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Phlebotomy and its effect on the work output of athletes Dennison, John David 1960

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PHLEBOTOMY AND ITS EFFECT ON THE WORK OUTPUT OF ATHLETES by JOHN DAVID DENNISON Diploma of P.E. Sydney Teachers' College, 19J>5. B.P.E. University of B r i t i s h Columbia, 19!?9. A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PHYSICAL EDUCATION i n the School of PHYSICAL EDUCATION AND RECREATION We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA July, I960. In presenting t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r agree that permission f o r extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r e p r e s e n t a t i v e s . I t i s understood tha t copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be allowed without my w r i t t e n permission. Department of Physical Education The U n i v e r s i t y of B r i t i s h Columbia, Vancouver 8, Canada. ABSTRACT The purpose of this study was to determine the effect of blood donation upon the work output of University athletes. Further, to determine whether the effect i s physiological or psychological, suitable controls were exercised over the subjects. A suitable test item representing a s p e c i f i c measure of work output was predetermined for the study. Twenty members of various University of B r i t i s h Columbia a t h l e t i c teams were selected and equated into two groups of ten using t h e i r performance on the test item as a basis f o r d i v i s i o n . The test item consisted of making as many pedal revolutions as possible over a two minute period on a standard bicycle ergometer set at a resistance of l i | kilograms. Both groups were taken to the Blood Donation C l i n i c where the control group had 500 cc of blood removed. The experimental group underwent an i d e n t i c a l procedure but no blood was drawn. Careful controls at the c l i n i c ensured that neither group was aware of what occurred. Later questioning indicated that both groups believed a l l subjects had given blood. A l l subjects were retested under standard conditions two hours, twenty-four hours and seven days after blood donation. Results were subjected to standard s t a t i s t -i c a l analysis. The control group showed, a s i g n i f i c a n t gain i n performance i n the test item i n a l l subsequent te s t s . The experimental group also showed a s i g n i f i c a n t gain i n performance i n the test item i n a l l subsequent t e s t s . At no stage was any s i g n i f i c a n t difference found to ex i s t between the two groups. It was concluded that under the conditions of the study, blood donation does not deleteriously affect the performance of athletes i n an item involving a short period of muscular work. In f a c t , the mean performance was s i g n i f i c a n t l y improved. No psychological effect was found i n the group which believed that i t had donated blood. TABLE OP CONTENTS CHAPTER PAGE I STATEMENT OP THE PROBLEM 1 I I REVIEW OP THE LITERATURE Ij. • I l l METHODS AND PROCEDURE. 16 IV RESULTS 21 V DISCUSSION 29 VI SUMMARY AND CONCLUSIONS 3k BIBLIOGRAPHY 36 APPENDICES A. STATISTICAL TREATMENT 38 B. TIME TABLE FOR PROCEDURE C. INDIVIDUAL SCORE SHEET k5 D. RAW SCORES FOR GROUP A lj.6 E. RAW SCORES FOR GROUP B 1+7 LIST OP TABLES I Effect of Blood Donation on Work Output 6 I I Comparison of Results Between Control Score and Test 3 22 I I I Comparison of Results Between Test 3 and Test h, 23 IV Comparison of Results Between Control Score and Test [j. 2l| V Comparison of Results Between Test 1+ and Test $ Z$ VI Comparison of Results Between Control Score and Test $ 26 VII Comparison of Results Between Test 3 and Test 5 26 LIST OF TABLES (Cont'd.) PAGE VIII Comparison of Group A and Group B on Test 3 . 27 IX Comparison of Group A and Group B on Test Lj. 28 X Comparison of Group A and Group B on Test 5 28 i CHAPTER I STATEMENT OP THE PROBLEM s Within the f i e l d of physical education and a t h l e t i c s i n general, there has been much conjecture as to whether the giving of blood by an athlete w i l l i n any way affect h i s performance i n a c t i v i t y involving muscular work. Karpovich (1) reported that athletes.assert that blood donation w i l l not seriously affect them, while coaches are d e f i n i t e l y against the practice. Jones, Widing and Nelson (2) reported one i n s t i t u t i o n i n which a student was permitted to give blood only once a semester because one student became seriously i l l following blood donation. In a l l , very few studies have been conducted to determine the effects of donation. Most were concerned with items other than muscular work and found no i l l effects of donation with normal healthy subjects provided a short resting period was allowed after the venesection. However, i n none of these reported studies was any psychological control exercised over the subjects. In each case the athletes were aware of giving blood and that t h e i r subsequent performance was being measured. On no occasion was an experimental group set up which involved athletes who thought that they had given blood but i n fact had not done so. 2 This study w i l l investigate whether performance i s s i g n i f i c a n t l y affected by blood donation. I f so, i s the group who actually gave blood more or less affected than the group who believed they had done so? These figures w i l l give some i n d i c a t i o n as to whether the effect on performance i s actually physiological or a r e s u l t of the b e l i e f that blood had actually been removed. Performance i n t h i s study w i l l be measured i n terms of work output i n a predetermined time period. Work output w i l l be calculated by the performance of the subject on a standard bicycle ergometer. In view of the varied opinions held by athletes as to whether blood donation w i l l or w i l l not prejudice t h e i r performance at t h e i r chosen sport, i t seems appropriate that some investi g a t i o n of the effect of t h i s practice be made. Moreover, to i s o l a t e the a l l important physiological effect of the donation, the psychological aspects of the preconceived b e l i e f i n what w i l l occur must be suitably controlled. 