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Maximal oxygen uptake (VO2max) in healthy subjects is primarily limited by systemic oxygen delivery. In chronic kidney disease (CKD), VO2max is potentially reduced by both central and peripheral factors. We aimed to investigate the effect on VO2peak of adding arm exercise to leg exercise. Ten individuals with CKD stages 3–5 and 10 healthy controls, matched for age, sex, body size, and physical activity level, were included. Subjects performed two maximal exercise tests, one with legs only (L exercise) and one test where arm exercise was added to leg exercise (LA exercise). The increase in VO2peak, when comparing LA exercise with L exercise, was significantly higher in CKD (0.20 ± 0.18 L/min or 2.31 ± 1.78 mL/(kg·min)) than in controls (0.019 ± 0.12 L/min or 0.26 ± 1.62 mL/(kg·min); p = 0.02 and 0.01, respectively). The decrease in peak leg workload, when comparing L exercise with LA exercise, was larger in controls than in CKD, in absolute terms (p = 0.002) and relative to body weight (p = 0.01). VO2max in individuals with CKD is dependent on the active muscle mass, supporting a peripheral limitation to VO2max in CKD. By contrast, the control group appeared to have a more central limitation to VO2max.

A new portable arm exercise device is presented as a laboratory prototype to assist arm movements in rehabilitation therapies and movement exercises. Unlike the devices currently used, a portable design is proposed, with easy assembly and operational characteristics that enable it to be used by users in the home and in a familiar environment. Sensors are also provided on the rotating crank to validate and monitor the efficiency of the arm exercise. A low-cost prototype is assembled using off-the-shelf components and 3D-printed parts. Design issues are discussed and elaborated on to build a prototype for future laboratory testing using fairly simple experimental methodology. Preliminary testing by one author shows good feasibility of the device. The findings from the experimental results can be summarized as effective smooth-monitored cyclic motion in the crank rotation with limited values for acceleration less than 1 g and for acting user forces less than 22 N. The values detected are significantly lower in the left hand, with the testing subject being right-handed and healthy, without injury to her upper limbs.

PurposePatients who are post-implantation of cardiac rhythm management devices (CRMDs) are commonly instructed to restrict ipsilateral arm movement to reduce risk of lead dislodgement. This immobilization practice increases risk of shoulder-related pain leading to limited shoulder function. We aimed to assess effect of pendulum exercise on shoulder function in patients after CRMD implantation.MethodsThis study was a prospective, randomized, open-blinded end point study conducted with 200 patients undergoing CRMD implantation. They were randomized into two groups, standard care (control) and pendulum exercise (experimental) groups. The shoulder function was assessed using QuickDASH-TH scores and measurement of the range of motion (ROM) of shoulder abduction and flexion before and 1 month after implantation.ResultsBaseline characteristics did not differ between the two groups. The lower incidence of shoulder ROM reduction after CRMD implantation was demonstrated in the pendulum exercise group compared to the control group in both flexion (16.8% vs. 40.4%, P < 0.001) and abduction (9.9% vs. 32.3%, P < 0.001). A lower disability of shoulder function after implantation assessed by QuickDASH-TH scores was also noted in the exercise group compared to control (15.2 ± 16.4 vs. 23.4 ± 18.1, P = 0.001). Two patients in the control group and one in the exercise group had atrial lead dislodgement on the day following the procedure.ConclusionsEarly pendulum exercise with ipsilateral arm after CRMD implantation was safe and resulted in lower incidence of limited shoulder ROM and less disability of shoulder function compared to control group.Trial registrationThe study was registered in clinicaltrials.in.th, and the identification number is TCTR20180612003.

Purpose This study aims to evaluate a handcycling training protocol based on ACSM guidelines in a well-controlled laboratory setting. Training responses of a specific dose of handcycling training were quantified in a homogeneous female subject population to obtain a more in depth understanding of physiological mechanisms underlying adaptations in upper body training. Methods 22 female able-bodied participants were randomly divided in a training (T) and control group (C). T received 7-weeks of handcycling training, 3 × 30 min/week at 65 % heart rate reserve (HRR). An incremental handcycling test was used to determine local, exercise-specific adaptations. An incremental cycling test was performed to determine non-exercise-specific central/cardiovascular adaptations. Peak oxygen uptake (peak V O 2 ), heart rate (peakHR) and power output (peakPO) were compared between T and C before and after training. Results T completed the training sessions at 65 ± 3 % HRR, at increasing power output (59.4 ± 8.2 to 69.5 ± 8.9 W) over the training program. T improved on handcycling peak V O 2 (+18.1 %), peakPO (+31.9 %), and peakHR (+4.0 %). No improvements were found in cycling parameters. Conclusion Handcycling training led to local, exercise-specific improvements in upper body parameters. Results could provide input for the design of effective evidence-based training programs specifically aimed at upper body endurance exercise in females.

