Prolonged Arm Research Articles

Eyes on the street: To what end?

In contrast to the constantly increasing surveillance of the streets of cities, Jane Jacobs’ theory of the ‘eyes on the street’ offers a theory of a positive form of surveillance and these eyes can thus perhaps take on the role of a counterforce to problematic forms of surveillance. To examine under what conditions Jacobs could help formulate such a counterforce is the main aim in this article. But for this purpose, certain obstacles need to be addressed, for instance, the usage of Jacobs’ theory in the field of CPTED. What in Jacobs’ theory makes it vulnerable to this kind of usage? In order for Jacobs’ street-eyes to avoid becoming a prolonged arm for state surveillance, this article suggests a critical reading of Jacobs’ thinking in relation to Foucault’s surveillance-critique, ultimately with the aim to strengthen her eyes on the street.

Risk factors for long-term arm morbidities following breast cancer treatments: A systematic review.

To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain, lymphedema, decreased range of motion, and functional limitations. A systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the risk factors for prolonged arm morbidity following breast cancer surgery and treatments were included. The studies were assessed independently according to pre-eligibility criteria, following data extraction and methodological quality assessment. 1,242 articles were identified. After removing duplicates, the full texts of 1,153 articles were examined. Sixty-nine of these articles met the criteria and were included in the review. These 69 articles identified 29 risk factors for arm morbidity following treatments for breast cancer. The risk of bias was evaluated using NIH study quality assessment tools. The studies reviewed were published between 2001 and 2021 and included a total of 22,886 patients who were followed up for between three months and 10 years. The main risk factors for long-term morbidity are removal of lymph nodes from the axilla, body mass index >30, having undergone a mastectomy, the stage of the disease, radiation therapy, chemotherapy, infection and trauma to the affected arm after surgery. An understanding of the risk factors for prolonged arm morbidity after surgery can help doctors and therapists in making personalized decisions about the need and timing of rehabilitation treatments.

Technical efficacy and safety of CT-guided transforaminal periradicular infiltration using CT foot switches and MPR images.

Purpose:To demonstrate the technical efficacy and safety of CT-guided transforaminal periradicular infiltration in the treatment of the radicular pain without surgical intervention, using CT foot switches and MPR images.Materials and Methods:Four hundred and eighty two patients (286 males and 196 females, age range 27-71 years, mean age 56 years) with a unilateral or bilateral radiculopathy who underwent CT-guided transforaminal periradicular infiltration without surgical intervention, were retrospectively selected in the period from January 2019 to February 2020. Patients who had received surgery for herniated disc or laminectomy, patients with a previous vertebral fractures, and patients with inflammatory syndrome or risk of bleeding were excluded.Results:There were no major or minor clinically relevant complications. Many patients a marked reduction or resolution of pain after the CT-guided infiltration (P<0.05). No patient required hospitalization. One patient reported an episode of intense headache, which resolved after twenty minutes. In eleven cases, a slight increase in pain related to spinal compression caused by the administration of the drug was reported, even if administrated extremely slowly. Sixteen patients reported pain in the upper limbs during and after the procedure, however this was not related to infiltration but to the forced and prolonged arm position.Conclusion:CT-guided transforaminal periradicular infiltration is a semi-invasive and well tolerated procedure, moreover it has a reduced comorbidity and no observed major or minor complications. The CT foot switches and MPR evaluation may help to make the procedure more efficient. (www.actabiomedica.it)

525 SURGICAL MORBIDITY AND MORTALITY FROM THE NEORESII TRIAL: STANDARD VS. PROLONGED TIME TO SURGERY AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER

Abstract For carcinoma of the esophagus or esophagogastric junction the time to surgery (TTS) has traditionally been 4-6 weeks after completed neoadjuvant chemoradiotherapy (nCRT). However, the optimal timing is not known. A majority of previous non-randomized studies addressing this issue, have not detected any significant differences in complication rates comparing patients operated with standard TTS compared to prolonged TTS. The aim of this sub-study was to investigate if prolonged TTS after completed nCRT improves postoperative outcomes. Methods A multicenter clinical trial was performed with randomized allocation to standard TTS (4–6 weeks) or prolonged TTS (10–12 weeks). All patients received nCRT according to the CROSS regimen. Patients were enrolled between 2015–2019 from 10 University Hospitals in Sweden, Norway and Germany. The primary endpoint of this sub-study was overall postoperative complications defined as Clavien-Dindo grade II-V. Secondary endpoints included complication severity according to Clavien-Dindo grade IIIb-V, postoperative 90-day mortality and length of hospital stay. The study was registered in Clinicaltrials.gov (NCT02415101). Results In total 248 patients were randomized. There were no significant differences between standard TTS and prolonged TTS regarding overall complications Clavien-Dindo II-V (59.0% vs. 69.8%, P = 0.092) or Clavien-Dindo IIIb-V (31.6% vs. 35.0%, P = 0.603). Furthermore, there were no significant differences regarding anastomotic leak (P = 0.601), conduit necrosis (P = 0.524), chyle leak (P = 0.427), pneumonia (P = 0.548) or respiratory failure (P = 0.723). The 90-day postoperative mortality was 4.3% (5 patients) in the standard TTS, and 3.8% (4 patients) in the prolonged TTS arm (P = 1.0). Median length of hospital stay was 15 days in the standard TTS arm and 17 days in the prolonged TTS arm (P = 0.220). Conclusion The timing of surgery after completed nCRT for carcinoma of the esophagus or esophagogastric junction is not of major importance with regard to short-term postoperative outcomes.

Cubital tunnel syndrome masked by spinal osteochondrosis

Cubital tunnel syndrome (CTS) is the second most common compression mononeuropathy that is effectively treated. The risk factors for CTS include repetitive arm flexion at the elbow joint and prolonged arm flexion with support on the elbow. The diagnosis of CTS is based on its clinical presentations, the data of neurological examinations, and the results of electroneuromyography and ultrasound examination. The symptoms of the disease progress quickly, therefore the early diagnosis of CTS and its timely treatment are of great importance for the patient's recovery. Unfortunately, patients with CTS are often observed to be erroneously diagnosed with degenerative and dystrophic spinal changes. The paper presents an observation of effective treatment in a young patient who has been suffering from CTS for a long time and been erroneously diagnosed with spinal osteochondrosis. Six months after surgical treatment (for decompression and neurolysis of the left ulnar nerve), the patient regained hand sensitivity and movement. It is concluded that further investigation is necessary to assess predictors of effective surgical treatment in patients with this disease.

Late Health Outcomes After Contemporary Lymphome Malin de Burkitt Therapy for Mature B-Cell Non-Hodgkin Lymphoma: A Report From the Childhood Cancer Survivor Study.

The widely used, risk-based Lymphome Malin de Burkitt (LMB) chemotherapy regimen has improved survival rates for children with mature B-cell non-Hodgkin lymphoma (NHL); however, associated late effects remain understudied. We assessed late health outcomes after LMB treatment in the Childhood Cancer Survivor Study. Multivariable regression models compared chronic health conditions, health status, and socioeconomic and neurocognitive outcomes between survivors of NHL treated with the LMB regimen (n = 126), survivors of NHL treated with non-LMB regimens (n = 444), and siblings (n = 1,029). LMB survivors were a median age of 10.2 years (range, 2.5 to 20.5 years) at diagnosis and 24.0 years (range, 10.3 to 35.3 years) at evaluation. Compared with siblings, LMB survivors were at increased risk for adverse health outcomes. However, survivors of NHL treated with LMB and non-LMB regimens did not differ with regard to risk of having any chronic health conditions, impaired health status, neurocognitive deficits, or poorer socioeconomic outcomes. Increased risk for the following specific neurologic conditions was observed in LMB survivors compared with non-LMB survivors: epilepsy (relative risk [RR], 15.2; 95% CI, 3.1 to 73.4); balance problems (RR, 8.9; 95% CI, 2.3 to 34.8); tremors (RR, 7.5; 95% CI, 1.9 to 29.9); weakness in legs (RR, 8.1; 95% CI, 2.5 to 26.4); severe headaches (RR, 3.2; 95% CI, 1.6 to 6.3); and prolonged arm, leg, or back pain (RR, 4.0; 95% CI, 2.2 to 7.1). The survivors from the group C LMB risk group (n = 50) were at the highest risk for these conditions; however, except for worse functional status (odds ratio, 2.7; 95% CI, 1.2 to 5.8), they were not at increased risk for other adverse health status or socioeconomic outcomes compared with non-LMB survivors. Survivors treated with LMB and non-LMB regimens are largely comparable in late health outcomes except for excess neurotoxicity among LMB survivors. These data inform treatment efforts seeking to optimize disease control while minimizing toxicity.

