Perceived Exertion Research Articles

Neural Respiratory Drive During Different Dyspnea Relief Positions and Breathing Exercises in Individuals With COPD.

When the work load of the respiratory muscles increases and/or their capacity decreases in individuals with COPD, respiratory muscle activation increases to maintain gas exchange and respiratory mechanics, and perception of dyspnea occurs. The present study aimed to compare diaphragm and accessory respiratory muscle activation during normal breathing, pursed-lip breathing, and breathing control in different dyspnea relief positions, supine and side lying. A cross-sectional study design was used. Sixteen individuals with COPD age between 40-75 y were included. Pulmonary function was evaluated by spirometry, muscle activation by surface electromyography, and dyspnea by the modified Borg scale. Muscle activation was measured in the diaphragm, scalene, sternocleidomastoid, and parasternal muscles. The evaluation was made in the dyspnea relief positions (sitting leaning forward, sitting leaning forward at a table, leaning forward with back against a wall, standing leaning forward, and high lying), seated erect, supine, and side lying. There were significant differences between the 8 positions (P < .001). There was no significant difference in muscle activation between sitting leaning forward and sitting leaning forward at a table position with analyzing post hoc test results (P > .99 for each muscle). However, muscle activation was lower in these 2 positions than in the other positions (P < .001 for each muscle). Muscle activation was greater in the supine position than in the other positions (P < .001 for each muscle). No difference was observed in muscle activation between the seated erect, leaning forward with back against a wall, standing leaning forward, high-lying, or side-lying positions (P > .05 for each muscle with a minimum P value of .09). The use of sitting leaning forward and sitting leaning forward at a table positions together with breathing control may help people with COPD to achieve more effective dyspnea relief and greater energy efficiency.

Energy expenditure and effort of patients with stroke during sit to stand: A pilot study

Background: Sit-to-stand (STS) is a mechanically demanding task. Little is known about the energy expenditure (EE) and the perceived effort of patients with stroke during STS.Objectives: The objectives of our study were to assess the perceived effort and EE of patients with stroke when moving from STS and to determine whether an association between actual energy expended and patient-perceived effort exists.Method: This descriptive cross-sectional pilot study assessed participants’ EE and perceived effort during STS, with a triaxial accelerometer and the modified Borg scale (MBS), respectively.Results: The team screened 428 individuals for potential inclusion, with nine participants (n = 5 female, 55.5%) meeting the criteria for our pilot study. Participants had a mean age of 52.77 (standard deviation [SD] ± 11.33) years, the majority had a haemorrhagic stroke (n = 6, 66.6%) and left hemiplegia (n = 6, 66.6%), and they were assessed 9.11 (SD ± 6.57) days post-stroke. The mean EE during STS was 2.82 (SD ± 1.9) kCal. Most participants (n = 7, 77.77%) perceived STS as more than a ‘moderate’ effort on the MBS. The correlation coefficient between the metabolic equivalent of task (METs) and MBS was r = 0.34 (p = 0.38).Conclusion: Our study found a fair positive correlation between METs and MBS for patients with stroke during STS.Clinical implications: The increased EE shown can be a key point for rehabilitation to lessen the extent of EE during STS. Further research is warranted.

The Acute: Chronic Workload Ratio and Injury Risk in Semiprofessional Football Players.

The purpose of this study was to analyze the association and predictive capacity between the acute:chronic workload ratio (ACWR) and non-contact injuries in a semiprofessional football team. Seventeen football or soccer players from a Spanish Third Division football team participated voluntarily in this study. A prospective longitudinal study was developed during the 2020/2021 season. Twenty-four weeks were analyzed from October to March, including a regenerative microcycle due to the absence of competition during Christmas. Rate of perceived exertion (RPE) and session-rate of perceived exertion (sRPE) were registered for every training and game session. Afterward, acute and chronic workloads were calculated, and ACWR was subsequently derived from them. Furthermore, non-contact injuries were registered during the period mentioned. The main findings were that there is a poor correlation between the ACWR and non-contact injuries (r=0.069 (p<0.05)), and the use of the ACWR by itself is insufficient to predict the occurrence of non-contact injuries in a semiprofessional football team. Consequently, the ACWR is not an useful predictive tool for injuries in semiprofessional football teams.

Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Enhances Recovery for Persons with Spinal Cord Injury-A Pilot Randomized Controlled Trial.

