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The cardiopulmonary demand of kettlebell snatches Chan, Margaux 2014

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      THE CARDIOPULMONARY DEMAND OF KETTLEBELL SNATCHES  by Margaux Chan B.S., Santa Clara University, 2009  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  MASTER OF SCIENCE in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Kinesiology)  THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver)  December 2014    © Margaux Chan, 2014     ii Abstract  Kettlebell lifting continues to gain popularity as a strength and conditioning training tool and as a sport in and of itself (Girevoy Sport). Although the swing to chest-level and several multi-movement protocols have been analyzed, little research has attempted to quantify the aerobic stimulus of individual kettlebell movements, which would best inform kettlebell-related exercise prescription. The purpose of this study was to quantify the cardiopulmonary demand, assessed by oxygen consumption (V̇O2) and heart rate (HR), of continuous high-intensity kettlebell snatches under conditions that consider Girevoy Sport, and to compare this demand to a more traditional graded rowing exercise test. Ten male participants (age = 28.4 ± 4.6 years, height = 185 ± 7 cm, body mass = 95.1 ± 14.9 kg) completed (1) a graded rowing exercise test to determine maximal oxygen consumption (V̇O2max) and maximal heart rate (HRmax) and (2) a graded kettlebell snatch exercise test with a 16-kg kettlebell to determine peak oxygen consumption (V̇O2peak) and peak heart rate (HRpeak) during this activity. Subjects achieved a V̇O2max of 45.7 ± 6.9 ml·kg-1·min-1 and an HRmax of 177 ± 6.9 beats per minute (bpm). The kettlebell snatch test produced a V̇O2peak of 37.3 ± 5.2 ml·kg-1·min-1 (82.1 ± 7.4% V̇O2max) and a heart rate of 173 ± 8 beats per minute (97.3 ± 4.8% HRmax). These findings suggest that continuous high-intensity kettlebell snatches with 16-kg are likely provide an adequate aerobic stimulus to improve cardiorespiratory fitness in those whose V̇O2max is ≤ 51 ml·kg-1·min-1 and those who are moderately trained and lower, according to recommendations from the American College of Sports Medicine.     iii Preface  Michael Koehle, MD, PhD, A. William Sheel, PhD, and Maria Gallo, PhD, contributed to research design and document preparation.  Sarah Koch, MSc, assisted with editing, data analyses, study development, and equipment troubleshooting.  Martin McInnis, PhD, and Kristin MacLeod, MSc, assisted with editing and the ethics approval process.  Margaux Chan, BS, developed the research design, completed the application for ethics approval, recruited subjects, performed data collection, ran statistical analyses, and generated the original documentation.  No manuscripts resulting from the work presented in this thesis have been published to date.  This study involved human subjects and was granted full board approval from the University of British Columbia Clinical Research Ethics Board (H13-00475).     iv Table of Contents  Abstract .......................................................................................................................................... ii!Preface .......................................................................................................................................... iii!Table of Contents .......................................................................................................................... iv!List of Tables ................................................................................................................................ vii!List of Figures ............................................................................................................................ viii!List of Abbreviations .................................................................................................................... xi!Acknowledgements ...................................................................................................................... xii!Dedication ................................................................................................................................... xiii!Chapter 1: Introduction ................................................................................................................ 1!1.1! Why Investigate the Kettlebell Snatch? .............................................................................. 1!1.2! Strength Gain and Transference ......................................................................................... 2!1.3! Injury Rehabilitation and Provocation ................................................................................ 5!1.4! Metabolic Effects and Aerobic Fitness Improvement ........................................................ 6!1.5! Blood Glucose and Blood Pressure .................................................................................... 8!1.6! Summary and Indications for Further Research ............................................................... 10!Chapter 2: Oxygen Cost and Chronotropic Stimulus of Kettlebell Snatches ........................ 11!2.1! Purpose, Objectives & Hypotheses .................................................................................. 11!2.2! Justification ....................................................................................................................... 12!2.3! Methods ............................................................................................................................ 14!2.3.1! Inclusion and Exclusion Criteria ............................................................................... 15!    v 2.3.2! Recruitment ............................................................................................................... 17!2.3.3! Data Collection .......................................................................................................... 18!2.3.3.1! Kettlebell Snatch Test ......................................................................................... 18!2.3.3.2! Row Ergometer Test ........................................................................................... 21!2.3.4! Procedures ................................................................................................................. 23!2.3.5! Risks of Participation ................................................................................................. 27!2.3.6! Statistical Analysis .................................................................................................... 27!2.4! Results .............................................................................................................................. 28!2.4.1! Oxygen Consumption ................................................................................................ 29!2.4.2! Heart Rate .................................................................................................................. 30!2.4.3! Rating of Perceived Exertion ..................................................................................... 30!2.4.4! Interaction Effects within Study Design .................................................................... 31!2.5! Discussion ......................................................................................................................... 34!Chapter 3: Conclusion ................................................................................................................. 37!3.1! Accepted Hypotheses ....................................................................................................... 37!3.2! Training Applications ....................................................................................................... 37!3.3! Limitations and Indications for Further Research ............................................................ 37!3.4! Future Directions .............................................................................................................. 38!References ..................................................................................................................................... 40!Appendices ................................................................................................................................... 45!Appendix A : Primary Outcome Measures ................................................................................ 45!Appendix B : Individual Raw Data ........................................................................................... 47!B.1! Raw Data ...................................................................................................................... 47!    vi B.2! Raw Data Graphical Representation ............................................................................ 52!B.3! Individual Percentage Outcomes Graphical Data ........................................................ 62!Appendix C : Consent Form ...................................................................................................... 66!Appendix D : Questionnaires .................................................................................................... 73!Appendix E : Session Log ......................................................................................................... 75!     vii List of Tables  Table 1. Study objectives and corresponding hypotheses. ............................................................ 11!Table 2. Inclusion and exclusion criteria. ...................................................................................... 17!Table 3. Row test protocol. ............................................................................................................ 24!Table 4. Kettlebell snatch protocol cadence. ................................................................................. 25!Table 5. Summary of subject anthropomorphic data and skill-related confidence levels. ............ 28!Table 6. Summary statistics of V̇O2max and V̇O2peak values. ....................................................... 29!Table 7. Summary statistics of HRmax and HRpeak values. ........................................................ 30!Table 8. Summary statistics of mixed between-within subjects ANOVA. ................................... 31!Table 9. Summary statistics for t-tests. .......................................................................................... 32!Table 10. ACSM recommended thresholds for improving aerobic fitness. .................................. 35!Table 11. Individual V̇O2 data. ....................................................................................................... 45!Table 12. Individual heart rate data. .............................................................................................. 45!Table 13. RPE for similar V̇O2values between tests. ..................................................................... 46!Table 14. Individual descriptive and anthropometric data. ........................................................... 47!Table 15. Self-reported confidence levels. .................................................................................... 47!Table 16. Individual data from maximal row test 1. ..................................................................... 48!Table 17. Individual data from maximal row test 2. ..................................................................... 49!Table 18. Individual data from maximal kettlebell snatch test 1. .................................................. 50!Table 19. Individual data from maximal kettlebell snatch test 2. .................................................. 51!     viii List of Figures Figure 1. The kettlebell snatch. ....................................................................................................... 2!Figure 2. Kettlebell test set-up. ...................................................................................................... 20!Figure 3. Row test set-up. .............................................................................................................. 20!Figure 4. Estimated session timelines. ........................................................................................... 22!Figure 5. V̇O2 and heart rate values at each stage of snatch testing. .............................................. 33!Figure 6. Regression analysis for 16-kg kettlebell snatches. ......................................................... 33!Figure 7. Subject 1A V̇O2 measurements during Sessions 1 and 2. ............................................... 52!Figure 8. Subject 1A HR measurements during Sessions 1 and 2. ............................................... 52!Figure 9. Subject 1A RPE measurements during Sessions 1 and 2. .............................................. 52!Figure 10. Subject 2B V̇O2 measurements during Sessions 1 and 2. ............................................. 53!Figure 11. Subject 2B HR measurements during Sessions 1 and 2. .............................................. 53!Figure 12. Subject 2B RPE measurements during Sessions 1 and 2. ............................................ 53!Figure 13. Subject 3B V̇O2 measurements during Sessions 1 and 2. ............................................. 54!Figure 14. Subject 3B HR measurements during Sessions 1 and 2. .............................................. 54!Figure 15. Subject 3B RPE measurements during Sessions 1 and 2. ............................................ 54!Figure 16. Subject 5A V̇O2 measurements during Sessions 1 and 2. ............................................. 55!Figure 17. Subject 5A HR measurements during Sessions 1 and 2. ............................................. 55!Figure 18. Subject 5A RPE measurements during Sessions 1 and 2. ............................................ 55!Figure 19. Subject 6A V̇O2 measurements during Sessions 1 and 2. ............................................. 56!Figure 20. Subject 6A HR measurements during Sessions 1 and 2. ............................................. 56!Figure 21. Subject 6A RPE measurements during Sessions 1 and 2. ............................................ 56!    ix Figure 22. Subject 7B V̇O2 measurements during Sessions 1 and 2. ............................................. 