Responses of people with coronary artery disease to common lawn-care tasks.

The primary purpose of the present study was to determine oxygen uptake (VO2) and heart rate (HR) responses of patients with coronary artery disease (CAD) to common lawn-care activities. The study was conducted in three phases. In phase I, 8 men with CAD performed 30 min of push motorized lawn mowing at a self-paced rate. In phase II, 9 men with CAD performed push (no power) mowing, trimming (power and manual), and raking for 8 min each. In phase III, age-matched men and women with and without CAD (9-11 per group) performed self-propelled motorized mowing and push motorized mowing. In phase I, VO2 averaged 17.3 (SEM 3.8) ml.kg-1.min-1 during 30 min of mowing. Relative effort was 68 (SEM 1) and 76 (SEM 4)% of treadmill maximal VO2 (VO2max) and HR, respectively. In phase II, mean VO2 ranged from 8.6 (SEM 0.4) with grass trimming to 22.2 (SEM 1.6) ml.kg-1.min-1 with push manual mowing. With self-propelled mowing at three speeds in phase III, mean VO2 of the CAD groups ranged from 9.5 (SEM 0.3) to 13.8 (SEM 1.4) ml.kg-1.min-1 and represented 37%-62% VO2max. The results indicated that lawn mowing is often performed at an exercise intensity recommended for aerobic exercise training; patients who achieve a treadmill peak capacity of 4 times resting metabolic rate (4 METs) should be able to perform self-propelled motorized lawn mowing (slow speed) and grass trimming at less than 80% peak VO2; and VO2 demands of lawn mowing can be adjusted by equipment selection and/or pace.

Energy expenditure during household tasks in women with coronary artery disease.

The energy expenditure for and heart rate responses to common household tasks were determined in 26 older (mean age 62 +/- 2 years) women with coronary artery disease (CAD). Each activity was performed at a self-determined pace for 6 or 8 minutes. The average oxygen uptake (ml/kg/min) for each task evaluated was 6.5 for washing dishes, 6.8 for ironing, 7.2 for scrubbing pans, 8.6 for unpacking groceries, 9.5 for vacuuming, 9.8 for sweeping, 10.1 for mopping, 12.0 for changing bed linens, and 12.4 for washing the floor (hands and knees). None of the subjects reported angina. Mean relative oxygen uptake (i.e., percentage of peak response with treadmill testing) ranged from 31 +/- 2% for washing dishes to 62 +/- 3% for changing the bed linens and washing the floor. Percentage of peak treadmill heart rate ranged from 62 +/- 2% for washing dishes to 73 +/- 2% for washing the floor. In 4 of the more physically demanding household activities (i.e., vacuuming, mopping, washing the floor, and changing bed linens), the responses of 10 age-matched normal women were evaluated. The absolute and relative demands of the tasks were similar between the CAD and normal groups. Results indicate that the mean energy expenditure rate of common household tasks evaluated in this study range from 2 to 4 METs, suggesting that most women with CAD who are able to achieve > or = 5 METs during a treadmill exercise test without adverse signs or symptoms should be able to resume these activities.

Snow blowing and shoveling in normal and asymptomatic coronary artery diseased men.

We evaluated the oxygen uptake and heart-rate responses to self-paced snow blowing and snow shoveling in 10 men with asymptomatic coronary artery disease, 10 older normal men, and six younger normal men. Mean peak treadmill oxygen uptake in the three groups ranged from 26.4 +/- 1.1 to 47.3 +/- 3.9 ml/kg per min (P < 0.05). Oxygen uptake during snow blowing did not differ significantly among subject groups; values were 17.1 +/- 1.3, 17.7 +/- 1.1, and 17.2 +/- 0.9 ml/kg per min in the coronary artery disease, older normal, and younger normal groups, respectively. Oxygen uptake with snow shoveling was lower (P < 0.05) in those with coronary artery disease (18.4 +/- 1.0 ml/kg per min) than in the normal groups. In comparison with snow shoveling, oxygen uptake and heart rate did not differ (P = NS) from snow blowing in the coronary artery disease group but were lower (P < 0.05) with snow blowing in the two normal groups. The results indicate that men with asymptomatic coronary artery disease and relatively good functional work capacity perform snow blowing and snow shoveling at similar levels of oxygen uptake and heart rate.

Physiologic responses to shoveling and thermal stress in men with cardiac disease.

