Healthcare professionals' knowledge and practice of physical activity promotion in cancer care: Challenges and solutions.

Limited research exists regarding healthcare professionals' knowledge and practice of physical activity promotion for cancer survivors in Ireland. There is also a lack of research identifying the barriers experienced by oncology professionals when promoting physical activity, or referring patients to community-based exercise programmes. This study aims to identify healthcare professionals' knowledge, barriers and practices in relation to physical activity promotion for cancer survivors, and to generate guidance regarding the optimisation of the referral process to community-based exercise programmes. Oncology healthcare professionals (n = 114) were invited to participate in two rounds of an online Delphi study. The response rates in rounds one and two were 38% (43/114) and 70% (30/43). Most respondents acknowledged the value of physical activity for cancer survivors (≥86%) and agreed that discussing physical activity with cancer patients was part of their role (88%). However, the majority of recommendations provided to patients did not align with the current physical activity guidelines. Strategies related to four themes that could optimise the referral process to community-based exercise programmes achieved consensus, including providing education to healthcare professionals and patients regarding the benefits of physical activity and the logistics and quality of programmes, and optimising the logistics of the referral process.

Leptin and leptin receptor genetic variants associate with habitual physical activity and the arm body composition response to resistance training.

PURPOSE: We investigated the influence of Leptin (LEP) and leptin receptor (LEPR) SNPs on habitual physical activity (PA) and body composition response to a unilateral, upper body resistance training (RT) program. METHODS: European-derived American volunteers (men=111, women=131, 23.4 ± 5.4 yr, 24.4 ± 4.6 kg·m(-2)) were genotyped for LEP 19 G>A (rs2167270), and LEPR 326 A>G (rs1137100), 668 A>G (rs1137101), 3057 G>A (rs1805096), and 1968 G>C (rs8179183). They completed the Paffenbarger PA Questionnaire. Arm muscle and subcutaneous fat volumes were measured before and after 12 wk of supervised RT with MRI. Multivariate and repeated measures ANCOVA tested differences among phenotypes by genotype and gender with age and body mass index as covariates. RESULTS: Adults with the LEP 19 GG genotype reported more kcal/wk in vigorous intensity PA (1273.3 ± 176.8, p=0.017) and sports/recreation (1922.8 ± 226.0, p<0.04) than A allele carriers (718.0 ± 147.2, 1328.6 ± 188.2, respectively). Those with the LEP 19 GG genotype spent more h/wk in light intensity PA (39.7 ± 1.6) than A allele carriers (35.0 ± 1.4, p=0.03). In response to RT, adults with the LEPR 668 G allele gained greater arm muscle volume (67,687.05 ± 3186.7 vs. 52,321.87 ± 5125.05 mm(3), p=0.01) and subcutaneous fat volume (10,599.89 ± 3683.57 vs. -5224.73 ± 5923.98 mm(3), p=0.02) than adults with the LEPR 668 AA genotype, respectively. CONCLUSION: LEP19 G>A and LEPR 668 A>G associated with habitual PA and the body composition response to RT. These LEP and LEPR SNPs are located in coding exons likely influencing LEP and LEPR function. Further investigation is needed to confirm our findings and establish mechanisms for LEP and LEPR genotype and PA and body composition associations we observed.

Adiposity attenuates muscle quality and the adaptive response to resistance exercise in non-obese, healthy adults.

BACKGROUND: Emerging data have revealed a negative association between adiposity and muscle quality (MQ). There is a lack of research to examine this interaction among young, healthy individuals, and to evaluate the contribution of adiposity to adaptation after resistance exercise (RE). OBJECTIVE: The purpose of this investigation was to examine the influence of subcutaneous adipose tissue (SAT) on muscle function among non-obese individuals before and after RE. DESIGN: Analyses included 634 non-obese (body mass index <30 kg m(-2)) subjects (253 males, 381 females; age=23.3 ± 5.2 years). SAT and muscle mass (magnetic resonance imaging-derived SAT and biceps muscle volume), isometric and dynamic biceps strength, and MQ (strength/muscle volume), were analyzed at baseline and after 12 weeks of unilateral RE. RESULTS: At baseline, SAT was independently associated with lower MQ for males (ß=-0.55; P<0.01) and females (ß=-0.45; P<0.01), controlling for body mass and age. Adaptation to RE revealed a significant negative association between SAT and changes for strength capacity (ß=-0.13; p=0.03) and MQ (ß=-0.14; P<0.01) among males. No attenuation was identified among females. Post-intervention SAT remained a negative predictor of MQ for males and females (ß=-0.47; P<0.01). CONCLUSIONS: The findings reveal that SAT is a negative predictor of MQ among non-obese, healthy adults, and that after 12 weeks of progressive RE this association was not ameliorated. Data suggest that SAT exerts a weak, negative influence on the adaptive response to strength and MQ among males.

