El largo camino: recorrido de la fisioterapia hacia la práctica independiente / The long march: the pathway of physiotherapy towards independent practice

ResumenEl Largo Camino es una revisión acerca de los orígenes y desarrollo de la profesión de Fisioterapia en los EE.UU. desde principios del s. XX. Se presenta la evolución experimentada a lo largo de estos años tanto de los perfiles profesionales, como de su denominación y de la formación académica que han ido recibiendo y se contextualiza la evolución de la relación entre el fisioterapeuta y el médico, hacia el respeto mutuo y de mejora en la práctica profesional.ResumenPor otra parte, se presentan de forma clara y destacada los principales hitos en el largo camino que se ha ido recorriendo desde su nacimiento como profesionales totalmente dependientes del médico, hasta la situación actual de profesionales con una sólida formación científica y clínica que pueden ejercer y gobernar libremente su profesión sin dependencias ajenas (AU)

AbstractThe Long March is a review of the origins and development of the Physical Therapy profession in the United States since the beginning of the 20th century. It shows the evolution experienced since that time of its professional profile, name and academic training received. It is shown how the relationship between the physical therapist and physician has grown and evolved into a relationship of mutual respect and of improvement in the professional practice.AbstractOn the other hand, the principal milestones in the long march of the physical therapy profession from the time of its birth as a profession that was totally dependent on the physician to its current status as a profession with professionals having a deep science base and high university level training who are able to practice and freely govern their profession without external control are presented (AU)

The restorative effects of pulsed infrared light therapy on significant loss of peripheral protective sensation in patients with long-term type 1 and type 2 diabetes mellitus.

Pulsed infrared light therapy (PILT) has been shown to increase peripheral sensation in diabetic patients with diabetic peripheral neuropathy (DPN). However, most studies last for very short periods, with the subjects receiving only 6-20 treatments. The purpose of this study was to evaluate the effectiveness of an eight-week course of PILT in reversing long-standing, profound DPN in patients with type 1 and type 2 diabetes. Twenty-two subjects with a diagnosis of type 1 (n=2) or type 2 (n=20) diabetes participated in the study. PILT was administered to one foot chosen at random with the other foot serving as a within-subject control (no treatment). Patients underwent 24 treatments (3 times/week, for eight weeks) for 30 min per treatment. Changes in peripheral protective sensation (PPS) were measured using Semmes-Weinstein monofilaments (SWM) ranging from 3.7 to 6.48. PILT improved PPS even in patients with long-standing chronic neuropathies whose initial pre-study sensation was not measurable with a 200-g SWM. PILT significantly improves PPS. While the exact mechanism of action is not understood, infrared light may improve peripheral neuropathies by improving foot perfusion by stimulating nitric oxide production.

Muscle glycogen supercompensation is enhanced by prior creatine supplementation.

PURPOSE: Recently, it was shown that glycogen supercompensation tended (P = 0.06) to be greater if creatine and glycogen were loaded simultaneously. Because the authors suggested that creatine loading increased cell volumes and, therefore, enhanced glycogen supercompensation, we decided to determine whether an enhanced glycogen supercompensation could be realized if the glycogen loading protocol was preceded by a 5-d creatine load. METHODS: Twelve men (19-28 yr) performed two standard glycogen loading protocols interspersed with a standard creatine load of 20 g.d(-1) for 5 d. The vastus lateralis muscle was biopsied before and after each loading protocol. RESULTS: The initial glycogen loading protocol showed a significant 4% increase (P < 0.05) in muscle glycogen (Delta upward arrow 164 +/- 87 mmol.kg(-1) d.m.), and no change (P > 0.05) in total muscle creatine. Biopsies pre- and post-creatine loading showed significant increases in total muscle creatine levels in both the left leg (Delta upward arrow 41.1 +/- 31.1 mmol.kg(-1) d.m.) and the right leg (Delta upward arrow 36.6 +/- 19.8 mmol.kg(-1) d.m.), with no change in either leg's muscle glycogen content. After the final glycogen loading, a significant 53% increase in muscle glycogen (Delta upward arrow 241 +/- 150 mmol.kg-1 d.m.) was detected. Finally, the postcreatine load total glycogen content (694 +/- 156 mmol.kg(-1) d.m.) was significantly (P < 0.05) greater than the precreatine load total glycogen content (597 +/- 142 mmol.kg(-1) d.m.). CONCLUSION: It is suggested that a muscle's glycogen loading capacity is influenced by its initial levels of creatine and the accompanying alterations in cell volume.

