Marlon Abrazado

Eight weeks of exercise training improves fitness measures in methamphetamine-dependent individuals in residential treatment.

Objectives:Physical exercise has been shown to benefit diverse medical and behavioral conditions. This study assesses the feasibility and efficacy of an 8-week endurance and resistance training program on fitness measures in individuals undergoing residential treatment for methamphetamine (MA) dependence. Methods:A total of 39 MA-dependent individuals were randomized to 3 days/week of exercise training (ET, n = 15) or health education without training (equal attention [EA], n = 14) over 8 weeks. Aerobic performance (O2max) was measured by indirect calorimetry, body composition by skinfolds, muscle strength by 1-repetition maximum (1-RM), and endurance at 85% of 1-RM for both leg press (LP) and chest press (CP). Results:A total of 29 individuals completed the study for a 74% adherence rate. Baseline characteristics (mean ± SD) were balanced between groups: age 31 ± 7 years; height = 1.74 ± 0.07 m; weight 82.0 ± 15.0 kg. The ET group significantly improved O2max by 0.63 ± 0.22 L/min (+21%), LP strength by 24.4 ± 5.6 kg (+40%), and CP strength by 20.6 ± 5.7 kg (+49%). The ET group increased LP and CP endurance by 120% and 96%, respectively and showed significant reductions in body weight of 1.7 ± 2.4 kg (−2%), % body fat of 2.8 ± 1.3% (−15%), and fat weight 2.8 ± 1.8 kg (−18%). All changes were significant (P < 0.001) for ET, and no changes were seen for the EA group. Conclusions:Individuals recovering from MA dependence showed substantial improvements in aerobic exercise performance, muscle strength and endurance, and body composition with ET. These findings demonstrate the feasibility of an ET intervention in these participants and also show excellent responsiveness to the exercise stimulus resulting in physiological changes that might enhance recovery from drug dependency.

Cardiovascular magnetic resonance in patients with pectus excavatum compared with normal controls

PurposeTo assess cardiothoracic structure and function in patients with pectus excavatum compared with control subjects using cardiovascular magnetic resonance imaging (CMR).MethodThirty patients with pectus excavatum deformity (23 men, 7 women, age range: 14-67 years) underwent CMR using 1.5-Tesla scanner (Siemens) and were compared to 25 healthy controls (18 men, 7 women, age range 18-50 years). The CMR protocol included cardiac cine images, pulmonary artery flow quantification, time resolved 3D contrast enhanced MR angiography (CEMRA) and high spatial resolution CEMRA. Chest wall indices including maximum transverse diameter, pectus index (PI), and chest-flatness were measured in all subjects. Left and right ventricular ejection fractions (LVEF, RVEF), ventricular long and short dimensions (LD, SD), mid-ventricle myocardial shortening, pulmonary-systemic circulation time, and pulmonary artery flow were quantified.ResultsIn patients with pectus excavatum, the pectus index was 9.3 ± 5.0 versus 2.8 ± 0.4 in controls (P < 0.001). No significant differences between pectus excavatum patients and controls were found in LV ejection fraction, LV myocardial shortening, pulmonary-systemic circulation time or pulmonary flow indices. In pectus excavatum, resting RV ejection fraction was reduced (53.9 ± 9.6 versus 60.5 ± 9.5; P = 0.013), RVSD was reduced (P < 0.05) both at end diastole and systole, RVLD was increased at end diastole (P < 0.05) reflecting geometric distortion of the RV due to sternal compression.ConclusionDepression of the sternum in pectus excavatum patients distorts RV geometry. Resting RVEF was reduced by 6% of the control value, suggesting that these geometrical changes may influence myocardial performance. Resting LV function, pulmonary circulation times and pulmonary vascular anatomy and perfusion indices were no different to controls.

Firefighter health and fitness assessment: a call to action.

