An integrated biomechanical analysis of high speed incline and level treadmill running.

PURPOSE: Recent sprint training regimens have used high-speed incline treadmill running to provide enhanced loading of muscles responsible for increasing forward running speed. The goal of this study was to document the joint kinematics, EMG, and swing-phase kinetics of incline treadmill running at 4.5 m x s(-1) with a 30% grade, and compare these data to that of level running under similar conditions. METHODS: Sagittal plane video (200 Hz) and EMG from eight lower extremity muscles were recorded during each of three locomotion conditions: incline running at 4.5 m x s(-1) and 30% grade (INC), level running at 4.5 m x s(-1) (LSS), and level running at the same stride frequency as INC (LSSF). A rigid body model was used to estimate net muscle power and work values at the hip, knee, and ankle during swing. Timing and amplitude of EMG signals for each muscle relative to footstrike were compared between conditions. RESULTS: Stride frequency and percentage of stride spent in stance were significantly higher during INC (1.78 Hz; 32.8%) than in the LSS (1.39 Hz; 28.8%) condition. Stride frequency played an important role, as most measures were more similar between INC and LSSF. Extensor range of motion of all joints during push-off was higher for INC. During INC, average EMG amplitude of the gastrocnemius, soleus, rectus femoris, vastus lateralis, and gluteus maximus were higher during stance, whereas the hamstrings activity amplitudes were lower. Average power and energy generated during hip flexion and extension in the swing phase were greatest during INC. CONCLUSIONS: These data suggest that compared with LSSF and LSS, INC provides enhanced muscular loading of key mono- and bi-articular muscles during both swing and stance phases.

Muscle activity in the slalom turn of alpine skiing and in-line skating.

The electromyographic (EMG) activity of seven muscles of the trunk and lower extremity in five male masters level ski racers during a slalom turn in both alpine skiing and in-line skating was recorded using a telemetry system. Measurements were made on separate testing days using slopes commonly used in each activity (24 slope alpine skiing, 5 in-line skating). Qualitative video recorded at 60 Hz was analyzed to partition the turning cycle in both slalom skiing and in-line skating into initiation and turning phases. The EMG data from each turning cycle were normalized to standard isometric contractions (SIC's) for each muscle in order to quantitatively compare the amplitude characteristics of each phase of the turning cycle in both slalom skiing and in-line skating. The turning phase of in-line skating was found to be significantly longer (55%) than in slalom skiing, most likely due to significantly lower subject velocities recorded during in-line skating (8.5 m/s vs 10.2 m/s). All muscles were active at moderate to high levels (48-172% of SIC) during each phase of the turning cycle in both slalom skiing and in-line skating. The EMG amplitude characteristics were similar for six of the muscles in both slalom skiing and in-line skating for each of the turning phases. Only the erector spinae displayed significantly higher average and peak amplitudes in slalom skiing for both phases. It is concluded that the muscle activity patterns associated with the slalom turn of in-line skating are similar but notably more quasi-static than in slalom skiing.

Dynamic impact response of human cadaveric forearms using a wrist brace.

The purpose of this study was to compare the dynamic impact response of braced and unbraced cadaveric wrists using a commercially available wrist guard. Twelve arms were harvested from six cadavers. Each pair of forearms, one with and one without a brace, were impacted using a modified guillotine-type drop fixture placed over a force platform. Using a piece-wise linear regression analysis, we identified four phases of dynamic loading in the vertical force profile before fracture. These phases included an initial linear loading phase starting at impact, followed by a nonlinear phase, a second rapid linear loading phase, and a final nonlinear loading phase to failure. Three transition points were identified that defined the boundaries of the linear loading phases. Vertical force and impulse were significantly higher (P < 0.01) at each transition point and at failure in all braced specimens compared with unbraced specimens. However, the most noticeable differences were found during the initial two loading phases. Time to each transition point and to failure was not significantly different (P > 0.27) between the braced and unbraced wrists. The results of this study differ from those obtained under more quasistatic loading conditions. Dynamic impact testing suggests that wrist guards may have a prophylactic effect during low-energy dynamic impact situations.

Neonatal integrated home care: nursing without walls.

A Neonatal Integrated Home Care Program was developed to cross-train NICU staff nurses to provide follow-up care for high-risk neonates in the home. Implementation required collaboration of the NICU and the Center for Home Care and Hospice. Initial target populations were premature infants in transition to oral feeds and oxygen-dependent neonates. Staff, parent, and insurer enthusiasm for this innovative program resulted in expansion to serve infants and families with many other care needs. Continuity of care provides an invaluable resource for families at home with their high-risk infants. Outcomes include reduction in NICU length of stay and readmission for this population. The NICU home care team shares experiences with staff, increasing awareness of and sensitivity to family strengths and discharge realities. The program has fostered revisions in practice regarding preparation for discharge and education of families, facilitating the transition to home following NICU hospitalization.