To investigate the effect of temperature stress on responses to static-dynamic work in patients with ischemic heart disease (IHD), 10 men with IHD shoveled gravel for 30 min in a warm (29 degrees C), neutral (24 degrees C), and cold (-8 degrees C) environment (on separate days). A pace of 15 lifts.min-1 was set, and the load per lift approximated 5.5 kg. Heart rate (HR), oxygen consumption (VO2), and systolic (SBP) and diastolic blood pressures (DBP) were evaluated at 5-min intervals. Arrhythmias and ST-segment depression were evaluated by ambulatory electrocardiographic monitoring. At 30 min, VO2, SBP, and DBP were higher (P < 0.05) in the cold environment, and HR was higher (P < 0.05) in the warm environment compared with the neutral environment. HR increased (P < 0.05) from 5 to 30 min in all three conditions. The increase in HR was greater (P < 0.05) in the warm environment. None of the subjects reported angina or demonstrated electrocardiographic ST-segment changes during shoveling in any environment. The results indicate that low-risk patients with stable IHD show modest temperature-induced alterations in hemodynamic and VO2 responses during 30 min of moderate intensity (50-60% of peak VO2) static-dynamic work without adverse electrocardiographic responses or symptomatology.

Baltimore Therapeutic Equipment work simulator: energy expenditure of work activities in cardiac patients.

The energy expenditure and hemodynamic responses to tasks performed on the Baltimore Therapeutic Equipment (BTE) work simulator were evaluated in men with coronary artery disease and compared to tasks performed at a laboratory workstation in which actual tools and equipment were used. Met units for the BTE work simulator and corresponding workstation tasks, respectively, were drill press operation, 1.5 +/- 0.1 and 1.5 +/- 0.3Mets; hammering, 2.3 +/- 0.3 and 3.4 +/- 0.8Mets (p < 0.05); repetitive lifting a 22.7kg weight load, 3.8 +/- 0.6 and 4.5 +/- 0.9Mets (p < 0.05); mechanic work in a supine position, 2.0 +/- 0.5 and 1.7 +/- 0.2Mets; sanding wood, 2.0 +/- 0.3 and 2.5 +/- 0.7Mets; sawing wood, 3.2 +/- 0.6 and 4.3 +/- 0.7Mets (p < 0.05); screwdriving, 2.2 +/- 0.3 and 2.5 +/- 0.5Mets (p < 0.05); shoveling, 5.45kg load 4.6 +/- 1.0 and 4.2 +/- 0.7Mets; sweeping, 1.7 +/- 0.2 and 3.0 +/- 0.4Mets (p < 0.05); and vacuuming, 2.7 +/- 0.7 and 2.9 +/- 0.5Mets. The results indicate that there is a tendency for the metabolic and hemodynamic responses to BTE work simulator tasks to be lower than that of the actual activity.

Effect of age and coronary artery disease on response to snow shoveling.

OBJECTIVES: The objective of this study was to evaluate the effect of age and coronary artery disease on responses to snow shoveling. BACKGROUND: Little information is available on the hemodynamic and metabolic responses to snow shoveling. METHODS: Sixteen men with asymptomatic coronary artery disease and relatively good functional work capacity, 13 older normal men and 12 younger normal men shoveled snow at a self-paced rate. Oxygen consumption, heart rate and blood pressure were determined. In nine men with coronary artery disease left ventricular ejection fraction was evaluated with an ambulatory radionuclide recorder. RESULTS: Oxygen consumption during snow shoveling differed (p < 0.05) among groups; it was lowest (18.5 +/- 0.8 ml/kg per min) in those with coronary artery disease, intermediate (22.2 +/- 0.9 ml/kg/min) in older normal men and highest (25.6 +/- 1.3 ml/kg/min) in younger normal men. Percent peak treadmill oxygen consumption and heart rate with shoveling in the three groups ranged from 60% to 68% and 75% to 78%, respectively. Left ventricular ejection fraction and frequency of arrhythmias during shoveling were similar to those during treadmill testing. CONCLUSIONS: During snow shoveling 1) the rate of energy expenditure selected varied in relation to each man's peak oxygen consumption; 2) older and younger normal men and asymptomatic men with coronary artery disease paced themselves at similar relative work intensities; 3) the work intensity selected represented hard work but was within commonly recommended criteria for aerobic exercise training; and 4) arrhythmias and left ventricular ejection fraction were similar to those associated with dynamic exercise.

Cardiac response to combined moderate heat and exercise in men with coronary artery disease.

The effect of moderate heat stress on cardiac performance during sustained moderate physical work was evaluated in men greater than or equal to 6 weeks after a cardiac event. Subjects (n = 10) performed upright leg cycle ergometer exercise at approximately 50% of peak oxygen uptake for up to 60 minutes in warm (30.0 +/- 0.9 degrees C) and thermoneutral (21.5 +/- 0.3 degrees C) environments. Cardiac output (carbon dioxide rebreathing method), left ventricular ejection fraction and relative left ventricular end-diastolic volume (portable nuclear VEST monitor) were periodically determined. In both environments, heart rate increased (p less than 0.05), stroke volume decreased (p less than 0.05), and cardiac output remained unchanged with exercise time. In the warmer environment, heart rate was increased (p less than 0.05) and stroke volume tended to be decreased (p less than 0.08), with no difference in cardiac output. In both environments, left ventricular ejection fraction did not change from minute 6 to 60 of exercise, whereas relative left ventricular end-diastolic volume decreased (p less than 0.05) with exercise time. Arterial blood pressure was unchanged from minute 6 to 60 in the warm environment. Arrhythmias were not altered by exercise time or environment, and no subjects had evidence of myocardial ischemia. The data indicate that although heart rate increased and stroke volume and relative left ventricular end-diastolic volume decreased with exercise time, cardiac output and left ventricular ejection fraction remained unchanged in both thermoneutral and warm environments.(ABSTRACT TRUNCATED AT 250 WORDS)