Abstract Storer, TW, Dolezal, BA, Abrazado, ML, Smith, DL, Batalin, MA, Tseng, C-H, and Cooper, CB; The PHASER Study Group. Firefighter health and fitness assessment: A call to action. J Strength Cond Res 28(3): 661–671, 2014—Sudden cardiac deaths experienced by firefighters in the line of duty account for the largest proportion of deaths annually. Several fire service standards for fitness and wellness have been recommended but currently only 30% of U.S. fire departments are implementing programs for this purpose. The Department of Homeland Security Science and Technology Directorate has initiated the Physiological Health Assessment System for Emergency Responders (PHASER) program aiming to reduce these line-of-duty deaths through an integration of medical science and sensor technologies. Confirming previous reports, PHASER comprehensive risk assessment has identified lack of physical fitness with propensity for overexertion as a major modifiable risk factor. We sought to determine if current levels of fitness and cardiovascular disease (CVD) risk factors in a contemporary cohort of firefighters were better than those reported over the past 30 years. Fifty-one firefighters from a Southern California department were characterized for physical fitness and CVD risk factors using standard measures. Overall, physical fitness and risk factors were not different from previous reports of firefighter fitness and most subjects did not achieve recommended fitness standards. Considering the lack of widespread implementation of wellness/fitness programs in the U.S. fire service together with our findings that low physical fitness and the presence of CVD risk factors persist, we issue a call to action among health and fitness professionals to assist the fire service in implementing programs for firefighters that improve fitness and reduce CVD risk factors. Fitness professionals should be empowered to work with fire departments lending their expertise to guide programs that achieve these objectives, which may then lead to reduced incidence of sudden cardiac death or stroke.

Development and implementation of treadmill exercise testing protocols in COPD.

Background: Because treadmill exercise testing is more representative of daily activity than cycle testing, we developed treadmill protocols to be used in various clinical settings as part of a two-year, multicenter, chronic obstructive pulmonary disease (COPD) trial evaluating the effect of tiotropium on exercise. Methods: We enrolled 519 COPD patients aged 64.6 ± 8.3 years with a postbronchodilator forced expiratory volume in one second (FEV1) of 1.25 ± 0.42 L, 44.3% ± 11.9% predicted. The patients performed symptom-limited treadmill tests where work rate (Ẇ) was increased linearly using speed and grade adjustments every minute. On two subsequent visits, they performed constant Ẇ tests to exhaustion at 90% of maximum Ẇ from the incremental test. Results: Mean incremental test duration was 522 ± 172 seconds (range 20–890), maximum work rate 66 ± 34 watts. For the first and second constant Ẇ tests, both at 61 ± 33 watts, mean endurance times were 317 ± 61 seconds and 341 ± 184 seconds, respectively. The mean of two tests had an intraclass correlation coefficient of 0.85 (P < 0.001). During the second constant Ẇ test, 88.2% of subjects stopped exercise because of breathing discomfort; 87.1% for Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stage II, 88.5% for GOLD Stage III, and 90.2% for GOLD Stage IV. Conclusion: The symptom-limited incremental and constant work treadmill protocol was well tolerated and appeared to be representative of the physiologic limitations of COPD.

Effect of Cs-4® (Cordyceps sinensis) on Exercise Performance in Healthy Older Subjects: A Double-Blind, Placebo-Controlled Trial

OBJECTIVE The objective of this study was to examine the effect of Cs-4 (Cordyceps sinensis) on exercise performance in healthy elderly subjects. DESIGN Twenty (20) healthy elderly (age 50-75 years) subjects were enrolled in this double-blind, placebo-controlled, prospective trial. The subjects were taking either Cs-4 333 mg or placebo capsules 3 times a day for 12 weeks. MEASUREMENT Subjects received baseline screening including physical examination and laboratory tests. Maximal incremental exercise testing was performed on a stationary cycle ergometer using breath-by-breath analysis at baseline and at the completion of the study. RESULTS After receiving Cs-4 for 12 weeks, the metabolic threshold (above which lactate accumulates) increased by 10.5% from 0.83 +/- 0.06 to 0.93 +/- 0.08 L/min (p < 0.02) and the ventilatory threshold (above which unbuffered H(+) stimulates ventilation) increased by 8.5% from 1.25 +/- 0.11 to 1.36 +/- 0.15 L/min. Significant changes in metabolic or ventilatory threshold were not seen for the subjects in the placebo group after 12 weeks, and there were no changes in Vo(2) max in either group. CONCLUSION This pilot study suggests that supplementation with Cs-4 (Cordyceps sinensis) improves exercise performance and might contribute to wellness in healthy older subjects.