Temperature of ingested water and thermoregulation during moderate-intensity exercise.

The effect of the temperature of ingested water on the rise in core temperature (Tco) during exercise is not clear. Seven trained subjects were recruited to complete 2 hr of recumbent cycling at 51% VO2peak in a temperate environment (Ta = 26 degrees C, relative humidity = 40%) on four occasions, while ingesting either no fluid (trial NF26), cold water (0.5 degree C; trial CD26), cool water (19 degrees C; trial CL26), or warm water (38 degrees C; trial WA26) during the second hour of exercise. A fifth trial was conducted during which convective and radiative heat loss were reduced by raising Ta to 31 degrees C. During this trial, subjects ingested cold water (0.5 degree C; trial CD31). When compared to WA26, over the second hour of exercise, CD26 attenuated the time-averaged changes in (Tco) and forearm blood flow and decreased whole-body sweat rate and forearm sweat rate (p < .05). Similarly, relative to WA26, the CL26 trial attenuated the time-averaged changes in Tco and reduced whole-body sweat rate (p < .05) during the second hour of exercise, but CL26 had no significant effect on forearm sweat rate or blood flow. Finally, regardless of beverage temperature, water ingestion (vs. NF26) reduced the time-averaged changes in Tco and in heat storage during the second hour of exercise (p < .05).

A comparison of the effect of ski sidecut on three-dimensional knee joint kinematics during a ski run.

The popularity of alpine skis with large sidecuts has increased dramatically in the last few years. However, little scientific data exists regarding the effect of these skis on certain human factors. The purpose of this study was to compare three-dimensional knee joint motions during entire ski runs while skiing on two skis with a large difference in sidecut (Elan SCX and Elan RP90). Five, expert male skiers performed three runs on each ski. Three-dimensional knee joint motion was collected throughout each run using a portable, magnetic motion tracking system. Twenty-four turns from each run were analyzed for joint motion characteristics. The results indicated that no statistically significant differences in knee joint range of motion or angular velocities were found to exist between the Elan SCX and Elan RP90 during normal skiing maneuvers. Further research is needed on the effect of ski sidecut on knee joint kinematics while skiing on varied terrain and/or with different skiing styles. In addition, similar studies comparing the effect of ski sidecut on metabolic cost and effect on injury rates are also needed.

Development of a three-scale MMPI: the MMPI-TRI.

A 60-item short form of the MMPI with very high content validity and items that appear on both the MMPI and MMPI-2 was developed and named the MMPI-TRI. It contains three 20-item scales--the Subjective Distress, Acting-Out, and Psychosis scales. These three scales have excellent internal consistency and sufficient independence from each other. An anxiety and depression group of patients, prison inmate group, and a schizophrenic and other psychotic group had the highest mean scores on Subjective Distress, Acting-Out, and Psychosis, respectively. Correlations with the 13 regular scales of the MMPI and MMPI-2, their content and supplementary scales, and four other psychometric instruments provided very strong evidence for validity. Norms are provided.

Effect of endurance training on hepatic glycogenolysis and gluconeogenesis during prolonged exercise in men.

In humans, endurance training markedly reduces the rate of hepatic glucose production during exercise. To determine whether this is due to a reduction in glycogenolysis, in gluconeogenesis, or in both processes, six men were studied at rest and during 2 h of cycle ergometer exercise at 60% pretraining peak O2 consumption (VO2peak), both before and after completion of a strenuous endurance training program (cycling at 75-100% VO2peak for 45-90 min/day, 6 days/wk for 12 wk). The overall rate of glucose appearance (Ra) was determined using a primed continuous infusion of [6,6-2H]glucose, whereas the rate of gluconeogenesis (Rgng) was estimated from the incorporation of 13C into glucose (via pyruvate carboxylase) from simultaneously infused [13C]bicarbonate. Training did not affect glucose kinetics at rest but reduced the average Ra during exercise by 42% [from 36.8 +/- 3.8 to 21.5 +/- 3.6 (SE) mumol.min-1.kg-1; P < 0.001]. This decrease appeared to be mostly due to a reduction in hepatic glycogenolysis. However, the estimated Rgng during exercise also decreased significantly (P < 0.001) with training, falling from 7.5 +/- 1.6 mumol.min-1.kg-1 (23 +/- 3% of total Ra) before training to 3.1 +/- 0.6 mumol.min-1.kg-1 (14 +/- 3% of total Ra) after training. These training-induced adaptations in hepatic glucose metabolism were associated with an attenuated hormonal response to exercise (i.e., higher insulin and lower glucagon, norepinephrine, and epinephrine concentrations) as well as a reduced availability of gluconeogenic precursors (i.e., lower lactate and glycerol concentrations). We conclude that endurance training reduces both hepatic glycogenolysis and gluconeogenesis during prolonged exercise in men.