57!Figure 23. Subject 7B HR measurements during Sessions 1 and 2. .............................................. 57!Figure 24. Subject 7B RPE measurements during Sessions 1 and 2. ............................................ 57!Figure 25. Subject 8A V̇O2 measurements during Sessions 1 and 2. ............................................. 58!Figure 26. Subject 8A HR measurements during Sessions 1 and 2. ............................................. 58!Figure 27. Subject 8A RPE measurements during Sessions 1 and 2. ............................................ 58!Figure 28. Subject 9B V̇O2 measurements during Sessions 1 and 2. ............................................. 59!Figure 29. Subject 9B HR measurements during Sessions 1 and 2. .............................................. 59!Figure 30. Subject 9B RPE measurements during Sessions 1 and 2. ............................................ 59!Figure 31. Subject 10A V̇O2 measurements during Sessions 1 and 2. ........................................... 60!Figure 32. Subject 10A HR measurements during Sessions 1 and 2. ........................................... 60!Figure 33. Subject 10A RPE measurements during Sessions 1 and 2. .......................................... 60!Figure 34. Subject 11B V̇O2 measurements during Sessions 1 and 2. ........................................... 61!Figure 35. Subject 11B HR measurements during Sessions 1 and 2. ............................................ 61!Figure 36. Subject 11B RPE measurements during Sessions 1 and 2. .......................................... 61!Figure 37. Subject 1A %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ..................... 62!Figure 38. Subject 2B %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ..................... 62!Figure 39. Subject 3B %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ..................... 62!Figure 40. Subject 5A %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ..................... 63!Figure 41. Subject 6A %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ..................... 63!Figure 42. Subject 7B %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ..................... 63!Figure 43. Subject 8A %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ..................... 64!    x Figure 44. Subject 9B %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ..................... 64!Figure 45. Subject 10A %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ................... 64!Figure 46. Subject 11B %V̇O2max and %HRmax outcomes from Sessions 1 and 2. ................... 65!    xi List of Abbreviations The following table lists the abbreviations used in this thesis. Abbreviation Meaning ACSM American College of Sports Medicine BTPS body temperature and ambient pressure, saturated with water vapor FECO2 expiratory O2 fraction, percentage (%) FEO2 expiratory CO2 fraction, percentage (%) HR heart rate, beats per minute (bpm) HRmax maximum heart rate, beats per minute (bpm) HRpeak peak heart rate, beats per minute (bpm) HRR heart rate reserve, difference between resting and maximum HR (bpm) METS metabolic equivalents, 3.5 ml·kg-1·min-1 RER respiratory exchange ratio RM repetition maximum RR respiratory rate, breaths per minute (BPM) STPD standard temperature (0°C) and pressure at sea level, dry UBC University of British Columbia V̇CO2 volume of carbon dioxide production, liters per minute (L·min-1) V̇E minute ventilation, liters per minute (L·min-1) V̇O2 volume of oxygen consumption,       liters per minute (L·min-1) or       milliliters per kilogram per minute (ml·kg-1·min-1) V̇O2max maximum volume of oxygen consumption       liters per minute (L·min-1) or       milliliters per kilogram per minute (ml·kg-1·min-1) V̇O2peak peak volume of oxygen consumption       liters per minute (L·min-1) or       milliliters per kilogram per minute (ml·kg-1·min-1) V̇O2R oxygen consumption reserve, difference between resting and maximum V̇O2       liters per minute (L·min-1) or       milliliters per kilogram per minute (ml·kg-1·min-1)  VT tidal volume, liters (L) W watts          xii Acknowledgements  Infinite thanks is due to my supervisor, Dr. Michael Koehle, for his guidance, as well as to  my committee members, Dr. A. William Sheel and Dr. Maria Gallo, to Sarah Koch, for generously sharing her wealth of knowledge through the entire process, to Dr. Martin MacInnis and Kristin MacLeod, for their advice and example, to Maha Elashi, Sean Nugent, and Eric Carter, for their camaraderie and helpful suggestions, to Dr. Keith Lohse, for his patient statistical consultation, to Helen Luk and Kyla Hicks for their administrative aid, to the British Columbia CrossFit community, whose athletes eagerly volunteered to participate, to Dr. Darlene Chan and Dr. Gregory Chan for their unwavering support, to Carlyle and Mio Machinski, for being my family away from home, and to Rueben Baca, Jeff Martone, and Tom Corrigan for inspiring and supporting my interest in  kettlebells.     xiii Dedication  To my parents, whose (literally) hard heads have been an inspiration and a blessing.    1 Chapter 1: Introduction 1.1 Why Investigate the Kettlebell Snatch? Kettlebell lifting has become increasingly popular in North America both as a strength and conditioning tool and as a sport in and of itself (“Girevoy Sport”). Research addressing the physiological and biomechanical impact of kettlebell lifting has examined various movements alone and in combination protocols, but its focus has been the standard swing to chest-level. Several aspects of this particular movement have been explored, including oxygen cost (Farrar et al., 2010), rate of perceived exertion (Husley et al., 2012), hormonal response (Budnar et al., 2014), muscle activation (McGill & Marshall, 2012), mechanical demand (Lake & Lauder, 2012), and benefit in strength training (Manocchia et al., 2013; Otto et al., 2012). Data from these studies have helped to support the incorporation of the kettlebell swing into mainstream fitness programming. The swing, however, is not exceedingly representative of the breadth of kettlebell lifting, nor is it specifically applicable to Girevoy Sport. This sport consists solely of the Olympic lifts (the kettlebell snatch, clean, and jerk), which have been relatively neglected by the field of exercise science. The object of Girevoy Sport competition is to accumulate as many repetitions as possible within a given timeframe without releasing the weight. Because releasing the weight terminates the lifter’s ability to accumulate repetitions, a common strategy employed during competition is to pause, holding the weight still, in an attempt to recover for further ballistic motion. This element of static exertion is somewhat unique to this sport, and does not seem to have been replicated in previous research protocols.      2  Figure 1. The kettlebell snatch.  Examining the cardiopulmonary demand of the kettlebell snatch (see Figure 1) in a sport-specific setting will provide data to (1) inform program design for active Girevoy Sport athletes who can use heart rate monitoring to achieve target training intensities and (2) validate the incorporation of kettlebell snatch into general aerobic fitness programs. These data will also serve as a launch point from which the understanding of Girevoy Sport can be better developed. This introductory chapter summarizes the existing kettlebell-related research from which this study draws context. It is organized into categories of physiological impact, within which studies are critically compared to each other.  1.2 Strength Gain and Transference A great deal of literature has focused on the strength-building potential of kettlebell lifting protocols, particularly those utilizing the kettlebell swing. One such study found significant improvements in leg press strength (+14.8%), grip strength (+9%), and core strength (+70%) after an 8-week kettlebell training program (Beltz et al., 2013). These strength adaptations are probably mediated by the increased levels of testosterone and immunoreactive growth hormone after kettlebell swing exercise (Budnar et al., 2014). Although the acute hormonal response following kettlebell swings was shorter-lived than the response to heavier     3 lower-body resistance exercise, it was suggested that kettlebell swings could be incorporated into conventional strength and conditioning programs to augment the training stimulus, particularly on days when hormonal response to traditional training is expected to be lower (e.g. when protocols involve lower repetitions with longer rest periods).  Multiple studies have determined that training adaptations to kettlebell lifting transfer to other resistance-based exercises. Manocchia et al. (2013) determined that kettlebell training could benefit other weightlifting and powerlifting activities through transference of strength and power. They found that participation in a 10-week kettlebell training program induced significant improvements in 3-repetition maximum (3RM) clean-and-jerk and 3RM bench press. Based on these results, it was not only suggested that kettlebell training could lead to improved execution of explosive movements, but also that kettlebells are a feasible alternative to traditional weight training (Manocchia et al., 2013). A study by Otto et al. (2012) also supports the transference of kettlebell training to other modalities, showing that a 6-week program with a 16-kg kettlebell significantly increased vertical jump height. These gains, which were equivalent to those achieved with traditional resistance exercises, were credited to the similar movement patterns of simultaneous ankle, knee, and hip extension between vertical jump and kettlebell swing execution. Conversely, Lake & Lauder (2012) concluded that the kettlebell swing might not provide a sufficient stimulus to improve maximal strength in comparison to traditional resistance training (i.e. 80% of 1RM back squat). They did, however, conclude that the kettlebell swing could be useful in developing the ability “to rapidly apply large forces to sports specific resistances” because (though the force itself is lower) the rate at which the force is applied to the lifter’s center of mass is significantly higher in kettlebell swings than in traditional resistance exercises (Lake & Lauder, 2012).     4 While these data were collected from male subjects, a compelling study by Boessneck et al. (2014) sought to characterize the effect of kettlebell mass on peak velocity and total body center of mass impulse in women performing an overhead variation of the kettlebell swing. Although increased kettlebell mass was associated with decreased movement velocity, performing 16-kg overhead kettlebell swings maximized peak power and impulse. These findings lead to the conclusion that females weighing 69.3 ± 9.6kg who are experienced in kettlebell swings should train with 16-kg kettlebells or greater in order maximize strength and power adaptations (Boessneck et al., 2014). It should be noted that 16-kg was the highest weight analyzed in this study, and therefore does not necessarily represent a weight cap in terms of strength generation. While the overhead swing has a similar range of motion to the kettlebell snatch, it may not induce the same muscle activation patterns. This notion is based on the differences in their execution, namely that the overhead swing is not a unilateral movement, nor does it involve holding the kettlebell statically overhead (both of which are characteristics of the snatch).  In comparison to the chest-level swing, kettlebell snatches appear to rely on “a more controlled application of forces,” which may be due to the greater precision necessary to complete the movement (Lake & Lauder, 2014). Both the kettlebell snatch and the chest-level swing appear to have a positive impact on a variety of athletic applications, but training with snatches may be capable of improving trunk and shoulder stability due to the unilateral and overhead elements involved  (Lake & Lauder, 2014). Activation of the semitendinosus muscles is quite significant during the kettlebell swing, and is in fact greater than that of the biceps femoris muscles (Zebis et al., 2013). The mechanical demands of the kettlebell snatch lend it to being particularly useful in exercise programs for the development of posterior chain power, as it     5 involves high percentages of maximal voluntary contraction of several posterior chain muscles. Muscles activated during the kettlebell snatch include the ipsilateral gluteus maximus, internal oblique, rectus femoris muscles, contralateral latissimus dorsi, upper and lower erector spinae, and internal oblique muscles (McGill & Marshall, 2012).   1.3 Injury Rehabilitation and Provocation While the specific muscular recruitment data have been developed for practical application in strength training, they are also applicable to targeted rehabilitation efforts. The rehabilitation benefits of kettlebell training were explored by Jay et al. (2011), who found that an 8-week ballistic kettlebell training program based on the kettlebell swing markedly reduced neck and shoulder pain in participants. Consequently, it has been suggested that kettlebell lifting is one of the best exercise-based treatment options for the management of chronic neck pain (Anderson, 2013). Others have also touted the therapeutic effects of kettlebell exercises on post-injury function (Brumitt et al. 2010; Liebenson 2011). Similarly, kettlebell training has been shown to improve postural reactions to sudden perturbation. This has implications for reducing the incidence of back pain and injury associated with poor motor control of the lumbar spine (Jay et al., 2013). Little has been published on any injury provoking tendencies of kettlebell lifting, one case study has described extensor pollicis brevis tendon damage (i.e. deQuervain’s disease) attributed to kettlebell practice (Kathik et al., 2013), while another has detailed exercise-induced rhabdomyolysis in a patient following first-time participation in a particularly intense kettlebell training session (Calzetta & Bames, 2014).      