Spinal cord injury (SCI) negatively impacts individuals' functional independence, and motor and sensory function. Intense walking training has been shown to facilitate recovery for individuals with chronic SCI. Powered robotic exoskeletons provide therapists with a tool that allows them to conduct walking training with less therapist effort as compared to conventional walking training. Exoskeletal-assisted walking (EAW) has been studied in the chronic SCI population with preliminary reports showing benefits in mobility, health, and quality-of-life outcomes. However, few reports have studied EAW's benefits in the acute (<90 days post) SCI population at a time when neural plasticity is most dynamic and modifiable. The purpose of the study was to conduct a pilot randomized controlled trial (RCT) to understand the effects of incorporated EAW in acute inpatient rehabilitation (AIR) for individuals with SCI on functional, motor, and sensory recovery. The study outcomes included the Spinal Cord Independence Measure (SCIM) III and International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores that were assessed by unblinded assessors. We also recorded EAW session data, including adverse events, walking and up time, step counts, Borg Rating of Perceived Exertion (RPE), and compliance with scheduled EAW training. From August 2019 to July 2022, 16 participants completed the AIR with incorporated EAW, and 12 completed the standard AIR, all with SCI and preserved leg function within 90 days post-injury. During each session, the AIR with incorporated EAW group averaged 34.3 (±9.4) min of up time, 25.4 (±7.7) min of walk time, and 536 (±157) steps. Analysis via two-by-two mixed-effects models showed significant increases in the SCIM total score and ISNCSCI total motor and sensory scores over time for the AIR with incorporated EAW group [SCIM total score: F(1, 26) = 5.59, p = 0.03; total motor score: F(1, 26) = 8.06, p < 0.01; total sensory score: F(1, 19.2) = 5.08, p = 0.04], outperforming the standard AIR group. The AIR with incorporated EAW group showed 13, 14, and 22 points higher changes in the SCIM total score, total motor score, and total sensory score (respectively) by discharge compared with the standard AIR group. Incorporating EAW into AIR may facilitate functional, motor, and sensory recovery for individuals with SCI during AIR better than standard AIR. However, the study had a limited sample size. Further studies are needed to clarify the effects of EAW in AIR.

Surgical management of omega deformity in a patient with neurofibromatosis type 1: a case report.

To describe the surgical treatment in a patient with a partial omega deformity in the thoracic spine with neurofibromatosis type 1. The patient was a 55-year-old man with an omega deformity, which is defined as a curvature in which the end vertebra is positioned at the level of, above, or below the apical vertebra (i.e., a horizontal line bisecting it). We performed halo gravity traction (HGT) for 7weeks, followed by posterior spinal instrumented nearly equal in situ fusion from T2-L5 with three femoral head allografts and a local bone autograft. We avoided reconstruction of the thoracic anterior spine because of his severe pulmonary dysfunction. HGT improved the % vital capacity from 32.5 to 43.5%, and improved the Cobb angle of the kyphosis from > 180° before traction to 144° after traction. The Cobb angle of kyphosis and scoliosis changed from > 180° preoperatively to 155° and 146°, respectively, postoperatively, and 167° and 156°, respectively, at final follow-up. His postoperative respiratory function deteriorated transiently due to bilateral pleural effusions and compressive atelectasis, which was successfully treated with a frequent change of position and nasal high flow for 1week. At final follow-up, his pulmonary function improved from 0.86 to 1.04L in VC, and from 32.5 to 37.9% in %VC. However, there was no overall improvement in preoperative distress following surgery, although his modified Borg scale improved from 3 preoperatively to 0.5 postoperatively. One month after discharge, he felt worsening respiratory distress (SpO2:75%) and was readmitted for pulmonary hypertension for 2months. He was improved by non-invasive positive pressure ventilation (biphasic positive airway pressure) for 1week, medication and daily lung physiotherapy. Thereafter, he has been receiving permanent daytime (0.5L/min) and nighttime (2L/min) oxygen therapy at home. A solid arthrodesis through the fusion area was confirmed on computed tomography. However, the kyphosis correction loss was 12° (i.e., 155°-167°), while the scoliosis correction loss was 10° (i.e., 146°-156°) at 2years of recovery. We suggest that nearly equal in situ fusion is a valid option for preventing further deformity deterioration and avoiding fatal complications.

The relationship between prescribed ratings of perceived exertion and force production in repeated isometric contractions

Ratings of perceived exertion (RPE) are frequently used to monitor and prescribe exercise intensity. However, studies examining the shape and robustness of how feelings of effort map onto objective outputs are limited and report inconsistent results. To address this, we investigated whether (1) producing isometric forces according to RPE levels reliably leads to differences in force output, (2) if feelings of effort map linearly or non-linearly onto force output, and (3) if this mapping is robust when visual feedback and social facilitation are present. In a counterbalanced repeated measures design, N = 26 participants performed isometric handgrip contractions prescribed by ten levels of the Borg CR-10 scale. They did so either with or without the availability of concurrent visual feedback regarding their force production, and in the presence or absence of another person performing the same task simultaneously. We found that subjects reliably produced different force outputs that corresponded to each RPE level. Furthermore, concurrent visual feedback led to a linearization of force output, while in the absence of feedback, the produced forces could also be described by quadratic and cubic functions. Exploratory post-hoc analyses revealed that participants perceived moderate RPE levels to be more challenging to produce. By shedding light on the dynamic nature of the mapping between RPE and objective performance, our findings provide helpful insights regarding the utility of RPE scales.