3 REFERENCES Karpovich, P.V. and Millman, N., "Athletes as Blood Donors", Research Quarterly, 13, 19^2, pp.166-168. : Jones, H.W., Widing, H., and Nelson, L., "A Study of the Effect in,Donors of Repeated Blood Loss", Journal of the American Medical Association, 96, 1931, PP. 1297-1300. CHAPTER I I REVIEW OF THE LITERATURE A study conducted by Karpovich and Millman (1) gave some i n d i c a t i o n of the effect of blood loss by athletes. They report that a bicycle r i d e r , who had been p r a c t i s i n g on a bicycle ergometer, dropped considerably i n r i d i n g performance after admitting to a loss of 500 cc of blood. Three weeks elapsed before h i s performance l e v e l was regained. A r e p e t i t i o n of the experiment showed s i m i l a r r e s u l t s . A further investigation (1) by the same experim-enters upon four subjects involved i n bicycle r i d i n g showed that three of the four decreased i n performance on the day of transfusion and on the following day. However, the two subjects \4tio were involved i n a "sprint" type of a c t i v i t y quickly regained t h e i r performance l e v e l . The " s p r i n t " type of a c t i v i t y involved r i d i n g a l l out for one minute once a day. Those engaged i n endurance work suffered a ten to eighteen day reduction i n performance after transfusion. This fact i s further supported by Karpovich and Millman (1) who reveal s i m i l a r r e s u l t s from blood donation by a long distance swimmer, a cross country runner, a sprinter and a sprint swimmer. The f i r s t two suffered considerably from the donation while the l a t t e r p a i r equalled t h e i r best performance a few hours l a t e r . 5 Reference i s made to motivational factors by the investigators when they reveal that the bicycle r i d e r previously mentioned actually increased h i s performance the day after donation before admitting to the loss of blood. I t was f e l t that t h i s subject, anxious to prevent the effect of hi s blood loss from being known, t r i e d harder than usual to produce a good performance. Karpovich and Millman (1) sum up the study by saying (l,p.l68): Performance on the day of loss of blood, and the following day, was usually lowered, but occasionally s l i g h t l y increased. This increase was probably due to the summation of the concomitant e x c i t i n g factors. In our study the s l i g h t increase i n two cases was probably due to a f r a n t i c e f f o r t to prove that loss of blood did not affect the subjects seriously. Balke, G r i l l o , Konecci and Luft (2), investigating work capacity after blood donation, found s l i g h t l y different r e s u l t s . These investigators used fourteen subjects. They were divided into two groups of seven subjects each and t h e i r performance was measured on a tre a d m i l l . A mean performance was established by te s t i n g each group on two separate occasions. Five hundred cc of blood was then removed from each subject and the f i r s t group was retested, under the same conditions, one hour, two days and ten days after transfusion. S i m i l a r l y , the second group was retested one hour, three days and eight days after transfusion. In both groups a simi l a r pattern was found. An i n i t i a l f a l l i n performance was followed 6 by a r a p i d recovery i n two to three days and an improved performance i n ei g h t to ten days. The r e s u l t s are shown i n Table I . TABLE I E f f e c t of Blood Donation on Work Outputs-Subjects Controls Blood 1 Blood 2 Blood 3 2 3 8 10 1 h r . days days days days Group A = 7 970 , 9 0 3 91+0 1058 Group B = 7 1096 1002 1119 1200 Av. D i f f . -93.7 -27 -8 +89.3 +76.5 S.D. of D i f f . 68.78 93.95 58.8 ll+.k 57.9 P value .01 .5 .5 .029 .013 C a l c u l a t i o n i n meter kilograms/minute These i n v e s t i g a t o r s summarised t h e i r f i n d i n g s by saying that (2,p.236): Loss of blood i n amounts customary i n blood donation imposes s i g n i f i c a n t l i m i t a t i o n s on p h y s i o l o g i c a l adjustment to severe e x e r c i s e w i t h i n the f i r s t few hours a f t e r venesection. But there i s a r a p i d recovery of i n i t i a l work capac-i t y i n two to three days and a marked improvement i n performance a f t e r an i n t e r v a l of a week. 1 Balke, B., G r i l l o , G.P., Konecci, E.B., and L u f t , V.C., "Work Capacity A f t e r Blood Donation", Journal of Ap p l i e d Physiology, 7, 1951)-, p.233. 7 Similar results were obtained by Spealman, Bixby, Wiley and Newton (3). These investigators studied the influence of hemorrhage by subjects on t h e i r performance i n the heat. Using four subjects as a basis of inves-t i g a t i o n , the investigators concluded that removal of 500 cc of blood resulted i n an immediate and marked decrease i n a b i l i t y to carry out physical a c t i v i t i e s . These a c t i v i t i e s consisted of active and passive standing and exertion on a bicycle ergometer i n a high temperature. Several days elapsed before the control l e v e l of perform-ance was regained again. Moreover, performance was .affected but to a lesser degree following removal of 200 cc of blood. Infusion of serum albumin i n quantities equivalent to $00 cc of blood plasma improved performance. Hoffman, Litwins and Sussman (Ij.) investigated electrocardiographic changes as a r e s u l t of bloodletting. I t was stated, i n summary, that (lj.,p,1052): Our findings indicate that a complete return of the electrocard-iogram to normal can be anticipated i n a normal healthy donor, even i f exercise i s performed immediately after the phlebotomy, providing the person i s given a rest period of at least several minutes following the blood l e t t i n g . This point i s of importance i n that i t i s the custom of the average healthy donor to return immediately to work with a l l i t s attendant exercise, after giving blood. The practice of a r i s i n g from the bleeding table immediately after the blood donation should be discouraged and a ten minute rest period rule be required. 8 I t was further found that the heart rate, however, was s i g n i f i c a n t l y greater immediately after the post-phlebotomy exercise test. Jones, Widing and Nelson (5) indicated v i t a l capacity varied before and after blood donation. Some-times t o t a l expired volume increased, other times i t decreased. The greatest increase was found to be 250 cc but i t was considered doubtful whether the increased v i t a l capacity was s i g n i f i c a n t l y so or due to greater s k i l l of operation of the measuring instrument. Studies carried out by Martin and Myers (6), and further supported by Litwins, Sussman and Peltenstein (7), indicate that 5>00 cc of blood i s a safe and convenient amount of blood to remove at any one time for transfusion purposes. However, an experiment conducted by Ebert, Stead and Gibson (8) gave some i n d i c a t i o n as to the effects of acute blood loss (760 to 1220 ccs). These investigators found i n t e r a l i a , that (8,p.580): The plasma volume began to increase immediately after hemorrhage and con-tinued to increase for the next f o r t y -eight to seventy-two hours. At the end of seventy-two hours i t was approximately equal to the plasma volume before hemorrhage plus the volume of red c e l l s removed. Furthermore, after hemorrhage the blood volume was not restored to normal u n t i l new plasma protein had been added to the c i r c u l a t i o n . 