Growth and overweight of Navajo youth: secular changes from 1955 to 1997.

OBJECTIVE: To examine the growth status, prevalence of risk of overweight and of overweight, and secular changes in growth status in Navajo youth from 1955 to 1997. SUBJECTS: 526 (256 males, 270 females) Navajo children 6-12 y of age. MEASUREMENTS: Stature and mass were measured and the body mass index (BMI) was calculated. ANALYSIS: All three variables were plotted relative to age- and sex-specific US reference data and the prevalence rates for risk of overweight and of overweight were estimated using the BMI as the criterion. The cut-off for the risk of overweight was the age- and sex-specific 85th and 95th percentiles of NHANES I, while the cut-off for overweight was a BMI>/=95th percentiles. Age-specific sex differences were compared using independent samples t-tests. Secular changes for body size were estimated by comparing age- and sex-specific means for stature, mass, and the BMI in the present study and two previous studies in 1955 and 1989. RESULTS: No statistically significant differences were observed between sexes within age groups. In both sexes, mean age-specific stature appeared to be relatively stable around the 50th percentile of US reference values. Mean age-specific mass appeared to be relatively stable between the 50th and 90th percentiles of the reference values, while the mean BMI tended to fluctuate about the 85th percentile. Approximately 41% of the Navajo boys and girls 6-12 y of age had BMIs >/=85th percentiles of US reference data. Compared to corresponding data on Navajo youth in 1955 and 1989, the current sample was larger in mass and the BMI. The estimated rate of secular change in mass was about 1.5 kg/decade in younger boys and girls, and about 3 kg/decade in older boys and girls between 1955 and 1997. The estimated rate of secular change in the BMI was about 0.5-1.0 units/decade between 1955 and 1997, while that for stature was about 2 cm/decade between 1955 and 1997. CONCLUSIONS: The results are consistent with recent findings on the Navajo Health and Nutrition Survey that overweight is a serious public health concern across the lifespan in the Navajo, and that the problem begins in childhood. Furthermore, Navajo children appear to be heavier than about a decade ago. International Journal of Obesity (2000) 24, 211-218

A chest wall restrictor to study effects on pulmonary function and exercise. 1. Development and validation.

Chest wall-restrictive loading reduces a person's ability to expand the chest wall during inhalation and results in decrements in lung capacities, resting pulmonary function, and ultimately, exercise performance. Chest wall restriction is observed in some forms of skeletal and pulmonary diseases (e.g., scoliosis) as well as in occupational situations (e.g., bulletproof vests). We have designed a constant-pressure chest wall-restrictive device that provides a quantifiable and reproducible load on the chest. This paper describes the device and the initial pulmonary function tests conducted. Ten subjects participated in this study. Subjects wore the restrictive device while performing pulmonary function tests at four externally added restrictive loads on three separate occasions. A two-way repeated-measures multivariate analysis of variance revealed significant decreases in forced expiratory vital capacity (FVC) and forced expiratory volume in 1 s (FEV1.0) at each load while the ratio of FEV1.0 to FVC (FEV1.0%) was maintained. No significant differences in any variable were found across time or between the seated and standing position. These results indicate that this chest wall-restrictive device provides a quantifiable added inspiratory load in the breathing cycle that results in reproducible decrements in pulmonary function representative of those seen in some restrictive pulmonary disease and occupational situations.

Persistence of supercompensated muscle glycogen in trained subjects after carbohydrate loading.

Several carbohydrate (CHO)-loading protocols have been used to achieve muscle glycogen supercompensation and prolong endurance performance. This study assessed the persistence of muscle glycogen supercompensation over the 3 days after the supercompensation protocol. Trained male athletes completed a 6-day CHO-loading protocol that included cycle ergometer exercise and dietary manipulations. The 3-day depletion phase began with 115 min of cycling at 75% peak oxygen uptake followed by 3 x 60-s sprints and included the subjects consuming a low-CHO/high-protein/high-fat (10:41:49%) diet. Subjects cycled 40 min at the same intensity for the next 2 days. During the 3-day repletion phase, subjects rested and consumed a high-CHO/low-protein/low-fat (85:08:07%) diet, including a glucose-polymer beverage. A 3-day postloading phase followed, which involved a moderately high CHO diet (60%) and no exercise. Glycogen values for vastus lateralis biopsies at baseline and postloading days 1-3 were 408 +/- 168 (SD), 729 +/- 222, 648 +/- 186, and 714 +/- 196 mmol/kg dry wt, respectively. The CHO-loading protocol increased muscle glycogen by 1.79 times baseline, and muscle glycogen remained near this level during the 3-day postloading period. Results indicate that supercompensated muscle glycogen levels can be maintained for at least 3 days in a resting athlete when a moderate-CHO diet is consumed.