Ultrasound in predicting improvement in dyspnoea after therapeutic thoracentesis in patients with recurrent unilateral pleural effusion

ABSTRACT Background In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following drainage may support the management of these patients. This study aimed to assess the association between ultrasound (US) characteristics and a relevant improvement in dyspnoea immediately following drainage. Methods In a prospective, observational study, patients with recurrent unilateral pleural effusion underwent US evaluation of effusion characteristics and diaphragm movement measured by M-mode and the Area method before and right after drainage. The level of dyspnoea was assessed using the modified Borg scale (MBS). A minimal important improvement in dyspnoea was defined as delta MBS ≥ 1. Results In the 104 patients included, 53% had a minimal important improvement in dyspnoea following thoracentesis. We found no association between US-characteristics, including diaphragm shape or movement (M-mode or the Area method), and a decrease in dyspnoea following drainage. Baseline MBS score ≥ 4 and a fully drained effusion were significant correlated with a minimal important improvement in dyspnoea (OR 3.86 (1.42–10.50), p = 0.01 and 2.86 (1.03–7.93), p = 0.04, respectively). Conclusions In our study population, US-characteristics including assessment of diaphragm movement or shape was not associated with a minimal important improvement in dyspnoea immediately following thoracentesis.

Are incremental exercise relationships between rating of perceived exertion and oxygen uptake or heart rate reserve valid during steady-state exercises?

Rating of perceived exertion (RPE) is considered a valid method for prescribing prolonged aerobic steady-state exercise (SSE) intensity due to its association with physiological indicators of exercise intensity, such as oxygen uptake (V̇O2) or heart rate (HR). However, these associations between psychological and physiological indicators of exercise intensity were found during graded exercise tests (GXT) but are currently used to prescribe SSE intensity even though the transferability and validity of the relationships found during GXT to SSE were not investigated. The present study aims to verify whether (a) RPE-HR or RPE-V̇O2 relations found during GXTs are valid during SSEs, and (b) the duration and intensity of SSE affect these relations. Eight healthy and physically active males (age 22.6 ± 1.2 years) were enrolled. On the first visit, pre-exercise (during 20 min standing) and maximal (during a GXT) HR and V̇O2 values were measured. Then, on separate days, participants performed 4 SSEs on the treadmill by running at 60% and 80% of the HR reserve (HRR) for 15 and 45 min (random order). Individual linear regressions between GXTs' RPE (dependent variable) and HRR and V̇O2 reserve (V̇O2R) values (computed as the difference between maximal and pre-exercise values) were used to predict the RPE associated with %HRR (RPEHRR) and %V̇O2R (RPEV̇O2R) during the SSEs. For each relation (RPE-%HRR and RPE-%V̇O2R), a three-way factorial repeated measures ANOVA (α=0.05) was used to assess if RPE (dependent variable) was affected by exercise modality (i.e., RPE recorded during SSE [RPESSE] or GXT-predicted), duration (i.e., 15 or 45 min), and intensity (i.e., 60% or 80% of HRR). The differences between RPESSE and GXT-predicted RPE, which were assessed by evaluating the effect of modality and its interactions with SSE intensity and duration, showed no significant differences between RPESSE and RPEHRR. However, when RPESSE was compared with RPEV̇O2R, although modality or its interactions with intensity were not significant, there was a significant (p=0.020) interaction effect of modality and duration yielding a dissociation between changes of RPESSE and RPEV̇O2R over time. Indeed, RPESSE did not change significantly (p=0.054) from SSE of 15 min (12.1 ± 2.0) to SSE of 45 min (13.5 ± 2.1), with a mean change of 1.4 ± 1.8, whereas RPEV̇O2R decreased significantly (p=0.022) from SSE of 15 min (13.7 ± 3.2) to SSE of 45 min (12.4 ± 2.8), with a mean change of -1.3 ± 1.5. The transferability of the individual relationships between RPE and physiological parameters found during GXT to SSE should not be assumed as shown by the results of this study. Therefore, future studies modelling how the exercise prescription method used (e.g., RPE, HR, or V̇O2) and SSE characteristics (e.g., exercise intensity, duration, or modality) affect the relationships between RPE and physiological parameters are warranted.