9 There appears to be no doubt from the evidence • col l e c t e d , that work output i s affected by blood donation. Just how much effect takes place and f o r how long i t l a s t s i s not clear. Moreover, there i s no i n d i c a t i o n of whether the effect was actually a re s u l t of the physical loss of blood or a b e l i e f , suggested by a f e e l i n g of weakness or nausea, or merely preconceived opinion, that work performance would be affected. Related Studies Studies concerned with work output as measured by performance on a bicycle ergometer reveal many and varied ways of using the ergometer. B a s i c a l l y , Karpovich states (9,p.212): The general formula f or work i s F x D where F i s force used and D, the distance covered. In the case of the b i c y c l e , the force obviously i s equal to the. resistance to be overcome. Karpovich (9) suggests that work done i n a given time may be calculated i n foot pounds by u t i l i z i n g the resistance, the number of wheel revolutions and the circumference of the wheel. He further indicates a method whereby a sp e c i f i e d amount of work may be done by adjusting the load and keeping the pedal revolutions constant, Karpovich and Hale (10), while investigating the effect of tobacco smoking on physical performance, had 10 t h e i r subjects perform a prescribed amount of work on the ergometer. The amount of work selected was comparable to a one mile run on the track i n the short-est possible time. I t consisted i n making a t o t a l of 1^.25 pedal revolutions against a load of eight pounds. This resulted i n a t o t a l distance covered of 6,116 feet and lj.8,928 foot pounds of work performed. The time range f o r subjects for the completion of the work was 3 minutes seconds to $ minutes 7.8 seconds. In another study, Karpovich and Pestrecov (11) asked subjects to work at a rate of 0.506 horsepower at 117 pedal revolutions per minute. The maximum time achieved was 7 minutes 30 seconds. Cogswell, Henderson and Berryman (12), i n a s i m i l a r type of study, measured maximum performance using a load such that each ride lasted approximately s i x t y seconds. I t was found that a ten minute rest period between rides was s u f f i c i e n t to allow for recovery. Walters (13) exercised her subjects f o r one minute at maximum work capacity. In t h i s study the object was the determination of maximum work output. A f i e l d current of three amperes and a pedal revolution speed of s i x t y revolutions per minute on the bicycle ergometer required a work rate of 0.33 horsepower. Work was then converted into kilogram metres per minute d i r e c t l y from a conversion table. These investigators also found that a 11 single practice session three days before t e s t i n g was s u f f i c i e n t . U l r i c h and Burke (11}.) measured work on a bicycle ergometer i n terms of calories per hour. The work done was equal to 61.67 foot pounds per wheel revolution regardless of the speed of peddling. These investigat-ors measured the amount of work done i n one minute by u t i l i z i n g the number of wheel revolutions. Tuttle (15) investigated the effect of physical t r a i n i n g on capacity to do work as measured by the bicycle ergometer. The subjects worked at a rate of 33 horsepower f o r e i t h e r one or two minutes at a wheel rate of s i x t y revolutions per mimtte. As a result of t h i s study, Tuttle f e l t the following conclusions j u s t i f i e d (16,p.396): (1) The work which an in d i v i d u a l performs i n one minute of maximum ef f o r t i s as good a c r i t e r i o n of work capacity as the amount accomplished i n two minutes. In addition, by working only one minute, severe exhaustive reactions are avoided. (2) Maximum work rate i s attained i n approximately 15 seconds but i t i s maintained for only a few seconds after which there i s a gradual decline i n maximum work output. In p h y s i c a l l y well t r a i n -ed subjects t h i s decline continues, on the average, 75 seconds after which a plateau or fatigue l e v e l of work i s reached and maintained f o r the remainder of the two minute work period. 12 F i n a l l y , Nelson (16), Scott, Moody and Wilson (17), and Scott and Wilson (18) used the ergometer i n different ways but gained highly satisfactory r e s u l t s . In one of these studies (17) the c r i t e r i o n of capacity to do work was estimated by requiring each subject to ride the machine f o r two minutes at maximum speed. Resistance was set at three amperes. Work capacity was then computed i n kilogram metres f o r two minutes. In I9I4.8, Scott and Wilson (18) studied physical e f f i c i e n c y tests f o r college women. In reference to the use of the ergometer they stated (l8,p,131)s The ergometer gives r e l i a b l e and objective scores on the work done, and therefore, i n d i r e c t l y on the capacity of the subject to work hard f o r a b r i e f period of time. The generated voltage i s translated d i r e c t l y into kilogram metres of work and th i s i s not possible i n other types of work estimates. The ergometer also y i e l d s a r e l a t i v e -l y quick measure of work. Nelson (16) studied the effects of alcohol on performance i n selected gross motor tests... .This investigator considered performance on a bicycle ergometer as an endurance item. The subjects were asked to perform f o r seconds against a ten pound resistance and found that the mean performance for various groups ranged between 220 and 230 revolutions. Nelson speaks highly of the r e l i a b i l i t y of the bicycle ergometer used i n t h i s way when he states (l6,p.320): 13 The timing device used i n the speed and reaction test and the bicycle ergometer seemed to be the most precise measuring instruments, as evidenced by the small c o e f f i c i e n t of v a r i a t i o n . The foregoing reported studies w i l l be considered as a basis.for defining the method of using the bicycle ergometer i n the way best suited to the needs of this experiment. 