6 1.4 Metabolic Effects and Aerobic Fitness Improvement Research addressing the cardiopulmonary effects of kettlebell lifting has had varied results, which can be attributed to the wide range of protocols studied. These protocols differ in terms of the movement(s) performed, the amount of weight lifted, the repetition prescription, and the work-to-rest ratio employed. Kettlebell swings have been shown to induce lactate levels that are lower than traditional weightlifting, suggesting that kettlebell lifting is either less anaerobically demanding or perhaps utilizes less muscle mass, and therefore may not induce the same metabolic or cardiopulmonary impact (Budnar et al., 2014). In contrast, there is evidence that kettlebell lifting is capable of challenging the cardiorespiratory system to a greater degree than has been seen in traditional circuit weight training. This was determined after analysis of a protocol consisting of 16-kg chest-level kettlebell swings performed as quickly as possible over a 12-minute period, which was said to impart a metabolic challenge sufficient to increase V̇O2max according to recommendations from the ACSM (see Table 10) (Farrar et al., 2010). This finding was supported by Beltz et al. (2013), who found that 30-45 minutes of kettlebell exercises (including one and two-handed swings, snatches, cleans, presses and Turkish get-ups) performed twice per week for 8 weeks produced significant increases in aerobic capacity (+13.8%) as well as gains in strength. Jay et al. (2011), however, found no change in aerobic fitness after an 8-week kettlebell training program. This is more than likely due to an insufficiently challenging protocol, which was lighter in weight, shorter in duration, and lower in intensity than the protocol used in the studies conducted by Farrar et al. (2010) and Beltz et al. (2013). Thomas et al. (2014) tested a     7 protocol involving 3 sets of 10-minutes of alternating chest-level kettlebell swings and sumo-deadlift high-pulls (a kettlebell movement which also ends at chest-level and requires a hip-hinge pattern similar to the swing), with 3-minutes of rest between sets. They found that the metabolic response to this protocol was similar to that of a moderate-intensity treadmill walking protocol aimed at aerobic fitness improvement. This led to the conclusion that kettlebell lifting may have the potential to effectively maintain and even improve cardiorespiratory fitness (Thomas et al., 2014). In another comparison to graded treadmill walking, Husley et al. (2012) found that the metabolic responses to chest-level kettlebell swings met the ACSM standards for improvement of cardiorespiratory fitness (see Table 10); however, these responses were lower than those elicited by treadmill running at similar rates of perceived exertion. Again, the kettlebell lifting protocol is partly responsible for the discrepancy between exercise modalities: the kettlebell exercise test (swings performed continuously for 35 seconds, followed by 25 seconds of rest for a total of 10-minutes) included forced rest periods while the treadmill test did not. Yet another relationship was drawn to treadmill exercise by Castellano (2009), who found that multiple 5-7 minute cycles of a combination of 9 different kettlebell movements performed at a self-selected pace produced a metabolic effect equivalent to traditional aerobic exercise modalities like walking on an incline, running, cycling, elliptical exercise, or stepping. This lead to the conclusion that kettlebell lifting is a viable form of cross-training for health maintenance and fitness improvement (Castellano, 2009). Conversely, Bishop et al. (2005) reported that the cardiorespiratory response to kettlebell exercise (in this case, 10 repetitions of swings, snatches, and clean-and-presses performed in 5 sets with 4-kg to16-kg) was relatively low, considerably less than traditional weight training at 40% 1RM. The protocol used in this     8 study elicited V̇O2 measures of only 9.7-18.0 ml·kg-1·min-1 (0.65-1.28 L·min-1). In another publication by the same authors (Lanier, et al. 2005), they further concluded that the protocol provided a training stimulus of only 32% V̇O2max (14.25 ±3.08 ml·kg-1·min-1) and therefore fell below the ACSM’s recommendation for improvement of aerobic fitness (see Table 10). Despite the low training stimulus, they stated that kettlebell lifting under this protocol could be an effective way to achieve the Surgeon General’s recommendation for physical activity (i.e. a daily caloric expenditure of 150-200 kcal/day at a 3-6 METS intensity level).  After establishing a V̇O2peak (26.6 ± 5 ml·kg-1·min-1) via kettlebell swings performed at increasing weight to exhaustion, Fung & Shore (2010) found that a “standard” workout consisting of swings, snatches, and clean-and-presses stimulated approximately 90% (23.8 ± 0.9 ml·kg-1·min-1) of kettlebell V̇O2peak. This oxygen cost was equivalent to an average of 6.3 METS, leading the authors to deem the protocol “moderately hard” aerobic work. They determined that the protocol stresses the aerobic system preferentially when the kettlebell weight was kept below 13% body mass, as this resistance corresponded with respiratory quotients of less than 1, indicative of sub-anaerobic threshold work. Porcari et al. (2010) found that kettlebell snatches performed at increasing speed to exhaustion with 4-kg to 16-kg produced a V̇O2peak of 40.3 ± 2.2 ml·kg-1·min-1, which was remarkably higher than the peak value obtained with swings by Fung & Shore (2010). This was approximately 80% of treadmill V̇O2max (49.7 ± 6.6 ml·kg-1·min-1), with heart rate values that were not significantly different.   1.5 Blood Glucose and Blood Pressure Seger et al. (2014) explored the effect of kettlebell exercise (a combination of 7 movements performed in 2 sets, lasting approximately 26 minutes) and high-intensity interval     9 running (performed in 10 intervals at 90% V̇O2max) on blood glucose concentration in healthy, sedentary males. The running protocol lowered blood glucose in the short term (i.e. at the 60 minute post-exercise time point), but not the long term (i.e. at the 120 minute time point). Kettlebell lifting, on the other hand, had an opposite temporal effect: blood glucose was not significantly different in the short term, but was considerably lower at 120 minutes post-exercise. In terms of health maintenance, these longer lasting effects may be more beneficial for blood glucose control. In an investigation of the blood pressure responses to an 8-week kettlebell training program, diastolic blood pressure was increased in post-training session measurements, while mean arterial blood pressure was decreased at the termination of the training program. This was attributed to the intra-thoracic and intra-abdominal pressures generated during the eccentric component of the kettlebell swing, which may have influenced baroreceptor sensitivity (Smith et al., 2011). Kettlebell exercise consisting of two-handed swings was found to cause acute decreases in post-exercise blood pressure in pre-hypertensive and hypertensive males (systolic = 133 ± 7 mmHg, diastolic = 82 ± 6 mmHg). The protocol induced post-exercise systolic measures of < 130 mmHg or diastolic measures of < 80 mmHg in the tested population (Martin et al., 2012). The magnitude of this decrease was deemed clinically significant, as a blood pressure measure < 130/80 mmHg is the target in treatment of patients with diabetes or chronic kidney disease according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (Chobanian et al., 2003).      10 1.6 Summary and Indications for Further Research Overall, kettlebell lifting is capable of stimulating improvements in both muscular strength and aerobic conditioning (Thomas et al., 2014): a conclusion that is echoed by many investigators who suggest that kettlebell lifting is a valuable addition to strength and conditioning programs geared toward increasing aerobic capacity (Budnar et al., 2014). There is even evidence that group kettlebell training improves more psychosocial factors, such as self-perceived changes in overall well-being and job satisfaction (Jay et al., 2013).  A foundation has been laid for building the understanding of kettlebell lifting’s cardiopulmonary impact using general protocols with a wide variety of movements and work-to-rest ratios. The positive results of this body of work have given reason to continue the research of kettlebell lifting but with a more refined scope. Aside from those examining the kettlebell swing, few studies have identified the magnitude of aerobic stimuli provided by specific kettlebell movements (as opposed to generalized multi-movement protocols and training programs). Identifying and understanding those individual movements that are particularly relevant to strength and conditioning and sport training will allow coaches and athletes to craft their training sessions to more effectively and efficiently address their specific goals.     11 Chapter 2: Oxygen Cost and Chronotropic Stimulus of Kettlebell Snatches 2.1  Purpose, Objectives & Hypotheses The purpose of this study was to investigate the cardiopulmonary demand of continuous high-intensity kettlebell snatches performed in a sport-specific manner (i.e. constantly weighted, using standard equipment for a relevant lifting duration) and to quantify it as a percentage of maximal oxygen consumption (%V̇O2max) and heart rate (%HRmax) from a row ergometer exercise test. Objectives for the study and corresponding hypotheses are stated in Table 1. Maximum oxygen consumption (V̇O2max) and maximum heart rate (HRmax) were ascertained from the row ergometer test. As these were considered the baseline for maximum cardiopulmonary capacity, they were denoted with the subscript “max.” There is no evidence that kettlebell lifting is capable of eliciting the same maximum values, so the highest oxygen consumption and heart rate values obtained during the continuous kettlebell snatch protocol were denoted with the subscript “peak.”  Table 1. Study objectives and corresponding hypotheses. Objective Hypothesis 1. To determine the relationship between V̇O2max from a maximal graded exercise test on a row ergometer and V̇O2peak from a sport-specific kettlebell snatch protocol. 1. The peak V̇O2 value obtained during maximal continuous kettlebell snatching will be greater than or equal to 65% of V̇O2max from rowing. 2. To determine a relationship between maximum heart rate (HRmax) from a maximal graded exercise test on a row ergometer and peak heart rate (HRpeak) during a continuous kettlebell snatch protocol. 2. The peak heart rate value (HRpeak) obtained during maximal continuous kettlebell snatching will be greater than or equal to 85% of HRmax from rowing.      12 2.2 Justification The kettlebell snatch differs in several ways from the chest-level swing, but the swing has been made the point of comparison as it is the best-represented kettlebell movement in the literature to date. Perhaps the most important difference in terms of aerobic impact is that the snatch has a larger range of motion (i.e. the weight extends overhead rather than ending its arc of motion at chest-level). This increased weight path may have significant implications for an athlete’s cardiopulmonary training, as supplying blood and oxygen to activated muscles elevated above the heart requires greater cardiovascular work.  Research involving the kettlebell snatch has highlighted aspects of its muscle activation in comparison to the chest-level swing, both of which feature somewhat similar movement patterns and muscle activation-relaxation cycles. The snatch, however, has been shown to require greater muscle activation in almost all areas as compared to the chest-level swing, particularly in the abdominals, which is probably associated with the greater effort needed to generate acceleration of the kettlebell into the overhead position (McGill & Marshall, 2012).  The similarity in muscle activation between chest-level swings and snatches gives basis for the hypothesis that %V̇O2max and %HRmax for kettlebell snatches will be similar to, if not greater than, the values elicited by kettlebell swings at maximal intensity. Chest-level swings were found to average 65% V̇O2max and 87% HRmax when peak values were compared to a treadmill V̇O2max baseline (Farrar et al., 2010). This hypothesis is also supported by Porcari, et al. (2010), who found that snatches produced a stimulus of approximately 80% V̇O2max and 100% HRmax (i.e. heart rates that were not statistically different) compared to a treadmill baseline. These V̇O2 values were greater than previous investigations of V̇O2 during general     13 weightlifting, which have been shown to range from 20-50% (Collins et al., 1991) and 35-55% (Hurley et al., 1983) of treadmill-determined V̇O2max.  The greater range of motion and greater muscle activation required for the snatch is expected to produce greater V̇O2peak values than the swing. Theoretically, the greater muscle involvement of the upper body necessary to extend and support the kettlebell overhead should increase oxygen consumption. There is some evidence that increased involvement of the upper body does not affect cardiorespiratory response when performed simultaneously (Faria & Faria, 1998), but this is only when workloads between the upper and lower body are at an equal relative strength level (which may not be the case for the kettlebell snatch movement).  