Heel riser height influence on kinematics and muscle activity of ski mountaineering – A field based study

Introduction The ski binding plays an important role in ski mountaineering. When traveling uphill, the binding has an adjustable heel height known as the riser. Previous laboratory research reported joint kinematics and kinetics are influenced by riser height, however little is known about changes to muscle activity associated with differing joint motion. The purpose of this work was to assess riser height influence on kinematics and muscle activity at different slopes during on-snow skiing. Methods Three female and nine male recreational ski mountaineers (19-26 y) were tested on 5o and 16o gradients using no riser (0 cm) and riser (5.3 cm) at a submaximal 80% HRmax. Each subject used Backland 85 UL skis and Backland Bindings (Atomic Skis, Altenmarkt, Austria). Subjects skied for 6 min at each binding setting with the last 10 gait-cycles evaluating lower limb joint motion gathered from 2D-sagittal plane motion capture. Electromyography (EMG) collected unilaterally on the rectus femoris, biceps femoris, medial gastrocnemius and triceps brachii also. Results 5o slope: hip range of motion (ROM) decreased (p = .003), ankle ROM decreased (p = .005), stride length decreased (p = .004), rating of perceived exertion (RPE) increased (p = .02) for riser compared to no riser. At 16o slope: hip ROM decreased (p = .001), and RPE decreased (p = .004) for riser compared to no riser. HR, glide distance, velocity, EMG, and net mechanical efficiency were not different between riser heights on either slope. Discussion/Conclusion Lower body joint kinematics, step length and RPE varied significantly with riser height. Kinematic differences did not impact velocity or muscle activity when controlling pace. These results agree with previous findings showing minimal differences in EMG and HR while lower body kinematics and RPE changed with riser height.

Inhalation of hydrogen-rich gas before acute exercise alleviates exercise fatigue.

Hydrogen, as an antioxidant, may have the potential to mitigate fatigue and improve selected oxidative stress markers induced by strenuous exercise. This study focused on previously unexplored approach of pre-exercise inhalation of hydrogen-rich gas (HRG). Twenty-four healthy adult men first completed prelaboratories to determine maximum cycling power (Wmax) and maximum cycling time (Tmax). Then they were subjected to ride Tmax at 80% Wmax on cycle ergometers after inhaled HRG or placebo gas (air) for 60-minute in a double-blind, counterbalanced, randomized, and crossover design. The cycling frequency in the fatigue modelling process and the rating of perceived exertion (RPE) at the beginning and end of the ride were recorded. Before gas inhalation and after fatigue modeling, visual analog scale (VAS) for fatigue and counter-movement jump (CMJ) were tested, and blood samples were obtained. The results showed that compared to placebo, HRG inhalation induced significant improvement in VAS, RPE, the cycling frequency in the last 30 seconds, the ability to inhibit hydroxyl radicals, and serum lactate after exercise (p < 0.028), but not in CMJ height and glutathione peroxidase activit. In conclusions, HRG inhalation prior to acute exercise can alleviate exercise-induced fatigue, maintain functional performance, and improve hydroxyl radical and lactate levels.

Effect of Structured Cardio-Respiratory Fitness Protocol on Physical Function and Performance in Geriatric Patients: A Quasi Experimental Study

Background: Exercise interventions have emerged as a promising avenue for mitigating age-related declines, particularly in the context of physiological changes such as sarcopenia and muscle strength loss. A recent study utilizing the International Classification of Functioning, Disability, and Health (ICF) framework underscored declines in physical functioning among older adults. Geriatric individuals commonly undergo cardio-respiratory changes and experience a decrease in physical fitness. This study seeks to compare the effects of a structured cardio-respiratory fitness protocol with a conventional exercise program on physical function and performance in geriatric patients, with a specific focus on the impact of cardio-respiratory fitness on overall physical function. Methods: Employing a quasi-experimental pre-test post-test design spanning six months, two groups of participants aged 50 to 70, encompassing both genders and with a BMI between 20 and 30, was included. The experimental group adhered to the structured cardio-respiratory fitness protocol, while the control group received conventional physiotherapy. Measured parameters included heart rate (HR), respiratory rate (RR), peak expiratory flow rate (PEFR), and Borg scale ratings. Pre and post-treatment data underwent statistical analysis. Results: Both groups demonstrated improvements in HR, RR, PEFR, and Borg scale ratings post-intervention. Notably, the experimental group exhibited significantly greater improvements in these parameters compared to the control group (p &lt; 0.05). Conclusion: The structured cardio-respiratory fitness protocol yielded a significant enhancement in physical function and performance among geriatric patients. Recommendations for future research involve incorporating larger sample sizes, extended intervention durations, and personalized approaches to maximize effectiveness. This study contributes valuable insights into the potential benefits of structured cardio-respiratory fitness interventions for augmenting geriatric physical function and overall quality of life.

The Effects of Anchoring a Fatiguing Forearm Flexion Task to a High vs. Low Rating of Perceived Exertion on Torque and Neuromuscular Responses.