1*4. REFERENCES Karpovich, P.V. and Millman, N., "Athletes as Blood Donors", Research Quarterly, 13, 19l|!2, pp. 166-168. Balke, B., G r l l l o , G., Konecci, E.B., and Luft, V.C., "Work Capacity after Blood Donation", Journal  of Applied Physiology, 7, 195k, pp.231-236. Spealman, C.R., Bixby, E.W., Wiley, J.L., and Newton, M., "Influence of Hemorrhage, Albumin Infusion, Bed Rest and Exposure to Gold on Performance i n the Heat", Journal of Applied Physiology, 1, 1914-8, pp.2l].2-253. Hoffman, I . , Litwins, J., and Sussman, L., "Electro-cardiographic Changes i n Donors during Blood-l e t t i n g " , American Journal of C l i n i c a l Path- ology, 21, 1951, pp.1031-10524-. Jones, H.W., Widing, H., and Nelson, L., "A Study of the Effect i n Donors of Repeated Blood Loss", Journal of American Medical Association, 96, 1931, pp.1297-1300. Martin, J.W., and Myers, J.T., "The Effects of Blood Transfusion on Donors", Journal of Laboratory  and C l i n i c a l Medicine, 20, 1935, pp.593-597. Litwins, J . , Sussman, L.N., and Feltenstein, M., "Hematologic and Chemical Changes i n Donors during Blood Letting", American Journal of  C l i n i c a l Pathology, 20, 1950, pp.[4.6-14.7. Ebert, R.V., Stead, E.A., and Gibson, J.G., "Response of Normal Subjects to Acute Blood Loss", Archives  of Internal Medicine, 68, 19*4-1, pp.578-583. Karpovich, P.V., "A F r i c t i o n a l Bicycle Ergometer", Research Quarterly, 21, 1950, pp.210-21$. Karpovich, P.V., and Hale, C.J., "Tobacco Smoking and Physical Performance", Journal of Applied  Physiology, 3, 1951, pp.616-621. Karpovich, P.V., and Pestrecov, K., "Effect of Gelatin upon Muscular Work i n Man", American Journal of  Physiology, 13k, 19*4-1, pp.300-309. 15 12 Cogswell, R.C., Henderson, C.R., and Berryman, G.H., "Some Observations of the Effects of Training on Pulse Rate, Blood Pressure and Endurance i n Humans, Using the Step Test (Harvard), Tread-m i l l and Electrodyhamic Brake Bicycle Ergometer", American Journal of Physiology, II4.6, 1946, pp .422-14.30. 13 Walters, C.E., "A Study of the Effects of Prescribed Strenuous Exercises on the Physical E f f i c i e n c y of Women", Research Quarterly, 25, 1953, pp.102-111. 14 U l r i c h , C , and Burke, R.K., "Effect of Motivational Stress upon Physical Performance", Research  Quarterly, 28, 1957, pp.403-lj.12. 15 T u t t l e , W.W., "Effect of Physical Training on Capacity to do Work as Measured by the Bicycle Ergometer", Journal of Applied Physiology, 2, 1950, pp.393-39H*: ' 16 Nelson, D.O., "Effects of Ethyl Alcohol on the Per-formance of Selected Gross Motor Tests", Research  Quarterly, 30 , . 1959, pp.317-320. 17 Scott, M.G., Moody, M., and Wilson, M., "Validation of Mass Type Physical Tests with Tests of Work Capacity", Research Quarterly, 16, 1945, pp. 128-138. 18 Scott, M.G.., and Wilson, M., "Physical E f f i c i e n c y Tests f o r College Women", Research Quarterly, 19, 1948, pp.62-69. CHAPTER I I I METHODS AND PROCEDURE Twenty u n i v e r s i t y athletes selected from various a t h l e t i c teams from the University of B r i t i s h Columbia were the subjects for t h i s study. A l l subjects met before any test i n g took place and the purpose of the study was outlined. The instructions given were as follows: You w i l l be tested on a bicycle ergometer, the object being to see how many pedal revolutions you can perform i n two minutes. You w i l l be given an opportunity to repeat the test one week l a t e r . Seven days after the second test you w i l l go down to the Blood Donation Service and have 500 cc of blood removed by the doctor. You w i l l Immediately return to the gymnasium and repeat the te s t . Further tests w i l l be conducted on the following day and again a week l a t e r . The object of the study i s to deter-mine i f the blood donation w i l l affect your performance. I t i s most important that you continue through with the experiment and that you cooperate to the best of your a b i l i t y at a l l times. The bicycle ergometer used i n the study was manufactured by J.A. Preston Corporation and was f i t t e d with a variable,resistance and revolution counter. Henry (1) notes that there i s some element of acquired s k i l l i n performing e f f i c i e n t l y on a bicycle ergometer. To f a m i l i a r i s e each subject with the apparatus, 17 practice sessions were arranged which enabled each subject to perforin with reasonable s k i l l and to minim-ise the learning f a c t o r . The end of each practice session was devoted to the subjects 1 peddling for two minutes with a l i g h t resistance so as to become accustom-ed to the time period which was employed i n the experiment. In determining the procedure for the test item the following points were considered: 1. Work i s measured by the product of force times distance t r a v e l l e d on the bicycle ergometer. Force i s defined as the resistance against which the subject pedals while distance i s the wheel circumference multip-l i e d by the number of revolutions. W - F S - F x 2 7T r x no. of revolutions 2. The resistance w i l l remain a constant as does the circumference of the wheel. Thus work output varies with the number of revolutions. 3. I t seems that various psychological factors must be controlled which natu r a l l y affect the study when the subject i s asked to work to exhaustion. The subject, then, was asked to work f o r two minutes only. I t was f e l t that the two minute time i n t e r v a l would be large enough to obtain a suitable range of performance with diff e r e n t subjects and short enough to ensure continual e f f o r t by the subject and s t i l l avoid the effects of mental 18 fatigue or boredom.. I 4 . . The search of the related l i t e r a t u r e suggested that constant pedal revolutions per minute would be d i f f i c u l t to control whereas maximum revolutions i n a given time forces no p a r t i c u l a r pace upon the subject but would allow him to extend himself as he desired. 