Introduction: Maximal oxygen uptake (VO2) may be one of the most important variables in the study of the responses ofpeople with spinal cord injury (SCI) and without SCI to physical exercise. The results achieved during its assessment serve as adiagnostic and health indicator in clinical settings. Objective: this study aimed to investigatethe physiological responses in males withand without SCI performing a maximal incremental test on an asynchronous arm crank ergometer (ACr) and on a recumbent synchronoushandbike ergometer (HB). Methods: ten males with SCI and 11 able-bodied males (AB group) participated in this study. Two maximalgraded exercise tests were performed, starting at 10 watts and increasing the workload by 10 watts every minute until exhaustion.Results: the AB group achieved lower workloads and absolute VO2 values than the SCI group during the HB test (all p < 0.05). Thesubmaximal values of the relative VO2 peak and RER at workloads between 40-90 watts showed significant differences between SCI andAB on HB and ACr. Significant linear relationships between workload and relative VO2 peak were found during the HB test (p < 0.001).Conclusions: these findings demonstrate that there are different physiological responses between adults with and without SCI whenperforming maximal and submaximal arm-ergometry. Interestingly, higher VO2 peak and workloads were achieved by the SCI group. Inaddition, specific prediction equations derived from the current study can be used to calculate the relative VO2 peak in handbikers with Introducción: el consumo de oxígeno (VO2) es una de las variables más importantes en el estudio de la respuesta al ejercicio en personas con y sin lesión medular (SCI; AB). Objetivo: en este estudio se analizaron las respuestas fisiológicas en hombres adultos con y sin SCI al realizar pruebas de esfuerzo máximas en un ergómetro de brazos asincrónico (ACr) en sedestación y en un ergómetro de brazos sincrónico (HB) en posición supina. Métodos: diez hombres con SCI y 11 sin SCI participaron en este estudio. Dos pruebas de esfuerzo gradual fueron realizadas por cada participante, iniciando a 10 watts e incrementando la carga 10 watts cada minuto. Resultados: el grupo sin SCI alcanzó cargas y VO2 menores que los participantes con SCI durante el test en HB (p < 0.05). Los valores submáximos para el VO2 relativo y el RER a cargas de 40-90 watts fueron estadísticamente diferentes entre los grupos en ambos tests. Se observó una correlación lineal entre las cargas de trabajo y el VO2 relativo durante el test en HB (p < 0.001). Conclusiones: los resultados obtenidos en este estudio demuestran que existen respuestas fisiológicas diferentes entre personas con y sin SCI cuando realizan pruebas de esfuerzo con cargas máximas y submáximas. Llamativamente, el grupo SCI alcanzó mayores cargas de trabajo y VO2 que los no SCI. Finalmente, se presentan dos ecuaciones específicas para obtener el VO2 de manera indirecta en personas con y sin SCI mediante el uso de un HB.

Background The aim of the study was to assess four evidence-based assessments utilising exercise challenges that induce breathlessness, each with progressively less demanding levels of exertion, which can be tailored to people with a range of functional capabilities in the setting of advanced cancer for research studies. Functional cut off points for these assessments have not previously been defined. Methods A cross sectional study of four exercise tests attempted by all participants: 6 min walk test (6MWT); (derived) 2 min walk test (2MWT); arm exercises; and reading numbers aloud. Performance status (Australia-modified Karnofsky Performance Status (AKPS)), baseline breathlessness using the modified Medical Research Council (mMRC) breathlessness scale, and a visual analogue scale of intensity and unpleasantness of breathlessness were measured. Co-morbidity was codified using the Charlson Co-morbidity Index. Percentage of people completing each test by AKPS level of function and baseline mMRC breathlessness scores were quantified. Results In the 68 participants, poorer function decreased the proportion of people able to complete the exercise tests. For completion rates ≥80%, of 6MWT and 2MWT, only people with an AKPS 70–90 had completion. For arm exercises, this included people with an AKPS as low as ≥50; and for reading numbers, it included people with an AKPS of 40 but not below. Conclusions Walking tests have poor utility in people with high levels of functional impairment. For people with high levels of dependence, reading numbers should be used in evaluating exercise-induced breathlessness in research studies. These data also suggest that people’s exertional limitations have been under-estimated as cancer progresses.