Ortega, DG, Housh, TJ, Smith, RW, Arnett, JE, Neltner, TJ, Schmidt, RJ, and Johnson, GO. The effects of anchoring a fatiguing forearm flexion task to a high versus low rating of perceived exertion on torque and neuromuscular responses. J Strength Cond Res 38(5): e219-e225, 2024-This study examined the torque and neuromuscular responses following sustained, isometric, forearm flexion tasks anchored to 2 ratings of perceived exertion (RPE). Nine men (mean ± SD: age = 21.0 ± 2.4 years; height = 179.5 ± 5.1 cm; body mass = 79.6 ± 11.4 kg) completed maximal voluntary isometric contractions (MVIC) before and after sustained, isometric, forearm flexion tasks to failure anchored to RPE = 2 and RPE = 8. The amplitude (AMP) and mean power frequency (MPF) of the electromyographic (EMG) signal were recorded from the biceps brachii. Normalized torque was divided by normalized EMG AMP to calculate neuromuscular efficiency (NME). A dependent t-test was used to assess the mean difference for time to task failure (TTF). Repeated-measures analysis of variances was used to compare mean differences for MVIC and normalized neuromuscular parameters. There was no significant difference in TTF between RPE = 2 and RPE = 8 (p = 0.713). The MVIC decreased from pretest to posttest at RPE = 2 (p = 0.009) and RPE = 8 (p = 0.003), and posttest MVIC at RPE = 8 was less than that at RPE = 2 (p < 0.001). In addition, NME decreased from pretest to posttest (p = 0.008). There was no change in normalized EMG AMP or EMG MPF (p > 0.05). The current findings indicated that torque responses were intensity specific, but TTF and neuromuscular responses were not. Furthermore, normalized EMG AMP and EMG MPF remained unchanged but NME decreased, likely due to peripheral fatigue and excitation-contraction coupling failure. Thus, this study provides information regarding the neuromuscular responses and mechanisms of fatigue associated with tasks anchored to RPE, which adds to the foundational understanding of the relationship between resistance exercise and the perception of fatigue.

Comparison Between Traditional and Alternated Resistance Exercises on Blood Pressure, Acute Neuromuscular Responses, and Rating of Perceived Exertion in Recreationally Resistance-Trained Men.

Corrêa Neto, VG, Silva, DdN, Palma, A, de Oliveira, F, Vingren, JL, Marchetti, PH, da Silva Novaes, J, and Monteiro, ER. Comparison between traditional and alternated resistance exercises on blood pressure, acute neuromuscular responses, and rating of perceived exertion in recreationally resistance-trained men. J Strength Cond Res 38(5): e211-e218, 2024-The purpose of this study was to compare the acute effects of traditional and alternated resistance exercises on acute neuromuscular responses (maximum repetition performance, fatigue index, and volume load), rating of perceived exertion (RPE), and blood pressure (BP) in resistance-trained men. Fifteen recreationally resistance-trained men (age: 26.40 ± 4.15 years; height: 173 ± 5 cm, and total body mass: 78.12 ± 13.06 kg) were recruited and performed all 3 experimental conditions in a randomized order: (a) control (CON), (b) traditional (TRT), and (c) alternated (ART). Both conditions (TRT and ART) consisted of 5 sets of bilateral bench press, articulated bench press, back squat, and Smith back squat exercises at 80% 1RM until concentric muscular failure. The total number of repetitions performed across sets in the bench press followed a similar pattern for TRT and ART, with significant reductions between sets 3, 4, and 5 compared with set 1 (p < 0.05). There was a significant difference for set 4 between conditions with a lower number of repetitions performed in the TRT. The volume load was significantly higher for ART when compared with TRT. TRT showed significant reductions in BP after 10-, 40-, and 60-minute postexercise and when compared with CON after 40- and 60-minute postexercise. However, the effect size illustrated large reductions in systolic BP during recovery in both methods. Thus, it is concluded that both methods reduced postexercise BP.