5>. I t was f e l t that most subjects would "give of t h e i r best" f o r a l i m i t e d period of two minutes provided they were continually aware how much time had elapsed and how much time remained. One week after the practice sessions were completed the f i r s t test was given. The load was predetermined so as to bring the subjects close to physical exhaustion at the end of the two minute period. The resistance set was lij. k g : l . The instructions given to a l l subjects were standardised and were as follows: I want you to pedal as fast as you can for two minutes. I w i l l c a l l out the time i n 15 second i n t e r v a l s . You w i l l make as many pedal revolutions as you can i n t h i s time. I t i s most important that you keep working hard through-out the f u l l two minute period. After test I the r e s u l t s were analysed and the subjects were paired on performance into Group A and Group B. The method used was that described by Garrett (2,p.228). One week after test 1, test 2 was given under the same conditions. The results of test 2 were c o r r e l a t -ed against those of test 1 to est a b l i s h a c o e f f i c i e n t of 19 r e l i a b i l i t y f o r the test item. At no stage i n the study did subjects know th e i r own score nor the score of any other subject. This eliminated the competitive factor between i n d i v i d u a l s . A f t e r a week's i n t e r v a l both groups were taken to the Blood Donation Centre. The procedure undergone by the two groups while at the Centre was i d e n t i c a l . A l l subjects were t o l d that they were giving 5>00 cc of blood and l a t e r questioning indicated that a l l were convinced that they had done so. In actual fact only the control group, designated as Group B, gave blood. The experim-ental group, designated as Group A, had a needle i n s e r t -ion made i n the muscle and no blood was drawn. At a l l times before, during and after the actual donation period, the treatment administered to both groups was i d e n t i c a l . During the venesection the subjects were prevented from seeing the procedure by the placing of a b l i n d f o l d over t h e i r eyes and as an extra precaution, the covering of a l l pieces of apparatus by tape. The subjects were t o l d that the b l i n d f o l d was to a l l e v i a t e any p o s s i b i l i t y of t h e i r performance being affected by the sight of blood. As close as possible to two hours after venesection each subject reported f r o test 3. This test was conduct-ed under the same conditions except f o r the presence of a doctor i n case an emergency arose. Test 1+ w-as administered twenty-four hours after venesection and test 5 seven days after. 20 REFERENCES Henry, F.M., "Physiology of Work", Associated Students Store, University of C a l i f o r n i a , 1951, P.15. Garrett, H.E., " S t a t i s t i c s i n Psychology and Education", Longmans, Green and Co., New York, 1958, p.228. CHAPTER IV RESULTS The data obtained from the experimental group and the control group are summarized i n the accompanying tables. The experimental group (A) did not donate blood but believed they had done so. The control group (B) did actually donate blood. The s t a t i s t i c a l treatment of the res u l t s deals with the effect on performance i n the test item i n each group on each of the l a s t four t e s t s ; the comparison between the performance of the two groups on each of the l a s t three te s t s ; and, i n addition, a c a l c u l a t i o n of the c o e f f i c i e n t of c o r r e l a t i o n e x i s t i n g between the results of each subject on the f i r s t two tests i n order to est a b l i s h a co e f f i c i e n t of r e l i a b i l i t y f o r the test item. R e l i a b i l i t y of the Test Item: The scores of twenty-two subjects on the bicycle ergometer i n Test I were correlated with t h e i r scores i n Test 2. The calculated c o e f f i c i e n t of co r r e l a t i o n was O..98 which showed high r e l i a b i l i t y f o r the test item. Test 3 (Two hours after donating blood): In group A each subject showed improvement i n performance over h i s control score. The range of improvement was from one revolution to 2$ revolutions with a mean increase of 10.2 22 revolutions. In group B, a l l subjects, except one, exhibited improved performances. This subject gave the same performance as i n the control test . The improvem-ent ranged from two revolutions to 28 revolutions with a mean increase of 8 .5 revolutions. The differences i n the performance l e v e l s of each group two hours after donating blood are summarised i n Table I I . Both group A and group B showed differences between the control scores and the res u l t s on Test 3 which were s t a t i s t i c a l l y s i g n i f i c a n t . The mean improvement of group A was 10.2 revolutions with a t - r a t i o of 3 . 8 . This was s i g n i f i c a n t at the 1 percent l e v e l of confidence. Group B showed an increase i n mean performance of 8 . 5 revolutions with a t - r a t i o of 3.4* This was also . s i g n i f i c a n t at the 1 percent l e v e l of confidence. TABLE I I Comparison of Results between Control Score Means and Means on Test 3 M 2 SD2 M3 SD3 M3-M1 t Group A 254.8 9.97 265.0 13.0 10.2 3 . 8 * Group B 254.3 10.88 262.8 10.96 8.5 3 . 4 * * Sig n i f i c a n t at the 1 percent l e v e l of confidence Test 4 (24 hours after donating blood): In group A each subject, except one, gave improved performances over the results i n Test 3 . This subject showed a f a l l 23 of two revolutions. The improvements ranged from 17 revolutions to one revolution with a mean improvement of 8,2 revolutions. In group B eight subjects showed improvement over t h e i r performance i n Test 3. The improvements ranged from 17 revolutions to one revolution. Two subjects showed decreases of ten and s i x revolutions. The mean improvement was 5.i| revolutions. Table I I I shows the differences i n the performance l e v e l s of each group which occurred between two hours and 21}. hours after giving blood. Both group A and group B showed mean differences which varied i n significance. Group A showed a mean improve-ment of 8.2 revolutions and a t - r a t i o of I 4 . . I , s i g n i f i c a n t at the 1 percent l e v e l of confidence. Group B showed a mean improvement of 5.1+- revolutions and a t - r a t i o of 1.9 which was not s t a t i s t i c a l l y s i g n i f i c a n t . TABLE I I I Comparison of Results between Means of Performance on Test 3 and Test I4. M3 SD3 SD^ M^-My t Group A 265.0 13.0 273.2 15 .5 8.2 l+.l* Group B 262.8 10.96 268.2 9.38 S.k 1.9 * Significant at the 1 percent l e v e l of confidence Table IV shows the difference i n performance le v e l s of each group which occurred between the control performance 2k and the performance 2k hours after giving blood (Test k). Both group A and group B showed mean differences which were s t a t i s t i c a l l y s i g n i f i c a n t . Group A showed a mean improvement of 18.1}. revolutions and a t - r a t i o of 6.1}., s i g n i f i c a n t at the 1 percent l e v e l of confidence. Group B showed a mean improvement of 13.9 with a t - r a t i o of 5 . 7 , also s i g n i f i c a n t at the 1 percent l e v e l of confidence. TABLE IV Comparison of Results between Means of Performances on Control (Test 2) and Test k M 2 SD 2 SD^ M^-M2 t Group A 2514..8 9.97 273.2 15.5 18.1}. 6.1}* Group B 25I4-.3 10.88 268.2 9.38 13.9 5 . 