Leptin responses to long-term cardiorespiratory exercise training without concomitant weight loss: a prospective study.

AIM: The aims of the present study were to examine 1) whether changes in circulating leptin levels occur in response to six months of aerobic exercise training (ET) without concomitant weight loss; 2) whether there is a different response with respect to gender; and 3) the relationship between age and leptin and whether this relationship has any impact on the response to ET without weight-loss. METHODS: Thirty-eight healthy, sedentary men and women (age 38.43+/-2.24, range 18-59 years) participated in 6 months of supervised, moderate intensity (ET) performed 4 days per week. Maintenance of usual dietary practices were encouraged to minimize weight-loss. Participants were evaluated for circulating fasting leptin, body mass, body fat percentage and maximal aerobic power (VO2max) prior to and after ET. RESULTS: There was no decrease in body weight or leptin concentration (17.69+/-2.67 vs 16.85+/-3.12 ng dL(-1)). Gender did not affect the response to exercise training. The bivariate correlation between leptin and age was not significant, but the relationship reached significance after controlling for body fat percentage and VO2max (r = -0.358, P < 0.05). Age did not affect the response of leptin concentration to ET. CONCLUSION: It is probable that changes in leptin concentration reported previously with ET may be attributable to concomitant weight loss, but age does not play a role in how leptin responds to ET.

The effect of physical activity on endothelial function in man.

Endothelial dysfunction occurs early in the atherosclerosis in response to elevated atherosclerotic risk factors, and endothelial dysfunction itself may exacerbate the atherosclerotic process. Treatments that reduce atherosclerotic risk factors also generally improve endothelial function. The present review seeks to summarize the effect of exercise training on endothelial function in human subjects. Cross-sectional studies comparing healthy physically active and inactive subjects as well as longitudinal exercise training studies of healthy individuals show little effect of exercise training on endothelial function. In contrast, both cross-section and longitudinal studies document improved endothelial function with exercise training in subjects with abnormal baseline endothelial function, including the elderly and patients with heart failure or coronary artery disease. Improvements in endothelial function with physical activity may explain some of the benefits of exercise in subjects with, or at risk for, vascular disease.

Intermodal comparison of energy expenditure at exercise intensities corresponding to the perceptual preference range.

PURPOSE: This study compared the rate of energy expenditure among six popular exercise machines at intensities corresponding to ratings of perceived exertion (RPE) for fairly light (RPE-11), somewhat hard (RPE-13), and hard (RPE-15) in 9 healthy men and 10 healthy women. METHODS: A maximal exercise test on each exercise machine was used to anchor the Borg 15-point category scale. Subjects performed three submaximal exercise tests at selected RPEs on a treadmill, stair-stepper, cycle ergometer, rowing ergometer, cross-country ski simulator, and rider. The submaximal tests on each exercise device were performed in random order and were 6 min in duration with 15-min rest between trials. Oxygen uptake, heart rate, and blood lactate concentration were measured during the final 2 min of each exercise intensity. RESULTS: Energy expenditure at each RPE was highest on the treadmill and ski simulator in men, and on the treadmill, ski simulator, and rowing ergometer in women. Energy expenditure in men and women at all RPEs was lowest on the rider and cycle ergometer. Energy expenditure at a given RPE was greater in men than women on all exercise machines, but men and women used a similar percentage of their machine specific peak oxygen uptake at each RPE on all machines. Heart rate was generally similar among the machines and between both men and women at each RPE. CONCLUSIONS: Our results indicated that there are large differences in energy expenditure between exercise machines and between men and women at intensities perceived to be fairly light, somewhat hard, and hard. Consequently, subjects can expend more calories at the same RPE during treadmill and ski simulator exercise, for example, than during exercise with other devices. This may have important implications for the health benefits of different exercises and in promoting long term exercise adherence.

The acute versus the chronic response to exercise.