While two studies have compared kettlebell protocols to kettlebell maximal exercise tests (Fung & Shore, 2010; Porcari et al., 2010), the aerobic impact of kettlebell lifting has been primarily assessed against baseline V̇O2max values ascertained from treadmill tests (Farrar et al., 2010; Castellano, 2009; Husley et al., 2012). It may be more useful (particularly from an application standpoint) to compare kettlebell snatches to another power-endurance modality such as rowing, the upper-body involvement and pacing patterns of which are more similar to kettlebell lifting than conventional cycling or running V̇O2max testing protocols. This is based on evidence suggesting that the assessment of V̇O2max and HRmax are highly dependent on modality (Gordon et al., 2012). A goal of this study was to develop a kettlebell testing protocol that reflected the conditions of Girevoy Sport. Sport-specific parameters that were preserved in this testing protocol were the kettlebell itself (i.e. a hollow competition weight rather than a solid hardstyle weight) and the element of static exertion, in which the lifter remains constantly weighted while     14 performing the test. This element mimics Girevoy Sport, in which lifters may not set the weight down unless they wish to end their set. The static exertion component, which has not been highlighted in any existing kettlebell research, may have significant aerobic implications. Arimoto et al. (2005) demonstrated that V̇O2 under static conditions could reach the same level as dynamic motion involving the same muscle groups. They also showed that ventilation and heart rate can actually exceed values obtained in a dynamic version (Arimoto et al., 2005). Involving this variable in the testing protocol is both novel and sport-applicable. Furthermore, by examining the standard weight of 16-kg, the results of this study can be applied to both the understanding of pacing techniques used in Girevoy Sport competition, as well as in popular functional fitness programs utilizing 16-kg as a standard protocol weight (e.g. CrossFit). These factors differentiate this protocol from that used by Porcari et al., (2010), in which multiple kettlebell weights were used and did not specify that the athlete to remain constantly weighted. Though the pacing prescription used in this protocol was adapted from Porcari et al., (2010), it was extended to 10 minutes in order to mimic the 10 minute time limit of Girevoy Sport events.  2.3 Methods This study employed a within-subject, repeated-measures experimental design. Oxygen consumption (V̇O2) and heart rate were the primary dependent variables, which were subject to the independent variable, exercise modality (i.e. row ergometer or kettlebell snatch).      15 2.3.1 Inclusion and Exclusion Criteria Ten adult males between the ages of 19 – 40 years old were recruited for participation. Only males in this age range were tested to eliminate possible confounding variables related to sex and cardiopulmonary function (or any other factors that may have caused an interaction effect with V̇O2max/peak values), such as the effect of estrogen and progesterone on airway responsiveness (Bayliss & Millhorn, 1992; Haggerty et al., 2003). Subjects were classified as “conditioned” by reporting their general workout type and frequency for the majority of 6 months prior to their participation in the study, which was required to exceed a total of 60 minutes of high-intensity interval training with external loads (e.g. weightlifting) per week. High-intensity interval training was defined as repeated efforts of a short duration at work rates of near-maximal to supramaximal intensity, interspersed with recovery periods (Astorino et al., 2012). The subjects’ training regimen information was obtained through a written questionnaire (see Appendix D) prior to maximal exercise testing. Because efficiency of movement may have been another possible confounder, it was important that subjects were proficient in both kettlebell snatching and use of the rowing ergometer. To assess whether the subjects could perform the kettlebell snatch with “safe and efficient” technique, they were asked via written questionnaire (see Appendix D) if they had a combined lifetime experience of 2 hours or greater with kettlebell lifting. Furthermore, study participants rated their level of confidence performing the movement with the protocol weight (16-kg) on a scale of 1 to 5 (5 being very confident, see Appendix D for the complete questionnaire). Only participants answering with ratings of 3 or higher were considered for participation. Subjects were also required to demonstrate 10 consecutive kettlebell snatches with     16 each arm prior to execution of the protocol. Adequate technique was assessed by the subject’s ability to swing the weight between the legs until some portion of it was visible behind the vertical plane of the knees, achievement of a “full lockout” overhead with shoulder and elbow extension, and to do so without resting the kettlebell on the ground or anywhere on the body. A subjective assessment on the part of the investigator was made to determine if the weight was under control during the demonstration. Control was defined as there being no threat that the weight will leave the hand of the subject unintentionally or exceed the range of motion necessary to meet the criteria of the movement. Similar self-ratings (via written questionnaire) were made for the row ergometer, with a demonstration during the warm-up period prior to execution of the row ergometer test. To control for fitness level, only subjects that were able to complete 8 minutes of the row testing protocol were included. These inclusion criteria were chosen to ensure that the subjects were prepared for the rigors of the testing regimen. Inclusion and exclusion criteria are summarized in Table 2. Controlling for sex, age, level of conditioning and kettlebell skill supports the internal validity of the design. While testing this niche population may have some implications for external validity, the findings will still hold significant relevance in the sport-specific and fitness realm.          17 Table 2. Inclusion and exclusion criteria. Inclusion Criteria Exclusion Criteria Males aged 19-40 years Females and males < 19 and > 40 years Conditioned with high-intensity interval training with external loads (>60 minutes total per week for the majority of the last 6 months) Smokers Completion of at least 8 minutes of the rowing protocol History of respiratory, cardiovascular, neurological or metabolic disease  Kettlebell lifting experience (lifetime total of 2 hours, questionnaire confidence level of 3+) Injuries potentially aggravated by rowing or kettlebell snatching  Rowing ergometer experience (lifetime total of 2 hours, questionnaire confidence level of 3+) Movement patterns preventing safe execution of the testing protocol English reading and speaking Those with little or no weightlifting experience  2.3.2 Recruitment Recruitment was focused on the British Columbia CrossFit community, using posters, online posts, and word-of-mouth advertising. Athletes of this type typically engage in frequent high-intensity interval training and have undergone instruction in the use of the rowing ergometer and in kettlebell lifting (the standard weights of which are typically heavier than the 16-kg for this study protocol). Upon volunteering, subjects were provided (via e-mail) a consent form briefing the risks and requirements of the study (see Appendix C). Testing did not take place unless informed written consent was provided. This study was granted full board approval from the University of British Columbia Clinical Research Ethics Board (H13-00475).      18 2.3.3 Data Collection Data were collected in two laboratory sessions of approximately 2 hours (4 hours total). Both the rowing and the snatch tests were completed during each session, the order of which was randomly assigned in Session 1 and reversed in Session 2.  Estimated session timelines are summarized in Figure 5. The timeline was extended on a case-by-case basis if the participant required additional time for paperwork, set-up, recovery, or general questions.   Session 1:  During the first session, the subject was introduced to the testing site and protocols. Participants reviewed and signed the consent form and completed the Physical Activity Readiness Questionnaire (PAR-Q) and study questionnaire (see Appendix D) to confirm the inclusion and exclusion criteria. Height, weight, resting pulse and blood pressure were recorded. Subjects were then randomly assigned to complete the row or kettlebell snatch test first. Subjects assigned to Group A performed the row test first, while subjects assigned to Group B performed the kettlebell snatch test first.  2.3.3.1 Kettlebell Snatch Test After an adequate kettlebell snatch movement screening demonstrating safe and efficient task execution, the subject was given a 10-minute self-selected warm-up period to prepare for testing and become accustomed to the testing conditions. The subject was then fitted with a heart rate monitor (Polar, Lake Success, NY, USA) and spirometry mask (Hans Rudolf, Shawnee, KS, USA). The heart rate monitor was wireless, and was secured just below mid-sternum with an adjustable elastic strap to the subject’s comfort. The spirometry mask was attached to a Y-shaped     19 one-way non-rebreathing valve (Hans Rudolf, Shawnee, KS, USA) and secured to the face with elastic adjustable head straps to create a seal surrounding the nose and mouth, allowing the subject to breathe freely through both. Tubing extended from the facemask to the top of the head, where it was secured to the elastic head strap before extending to the metabolic cart (ParvoMedics TrueOne, Sandy, UT, USA) (see Figure 2). Directing the tubing over the head ensured freedom of motion of the arms anteriorly and overhead. The subject then executed the kettlebell snatch protocol while breathing through the mask to the metabolic cart. The kettlebell snatch protocol was a graded test, in which the pace of lifting increased each minute to a maximum of 10 minutes (see Table 4). The pace was audibly indicated via increasingly paced tones, starting with 1 rep every 9 seconds and ending with 1 rep every 3 seconds). The subject was allowed to switch hands at will. Testing was terminated when any of the following conditions were met: (1) the subject reached volitional exhaustion, (2) the kettlebell was rested on the ground or the body, (3) the lifting technique deteriorated to the point of questionable control, or (4) the repetition count fell below the pace prescribed for the stage of testing.  After completion of the kettlebell snatch protocol, the mask and heart rate monitor were removed from the subject. Rest was required until the pulse and blood pressure returned to within 10 beats or points of resting values, with a minimum recovery time of 30 minutes, before initiation of the rowing protocol (or vice versa, if the rowing protocol was performed first).      20  Figure 2. Kettlebell test set-up.   Figure 3. Row test set-up.    21 2.3.3.2 Row Ergometer Test The rowing ergometer test (Table 3) provided baseline V̇O2max and HRmax values. The subject was fitted with the heart rate monitor and spirometry mask with a T-shaped, one-way non-rebreathing valve (Hans Rudolf, Shawnee, KS, USA) (see Figure 3). After ≤ 10-minutes of self-paced warm-up time (with a minimum requirement of 1000 meters of simulated rowing), the subject began the row ergometer protocol. The row ergometer protocol is a graded test, in which the power generated must increase by 50 Watts every 1 minute and 30 seconds, beginning at 50 Watts, until volitional exhaustion. Power was determined by the digital display reading on the rowing ergometer (Concept II Model C, Morrisville, VT, USA). The subject was able to manipulate the power generated by increasing the force of each stroke, increasing stroke frequency, or both. Subjects were allowed to choose their own resistance damper setting. Testing was terminated when the subject reached volitional exhaustion, or when the power reading fell below the power prescribed for the stage of testing for five consecutive strokes.!!!When the subject was randomly assigned to perform the row ergometer protocol first, the kettlebell protocol was performed second after at least 30 minutes of recovery time and the return to resting pulse and blood pressure ± 10 beats/points. After completion of the second protocol, the subject was allowed at least 20 minutes of cool down and debriefing time. Prior to departure from the lab, subjects were monitored for their return to resting pulse and blood pressure ± 10 beats/points.  Although the primary purpose of Session 1 was to familiarize the participant with testing procedures, the data collected from this session were used to assess whether a learning effect     22 played a significant role in the subjects’ V̇O2max/peak and whether the order in which the two tests were performed affected the data collected. Rating of perceived exertion was verbally ascertained at each stage of each test.   Session 2:  Session 2 occurred at least 24 hours and no more than 14 days after Session 1, a parameter that was set in an effort to ensure adequate recovery while minimizing potential training effects from other activities. The subject’s weight, height, resting pulse and blood pressure were re-assessed. The protocol then followed in the same manner as Session 1, although subjects performed the tests in the opposite order of their random assignment in Session 1 in an attempt to control for the potential effect of fatigue.  SESSION 1:  Consent, PAR-Q, Questionnaire, Height/Weight/Pulse/Blood Pressure Measurements Movement Screening Warm Up Test 1 Recovery Warm Up Test 2 Debrief                    0 min (Arrival)  20 min 30 min       40 min      50 min  80 min     90 min     100 min 120 min (Departure)  SESSION 2:  Figure 4. Estimated session timelines.      23 Both exercise tests were performed in each session to minimize the necessary time commitment for the subject and thereby reduce inconvenience involved with participation. Evidence exists that, with 1.5 hours of passive recovery between tests, both trained and untrained individuals can perform at least four maximal incremental cycling tests in one day if V̇O2max is the primary outcome measure (Scharhag-Rosenberger et al., 2014). Unfortunately, no evidence for or against less recovery time between tests has been identified. To minimize burden to subjects, an alternating order of testing protocols was instituted across Sessions I and II, with the intent to wash out effects of fatigue due to testing order while maintaining the existence of a “familiarization” day (Session 1) to address learning effects between sessions.    2.3.4 Procedures Testing Area: Subjects executed the kettlebell snatch protocol on 2cm-thick rubber matting, approximately 1 meter by 1 meter in size to mimic Girevoy Sport lifting platforms. The testing area was set up in the Environmental Physiology Laboratory at the University of British Columbia (UBC).   Kettlebell: The lifting protocol was performed using a 16-kg competition kettlebell (Perform Better, Cranston, RI, USA), constructed of a steel shell with an unpainted, sanded handle. This is the same type of kettlebell that is used in Girevoy Sport competition. The chosen weight (16-kg) is a commercially-available, standard weight used in both Girevoy Sport and popular fitness programs.      