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Non-weight bearing water exercise : changes in cardiorespiratory function in elderly men and women Jessop, Darrell James 1988

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Non-Weight Bearing Water Exercise:  Changes i n Cardiorespiratory  Function i n E l d e r l y Men and Women  by  D a r r e l l James Jessop B.Sc,  University of B r i t i s h Columbia, 1977  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PHYSICAL EDUCATION in THE FACULTY OF GRADUATE STUDIES School of Physical Education and Recreation  We accept this thesis as conforming to the required standards  THE UNIVERSITY OF BRITISH COLUMBIA October, 1988  © D a r r e l l James Jessop, 1988  In  presenting  degree  this  at the  thesis  in  University of  partial  fulfilment  of  of  department  this or  thesis for by  his  her  representatives.  for  an advanced  Library shall make it  agree that permission for extensive  scholarly purposes may be  or  requirements  British Columbia, I agree that the  freely available for reference and study. I further copying  the  It  is  granted  by the  understood  that  head of copying  my or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department of  Physical Education/Recreation  The University of British Columbia Vancouver, Canada  D a t e  DE-6 (2/88)  Octohftr l T  f  IQfifi  ABSTRACT Non-Weight B e a r i n g Water E x e r c i s e :  Changes i n C a r d i o r e s p i r a t o r y F u n c t i o n i n  E l d e r l y Men and Women The  purpose o f t h i s s t u d y was t o e v a l u a t e  of aquatic  exercise  participant.  t h e impact o f a 5 week program  on s e l e c t e d c a r d i o r e s p i r a t o r y parameters i n the e l d e r l y  F i f t e e n men and women (mean age 68.5 y e a r s , range 61-75 y e a r s )  were r e c r u i t e d v o l u n t a r i l y from r e g i o n a l a d u l t day-care and community  centre  facilities.  before  the  P a r t i c i p a n t s underwent a s e r i e s o f p h y s i o l o g i c a l t e s t s  program  and 5  started  weeks  Measurements i n c l u d e d h e i g h t ,  later  weight,  V„Emax ) , r e s t i n o g blood rpressure,  a t t h e end o f t h e program.  spirometry  r e s t i nog h e a r t  measurements  1 0 (FVC, FEV ,  rate, exercise heart  r a t e and  V0~ as d e t e r m i n e d by a c o n t i n u o u s t r e a d m i l l t e s t ( m o d i f i e d a f t e r Jones and 2max J  C a m p b e l l , 1982). Following (n = 8) showed (SBPR)  t h e 5 week a q u a t i c a significant  exercise  decrease  (EXPTL:131.5<CTRL:133.4  mmHg)  program, t h e e x p e r i m e n t a l  i n resting systolic  blood  pressure  and  rate  (HR  resting  heart  (EXPTL:71.0<CTRL:76.6 b t s ^ m i n " ) i n c o m p a r i s o n t o t h e c o n t r o l group 1  which  e x h i b i t e d no change.  significant  increase  (EXPTL:2.4>CTRL:2.2  I n a d d i t i o n , the experimental in  l-sec" ) 1  forced and  group  expiratory maximal  oxygen °  nt?cri  ,)  (n = 7)  group y i e l d e d a  volume uptake  (FEV''"'^) (V0 ) 2max o  - 1 - 1 (EXPTL:25.8>CTRL:23.5 ml*kg The  findings i n this  «min  study i n d i c a t e that  e l d e r l y p a r t i c i p a n t can increase exercise  ) i n comparison t o t h e c o n t r o l group.  with  aquatic  the exercise exercise:  capacity  supervised  a t o r above t h e recommended i n t e n s i t y o f e x e r c i s e  performed  o f the aquatic three  times w e e k l y c a n produce s i g n i f i c a n t changes i n t h e p h y s i c a l work c a p a c i t y o f the e l d e r l y .  ii  TABLE OF CONTENTS Page Abstract  . . .  i i  L i s t of Tables  '  iv  Acknowledgement  v  I  Introduction  1  II  Review o f L i t e r a t u r e  8  III  Methods and P r o c e d u r e s  35  IV  Experimental  38  V  Results  40  VI  Discussion  46  VII  Conclusions  59  V I I I Recommendations  61  IX  83  D e s i g n and Data A n a l y s i s  References  Appendix A  Time E f f e c t :  Means a t B a s e l i n e  L a t e r (T2) ( E x p e r i m e n t a l Appendix B  Time E f f e c t :  ( T l ) and 5 Weeks  Group, n = 8)  Means a t B a s e l i n e  ( T l ) and 5 Weeks  L a t e r (T2) ( C o n t r o l Group, n = 7) Appendix C  Means o f E x p e r i m e n t a l  62  63  and C o n t r o l Groups a t B a s e l i n e  ( T l ) and 5 Weeks L a t e r (T2)  64  Appendix D  Model f o r Repeated Measures D e s i g n  65  Appendix E  ANOVA T a b l e s '  66  Appendix F  C o n t r a i n d i c a t i o n s f o r E x e r c i s e P a r t i c i p a t i o n and T e s t i n g  Appendix G  Informed Consent Form  ... 79 81  iii  List of Tables Table I  Page Mean and S t a n d a r d D e v i a t i o n s o f P h y s i c a l and M e t a b o l i c C h a r a c t e r i s t i c s (Experimental  II  and C o n t r o l Groups Combined) ....  41  Mean and S t a n d a r d D e v i a t i o n s o f P h y s i c a l and M e t a b o l i c C h a r a c t e r i s t i c s ( E x p e r i m e n t a l v s . C o n t r o l Groups)  42  III  Summary o f V a r i a b l e A n a l y s i s  43  IV  Comparison o f S e l e c t e d Parameters w i t h Other S t u d i e s  44  V  Summary o f H y p o t h e s i s  45  Testing  iv  ACKNOWLEDGEMENT This  work  i s d e d i c a t e d t o Karen,  whose  unwavering  e n t h u s i a s m and  encouragment s p u r r e d me on and t o my p a r e n t s and f a m i l y who always  believed  i n me. I would a l s o l i k e o f t h i s work:  t o thank a l l t h o s e who a s s i s t e d me i n the c o m p l e t i o n  Dr. J a c k Taunton  (committee c h a i r m a n ) , committee  R i c h a r d Ham, Dr. E. Rhodes and Dr. P. Grantham.  A d d i t i o n a l thanks a l s o t o  Dr. Gary S i n c l a i r and Dr. R. S c h u t z . Thank you everyone f o r g i v i n g d i r e c t i o n t o my n e u r o t i c i s m .  v  members Dr.  INTRODUCTION  The o f the  aging  p r o c e s s has  been d e f i n e d  as a g r a d u a l  i n d i v i d u a l t o adapt t o changes i n the  the p o p u l a t i o n  ages, h e a l t h c a r e  special  of  needs  the  d e c l i n e i n the  environment ( B a r r y ,  professionals w i l l A  elderly.  program  of  be  regular  ability  1986).  As  pressed  t o meet  the  exercise  may  aid  in  meeting these goals. N o r t h Americans g e n e r a l l y engage i n l e s s p h y s i c a l a c t i v i t y as they According  to  between the  the  1981  ages o f  20  Canada  Fitness  and  engage i n s p o r t  24  a c t i v i t y a t l e a s t 3 h o u r s per week. and  69,  only  L e s s t h a n 9% exercise.  It  6.5%  are  Survey,  considered  or  seen t o engage i n r e g u l a r  o f Canadians over the is particularly  age  the  other  25%  of  forms o f  those  vigorous  W i t h i n d i v i d u a l s between the ages of  o f 55  activities  (Hogan,  p a r t i c i p a t e i n any  institutionalized  l e a s t a c t i v e ( M o l l o y and Watson, 1987). be  approximately  age.  adequately a c t i v e f o r maintaining  1986).  deliberate  e l d e r l y that  C u r r e n t l y , o n l y 24%  are  o f Canadians  or i m p r o v i n g  65  the can  cardiovascular  f i t n e s s (Hogan, 1986). An  understanding  physiological  decline  is  needed  i n aging  concerning  the  i n d i v i d u a l s and  the  r e l a t i o n s h i p between  the  e f f e c t s of e x e r c i s e  and  r e g u l a r a c t i v i t y , b o t h i n the p r e s e n c e and  absence o f d i s e a s e .  concerning appropriate  prescription guidelines  are  presently  activity  inadequate  i n i t i a t e d i n a d u l t h o o d and  (Holm  l e v e l s and and  continues  Kirchhoff,  t h r o u g h o u t the  d i f f e r e n t from e x e r c i s e t h a t commences i n o l d age an  acute  illness  (arthritis).  (such  as  a  1984).  cardiovascular  Information  Exercise  f o r them that  is  l i f e t i m e i n t o o l d age  is  a f t e r y e a r s of  e v e n t ) or  chronic  inactivity, debilitation  P h y s i o l o g i c a l changes t h a t are seen to o c c u r w i t h a g i n g may  d i f f i c u l t t o s e p a r a t e from those r e s u l t i n g from d i s e a s e  (Holm and  be  Kirchhoff,  - 2 1984), b u t i n c r e a s i n g e v i d e n c e s u g g e s t s t h a t much o f t h e d i s a b i l i t y the e l d e r l y i s a r e s u l t o f d i s u s e o r h y p o k i n e t i c The  literature  perspectives.  addresses  I n recent  aging  years,  there  disease  and  exercise  have  been  seen i n  (Hogan, 1986). from  reports  many of  varied  significant  improvements i n p h y s i o l o g i c f u n c t i o n and performance i n t h e e l d e r l y who have undergone  extensive  physical  training.  Evidence  i s accumulating  that  r e g u l a r , l o n g - t e r m e x e r c i s e slows t h e e f f e c t s o f t h e a g i n g p r o c e s s i n s e v e r a l body  systems  1982).  and h e l p s  Exercise  disease,  i n the prevention  may p r e v e n t o r r e v e r s e  disease  (Kent,  t h e e f f e c t s o f premature a g i n g and  b u t i t does n o t appear t o a f f e c t t h e " n a t u r a l " r a t e o f a g i n g ,  measured by t h e maximum l i f e studies  of cardiovascular  examining  span (Kent,  the e f f e c t s of regular  1982).  as  There a r e few c o n c l u s i v e  activity  on l o n g e v i t y  i n humans  ( M o l l o y and Watson, 1987). I n a d d i t i o n t o t h e e f f e c t o f e x e r c i s e i n t h e r e d u c t i o n o f m o r t a l i t y from cardiovascular increases  exercise  i n serum l i p i d  bone ( M o l l o y are  disease,  seen  and i n s u l i n  and Watson, 1987).  t o accompany  aging  decreased c a r d i a c reserve  has been  1986).  Aging  also  this  may  although lifestyles is  a  increased  blood  high  levels,  a  predominantly  These changes l i m i t the e l d e r l y  levels  i n s t i g a t e s an o v e r a l l  problem  pressure  that  c a p a c i t y and c h e s t w a l l c o m p l i a n c e , r e s u l t i n g  of aerobic  decrease  related  to  i n the e l d e r l y  fitness  i n muscular changes  ( i . e . decreased l e v e l s o f a c t i v i t y ) (Piscopo,  serious  loss i n  The i n e v i t a b l e p h y s i o l o g i c a l changes  include  to maintain  be  age-related  l e v e l s and reduce t h e m i n e r a l  i n a r e d u c e d maximum v o l u n t a r y v e n t i l a t i o n . capacity  the  ( p r i m a r i l y secondary t o a d e c r e a s e i n maximal h e a r t  r a t e ) , and a d e c r e a s e i n v i t a l  individual's  shown t o l e s s e n  strength,  i n individual  1985).  and i t s s e q u e l a e  Osteoporosis  (i.e. vertebral  c o m p r e s s i o n and h i p f r a c t u r e s ) a r e major causes o f m o r t a l i t y ( B a r r y , A g i n g causes a d e c r e a s e i n bone d e n s i t y  (Barry,  1986).  o f a p p r o x i m a t e l y 30% t o 50% a t the  - 3 r a t e o f a p p r o x i m a t e l y 0.4% p e r y e a r , b e g i n n i n g a t about age 50 (Hogan, Men  do n o t e x p e r i e n c e d i f f i c u l t i e s  1986).  as a r e s u l t o f t h e c u m u l a t i v e e f f e c t s o f  o s t e o p o r o s i s u n t i l a p p r o x i m a t e l y t h e e i g h t h decade o f l i f e  ( B a r r y , 1986).  In  women, bone l o s s may b e g i n a t age 30-35 y e a r s and c o n t i n u e s a t a more r a p i d r a t e t h a n t h a t o b s e r v e d i n man.  The r a t e o f bone l o s s i n woman may p r o g r e s s  from a p p r o x i m a t e l y 1% p e r y e a r t o 2% - 3% p e r y e a r a t post-menopause (Mazess; 1979, Smith, 1982). or  I n d i v i d u a l s t h a t a r e i m m o b i l i z e d , b e d r i d d e n (unweighted)  who have e x p e r i e n c e d a l o s s  o f muscular  f u n c t i o n may e x p e r i e n c e an even  g r e a t e r r a t e o f bone l o s s , as h i g h as 1% p e r week ( B a r r y , 1986). of  regular  exercise  on  the  structural  d e m o n s t r a t e d i n numerous s t u d i e s .  