Delayed and prolonged arm weakness and atrophy following botulinum toxin injection for musician's cramp

Delayed and prolonged arm weakness and atrophy following botulinum toxin injection for musician's cramp

Early use of autogenous arteriovenous fistula in patients with urgent hemodialysis.

This study was designed to evaluate the long-term patency rate and complications associated with early use of the autogenous forearm arteriovenous fistula (AFAVF) in patients needing urgent hemodialysis. The clinical data of all patients undergoing AFAVFs for hemodialysis access between June 1996 and June 2016 were retrospectively evaluated. The primary and secondary patencies were estimated using the life table method. A total of 104 AFAVFs were created for 102 patients. All patients had entered hemodialysis when fistulas were constructed. The mean time to the first cannulation of the AFAVF was 17.33±4.60 (5-27days). Four AFAVFs (3.8%) became occluded within 30days of creation of the access, and five AFAVFs (4.8%) had hematomas after cannulation. There were no cases of infection of the wound or steal syndrome or prolonged arm edema. The primary patency rate was 77.81% at 1year, 73.05% at 2years, 64.64% at 3years, 60.75% at 5years and 47.48% at 10years. The secondary patency rate was 96.78% at 1year, 95.18% at 5years and 85.81% at 10years. In this study, the patency rates following the early use of the AFAVFs were not inferior to the previously reported patency rates in the literature. For patients entering hemodialysis with an inserted central catheter, the early use of the AFAVFs decreases the complications associated with catheters.

Extended detection time to reduce shocks is safe in secondary prevention patients: The secondary prevention substudy of PainFree SST

Prolonged ventricular fibrillation (VF) detection has been shown to reduce implantable cardioverter-defibrillator (ICD) therapies and improve prognosis in primary prevention ICD patients. Data in secondary prevention patients are limited. The PainFree SST secondary prevention study is the largest trial of secondary prevention patients randomized between standard and prolonged detection to assess the safety of this strategy in these patients. A total of 705 secondary prevention patients implanted with an ICD in the PainFree SST trial were enrolled in this substudy; 353 patients were randomized to VF detection of 18/24 intervals and 352 patients to 30/40. All other VF parameters were standardized by protocol. The 1-year arrhythmic syncope-free rates in the standard and prolonged groups were 97.7% vs 96.9%, respectively, (P = .0034 for noninferiority). Freedom from all-cause syncope was 96% in both arms (P = .0013 for noninferiority). There was no difference in the time to first appropriate or inappropriate VF therapy. However, the rates of treated VF episodes were lower in the prolonged arm (1.48 per patient per year vs 0.44 per patient per year, P = .0001). A trend toward lower mortality in the prolonged group was not statistically different (5.6% 1 year, 12% 2 years vs 3.8% 1 year, 7.7% 2 years, adjusted hazard ratio = 0.60, P = .061). This large prospective randomized study shows that prolonged detection can safely be programmed in secondary prevention ICD patients with new or existing devices. This programming strategy decreases the rate of treated events and is not associated with an increased risk of syncope or mortality.

Work with prolonged arm elevation as a risk factor for shoulder pain: A longitudinal study among young adults

This prospective study aimed at examining if work with prolonged arm elevation predicts shoulder pain among 41 young adults in their first years of working life. Fifteen hairdressers, 15 electricians, 5 students and 6 with various work were followed over a 2.5-year period (2006/7–2009). Arm elevation was measured with inclinometers during a full working day at baseline. Shoulder pain was reported at baseline and twice in the follow-up period. Data were analyzed by generalized estimating equations (GEE-analysis), stratified by gender and adjusted for time, mechanical workload, work demand, physical activity, tobacco use and prior shoulder pain. Work with prolonged arm elevation with angles >60° and >90° were associated with shoulder pain among women. Even though the shoulder pain levels are low the study suggests work with arms elevated as an early work-related risk factor among women, and indicates the importance of early prevention strategies.