Body fat and exercise endurance in trained rats adapted to a high-fat and/or high-carbohydrate diet.

To study how diet composition affects exercise endurance and body composition, 48 male Sprague-Dawley rats were treadmill trained for 8 wk while consuming either a high-fat (F) diet or high-carbohydrate (C) diet. The diets were switched for one-half the number of rats in each group 3 days before the animals were killed, during which feeding time the rats did not exercise. One-half of rats receiving each of the four diet combinations were taken at rest (R) or exhaustion (E), resulting in eight groups: CCR, CFR, FFR, FCR, CCE CFE, FFE, and FCE. An analysis of variance revealed that resting glycogen in the FCR group was enhanced in muscle (19-33%) and liver (23%) compared with controls. Each F group's exercise time to exhaustion [CFE, 322.9 +/- 25.0; FFE, 356.8 +/- 37.8; FCE, 467.0 +/- 32.6 (SE) min] was different (P < 0.05) from control (CCE, 257.5 +/- 29.2 min). Postexercise glycogen was equivalent among all dietary groups, were muscle triglycerides. The FF and FC groups had higher 3-hydroxyacyl-CoA dehydrogenase activity in soleus muscle than either CC or CF animals. After training, body weights were similar between the two dietary groups; however, percent body fat was 17% greater after the F diet, even though F diet animals voluntarily consumed 12% less energy than did C diet animals. These data suggest that exercise endurance time is optimized in trained rats that receive a carbohydrate load after adaptation to a F diet. However, despite intense exercise training, the F diet promotes body fat deposition, and the health consequences of following such a regimen are still unknown.

Pulmonary function test outcomes in healthy Navajo Native American adolescents.

Prediction equations for estimating lung volumes have been determined for Caucasians, African-Americans, and Mexican-Americans. These separate equations were determined because of differences in thoracic morphology between people of various racial groups, making it impossible to use one prediction formula to accurately estimate lung volumes for all individuals. One hundred ninety-one adolescent Navajo children (males, n = 110; females, n = 81) between 11 and 18 yr of age volunteered for the study and underwent a series of pulmonary function tests (PFT). New pulmonary function prediction equations for Navajo youth were generated for estimating pulmonary volumes and capacities that more accurately predict expected PFT outcomes than formulas in common use for Caucasian, Mexican-American, or African-American youth.

Effect of microamperage stimulation on the rate of wound healing in rats: a histological study.

BACKGROUND AND PURPOSE: This study examined cutaneous wound healing after microamperage stimulation (MS). SUBJECTS: Twelve female Sprague-Dawley rats were studied. METHODS: The treatment (wound reduction) group (n = 6) received 100 microA of current at 0.3 Hz on a 50% duty cycle for 2 hours a day for 14 days. The control group (n = 6) received the same handling and electrode placement, but no current was applied. Wound size was measured daily following each treatment. Histological analysis included measurement of epithelial thickness, vascularity, and fibroblast density from tissue sections taken at the end of the experiment. RESULTS: An analysis of variance showed no significant difference between the two groups with respect to the change in wound size over the 14 treatment days. A series of t tests showed no significant differences between the groups for any of the histological measurements. CONCLUSION AND DISCUSSION: The results of this study do not support the hypothesis that MS accelerates acute cutaneous wound healing.

Failure to reduce body water loss in cold-water immersion by glycerol ingestion.

The efficacy of ingesting an aqueous glycerol solution to enhance body water retention during prolonged cold-water dives was evaluated. Nine Naval Special Warfare divers performed a 3-h dive in 13 degrees C water. Divers were assigned to either a water-treatment group (WT) or a glycerol-treatment (GT) group. WT ingested 30 ml water/kg lean body mass (LBM). GT ingested a solution consisting of 1.2 ml glycerol/kg LBM and 30 ml water/kg LBM. Blood was drawn at prehydration, 90 min after hydration, and 20 min after the 3-h dive for serum glycerol, glucose, free fatty acids, lactate, and electrolyte determinations. Fluid intake and output was recorded and urine analyzed for osmolality, electrolytes, and specific gravity. Serum glycerol values in GT were 200 times greater at posthydration than prehydration and 100 times greater at postdive than at prehydration. Urine output, total body weight loss, and non-urine weight loss during posthydration and dive sampling periods were not significantly different between treatment groups. Hyperhydration with an aqueous glycerol solution of 1.2 ml glycerol/kg LBM seems ineffective in significantly reducing body water loss in divers during prolonged cold-water immersion.