integrity  of  I t has been shown t h a t  The e f f e c t s  bone  have  been  t h e bone m i n e r a l  c o n t e n t i n t h e c o r t e x i s t h i c k e r i n i n d i v i d u a l s who e x e r c i s e r e g u l a r l y when compared t o t h o s e who do n o t ( D a l e n and O l s s o n , 1974; Jones Montoye e t a l . ,  1980).  From t h e f i f t h decade o f l i f e , per  decade w i t h  the greatest l o s s  t r u n k ( B a r r y , 1986). disuse  from  a  e t a l . , 1977;  t h e r e i s a 3% - 5% l o s s o f muscle  tissue  seen i n t h e m u s c u l a t u r e o f t h e l e g s and  T h i s l o s s o f muscle t i s s u e i s enhanced by t h e r e s u l t i n g  sedentary  lifestyle.  Decreased  flexibility  is  usually,,  e n c o u n t e r e d w i t h t h e l o s s o f m u s c u l a t u r e ; a g e - r e l a t e d d e g e n e r a t i v e changes i n the  elastin  arthritis all  of connective  tissue  and  the e f f e c t s  of osteoporosis  and  i n a d d i t i o n t o the a c t u a l shortening o f the musculo-tendinous  unit  c o n t r i b u t e t o a decrease i n o v e r a l l f l e x i b i l i t y .  yielded  significant  improvements  i n joint  flexibility  E x e r c i s e programs have and range  o f motion  (Munns, 1981). A s l o w i n g i n r e a c t i o n time i s seen w i t h  i n c r e a s i n g age, b u t t h i s  appears t o be r e l a t e d t o d i s u s e from i n a c t i v i t y . function i n elderly of  absent  individuals  deep tendon  reflexes  Decreased p e r i p h e r a l nerve  i s s u b s t a n t i a t e d by t h e i n c r e a s e d (Hogan,  1986).  also  In addition  incidence  to the o v e r a l l  r e d u c t i o n i n sensory  4  f u n c t i o n , a s l o w i n g o f m e n t a t i o n and impairment o f motor  responses are noted.  C o o r d i n a t i o n and  poor  inability  motivation  Regular  and  exercise  cognitive  and  has  been  psychomotor  e f f e c t s on d e p r e s s i o n ,  and  mental  expenditures.  in  perform  shown  years  d e c l i n e , c o n t r i b u t i n g to  everyday  to  slow  the  f u n c t i o n as  well  as  disorders  head  H e a l t h expenses c o n t i n u e  the  may  tasks  (Barry,  deterioration in proving  to have  1986). memory,  beneficial  ( h e a r t d i s e a s e , s t r o k e and h y p e r t e n s i o n ) , d i g e s t i v e  number o f m i d d l e - a g e d and costs  to  balance  a n x i e t y and s t r e s s ( M o l l o y and Watson, 1987).  C i r c u l a t o r y diseases diseases  -  the  list  of  current  health  care  t o r i s e and w i t h the i n c r e a s e i n the  older adults, h e a l t h p r o f e s s i o n a l s forecast higher  ahead  (Piscopo,  1985).  The  prospect  of  continued  e s c a l a t i o n i n h e a l t h c a r e s p e n d i n g makes i t a major i s s u e f o r b o t h the p u b l i c and p r i v a t e s e c t o r s o f our s o c i e t y . Our h e a l t h c a r e system i s p r i m a r i l y d e s i g n e d  to a s s i s t i n d i v i d u a l s a f t e r  they have become i l l or f u n c t i o n a l l y i n c a p a c i t a t e d . b u t the i n d i v i d u a l ' s enjoyment o f l i f e , to has  s o c i e t y outweigh any  b u t we  q u a n t i t a t i v e dimension of aging.  health  and  measures.  development  of  emphasis on  f a c t o r s which w i l l  acute  It  well-being  promotional  important  so.  care  is  clear  through that  modalities  maintenance aspects  of  Many s p e c i f i c  of h e a l t h care.  e l d e r l y have been documented and  and  be c o n t r o l l e d  a  must be  preventative continuing balanced  improve the q u a l i t y  health  technology  the v a l u e o f i m p r o v i n g  i n d i v i d u a l and improve t h e i r a b i l i t y t o m a i n t a i n The  t o do  Medical  c u r a b l e and the e f f e c t s o f many o t h e r s can now  have o n l y r e c e n t l y begun t o r e c o g n i z e  population's  i s desirable,  sense o f w e l l - b e i n g and c o n t r i b u t i o n s  expanded the a g i n g p o p u l a t i o n and w i l l c o n t i n u e  d i s e a s e s are now  Longevity  the aged  and  emphasis with  of l i f e  an  health on  the  increased  f o r the  elderly  independence.  preventative  medicine  have  emerged  as  The b e n e f i c i a l e f f e c t s o f e x e r c i s e f o r the i t i s b e l i e v e d t h a t the  elderly  should  be  - 5 encouraged  to  engage  in  regular  physical  exercise.  With  number o f s u c h programs, i t has become n e c e s s a r y t o e v a l u a t e  the  increasing  them i n terms of  t h e i r a b i l i t y t o p o s i t i v e l y change the l e v e l o f f i t n e s s i n the p a r t i c i p a n t . The  factors preventing  the  e l d e r l y from p a r t i c i p a t i n g i n a  structured  e x e r c i s e program are v a r i e d , numerous and not u n l i k e the reasons c i t e d by younger  population  activities may  be  for  (Piscopo, seen  as  not  implementing  1985). a  Factors  cardiopulmonary  (Alzheimer's,  stroke),  to  impairment by  metabolic  disorders  a r e a s o f c o n c e r n w i t h e x e r c i s e and the m o t i v a t i o n  unique t o  contraindication  osteoporosis,  regular  exercise  the  an  in  their  daily  e l d e r l y population  exercise  program  decreased  deficit  mobility.  Some  i t s p r e s c r i p t i o n i n the e l d e r l y has  t o e x e r c i s e , the r i s k o f i n j u r y and  that  include  pathology, n e u r o l o g i c a l and  the  been  the r e q u i r e m e n t f o r p r o p e r  m e d i c a l assessment b e f o r e p a r t i c i p a t i o n i n an e x e r c i s e program (Hogan, 1986). In  supervised  exercise  programs,  p r o h i b i t p a r t i c i p a t i o n has In  20%  of  permanent  the  essential  of  of  disease  before  Underlying  activity  states  i n the  prescribing  exercise  disease but  as  program t o s u i t the Aquatic effective (Koszuta,  or  be  t o 50%  severe  (Piscopo,  1985).  of  n o t be  i n d i c a t i o n of  the  considered  as  requirement  to  to  to  warrant the  high  assessment  is  detection  of  The  a c o n t r a i n d i c a t i o n to modify  the  exercise  individual.  in-pool  exercise  Water  programs have  r e c e n t l y been  e x i s t i n g l e v e l s of  programs  provide  a  cited  fitness i n injured means  m u s c u l a t u r e can be e x e r c i s e d ; the f l u i d medium p r o v i d e s o f r e s i s t a n c e and  enough Due  exercise.  to  of p a r t i c i p a n t s .  e l d e r l y , p r i o r medical  program  enough  s h o u l d be the f o c u s o f t h i s assessment (Hogan, 1986).  means t o m a i n t a i n 1986).  any  states should an  injury w i l l  the  ischaemic heart disease  i n j u r y serious  been seen t o o c c u r i n up  p a r t i c i p a n t s , the  cessation  prevalence  musculoskeletal  the buoyant f o r c e s d e c r e a s e the  by  which  the  as  an  runners major  an accommodating type  impact f o r c e s  i m p a r t e d to  - 6 the  participant.  Conventional  "walk-jog"  programs may  even p o s s i b l e f o r the e l d e r l y i n d i v i d u a l who gait  problems  conditions.  as  a  r e s u l t of  Clinically  and  orthopedic  f o r the  not  be  practical  e x h i b i t s decreased  i n t e r v e n t i o n or  m o b i l i t y or  chronic  purpose o f p r o v i d i n g  or  arthritic  these i n d i v i d u a l s  w i t h a means by w h i c h they can i n c r e a s e t h e i r l e v e l o f f i t n e s s i n a s a f e enjoyable  manner,  investigation into  programs i s b o t h w a r r a n t e d and Water  exercise  flexibility  has  and  participants'  been  level  shown  and  heat-stress  utilizes  resistance  water's  to  provide  of  aquatic  i t s benefits  conditioning  i t reduces  overuse syndromes and the  potential  exercise  necessary.  cardiovascular  skill  the  and  the  achieve  or  strength,  independently likelihood  problems ( K o s z u t a , to  to  of  1986).  maintain  of  the  injury  from  Water  exercise  fitness:  vigorous  movements f o r a p r e s c r i b e d l e n g t h o f time account f o r the c a r d i o v a s c u l a r respiratory benefits.  The  " a e r o b i c " water e x e r c i s e s e s s i o n s  are  similar  and to  the l a n d - b a s e d c l a s s e s i n t h a t choreographed movements are p e r f o r m e d t o music while  an  i n s t r u c t o r leads  from  u s u a l l y l a s t f o r one  hour and  the  chest  water  is  only  P a r t i c i p a n t s are intensity  or  the  pool  are h e l d i n the  deep,  the  of  their  own  workout.  t o engage i n a s u p e r v i s e d  p o s s i b l e f o r them on d r y l a n d . b e n e f i t s , a r t h r i t i c s may  In  shallow  the end  water.  Classes  o f the p o o l . not  be  swimmers.  they can  a d d i t i o n , water  As  vary  acts  as  the an  have a r t h r i t i s or back problems  e x e r c i s e program w h i c h may  not  be  I n a d d i t i o n to the p o t e n t i a l c a r d i o v a s c u l a r  b e n e f i t from t h i s e x e r c i s e as w e l l p a r t i c u l a r l y when  r a n g e - o f - m o t i o n e x e r c i s e s are i n c l u d e d ( K o s z u t a ,  1986).  There have been few n o t e w o r t h y s t u d i e s c o n c e r n i n g elderly.  in  i n s t r u c t o r and  e q u a l i z i n g medium as i t p r o v i d e s p a t i e n t s who an o p p o r t u n i t y  or  p a r t i c i p a n t s need  encouraged t o f o l l o w the  pace  deck  w a t e r e x e r c i s e and  the  I t w i l l be the purpose o f t h i s s t u d y to i n v e s t i g a t e the impact of a  5 week program o f a q u a t i c  e x e r c i s e on s e l e c t e d c a r d i o r e s p i r a t o r y parameters  - 7 in  the  elderly  representative Lower M a i n l a n d .  participant.  of, adult  The  day-care  subjects  will  and community  be  culled  from,  centre f a c i l i t i e s  These p e o p l e a r e , f o r the most p a r t ,  and  i n the  u n f i t v o l u n t e e r s who  a l l e x h i b i t some degree o f s o c i a l impairment and i s o l a t i o n .  - 8LITERATURE REVIEW  Numerous  studies  have  attempted  exercise  and h e a l t h  interest  i n how t h e e l d e r l y f e e l  to describe  ( B e l l o c and B r e s l o w ,  t h e r e l a t i o n s h i p between  1972) and r e s e a r c h e r s  about h e a l t h  and p h y s i c a l  have  shown  activity.  One  s t u d y c h a r a c t e r i z e d t h e b e l i e f s t h a t t h e e l d e r l y h e l d c o n c e r n i n g e x e r c i s e and physical attitudes  activity  i n general  included  decreases w i t h  (Sidney  (1) t h e y p e r c e i v e d  age; (2) e x e r c i s e  and Shephard,  i s dangerous;  (3) l i g h t ,  and (4) t h e i r own p e r s o n a l  limited.  contention  author's  consequence o f p r e v a l e n t should  social  Some  the requirement f o r p h y s i c a l  is b e n e f i c i a l to health; The  1976).  was  that  o f the activity  sporadic  exercise  physical a b i l i t i e s  such  attitudes  a t t i t u d e s which decree  that  may  were  be the  an i n d i v i d u a l  "slow down" a t r e t i r e m e n t .  With aging, developmental  the older i n d i v i d u a l i s faced with adapting  changes  physical health,  (Riffle,  a possible  1982).  increase  These  include  to a v a r i e t y of  an a l t e r e d  i n dependency l e v e l ,  state of  d e a l i n g w i t h the  l o s s o f a spouse and f a m i l y members ( s i b l i n g s ) and f r i e n d s t h r o u g h death, and a p o s s i b l e change i n l i v i n g s i t u a t i o n . to  less  physical  potentially  activity,  negative  functioning.  