PURPOSE: There is strong and consistent evidence that a single exercise session can acutely reduce triglycerides and increase high-density lipoprotein (HDL) cholesterol (HDL-C), reduce blood pressure, and improve insulin sensitivity and glucose homeostasis. Such observations suggest that at least some of the effects on atherosclerotic cardiovascular disease (ASCVD) risk factors attributed to exercise training may be the result of recent exercise. RESULTS: These acute and chronic exercise effects cannot be considered in isolation. Exercise training increases the capacity for exercise, thereby permitting more vigorous and/or more prolonged individual exercise sessions and a more significant acute effect. The intensity, duration, and energy expenditure required to produce these acute exercise effects are not clearly defined. The acute effect of exercise on triglycerides and HDL-C appears to increase with overall energy expenditure possibly because the effect maybe mediated by reductions in intramuscular triglycerides. Prolonged exercise appears necessary for an acute effect of exercise on low-density lipoprotein (LDL) cholesterol (LDL-C) levels. The acute effect of exercise on blood pressure is a low threshold phenomenon and has been observed after energy expenditures requiring only 40% maximal capacity. The acute effect of exercise on glucose metabolism appears to require exercise near 70% maximal, but this issue has not been carefully examined. CONCLUSIONS: Exercise has definite acute effects on blood lipids, blood pressure, and glucose homeostasis. Exercise also has acute effects on other factors related to atherosclerosis such as immunological function, vascular reactivity, and hemostasis. Considerable additional research is required to define the threshold of exercise required to produce these putatively beneficial effects.

Effect of potassium phosphate supplementation on perceptual and physiological responses to maximal graded exercise.

This investigation evaluated the effect of oral potassium phosphate supplementation on ratings of perceived exertion (RPE) and physiological responses during maximal graded exercise tests (GXT). Eight highly trained endurance runners completed a GXT to anchor the Borg 15-point RPE scale and two double-blind counterbalanced GXTs. Subjects ingested either 4,000 mg x day(-1) of phosphate (PHOS) or a placebo (PLA) for 2 days. Two weeks separated GXTs. Phosphate levels obtained immediately prior to the GXTs were greater in PHOS than PLA. No differences between PHOS and PLA were noted for the submaximal and maximal physiological responses. RPE for the overall body were lower during PHOS than PLA at intensities corresponding to 70-80% of VO2max. This suggests that oral potassium phosphate supplementation mediates perceived exertion during moderately intense exercise.

Gender comparison of RPE at absolute and relative physiological criteria.

PURPOSE: The effect of gender on ratings of perceived exertion for the overall body (RPE-O), chest (RPE-C), legs (RPE-L), and arms (RPE-A (ski)) was determined. METHODS: Comparisons were made at, a) absolute oxygen uptake (VO2, L x min(-1); mL x kg(-1) x min(-1)) and heart rate (HR, b x min(-1)) and b) relative VO2 (%VO2max/peak) and HR (% HRmax/peak) reference criteria. Nine male and 10 female subjects were compared using a perceptual estimation paradigm for treadmill (weight bearing), simulated ski (partial weight bearing), and cycle (nonweight bearing) exercise. RPE was determined by the Borg 15-category scale. RESULTS: For each exercise mode, RPE-O, RPE-L, RPE-A (ski), and RPE-C were higher (P < 0.05) in the female than male cohort when compared at submaximal absolute VO2 criteria. RPE did not differ between female and male cohorts when compared at mode specific relative VO2 criteria. Differences in RPE-O, RPE-L, RPE-A (ski), and RPE-C were not found between female and male subjects when comparisons were made at both absolute and relative HR. Responses were consistent for the three exercise modes. CONCLUSION: RPE did not differ between gender when comparisons were made at relativized VO2 and HR reference criteria at exercise intensities between 70 and 90% of mode specific maximal/peak values.

The effect of testosterone on health-related quality of life in elderly males - a pilot study.

OBJECTIVE: To assess the effect of short-term testosterone supplementation on health-related quality of life in elderly males. METHOD: As part of a double-blind, placebo-controlled study, healthy males > or = 65-year-old were randomised to receive a total of four doses of 200 mg testosterone enanthanate (n = 14) or placebo (n = 8) intramuscularly every 2 weeks. Health-related quality of life (HRQOL) was assessed using the Short Form 36-item (SF-36) and Psychological General Well-Being (PGWB) scales, at baseline, week 8 and during therapy withdrawal, 6 weeks after the last dose. RESULTS: The baseline SF-36 scores were similar between the groups in seven domains; only vitality was significantly lower in the placebo group (T: 80.4, P: 65.6; P = 0.007). After the 8-week treatment period and withdrawal phase, SF-36 scores were not significantly different between the groups. The PGWB scores at baseline, on treatment and off treatment were not significantly different between the groups. Moreover, the SF-36 and PGWB scores within each group did not change significantly over time. CONCLUSION: This pilot study suggests that intramuscular testosterone, administered at a dose of 200 mg every 2 weeks, does not affect the HRQOL of elderly males.