24 Rowing Ergometer V̇O2max Test: The rowing ergometer test (Table 3) was conducted using a rowing ergometer (Concept II Model C, Morrisville, VT, USA) and a metabolic cart (ParvoMedics TrueOne, Sandy, UT, USA) with a spirometry mask and T-shaped one way non-rebreathing valve (Hans Rudolf, Shawnee, KS, USA) covering the nose and mouth to measure all expired gases. Tubing extended from the left of the mask to the cart, which measured heart rate, V̇CO2, V̇O2, ventilation (V̇E), and respiratory exchange ratio (RER) to assess achievement of V̇O2max and quantify the volume of oxygen consumed at maximum intensity.  Table 3. Row test protocol. Stage Wattage Time 1 50 0:00-1:30 2 100 1:31-3:00 3 150 3:01-4:30 4 200 4:31-6:00 5 250 6:01-7:30 6 300 7:31-9:00 7 350 9:01-10:30 8 400 10:31-12:00 etc.  Snatch Protocol: The snatch protocol was conducted using a 16-kg competition kettlebell and metabolic cart with a spirometry mask and Y-shaped one way non-rebreathing valve (Hans Rudolf, Shawnee, KS, USA) covering the nose and mouth to measure all expired gases, as described for the row protocol. Subjects were required to meet the movement standards for each repetition without dropping the weight and only resting in the overhead lockout position.     25 Repetitions were executed according to a paced cadence (see Table 4), which was given via a metronome-style audio file. Table 4. Kettlebell snatch protocol cadence. Stage Total Reps Pace Time 1 6 1 rep per 9 seconds 0:00-1:00 2 7 1 rep per 8 seconds 1:01-2:00 3 8 1 rep per 7 seconds 2:01-3:00 4 10 1 rep per 6 seconds 3:01-4:00 5 12 1 rep per 5 seconds 4:01-5:00 6 15 1 rep per 4 seconds 5:01-6:00 7 20 1 rep per 3 seconds 6:01-7:00 8 MAX as quickly as possible  7:01-10:00  V̇O2max: V̇O2max was identified by achievement of a plateau in V̇O2 despite increases in exercise intensity. A plateau was defined as a change of less than 2.1 ml·kg-1·min-1 (or 50 mL·min-1) over the last minute of testing (Gordon et al., 2012). If the plateau phenomenon was not identified, secondary criteria included the V̇O2 corresponding with a heart rate within 10 beats of the subject’s age-predicted maximum (the difference between 220 and the subject’s age in years) and/or an RER of greater than 1.10. These secondary criteria were put in place due to the fact that plateau is often difficult to identify, as no specific minimum change in V̇O2 exists to confirm incidence of V̇O2max, particularly for those subjects that are reluctant to maintain peak effort as long as 60 seconds (Astorino et al., 2005).   Heart Rate: Heart rate was measured with a wireless chest strap (Polar, Lake Success, NY, USA) with a receiver on the metabolic cart. Maximum heart rate for data analysis of study     26 results was defined as the maximum heart rate achieved during the V̇O2max row test. Maximum heart rate for the purposes of secondary criteria in the ascertainment of V̇O2max was the difference between 220 and the subject’s age in years.  Blood Pressure: Blood pressure was taken using an automatic cuff (BP-200, BpTRU Medical Devices, Coquitlam, BC, Canada). The average of five measurements taken in succession, separated by 30 seconds, was used to assess recovery. Measures were taken on the left arm before and after execution of each test while the patient was quietly seated with legs uncrossed. These parameters were based on evidence that talking and alterations in posture can artificially raise blood pressure measurements (Peters et al., 1999; Long et al., 1982).   Rating of Perceived Exertion (RPE): RPE was taken verbally during each stage of both tests (i.e. every minute during the kettlebell protocol and every 1:30 during the row protocol). Subjects reported their self-assessed effort level using the CR10 Borg Scale (Borg, 1990).  Intra-Session Recovery: Subjects had a required rest period of at least 30 minutes between exercise tests in the same session. This duration was based on the finding that exercise disturbs  pulmonary gas exchange for at least the 30 minutes following each bout (Caillaud et al., 1996). A secondary assessment of recovery was made through pre- and post-test blood pressure measurements to address cardiovascular recovery to within baseline levels.      27 2.3.5 Risks of Participation The risks and potential discomforts of this study were similar to those associated with any maximal-intensity exercise or weightlifting activity. Participants were accustomed to the demands of high-intensity interval training and weightlifting, so they had a low chance of injury or excessive musculoskeletal or cardiopulmonary-associated discomfort. Some subjects reported that the heart rate monitor, facemask and/or headgear felt unusual or uncomfortable.  Kettlebell snatching has the potential to cause bruising to the forearms or blistering or tearing of the skin on the palmar side of the hand and fingers. Chalk was available to the subject to prevent build up of moisture that may have exacerbated these risks. Subjects were allowed and encouraged to wear protective wrist wraps (as are typically worn during this movement in the sport setting). Participants may have sustained injury if the kettlebell was dropped on the body, but this did not occur during this study. Rowing on the row ergometer also had the potential to cause blistering or tearing of the palmar side of the fingers and hands, but did not occur in this study.  2.3.6 Statistical Analysis Mixed between-within subjects ANOVA (see Table 8) and paired samples t-tests (see Table 9) were used to determine (1) if the snatch V̇O2peak was significantly different than the rowing ergometer V̇O2max, (2) if the snatch HRpeak was significantly different than the rowing ergometer HRmax, (3) if the row and snatch V̇O2 test results collected during Session 1 were significantly different than those collected in Session 2, and (4) if the row and snatch V̇O2 test results were different depending on their performance order (i.e. completed first or second within     28 the session). Analyses (1) and (2) address the hypotheses, whereas (3) and (4) were primarily for validation of the study design and, consequently, the legitimacy of the parameter values. The %HRmax and %V̇O2max achieved during the kettlebell snatch protocol were calculated for each subject (see Tables 11-12 in Appendix A and Figures 37-46 in Appendix B.3). The sample size for this study was n = 10, based on data from studies of the oxygen cost of kettlebell swings (Farrar et al., 2010) and kettlebell snatches (Porcari et al., 2010). Regression analyses were conducted to identify a correlation between V̇O2 and HR for the kettlebell snatch (see Figure 6).  2.4 Results Ten healthy, conditioned males volunteered for the study, including eight CrossFit participants, one recreationally active athlete, and one competitive Girevoy Sport kettlebell lifter. Self-assessed confidence levels for the tested movements were rated as 3 or higher for all subjects. A summary of anthropomorphic data and confidence ratings are shown in Table 5 (for individual data see Table 14, Appendix B.1).  Table 5. Summary of subject anthropomorphic data and skill-related confidence levels. Statistic Age (years) Weight (kg) Height (cm) Confidence Level Row Snatch Minimum 22 73.4 165.1 3 3 Maximum 36 130.8 190.5 5 5 Mean 28.4 95.1 184.8 4.5 4.1 SD 4.6 15.0 7.4 0.8 0.9  As stated in section 2.1, the maximum oxygen consumption and maximum heart rate values from the row ergometer test are denoted with the subscript “max” (i.e. V̇O2max and     29 HRmax). The highest oxygen consumption and heart rate values from the continuous kettlebell snatch protocol are denoted with the subscript “peak” (i.e. V̇O2peak and HRpeak).  2.4.1 Oxygen Consumption All subjects reached V̇O2max during the rowing test according to either primary or secondary criteria outlined in the study procedures. The highest 15-second average V̇O2 from the Session 2 tests were used for data analysis. This study showed that V̇O2max from rowing was 45.7 ± 6.9 ml·kg-1·min-1 and V̇O2peak from snatching was 37.3 ± 5.2 ml·kg-1·min-1. The V̇O2peak of kettlebell snatching was 82.1 ± 7.4% rowing V̇O2max. Session 2 row V̇O2max and snatch V̇O2peak were significantly different (p < 0.05). A summary of V̇O2max and V̇O2peak data are summarized in Table 6 (for individual data see Table 11, Appendix A). Average time to exhaustion for the row test was 10.25 ± 1.05 minutes, while all subjects except one completed a full 10 minutes of snatches as allotted by the protocol.   Table 6. Summary statistics of V̇O2max and V̇O2peak values.  V̇O2max (ml·kg-1·min-1) V̇O2peak (ml·kg-1·min-1) %V̇O2max Statistic Row 1 Row 2 Snatch 1 Snatch 2 Mean 45.7 45.7 37.8 37.3 82.1 Minimum 31.3 31.6 30.6 28.4 66.3 Maximum 54.3 54.0 43.8 45.5 91.4 SD 6.7 6.9 3.8 5.2 7.4 Note: Row 1 = V̇O2max from Session 1 row test, Row 2 = V̇O2max from Session 2 row test, Snatch 1 = V̇O2peak from Session 1 snatch test, Snatch 2 = V̇O2peak from Session 2 snatch test, %V̇O2max = [(Snatch 2) / (Row 2)].      30 2.4.2 Heart Rate Only five subjects reached age-predicted maximum heart rate during the V̇O2max row test. This study showed that HRmax from rowing was 177 ± 6.9 beats per minute (bpm) and HRpeak from snatching was 172 ± 9.9 bpm. Kettlebell snatching was 97.3 ± 4.8% row HRmax. Maximum heart rate from rowing and HRpeak from snatching were not significantly different (p > 0.05).  A summary of HRmax and HRpeak data are summarized in Table 7 (for individual data see Table 12, Appendix A). Heart rate increases during the snatch test are shown with V̇O2 increases in Figure 5 and a regression analysis between %HRmax and %V̇O2max are shown in Figure 6.  Table 7. Summary statistics of HRmax and HRpeak values.  HRmax (bpm) HRpeak (bpm) %HRmax Statistic Row1 Row 2 Snatch 1 Snatch 2 Mean 177 177 174 172 97.3 Minimum 162 168 157 158 85.4 Maximum 190 190 191 187 104 SD 8.9 7.9 10.8 9.9 4.8 Note: All statistics have n = 10 except Row 1 (n = 8) and Snatch 1 (n = 9). Row 1 = HRmax from Session 1 row test, Row 2 = HRmax from Session 2 row test, Snatch 1 = HRpeak from Session 1 snatch test, Snatch 2 = HRpeak from Session 2 snatch test, HRmax = [(Snatch 2) / (Row 2)].  2.4.3 Rating of Perceived Exertion Only 6 of 10 subjects reported reaching a RPE rating of 10 on the CR10 scale during the snatch protocol (mean = 9.2 ± 1.5), whereas 9 of 10 subjects reported reaching a rating of 10 during the row protocol (mean = 9.8 ± 0.6). Relationships for individual subjects of similar V̇O2 and corresponding RPE for both protocols are shown in Figure 13 in Appendix A.       31 2.4.4 Interaction Effects within Study Design There was no significant interaction effect with the order in which the tests were performed (i.e. the group in which subjects were randomly assigned). There were no significant differences between V̇O2 values from the rowing test during Session 1 versus Session 2 (p > 0.05), nor between V̇O2 values from the snatch test during Session 1 versus Session 2 (p > 0.05). These conclusions are based on t-test analyses (see Table 9) and mixed between-within subjects ANOVA (see Table 8).  Table 8. Summary statistics of mixed between-within subjects ANOVA. Variable F Significance Session x Group 0.108 p = .751 Test x Group 0.184 p = .679 Session x Test 0.172 p = .689  Session x Test x Group 0.359 p = .566     32     Table 9. Summary statistics for t-tests. Comparison for Differences Mean SD SEM 95% Confidence Interval t df Significance (2-tailed) Lower Upper Row Session 1 vs. Row Session 2 -.00749 1.37393 .43447 -.99034 .97536 -.017 9 p = .987 Snatch Session 1 vs. Snatch Session 2 .41457 2.68049 .84765 -1.50293 2.33208 .489 9 p = .636 Row Session 1 vs. Snatch Session 1 7.98191 3.92119 1.23999 5.17686 10.78696 6.437 9 p = .000 Row Session 2 vs. Snatch Session 2 8.40397 4.30847 1.36246 5.32188 11.48607 6.168 9 p < .001 Row Session 1 vs. Snatch Session 2 8.39648 4.51175 1.42674 5.16897 11.62399 5.885 9 p < .001 Row Session 2 vs. Snatch Session 1 7.98940 3.61172 1.14213 5.40573 10.57307 6.995 9 p < .001 Row as 1st Test vs. Row as 2nd Test .09687 1.37015 .43328 -.88327 1.07702 .224 9 p = .828 Snatch as 1st Test vs. Snatch as 2nd Test .51272 2.66156 .84166 -1.39125 2.41669 .609 9 p = .557    33 Figure 5. V̇O2 and heart rate values at each stage of snatch testing.   Figure 6. Regression analysis for 16-kg kettlebell snatches.%VO2max(=(1.293(%HRmax)(2(43.74(R²(=(0.69 (SEE(=(4.3%(60(65(70(75(80(85(90(95(80( 85( 90( 95( 100( 105( 110(%VO 2max(%HRmax(0(20(40(60(80(100(120(140(160(180(200(0(5(10(15(20(25(30(35(40(0( 1( 2( 3( 4( 5( 6( 7( 8( 9( 10(Heart(Rate((bpm)(V2 O2((ml4kg714min71)(Time((min)(V<O₂(Heart(Rate(    34 2.5 Discussion The primary outcomes of this study were that 16-kg kettlebell snatches provided a stimulus of (1) 82.1 ± 7.4% V̇O2max and (2) 97.3 ± 4.8% HRmax. V̇O2max from rowing was 45.7 ± 6.9 ml·kg-1·min-1 and V̇O2peak from snatching was 37.3 ± 5.2 ml·kg-1·min-1. The results of this study support existing literature, which reported the oxygen cost of kettlebell snatches (with a mean V̇O2peak of 40.3 ± 2.2 ml·kg-1·min-1) to be approximately 80% of treadmill V̇O2max (49.7 ± 6.6 ml·kg-1·min-1), with heart rate values that were not significantly different (Porcari, et al., 2010). Because the difference between %V̇O2max found in this study and by Porcari et al. (2010) is less than the standard deviations of these values, it is unlikely that they are significantly different from each other. This could mean that the standard weight (16-kg) and element of static exertion featured in this study’s protocol did not play a significant role in affecting aerobic stimulus. It may also suggest that the modality from which V̇O2max is measured does not have a significant effect on the quantification of the snatch’s aerobic stimulus. In relation to other kettlebell protocols tested, the snatch test elicited V̇O2peak averages much higher than values previously reported with protocols consisting of other movements, alone or in combination, with different work-to-rest ratios and repetition schemes (Bishop et al., 2005; Farrar et al., 2010; Fung & Shore, 2010; Lanier et al., 2005). It should be noted that the goal of the protocol used here was to achieve V̇O2peak, not to establish a steady-state V̇O2 (which may have been the goal in several of the aforementioned studies). The difference in stimulus seen in this study compared to others is attributed to the protocol design, which was meant to stimulate and quantify maximum aerobic challenge in order to inform program design, not test a protocol already in use for alleged training benefit.     