presenting  effects  Clinically,  A g i n g a l s o tends t o p r e d i s p o s e people  upon  this  a  both  could  situation  that  psychological  constitute  has  numerous  and p h y s i o l o g i c a l  a health  threat  (Riffle,  1982). The  elderly's perception  inclination Shephard,  1977b) have  administered exercise  f o r exercise.  Studies  shown  to volunteers  o f e x e r t i o n appears t o be i m p l i c a t e d w i t h the  that  than t h a t p e r c e i v e d  when  (60-70  program, t h e p e r c e p t i o n  (Sidney  years  and Shephard,  t h e Borg  1977; S i d n e y and  Psychophysical  o f age) d u r i n g  a  Scale  pre-retirement  o f p h y s i c a l e x e r t i o n was 2-3 u n i t s  by younger a d u l t s  (age 30-50) i n p r e v i o u s  was  studies.  higher This  - 9 d i f f e r e n c e was  noted at a l l heart  rates.  s i g n i f i c a n t l y change t h i s p e r c e i v e d r e s u l t i n g heart  also reported  years  of  age)  activity  t h a t men  tended  monitored  (Sidney  and  (Sidney  overestimate  heart  rates  Shephard,  time  did  not  1977).  A  devoted  coincide  seen to  Shephard,  1977).  subjects  to  60-80  exercise,  with  substantial  a c t u a l l y devoted to a c t i v i t i e s which r e s u l t e d i n heart per  and  and women (the sample c o n t a i n e d  to  not  e x e r t i o n a t any work l o a d even though the  r a t e s were s u b s t a n t i a l l y lower  I t was  continuously  P h y s i c a l t r a i n i n g was  the  amount  as  described  of  time  r a t e s below 120  was  beats  minute. The  issues  variables  in  addressed.  o f whether poor h e a l t h  the  The  elderly's  attitudes  o r a f e a r o f e x e r t i o n are  important  concerning  not  exercise  have  been  r e a s o n ( s ) f o r tendency t o engage i n fewer p h y s i c a l a c t i v i t i e s  w i t h i n c r e a s i n g age  i s / a r e not c l e a r .  Epidemiology These s t u d i e s are o f importance t o the f i e l d o f a g i n g b e n e f i c i a l requirement f o r p h y s i c a l a c t i v i t y part  of  fitness  a  normal,  by  subsequent  the  healthy  public  studies  lifestyle.  was  outlined  indicated  that  i n f a r c t i o n and  routinely  physically  involved  compared w i t h conclusion  in  i s that  physical  occupationally  Morris'  Hedley  (1939).  incidence  and/or  active  selection"  observations  were  encourage i t as  This  physical  study  and  events,  sudden d e a t h , were l o w e r i n  subjects  active  and  of  in  cardiovascular  inactivity  demanding  i s not  as  potent  occupations The a risk  when  historical factor  as  hypercholesterolemia.  M o r r i s e t a l . (1958, 1973)  "occupational  by  i n d i v i d u a l s engaged i n s e d e n t a r y o c c u p a t i o n s .  smoking, h y p e r t e n s i o n  in  a need t o  Originally, interest  the  p a r t i c u l a r l y myocardial  and  as t h e y suggest a  s i m i l a r l y reported rates of cardiac m o r t a l i t y  subjects may  have  even  though  influenced  substantiated  at  it the  was  determined  outcome.  postmortem  that  Regardless,  examination  by  the  10 appearance  of  d i f f e r e n c e s i n the  comparing  active  and  sedentary  "weekend"  bouts  of  increased  type  of  lesions  people.  He  physical  activity  i n the  concluded  myocardium  that  even  produced  when  isolated  benefits  not  c o n f e r r e d to t o t a l l y sedentary populations. A c t i v e p o p u l a t i o n s may coronary  heart  sudden d e a t h  disease  are  even when the  lower  physical activity  exhibit higher  (Naughton,  i s not  i n c i d e n c e s o f v a r i e d symptoms o f  overall  1982).  incidence  Therefore,  of  infarction  and  i t i s apparent  s o l e l y p r e v e n t a t i v e o f the development o f  that  coronary  obstruction. Kannel  and  Sorlie  (1979)  (the  Framingham  Study)  typified  physical  i n a c t i v i t y as a r i s k f a c t o r i n the development o f i s c h a e m i c h e a r t d i s e a s e i n men  of  first  a l l ages. emphatic  physical  To  this  health  The  statement  Framingham i n v e s t i g a t i o n  concerning  the  need  to  provided  promote  the  regular  activity.  Paffenbarger's  (1978) l o n g i t u d i n a l s t u d y a l l o w e d c o n t r o l l e d o b s e r v a t i o n s  f o r the major c o r o n a r y direct  end,  relationship  risk factors.  The  between o c c u p a t i o n a l  f i n d i n g s suggest or  that there i s a  leisure-time activity  and  the  incidence of c a r d i a c events. Physiological  Observations  V a r i o u s p o p u l a t i o n groups have been i n v e s t i g a t e d . S t u d i e s have examined physically  active  subjects  and  c o n d i t i o n i n g on p r e v i o u s l y s e d e n t a r y d e s i g n o f the s u b j e c t s are rates,  have  study, capable  lower  the of  heart  determined  the  subjects.  Regardless  f i n d i n g s have been c o n s i s t e n t :  r a t e s and  systolic  blood  of  physical  o f the i n t e n t physically  a g r e a t e r work c a p a c i t y , have lower  e x e r c i s e t h a n s e d e n t a r y s u b j e c t s (Naughton, 1982). a l s o promotes  effects  pressures  resting in  and  active heart  submaximal  Regular p h y s i c a l a c t i v i t y  i n c r e a s e d l e a n body mass ( i . e . i n c r e a s e d muscle mass w i t h  a  - 11 corresponding  d e c r e a s e i n p e r c e n t body f a t . ) ,  improved g l u c o s e  t o l e r a n c e and  improved i n s u l i n t o l e r a n c e . The  i n f l u e n c e o f age on p h y s i c a l f i t n e s s  investigated  b y Naughton  (1982),  Robinson  i n healthy  (1938)  s u b j e c t s has been  and D i l l  (1963).  The  f i n d i n g s have been c o n s i s t e n t i n t h a t t h e l e v e l o f p h y s i c a l f i t n e s s decreases w i t h age i n b o t h men and women. fitness  t h a n men.  selection, attempted  sedentary  These s t u d i e s were c r o s s - s e c t i o n a l and b i a s e d by s u b j e c t  particularly to correct  population  A t a l l ages, women e x h i b i t e d lower l e v e l s o f  this  i n relation activity).  i n t h e young by studying  to their  Their  based on a c t i v i t y l e v e l s  subjects. fitness  Taylor levels  a c t i v i t y patterns  and Montoye reported  (vigorous,  (1974)  i n healthy moderate o r  findings indicated that differences i n fitness  e x i s t e d across  a l l ages, b u t t h a t  regardless of  group a s s i g n m e n t , t h e l e v e l o f p h y s i c a l f i t n e s s d e c r e a s e d w i t h a d v a n c i n g age. A l e x a n d e r (1974) examined t h e d e c r e a s e o f f i t n e s s w i t h age b a s e d on some o f the r e p o r t e d o b s e r v a t i o n s .  He found a d e c r e a s e i n p h y s i c a l f i t n e s s  from 0.93 t o 1.04 ml oxygen p e r k g body w e i g h t p e r m i n w i t h each year  (when d e t e r m i n e d  analyzed  i n relation  successive  When t h e decrease was  i n r e l a t i o n to h a b i t u a l p h y s i c a l a c t i v i t y s t a t u s , the d e c l i n e with  a d v a n c i n g age was s t e e p e r subjects.  t o body w e i g h t ) .  ranging  Naughton  f o r the sedentary  and Nagle  (1965),  than f o r the p h y s i c a l l y a c t i v e  studying  a  healthy  m i d d l e - a g e d men, d i d n o t f i n d t h e u s u a l h i g h l e v e l o f f i t n e s s  population  i n t h e younger  s u b j e c t s b u t a d e c r e a s e w i t h men i n t h e p o p u l a t i o n group s t u d i e d . t h a t t h e f i t n e s s l e v e l s were n e a r l y i d e n t i c a l a c r o s s  of  They found  t h e f o u r decades.  This  i n d i c a t e s t h a t many young s u b j e c t s i n t h e g e n e r a l p o p u l a t i o n may n o t develop a h i g h l e v e l o f f i t n e s s and t h a t f o r t h e n o n a c t i v e p o p u l a t i o n t h e more normal l e v e l f i t n e s s i s 32 ml oxygen p e r k g body w e i g h t p e r m i n o r about 8 t o 9 mets ( 1 met = approx. 3.5 ml oxygen p e r k g body w e i g h t p e r m i n . ) , i n s t e a d o f the significantly  higher  levels  reported  by  other  investigators.  Eighteen  - 12 subjects  were  re-evaluated  following  fitness  l e v e l s had increased  healthy  i n d i v i d u a l s o f a l l ages  expected that  expression  a  and i t was  regardless  a capacity  o f age.  resting  heart  and an  demonstrated rate  (as an  e f f i c i e n c y while  those who higher  trained systolic  irregularly blood  showed a d e c r e a s e d  pressure  values  at rest.  a u t h o r s a l s o s t a t e t h a t t r a i n i n g induces a d e c r e a s e i n m y o c a r d i a l  a higher  aerobic  that  Therefore,  f o r conditioning  C u p e l l i e t a l . (1984)  decreased  found  o f d e c r e a s e d s y m p a t h e t i c s t i m u l a t i o n o f t h e s i n o a t r i a l node) and a  consumption. with  have  t r a i n i n g provided  p h y s i c a l work c a p a c i t y w i t h The  significantly  range o f change i s o b t a i n e d .  regular  greater  conditioning  Their conclusions basic blood  oxygen  a r e t h a t e l d e r l y s u b j e c t s , p a r t i c u l a r l y those  pressure,  should  be encouraged t o p a r t i c i p a t e i n  activities.  Investigators  have s t u d i e d  the e f f e c t s o f p h y s i c a l  activity  l i p i d s , p a r t i c u l a r l y c h o l e s t e r o l , t r i g l y c e r i d e s and h i g h - d e n s i t y c h o l e s t e r o l (HDL-C) (La Rosa e t a l . , 1981). been f o u n d t o i n f l u e n c e  on serum  lipoprotein  P h y s i c a l a c t i v i t y i t s e l f has n o t  serum c h o l e s t e r o l , as w e i g h t l o s s c o r r e s p o n d i n g t o  the a c t i v i t y program may cause t h e d e c l i n e i n c h o l e s t e r o l .  As p e r c e n t body  fat  i s r e d u c e d (and l e a n body mass i n c r e a s e d ) , t r i g l y c e r i d e  l e v e l s a r e seen  to  decrease.  significantly  La  Rosa  b y physical  (1981)  concluded  activity  that  programs.  HDL-C  i s not  I t i s suggested  affected  that  prior  s t u d i e s t h a t have shown a s i g n i f i c a n t r e l a t i o n s h i p between HDL-C and p h y s i c a l a c t i v i t y e x h i b i t bias i n subject had  shown e a r l i e r  that  selection.  t h e average HDL l e v e l was 33% h i g h e r  t h a n i n s e d e n t a r y men and 25% h i g h e r  s e d e n t a r y men on a w a l k i n g described  increase  i n HDL l e v e l s among obese  program w i t h o u t d i e t a r y changes. a progressive  r e l a t e d to the quantity of exercise.  i n men runners  i n women r u n n e r s t h a n s e d e n t a r y women.  Leon e t a l . (1977) showed a s i g n i f i c a n t  (1980) summarily  I n c o n t r a s t , Wood e t a l . (1977)  increase  i n HDL  Hartung e t a l . levels  directly  - 13 I  CARDIOVASCULAR CHANGES WITH AGING - AN OVERVIEW A gradual  Kirchhoff,  1984).  decline with the  d e c l i n e i n a l l body systems i s presumed w i t h a g i n g Although  a d v a n c i n g age,  diminution  with  exercise  does  help  to retard  i t cannot p r e v e n t i t .  age i n t h e b e n e f i c i a l  Studies  effects  (Holm and  cardiovascular have documented  of exercise  on t h e  c a r d i o v a s c u l a r system (Montoye, 1982). Blood  pressure  increases  increasing t o a greater output  response  extent  to exercise  with  age, w i t h  systolic  than d i a s t o l i c pressure.  