Ten days of exercise training reduces glucose production and utilization during moderate-intensity exercise.

We have previously shown that 12 wk of endurance training reduces the rate of glucose appearance (Ra) during submaximal exercise (Coggan, A. R., W. M. Kohrt, R. J. Spina, D. M. Bier, and J. O. Holloszy. J. Appl. Physiol. 68: 990-996, 1990). The purpose of the present study was to examine the time course of and relationship between training-induced alterations in glucose kinetics and endocrine responses during prolonged exercise. Accordingly, seven men were studied during 2 h of cycle ergometer exercise at approximately 60% of pretraining peak oxygen uptake on three occasions: before, after 10 days, and after 12 wk of endurance training. Ra was determined using a primed, continuous infusion of [6,6-2H]glucose. Ten days of training reduced mean Ra during exercise from 36.9 +/- 3.3 (SE) to 28.5 +/- 3.4 mumol.min-1.kg-1 (P < 0.001). Exercise-induced changes in insulin, C-peptide, glucagon, norepinephrine, and epinephrine were also significantly blunted. After 12 wk of training, Ra during exercise was further reduced to 21.5 +/- 3.1 mumol.min-1.kg-1 (P < 0.001 vs. 10 days), but hormone concentrations were not significantly different from 10-day values. The lower glucose Ra during exercise after short-term (10 days) training is accompanied by, and may be due to, altered plasma concentrations of the major glucoregulatory hormones. However, other adaptations must be responsible for the further reduction in Ra with more prolonged training.

Muscle metabolism during exercise in young and older untrained and endurance-trained men.

To examine effects of aging and endurance training on human muscle metabolism during exercise, 31P magnetic resonance spectroscopy was used to study the metabolic response to exercise in young (21-33 yr) and older (58-68 yr) untrained and endurance-trained men (n = 6/group). Subjects performed graded plantar flexion exercise with the right leg, with metabolic responses measured using a 31P surface coil placed over the lateral head of the gastrocnemius muscle. Muscle biopsy samples were also obtained for determination of citrate synthase activity. Rate of increase in P(i)-to-phosphocreatine ratio with increasing power output was greater (P < 0.01) in older untrained [0.058 +/- 0.022 (SD) W-1] and trained men (0.042 +/- 0.010 W-1) than in young untrained (0.038 +/- 0.017 W-1) and trained men (0.024 +/- 0.010 W-1). Plantar flexor muscle cross-sectional area and volume (determined using 1H magnetic resonance imaging) were 11-12% (P < 0.05) and 16-18% (P < 0.01) smaller, respectively, in older men. When corrected for this difference in muscle mass, age-related differences in metabolic response to exercise were reduced by approximately 50% but remained significant (P < 0.05). Citrate synthase activity was approximately 20% lower (P < 0.001) in older untrained and trained men than in corresponding young groups and was inversely related to P(i)-phosphocreatine slope (r = -0.63, P < 0.001). Age-related reductions in exercise capacity were associated with an altered muscle metabolic response to exercise, which appeared to be due to smaller muscle mass and lower muscle respiratory capacity of older subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Isotopic estimation of CO2 production during exercise before and after endurance training.

Endurance training reduces the rate of CO2 release (i.e., VCO2) during submaximal exercise, which has been interpreted to indicate a reduction in carbohydrate oxidation. However, decreased ventilation, decreased buffering of lactate, and/or increased fixation of CO2 could also account for a lower VCO2 after training. We therefore used a primed continuous infusion of NaH13CO3 to determine the whole body rate of appearance of CO2 (RaCO2) in seven men during 2 h of cycle ergometer exercise at 60% of pretraining peak O2 uptake (VO2peak) before and after endurance training. RaCO2 is independent of the above-described factors affecting VCO2 but may overestimate net CO2 production due to pyruvate carboxylation and subsequent isotopic exchange in the tricarboxylic acid cycle. Training consisted of cycling at 75-100% VO2peak for 45-90 min/day, 6 days/wk, for 12 wk and increased VO2peak by 28% (P < 0.001). VCO2 during submaximal exercise was reduced from 86.8 +/- 3.7 to 76.2 +/- 4.2 mmol/min, whereas RaCO2 fell from 88.9 +/- 4.0 to 76.4 +/- 4.4 mmol/min (both P < 0.001). VCO2 and RaCO2 were highly correlated in the untrained (r = 0.98, P < 0.001) and trained (r = 0.99, P < 0.001) states, as were individual changes in VCO2 and RaCO2 with training (r = 0.88, P < 0.01). These results support the hypothesis that endurance training decreases CO2 production during exercise. The magnitude and direction of this change cannot be explained by reported training-induced alterations in amino acid oxidation, indicating that it must be the result of a decrease in carbohydrate oxidation and an increase in fat oxidation.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional manipulations before and during endurance exercise: effects on performance.