7* «• Sig n i f i c a n t at the 1 percent l e v e l of confidence Test 5 (Seven days after donating blood): In group A, eight subjects gave decreased performances over t h e i r r e s u l t s i n Test I4.. The decreases ranged from 17 revolut-ions to f i v e revolutions. Two subjects gave increases of seven and f i v e revolutions. The mean decrease was 6 .3 revolutions. In group B, four subjects showed improved perform-ances, f i v e showed decreased performances and one remain-ed the same. The mean decrease i n performance was two 25 revolutions., Table V shows the difference i n performance l e v e l s of each group which occurred between the results of Test I4. and Test 5 . Group A showed a mean decrease of 6.3 and a t - r a t i o of 2 .6, s i g n i f i c a n t at the 5 percent l e v e l of confidence. Group B showed a mean decrease of two revolutions and a t - r a t i o of 0.8 which was not s t a t i s t i c a l l y s i g n i f i c a n t . TABLE V Comparison of Results between Means of Performance on Test I4. and Test 5 SD5 v Mjj-M^ t Group A 266.9 19.8 273.2 15.5 6.3 2 .6 * Group B 266.2 11.-7 268.2 9.38 2.0 0.8 # Signi f i c a n t at the 5 percent l e v e l of confidence Table VI shows the difference i n mean performance found i n the two groups between the control score (Test 2) and the results i n Test 5 . Group A shows a mean increase of 12.1 revolutions and a t - r a t i o of 2 .9, s t a t i s t i c a l l y s i g n i f i c a n t at the 1 percent l e v e l of confidence. Group B shows a mean increase of 11.9 revolutions and a t - r a t i o of 1}..9, s t a t i s -t i c a l l y s i g n i f i c a n t at the 1 percent l e v e l of confidence. 26 TABLE VI Comparison of Results between Means of Performances on Test 2 (Control) and Test 5 M 2 SD 2 M^-M2 t Group A 254.8 9.97 266.9 19.8 12.1 2 . 9 * Group B 254.3 10.99 266.2 11 .7 11 .9 1+.9* S i g n i f i c a n t at the 1 percent l e v e l of confidence Table VII shows the difference i n mean performance found i n the two groups between the scores on Test 3 and the scores on Test 5 . Both groups show increases that were not s t a t i s t i c a l l y -s i g n i f i c a n t i n performance over Test 3 . Group A shows a mean improvement of 1.9 revolutions with a t - r a t i o of 0 . 6 , Group B shows a mean improvement of 3 . 4 revolutions with a t - r a t i o of 1 . 5 5 . Both t - r a t i o s are not s t a t i s t i c a l l y s i g n i f i c a n t . TABLE VII Comparison of Results between Means of Performances on Test 3 and Test 5 M3 SD3 M5 SD5 M 5 - M3 t Group A 265.0 13.0 266.9 19 .8 1.9 0.6 Group B 262.8 10.96 266.2 11.7 3.U- 1.55 27 Comparison between Group A and Group B; As the groups were equated on the means of t h e i r performances on Test 1 and Test 2, there was a d i f f e r -ence of 0 . 5 of a revolution between the control mean of Group A and the control mean of Group B. This difference was not s t a t i s t i c a l l y s i g n i f i c a n t . Comparisons were made of the differences between the means of the two groups on t h e i r r e s u l t s i n tests 3, k- an^i 5. I t was further determined whether these differences were s t a t i s t i c a l l y s i g n i f i c a n t . Table VIII shows the results of the difference between the means of both groups on Test 3. I t may be seen that the standard error of the difference i s 5.37 with a mean difference of 2.2. This gives a t - r a t i o of 0.I4.I, which i s not s t a t i s t i c a l l y s i g n i f i c a n t . TABLE VIII Comparison of Difference between Group A and Group B or Results of Test 3 M A M B MA-MB SD D SE D t 265.0 262.8 2 .2 12.02 5.37 O.J4.I Table IX shows the results of the difference between means of both groups on Test 1|. I t may be seen that the standard error of the difference i s 5.61). with a mean difference of f i v e . This gives a t - r a t i o of 0.88, which 28 was not s t a t i s t i c a l l y s i g n i f i c a n t . TABLE IX Comparison of the Difference between Group A and Group B on Results of Test Ij. % M B M A- M B SD D S E D t 273.2 268.2 5 12.62 5 .64 0.88 Table X shows the r e s u l t s of the d i f f e r e n c e between the means of both groups on Test 5 . I t may be seen that the standard e r r o r of the d i f f e r e n c e i s 7 .35 w i t h a mean d i f f e r e n c e of 0 . 7 . This gives a t - r a t i o of 0 . 0 9 , which i s not s t a t i s t i c a l l y s i g n i f i c a n t . TABLE X Comparison of the Difference between Group A and Group B on Results of Test 5 M A M B MA- M B SD D S E D t 266 .9 266.2 0.7 I6.i}4 7.35 0.09 CHAPTER V DISCUSSION The studies of Karpovich and Millman (1) demonstrated that a difference i n the effect of blood donation may be expected between subjects engaged i n a "spri n t " type of a c t i v i t y and those engaged i n endurance work. Both the sprint runner and the sprint swimmer, i n the foregoing experiment, were able to equal t h e i r best performances a few hours after blood donation. Further-more, Karpovich and Millman (1) were cognizant of the motivational factor when they offered an explanation for the s l i g h t increases i n performance which were obtained from two subjects on the day of donation. They state ( l , p . l 6 8 ) : In our study, the s l i g h t increase i n two cases was probably due to a f r a n t i c e f f o r t to prove that loss of blood did not affect the subjects seriously. The experimental studies of Balke, et a l (2) were prim a r i l y concerned with the adaptation of the blood donors to "severe" exercise shortly after donation. A f a l l i n performance one hour after donation was obtained. In none of these studies was the psychological factor suitably controlled. The present study, which involved, u n i v e r s i t y athletes i n t r a i n i n g , engaged i n a test item which may be considered 30 as a " s p r i n t " type. Riding for two minutes on a bicycle ergometer against a II4. kilogram resistance was shown to impose a short burst of strenuous e f f o r t upon the subjects. A l l subjects were able to complete the two minute r i d i n g period but i t was observed that a l l displayed evidence of physiological stress, eg. increased pulse rate, increased breathing, profuse perspiration, etc. Both groups gave s i g n i f i c a n t l y higher performances than t h e i r control e f f o r t s . Further, the differences exhibited between the two groups were not s t a t i s t i c a l l y s i g n i f i c a n t . Hence, i t would appear that both group A and group B were s i m i l a r l y affected by the t e s t . I t i s suggested that either one or a l l of three factors may have been responsible f o r the improved performance of both groups, (1) A strong psychological desire to show that the blood donation had not affected them. Further, a l l but two of the subjects stated after the test that t h e i r performance had not been affected, although several complained of various e f f e c t s , eg, s t i f f n e s s , tiredness, numbness, etc., after the two minute r i d e . (2) An improvement i n the technique of r i d i n g a bicycle ergometer. (3) An improvement i n performaro e as a result of the tr a i n i n g factor. 