35 The 82.1 ± 7.4% V̇O2max result suggests that 16-kg kettlebell snatches alone are capable of providing a stimulus that may increase V̇O2max for individuals who are well trained or below well trained, according to ACSM standards (see Table 10). These recommendations are supported by studies that tested effective intensity levels in training programs. It is worth noting that these studies frequently report the necessary thresholds in terms of V̇O2 reserve (V̇O2R, the difference between resting and maximal oxygen consumption) rather than V̇O2max. This may be due to evidence that V̇O2R is directly correlated with heart rate reserve (HRR), potentially allowing for more accurate intensity monitoring during training (Swain & Leutholtz, 2004). In either case, %V̇O2R will most assuredly be less than %V̇O2max in the same individual, which means training at the necessary %V̇O2max will also be training over %V̇O2R. Research of protocol intensity shows that subjects with V̇O2max values below 40 ml·kg-1·min-1 experienced increases in aerobic capacity with training programs set at 28-32% V̇O2R, and subjects with V̇O2max values at an average of 40 ml·kg-1·min-1 experienced intensity-dependent increases when trained at or above 46% V̇O2R (Swain & Franklin, 2002).  In subjects whose average V̇O2max was 58 ml·kg-1·min-1, intensity dependent increases in V̇O2max were seen after training at 50% V̇O2R, 75% V̇O2R, and 95% V̇O2R (Gormley et al., 2008).   Table 10. ACSM recommended thresholds for improving aerobic fitness. Scale Fitness Level Stimulus Required (%V̇O2max) V̇O2max (ml·kg-1·min-1) < 40 ~ 30% 40-51 > 45% Training Status “moderately” 65-80% “well” 95-100% Note: Derived from Garber et al. (2011).      36 With an average oxygen cost of 37.3 ± 5.2 ml·kg-1·min-1, 16-kg kettlebell snatches may not provide adequate stimulus for those athletes whose V̇O2max is above 57 ml·kg-1·min-1 (as the average V̇O2peak will not exceed the 65% threshold necessary for improvements). While HRmax from rowing (177 ± 6.9 bpm) and HRpeak from snatching (172 ± 9.9 bpm) were not significantly different (p > 0.05), there were 4 subjects whose snatch HRpeak actually exceeded their row HRmax in one or both of the testing sessions despite maximum intensity at each activity (see Figures 40, 42, 43, and 45, Appendix B.3). This phenomenon could be due to the postures at which these exercises are performed: rowing being a more supine activity and snatching being a more upright activity. Maximum heart rates during upright exercise commonly surpass those during supine exercise at similar workloads (Poliner et al., 1980). One explanation may be that the horizontal position decreases the effects of gravity, facilitating venous return and increasing stroke volume (DiCarlo et al., 1991; Hauber et al., 1997; Yoshiga & Higuchi, 2002). Consequently, a lower heart rate is necessary to achieve a similar cardiac output. The amount of activated muscle mass may also affect hemodynamics in a similar fashion. This is based on the concept that muscle contraction acts as a pump, facilitating venous return. Should rowing require increased muscle recruitment, the greater pumping power may also lead to decreased heart rates via increased stroke volume (Yoshiga & Higuchi, 2002).  In terms of RPE, the snatch test had a consistently higher RPE than similar V̇O2 values during the rowing test. This is congruent with the findings of Husley et al. (2012) who reported that subjects are likely to have higher V̇O2 values during treadmill exercise than kettlebell swings at the same RPE.      37 Chapter 3: Conclusion 3.1 Accepted Hypotheses Hypothesis 1 is accepted: The peak V̇O2 value obtained during maximal continuous kettlebell  snatching was greater than or equal to 65% of V̇O2max from rowing. Hypothesis 2 is accepted: The peak heart rate value obtained during maximal  continuous kettlebell snatching was greater than or equal to 85% of HRmax from rowing.  3.2 Training Applications These data can be used to better inform program design for a variety of strength and conditioning interests. The regression analysis (see Figure 6) shows the relationship between heart rate and %V̇O2max, which can be used to target pacing during kettlebell snatch exercise. This will guide athletes and coaches toward achieving intensity levels that are likely to support gains in aerobic fitness. Should resources allow, athletes may benefit from performing the kettlebell snatch protocol utilized in this study to assess the relationship between heart rate and V̇O2 on an individual basis.   3.3 Limitations and Indications for Further Research This study involved a specific population of recreationally-active males. To increase the relevance of these results in the field, the protocols should be repeated with both males and females of varying ages and fitness levels, particularly with elite athletes whose baseline V̇O2max is significantly higher than the V̇O2peak values measured with the kettlebell protocol.     38 While this study attempted to reproduce Girevoy Sport conditions as much as possible, it did not enforce the one hand-switch rule that results in substantial grip fatigue for most competitive lifters. To replicate competition conditions even further, enforcing the one hand-switch rule and allowing for self-paced repetitions with a standard repetition total and time cap may better represent varying oxygen demands during competition. Examining a population of expert Girevoy Sport competitors would also provide insight into the training outcomes of dedicated kettlebell lifting.  This study utilized a standard weight, which represented a different percentage of body mass for each subject. Instead of a standard kettlebell weight, resistance could be adjusted to represent a certain percentage of body mass. This may provide a more accurate quantification of oxygen cost of kettlebell snatches, but may not be as applicable in training or sport, due to the fact that kettlebells are typically made, sold, and used in 4-kg increments. Another important limitation of this study is that it does not directly compare the cardiopulmonary demand of kettlebell swings performed in a similar fashion within the same set of subjects. This data, though not particularly relevant to Girevoy Sport, would give stronger context for the utilization of one movement over the other in fitness programming. Any further studies should include the calculation of V̇O2R and HRR, from which potentially more accurate regression analyses could be drawn.  3.4 Future Directions Girevoy Sport, which has played an important role in the development and maintenance of fitness in the former USSR for decades, has recently developed a fervent following in North     39 America and beyond. The features of this sport, particularly its high-repetition Olympic-style lifting and static exertion components, are relatively unexplored in the literature to date. As current data on kettlebell lifting has been supportive of both its combined strength and aerobic benefits, it is worth continuing to pursue on a more specific level. In contrast to the study of broad, multi-movement protocols, developing further understanding of the physiological impact of individual movements will allow for (1) tailored program design emphasizing movements that are capable of inducing a particularly high aerobic stimulus and (2) an appreciation of the potential training effects of kettlebell lifting performed in the fashion for which kettlebells were designed (i.e. for Girevoy Sport). This study supports existing literature that kettlebell lifting is capable of challenging the aerobic system.  The cardiopulmonary demand of 16-kg kettlebell snatches upon the population tested was of a sufficient magnitude to potentially provoke increases in aerobic fitness in the moderately trained and lower. These data serve to increase the validity of program design with kettlebells, as well as highlight Girevoy Sport as an effective method of challenging and improving aerobic fitness.       40 References 1. Andersen LL. 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Heart rate is lower during ergometer rowing than during treadmill running. Eur J Appl Physiol. 2002;87(2):97-100.  54. Zebis MK, Skotte J, Andersen CH, et al. Kettlebell swing targets semitendinosus and supine leg curl targets biceps femoris: an EMG study with rehabilitation implications. Br J Sports Med. 2013;47(18):1192-8.     45 Appendices Appendix A  : Primary Outcome Measures  Table 11. Individual V̇O2 data. Subject Row 1 (ml·kg-1·min-1) Row 2 (ml·kg-1·min-1) Snatch 1 (ml·kg-1·min-1) Snatch 2 (ml·kg-1·min-1) %V̇O2max 1A 48.6 48.7 38.9 41.9 86.0 5A 50.2 49.8 40.1 45.5 91.4 6A 54.3 53.8 39.1 35.7 66.3 8A 43.6 43.6 35.7 33.4 76.6 10A 31.3 31.6 30.6 28.4 90.1 2B 46.8 45.6 37.7 37.2 81.6 3B 44.5 44.0 37.1 34.8 79.1 7B 44.6 47.7 41.2 40.5 84.9 9B 53.0 54.0 43.8 42.6 78.8 11B 40.5 38.6 33.3 33.4 86.5 Minimum 31.3 31.6 30.6 28.4 66.3 Maximum 54.3 54.0 43.8 45.5 91.4 Mean 45.7 45.7 37.8 37.3 82.1 SD 6.7 6.9 3.8 5.2 7.4 Note: Row 1 = V̇O2max from Session 1 row test, Row 2 = V̇O2max from Session 2 row test, Snatch 1 = V̇O2peak from Session 1 snatch test, Snatch 2 = V̇O2peak from Session 2 snatch test, %V̇O2max = [(Snatch 2) / (Row 2)].  Table 12. Individual heart rate data. Subject Row 1 (bpm) Row 2 (bpm) Snatch 1 (bpm) Snatch 2 (bpm) %HRmax 1 X 190 X 187 98.4 5 180 180 178 181 100.6 6 181 185 172 158 85.4 8 189.5 185 191 179 96.8 10 172 168.5 176 167 99.1 2 168 169 167 166 98.2 3 X 171 163 166 97.1 7 183 176 186 183 104 9 162 168 156.5 161.5 96.1 11 179 175.5 176 171 97.4 Minimum 162 168 156.5 158 85.4 Maximum 189.5 190 191 187 104 Mean 176.8 176.8 173.9 172 97.3 SD 8.9 7.9 10.8 9.9 4.8 Note: All statistics have n = 10 except Row 1 (n = 8) and Snatch 1 (n = 9). Row 1 = HRmax from Session 1 row test, Row 2 = HRmax from Session 2 row test, Snatch 1 = HRpeak from Session 1 snatch test, Snatch 2 = HRpeak from Session 2 snatch test, X = no measurement available, %HRmax = [(Snatch 2) / (Row 2)].     46 Table 13. RPE for similar V̇O2values between tests. Subject V̇O2peak (ml·kg-1·min-1) RPE V̇O2peak V̇O2row (ml·kg-1·min-1) RPE V̇O2row RPE V̇O2max 1A 41.9 10 42.5 6-8 10 5A 45.5 9 44.9 6-10 10 6A 35.7 9 35.8 4-5 10 8A 33.4 10 33.9 6-8 10 10A 28.4 5 28.3 3 8 2B 37.2 10 31.7 3-5 10 3B 34.8 10 34.9 4-6 10 7B 40.5 10 41.0 6-8 10 9B 42.6 9 42 5-6 10 11B 33.4 9 33.2 7-9 10 Minimum  5   8 Maximum  10   10 Mean  9.2   9.8 SD  1.5   0.6 Note: RPE data are presented as CR10 values, V̇O2peak = peak oxygen consumption achieved during the kettlebell test, V̇O2row = oxygen consumption value from row test corresponding with V̇O2peak.    47 Appendix B  : Individual Raw Data B.1 Raw Data Table 14. Individual descriptive and anthropometric data. Subject Age (years) Height (cm) Mass (kg) 1A 22 165.1 82.7 2B 28 188.0 91.8 3B 27 190.5 91.8 5A 31 161.4 73.4 6A 26 189.2 217.8 7B 36 190.5 98.5 8A 28 182.9 93.6 9B 22 187 89.2 10A 34 185.4 130.8 11B 30 186.7 100.5 Minimum 22 165.1 73.4 Maximum 36 190.5 130.8 Mean 28.4 184.8 95.1 SD 4.6 7.4 15.0  Table 15. Self-reported confidence levels.  Confidence level Subject Row Snatch 1A 5 5 2B 5 4 3B 5 5 5A 5 5 6A 3 4 7B 5 5 8A 5 3 9B 5 3 10A 4 4 11B 3 3 Scale: 1 2 3 4 5 not confident somewhat confident confident very confident extremely confident    48    Table 16. Individual data from maximal row test 1. Maximal Row Test 1 Subject Time (min) V̇O2 (L·min-1) V̇O2 (ml·kg-1·min-1) METS V̇CO2 (L·min-1) VE (L·min-1) RER RR (BPM) VT (L) FEO2 % FECO2 % HR (bpm) 1A 8.52 4.02 48.6 13.9 4.58 139.1 1.16 52.7 3.20 17.3 4.5 X 2B 8.26 4.30 46.8 13.4 4.83 157.1 1.14 56.3 2.79 17.6 3.9 168 3B 9.26 4.08 44.5 12.7 4.84 156.3 1.20 54.3 3.02 17.6 3.8 X 5A 10.25 3.68 50.2 14.3 4.58 147.5 1.26 56.4 2.93 17.8 4.0 180 6A 12.26 5.38 54.3 15.5 6.43 188.0 1.20 56.0 3.36 17.3 4.3 181 7B 10.51 4.39 44.6 12.7 5.17 179.9 1.18 63.4 2.84 17.8 4.4 183 8A 9.51 4.08 43.6 12.5 4.48 137.1 1.14 58.3 2.70 17.3 4.3 189.5 9B 11.01 4.73 53.0 15.1 5.46 159.9 1.16 51.1 3.41 17.4 4.6 162 10A 8.26 4.09 31.3 8.9 4.35 121.3 1.08 35.0 3.83 16.9 4.4 172 11B 9.51 4.07 40.5 11.6 4.84 171.6 1.21 66.4 2.69 18.1 3.7 179      49    Table 17. Individual data from maximal row test 2. Maximal Row Test 2 Subject Time (min) V̇O2 (L·min-1) V̇O2 (ml·kg-1·min-1) METS V̇CO2 (L·min-1) VE (L·min-1) RER RR (BPM) VT (L) FEO2 % FECO2 % HR (bpm) 1A 9.26 4.01 48.7 13.9 4.68 137.0 1.19 52.6 3.07 17.2 4.5 190 2B 9.75 4.16 45.6 13.0 4.67 154.8 1.14 57.0 3.02 17.6 3.9 169 3B 11.01 4.05 44.0 12.6 5.10 167.2 1.26 58.5 3.05 17.8 3.9 171 5A 9.75 3.65 49.8 14.2 4.24 147.4 1.18 57.7 2.95 17.8 3.7 180 6A 12.00 5.37 53.8 15.4 6.66 194.4 1.25 57.4 3.42 17.4 4.3 185 7B 10.76 4.73 47.7 13.6 5.35 184.9 1.16 62.5 3.07 17.8 3.8 176 8A 9.51 4.08 43.6 12.6 4.50 138.0 1.14 58.7 2.61 17.2 4.3 185 9B 12.02 4.83 54.0 15.4 5.47 160.6 1.16 48.9 3.72 17.4 4.6 168 10A 9.26 4.15 31.6 9.0 4.55 132.3 1.13 41.0 3.28 17.2 4.5 168.5 11B 9.01 3.88 38.6 11.0 4.71 166.6 1.24 66.2 2.55 18.1 3.6 175.5      50    Table 18. Individual data from maximal kettlebell snatch test 1. Maximal Kettlebell Snatch Test 1 Subject Time (min) V̇O2 (L·min-1) V̇O2 (ml·kg-1·min-1) METS V̇CO2 (L·min-1) VE (L·min-1) RER RR (BPM) VT (L) FEO2 % FECO2 % HR (bpm) 1A 7.51 3.22 38.9 11.2 3.13 107.7 0.97 54.7 1.97 17.3 3.7 X 2B 9.51 3.46 37.7 10.8 4.00 151.9 1.18 59.1 3.07 18.2 3.4 167 3B 9.76 3.40 37.1 10.6 3.56 116.9 1.09 53.9 2.86 17.5 3.8 163 5A 6.75 2.95 40.1 11.5 2.97 117.2 1.01 50.9 2.34 18.0 3.2 178 6A 10.00 3.87 39.1 11.2 3.83 120.9 1.00 57.0 2.25 17.1 4.0 172 7B 10.00 4.06 41.2 11.8 4.61 161.1 1.17 58.2 2.87 17.9 3.5 186 8A 10.00 3.34 35.7 10.2 3.57 119.8 1.09 51.6 2.39 17.6 3.6 191 9B 10.00 3.90 43.7 12.5 4.00 122.4 1.07 46.2 2.92 17.2 3.9 156.5 10A 10.00 4.01 30.6 8.8 4.58 151.7 1.14 60.2 2.64 17.6 3.7 176 11B 9.25 3.34 33.3 9.5 3.87 141.4 1.16 62.5 2.31 18.0 3.54 176      51    Table 19. Individual data from maximal kettlebell snatch test 2. Maximal Kettlebell Snatch Test 2 Subject Time (min) V̇O2 (L·min-1) V̇O2 (ml·kg-1·min-1) METS V̇CO2 (L·min-1) VE (L·min-1) RER RR (BPM) VT (L) FEO2 % FECO2 % HR (bpm) 1A 10.00 3.45 41.9 12.0 3.70 117.5 1.08 60.4 2.32 17.4 3.8 187 2B 10.00 3.40 37.2 10.6 3.81 162.9 1.12 73.4 2.63 18.3 2.9 166 3B 10.00 3.20 34.8 9.9 3.47 131.2 1.10 64.5 2.21 17.9 3.3 166 5A 9.52 3.34 45.5 13.0 3.92 145.6 1.19 57.2 2.58 18.1 3.3 181 6A 10.00 3.52 35.7 10.1 3.65 114.7 1.05 56.5 2.43 17.3 3.8 158 7B 10.00 4.02 40.5 11.6 4.50 163.0 1.14 61.0 2.69 17.9 3.4 183 8A 10.00 3.13 33.4 9.5 3.28 98.6 1.09 47.1 2.38 17.2 4.0 179 9B 10.00 3.67 41.1 11.7 3.72 131.5 1.08 56.3 3.34 17.7 3.4 161.5 10A 10.00 3.74 28.4 8.1 4.03 134.1 1.11 59.8 3.22 17.6 3.6 167 11B 10.00 3.36 33.4 9.5 3.76 140.5 1.14 64.0 2.79 18.0 3.3 171    52 B.2 Raw Data Graphical Representation  Figure 7. Subject 1A V̇O2 measurements during Sessions 1 and 2.   