1) Ingesting CHO during prolonged, moderate-intensity (60-85% VO2max) exercise can improve performance by maintaining plasma glucose availability and oxidation during the later stages of exercise. 2) Plasma glucose may be oxidized at rates in excess of 1 g.min-1 late in exercise. Athletes therefore need to ingest sufficient quantities of CHO in order to meet this demand. This can be accomplished by ingesting CHO at 40-75 g.h-1 throughout exercise or by ingesting approximately 200 g of CHO late in exercise. Ingesting CHO after fatigue has already occurred, however, is generally ineffective in restoring and maintaining plasma glucose availability, CHO oxidation, and/or exercise tolerance. 3) No apparent differences exist between glucose, sucrose, or maltodextrins in their ability to improve performance. Ingesting fructose during exercise, however, does not improve performance and may cause gastrointestinal distress. 4) The form of CHO (i.e., solid vs liquid) ingested during exercise is unlikely to be important provided that sufficient water is also consumed when ingesting CHO in solid form. 5) Ingesting 50-200 g of CHO 30-60 min before exercise results in transient hypoglycemia early in exercise, but this does not affect the rate of muscle glycogen utilization or, in most people, cause overt symptoms of neuroglucopenia. Whether performance is impaired, unaffected, or enhanced by such pre-exercise CHO feedings remains equivocal. 6) Ingesting 200-350 g of CHO 3-6 h before exercise appears to improve performance, possibly by maximizing muscle and/or liver glycogen stores or by supplying CHO from the small intestine during exercise itself.(ABSTRACT TRUNCATED AT 250 WORDS)

The relative influence of identified components of test anxiety in baccalaureate nursing students.

The relative influence on test anxiety of cognitive interference, self-concept, study and test-taking skills, and cumulative grade point average was investigated. Fifty-six female baccalaureate nursing students completed the following measures: Sarason's Test Anxiety Scale, Brown's Effective Study Test, Sarason's Cognitive Interference Questionnaire, and Brookover's Self-Concept of Ability Scale. Subjects also reported their cumulative grade point average (GPA). Data were analyzed through the use of correlation and stepwise multiple regression. Data analyses revealed significant negative relationships between test anxiety and the variables of academic self-concept and GPA (p less than .05). Academic self-concept was the most powerful predictor of test anxiety, while GPA and cognitive interference contributed significantly but minimally to the multiple regression equation. Results support Meichenbaum and Butler's (1980) contention regarding the multidimensional nature of the test anxiety construct.

Long term effects of nightly dexamethasone administration in patients with polycystic ovarian disease.

The long term effects of nightly dexamethasone administration on basal levels and diurnal fluctuations of circulating gonadotropins, androgens, and cortisol were studied by frequent sampling in four women with polycystic ovarian disease and a similar number of normal women. Basal LH, testosterone, and androstenedione levels were elevated in the patients with polycystic ovarian disease. There were significant diurnal variations of all steroids measured in both groups, with the exception of androstenedione and androstenediol in the polycystic ovarian disease and control subjects, respectively. Nightly dexamethasone administration for 1 month resulted in marked suppression of dehydroepiandrosterone, androstenediol, and cortisol. For testosterone the mean percent decreases of the 24-h transverse means were 15% and 46% for the polycystic ovarian disease and normal subjects, respectively. For androstenedione the mean percent decreases were only 7% and 20%, respectively. The diurnal variation of all steroids disappeared with dexamethasone. These results support the concept that in patients with polycystic ovarian disease the majority of delta 5-androgens is adrenal while the preponderance of elevated testosterone and androstenedione is ovarian in origin. These results do not support the use of long term dexamethasone as an effective agent in suppressing the elevated levels of testosterone and androstenedione in patients with this disease.