Time Course and Degree of Hyperinflation with Metronome-Paced Tachypnea in COPD Patients

In COPD patients, tachypnea should increase (dynamic) hyperinflation by shortening expiratory time. We developed a method to evaluate the time course and degree of dynamic hyperinflation during metronome-paced tachypnea. Fourteen patients with stable COPD (FEV1 43 ± 13% predicted) were studied. Inspiratory capacity (IC) was measured breathing through a flow transducer. Subjects paced their respiratory rate (fR) at 20/min, 30/min and 40/min for 60-second periods in response to audible tones generated by a computer. IC measurements were obtained at baseline and after 30 and 60 seconds at each fR. End-tidal carbon dioxide was monitored and fR was allowed to return to baseline between periods of tachypnea. Tachypnea produced reductions in IC of 200 ± 240 ml, 380 ± 330 ml and 540 ± 300 ml after 30 seconds at 20/min, 30/min and 40/min, respectively. IC reduction at 60 seconds was similar to 30 seconds for each fR. In patients with moderate-to-severe COPD, the dynamic hyperinflation induced by metronome-paced tachypnea was shown to occur rapidly and be complete by 30 seconds for a given fR. Controlled increments in fR produced stepwise increases in dynamic hyperinflation. This standardized method could be a useful and easier method of assessing dynamic hyperinflation in COPD patients before and after therapeutic interventions.

Validation of Heart Rate Derived from a Physiological Status Monitor-Embedded Compression Shirt Against Criterion ECG

Firefighters are subject to extreme environments and high physical demands when performing duty-related tasks. Recently, physiological status monitors (PSM) have been embedded into a compression shirt to enable firefighters to measure, visualize, log, and transmit vital metrics such as heart rate (HR) to aid in cardiovascular risk identification and mitigation, thereby attempting to improve the health, fitness, and safety of this population. The purpose of this study was to validate HR recorded by the PSM-embedded compression shirt against a criterion standard laboratory ECG-derived HR when worn concurrently with structural firefighting personal protective equipment (PPE) during four simulated firefighting activities. Ten healthy, college-age men (mean ± SD: age: 21 ± 1 yr; body mass: 91 ± 10 kg; body mass index: 26.9 ± 3.1 kg/m2) completed four tasks that are routinely performed during firefighting operations: outdoor fast-paced walking (FW), treadmill walking (TW), searching/crawling (SC), and ascending/descending stairs (AD). They wore the PSM-embedded compression shirt under structural firefighting PPE. HR was recorded concurrently by the PSM-embedded compression shirt and a portable metabolic measurement system accompanied with a standard 12-lead electrocardiograph that was used to provide criterion measures of HR. For all four tasks combined there was very high correlation of PSM and ECG HR (r > 0.99; SEE 0.84 /min) with a mean difference (bias) of −0.02 /min and limits of agreement of −0.07 to 0.02 /min. For individual tasks, the correlations were also high (r-values = 0.99; SEE 0.81–0.89). The mean bias (limits of agreement) was: FW 0.03 (-0.09 to 0.14); TW 0.04 (−0.05 to 0.12); SC −0.01 (−0.12 to 0.10); AD −0.13 (−0.21 to −0.04) /min. These findings demonstrate that the PSM-embedded compression shirt provides a valid measure of HR during simulated firefighting activities when compared with a standard 12-lead ECG.