Figure 8. Subject 1A HR measurements during Sessions 1 and 2.  Figure 9. Subject 1A RPE measurements during Sessions 1 and 2. Subject 1A: Session 1 VO2 Subject 1A: Session 2 VO2 Subject 1A: Session 1 HR Subject 1A: Session 2 HR     53   Figure 10. Subject 2B V̇O2 measurements during Sessions 1 and 2.  Figure 11. Subject 2B HR measurements during Sessions 1 and 2.  Figure 12. Subject 2B RPE measurements during Sessions 1 and 2.     54   Figure 13. Subject 3B V̇O2 measurements during Sessions 1 and 2.  Figure 14. Subject 3B HR measurements during Sessions 1 and 2.  Figure 15. Subject 3B RPE measurements during Sessions 1 and 2.     55   Figure 16. Subject 5A V̇O2 measurements during Sessions 1 and 2.  Figure 17. Subject 5A HR measurements during Sessions 1 and 2.  Figure 18. Subject 5A RPE measurements during Sessions 1 and 2.     56   Figure 19. Subject 6A V̇O2 measurements during Sessions 1 and 2.  Figure 20. Subject 6A HR measurements during Sessions 1 and 2.  Figure 21. Subject 6A RPE measurements during Sessions 1 and 2.     57   Figure 22. Subject 7B V̇O2 measurements during Sessions 1 and 2.  Figure 23. Subject 7B HR measurements during Sessions 1 and 2.   Figure 24. Subject 7B RPE measurements during Sessions 1 and 2.     58   Figure 25. Subject 8A V̇O2 measurements during Sessions 1 and 2.  Figure 26. Subject 8A HR measurements during Sessions 1 and 2.  Figure 27. Subject 8A RPE measurements during Sessions 1 and 2.     59   Figure 28. Subject 9B V̇O2 measurements during Sessions 1 and 2.  Figure 29. Subject 9B HR measurements during Sessions 1 and 2.  Figure 30. Subject 9B RPE measurements during Sessions 1 and 2.     60   Figure 31. Subject 10A V̇O2 measurements during Sessions 1 and 2.  Figure 32. Subject 10A HR measurements during Sessions 1 and 2.  Figure 33. Subject 10A RPE measurements during Sessions 1 and 2.     61   Figure 34. Subject 11B V̇O2 measurements during Sessions 1 and 2.  Figure 35. Subject 11B HR measurements during Sessions 1 and 2.  Figure 36. Subject 11B RPE measurements during Sessions 1 and 2.     62 B.3 Individual Percentage Outcomes Graphical Data   Figure 37. Subject 1A %V̇O2max and %HRmax outcomes from Sessions 1 and 2.  Figure 38. Subject 2B %V̇O2max and %HRmax outcomes from Sessions 1 and 2.  Figure 39. Subject 3B %V̇O2max and %HRmax outcomes from Sessions 1 and 2.  Subject 1A: %VO2max Subject 1A: %HRmax     63  Figure 40. Subject 5A %V̇O2max and %HRmax outcomes from Sessions 1 and 2.  Figure 41. Subject 6A %V̇O2max and %HRmax outcomes from Sessions 1 and 2.  Figure 42. Subject 7B %V̇O2max and %HRmax outcomes from Sessions 1 and 2.     64  Figure 43. Subject 8A %V̇O2max and %HRmax outcomes from Sessions 1 and 2.  Figure 44. Subject 9B %V̇O2max and %HRmax outcomes from Sessions 1 and 2.  Figure 45. Subject 10A %V̇O2max and %HRmax outcomes from Sessions 1 and 2.     65  Figure 46. Subject 11B %V̇O2max and %HRmax outcomes from Sessions 1 and 2.               66 UNIVERSITY OF BRITISH COLUMBIA   School of Kinesiology           Environmental Physiology Laboratory    Rm. 3031, Biological Sciences    6270 University Blvd.    Vancouver, BC, Canada V6T 1Z4 !Description: Cardiopulmonary Demand of Kettlebell Snatches - Consent Version: 3.0 (13 June 2014)  !Page 1 of 7  SUBJECT INFORMATION AND CONSENT FORM  Research Study: the Cardiopulmonary Demand of Kettlebell Snatches  Principal Investigator:   Michael Koehle, MD, PhD       School of Kinesiology       University of British Columbia       210 – 6081 University Boulevard       Vancouver, BC Canada V6T 1Z4       michael.koehle@ubc.ca       604-822-9331 Co-Investigator  & Contact Person:   Margaux Chan       ubc.kbstudy@gmail.com       604-446-1926  Emergencies:     Dr. Michael Koehle (24 hours/day, 7 days/week)  778-558-0697   Introduction  Thank you for your interest in this study! You are being invited to take part in this research because you are a 19-40 year old male who is conditioned with high-intensity interval training, and are comfortable rowing on a row ergometer and performing kettlebell snatches.  Your participation is completely voluntary, so you are free to decide whether or not you would like to take part in this study. If you decide to participate but change your mind later, you can withdraw from the study at any time without penalty of any kind. Before you decide whether or not to participate, it is important that you understand what the research involves. This consent form will tell you about the study, why the research is being done, what will happen during the study, and the possible benefits, risks and discomforts involved in participation.  If you wish to participate, you will be asked to sign the bottom of this form before testing. Please take time to read the following information carefully and to discuss it with your family, friends, and doctor before you decide. Any questions you have about the following material are welcome to the Contact Person (see above).  Research Team  The study is being conducted by researchers at the University of British Columbia. These investigators are not receiving payment or compensation from any party for doing this research. The investigators will work to serve the best interests of the subject (you). There are no conflicts of interest between the investigators and any organization.     Appendix C  : Consent Form                           67 UNIVERSITY OF BRITISH COLUMBIA   School of Kinesiology           Environmental Physiology Laboratory    Rm. 3031, Biological Sciences    6270 University Blvd.    Vancouver, BC, Canada V6T 1Z4 !Description: Cardiopulmonary Demand of Kettlebell Snatches - Consent Version: 3.0 (13 June 2014)  !Page 2 of 7  Background  Aerobic fitness can be determined by measuring how much oxygen the body uses (VO2) during maximal-intensity exercise. Because VO2 is a measure of the body’s ability to process oxygen for muscle exertion, it varies depending on the type of exercise (due to different muscular and mechanical demands). The body’s maximum aerobic capacity (VO2max) can be reached while performing highly aerobic exercise, such as cycling, running, or rowing.  Kettlebell snatching is also an aerobic exercise, but very little research has been done to measure how much aerobic stress it puts on the body. As kettlebell lifting becomes more popular, it would be useful for athletes and coaches to have this information to help in designing programs for conditioning and sport-specific training.  Purpose  The goal of this study is to find out how much aerobic stress kettlebell snatches put on the body by measuring your oxygen use (VO2) while you perform them at a maximum effort. The highest VO2 you achieve during continuous kettlebell snatches will be compared to the VO2max you reach while rowing on the row ergometer.  Participants Who can participate?  In order to be eligible for participation in this study, you must be an English-speaking and reading male between the ages of 19-40 years old. To make sure you are prepared for the testing procedures, there are a few important requirements:  You must be accustomed to high-intensity interval training with external loads (such as weightlifting). This means your normal workouts include repeated short bursts of maximum effort exercise followed by short periods of rest, totaling at least 60 minutes per week (e.g. 20 minutes a day, 3 times per week) for the majority of the past 6 months.   You must also be confident and comfortable rowing on the rowing ergometer and performing continuous, unbroken kettlebell snatches.  Participants in this study should have at least 2 hours of total lifetime experience with kettlebell lifting, and at least 2 hours total lifetime experience with rowing on the row ergometer.  Who should NOT participate?  - Smokers  - Females  - Those with a history of respiratory, cardiovascular, neurological or metabolic problems    (this includes diabetes, but excludes controlled asthma and non-threatening     abnormal heart rhythms)  - Those with injuries or movement patterns preventing safe execution of the tests  - Those who are not accustomed to high-intensity interval training  - Those with little or no weightlifting experience  - Those with little or no row ergometer experience                             68 UNIVERSITY OF BRITISH COLUMBIA   School of Kinesiology           Environmental Physiology Laboratory    Rm. 3031, Biological Sciences    6270 University Blvd.    Vancouver, BC, Canada V6T 1Z4 !Description: Cardiopulmonary Demand of Kettlebell Snatches - Consent Version: 3.0 (13 June 2014)  !Page 3 of 7  Study Procedures  Participation in this study requires two (2) laboratory visits that last approximately 2 hours each (4 hours total). At the first visit, you will be introduced to the testing facility and familiarized with the testing equipment and protocols. On the second visit, you will perform 2 graded maximal exercise tests. You are welcome to wear any supportive garments, like wrist wraps, knee sleeves or belts during testing.  Visit 1  If you volunteer, you will be scheduled for your first session in the Biological Sciences Building (Room 3031) at the University of British Columbia’s Vancouver campus. You will be asked to review and sign this consent form, as well as a Physical Activity Readiness Questionnaire (PAR-Q) and a study-specific questionnaire. You are welcome to ask questions at any point during the session. Upon the completion of these forms, you will be given an identification number (in an effort to protect your privacy, your identification number will be used to link you to your test results without the use of your name). Your height, weight, pulse and blood pressure will be recorded. You will be given a tour of the testing area and introduced to the equipment and the testing protocols. You will practice the exercise protocols during this visit so that you are ready on testing day (Visit 2).  Visit 2  On your second visit, you will be asked to review the consent, PAR-Q, and study-specific questionnaire to allow you to make any changes or updates. Your height, weight, pulse and blood pressure will be re-measured. Before beginning the first test, you will demonstrate that you can safely and comfortably perform 10 unbroken 16kg-kettlebell snatches with each arm, without setting the kettlebell on the ground. Once the skills demonstration is complete, you will be fitted with a chest-strap heart rate monitor and facemask. The facemask is secured to your head with soft adjustable straps. Tubing will connect the facemask to a metabolic cart, which will measure the gases you breathe in and breathe out.  You will be randomly assigned to either perform the kettlebell snatch test or the rowing test first. If you are assigned to perform the rowing test first, you will have 10 minutes to warm up and get used to rowing with the monitoring equipment on. You will then perform a graded VO2max test to volitional exhaustion (meaning you dictate when the test is over) on a row ergometer. This test lasts less than 10 minutes.  When the test is over, all the monitoring equipment will be taken off and you will have a chance to rest and recover for 30 minutes.  After 30 minutes and your pulse and blood pressure return to normal, the monitoring equipment will be put back on and you will be given 10 minutes to warm up with the kettlebell (16kg). You will then perform the kettlebell snatch protocol (see below) to volitional exhaustion. This test will be no longer than 10 minutes.  If you were assigned to perform the kettlebell snatch test first, you will perform the rowing ergometer test second. After testing, you will have time to cool down before you leave.                            69 UNIVERSITY OF BRITISH COLUMBIA   School of Kinesiology           Environmental Physiology Laboratory    Rm. 3031, Biological Sciences    6270 University Blvd.    Vancouver, BC, Canada V6T 1Z4 !Description: Cardiopulmonary Demand of Kettlebell Snatches - Consent Version: 3.0 (13 June 2014)  !Page 4 of 7  Summary of Procedures Row VO2max Test Protocol: The test will be continuous and graded beginning at 50 Watts, with resistance increasing by 50 Watts every 1 minute and 30 seconds, until volitional exhaustion or 15 minutes have elapsed. You will be responsible for achieving and maintaining the prescribed power in each stage of the test by altering your stroke rate or force. If the power falls below the required value for 5 consecutive strokes, the test will be terminated.   Snatch Protocol:  The snatch protocol will be conducted using a 16kg competition kettlebell. You must meet the movement standards for each repetition, which include extension of the kettlebell between the legs and behind the knees, lockout of the weight overhead with full extension of the loaded elbow, knees and hips, and “control” of the weight at all times. During the test, you must lift according to a paced cadence, which will be given via audible instruction: 1st minute:  6 reps   (1 rep per 9 seconds) 2nd minute:  7 reps   (1 rep per 8 seconds) 3rd minute:  8 reps   (1 rep per 7 seconds) 4th minute:  10 reps  (1 rep per 6 seconds) 5th minute:  12 reps  (1 rep per 5 seconds) 6th minute:  15 reps  (1 rep per 4 seconds) 7th minute:  20 reps  (1 rep per 3 seconds) 8th – 10th minutes:  Perform as many repetitions as possible until volitional fatigue (at least 20 reps per minute) You may perform hand-switches whenever necessary, but must maintain the prescribed pace at each stage of testing. Testing will be terminated when you set the kettlebell on the ground, you are too tired to keep going, your lifting technique becomes unsafe, or the rep count falls below the pace prescribed for the stage of testing.  