31 On being tested, twenty-four hours after donation, both groups showed further improvement, although group A, which had not given blood, showed a s t a t i s t i c a l l y s i g n i f i c a n t improvement, while i n the case of group B, which gave the blood, the improvement was not s t a t i s t i c a l l y s i g n i f i c a n t . I t i s possible that the loss of blood may have shown i t s effects at t h i s stage. I f one accepts the actual blood donation of group B as the only v a r i a t i o n between the groups then t h i s premise i s reasonable. On being retested after s i x days of normal a c t i v i t y , group A showed a s i g n i f i c a n t f a l l i n performance. The result s of t h i s t e s t , however, remained s i g n i f i c a n t l y greater than the control l e v e l . Group B, on the other hand, showed a f a l l i n the s i x day period which was not s i g n i f i c a n t s t a t i s t i c a l l y , but nevertheless, remained s i g n i f i c a n t l y above the control l e v e l . Continual reference must be made to the fact that the test item was highly s p e c i f i c . The required time of r i d i n g was only two minutes, and t h i s cannot be accepted as an a l l - o u t e f f o r t , nor does i t suggest the requirement of great endurance. I t i s impossible to offer any conclus-ive explanation f o r the differences that occurred i n performance. Possibly the aforementioned psychological drive deteriorated during the seven day period. However, even after seven days, the subjects seemed s u f f i c i e n t l y 32 motivated to maintain t h e i r performance s i g n i f i c a n t l y above the control l e v e l . Further p o s s i b i l i t i e s are the b e n e f i c i a l effects of the t r a i n i n g and learning factors which, i n themselves, could improve performance. It may be observed, furthermore, that at no stage was any s i g n i f i c a n t difference between the performances of the two groups observed. It i s , therefore, suggested, that, under the conditions of t h i s experiment, no s i g n i f i c a n t differences w i l l occur between a group that gives blood and a group that does not. In addition, again under the l i m i t a t i o n s of the study, i t appears that a blood donation of 500 cc w i l l not deleteriously affect the performance of athletes on r i d i n g fo r two minutes on a bicycle ergometer against a resistance of llj. kilograms. 33 REFERENCES Karpovich, P.V., and Millman, N., "Athletes as Blood Donors", Research Quarterly, 13, 1942, pp.166-168. Balke, B., G r i l l o , G.P., Konecci, E.B., and Luft , V.C., "Work Capacity after Blood Donation", Journal of Applied Physiology, 7, 1954, pp.231' CHAPTER VI SUMMARY AND CONCLUSIONS Twenty-six University of B r i t i s h Columbia athletes, engaged i n various sports, were selected and tested. The test item consisted of r i d i n g a bicycle ergometer f o r two minutes against a resistance of lij. kilograms. The maximum number of revolutions performed i n this time was recorded. On the basis of the test r e s u l t s , the subjects were divided into two equated groups. Both groups were taken to a blood donation c l i n i c where each person i n one group donated 500 cc of blood. The other group underwent the same procedure, but the needle i n s e r t i o n was made i n the muscle and no blood was drawn. As both groups were blindfolded, neither had any knowledge of what was occurr-ing, other than that they were giving blood. The test item was given to a l l subjects two hours, twenty-four hours and seven days after donation. The differences i n mean performances were calculated s t a t i s t i c a l l y within each group and a comparison of t h i s difference was made between the groups. On the basis of s t a t i s t i c a l treatment the following results were evident: 1. The group which donated blood showed a s i g n i f i c a n t gain i n performance i n the test item, two hours (t=3.*J-), twenty-four hours (t=5.7) and seven days (t«lj..9) after the 35 time of donation. 2. The group which did not donate blood also showed a s i g n i f i c a n t gain i n performance i n the test item, two hours (t= 3 . 8 ) , twenty-four hours (t=6.!{.), and seven days (t«2.9) after the time of donation. 3. At none of the three stages was any s i g n i f i c a n t difference found to e x i s t between the two groups,. On the basis of these r e s u l t s , evidence i s provided which indicates that a blood donation of 500 cc does not deleteriously affect the performance of athletes on r i d i n g a bicycle ergometer for two minutes against a resistance of II4. kilograms. In f a c t , the. mean performance i s s i g n i f i c a n t l y improved. The improvement i s maintained two hours, twenty-four hours and, to a lesser degree, seven days after donation. The psychological ef f e c t of the b e l i e f that blood donation w i l l affect performance i s not evident under the conditions of the study. No deleterious psychological effect was obtained i n the performance of the group which believed that i t had given blood. I t must be concluded, therefore, that blood donation of 500 cc w i l l not deleteriously affect u n i v e r s i t y athletes i n r i d i n g a bicycle ergometer f o r two minutes against a llj. kilogram resistance, either p h y s i o l o g i c a l l y or psychologically at stages of two hours, twenty-four hours or seven days aft e r donation. 