ACUTE EFFECT OF INTERVAL TRAINING SET STRUCTURE ON PHYSIOLOGICAL AND PERCEPTUAL RESPONSES TO EXERCISE

INTRODUCTION &amp; AIMS A novel method for prescribing maximal aerobic speed (MAS) interval sessions involves the use of rest redistribution (RR). This approach could reduce perceived exertion and fatigue, preventing a decline in performance. This study aimed to compare acute physiological and perceptual responses between traditional (TS) and RR MAS interval training in endurance athletes. METHODS Twenty-five endurance runners (19 males, 6 females; age=31.9±8.5 y; maximal oxygen consumption (V̇O2max)=54.6±5.7 ml·kg·min-1; height=1.77±0.10 m; body-mass=74.0±13.0 kg) who ran &amp;gt;5 hours/week participated. Participants completed two MAS interval sessions equal in duration (18 min total, 360 s exercise, TS=660 s rest/RR=680 s rest) in a randomised order; TS: 3 sets x 6 repetitions (1 rep=20 s running:20 s rest) at 110% MAS and RR: 18 sets x 1 repetition (20 s running:40 s rest) at 110% MAS. During both sessions V̇O2 and heart rate (HR) were measured after each repetition, and blood lactate (HLa-) measured pre-exercise and after repetitions 6, 12 and 18. Rating of perceived exertion (RPE) was measured after repetitions 6, 12, and 18, and overall session RPE 10 minutes post-session. RESULTS Linear mixed effects models showed that TS led to a faster increase in V̇O2 (β=.16, p=.04) and HLa- (β=.09, p&amp;lt;.01), with consistently higher HR than RR (β=5.35, p&amp;lt;.01). Additionally, RPE (β=1.35, p&amp;lt;.01) and session RPE were lower in RR than TS (β=1.13, p&amp;lt;.01). CONCLUSION Results indicate that when session time is similar, TS (1:1 work-to-rest ratio), produces a greater physiological stimulus with higher V̇O2, HR and HLa-. Conversely, RR (1:2 work-to-rest ratio) resulted in lower perceived exertion and metabolic stress. This makes RR an appropriate choice for training periods with lower physiological stress or during periods of fatigue management. The reduced physiological demands in RR can facilitate a more controlled and sustainable training experience while still providing valuable training benefits.

THE EFFECT OF WATER DOUSING ON HEAT STRAIN AND PERFORMANCE DURING ENDURANCE RUNNING IN THE HEAT

INTRODUCTION Water dousing (pouring water on the body) is an easy-to-implement cooling method while running due to the availability of water at race aid stations, and may decrease the risk of heat illness and improve performance. However, dousing has not been investigated in extended duration running (i.e., ≥10 km), a typical distance in both elite and community level events. AIMS: Assess the effect of water dousing on heat strain and performance during self-paced and fixed-intensity exercise in the heat. DESIGN: Crossover, block randomised controlled trial. METHODS 13 trained runners completed a 10 km time trial (TT) and 60 min fixed pace run (60% velocity of VO2max) in a 30°C, 47% relative humidity environment using either water dousing (DOUSE) or no dousing (CON). RESULTS 10 km TT performance was faster in DOUSE compared to CON (44:11±6:14 vs. 44:38±6:03 min:s; p=0.033). Change in core temperature (Tc) was not different between groups during the TT (+0.02±0.33°C in DOUSE; p=0.853) or fixed pace run (+0.02±0.30°C; p=0.848). Change in mean skin temperature (Tsk) was lower in DOUSE during the TT (-1.80±0.63°C; p&amp;lt;0.001) and fixed pace run (-1.38±0.78°C; p&amp;lt;0.001). Heart rate (HR) was lower for DOUSE during the fixed pace run (-3.5±5.5 bpm; p=0.041) but not during the TT (-0.2±4.2 bpm; p=0.853). Thermal sensation was lower for DOUSE during the TT (-49.3±41.9 mm; p&amp;lt;0.001) and fixed pace run (-44.7±27.6 mm; p&amp;lt;0.001). Rating of perceived exertion (RPE) was not different between groups for the TT (-0.2±0.9; p=0.390) or fixed pace run (-0.2±1.0; p=0.480). CONCLUSION Water dousing improves 10 km TT performance in the heat but does not mitigate a rise in Tc. The positive change in thermal perception (via lower skin temperature) likely drives this ergogenic effect.

EXPLORING THE EFFECTS OF VIGOROUS INTERVAL TRAINING, MODERATE RESISTANCE TRAINING AND PILATES ON ARTERIAL STIFFNESS AND BLOOD PRESSURE DURING PREGNANCY: A RANDOMISED CROSS-OVER TRIAL