A decreased  may be due t o t h e i n t r i n s i c  a g i n g myocardium t o r e s p o n d t o an a d d i t i o n a l l o a d p l a c e d by decrements i n the v a s c u l a r network. the  decrease  i n exercise  stroke  pressure cardiac of  the  upon t h e v e n t r i c l e (1984) s t a t e  that  i s p r i m a r i l y due t o an i n c r e a s e i n  a f t e r l o a d and i s n o t r e l a t e d t o changes contractility.  inability  Holm and K i r c h h o f f  volume  blood  i n preload  ability  and m y o c a r d i a l  I t i s f e l t t h a t the c o m b i n a t i o n o f d e c r e a s e s i s maximal h e a r t  r a t e and e x e r c i s e s t r o k e volume reduces c a r d i a c o u t p u t (Yerg e t a l . , 1985). Y i n e t a l . , (1981) i n an a n i m a l s t u d y ,  demonstrated a 20% i n c r e a s e i n  impedance and a 28% d e c r e a s e  i n peripheral  resistance  stroke  (dogs) d u r i n g  graded  volume  i n o l d animals  c o n t r a s t , the younger a n i m a l s showed no i n c r e a s e  similar  exercise  cardiovascular  levels.  response  The marked  to exercise  treadmill exercise.  increase  difference  resulted  no i n c r e a s e i n In  i n impedance, a p r o g r e s s i v e  d e c r e a s e i n p e r i p h e r a l r e s i s t a n c e and a p r o g r e s s i v e at  with  i n s t r o k e volume  i n the older  i n a reduced  cardiac  animals output,  h e a r t r a t e , maximal e x e r c i s e c a p a c i t y and oxygen consumption. Wenger (1981) o u t l i n e d f o u r f e a t u r e s individual's capacity (V02  m a x  t o work:  that u l t i m a t e l y l i m i t  1) a d e c r e a s e i n maximal oxygen consumption  ) ; 2) a d e c r e a s e i n maximal h e a r t  r a t e , 3) a d e c r e a s e i n the  s t r o k e volume, and 4) a r e s u l t a n t d e c r e a s e i n c a r d i a c o u t p u t . VO  the e l d e r l y  exercise  A decline i n  h a s been demonstrated i n many s t u d i e s , b o t h c r o s s - s e c t i o n a l l y  (Hossack  14 and  B r u c e , 1982; S t r a n d e l l ,  R o b i n s o n e t a l . , 1975). adult years  1963) and l o n g i t u d i n a l l y  This  decline  i n VO. 2max  (Astrand e t a l . ,  i s linear  (McArdle e t a l . , 1981) and i s e s t i m a t e d  1973;  t h r o u g h o u t the  t o amount t o a t o t a l l o s s  o f 30-40% i n t h e 65 y e a r o l d compared t o t h e young a d u l t (Shephard, 1978). From age 20 y e a r s  t o 45 y e a r s ,  there i s l i t t l e  V O 2 d u r i n g i n c r e m e n t a l graded t r e a d m i l l w a l k i n g 45 y e a r s ,  t h e i n c r e a s e i n V0£ i s s l i g h t ,  and r e p r e s e n t s and  Adams  walking  a s m a l l decrease i n walking  e t a l (1969)  reported  a t submaximal work l o a d s .  age d i f f e r e n c e seen i n  (Montoye, 1982).  although  statistically  efficiency.  significant  Hanson e t a l . (1968)  no age d i f f e r e n c e s  i n V0£  On a c y c l e ergometer,  among  adults  the oxygen uptake  d u r i n g submaximal e x e r c i s e was n o t r e l a t e d t o age i n a d u l t s 1967).  Beyond age  (Julius et a l ,  T h i s i s a l s o t r u e f o r ergometry ( D u r n i n and M i k u l i c i c , 1956) a l t h o u g h  N o r r i s e t a l . (1955) r e p o r t e d a h i g h e r oxygen r e q u i r e m e n t f o r o l d e r  subjects  i n arm work.  A l o n g w i t h a demonstrated d e c l i n e i n maximal h e a r t r a t e , i t can  be  the heart  seen t h a t  (Whitbourne, responsible  1985).  loses  Both  i t s efficiency  as a pumping d e v i c e  c e n t r a l and p e r i p h e r a l a g e - r e l a t e d  f o r the reported  age l o s s e s  i n maximum h e a r t  rate  w i t h age  changes a r e and oxygen  consumption. A reduction  i n the l e f t  (Whitbourne, 1985).  v e n t r i c u l a r e j e c t i o n volume  i s seen w i t h age  T h i s p o t e n t i a t e s a d e c r e a s e d s t r o k e volume and r e s u l t s  i n a d e c r e a s e d c a r d i a c o u t p u t (Hossack and B r u c e , 1982; J u l i u s e t a l , 1967; P o r t e t a l . , 1980; R o b i n s o n e t a l . , 1975). Maximum oxygen consumption (V0 ) i s t h e r e f o r e reduced, as t h e r e s u l t i n g d e c r e a s e i n b l o o d f l o w 2max ° o  compromises  arterial  Ventricular  efficiency  overall The  increase  and  i s reduced  subsequent  anatomical  t o complete  the l e f t  tissue  due t o i n c r e a s e d  i n v e n t r i c u l a r mass  e f f e c t o f these  required  flow  oxygen  wall  extraction.  thickness  and an  ( G e r s t e n b l i t h , 1980; L a k a t t a ,  1979).  changes i s seen w i t h an i n c r e a s e i n the time v e n t r i c u l a r cardiac  cycle  (Granath  et al. ,  - 15 1970;  McArdle et  contractility  a l . , 1981;  i s observed  and/or a b n o r m a l i t i e s  may  Port  e t a l , 1980).  (Whitbourne, 1985). be  noted  during  Several  be i n a d e q u a t e l y  i n v e s t i g a t i o n s support  S-T  ischaemia  decreased  increase i n blood Sidney, and 1981)  1978).  diastolic and  occur  to  the  accommodate  and  hypothesis  blood  pressures  subrnaximal  the  that peripheral factors  systemic  One  suggestion  systolic  i s that  r e s i s t a n c e to b l o o d  flow  surges  The  and  seen i n o l d e r age (Bengsston et  populations  a l . , 1978)  and  flow,  result is an  overall  Shephard  T h i s mechanism c o u l d account f o r the h i g h e r r e s t i n g  during  and  systolic  (Sato  maximal  et  al. ,  exercise  1978).  A r e d u c e d o v e r a l l muscle mass may J  elderly.  may  f l o w d u r i n g e x e r c i s e (Brooks and Fahey, 1984;  (Bengsston et a l . ,  the  Therefore, i t  t o an i n c r e a s e d r i g i d i t y o f the a r t e r i a l w a l l s . ability  depression  s u p p l i e d w i t h oxygen.  the p e r i p h e r a l v a s c u l a r system i n c r e a s e s  a  myocardial  segment  Montoye, 1975).  are r e s p o n s i b l e f o r a d e c l i n e i n c a r d i a c f u n c t i o n .  t h i s b e i n g due  in  E l e c t r o c a r d i o g r a p h i c changes  a p p a r e n t t h a t a temporary, e x e r c i s e - i n d u c e d  i n v o l v e d m u s c u l a t u r e may  reduction  exercise;  b e i n g the most common (Bengsston e t a l . , 1978; is  A  Less  a l s o account f o r a d e c r e a s e d V0_ in 2max  oxygen i s e x t r a c t e d by  s k e l e t a l muscles r e q u i r i n g oxygen d u r i n g  the  muscles  exercise  as  there  (Brooks and  are  fewer  Fahey,  1984;  McArdle e t a l , 1981). With  advancing  age,  What p r o p o r t i o n o f these what i s due  A.  alterations  occur  changes i s due  to environmental  in  the  cardiovascular  t o the p r o c e s s  of aging  system.  alone  and  i n f l u e n c e s i s unknown.  Maximal Exercise 1.  Oxygen consumption (^2max^  The  maximal c a p a c i t y o f the c a r d i o v a s c u l a r system t o d e l i v e r oxygen to  the w o r k i n g muscles has been shown t o d e c r e a s e w i t h age.  T h i s has been found  16 i n l o n g i t u d i n a l (Dawson and H e l l e b r a n d t , 1945) and i n c r o s s - s e c t i o n a l s t u d i e s ( A s t r a n d , 1960; R o b i n s o n , 1938); e s t i m a t e s o f t h i s r e d u c t i o n range from 21 t o 30%  o v e r a 30 t o 40 y e a r  range.  Conversely,  has been i n c r e a s e d 10%  a f t e r 2 months ( M a z z a r e l l a e t a l . , 1966) and 17% a f t e r 1938)  o f endurance  (1963) examined  training.  Naughton  the influence  (1982),  6 months  Robinson  (Robinson,  (1938)  o f age on p h y s i c a l f i t n e s s  and D i l l  ( a s measured by  vO^max^ and i t was seen t o d e c r e a s e w i t h a d v a n c i n g age i n b o t h men and Women. Women were a l s o seen t o e x h i b i t a lower ages.  Montoye  (1974) found t h a t  levels  existed  across  decreased w i t h  a l l ages  a d v a n c i n g age.  w i t h age r a n g i n g  level  of fitness  differences i n fitness and t h a t  Alexander  the l e v e l s  t h a n men a t a l l based  on a c t i v i t y  of physical  fitness  (1974) found a d e c r e a s e i n V0„ 2max  from 0.93 t o 1.04 ml o f oxygen p e r k g o f body w e i g h t p e r  minute w i t h each a d v a n c i n g y e a r  (when d e t e r m i n e d i n r e l a t i o n t o body w e i g h t ) .  Naughton and Nagle (1965), e x a m i n i n g a h e a l t h y p o p u l a t i o n o f m i d d l e - a g e d men, found t h a t t h e younger s u b j e c t s d i d n o t n e c e s s a r i l y e x h i b i t a h i g h e r l e v e l o f f i t n e s s than t h e i r o l d e r counterparts. seen;  fitness  decades.  levels  This  were n e a r l y  A d e c r e a s e i n V0„ w i t h age was n o t 2max °  identical  across  i n d i c a t e d t h a t many young s u b j e c t s  the four  representative  i n the general  population  may n o t d e v e l o p a h i g h l e v e l o f f i t n e s s and t h a t f o r t h e n o n a c t i v e  population  the more normal l e v e l o f f i t n e s s i s 32 ml o f oxygen p e r body w e i g h t p e r min, or about 8-9 mets (1 met = a p p r o x i m a t e l y  3.5 ml oxygen p e r k g body w e i g h t p e r  min),  higher  instead  of  the s i g n i f i c a n t l y  levels  reported  by  other  i n one time  elite  investigators. The  rate  o f d e c l i n e i n V0„ seems t o be g r e a t e r 2max b  athletes  who  counterparts Such  have  become  who have  i s n o t t h e case  Clarence  sedentary  remained with  DeMar h a d a 0 v  m  a  x  sedentary  f  6  0  m  l  k  S~  1  with  and u n t r a i n e d  t h e a t h l e t e who remains o  2  i n comparison  their  (Robinson,  active  m i n " a t 49 y e a r s 1  untrained  into  1964). old  o f age o n l y  age;  - 17 somewhat below a mean v a l u e  o f 17-20 y e a r o l d males o f 52.0 ml k g ^ min ^  (Dill,  o f a t h l e t e s ages 42 t o 68 y e a r s ,  1965).  Saltin,  In a series  (Grimby and  1966), VOwas 30% h i g h e r than i n n o n - a t h l e t e s o f comparable age 2max °  a t a l l ages. V<  ^2max  P  e r  u n  ^  °^  t  lean  body  mass  (LBM) shows  a  similar  decline.  -1 Fischer  e t a l . (1965) n o t e d  that  although  VOg^  d e c l i n e s w i t h age, a c t i v e s u b j e c t s i n t h e i r s e v e n t h  ( i n ml k g  -1 min  LBM)  decade had s i g n i f i c a n t l y  h i g h e r v a l u e s than t h e i r s e d e n t a r y c o u n t e r p a r t s . 2.  HEART RATE  Maximal h e a r t r a t e (HR ) i s seen t o decrease -max women ( A s t r a n d , 1960; R o b i n s o n 1938; A s t r a n d ,  w i t h age i n b o t h men and  1973; J u l i u s ,  g i v e n i n c r e a s e i n oxygen consumption over b a s a l l e v e l s , c o n s t a n t o r d e c l i n e s w i t h age ( C o t e s , training  has been  found  t o be  1974; Granath,  negligible  i n v e s t i g a t o r s have found a decrease  i n heart rate.  For a  h e a r t r a t e remains  1964).  i n some  1967).  cases  The e f f e c t o f whereas  other  M a z z a r e l l a e t a l . (1966)  reported l i t t l e  o r no change f o l l o w i n g a 2 month e x e r c i s e program.  Skinner  et  reported  program  a l . (1964)  t h e same  findings  following  a  6  month  (endurance t r a i n i n g w i t h m i d d l e - a g e d men). O l d e r a t h l e t e s have shown a d e c r e a s e d HR w h i c h i s n o t u n l i k e t h a t found i n u n t r a i n e d men o f the same max age  (Astrand,  1956).  t r a i n i n g was reduced same r e l a t i v e  work  Seals  training  found  that  heart  rate  after  a t t h e same a b s o l u t e work r a t e s and unchanged a t the rates.  p h y s i o l o g i c a l l y decreases, following  e t a l . (1984)  provide  Although  the h e a r t  r a t e o f the o l d e r  subject  t h e maximal h e a r t r a t e and t h e h e a r t r a t e a t r e s t indications  o f vagotony  (Granath  e t a l . , 1970;  Z o n e r a i c h and Rhee, 1977). W i t h age, t h e r e a r e n o t e d changes i n t h e e f f e c t o f e x e r c i s e on s y s t o l i c b l o o d p r e s s u r e and h e a r t r a t e .  