Your Responsibilities You should refrain from eating a large meal before visiting the laboratory.   Risks and Side Effects  The harms and potential discomforts of participation in this study are similar to those associated with any maximal-intensity exercise or weightlifting activity. VO2max testing may induce dizziness, lightheadedness, headache, nausea, vomiting, or fainting. These symptoms are usually mild and resolve shortly after completion of the test. Kettlebell lifting and rowing may cause delayed onset muscle soreness, blistering or tearing of the palms and fingers, or forearm bruising. Chalk will be provided to you to help prevent these risks. You are welcome to wear any protective or supportive garments during testing (like wrist wraps or belts). Improper lifting technique may lead to injury, particularly if the weight is dropped on the body. The facemask, headgear, and heart rate monitor may feel a bit unusual or uncomfortable, but they should not cause you any pain. Please inform the investigators if you feel uncomfortable performing any of the tasks required by the study.                             70 UNIVERSITY OF BRITISH COLUMBIA   School of Kinesiology           Environmental Physiology Laboratory    Rm. 3031, Biological Sciences    6270 University Blvd.    Vancouver, BC, Canada V6T 1Z4 !Description: Cardiopulmonary Demand of Kettlebell Snatches - Consent Version: 3.0 (13 June 2014)  !Page 5 of 7  Your vital signs will be monitored during the testing session to ensure safe exercise conditions. Should an emergency situation occur, the supervising physician or paramedics will be summoned immediately. If deemed necessary, CPR and AED will be administered to you by the certified investigator present at your testing session and you will be transported to UBC Hospital Urgent Care Center (approximately 250 meters from the testing site).  Early Termination of the Study Something goes wrong  By signing this form, you do not give up any of your legal rights and you do not release the study doctor, participating institutions, or anyone else from their legal and professional duties. You will not be charged for any research procedures. If you become ill or physically injured as a result of participation in this study, medical treatment will be provided at no additional cost to you. The costs of your medical treatment will be paid by your provincial medical plan. Being asked to leave  If you are not able to follow the requirements of the study or for any other reason, the investigators may withdraw you from the study. The investigators might consider it to be in your best interest to withdraw you from the study without your consent if they judge that it would be better for your health.  Withdrawing consent  You may withdraw from this study at any time without giving reasons. If you choose to enter the study and then decide to withdraw at a later time, all data collected about you during your enrollment in the study will be retained for analysis, but may be removed from the results of the study. It is a legal requirement that these data cannot be destroyed.  Confidentiality  Your confidentiality will be respected. However, research records and health or other source records identifying you may be inspected in the presence of the Investigator or his or her designate by representatives of Clinical Research Ethics Board for the purpose of monitoring the research. No information or records that disclose your identity will be published without your consent, nor will any information or records that disclose your identity be removed or released without your consent unless required by law.   You will be assigned a unique study number as a subject in this study. This number will not include any personal information that could identify you (e.g., it will not include your Personal Health Number, SIN, or your initials, etc.). Only this number will be used on any research-related information collected about you during the course of this study, so that your identity (i.e. your name or any other information that could identify you) as a subject in this study will be kept confidential. Information that contains your identity will remain only with the Principal Investigator and/or his designate. This list that matches your name to the unique study number that is used on you research-related information will not be removed or released without your consent unless required by law.  Your rights to privacy are legally protected by federal and provincial laws that require safeguards to insure that your privacy is respected. Further details about these laws are available on request to your study doctor.                            71 UNIVERSITY OF BRITISH COLUMBIA   School of Kinesiology           Environmental Physiology Laboratory    Rm. 3031, Biological Sciences    6270 University Blvd.    Vancouver, BC, Canada V6T 1Z4 !Description: Cardiopulmonary Demand of Kettlebell Snatches - Consent Version: 3.0 (13 June 2014)  !Page 6 of 7  Discussing Your Results Your questions are welcome at any time during the study. Investigators will discuss the results of testing with you upon your request. Please direct any questions (before, during, or after study participation) to Margaux Chan at 604-446-1926 or ubc.kbstudy@gmail.com or to Dr. Michael Koehle at 604-822-9331.  Concerns About Your Rights  If you have any concerns or complaints about your rights as a research subject and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the University of British Columbia Office of Research Services by e-mail at RSIL@ors.ubc.ca or by phone at 604-822-8598 (Toll Free: 1-877-822-8598).                             72 UNIVERSITY OF BRITISH COLUMBIA   School of Kinesiology           Environmental Physiology Laboratory    Rm. 3031, Biological Sciences    6270 University Blvd.    Vancouver, BC, Canada V6T 1Z4 !Description: Cardiopulmonary Demand of Kettlebell Snatches - Consent Version: 3.0 (13 June 2014)  !Page 7 of 7 SUBJECT CONSENT TO PARTICIPATE Research Study: the Cardiopulmonary Demand of Kettlebell Snatches    By signing the form you indicate that you have read and understood the information regarding this study. My signature on this consent form means:  • I heave read and understood the subject information and consent form. • I have had the opportunity to ask questions and have had satisfactory responses to my questions. • I have had sufficient time to consider the information provided and to ask for advice if necessary. • I understand that all of the information collected will be kept confidential and that the results will only be used for scientific objectives. • I understand that my participation in this study is voluntary and that I am completely free to refuse to participate or to withdraw from this study at any time without any consequence. • I understand that I am not waiving any of my legal rights as a result of signing this consent form. • I understand that there is no guarantee that this study will provide any benefits to me. • I have been told that I will receive a signed copy of this consent form for my own records.  I consent to participate in this study.  ________________________________ __________________________ ____________ Subject’s Signature    Printed Name     Date  ________________________________ __________________________ ____________ Signature of Person Obtaining Consent Printed Name     Date  ________________________________ __________________________ ____________ Investigator Signature    Printed Name     Date        Emergencies:    Dr. Michael Koehle (24 hours/day, 7 days/week)  778-558-0697 Principal Investigator: Michael Koehle michael.koehle@ubc.ca 604-822-9331 Co-Investigator: Margaux Chan ubc.kbstudy@gmail.com 604-446-1926                            73 No changes permitted. You are encouraged to photocopy the PAR-Q but only if you use the entire form.1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?2. Do you feel pain in your chest when you do physical activity?3. In the past month, have you had chest pain when you were not doing physical activity?4. Do you lose your balance because of dizziness or do you ever lose consciousness?5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart con-dition? 7. Do you know of any other reason why you should not do physical activity?PLEASE NOTE:  If  your health changes so that you then answer YES to any of  the above questions, tell your fitness or health professional.   Ask whether you should change your physical activity plan.Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day.  Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.If  you are planning to become much more physically active than you are now, start by answering the seven questions in the box below.  If  you are between the ages of  15 and 69, the PAR-Q will tell you if  you should check with your doctor before you start.  If  you are over 69 years of  age, and you are not used to being very active, check with your doctor.Common sense is your best guide when you answer these questions.  Please read the questions carefully and answer each one honestly:  check YES or NO.Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal.  Tell your doctor about the PAR-Q and which questions you answered YES.‡ <RXPD\EHDEOHWRGRDQ\DFWLYLW\\RXZDQW³DVORQJDV\RXVWDUWVORZO\DQGEXLOGXSJUDGXDOO\2U\RXPD\QHHGWRUHVWULFW\RXUDFWLYLWLHVWRthose which are safe for you. Talk with your doctor about the kinds of  activities you wish to participate in and follow his/her advice.‡ )LQGRXWZKLFKFRPPXQLW\SURJUDPVDUHVDIHDQGKHOSIXOIRU\RXPAR-Q & YOU£Physical Activity ReadinessQuestionnaire - PAR-Q  (revised 2002)DELAY BECOMING MUCH MORE ACTIVE:‡ LI \RXDUHQRWIHHOLQJZHOOEHFDXVHRI DWHPSRUDU\LOOQHVVVXFKDVa cold or a fever – wait until you feel better; or‡ LI \RXDUHRUPD\EHSUHJQDQW²WDONWR\RXUGRFWRUEHIRUH\RXstart becoming more active.If  you  answered If  you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:‡ VWDUWEHFRPLQJPXFKPRUHSK\VLFDOO\DFWLYH²EHJLQVORZO\DQGEXLOGXSJUDGXDOO\7KLVLVWKHsafest and easiest way to go.‡ WDNHSDUWLQDILWQHVVDSSUDLVDO²WKLVLVDQH[FHOOHQWZD\WRGHWHUPLQH\RXUEDVLFILWQHVVVRthat you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated.  If  your reading is over 144/94, talk with your doctor before you start becoming much more physically active.NOTE:  If  the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes."I have read, understood and completed this questionnaire.  Any questions I had were answered to my full satisfaction."NAME ________________________________________________________________________  SIGNATURE _______________________________________________________________________________  DATE ______________________________________________________SIGNATURE OF PARENT  _______________________________________________________________________  WITNESS ___________________________________________________or GUARDIAN (for participants under the age of  majority)Informed Use of  the PAR-Q:  The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if  in doubt after completing this questionnaire, consult your doctor prior to physical activity.(A Questionnaire for People Aged 15 to 69) YES NOYES to one or more questionsNO to all questionsNote:  This physical activity clearance is valid for a maximum of 12 months from the date it is completed and  becomes invalid if your condition changes so that you would answer YES to any of the seven questions.© Canadian Society for Exercise Physiology  www.csep.ca/forms Yes [   ]          No [   ]Date: ____________________________V rsion: 2.  (15 May 2014)Appendix D  : Questionnaires                           74 UNIVERSITY OF BRITISH COLUMBIA   School of Kinesiology    Environmental Physiology Laboratory    Rm. 3031, Biological Sciences    6270 University Blvd.    Vancouver, BC, Canada V6T 1Z4 !Description: Cardiopulmonary Demands of Kettlebell Snatches - Questionnaire Version: 2.0 (15 May 2014)  !Page 1 of 1 PRE-PARTICIPATION QUESTIONNAIRE Research Study: the Cardiopulmonary Demand of Kettlebell Snatches         After reviewing and signing the consent form, please complete the following questionnaire:  1. Do your normal workouts include high-intensity interval training (i.e. short bursts of effort at near-maximal to supramaximal work rates, repeated with interspersed with periods of recovery)?  Check one:   Yes   No   I don’t know  2. Do your normal workouts include use of external loads (e.g. weightlifting)?  Check one:   Yes   No   I don’t know  3. Have you participated in high-intensity interval training with external loads for a total of at least 60 minutes per week (e.g. 20 minutes, 3 times per week) for the majority of the last 6 months?  Check one:   Yes   No   I don’t know  3. Please rate your confidence that you can safely perform continuous kettlebell snatches using 16kg (35 pounds) without hurting yourself or dropping the weight.  Check one:     4. Please rate your confidence that you can safely row on a rowing ergometer without hurting yourself.   Check one:    5. Does your total lifetime experience (e.g. practice or training) with kettlebell lifting meet or exceed 2 hours?  Check one:   Yes   No   I don’t know  6. Does your total lifetime experience (e.g. practice or training) with rowing on a rowing ergometer meet or exceed 2 hours?  Check one:   Yes   No   I don’t know  7. Do you smoke or have a history of heart or pulmonary disease?  Check one:   Yes   No   I don’t know  1  2  3  4  5 not confident somewhat confident confident very confident extremely confident  1  2  3  4  5 not confident somewhat confident confident very confident extremely confident                            75 Session LogSubject #:Date:Session: I IITEST 1: ROW KBTEST 2: ROW KBBLOOD PRESSURE MONITORING:PRE 1 POST 1 PRE 2 POST 2 DEPARTURERATE OF PERCIEVED EXERTION:ROW KB  Start Time:   Start Time:TIME WATTAGE RPE (1-10) TIME PACE RPE (1-10)0:00 - 1:30 50 0:00 - 1:00 1/9' (6)1:31 - 3:00 100 1:01 - 2:00 1/8' (7)3:01 - 4:30 150 2:01 - 3:00 1/7' (8)4:31 - 6:00 200 3:01 - 4:00 1/6' (10)6:01 - 7:30 250 4:01 - 5:00 1/5' (12)7:31 - 9:00 300 5:01 - 6:00 1/4' (15)9:01 - 10:30 350 6:01 - 7:00 1/3' (20)10:31 - 12:00 400 7:01 - 8:00 1/2' (30)12:01 - 13:30 450 8:01 - 9:00 MAX13:31 - 15:00 500 9:01 - 10:00 MAX  End Time:   End Time:BPPULSETHE CARDIOPULMONARY DEMAND OF KETTLEBELL SNATCHESAppendix E  : Session Log        

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