The effect of pharmacokinetically guided acute intravenous testosterone administration on electrocardiographic and blood pressure variables.

Previous studies have demonstrated that intravenous testosterone can dilate coronary arteries and increase exercise treadmill time, but the electrocardiographic and hemodynamic effects are unknown. This trial determined the hemodynamic and electrocardiographic effects of dosing intravenous testosterone to achieve a physiologic and a superphysiologic serum testosterone concentration. Twenty men (70.6 +/- 6.2 years) had individualized testosterone bolus and continuous infusions designed to increase the serum testosterone concentration by two (physiologic) and six times baseline (superphysiologic). The men were studied on three occasions when they were randomly allocated to received a placebo, physiologic testosterone regimen, or superphysiologic testosterone regimen. Blood pressures and 12-lead electrocardiograms (ECGs) were taken preinfusion and 28 minutes after initiating the infusion on each visit. The blood pressure (systolic and diastolic) and ECG variables (PR, QRS, QT, QTc, and RR intervals) preinfusion and during the infusion were compared, and the delta changes in the variables were compared between groups. The physiologic testosterone regimen increased the serum testosterone concentration by 2.39 +/- 0.48 times the preinfusion concentration, while the superphysiologic regimen increased it by 6.22 +/- 0.99 times. No significant changes occurred in the blood pressure or ECG variables in any group versus preinfusion values or between the three groups. Exogenously administered intravenous testosterone does not significantly affect the blood pressure or ECG variables when given to achieve physiologic or superphysiologic concentrations.

Relation between aerobic fitness level and stress induced alterations in neuroendocrine and immune function.

Alterations in neuroendocrine and immune function were examined in sedentary (n=15) (VO2peak; 31.4+/-0.7 ml x kg(-1) x min(-1); 24.4+/-1.2yr), moderately active (n=15) (VO2peak; 45.4+/-1.1 ml x kg(-1) x min(-1); 24.2+/-1.1 yr) and aerobically trained (n=15) (VO2peak; 58.8+/-0.9 ml x kg(-1) x min(-1); 24.3+/-1.0 yr) men following exposure to an acute mild psychological stressor. Subjects had 2 min to prepare, and 3 min to deliver a speech in front of 3 observers. Blood samples were drawn from an indwelling catheter before, during and 30 min following the speech task (ST). Self-reported measures of anxiety were obtained prior to and immediately following the stressor. The ST resulted in significant alterations in the number and function of immune cells, and in self-reported anxiety scores. Plasma levels of norepinephrine increased during the speech task. The neuroendocrine and immune response to the chosen stressor were independent of subject aerobic fitness level.

Neuromuscular activation and RPE in the quadriceps at low and high isometric intensities.

INTRODUCTION: The purpose of this study was to examine neuromuscular activation and ratings of perceived exertion (RPE) at 10% and 80% quadriceps MVC in healthy males. METHODS: Seventeen college-aged volunteers (mean age = 22.6 years, mean height = 178.9 cm, mean weight = 78.8 kg) were assessed for isometric EMG activity of the vastus medialis (VM) and vastus lateralis (VL) at 10% and 80% MVC, and RPE at 80% MVC. Perceived exertion was measured with a modified category ratio scale (CR-10) and was anchored with 1 high and 1 low anchor. Raw EMG signals were sampled via telemetry (rate = 1,000 Hz) and integrated (3 sec) for each contraction for each muscle (bandpass = 16-500 Hz, CMRR = 130 dB). A one-sample t-test was performed for each variable and 95% confidence intervals were calculated. RESULTS: Means and CI for each variable are as follows: 10% MVC VM IEMG (t16 = 5.05, p < 0.001, .95 CI = 3.11 +/- 1.3), 80% MVC VM IEMG (t16 = 22.51, p < 0.001, .95 CI = 73.2 +/- 6.89), 10% MVC VL IEMG (t16 = 8.10, p < 0.001, .95 CI = 9.41 +/- 2.47), 80% MVC VL IEMG (t16 = 39.56, p < 0.001, .95 CI = 87.32 +/- 4.68), and 80% MVC RPE (t16 = 11.85, p < 0.001, .95 CI = 5.24 +/- 0.93). DISCUSSION: The major findings illustrate an apparent underestimation of RPE at 80% MVC for the quadriceps. Neuromuscular activation appears to be lower than the expected force output at both intensities for the VM while VL activation corresponded closely at 10% MVC and was higher at 80% MVC.