The maximal oxygen uptake (V̇O peak) test is an approved pre-operative examination tool, in a clinical setting: Both V̇O peak and anaerobic threshold indicate a patient's physiological tolerance for major surgery and post-operative mortality, with cycle ergometry being routinely used for V̇O peak tests in clinical settings, in many European countries. Nevertheless, the opportunities to assess populations with restricted mobility of the lower limbs are limited, as alternative methods (such as an arm-crank test protocol) to assess V̇O peak are yet to be established. Twelve sedentary middle-aged adults (55.1 ± 5.0 years) performed two incremental protocols on an arm crank and cycle ergometer on separate occasions. During exercise, gas exchange was collected and analysed by an online breath-by-breath analysis system. Regression analysis showed that the model with dependent variable cycle ergometer V̇O peak (CEV̇O peak) in ml·kg ·min and independent variables arm crank V̇O peak (ACEV̇O ) in ml·kg ·min , lean body mass lower limbs (LBMLL) and total lean body mass (TLBM) fitted the population the best, with r = 0.87, adj. r = 0.82 and SEE = 3.14. The equation estimated with this model is: CE V̇O = 11.776 + 1.418 X ACE V̇O (ml·kg ·min ) - 1.454 x TLBM + 3.967 X LLLBM. Our study suggests that arm cranking could be an alternative mode of exercise for sedentary middle-aged adults (and potentially in clinical settings) to assess the cardiorespiratory fitness of people with restricted lower-limb mobility.

The effect in healthy elderly subjects of cycle ergometer or arm ergometer training on peak oxygen consumption (VO(2peak)) and ventilatory threshold (VT) was studied. The aim was to determine the benefit of each training modality on specific and cross exercise capacity. The cross-effect was also evaluated as an index of the central nature of the adaptive response to training. Twelve non-smoking healthy males (age: 67 +/- 5 year; body mass: 75 +/- 9 kg) were randomly divided in two age-matched groups of six, performing an arm cranking (ARM) or a cycloergometer (CYC) training (12-week, 30 min, 3 times/week), while a third group of 6 subjects (age: 73 +/- 4 year; body mass: 80 +/- 8 kg) performed no training (control, C). At baseline and following the intervention, subjects carried out an incremental test to exhaustion both on the ergometer on which they trained (specific test) and on the other ergometer (cross test). Respiratory variables were measured breath by breath and heart rate (HR) was recorded. Peak oxygen consumption (VO(2peak)), ventilation (VE(peak)), oxygen pulse (O2P(peak)) and heart rate (HR(peak)) were averaged over the last 10 s of exercise. Following training, while HR(peak) remained unchanged, significantly higher W(peak), VO(2peak), VE(peak) and O2P(peak) were obtained in both training groups, on both ergometers. The amplitude of the increase in W(peak), VO(2peak) and O2P(peak) was significantly higher for specific than for cross tests ( approximately 19% vs. approximately 8 % in CYC; approximately 22% vs. approximately 9% in ARM, P < 0.01) while the increase in same test condition was similar. No change was observed in the C group. The results indicate that aerobic training brought about with different muscle masses, produce similar improvements in maximal and submaximal exercise capacity. Roughly half of such improvements are specific to exercise mode, which suggests peripheral adaptations to training. The other half is non-specific since it influences also the alternative exercise modality, and is probably due to central adaptations.

Background The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer. Methods A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status. Results In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = -0.447, standard error (SE) = 0.050, p  < 0.001; B = 15.666, SE = 4.542, p  = 0.001, respectively). In model 3, performing shoulder-arm exercise for 30 min/day played a partial mediating role in the relationship of the severity of symptoms and QoL ( R 2  = 0.51, F  = 5.41, p  < 0.001). Conclusions During 2 ~ 4 months after surgery, regular shoulder-arm exercise for 30 min/day could decrease the effect of the severity of symptoms on the QoL among women with breast cancer. Clinical healthcare providers may inform and educate patients as to the benefits of regular shoulder-arm exercise for 30 min/day.