With  i n c r e a s i n g age, s y s t o l i c b l o o d  tends t o be h i g h e r a t a g i v e n i n t e n s i t y o f e x e r c i s e (Bevegard,  pressure  1967; J u l i u s ,  - 18 1967).  Maximum h e a r t  submaximal (Astrand, levels, Granath,  exercise 1973).  heart  level,  falls heart  For a given  rate  1964).  rate  remains  Rowlands  (Astrand, rate  i s greater  increase  constant  1973; J u l i u s ,  e t a l . (1984)  i n the o l d e r  i n oxygen  or declines using  1967), b u t a t a  consumption with  a  age  sample  subject  over  basal  (Cotes,  1974;  o f 33  subjects  ( i n c l u d i n g h y p e r t e n s i v e s ) , found t h a t d u r i n g dynamic ( w a l k i n g ) e x e r c i s e t h e r e was a s i g n i f i c a n t 3.  i n c r e a s e i n b l o o d p r e s s u r e and h e a r t  rate.  Stroke Volume  There appears t o be a s l i g h t d e c r e a s e i n maximal s t r o k e volume (SV ) ° max r  w i t h i n c r e a s e d age ( A s t r a n d , 1967); SV i n v e r y  o l d , untrained  men.  G r a n a t h e t a l . (1964) found a d i m i n i s h e d An i n c r e a s e d  SV has been  m i d d l e - a g e d and o l d e r a t h l e t e s (Grimby and S a l t i n , has  been r e p o r t e d  t o occur  i n older individuals  1966).  found  i n some  A d e c r e a s e i n SV  a t n e a r maximal work r a t e s  ( P o r t e t a l . , 1980). 4.  Cardiac Output  S i n c e maximal HR d e c r e a s e s and SV i s reduced t o a commensurate degree w i t h a g i n g , maximal c a r d i a c o u t p u t d e c r e a s e s a l s o (Granath  e t a l . , 1960).  A  d e c r e a s e i n CO has been r e p o r t e d by a s e r i e s o f s t u d i e s i n w h i c h SV and/or HR are d i r e c t l y o r i n d i r e c t l y measured (Brandfonbrener B r u c e , 1982; J u l i u s  e t a l . , 1955; Hossack and  e t a l . , 1967; P o r t e t a l . , 1980; R o b i n s o n e t a l . , 1975).  Grimby and S a l t i n  (1966) found l i t t l e  d i f f e r e n c e between t h e maximal CO  o f young and o l d a t h l e t e s , b u t b o t h h a d h i g h e r v a l u e s  t h a n d i d u n t r a i n e d men  o f t h e same age.  B.  Submaximal Exercise 1.  Heart Rate  Although  t h e maximal HR i s seen t o d e c r e a s e w i t h age, t h e r e  is little  d i f f e r e n c e i n t h e HR a t a g i v e n submaximal w o r k l o a d (Asmussen and M a t h i a s e n ,  19 1962;  Robinson,  heart rate training,  1938;  Strandell,  1964).  At  i s g r e a t e r i n the o l d e r s u b j e c t HR  i s seen  (Barry et a l . ,  1966;  t o be  a  subrnaximal e x e r c i s e  (Astrand,  1973).  decreased at a given l e v e l  S k i n n e r e t a l . , 1964).  level,  However, w i t h  o f subrnaximal work  An e l e v a t e d HR w h i l e p e r f o r m i n g  a s t a n d a r d work t a s k i s found i n s e d e n t a r y i n d i v i d u a l s compared t o a t h l e t e s o r p h y s i c a l l y a c t i v e men It  (Taylor et a l . ,  1963).  t a k e s l o n g e r f o r the c i r c u l a t o r y  (and r e s p i r a t o r y )  o l d e r p e r s o n t o adapt t o a w o r k l o a d (Robinson, 1938). for  their  1967).  HR  to  return  Following  a  to  the r e s t i n g  six-month  r e d u c t i o n s i n the r e c o v e r y HR  level  endurance  o f m i d d l e - a g e d men  of  the  More time i s r e q u i r e d  following  training  systems  exercise  program,  (Astrand, significant  were seen ( S k i n n e r e t a l . ,  1964). 2.  S y s t o l i c Blood Pressure  The  systolic  higher  i n older  BP  at  persons  fixed  subrnaximal w o r k l o a d s  (Norris  et a l . ,  1953;  has  Robinson,  been  shown  1938).  to  be  Endurance  t r a i n i n g has produced s i g n i f i c a n t r e d u c t i o n s i n the s y s t o l i c BP o f p r e v i o u s l y sedentary middle-aged (Barry et a l . , C.  subjects  (Skinner et a l . ,  1964)  and  elderly  subjects  1966).  Aging of the Cardiovascular System:  E f f e c t s of Exercise  The  interest  major  dependent  variables  of  in  - A Summary  training  studies  a e r o b i c c a p a c i t y (maximum oxygen consumption) and h e a r t r a t e under o f maximum e x e r c i s e (Whitbourne, 1985).  conditions  V a r i o u s i n v e s t i g a t i o n s have  the same parameters under subrnaximal e x e r c i s e c o n d i t i o n s .  examined  Subrnaximal s t u d i e s  have p r o g r e s s e d from the premise t h a t a more e f f i c i e n t c a r d i o v a s c u l a r will  require  less effort  are  (as i n d i c a t e d by a l o w e r h e a r t r a t e and  system  increased  s t r o k e volume and c a r d i a c o u t p u t ) t o p e r f o r m s u c c e s s f u l l y a t a g i v e n l e v e l o f oxygen  consumption.  20 v  1.  E f f e c t s of Physical Training on ° 2 m a x  Naughton increase  and Nagle  significantly  (1965)  found  regardless  healthy  individuals  fitness  and an e x p e c t e d r a t e  a l . , 1981; S e a l s  Pollock  adaptive have  decline  increase  o f change  over  training.  k°  i s obtained. t n  (i.e. °2 v  I t appears  training  capacity  o r no change  60 y e a r s  could,  v a r  2  i n ^C^max  o f t r a i n i n g have been r e p o r t e d  y*- 6 n  ^  that  and i n c r e a s e d  R e g u l a r l y performed  ^  n  e t a l . , 1968;  therefore,  i f older  o f age ( N i i n i m a a  v  m a x  the young ( A s t r a n d , 1964; H i c k s o n  reverse the  individuals  i n VC>2max ( S e a l s e t a l . , 1984).  1973), y e t i n c r e a s e s i n 0 m a x  1965)  l n  Endurance  i n aerobic  indicated l i t t l e  individuals  o f age w i t h  levels  e t a l , 1983) and m i d d l e - a g e d (Hanson  e t a l . , 1971).  age-related  fitness  o f a l l ages have a c a p a c i t y f o r t r a i n i n g  endurance e x e r c i s e i n c r e a s e s ^^2raax et  that  undergo  an  Previous i n v e s t i g a t i o n s response to t r a i n i n g i n  and Shephard,  1978; P o l l o c k ,  from 0.0 t o 38.0 p e r c e n t as a r e s u l t  i n the e l d e r l y  ( B a r r y e t a l , 1966; B e r e s t a d ,  Thomas e t a l . , 1985, e x a m i n i n g 88 e l d e r l y  men  (mean age 63 y e a r s ) ,  found an average i n c r e a s e o f 12 p e r c e n t i n ^^max' Few  s t u d i e s have  determination  i n v e s t i g a t e d the t r a i n i n g - i n d u c e d adaptations  i n the  o f VO. ( i . e . , maximal s t r o k e volume, maximal h e a r t r a t e and zmax  maximal a r t e r i o v e n o u s oxygen d i f f e r e n c e ) i n m i d d l e - a g e d and o l d e r i n d i v i d u a l s ( S e a l s , 1984).  H a r t l e y e t a l . (1969) r e p o r t e d t h a t a 14 p e r c e n t i n c r e a s e i n  vC^MAX was due t o an i n c r e a s e d maximal s t r o k e volume and c a r d i a c o u t p u t i n the e l d e r l y , whereas t h e 15 p e r c e n t i n c r e a s e i n - 2max ^ training V(  >  a  o b s e r v e d i n t h e s t u d i e s c o n c e r n i n g younger men was o b t a i n e d increases  i n maximal  cardiac  output  and  maximal  t ; e r  as a r e s u l t o f  arteriovenous  oxygen  difference.  They a t t r i b u t e d t h e l a c k o f marked change i n VO. subsequent • 2max  to  i n m i d d l e - a g e d and o l d e r  training  significant al.  J  increases  subjects  i n maximal a r t e r i o v e n o u s  to their  ability  oxygen d i f f e r e n c e .  to e l i c i t Seals et  (1984), i n c o n t r a s t t o H a r t l e y e t a l . (1969), s u g g e s t t h a t t h e i n c r e a s e  - 21 in  t h e ^C^max  adaptations extract  subjects  i n the s k e l e t a l  oxygen,  difference. includes  of their  as  The  both  muscle  reflected  of  t o have  resulting  in a  adaptations  an i n c r e a s e  appears  higher  been p r i m a r i l y  i n an maximal  skeletal  muscle  i n mitochondria  improved  due t o  ability  arteriovenous to  d e n s i t y , b o t h o f w h i c h c o u l d account f o r t h e i n c r e a s e  oxygen  endurance  and an i n c r e a s e  to  exercise  i n capillary  i n oxygen e x t r a c t i o n  ( H o l l o s z y e t a l . , 1977; S a l t i n e t a l . , 1977). Kiessling unaffected.  e t a l . , (1974),  however, s t a t e t h a t m i t o c h o n d r i a l volume i s  I t appears t h a t i n c r e a s e d p e r i p h e r a l c i r c u l a t i o n i s p o t e n t i a t e d  by changes i n t h e a r t e r i a l b l o o d 2.  Intensity and Duration of Exercise Training  Conflicting  conclusions  e l d e r l y have been r e p o r t e d . or l o w i n t e n s i t y  the e f f e c t  Seals  and Shephard,  intensity  intensity  larger  gains  training  i n the  that both high  1978) found t h a t h i g h  others  intensity  t h a n were seen w i t h a low i n t e n s i t y  e t a l . (1984) a l s o d e t e r m i n e d t h a t  s i x months o f h i g h produced  of training  Badenhop e t a l . (1983) r e p o r t e d  r e s u l t e d i n much l a r g e r g a i n s  program.  rate)  about  t r a i n i n g produced t h e same i n c r e a s e i n VO, while 2max  ( S e a l s e t a l . , 1984; Sidney training  flow.  i n o l d e r men and women,  (75-80% o f maximum a g e - a d j u s t e d  i n the d i r e c t l y  i n t e n s i t y t r a i n i n g o f t h e same d u r a t i o n .  measured  VO„ 2max  than  heart lower  S i d n e y and Shephard (1978) r e p o r t e d  that walking or jogging at a high i n t e n s i t y  ( h e a r t r a t e s o f 140 t o 150 b e a t s  per m i n u t e ) p r o d u c e d l a r g e r g a i n s t h a n a t low i n t e n s i t y  ( h e a r t r a t e o f 120 t o  130 b e a t s p e r m i n u t e ) . Previous moderate (Berestad,  s t u d i e s on o l d e r s u b j e c t s have u s u a l l y i n v o l v e d o n l y m i l d t o  intensity  exercise  for relatively  1965; N i i m a a and Shephard, 1978).  s i g n i f i c a n t improvements i n V^max ^ o f an i n a d e q u a t e t r a i n i n g  stimulus  n  °^  e r  S U D  brief Failure  periods  (6-12 weeks)  t o p r e v i o u s l y observe  J e c t s may have been t h e r e s u l t  ( S e a l s e t a l . , 1984).  Ernes (1979) found  - 22  -  t h a t a l i g h t program o f e x e r c i s e c o n s i s t i n g o f t h r e e week f o r  12  systolic  and  al.  weeks  determined  e l i c i t increases than  P o l l o c k et 1968;  i n noted  d i a s t o l i c blood  (1984)  magnitude  resulted  Pollock  et  12  months  i n pre-post  w e i g h t and of  resting rate.  endurance  exercise  et  training  can  previously  f o r younger  Seals  et  a l . , 1971)  a l . , 1983)  and  populations.  middle-aged  Their  findings  of  Seals  and women o f e q u a l o f  reported  per  measures  in h e a l t h y o l d e r men  have been  a l . , 1971;  pressures,  that  in  differences  45-minute s e s s i o n s  greater  (Astrand,  1964;  (Hanson e t  al. ,  indicate  that  a  moderate i n c r e a s e i n d a i l y p h y s i c a l a c t i v i t y o f a s i x month p e r i o d can r e s u l t i n a s m a l l but s i g n i f i c a n t i n c r e a s e ° directly  measured  responses  a  previously  (Berestad,  1965;  ^  t e r  ^  reported  Suominen e t  i n V0„  2max  months for  .  of  The the  subjects  a l . , 1977).  25-30 p e r c e n t i n c r e a s e same program  60  This  years  of  suggests  exceeds  age  that  and  the  the over  training  s t i m u l i i n e a r l i e r s t u d i e s were o f i n s u f f i c i e n t i n t e n s i t y and/or d u r a t i o n e l i c i t the a d a p t i o n s r e s u l t i n g i n an i n c r e a s e d Thomas e t  a l . (1985),  found an  average  training.  The  increase  of  investigators  e l d e r l y subject's V0„ . 