The effects of rest interval on quadriceps torque and perceived exertion in healthy males.

BACKGROUND: The ability to generate maximal muscular force is dependent upon time mediated mechanisms of fatigue. Interset rest interval length may not only affect force production but may also manifest changes in ratings of perceived exertion (RPE). The purpose of this study was to examine the effects of rest interval on quadriceps torque and RPE during multiple sets of resisted knee extensions. METHODS: 14 healthy male volunteers were assessed for concentric isokinetic quadriceps peak torque, total work, and average power on the Biodex System II Isokinetic Dynamometer at a preset angular velocity of 180 deg.sec-1. Perceived exertion was measured with a modified category-ratio scale (CR-10). Under isometric conditions the perceptual range was anchored with one high and two low anchors. Subjects were randomly assigned to one of two groups: short rest interval (Group 1, 40 sec) and long rest interval (Group 2, 160 sec). All subjects performed 4 sets of 20 maximal isokinetic contractions with an inter-set rest interval that corresponded to their group assignment. Following the completion of each set subjects were asked to assign a rating out of 10 to the feelings in their quadriceps by visually observing a chart of the CR-10 scale. RESULTS: The results demonstrated a significantly greater decline in quadriceps peak torque (p < 0.05), total work (p < 0.05), and average power (p < 0.05) by Group 1 as compared to Group 2. Changes in RPE across the 4 sets of exercise did not show a significant difference between the 2 groups. CONCLUSIONS: The generation of quadriceps torque is a function of rest interval length, whereas perceived exertion appears to be unaffected.

The pharmacokinetics of intravenous testosterone in elderly men with coronary artery disease.

Intracoronary testosterone injections have recently been shown to possess coronary vasodilating effects. The same may be true for intravenous testosterone, but the pharmacokinetic and hemodynamic aspects need exploration before pharmacologic studies can begin. This trial determined the pharmacokinetic and hemodynamic properties of 300 microg of testosterone given intravenously. Degree of testosterone aromatization to 17-beta estradiol after exogenous administration and overall patient tolerability also were evaluated. Eleven elderly men with coronary artery disease participated in the study and were given 300 microg of testosterone intravenously over 10 minutes. Serum blood concentrations of testosterone and 17-beta estradiol were measured at baseline and then periodically. Testosterone serum concentrations were stripped and fit to a two-compartment model for all patients. The volume of distribution (Vdarea) was 80.36 +/- 24.51 L, and the elimination half-life was 55.93 +/- 23.06 minutes. No hemodynamic differences or side effects were noted. The serum concentrations of 17-beta estradiol were significantly increased from baseline beginning 5 minutes after infusion to the end of the study (180 minutes after infusion).

Stressor-induced alteration of cytokine production in multiple sclerosis patients and controls.

OBJECTIVE: We administered an acute psychological stressor to multiple sclerosis (MS) patients and normal controls to determine whether differences in subjective and physiological responses to stress may underlie the susceptibility of MS patients to stress-related exacerbations. METHOD: Twenty-five MS patients (18 female, 7 male) and 25 age- and gender-matched controls participated in the study. They were asked to give a 5-minute videotaped speech defending themselves in a hypothetical scenario in which they were wrongly accused of stealing. Subjective and autonomic responses were monitored, and blood was sampled at baseline, 5, 20, and 60 minutes after the stressor to assess mitogen-stimulated production of interleukin-1beta(IL-1beta), interleukin-4 (IL-4), tumor necrosis factor-alpha (TNF-alpha), and interferon-gamma (IFN-gamma). RESULTS: MS patients and controls demonstrated similar subjective and physiological responses to the stressor that were independent of gender, mood, and disability status. The macrophage-derived cytokines IL-1beta and TNF-alpha were increased during the stressor, and remained elevated through 60 minutes. Th1 lymphocyte-derived IFN-gamma production also was increased at 5 and 60 minutes relative to baseline; however, there was no change in the Th2 lymphocyte-derived cytokine IL-4. CONCLUSIONS: These results favor the hypothesis that MS patients do not differ in stress response from normal controls; however, psychological stress may enhance cellular immune responses that would be potentially harmful to MS patients.

Lymphocyte function and cytokine production during incremental exercise in active and sedentary males and females.