36 BIBLIOGRAPHY BOOKS Garrett, H.E., S t a t i s t i c s i n Psychology and Education, New York, Longmans, Green, 1958. Henry, P.M., Psychology of Work, Berkeley, Associated Students Store, University of C a l i f o r n i a , 1951. Karpovich, P.V., Physiology of Muscular A c t i v i t y , P h i l -adelphia, W.B. Saunders Co., 1959. PERIODICALS Balke, B., G r i l l o , G., Konecci, E.B., and Luft, V.C., "Work Capacity After Blood Donation", Journal  of Applied Physiology, 7, 195k,. pp.231^236": Cogswell, R.C.., Henderson, C.R., and Berryman, G.H., "Some Observations of the Effects of Training on Pulse Rate, Blood Pressure and Endurance i n Humans, Using the Step Test (Harvard), Tread-m i l l , and Electrodynamic Brake Bicycle Ergom-eter", American Journal of Physiology, IJ4.6, I9I4.6, pp.!;22-1130~ Ebert, R.V., Stead, E.A., and Gibson, J.C., "Response of Normal Subjects to Acute Blood Loss", Archives  of Internal Medicine, 68, 19*1-1, pp.578-583. Hoffman, I . , Litwins, J . , and Sussman, L., "Electrocard-iographic Changes i n Donors during Bloodletting", •American Journal of C l i n i c a l Pathology, 21, 195l, pp. 1031-1051f.. Jones, H.W., Widing, H., and Nelson, L., "A Study of the Effect i n Donors of Repeated Blood Loss", Journal of American Medical Association, 96, 1931, pp.1297-1300. Karpovich, P.V.., "A P r i c t i o n a l Bicycle Ergometer", Research Quarterly, 21, 1950, pp.210-215. Karpovich, P.V., and Hale, C.J., "Tobacco Smoking and Physical Performance", Journal of Applied  Physiology, 3, 195l, pp76"l6-631. 37 PERIODICALS (Cont'd) Karpovich, P.V., and Millman, N., "Athletes as Blood Donors", Research Quarterly, 13, 191+2, pp. 166-168. Karpovich, P.V., and Pestrecov, K., "Effect of Gelatin Upon Muscular Work i n Man", American Journal  of Physiology, 134, 1941» pp.300-309. Litwins, J . , Sussman, L.N., and Peltenstein, M., "Hematologic and Chemical Changes i n Donors during Blood L e t t i n g " , American Journal of  C l i n i c a l Pathology, 20, 1950, pp. 1+6-47. Martin, J.W., and Myers, J.T., "The Effects of Blood Transfusion on Donors", Journal of Laboratory  and C l i n i c a l Medicine, 20, 1935, pp.593-597. Nelson, D.O., "Effects of Ethyl Alcohol on the Performance of Selected Gross Motor Tests", Research Quart- e r l y , 30, 1959, pp.317-320. Scott, M.G., Moody, M., and Wilson, M., "Validation of Mass Type Physical Tests with Tests of Work Capacity", Research Quarterly, 16, 191+5, pp. 128-138. Scott, M.G., and Wilson, M., "Physical E f f i c i e n c y Tests fo r College Women", Research Quarterly, 19, 1948, pp.62-69. Spealman, C.R., Bixby, E.W., Wiley, J.L., and Newton, M., "Influence of Hemorrhage, Albumin, Infusion, Bed Rest and Exposure to Cold on Performance i n the Heat", Journal of Applied Physiology, 1, 191+8, pp.2l;2l253: T u t t l e , W.W., "Effect of Physical Training on Capacity to Work as Measured by the Bicycle Ergometer", Journal of Applied Physiology, 2, 1950, pp.393-U l r i c h , C , and Burke, R.K., "Effect of Motivational Stress Upon Physical Performance", Research  Quarterly, 28, 1957, pp.lj.03-412. Walters, C.E., "A Study of the Effects of Prescribed Strenuous Exercises on the Physical E f f i c i e n c y of Women", Research Quarterly, 25, 1953, pp. 102-111. APPENDIX A STATISTICAL TREATMENT Study Design Two Groups A Experimental (N = 10) B Control (N = 10) One Test - performance of bicycle ergometer. administered f i v e times to each subject. group of subjects. (2) Placement of subjects into two groups equated on performance i n test 1. (3) Test 2 administered to Group A and Group B. ( I 4 . ) Calculation of r e l i a b i l i t y co-e f f i c i e n t between test 1 and test 2 . (5) Administration of t e s t 3. ( 6 ) Administration of test I4.. (7) Administration of test 5 . Procedure (1) Administration of test 1 to a 39 Test 1 Group A Group B Test 2 Test 2 Test 3 Test 3 Test I4. Test I}. Test 5 Test 5 General S t a t i s t i c a l Outline 1. Correlation of r e l i a b i l i t y c o e f f i c i e n t between test 1 and test 2. 2. Significance of differences i n performance of group A and group B on tests 3, I4., (Pour calculations) 3. Significance of difference i n performance of group A on tests 2, 3, k» 5 . (Six calculations) Significance of difference i n performance of group B on tests 2, 3t k-» 5 . (Six calculations) Procedure and Formulae 1. Correlation of r e l i a b i l i t y c o e f f i c i e n t between results of test 1 and test 2. Tabulation of data (Garrett, l,p.226) 1. No. of subjects. 2. Mean score -77" 3. Standard deviation ' /V- / U.0 ij.. Standard error of means S.£"-^ . - ~^  5 . Difference between means M1-M2 6. Correlation between i n i t i a l and f i n a l r e s u l t s . T = J i . e . Test 1 Group A J< Group B Test 2 Test 2 2. Significance of difference i n performance of group A and group B on tests 2, 3, k> 5 . (calculations 2, 3, *J-> 5) Difference of two independent means, Ma - mean of group A Mb - mean of group B C5~ ma - standard deviation of group A (T~mb - standard deviation of group B Differences i n means » Ma - Mb t r a t i o = Ma - Mb and w i l l be acceptable at the 5 perc l e v e l of confidence. ij-l i . e . Group A Test 2 Test 3 Test Ij. • Test 5 " Group B Test 2 Test 3 Test 1+ Test 5 Significance of difference i n performance of group A on tests 2, 3, k> (Calculations 6, 7, 8, 9, 10, 11) Method of difference (Garrett, l,p.227) MD a Mean of difference between test 2 and test 3. SDD s Standard Deviation of mean of difference. S.E.jyjD - Standard Error of mean of difference. t = M D and w i l l be acceptable at the SEMD 5 percent l e v e l of confidence. Similar s t a t i s t i c a l procedure for group B. i . e . Group A Test 2 lb Test 3 7 Test ]\ I 8 Test 5 >J.2 Thus i n Summary we have. Test 1 Group A Group B Test 2 h Test 3 17 , Test 1+ I' Test 5 Test 2 l f c Test i 3 I 7 Test 1 O I 8 Test 5 k3 REFERENCE 1 Garrett, H.E., S t a t i s t i c s i n Psychology and Education, New York, Longmans, Green and Co., 1958, pp. 226-227. APPENDIX B TIME TABLE FOR PROCEDURE Practice sessions - on days to be arranged. Day 1 - l a s t practice session. Day 8 - Test 1 Day 15 - Test 2 Day 22 - Test 3 - two hours after venesect-ion. Day 23 - Test 1; Day 30 - Test 5 APPENDIX C INDIVIDUAL SCORE SHEET NAME -ADDRESS -PHONE -HEIGHT -WEIGHT -SPORT -FACULTY -GROUP -Date Time Test Number Re suit s Test 1 Test 2 Test 3 Test 1+ Test 5 Did you believe that blood donation affected you i n t h i s test? • Have you ever given blood before? APPENDIX D RAW SCORES FOR GROUP A Subject 1 2 Mean 1 & 2 3 k 5 A 276 278 277 286 295 300 B 261 258 260 261 276 269 C 256 257 257 268 282 271 D 256 257 257 282 290 297 E 253 256 255 270 281 267 F 2^8 258 253 284 285 267 G 21+8 260 254 255 272 268 H 246 249 248 251 256 247 I 247 250 249 252 250 245 J 238 238 238 251 255 238 Mean SD 254.8 9.97 3.15 265.0 13.0 4 .1 273.2 15 .5 k.9 266.9 19.8 6 .3 APPENDIX E RAW SCORES FOR GROUP B > ject 1 2 Mean 1 & 2 3 1* 5 A 276 276 276 278 279 281* B 267 263 265 271 282, 280 C 256 255 256 266 268 260 D 258 251* 256 261* 281 267 E 256 251* 255 258 266 272 F 252 255 251* 251* 259 258 G 250 251* 252 263 257 276 H 250 250 250 278 268 276 I 239 21*1* 2I(.2 21*9 262 • 262 J 236 237 237 21*7 260 21*8 Mean 251*. 3 262.8 268.2 266 SD 10.88 10.96 9.38 11, 3.1*1* 3.1*7 2.97 3, 

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