Posterior segment findings of ocular cytomegalovirus infection in immunocompetent patients.

We sought to investigate and describe the clinical spectrum of posterior segment abnormalities in immunocompetent patients presenting with CMV-associated anterior uveitis. This was a prospective study conducted at the Singapore National Eye Centre, a tertiary referral centre, from August 2010 to June 2011. Eleven eyes of eleven patients with CMV anterior uveitis confirmed by polymerase chain reaction on aqueous humor sampling were recruited based on the study criteria. Patients were recruited from a single uveitis specialist clinic and underwent aqueous humor sampling and fluorescein and indocyanine green angiography as well as optical coherence tomography. They were further evaluated by the Infectious Disease physician for immunocompetence. Mean presenting visual acuity was logMAR 0.35 ± 0.29. The main presenting complaints were blurring of vision, eye redness, and pain. Anterior chamber cellular activity was present in all cases. Fine diffuse keratic precipitates (KPs) were present in 10 eyes, and the remaining one eye had mutton fat KPs. Iris changes were present in three eyes. Intraocular pressure (IOP) was elevated in nine eyes (mean presenting IOP was 40.2 ± 16.8 mmHg). In the posterior segment, none of the eyes had evidence of retinitis or hemorrhage. Posterior segment abnormalities were present in six eyes (macular edema, disc leakage, epiretinal membrane, phlebitis). Eight eyes also had prolonged arm to retina time (mean 24.8 ± 10.6 s) on fluorescein angiography. Indocyanine green angiography was unremarkable. Posterior segment manifestations can be seen in a proportion of immunocompetent patients with CMV anterior uveitis. The underlying mechanism remains to be determined.

Behavioral activation-based guided self-help treatment administered through a smartphone application: study protocol for a randomized controlled trial.

BackgroundThe need for cost-effective interventions for people suffering from major depressive disorders is essential. Behavioral activation is an intervention that can largely benefit from the use of new mobile technologies (for example smartphones). Therefore, developing smartphone-based behavioral activation interventions might be a way to develop cost-effective treatments for people suffering from major depressive disorders. The aim of this study will be to test the effects of a smartphone-delivered behavioral activation treatment.MethodsThe study will be a randomized controlled trial with a sample size of 120 participants, with 60 patients in each group. The treatment group includes an 8-week smartphone-based behavioral activation intervention, with minimal therapist contact. The smartphone-based intervention consists of a web-based psychoeducation, and a smartphone application. There is also a back-end system where the therapist can see reports from the patients or activities being reported. In the attention control group, we will include brief online education and then recommend use of a smartphone application that is not directly aimed at depression (for example, ‘Effective meditation’). The duration of the control condition will also be 8 weeks. For ethical reasons we will give the participants in the control group access to the behavioral activation treatment following the 8-week treatment period.DiscussionsWe believe that this trial has at least three important implications. First, we believe that smartphones can be integrated even further into society and therefore may serve an important role in health care. Second, while behavioral activation is a psychological treatment approach for which there is empirical support, the use of a smartphone application could serve as the therapist’s prolonged arm into the daily life of the patient. Third, as we have been doing trials on guided Internet treatment for more than 10 years it is now time to move to the next generation of information technology - smartphones - which are not only relevant for Swedish conditions but also for developing countries in the world which are increasingly empowered by mobile phones with Internet connection.Trial registrationClinicalTrials.gov NCT01463020

Comparison of internal temperature responses to prolonged arm and leg ergometer exercise