Weight carrying versus handgrip exercise testing in men with coronary artery disease.

The clinical merits of handgrip and weight carrying tests were compared in 30 patients with documented coronary artery disease. The static loads in the 2 tests were matched by percentage of maximal static effort and corresponded to 25 and 45% of maximal voluntary handgrip contraction and 25 and 45% of maximal 1-hand lift capacity. Each static load in both tests was continued for less than or equal to 3 minutes. At the 25% maximal effort stage, 93 and 90% of patients were able to complete 3 minutes of handgrip and weight carrying, respectively. Only 13 and 10% were able to complete 3 minutes at the 45% maximal effort stage with handgrip and weight carrying, respectively. Arm fatigue and an increase in diastolic blood pressure greater than 120 mm Hg were the predominant endpoints. Weight carrying resulted in significantly higher (p less than 0.05) heart rate, systolic blood pressure, pressure-rate product, ventilation and oxygen consumption compared to handgrip. Diastolic blood pressure responses did not differ between the tests. None of the patients demonstrated ischemic responses to either handgrip or weight carrying and the incidence of arrhythmias was rare. The diastolic blood pressure response to static effort is equally evaluated by handgrip and weight carrying tests. However, the greater myocardial oxygen demand, reflected by the pressure-rate product, in addition to the greater total body oxygen consumption, imposed by weight carrying, enhances the clinical application of the weight carrying test.

The safety of static-dynamic effort soon after myocardial infarction.

Many activities of daily living require static-dynamic effort. To evaluate the safety of such effort 3 weeks after myocardial infarction, 27 male patients underwent a weight-carrying test requiring 5 minutes of treadmill ambulation with graded weight loads of 10 to 30 pounds. The hemodynamic responses with weight carrying were compared to that of a predischarge graded dynamic exercise test. The peak heart rate was significantly lower (p less than 0.01) with weight carrying, the peak systolic blood pressure did not differ, and the diastolic pressure was significantly higher (P less than 0.01). ST segment depression and angina pectoris occurred less frequently with weight carrying. The type and frequency of ventricular arrhythmias were similar between the two tests. We conclude that many men are capable of performing static-dynamic activity equivalent to carrying up to 30 pounds by 3 weeks after myocardial infarction.

Use of simulated work testing in cardiac rehabilitation: a case report.

A significant percentage of patients do not return to work after myocardial infarction or coronary artery bypass surgery for nonmedical reasons. These reasons include unwarranted medical restrictions, patient anxiety concerning ability to meet job demands, apprehensive family members, and fearful employers. A case study is presented to illustrate how occupational therapists can enhance a patient's work potential by using skills in activity analysis to develop simulated work evaluations. Satisfactory performance on a test that closely simulates work demands can help the physician, patient, family, and employer gain confidence in the patient's ability to return to work.

Response of patients after myocardial infarction to carrying a graded series of weight loads.

Cardiovascular responses to carrying graded weight loads of 20 to 50 pounds were determined in 52 patients after myocardial infarction (MI) (greater than or equal to 2 months). Sixty percent of the patients were stopped before completing the heaviest weight load (50 pounds for 2 minutes) because of an increase in diastolic blood pressure (BP) to 120 mm Hg (end point) or arm fatigue. Compared with symptom-limited graded dynamic exercise, peak systolic and diastolic BP were significantly greater (p less than 0.05 and p less than 0.01, respectively) with weight carrying, while peak heart rate, pressure-rate product, ventilation and oxygen consumption were significantly lower (p less than 0.01). Ischemic responses were less frequent with weight carrying. Patients with severely reduced resting left ventricular ejection fraction (LVEF) (less than 35%) tolerated the weight carrying test as well as patients with normal resting LVEFs (greater than 50%). We conclude that (1) ischemic responses occur less frequently while carrying up to 50 pounds for 2 minutes than with symptom-limited dynamic exercise, (2) a significant number of patients have an increase in diastolic BP greater than or equal to 120 mm Hg while carrying objects that weigh 30 to 50 pounds for 2 minutes, and (3) a poor correlation exists between resting LVEF and tolerance for weight carrying.