2max  examining  DeVries  12  88  stated  would be  the  a f t e r one  (1971) examined the  (mean age  63  i n VG^max f o l l o w i n g 12  that  best  predictor  years),  months  of  what  an  of  y e a r o f t r a i n i n g i s the  r e l a t i o n o f change i n V0„ ° 2max  from a submaximal e x e r c i s e t e s t w i t h t r a i n i n g i n t e n s i t y and  initial estimated  initial  fitness.  M u l t i p l e r e g r e s s i o n a n a l y s i s i n d i c a t e d t h a t 41 p e r c e n t o f the v a r i a n c e change  score  could  be  explained  by  the  to  .  e l d e r l y men  percent  in  initial  predicted  VG^max  i n the  a n c  *  t n e  p e r c e n t a g e o f h e a r t r a t e range a t w h i c h the s u b j e c t t r a i n e d .  3.  Long-Term Training Effects  Prior  athletic  t r a i n i n g does  r e l a t e d decrements i n a e r o b i c that continued  not  capacity  preclude  an  i n d i v i d u a l to  (Robinson e t a l . , 1973).  the  age  I t appears  e x e r c i s e throughout the m i d d l e a d u l t y e a r s p r e v e n t s age  losses  - 23 in  aerobic  capacity  and perhaps  S i g n i f i c a n t i n c r e a s e s i n ^^2max ^  n  t  even  reverses  *  y e a r s between t e s t i n g i n one study  ^  ie  by R o b i n s o n e t a l . (1975) were seen o n l y i n those exercise  regularly  throughout  the d u r a t i o n  them  (Whitbourne,  1985).  s u b j e c t s who c o n t i n u e d t o  o f the study.  Subjects  who  t r a i n e d and t h e n stopped showed t h e same r a t e o f l o s s o f a e r o b i c power as the o t h e r s i n t h e l o n g i t u d i n a l sample.  Endurance a t h l e t e s ,  such  as o r i e n t e e r s ,  s k i e r s and o t h e r l o n g - d i s t a n c e a t h l e t e s have been shown t o have much l a r g e r aerobic  capacities  than  their  sedentary  c o n s i d e r a b l y younger (Suominen e t a l . ,  c o u n t e r p a r t s , even  those  that are  1980; Cumming, 1967; G o l l n i c k e t a l . ,  1972) . The  literature  supports  the c o n t e n t i o n  that  champion  or  a t h l e t e s who c o n t i n u e t o compete have h i g h e r l e v e l s o f ^ ~ 2max ^ (  adults  o f t h e same  age and younger  (Heath  >  t  master's  i a n  s e  e t a l . , 1981; Kavanagh  Shephard, 1978).  F u r t h e r s t u d i e s on o l d e r a d u l t s who have remained  throughout  their  middle  advantage  provided  years  by c o n t i n u e d  f u n c t i o n a l c a p a c i t y o f sedentary  have  provided  additional  exercise i n that  their  support  and  active  f o r the  s u b j e c t s have the  i n d i v i d u a l s who a r e 10 t o 20 y e a r s  (Plowman e t a l . , 1979; W r i g h t e t a l . ,  dentary  younger  1982).  S e a l s e t a l . (1984) found t h a t h e a r t r a t e a f t e r t r a i n i n g was reduced a t the same a b s o l u t e work r a t e s and unchanged a t t h e same r e l a t i v e work r a t e s . E q u i v a l e n t o r l a r g e r r e d u c t i o n s i n h e a r t r a t e a t t h e same a b s o l u t e work r a t e s o c c u r r e d i n response training.  t o low i n t e n s i t y t r a i n i n g . c o m p a r e d  intensity  progressing fitness  intensity  Low i n t e n s i t y t r a i n i n g was s i x months o f u n s u p e r v i s e d w a l k i n g f o r  20-30 m i n u t e s a t a h e a r t r a t e o f 120 b e a t s / m i n High  with high  training  was  s i x months  from w a l k i n g t o c y c l i n g  improved.  The  choice  subject's orthopedic status.  of  a t l e a s t t h r e e times p e r week.  of supervised  endurance e x e r c i s e ,  ergometer o r graded t r e a d m i l l training  modality  depended  as t h e i r upon  the  The d u r a t i o n and t h e i n t e n s i t y o f the e x e r c i s e  24 p r o g r e s s e d from minutes  at  85  30  minutes a t  percent  A l t h o u g h the h e a r t maximal h e a r t  of  75  the  r a t e o f the  rate  and  the  percent of  maximal  the  heart  older subject  heart  rate  at  rate  (156  ±  rate  6  to  ongoing  involvement  age-related  transport  rest following  training  a  blood  to  meet  i n endurance  during exhausting  large  tissue  requirements.  activities  stroke  seen.  appear  to  The  negative  or 40%  e f f e c t of aging  aerobic  exercise  between 25 i n any  and  65  2  to  t o be  1977) .  subjects  not  have  compensate  and  for  the  The h i g h l y t r a i n e d o l d e r p e r s o n  and  l e v e l of  cardiac  than  exercise  demonstrated  the  contractility  output,  particularly  maximum oxygen consumption can  The  normal  loss  age,  but  this  3 month t r a i n i n g s t u d y  Most o f the  older  i n t e n s i t y o f the  Continued  an  research years  be  i n which  the  o  v  e  r  t n e  m a x  r e d u c e d by  capacity  of  age  (Whitbourne,  (Hodgson  i n VO. 2max  (de  Vries,  1985). and  a  participants  i n w h i c h t h i s e f f e c t i s seen  i s s u f f i c i e n t l y s t r e n u o u s , men increase  u  l o s s can  or more o f t h e i r a e r o b i c  65  of ^ 2  be  1% per y e a r ( B r a n d f o n b r e n e r e t a l . , 1955),  years of  t r a i n 3 h o u r s per week a t 60% Buskirk,  on  training.  span i s e s t i m a t e d  maximum 50%  system's  work (de V r i e s , 1980).  Short-Term Training Effects  a d u l t age  70s  volume  4.  o f f s e t by  provide  i n d i c a t e s that there i s a s i g n i f i c a n t p o t e n t i a l  f u n c t i o n a l losses normally  ensuring  the  Z o n e r a i c h and Rhee, 1977).  possesses a l e f t v e n t r i c l e that i s capable of a high thereby  45  beats/min) .  b e n e f i t i n a e r o b i c e x e r c i s e as i t i n c r e a s e s the a g i n g c a r d i o v a s c u l a r ability  to  p h y s i o l o g i c a l l y decreases,  i n d i c a t i o n s o f vagotony (Granath e t a l . , 1970; I n summary, the r e s e a r c h  maximal h e a r t  and  involves When  the  women i n t h e i r  1980;  Whitbourne,  1985). Studies have'generally heart  rate  not  i n m i d d l e - a g e d and  decreased heart  rate during  shown a f a v o r a b l e older  adults  t r a i n i n g e f f e c t on maximum  (Hartley  subrnaximal e x e r c i s e has  et  a l . , 1969), but  a  been seen (Blumenthal et  - 25 a l . , 1982) . Cardiac adults  output  despite  a t submaximal  training  i n c r e a s e d by t r a i n i n g the  maximum h e a r t  (Rost  work  levels  remains  e t a l . , 1979).  constant  i n older  Maximum c a r d i a c  output i s  i n m i d d l e - a g e d and o l d e r a d u l t s  rate  i s n o t a l t e r e d by t r a i n i n g ,  (Skinner,  1970).  an i n c r e a s e d  As  cardiac  o u t p u t i n d i c a t e s an improved f u n c t i o n i n g o f t h e l e f t v e n t r i c l e d u r i n g maximal work, t h e r e b y  e n s u r i n g a g r e a t e r s t r o k e volume.  Submaximal similar  exercise  to that  subjects  attained  (Astrand  1984).  i n t h e e l d e r l y produces during  moderate  e t a l . , 1964; H a r t l e y  A decrease  i n stroke  a maximal  submaximal  stroke  exercise  i n young  e t a l . , 1969; R o d e h e f f e r  volume has been  reported  volume  t o occur  et al. , i n older  i n d i v i d u a l s a t n e a r maximal work r a t e s ( P o r t e t a l . , 1980). In  general,  training  the adaptions  are q u a l i t a t i v e l y  populations  (Astrand  observed  similar  during  submaximal  t o those r e p o r t e d  and R o d a h l , 1977;  exercise  previously  after  i n younger  Ekblom e t a l . , 1968; H a r t l e y e t a l . ,  1969) .  II  RESPIRATORY CHANGES WITH AGING - AN OVERVIEW The  l i t e r a t u r e contends t h a t w i t h age t h e r e i s a r e d u c t i o n i n t h e amount  o f oxygen t h a t i s t a k e n up by t h e t i s s u e s d u r i n g e x e r c i s e . o f t h e r e s p i r a t o r y system a r e r e n d e r e d l e s s e f f i c i e n t resulting lungs.  i n an o v e r a l l  The a g i n g  decreased  efficiency  The s t r u c t u r e ( s )  i n the older  o f gaseous  exchange  r e s p i r a t o r y system adds t o t h e l i m i t a t i o n s  person, in  the  o f t h e aging  c a r d i o v a s c u l a r and m u s c u l a r systems (Whitbourne, 1985). A.  Gaseous Exchange and V e n t i l a t i o n The  the  f u n c t i o n a l measure r e p r e s e n t i n g  alveolar  oxygen  capillary  pressure  the e f f i c i e n c y  of diffusion  i n t e r f a c e i s t h e d i f f e r e n c e between  compared  to the a l v e o l a r  oxygen  pressure.  across  the a r t e r i a l Studies  have  26 documented t h e drop i n a r t e r i a l alveolar-arterial Melmgaard, 1966). an  increased  oxygen  oxygen p r e s s u r e  difference with  and/or t h e i n c r e a s e  age ( M a r s h a l l  i n the  and Wycke, 1972;  The e x p l a n a t i o n f o r t h i s r e d u c e d oxygen t r a n s p o r t may be  r e s i s t a n c e t o oxygen d i f f u s i o n  across  a l v e o l a r and c a p i l l a r y  membranes (Anderson and Shephard, 1969; Mauderly, 1978). Robinson  (1938)  reported  that  t h e r e s p i r a t o r y exchange  ratio  moderate work on a t r e a d m i l l i n c r e a s e d from ages 8 t o 63 y e a r s . al.  (1967) c o n f i r m e d  this  i n subjects  aged 18 t o 68 y e a r s .  during  J u l i u s et  Wessel e t a l .  (1968) r e p o r t e d a s l i g h t i n c r e a s e i n r e s p i r a t o r y exchange r a t i o from ages 20 to  59 y e a r s  and t h e n  a decrease  d i f f e r e n c e s were n o t s t a t i s t i c a l l y thought t o be low. R u l l i  i n t h e 60 t o 69 y e a r significant  and M e n o t t i  age group.  These  and t h e e x e r c i s e v a l u e s  were  (1969) a l s o r e p o r t e d no s t a t i s t i c a l l y  s i g n i f i c a n t r e l a t i o n s h i p between r e s p i r a t o r y exchange r a t i o and age. Wessel  et  relationship  a l . (1968)  between  and  Rulli  and M e n o t t i  age and v e n t i l a t i o n  (V ) d u r i n g  (1969)  reported  submaximal  no  exercise.  R o b i n s o n e t a l . (1973) and P a t r i c k e t a l . (1983) showed an i n c r e a s e  inV  w i t h age as a r e s u l t o f an i n c r e a s e d t i d a l volume whereas H a r r i s and Thomson (1958) a t t r i b u t e d t h e i n c r e a s e  inV  to higher  respiratory rates  i n older  subj e c t s . B.  Dynamic and S t a t i c Ventilatory Volumes Lung f u n c t i o n may be q u a n t i f i e d by t h e e f f i c i e n c y by w h i c h t h e lungs and  their  associated  structures  c a n move  a i r volume.  Measurements  of  this  e f f i c i e n c y may d e s c r i b e t h e components o f t h e t o t a l l u n g c a p a c i t y t o h o l d a i r or d e s c r i b e Lower  t h e volumes o f a i r t h a t c a n be moved d u r i n g  values  efficiency,  during  submaximal  i n terms o f s u p p l y i n g  work  indicate  oxygen, w i t h  a  a p e r i o d o f time.  greater  respiratory  a minimum o f energy  cost.  H i g h l e v e l s o f f u n c t i o n on these measures i n d i c a t e t h a t t h e l u n g s c a n support the oxygen r e q u i r e m e n t s f o r t h e w o r k i n g muscles.  The f u n c t i o n a l measurements  - 27 o f the  l u n g b a s e d on l u n g volumes a r e u s e f u l f o r d e s c r i b i n g age  i n the pulmonary response t o e x e r c i s e (whitbourne, W i t h age, by  an  40%  i n r e s i d u a l volume  approximately  loss  1977) .  of  Age  1985).  t h e r e appears t o be a r e d u c t i o n i n v i t a l c a p a c i t y accompanied  increase  begins  differences  vital  a t age 40  (Asmussen e t  a l . , 1975).  (Brady e t a l . , 1974)  c a p a c i t y between  the  changes i n c o m p l i a n c e a r e  ages  This  process  and r e s u l t s i n a t o t a l o f  of  20  and  70  largely responsible  (Lynne-Davies,  f o r an  increased  c l o s i n g volume, and i t has been s u g g e s t e d t h a t the same p r o c e s s would account for  the  age-related  increase  in  the  residual  volume  (and  accompanying  d e c r e a s e i n v i t a l c a p a c i t y ) (Whitbourne, 1985). At  subrnaximal  literature  work  i s confusing  loads, as  e f f e c t s on  change w i t h  age  (Denolin  (de V r i e s and  Adams, 1972)  levels  of  has  exercise  not  exercise,  or  an  increase  l e s s able to maintain  c o m p l i a n c e w i t h age age  ventilatory  age  show no  i n d i v i d u a l s are  low  the  investigators  to  a  (Saltin  b r e a t h i n g w i t h age  Grimby,  been  affect  suggested  tidal that  i s desirable.  ventilatory  et  a  decrease Older  r a t e s o f v e n t i l a t i o n a t maximal A  decreased  chest  decreased  wall  e t a l . , 1948).  volume under c o n d i t i o n s o f  i s r e s p o n s i b l e f o r the  Some  ( R o b i n s o n e t a l . , 1975).  1968).  the  The  rate.  a l . , 1970),  i s a c o n t r i b u t i n g f a c t o r (Baldwin  been shown t o  i t has  and  high  rate  maximum  demonstrated age  Since maximal  frequency  of  l o s s i n maximum  v e n t i l a t o r y r a t e (Montoye, 1982). F o r c e d e x p i r a t o r y volume (1 sec.) The  flow  rate  i s reduced  q u a l i t i e s o f the lungs flow rate  (as e x p r e s s e d  H u b e r t , 1982;  with  age  i s an i n d e x and measure o f f l o w r a t e . as  (Whitbourne, 1985). by  i t i s dependent  the  elastic  There appears t o be a decrease i n  f o r c e d e x p i r a t o r y volume) w i t h  Shephard and Sidney,  upon  age  (Kannel  and  1978).  V e n t i l a t o r y e f f i c i e n c y ( r a t e of v e n t i l a t i o n / o x y g e n uptake) a l s o r e f l e c t s the  efficiency  of  the  oxygen t r a n s p o r t mechanisms o f  the  body  (de  Vries,  1980).  28  A t submaximal l e v e l s , the l u n g s o f o l d e r a d u l t s a r e l e s s e f f e c t i v e i n  oxygen t r a n s p o r t ,  this  index  et  (Robinson  ventilatory  being indicated al. ,  efficiency  individual  i s less  is  1975). reduced  able to  by  a higher v e n t i l a t o r y  Concurrently, with  age,  p r o v i d e adequate  the  maximum  suggesting levels  of  that  oxygen  efficiency level the at  of  older maximal  l e v e l s o f work, as v e n t i l a t i o n i s compromised. The r e s p o n s i v i t y o f the r e s p i r a t o r y response t o h y p o x i a i s reduced w i t h age  ( P e t e r s e n e t a l . , 1981).  respiratory  system  responsible.  or  the  Structural  and/or  neuromuscular  I t has been s u g g e s t e d  functional  control  over  changes  i n the  ventilation  may  be  that a decreased n e u r a l output to  the  r e s p i r a t o r y muscles under c o n d i t i o n s o f h y p o x i a i s the major r e a s o n f o r t h i s age  effect  increased  ( P e t e r s e n e t a l . , 1981). sympathetic  activity  There  i n the  i s , however,  older  evidence  individual.  t h e n , t h a t the d e c r e a s e d response t o h y p o x i a w i t h age  show  I t i s possible,  i s a f u n c t i o n o f the  i n a b i l i t y o f the l u n g s and c h e s t w a l l t o respond t o s y m p a t h e t i c (Whitbourne,  to  stimulation  1985).  The r e s p i r a t o r y c o n t r o l o f b r e a t h i n g i n response t o p r e s s u r e v a r i a t i o n s i n c a r b o n d i o x i d e has n o t been seen t o change w i t h age C.  A i r w a y C l o s u r e and  (Rubin et a l . ,  1982).  Compliance  There appears t o be an i n c r e a s i n g n o n - u n i f o r m i t y i n the d i s t r i b u t i o n o f a i r i n the l u n g s w i t h age, r e s u l t i n g i n a reduced oxygen c o n c e n t r a t i o n i n the arterial  blood.  This  non-uniformity of  a i r distribution  d i s c r e p a n c y between v e n t i l a t o r y and p e r f u s i o n r a t e s  (Edelman  results  in  a  e t a l . , 1968).  Such a d i s c r e p a n c y i s a l s o p r e v a l e n t i n young a d u l t s , b u t i t appears t h a t i n t h i s age  group,  the e f f i c i e n c y o f gaseous  exchange i s n o t compromised.  The  l u n g o f o l d e r i n d i v i d u a l s y i e l d s a g r e a t e r t o t a l a r e a o f i n e q u a l i t y between ventilation blood  and  leaving  perfusion.  the l u n g s  The  (West,  result 1977).  i s a decreased At  a l l ages,  oxygenation of  the  total  quality  the of  - 29 b l o o d l e a v i n g the l u n g s c o n t a i n s a l a r g e volume o f b l o o d from the lower l u n g . I n the  o l d e r person,  reduced  ventilation  elasticity  this blood i n the  lower  o f the t i s s u e .  closure i n expiration,  i s not w e l l - o x y g e n a t e d . aspect  A decreased  of  the  This  l u n g due  to  i s due the  to  decreased  e l a s t i c i t y promotes premature  thereby a l l o w i n g unexpired  a i r t o be  trapped  airway inside.  G r a v i t a t i o n a l f o r c e s a l s o cause a d i s c r e p a n c y i n the r e c o i l a c t i v i t y  i n the  upper and lower l u n g ( t h e p r e s s u r e over t h e l u n g s u r f a c e i s more p o s i t i v e , approximately tissue The  age  cm  E^O  to  the  lower  i t i s the bottom r e g i o n s  lung).  As  the  t h a t are more a f f e c t e d .  t o be u n d e r v e n t i l a t e d , r e l a t i v e t o the pulmonary c a p i l l a r y  ( B e g i n e t a l . , 1975; i s i n d i c a t e d by  less pressure  across  I n a d d i t i o n , l u n g compliance  i n c r e a s e ) i s seen t o be age  is  indicative  Alterations collagenous  in  of  the  L y n n e - D a v i e s , 1977)  are  and  This r e s u l t s  lung blood  elastic recoil  with  lung surface at a given  lung  (the volume i n c r e a s e f o r each p r e s s u r e  decreased  An  increased  r e s i s t a n c e to  lung  compliance  expansion  in  Elastic  and  1985).  alveolar  integrity  the  A lower  greater i n older adults.  i n s p i r a t i o n (Whitbourne,  1967) .  Bode e t a l . , 1976).  by  lung  r e s u l t i s t h a t the a l v e o l i i n the lower a s p e c t o f the a g i n g person's  volume.  with  i n comparison  loses e l a s t i c i t y ,  are l i k e l y flow  7.5  a  structure  compromised  alveolar  ducts  i n a decreased  are  seen  with  (Brandstetter and  alveoli  age. and  Kazenni,  1983;  increase i n size  (Reid,  t o t a l number o f a l v e o l i  and  functional  surface area. Aging  a l s o corresponds  with  an  w a l l s t r u c t u r e s (Shephard and Sidney, elasticity compress  of in  the  lung,  expiration  i n c r e a s e i n the 1978).  amount o f work r e q u i r e d by  expand the  c y c l e (Brooks and Fahey, 1984).  during  respiratory  of  the  T h i s , a l o n g w i t h the  f u r t h e r compromises and  rigidity  the  ability  inspiration, musculature  of  and  the  decreased lung  increases  i n the  chest  to the  ventilation  30 D.  Pulmonary Hemodynamics The  normal  w i t h age.  range  o f pulmonary  gradually  increases  I t has been d e t e r m i n e d t h a t the mean r e s t i n g a r t e r i a l  pulmonary  pressure  increases  0.8  mm  Hg  arterial  pulmonary  pressure  a r t e r i a l pulmonary p r e s s u r e al.,  per  arterial  decade  increases  pressures  after  0.7  mm  the age  Hg  o f 40.  p e r decade  Diastolic  while  i s n o t seen t o change s i g n i f i c a n t l y  systolic  ( P e r r a u l t et  1969). Tartfulier  et  a l . , (1972)  found  that  during  supine  o b s e r v e d r e l a t i o n s h i p between pulmonary a r t e r y p r e s s u r e s  exercise,  (systolic,  diastolic  and mean) and c a r d i a c o u t p u t were l i n e a r and were seen t o i n c r e a s e w i t h I t was  seen t h a t the pulmonary  c a p i l l a r y wedge p r e s s u r e  the  age.  increased with  age  and i s r e s p o n s i b l e f o r the a g e - r e l a t e d i n c r e a s e I n pulmonary a r t e r y p r e s s u r e s during supine e x e r c i s e .  The p r e s s u r e  bed (PAP-PCW) remains c o n s t a n t ,  g r a d i e n t a c r o s s t h e pulmonary  vascular  i n d i c a t i n g t h a t pulmonary v a s c u l a r r e s i s t a n c e  e x h i b i t s l i t t l e i n c r e a s e w i t h age ( P a l e v s k y , 1986). E.  E f f e c t s of Exercise Training on the Respiratory The  only  strengthened  muscular by  tissue  training  are  ( i n s p i r a t i o n and e x p i r a t i o n ) .  in the  the  System  respiratory  muscles  that  system control  that  can  ventilation  The c a r d i o v a s c u l a r system, by c o n t r a s t , has a  g r e a t e r p o t e n t i a l f o r the r e v e r s a l o f age e f f e c t s due t o the t r a i n a b i l i t y the myocardium The to t e s t  be  of  (Whitbourne, 1985).  l o n g term e f f e c t s o f c h r o n i c i n a c t i v i t y have n o t been i n v e s t i g a t e d the p o s s i b i l i t y  contribute  to  that decreased l e v e l s  age-related  decrements  of p a r t i c i p a t i o n  i n respiratory function  i n exercise (Whitbourne,  1985). A t h l e t e s and former a t h l e t e s show l e s s o f a d e c l i n e i n v i t a l w i t h age t h a n s e d e n t a r y  capacity  a d u l t s (Plowman e t a l . , 1979; R o b i n s o n e t a l . ,  1973).  T h i s f i n d i n g has n o t always been c o n s i s t e n t w i t h a l l s t u d i e s ( A s t r a n d , 1973).  - 31 S h o r t - t e r m s t u d i e s have n o t shown a p o s i t i v e change i n v i t a l aerobic  training  (Niinimaa  a l t h o u g h an i n c r e a s e in  and  Shephard,  1978; P o l l o c k  capacity  et a l . ,  with  1976),  i n v i t a l c a p a c i t y a t maximum l e v e l s o f e x e r t i o n was seen  an 8-week t r a i n i n g program i n w h i c h b o t h young and m i d d l e - a g e d men and  women p a r t i c i p a t e d (Heikkenen,  1978).  I t i s , therefore,  n o t c l e a r whether  e x e r c i s e c a n enhance v i t a l c a p a c i t y o r whether i t i s o t h e r v a r i a b l e s such as lifestyle  t h a t may be more i m p o r t a n t .  may have t h e g r e a t e s t  Whitbourne (1985) s t a t e s t h a t  e f f e c t on v i t a l c a p a c i t y  on those no o l d e r  exercise  than 50-60  y e a r s o f age. Ventilatory  rate  (tidal  d e c l i n e w i t h age, i s m o d i f i e d  volume  x  respiratory  frequency),  by b o t h l o n g and s h o r t - t e r m  known  to  e x e r c i s e programs.  However, t h i s seems t o be t r u e o n l y f o r v e n t i l a t o r y r a t e s measured a t maximum (not subrnaximal) l e v e l s o f e x e r t i o n .  T r a i n i n g , then, increases  maximum r a t e o f v e n t i l a t i o n ( A s t r a n d ,  1973; de V r i e s , 1970).  a r e s u l t o f an i n c r e a s e d maximum b r e a t h i n g  the p o t e n t i a l T h i s may be as  f r e q u e n c y ( S a l t i n e t a l . , 1969) o r  an i n c r e a s e d t i d a l volume (de V r i e s , 1970; R o b i n s o n e t a l . , 1973). Ventilatory with  flow  i s seen t o i n c r e a s e  t r a i n i n g (Whitbourne,  1985).  and o l d e r  I t has been e s t a b l i s h e d  volume o f a i r i n s p i r e d and e x p i r e d greater  i n middle-aged  during  that  adults  the t o t a l  a maximum v e n t i l a t o r y e f f o r t i s  i n a t h l e t e s and former a t h l e t e s t h a n t h e i r s e d e n t a r y c o u n t e r p a r t s  comparable expired  ages  during  (Saltin  and Grimby,  a maximum  respiratory  a t h l e t e s and former a t h l e t e s .  