INTRODUCTION Regular moderate intensity exercise throughout pregnancy provides significant benefits to both maternal and foetal cardiovascular health outcomes. Current exercise guidelines recommend a combination of moderate intensity aerobic and resistance training (RT). However, there is limited research exploring the cardiovascular effects of higher intensities (vigorous/high) in comparison to common pregnancy exercise modalities such as RT and Pilates (PIL). AIM: To investigate the acute effects of three modes of exercise (resistance, vigorous aerobic intervals and Pilates) during trimester two (T2) and three (T3) of pregnancy on measures of arterial stiffness (pulse wave velocity [PWV]) and blood pressure (BP). METHODS Eleven women with uncomplicated pregnancies (age 32 ± 3 years, pre-pregnancy BMI 23.9 ± 3.5 kg/m2) completed testing in T2 (average 20 ± 1.6 weeks gestation) and T3 (average 29 ± 2.5 weeks gestation). Participants performed one each of vigorous intensity interval training (VIIT) (∼33 min), resistance training (RT) (∼35 min) and Pilates (PIL) (∼35 min) in T2 and T3 in randomised order approximately 1 week apart each trimester. Resting outcome measures of PWV, BP and foetal heart rate (FHR) were obtained following 5 minutes of rest and again immediately and 10 minutes post exercise session. BP, maternal heart rate (MHR), and rating of perceived exertion (RPE) were monitored throughout. RESULTS There was no difference in the acute PWV response to each type of exercise across the trimesters (1 min VIIT: T2 = 5.53 ± 0.85m/s, T3 = 5.26 ± 0.67m/s, 95%CI[-1.36-0.67]; RT: T2 = 5.4 ± 0.80m/s, T3 = 5.48 ± 0.56m/s, 95%CI[-0.88-1.10]; PIL: T2 = 5.44 ± 0.68m/s, T3 = 5.44 ± 0.68m/s, 95%CI[-0.93-1.01]). There was no significant difference in the acute response in SBP to VIIT (T2 = 116 ± 12.1mmHg, T3 = 122 ± 7.2mmHg, 95%CI[-0.42 - 1.65]. SBP was significantly higher in T3 than T2 1 minute following PIL (T2 = 110 ± 5.8mmHg, T3 = 121 ± 11.7mmHg, 95%CI[0.04-2.1]) and 10 minutes following RT (T2 = 105 ± 10.1mmHg, T3 = 116 ± 5.0mmHg, 95%CI[0.27 - 2.46]. CONCLUSION VIIT, RT and PIL appear to elicit similar post-exercise haemodynamic and arterial stiffness responses in both the mother and foetus. As such, VIIT may be a suitable addition to standard moderate intensity and RT prescription during an uncomplicated pregnancy.

THE EFFECTS OF HYBRID FUNCTIONAL ELECTRICAL STIMULATION INTERVAL TRAINING ON AEROBIC FITNESS AND FATIGUE IN PEOPLE WITH ADVANCED MULTIPLE SCLEROSIS

INTRODUCTION &amp; AIMS Improving aerobic fitness in people with multiple sclerosis (MS) can reduce fatigue, and lower the risk of cardiovascular disease. Aerobic training can be challenging due to paresis, access to suitable equipment and fatigue. The aim was to investigate whether functional electrical stimulation (FES) cycling combined with arm crank interval exercise (hybrid FES interval training) is feasible for people with advanced MS, and its effects on aerobic fitness and fatigue. METHODS Hybrid FES interval training was performed 2 d/wk for 12 weeks. Each session consisted of 40 minutes of continuous FES cycling with arm crank intervals of 30 seconds work/30 seconds rest added concurrently for 20 minutes. The intensity target was a minimum of 60% of arm crank power and ‘hard’ measured by rate of perceived exertion (RPE) on a scale of 6-20. Feasibility was measured by attendance, compliance to intensity and time targets, adverse events, and drop outs. Aerobic fitness was assessed by an arm crank maximal test. Fatigue was measured via the Modified Fatigue Impact Scale (MFIS). RESULTS Seven participants (6 female; age 57.1±7.8y; Expanded Disability Status Scale 7.1±0.8) with advanced MS attended 80±10.4% of the scheduled sessions and there were no adverse events or drop outs. Average RPE at the end of each training session was 15±2, representing vigorous intensity exercise. Aerobic fitness did not change pre- to post-intervention [14.2±5.7 to 14.78±6.0 mL/kg/min (p=0.43)]. There was a trend towards a reduction in the MFIS score pre- to post-intervention [31.0±10.4 to 21.7±11.4 (p=0.10)]. CONCLUSION Hybrid FES interval training is feasible for people with advanced MS who need exercise equipment appropriate for their condition, and can represent vigorous intensity exercise. The positive findings support the need for future randomized control trials that can assess the aerobic fitness changes and associated health benefits of hybrid FES interval training.