This study examined the effects of acute continuous incremental exercise on lymphocyte mitogenic function and cytokine production in physically active and sedentary males and females. Physically active (n = 32) and sedentary (N = 32) male and female subjects were randomly assigned to an exercise or control condition. Exercise involved a continuous incremental protocol consisting of cycling for 3 periods of 6 min at workrates corresponding to 55%, 70% and 85% VO2peak. Blood samples were drawn from a venous catheter at baseline, 6 min, 12 min and 18 min, and 2 h following completion of exercise. Relative to baseline and control condition the percentage of T (CD3+) and B cells (CD19+) significantly decreased, and the percentage of NK cells (CD3-CD16+CD56+) increased (p < 0.001) during each stage of the incremental exercise test. The proliferative response to ConA was suppressed, enhanced, or unchanged using 1.25 micrograms/ml, 2.5 micrograms/ml and 5.0 micrograms/ml ConA, respectively. The in-vitro production of IL-1 and IFN-gamma increased during each workload. In contrast IL-4 production did not change during exercise. The resting and exercise induced alterations in lymphocyte function and cytokine production were independent of gender and fitness level, and returned to baseline 2 h into recovery. The in-vitro production of IFN-gamma and IL-4 suggests that physical activity may alter the balance of TH1 and TH2 lymphocytes.

Validity of the Borg perceived exertion scale for use in semirecumbent ergometry during immersion in water.

This investigation examined the validity of the Borg 15-category Ratings of Perceived Exertion (RPE) scale during semirecumbent exercise in 32 degrees C water. 9 men undertook 12 8-min. trials at 3 power outputs and 4 pedal-crank rates. The power output was distributed between the arms (20%) and legs (80%). RPEs were measured for the arms, legs, chest, and over-all body. Correlation coefficients for RPE expressed as a function of power output and gross metabolic efficiency (MEG) ranged from .56 to .83 and .54 to .70, respectively, for each pedal-crank rate. Validity coefficients were greatest at those pedal-crank rates having the highest MEG. The Borg 15-category RPE scale is valid for use during semirecumbent exercise in water.

Immunologic response to acute psychological stress in MS patients and controls.

To determine whether MS patients differ from healthy subjects in stress-related immune changes, we examined immunologic alterations following a public speaking task in 25 MS patients and 25 healthy controls. Both groups demonstrated similar autonomic, neuroendocrine and immunologic responses to acute stress. Neutrophils, monocytes, CD8+ suppressor/cytotoxic T-lymphocytes and NK-cells transiently increased, with parallel changes in NK-cell activity. T-cell proliferation declined at 20 min, followed by increased reactivity at 60 min relative to baseline. This data suggests that stress-induced immune alterations remain intact in MS patients, and may contribute to immune changes associated with disease exacerbation.

The effects of incremental submaximal exercise on circulating leukocytes in physically active and sedentary males and females.

To study the effects of exercise on circulating leukocytes and leukocyte subsets, physically active (n = 32) and sedentary (n = 32) male and female subjects were randomly assigned to an exercise or control condition. Exercise involved a continuous incremental protocol consisting of cycling for three periods of 6 min at power outputs corresponding to 55%, 70% and 85% maximal oxygen uptake (VO2max). Blood samples were drawn from a venous catheter at baseline, and at 6 min, 12 min, and 18 min after beginning the exercise and 2 h following completion of exercise. Resting- and exercise-induced alterations in total leukocytes were independent of gender and subject fitness level. Relative to baseline, each increment in workload resulted in a rapid increase in the number of circulating leukocytes. Increases in neutrophils, lymphocytes and monocytes accounted for the exercise-induced leukocytosis. With regard to lymphocytes, exercise resulted in a significant increase in the number of T cells (CD3+), T helper cells (CD4+), T suppresser (CD8+) and natural killer (NK) cells (CD3-/CD16+/CD56+). The largest percentage increase occurred in the NK cell population. The CD4+: CD8+ ratio decreased (P < 0.001) throughout exercise due to a larger increase in the number of CD8+ cells relative to CD4+ cells. An exercise-induced neutrophilia, lymphocytopenia, and eosinophelia was observed 2 h into recovery. Exercise resulted in significant increases in plasma epinephrine and norepinephrine levels. There was no indication of a hypothalamic-pituitarty-adrenal response during exercise. The results indicate that the rapid, albeit transient, alteration in the number of circulating leukocytes during and following an acute progressive incremental exercise test are independent of gender and fitness.