Consequences of combining strength and endurance training regimens.

A common belief among many clinicians and trainers is that intensive simultaneous training for muscle strength and cardiovascular endurance is counterproductive. To test this premise, 14 healthy, untrained men trained four days per week for 20 weeks on a bicycle ergometer for endurance (END Group, n = 4), on an isokinetic device for increased torque production (ITP Group, n = 5), or on both devices (COMBO Group, n = 5). The ITP and COMBO groups had equal torque gains throughout the study (234 +/- 45 and 232 +/- 23 N.m, respectively). After 11 weeks, both END and COMBO groups had similar gains in maximal oxygen consumption (VO2max) (in milliliters per kilogram of body weight per minute). During the last half of the study, however, the END Group had a significant gain in VO2max (p less than .05) of 4.7 +/- 1.2 mL.kg-1.min-1, whereas the COMBO Group had a nonsignificant gain (p greater than .05) of 1.8 +/- 0.6 mL.kg-1.min-1. In harmony with this finding, the END Group showed a significant increase (p less than .05) in citrate synthase activity (15.5 +/- 7.9 mumol.g-1.min-1), whereas the COMBO Group had no significant increase. The authors concluded that simultaneous training may inhibit the normal adaptation to either training program when performed alone. The extent of the interference probably depends on the nature and intensity of the individual training program. [Nelson AG, Arnall DA, Loy SF, et al: Consequences of combining strength and endurance training regimens.

Energy expenditure of ambulation using the Sure-Gait crutch and the standard axillary crutch.

Energy expenditure is increased for ambulation with various assistive devices such as canes, walkers, and crutches compared with unassisted ambulation. The purpose of the present investigation was to determine whether a significant difference in oxygen consumption and heart rate existed during ambulation with two different types of crutches. Ten healthy male subjects between the ages of 40 and 60 years participated in this study. Each subject ambulated at 1.5 mph on a treadmill using two different types of crutches--the standard axillary crutch and the Sure-Gait crutch. After walking on the treadmill without an assistive device, subjects ambulated using a three-point, swing-to gait pattern with one of the two types of crutches. This procedure was repeated using the other type of crutch. Oxygen consumption and heart rate were analyzed using an analysis of variance for repeated measures design. The results of the study showed a significant difference (p less than .01) between ambulation with crutches and unassisted ambulation for oxygen consumption and heart rate. No difference, however, was found between the two crutch types.

Effect of fasting on myocardial substrates in male and female rats.

Adult male and female rats were fasted for 1, 2, or 3 days to determine its effect on circulating and endogenous fuels available to the heart. Liver glycogen was depleted within the first 24 h of food restriction. Plasma glucose decreased approximately 2.5 mM in both sexes during the 3 days. Fasting significantly increased plasma beta-hydroxybutyrate to approximately the same level in female and male rats. Plasma free fatty acid (FFA) increased approximately 0.2 mM in both groups during the first 24 h without food and remained elevated over the next 2 days. FFA concentrations were higher in fed female than in fed male rats and remained significantly higher in female rats throughout the experimental period. Myocardial glycogen increased 64% during the first 2 days of fasting in the male rats and stayed elevated on the third day of fasting. In contrast, heart glycogen of female rats remained unchanged from an initial value of 3.13 mg/g throughout the 3-day fasting period. Endogenous triglyceride (TG) of male rats decreased from 2.14 +/- 0.09 to 1.41 +/- 0.21 mumol/g during the first 24 h without food and remained at that level during the second and third days. Heart TG in female rats fell progressively from 2.36 +/- 0.19 to 1.02 +/- 0.12 mumol/g during the fasting period. Cardiac FFA were higher in female than in male animals throughout the entire experiment. These data indicate that quantitative and qualitative metabolic differences exist between male and female rats stressed by fasting.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of the triacylglycerol lipase activity in three types of rat skeletal muscle.