PRESCRIBING BLOOD FLOW-RESTRICTED CYCLING USING RPE BALANCES THE PHYSIOLOGICAL AND PERCEPTUAL DEMANDS IN HEALTHY ADULTS

INTRODUCTION Aerobic exercise is commonly prescribed using fixed heart rates or power/speed. These methods may not be suitable when incorporating blood flow restriction (BFR), as this technique can influence these measurements. Prescribing exercise via perception of exertion (RPE), which reflects overall psychophysiological stress, may present an alternative to overcome these issues. Aim: Describe physiological and perceptual responses during fixed-power and fixed-RPE cycling performed with blood flow restriction (BFR_{PWR} and BFR_{RPE}) and without (CON_{PWR} and CON_{RPE}). METHODS Following baseline testing, twelve active males cycled for ten minutes under four conditions. CON_{PWR} was performed first, then the remaining conditions in a randomised and counterbalanced order. BFR_{PWR} and CON_{PWR} were performed at the power equivalent to the first ventilatory threshold (161±38W). CON_{RPE} and BFR_{RPE} were prescribed at the RPE reported during CON_{PWR}. Continuous ventilatory and heart rate measurements were recorded as two-minute averages. Subjective RPE, effort, muscular discomfort, and cuff pain were recorded every two minutes. Blood lactate was measured pre-exercise, post-exercise, and two-minutes post-exercise. RESULTS BFR_{PWR} resulted in the greatest physiological and perceptual responses among all conditions. Power output was lower during BFR_{RPE} (119±48W) than CON_{RPE} (139±47W). Oxygen consumption during BFR_{RPE} (20.8±5.1mL·kg-1·min-1) was lower than CON_{PWR} (25.3±6.0mL·kg-1·min-1, p&amp;lt;0.001) and CON_{RPE} (22.3±5.9mL·kg-1·min-1, p=0.007). Heart rate during CON_{PWR} (143±22beats·min-1) was greater than BFR_{RPE} (133±26beats·min-1, p&amp;lt;0.001) and CON_{RPE} (131±25beats·min-1, p&amp;lt;0.001). Muscular discomfort was not different between BFR_{RPE} (2.5±1.3au) and CON_{PWR}(2.3±1.5au), yet both were greater than CON_{RPE} (p&amp;lt;0.001, 1.8±1.5au). Cuff pain was greater during BFR_{PWR} (3.3±1.7au) than BFR_{RPE} (2.2±1.1au, p&amp;lt;0001). Blood lactate was greater during fixed-power (4.9±3.5mmol·L-1) compared to fixed-RPE trials (3.6±2.7mmol·L-1, p&amp;lt;0.001). CONCLUSIONS BFR_{RPE} caused less discomfort and pain than BFR_{PWR} without compromising physiological stress compared to CON_{RPE}. BFR_{RPE} should be considered when high mechanical loads are contraindicated, or discomfort/pain is undesirable. These findings improve our understanding of aerobic BFR exercise prescription to healthy adults.

Case Report: A comprehensive rehabilitation protocol in a post-operative case of ASD closure along with PAPVC

An array of congenital cardiac disorders known as partial anomalous pulmonary venous connections (PAPVC) occur when pulmonary veins, abnormally drain into the right atrium. This can happen directly into the right atrium or via draining into systemic veins. A 10 year old female patient had chief complaints of difficulty in breathing and frequent fever hence she visited rural hospital where 2D echo was done which reviled PAPVC associated with 16 mm ASD (Atrial Septal Defect). She underwent ASD closure along with pulmonary valvotomy as a part of surgical management after which a well-planned cardiac rehabilitation has been ingrained through several breathing methods such as breathing exercises, respiratory muscle strength and home exercise program, helping the patient to carry out her activities of daily living. The Visual Analog Scale (VAS), Respiratory Muscle Strength using MicroRPM device, 6 Minute Walk Distance (MWD), Borg Scale and Fatigue Severity Scale (FSS). In this present instance, carefully thought-out physical therapy rehabilitation has been shown to be successful in enhancing functional capacity, respiratory muscle strength, optimizing functional capacity, and lowering fatigue.

The Relationship Between Self-Efficacy and Functional Capacity Among Discharged Heart Failure Patients in Jordan.

Self-efficacy is an important factor associated with healthy lifestyle changes in heart failure treatment. Functional capacity testing of heart failure patients (HFPs) can stratify prognosis. Reduced functional capacities in HFPs are linked to a poor heart failure prognosis. Limited research has examined the potential relationship between self-efficacy and functional capacity. The aims of this study were to assess self-efficacy level and functional capacity among HFPs after hospitalization, and examine whether there is a relationship between them. A descriptive correlational design was used. A convenience sample of 220 HFPs was recruited from 2 hospitals in Jordan. The Arabic version of Cardiac Self-Efficacy Questionnaire was used to assess self-efficacy, the 6-Minute Walking Test (6-MWT) was used to assess functional capacity, and the Borg rating of perceived exertion scale (Borg Scale) was used to assess exertion during 6-MWT. The sample included 46.8% male (n = 103) and 53.2% female (n = 117). The mean age was 52.66 ± 8.91 years. Most of the HFPs were categorized based on New York Heart Association classification as class I, 35.9% (n = 79), and class II, 41.4% (n = 91). The mean ejection fraction was 41.46 ± 9.44. The global self-efficacy was moderate (32.98 ± 9.92), and the mean score for the 6-MWT was 494.35 ± 143.37. The Borg Scale mean was 10.94 ± 3.34. In addition, there was a positive relationship between self-efficacy and 6-MWT (r = 0.63, n = 220, P = .01). This study provides baseline data for further research on treatment of HFPs, and the development of evidence-based tailored health interventions to maintain and improve self-efficacy and functional capacity among these service users. Moreover, replicated researches can test the study results considering different methodologies, such as using objective functional capacity tool and longer follow-up periods.