Understanding thermoregulatory responses to different modes of exercise has important implications from both experimental and spaceflight‐countermeasure perspectives. It is unknown whether prolonged, dynamic arm or leg exercise at the same metabolic demand (i.e., VO2) will elicit similar internal temperature (Tcore) responses. Six subjects (N=6) completed separate, 60 minute trials of Arm and Leg cycle ergometry. Heart rate (HR), mean arterial pressure (MAP) and Tcore (via pill telemetry) were measured throughout exercise. The exercise workload was determined as follows: Watts = 0.35·Body Mass (kg). The VO2 responses to Arm (10.2±0.5) and Leg (9.9±0.6 ml/kg/min) exercise were not different (p = 0.4). However, HR responses were greater during Arm cycling (87±7) compared to Leg cycling (78±4 bpm) at minute 60 (mode*time interaction, p&lt;0.01). MAP responses only tended to be different between Arm and Leg cycling (p=0.051). Interestingly, Tcore responses were greater during Arm cycling at minutes 40, 50 and 60 (mode*time interaction, p&lt;0.01). Although the greater Tcore responses to Arm exercise were modest (difference of means ~0.1 °C), they are supportive of differences between exercise modes that may be of physiological relevance at both greater exercise intensities and during repeated exercise exposure (e.g., heat acclimation).Support by NASA Grant NNX08AY40G

Early use of Brachial-Basilic Arteriovenous Fistula

The aim of this study was to evaluate the long-term patency rate and complications associated with the use of the BBAVF in the early period. The records of all patients undergoing BBAVFs for hemodialysis access between June 2001 and June 2011 were retrospectively evaluated. We allowed the use of the BBAVF beginning two weeks after the fistula creation. The primary and secondary patencies were estimated using the Kaplan-Meier method. A total of 44 BBAVFs were created for 41 patients. Most (73.2%) of the patients had previously been on hemodialysis. A previous history of AVG creation was noted in 36.6% and previous insertion of a catheter was reported for 72.7% of the patients, respectively. The mean time to the first cannulation of the BBAVF was 18.8 days (13-42 days). In two cases, the BBAVFs were not used. Postoperative complications were noted in 2 cases, and included prolonged arm edema and thrombosis. There was no infection of the wound or steal syndrome. The primary and secondary patency rates were 68.1% and 84.2% at 1 year, 55.0% and 80.7% at 2 years, and 38.1% and 70.1% at 5 years, respectively. In this study, the patency rates following the early use of the BBAVFs were not inferior to the previously reported patency rates in the literature. In cases where the patients already have an inserted central catheter, the early use of the BBAVFs decreases the complications associated with catheters.

The use of a vertical arm support device to reduce upper extremity muscle firing in sonographers

Work-related musculoskeletal disorders (WRMSD) in sonographers have increased over the past 20 years with shoulder injuries being the most prevalent. Advancing ultrasound technologies have reduced a sonographer's need to move when performing exams and increased prolonged arm abduction, resulting in static work postures and decreased joint perfusion. Work modifications in other industries have demonstrated that reducing arm abduction to 30° reduces muscle firing and fatigue. Although this is the ideal work posture for sonographers, there are many instances in which excessive arm abduction and static postures cannot be avoided. These positions are further complicated by the fact that the scanning arm is also supporting the weight of the ultrasound transducer. This observational case study evaluated the use of a moveable arm support system as a means to provide support for the scanning arm and reduce muscle firing during ultrasound exams in the scanning lab of a university diagnostic ultrasound educational program.

Fuel Selection during Prolonged Arm and Leg Exercise with 13C-Glucose Ingestion

To compare fuel selection during prolonged arm (AE) and leg exercise (LE) with water or glucose ingestion. Ten subjects (VO2max: 4.77 +/- 0.20 and 3.36 +/- 0.15 L x min(-1) for LE and AE, respectively) completed 120 min of LE and AE at 50% of the mode-specific maximal power output (353 +/- 18 and 160 +/- 9 W, respectively) with ingestion of water (20 mL x kg(-1)) or 13C-glucose (2 g x kg(-1)). Substrate oxidation was measured using indirect respiratory calorimetry corrected for urea excretion and 13CO2 production at the mouth. The contribution of protein oxidation to the energy yield (%En) was higher during AE than LE (approximately 8% vs approximately 4%) because of the lower energy expenditure and was not significantly modified with glucose ingestion. With water ingestion, the %En from CHO oxidation was not significantly different during LE and AE (64 +/- 2% and 66 +/- 2%, respectively). Glucose ingestion significantly increased the %En from total CHO oxidation during AE (78 +/- 3%) but not during LE (71 +/- 2%). Exogenous glucose oxidation was not significantly different in AE and LE (56 +/- 4 and 65 +/- 3 g, respectively), but the %En from exogenous glucose was higher during AE than LE (30 +/- 1% and 24 +/- 1%) because of the lower energy expenditure. When glucose was ingested, the %En from endogenous CHO oxidation was significantly reduced during both AE (66 +/- 2% to 48 +/- 3%) and LE (64 +/- 2% to 47 +/- 3%) and was not significantly different in the two modes of exercise. The difference in fuel selection between AE and LE when water was ingested was modest with a slightly higher reliance on CHO oxidation during AE. The amount of exogenous glucose oxidized was lower but its %En was higher during AE because of the lower energy expenditure.