The purpose of this study was to characterize the lipolytic activity of the alkaline triglyceride lipase in homogenates of three types of skeletal muscle obtained from heparin-perfused rat hindlimb. Specifically, the red portion of the vastus lateralis, the white portion of the vastus lateralis, and the soleus muscles were examined. To remove capillary-bound lipoprotein lipase from the capillary beds, muscle was perfused with an erythrocyte-free buffer containing 4% albumin, 5 units of heparin/mL, and 7.5 microM adenosine. Adenosine reduced perfusion pressure from 117 +/- 5 to 86 +/- 6 mmHg (1 mmHg = 133.32 Pa), providing evidence for an effective vasodilation. This vasodilation increased the amount of lipoprotein lipase removed from the capillary beds. By the end of the experiment, perfusates were lipoprotein lipase-free. Oxygen supply to the perfused hindlimb appeared adequate as evidenced by similar high energy phosphate values for perfused and contralateral control tissues. For example, in soleus muscle, ATP content was 4.5 +/- 0.6 vs. 4.2 +/- 0.3 mumol/g, ADP concentration was 1.0 +/- 0.2 vs. 1.4 +/- 0.2 mumol/g, and creatine phosphate level was 12.9 +/- 0.7 vs. 11.0 +/- 0.6 mumol/g for perfused and contralateral control soleus, respectively. In addition, K+ output by the hindlimb was negligible, while glycolytic flux of perfused muscle was similar to that measured in control tissue. The findings that triglyceride levels of soleus and red vastus lateralis were decreased suggest that endogenous triglyceride was providing energy for the hindlimb during perfusion. Skeletal muscle triglyceride lipase activity was stimulated by serum and heparin, inhibited by NaCl and protamine, and had a pH optimum of 8.1.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of dietary sugar and of dietary fat on food intake and body fat content in rats.

The long term ingestion of a sugar-rich diet (low fat) caused severe obesity in adult rats. In a separate experiment, the habitual consumption of a fat-rich diet (40% kcal from fat) also caused severe obesity. Severe obesity developed in both groups of animals even though they did not overeat. Voluntary food intake for the sugar-fed rats averaged 28,314 +/- 756 calories/rat per 55 wks which was similar to the value of 28,884 +/- 953 calories/rat per 55 wks for the fat-fed rats. However, both values were lower than that of 32,869 +/- 588 for the control rats eating Purina chow. Despite a lower caloric intake, carcass fat averaged 45 +/- 1% for rats eating the sugar-rich diet and 46 +/- 2% for rats eating the fat-rich diet, but only 33 +/- 2% for rats eating a diet of Purina chow. These results provide evidence that severe obesity can develop in the absence of hyperphagia in animals eating a sugar-rich or fat-rich diet. Finally, a rat model for severe obesity is presented in which carcass fat ranged from 18% (lean) to 61% (severe obesity) using dietary intervention alone at critical stages of the animal's life.

Effect of cholera toxin on triacylglycerol lipase activity and triacylglycerol content of rat heart.

This study was performed to reexamine the effect of cholera toxin on total and intracellular alkaline lipoprotein lipase (LPL) activity in rat heart. In addition, the relationship between intracellular triacylglycerol (TG)lipase activity and TG content of cardiac tissue was determined in cholera toxin treated rats. One intravenous injection of cholera toxin increased total LPL activity significantly above control activity 4 h following treatment. After 16 h, total enzyme activity in hearts of cholera toxin treated rats was 2.4-fold above control levels and remained significantly above the control activity up to the 24-h time point. Intracellular alkaline TG lipase activity was increased 24%, 59%, 2.1-fold, and 2.1-fold above control levels measured 0.5, 8, 16, and 24 h following cholera toxin treatment, respectively. Heart TG content fell significantly following cholera toxin treatment, with a maximal reduction seen 8 h following agent injection. At that time, TG was 0.61 mumol/g, a reduction of 63% below the control concentration of 1.8 mumol/g. A negative relationship between myocardial intracellular TG lipase activity and TG concentration of r = -0.83 was highly significant (P less than 0.001). These findings indicate that cholera toxin injection can increase total cardiac LPL activity and show that 70% of this increased activity is in the intracellular fraction. The highly significant relationship between enzyme activity and TG content support our working hypothesis that the intracellular TG lipase (LPL) is playing a role in regulating cardiac TG content.

Effect of adrenodemedullation on metabolic responses to high-intensity exercise.

