaximal workrate is higher for male body builders compared to that measured in weight-matched men and that which is predicted by standard equations. These observed differences in exercise VO2 appear to be due to the higher resting VO2 in highly muscular participants.

Body mass index, physical activity, and dietary behaviors among members of an urban community fitness center: a questionnaire survey.

BackgroundDevelopment of effective behavioral interventions to promote weight control and physical activity among diverse, underserved populations is a public health priority. Community focused wellness organizations, such as YMCAs, could provide a unique channel with which to reach such populations. This study assessed health behaviors and related characteristics of members of an urban YMCA facility.MethodsWe surveyed 135 randomly selected members of an urban YMCA facility in Massachusetts to examine self-reported (1) physical activity, (2) dietary behaviors, (3) body mass index, and (4) correlates of behavior change among short-term (i.e., one year or less) and long-term (i.e., more than one year) members. Chi-square tests were used to assess bivariate associations between variables, and multivariate linear regression models were fit to examine correlates of health behaviors and weight status.ResultsEighty-nine percent of short-term and 94% of long-term members reported meeting current physical activity recommendations. Only 24% of short-term and 19% of long-term members met fruit and vegetable consumption recommendations, however, and more than half were overweight or obese. Length of membership was not significantly related to weight status, dietary behaviors, or physical activity. Most respondents were interested in changing health behaviors, in the preparation stage of change, and had high levels of self-efficacy to change behaviors. Short-term members had less education (p = 0.02), lower household incomes (p = 0.02), and were less likely to identify as white (p = 0.005) than long-term members. In multivariate models, females had lower BMI than males (p = 0.003) and reported less physical activity (p = 0.008). Physical activity was also inversely associated with age (p = 0.0004) and education (p = 0.02).ConclusionRates of overweight/obesity and fruit and vegetable consumption suggested that there is a need for a weight control intervention among members of an urban community YMCA. Membership in such a community wellness facility alone might not be sufficient to help members maintain a healthy weight. The data indicate that YMCA members are interested in making changes in their dietary and physical activity behaviors. Targeting newer YMCA members might be an effective way of reaching underserved populations. These data will help inform the development of a weight control intervention tailored to this setting.

Prediction of Oxygen Uptake and Energy Expenditure During Exercise in Obese Women

PURPOSE For patients concerned with weight loss, monitoring the energy balance between daily dietary intake and exercise expenditure can be useful. Formulas commonly used to estimate the energy costs of exercise were previously derived from healthy men of normal body weight. The purpose of this study was to determine the relationship between measured and predicted exercise energy expenditure for obese women. METHODS Oxygen uptake (VO2) was measured using respiratory gas analysis in 45 obese (92 +/- 16 kg; 40 +/- 7% fat) and 10 normal weight (control) (58 +/- 5 kg; 21 +/- 6% fat) women during progressive exercise on a motorized treadmill. VO2 was also calculated at matched workrates using a regression equation published by the American College of Sports Medicine. The relationship between predicted versus measured VO2 was determined using least squares regression analysis. RESULTS The slope of the regression line for measured versus predicted VO2 for controls (y = 0.98x +/- 0.56; P < .001) was different than that of obese women (y = 0.75x +/- 3.06; P < .001). The slope of the regression line for controls was in close approximation to the line of identity, whereas the slope for obese was below it. Using VO2 to calculate kcal, measured energy expenditure, was significantly lower than predicted energy expenditure for obese subjects, but not for controls at several matched workrates: Stage III (213 +/- 40 versus 225 +/- 38 kcal per 30 minutes, P < .001); stage 4 (292 +/- 55 versus 340 +/- 58 kcal per 30 minutes, P < .001); and stage 5 (330 +/- 55 versus 412 +/- 70 kcal per 30 minutes, P < .001) obese measured versus obese predicted, respectively. CONCLUSIONS The authors conclude that the standard prediction equation gives a better estimation of VO2 for women who have average body weight and body fat than for obese women. This may, in part, be due to the differences in weight and/or fat mass between these subjects and those used to derive this equation. These findings should be considered when estimates of VO2 and energy expenditure are used rather than direct measures for obese women.

Promoting Physical Activity and Science Learning in an Outdoor Education Program.

Outdoor education programs have been shown to have a positive effect on the educational, physical and emotional development of youth. They are increasingly being used to foster a sense of community in schools and to provide students with learning opportunities related to the environment. This article describes an integrated outdoor education program aimed at increasing physical activity and science knowledge among elementary school children in an economically disadvantaged urban community. Results from a study that was conducted showed that activity levels were significantly higher and sedentary time was significantly lower during the outdoor education program compared to the rest of the school day. Schools can utilize outdoor education programs to promote physical activity and improve science learning in elementary school children.

Active Science® pilot study: promoting physical activity and science learning among children -

We would like to thank you for consideration of our manuscript in the Journal of Behavioral Health. Our study showed that an innovative active education strategy was able to promote physical activity and improve science learning among children in the afterschool environment. The results are well aligned with national recommendations that endorse strategies to incorporate movement and activity into diverse afterschool curricular programs.