Effect of pre-exercise carbohydrate ingestion on substrate consumption in persons with spinal cord injury

To investigate the influence of pre-exercise carbohydrate ingestion on fat and carbohydrate oxidation during prolonged arm cranking exercise in persons with spinal cord injury. Six male paraplegic subjects (PS, Ll-Th3, 46.3+/-6.6 years) and seven able-bodied subjects (AB, 43.1+/-4.6 years) were volunteered to participate in the present study. The subjects were required to consume a glucose solution (1 g kg(-1) body mass and 500 ml plain water; glucose experiment) or only plain water (water experiment) before the prolonged exercise. Then the subjects performed for 1-h arm cranking exercise at a moderate workload. In the water experiment, the carbohydrate oxidation slightly decreased and the fat oxidation increased continuously in AB. In contrast, the carbohydrate and fat oxidation of PS was constant during the exercise in the water experiment. In the glucose experiment, the fat oxidation did not rise and the carbohydrate oxidation was constant until the end of the exercise in PS and AB. PS oxidized more fat than AB in the glucose experiment (P<0.05), but no significant difference was found between PS and AB in the water experiment. Using a wheelchair in daily life regularly was regarded as an exercise training that disciplined PS indirectly and is considered to cause PS to have more percentage of type I fiber than AB in the anterior deltoid muscle. Thus, the distribution of muscle fiber type in anterior deltoid muscle might be one of the factors that impacted the fat oxidation of PS in glucose experiment.

A randomised prospective study of prolonged treatment with tocopherol and pentoxifylline, in addition to carbogen in the management of radiation late effects

19682 Background: Pentoxifylline (PTX) and tocopherol (Vitamin E) are antioxidants previously shown to be useful in combination in the treatment of late radiation effects. To our knowledge, this is the first study to examine the clinical benefit of combination therapy with carbogen, tocopherol and pentoxifylline in the mitigation of late radiation effects. The optimal duration of PTX and tocopherol treatment has not been fully established. Therefore, we also studied short versus extended treatment duration. Methods: We conducted a phase II prospective randomised study of inhaled carbogen (95% oxygen + 5% carbon dioxide) over 90 minutes, 5 days per week for 3 weeks in addition to short versus prolonged treatment with pentoxifylline (800 mg) and tocopherol (1,000 IU) orally once daily. All 18 patients received carbogen therapy. Patients with grade 3 toxicity post radical radiotherapy for a variety of cancer primaries were eligible for the trial. The primary endpoint was improvement in maximum Lent-Soma toxicity scores. Ethical approval was obtained. Results: Maximum Lent-Soma scores improved with treatment in six of the eighteen patients giving a 33% response rate. The proportion of patients responding to treatment in the prolonged treatment arm B was more than double than in the shorter arm A (Fisher’s exact test: p = 0.321). Two patients in arm B had complete resolution of their symptoms, which was maintained at 2 and 3 years follow up. Conclusions: As late radiation effects are progressive by nature and have such a negative impact on quality of life in long-term cancer survivors, any treatment, which may ameliorate their symptoms, should be considered of benefit. This study confirms the benefit of prolonged treatment and we would recommend clinical use of these agents with treatment duration of at least 12 months, in the management of late radiation effects. No significant financial relationships to disclose.