To determine the role of epinephrine in glycogenolysis during high-intensity exercise, rats were adrenodemedullated (ADM) or sham operated (SHAM) and run for either 30 min at 38 m/min or for 5 min at 27, 38, or 48 m/min up a 15% grade. At the end of exercise the rats were anesthetized by intravenous injection of pentobarbital sodium. Liver, blood, and muscle samples were obtained. Plasma epinephrine values were 5.9 and 0.3 nM for SHAM and ADM animals, respectively, after 30 min of exercise. Liver glycogen decreased by 16 and 21 mg/g in the SHAM and ADM groups, respectively, and liver cAMP increased significantly in both groups. Glycogen in the soleus muscle decreased 80% in the SHAM but only 43% in the ADM animals after 30 min of exercise. The exercise-induced hyperglycemia observed in the SHAM animals was not present in the ADM animals. The responses of cyclic AMP, soleus glycogen, and blood glucose were similar in both the 5- and 30-min exercise groups. During intense exercise, epinephrine is unessential for stimulating liver glycogenolysis but does play an important role in stimulating glycogenolysis in the soleus muscle and in establishing exercise-induced hyperglycemia.

Effects of 24-hour fast on cycling endurance time at two different intensities.

Ten competitive cyclists were exercised to exhaustion to test the potential of a 24-h fast for increasing endurance. One group (n = 4) was tested at an initial intensity of 86% maximum O2 uptake (VO2max) (HI) and a second group (n = 6) at 79% VO2max (MI). Both groups repeated test rides in fasted and normal-diet conditions. Time to fatigue was designated at two points: fatigue 1 occurred when pedal frequency could not be maintained at the initial percent VO2max; fatigue 2 occurred when pedal frequency could not be maintained at a workload of approximately 65% VO2max. In both HI and MI the 24-h fast had no effect on resting muscle glycogen stores but significantly increased plasma free fatty acid (FFA) levels. Despite the increased FFA availability, time to fatigue was reduced in the fasted groups. Fatigue 1 and 2 times (mean +/- SE) for HI-fasted were 42.0 +/- 6.2 and 170.0 +/- 20.4 min, respectively, compared with those of the HI-normal diet of 115.3 +/- 25.6 and 201.0 +/- 14.8 min. Fatigue 1 and 2 times for MI-fasted were 142.0 +/- 19.6 and 167.5 +/- 10.5 min compared with those of the MI-normal diet of 191.3 +/- 25.0 and 214.3 +/- 18.9 min. The cause of fatigue at fatigue 1 was not readily apparent. Fatigue 2 in all groups seemed to be related to hypoglycemia as well as muscle glycogen depletion.

Effect of infusing epinephrine on liver and muscle glycogenolysis during exercise in rats.

To determine the possibility of a threshold concentration of plasma epinephrine that stimulates liver glycogenolysis during exercise, adrenodemedullated (ADM) and sham-operated (SHAM) rats were infused with saline or epinephrine at rates that produced plasma concentrations ranging between 0.01 ng/ml (0.06 nM) and 4.3 ng/ml (23.7 nM). During the infusion rats were run on a rodent treadmill for 0, 30, or 60 min at 21 m/min up a 15% grade. Liver glycogen decreased at similar rates in all exercising rats regardless of plasma epinephrine concentration. Epinephrine infusion stimulated significant muscle glycogen depletion in the soleus and red and white vastus lateralis muscles. ADM saline-infused animals exhibited the least muscle glycogen depletion. Blood glucose and lactate in exercising ADM rats increased as the epinephrine infusion concentration increased. During exercise, there was no epinephrine concentration that stimulated liver glycogenolysis more effectively than physiological saline.

Epinephrine is unessential for stimulation of liver glycogenolysis during exercise.

To determine the role of adrenal medullary hormones in controlling the rate of liver glycogenolysis during exercise, adrenodemedullated (ADM) and sham-operated (SO) rats were run on a rodent treadmill at 21 m/min up a 15% grade for 0, 30, or 60 min. Rats were anesthetized by intravenous injection of pentobarbital sodium, and liver, muscle, and blood were collected and frozen. Liver glycogen decreased at similar rates in ADM and SO rats. Hepatic adenosine 3',5'-cyclic monophosphate (cAMP), plasma glucagon, and plasma free fatty acids increased to the same extent in both ADM and SO rats. The adrenodemedullation caused a reduction in glycogenolysis in the fast-twitch white region of the quadriceps, soleus, and lateral gastrocnemius during exercise. The normal exercise-induced increase in blood glucose and lactate and the decline in plasma insulin were not observed in the demedullated rats. During submaximal exercise the principal targets for epinephrine released from the adrenal medulla appear to be pancreatic beta-cells and skeletal muscle and not the liver.