THE EFFECTS OF TWO COOLING STRATEGIES DURING PROLONGED ARM CRANK EXERCISE IN HOT CONDITIONS

PURPOSE: The aim of this study was to determine the effects of cooling either the lower or upper body during prolonged arm exercise in the heat. METHODS: Eight male subjects (mean ± sd age 24.5 ± 4.0yrs, weight 81.0 ± 7.8 kg, upper body VO2peak 3.13 ± 0.50 ± 1.min-1) volunteered to take part in this study which had received Faculty Ethics Committee approval. Subjects exercised for 30 minutes at 60% VO2peak in a hot environment (40.2 ± 0.4°C, 38.7 ± 7.4%rh) on three occasions. The order of testing was randomised and involved lower body cooling (LC), upper body cooling (UC) or a no cooling control (NC). Cooling was achieved by application of ice packs. Each subject wore lightweight tracksuit trousers and a sleeveless T-shirt in all trials to prevent direct contact of ice with the skin. After 30 minutes of exercise the ice packs were removed and subjects monitored for 30 minutes of passive recovery. RESULTS: No differences were observed between trials for oxygen consumption, minute ventilation, RER or blood lactate. At the end of exercise heart rate was greatest for the NC trial (151 ± 11 beat.min-1) when compared to the UC and LC trials (148 ± 16 and 138 ± 13 beats.min-1). Mean skin temperature (MST) at the end of exercise was lowest in the LC trial (28.5 ± 1.3°C, P < 0.05) and greatest in the NC trial (36.3 ± 0.5 °C). MST was also lower in the UC when compared to NC (31.2 ± 1.4, P < 0.05, respectively). No differences were observed for rectal or aural temperatures between trials. Heat storage at the end of exercise for NC was (3.04 ± 0.68 J. g-1, P < 0.05). After 5 minutes of exercise values were negative for both LC and UC decreasing further at 30 minutes for LC (−2.37 ± 0.81 J. g-1) and remaining neutral for UC (0.18 ± 1.21 J. g-1, P < 0.05). RPE was lowest during the LC trial throughout exercise and greatest for the NC trial (P < 0.05). CONCLUSIONS: The results of this study suggest that cooling the lower body during prolonged upper body exercise in hot conditions is more effective in reducing both physiological and thermal strain than cooling the upper body. Furthermore, the reduction in MST temperature with little change in core temperature suggest that the reduction in heat storage is local rather then central.

Thermoregulatory responses during prolonged upper body exercise in cool and warm conditions

The thermoregulatory responses of upper-body trained athletes were examined at rest, during prolonged arm crank exercise and recovery in cool (21.5 ± 0.9°C, 43.9 ± 10.1% relative humidity; mean ± s) and warm (31.5 &± 0.6°C, 48.9 - 8.4% relative humidity) conditions. Aural temperature increased from rest by 0.7 ± 0.7°C (P ≪ 0.05) during exercise in cool conditions and by 1.6 ± 0.7°C during exercise in warm conditions (P ≪ 0.05). During exercise in cool conditions, calf skin temperature decreased (1.5 ± 1.3°C), whereas an increase was observed during exercise in warm conditions (3.0 ± 1.7°C). Lower-body skin temperatures tended to increase by greater amounts than upper-body skin temperatures during exercise in warm conditions. No differences were observed in blood lactate, heart rate or respiratory exchange ratio responses between conditions. Perceived exertion at 45 min of exercise was greater than that reported at 5 min of exercise during the cool trial (P ≪ 0.05), whereas during exercise in the warm trial the rating of perceived exertion increased from initial values by 30 min (P ≪ 0.05). Heat storage, body mass losses and fluid consumption were greater during exercise in warm conditions (7.06 ± 2.25 J·g-1 ·°C-1, 1.3 ± 0.5 kg and 1038 ± 356 ml, respectively) than in cool conditions (1.35 ± 0.23 J·g-1·°C-1, 0.8 ± 0.2 kg and 530 ± 284 ml, respectively; P ≪ 0.05). The results of this study indicate that the increasing thermal strain with constant thermal stress in warm conditions is due to heat storage within the lower body. These results may aid in understanding thermoregulatory control mechanisms of populations with a thermoregulatory dysfunction, such as those with spinal cord injuries.