1968). attempt  The amount was  found  at  of a i r forcibly t o be h i g h e r  in  Improvements w i t h t r a i n i n g have n o t been shown  ( P o l l o c k e t a l . , 1976). Since increased efficiency also.  t h e maximum by e x e r c i s e  rate  o f v e n t i l a t i o n and v e n t i l a t o r y f l o w  training,  ( v e n t i l a t o r y rates  one may  relative  expect  t o oxygen  the i n d e x  can be  of v e n t i l a t o r y  consumption)  to  increase  T r a i n i n g h a s , however, no e f f e c t on t h e v e n t i l a t o r y e f f i c i e n c y index  32 at  either  maximal  1978; S t a n f o r d , Exercise the  rate  or  submaximal  of exercise  (Shephard  and  Sidney,  to  increase  1974).  training  e n a b l e s the m i d d l e - a g e d and  of breathing  levels  o f work.  volume:  tidal  dependent  levels  to l e v e l s  Training volume,  upon l u n g  has,  vital  volume),  adult  t h a t meet the demands p r e s e n t e d by however,  capacity do  older  no and  effect  on  lung  ventilatory  rate  n o t show p o s i t i v e  maximal  structure  and  (measurements  change(s) w i t h  training  (Whitbourne, 1985).  Ill  THE  PHYSIOLOGICAL RESPONSE TO AQUATIC EXERCISE  There  i s an  increasing  amount o f l i t e r a t u r e  v a r i o u s w a t e r e x e r c i s e programs. in  providing  potential  adequate  Many have been e v a l u a t e d  components  cardiovascular  benefits,  i n c l u s i o n o f warm-up and cool-downs Based on  the adequacy  evaluated  were deemed s a t i s f a c t o r y .  innovations  that  are b e n e f i c i a l  inconsequential;  available  of  fitness.  These  components body  and s a f e t y p r e c a u t i o n s a r e met,  11  (Koszuta,  o f the 15  Whether the v a r i o u s  1986). programs  books, v i d e o s  and  i n terms o f s a t i s f y i n g the above c r i t e r i a may  i t i s f e l t by  (Koszuta,  include  composition,  some t h a t any e x e r c i s e  a i d o r program  w i l l n o t cause i n j u r y may be h e l p f u l as a means o f i n c r e a s i n g the to e x e r c i s e  describes  as t o t h e i r worth  f l e x i b i l i t y , strength,  these c r i t e r i a  that  be that  motivation  1986) .  A t t e m p t s have been made t o determine the d i f f e r e n c e i n m e t a b o l i c demands between e x e r c i s e i n w a t e r and on l a n d . w a t e r c o u l d p e r f o r m 66.7%  t o 71.4%  Costill  (1971) f o u n d t h a t s u b j e c t s i n  o f the t o t a l amount o f work performed on  land.  The oxygen uptake d u r i n g submaximal work was found t o be  higher  i n the w a t e r e x e r c i s e c o n d i t i o n s .  significantly  When comparing the c a l o r i c c o s t o f  submaximal w a t e r work i n w a t e r t o t h a t o f e x e r c i s i n g on l a n d , w a t e r was  found t o i n c r e a s e  the energy r e q u i r e m e n t s by  33% t o 42%  exercise  f o r any  given  33 work l e v e l . heart  I n response t o the I n c r e a s e d  r a t e s were a l s o h i g h e r  c a l o r i c demand i n w a t e r e x e r c i s e ,  at a l l l e v e l s of  subrnaximal e x e r c i s e .  Water  r e s i s t a n c e appears t o be r e s p o n s i b l e f o r a mean i n c r e a s e o f a p p r o x i m a t e l y  34%  i n the energy r e q u i r e m e n t s d u r i n g subrnaximal e x e r c i s e . Vickery concerning the  e t a l . (1983) p r e s e n t e d  water "aerobic" e x e r c i s e  premise  primarily  that  of  i t was  aquatic  not  The  heart  water  swimming. crawl in  The  performed exercise  swimming, r u n n i n g  measured  individual  heart  included  movements p r o d u c e d  warm-up  varied the  the  in  highest  moderate i n t e n s i t y , p r o d u c i n g 70%  to  77%  u p t a k e s o f 1.2  of  the  t o 1.3  difference  between  that although intensity that  and  some e x e r c s e s  o f work, the  regular  and  the  and  rates  20  of a s e r i e s  of  followed  lap  simulated  Fluctuations  workout  suggest  movements  lap  by  and  that  bobbing  swimming produced  the  A l l t h r e e workouts were found to be  age-adjusted  heart  was  t o 57%  intensity  total  t o 152  rate),  average  I t was  calorie  o f work.  The  response t o  participation  a n c  *  oxygen a  v  e  r  found t h a t expenditure  authors  i n the workout p r o d u c e d a l o w e r  of  beats/minute  o f V-^max^ '  t o 65 k c a l s / m i n u t e .  workouts  overall  sufficient  of  heart  the  elicit  from  twisting,  average h e a r t r a t e s o f 132  three not  stopping,  Kicking  o f 5.9  to  of 3 college  t r e a d i n g water.  course  l i t e r s / m i n u t e ( o r 51%  the  duration of exercise  energy e x p e n d i t u r e  intensity.  maximal  r a t e s o f energy e x p e n d i t u r e  intensity  stretching,  from  program c o n s i s t i n g  Each workout c o n s i s t e d  h i g h e s t h e a r t r a t e and oxygen u p t a k e .  (or  sufficient  i n p l a c e , k i c k i n g and during  exercise  without  data  They proceeded  "Aqua Dynamics" w o r k o u t s , r a n g i n g  consecutively  rate  exercise  an  r a t e and  minutes i n d u r a t i o n .  exercises  p h y s i o l o g i c a l response  ("aqua dynamics").  known whether  women were d e t e r m i n e d d u r i n g t h r e e 60  first  calisthenics offered  acute t r a i n i n g e f f e c t s .  minutes t o  the  a  S  e  the and  concluded  than  required  this  type o f  exercise  suggests  would  probably  improve  physical  34 work c a p a c i t y , p a r t i c u l a r l y i n those i n d i v i d u a l s w i t h r e l a t i v e l y low p h y s i c a l work c a p a c i t i e s . Koszuta  (1986)  describes  a  study  i n which  six  a e r o b i c a l l y f i t male  s u b j e c t s p a r t i c i p a t e d i n an a q u a t i c e x e r c i s e program.  The  three routines  21, 36 and 46 minutes i n d u r a t i o n ) were s i m i l a r t o the c o n v e n t i o n a l  "aerobic"  c l a s s e s on l a n d .  H e a r t r a t e s and mean oxygen u p t a k e s were m a i n t a i n e d a t  l o w e r end  recommended ranges f o r f i t a t h l e t e s  Sports low  of  the  Medicine,  1978).  average  aerobic  to  The  (American C o l l e g e  i n v e s t i g a t o r s concluded  capacity  would  likely  that  receive  (at  the of  i n d i v i d u a l s with  cardiovascular  and  w e i g h t c o n t r o l b e n e f i t s from such a program. It  appears  then,  that  despite  an  inadequacy  i n v e s t i g a t i o n s e x a m i n i n g t h i s type o f e x e r c i s e , t h e r e that  water  exercise l e v e l s of  and  exercise i t may  fitness.  can be  be  regarded  particularly  as  a  viable  suited for  in  the  i s a general and  those  number  of  consensus  e f f e c t i v e form  individuals with  of low  - 35 METHODS AND PROCEDURES  Fifteen 61-75  subjects  years)  day-care  were  recruited  facilities.  p o t e n t i a l discomfort in  (8 females  voluntarily  A l l subjects  were  from  fully  regional informed  range  community  adult  o f the r i s k s  and  a s s o c i a t e d w i t h t h e t e s t i n g p r o c e d u r e s and p a r t i c i p a t i o n  t h e program b e f o r e  undergo m e d i c a l  and 7 males, mean age 68.5 y e a r s ,  giving their  screening  consent.  and c l e a r a n c e  A l l subjects  were r e q u i r e d t o  by t h e i r p h y s i c i a n s .  The  subjects  were r e q u i r e d t o demonstrate an absence o f : 1.  recent  illness requiring hospitalization,  2.  chronic  3.  uncontrolled  diabetes,  4.  uncontrolled  hypertension,  5.  symptomatic c a r d i o v a s c u l a r  6.  renal/hepatic  7.  n e u r o l o g i c a l disease  ( d e b i l i t a t i n g ) a r t h r i t i s or r e l a t e d j o i n t  disorders,  disease,  disease, (pronounced d e c l i n e i n motor a b i l i t i e s  and/or  mentition). (see.  Appendix  testing).  F  f o r contraindications  A l l subjects  f o r exercise  p a r t i c i p a t i o n and  completed forms o f i n f o r m e d c o n s e n t p r i o r t o e n t r y  i n t o t h e program (see Appendices G and H). Participants before  i n the study  underwent  a series  t h e program s t a r t e d and 5 weeks l a t e r a t t h e end o f t h e program.  results  i n Table I I .  weight, a 5-lead exercise electrocardiogram, capacity  ventilation heart  tests The  o f t h e s e p h y s i o l o g i c a l measurements and p h y s i c a l parameters a t the  s t a r t o f t h e program a r e g i v e n  vital  of physiological  rate,  Measurements i n c l u d e d spirometry  measurements  height, (forced  (FVC), f o r c e d e x p i r a t o r y volume i n 1 second ( F E V ^ " ^ ) , maximum )) • r e s t i n g b l o o d  exercise  heart  rate  pressure  and V0_  (systolic/diastolic) , resting as d e t e r m i n e d by a  continuous  36 treadmill  test  (modified  after  Jones  and Campbell,  1982).  c o n s i s t e d o f a 3 minute warm-up w a l k a t 2.0 mph ( 0 % g r a d e ) .  The  protocol  T r e a d m i l l speed  was t h e n i n c r e a s e d t o 2.5 mph w i t h 2% i n c r e a s e s i n e l e v a t i o n every 2 minutes. The  reliability  o f ^C^max  determinations  i n elderly  subjects  has  been  d e s c r i b e d by Thomas e t a l . (1985) w i t h t h e c o r r e l a t i o n c o e f f i c i e n t s between a first  stage  I (Jones and Campbell) t e s t and a second stage  I t e s t one year  l a t e r b e i n g 0.90. The  criteria  f o r stopping  the exercise  s u g g e s t e d by Cunningham and R e c h n i t z e r to c o n t i n u e  test  (1974).  was m o d i f i e d  from  that  A l l s u b j e c t s were encouraged  t h e t e s t u n t i l they i ) a t t a i n e d t h e i r maximal h e a r t r a t e and/or,  i i ) f a t i g u e ( b r e a t h l e s s n e s s , c l a u d i c a t i o n ) ensued. Subjects initial  were a c q u a i n t e d  o r i e n t a t i o n sessions  w i t h a l l t e s t s and t r e a d m i l l p r o t o c o l a t t h e J.M.  C e n t e r a t t h e U n i v e r s i t y o f B r i t i s h Columbia. visits  to the f a c i l i t y .  Resting heart heart  Blood  pressures  r a t e s were o b t a i n e d  r a t e s were  continuously  Buchannan R e s e a r c h  and F i t n e s s  T e s t i n g was done on s u c c e s s i v e were  obtained  by a r a d i a l p u l s e  monitored  during  by d i r e c t  by a u s c u l t a t i o n .  and e x e r c i s e ( t e s t i n g ) ECG.  Forced  expiratory  volume i n 1 second ( F E V ' ^ ) and f o r c e d v i t a l c a p a c i t y (FVC) were r e c o r d e d as 1  the h i g h e s t o f t h r e e t r i a l s  ( a f t e r Thomas e t a l . , 1985).  c o n t i n u o u s l y c o l l e c t e d and a n a l y z e d  by a Beckman M e t a b o l i c  (BMMC) i n t e r f a c e d w i t h a H e w l e t t - P a c k a r d second d e t e r m i n a t i o n s  E x p i r e d gases were Measurement  Cart  3052A Data A c q u i s i t i o n System f o r 15  o f r e s p i r a t o r y gas exchange v a r i a b l e s .  The a c c u r a c y o f  t h i s means o f d a t a c o l l e c t i o n has been deemed h i g h l y s a t i s f a c t o r y by Montoye e t a l . (1970). by  The a n a l y s i s o f e x p i r e d gases f o r each s u b j e c t was preceded  the c a l i b r a t i o n  Maximum exchange  oxygen ratios  o f t h e C O 2 and 0 ^ a n a l y z e r s  consumption, were  f i f t e e n second v a l u e s .  maximum  determined  by  ventilation averaging  with  a c a l i b r a t i o n gas.  and maximum  the h i g h e s t  2  respiratory consecutive  37 E x e r c i s e Program Subjects experimental males  to  were  randomly  (n = 8) groups.  ensure  equal  assigned  to  either  control  (n  =  7)  or  Females were a s s i g n e d t o groups f i r s t and  r e p r e s e n t a t i o n of  sex  i n each group.  The  then  exercise  s e s s i o n s f o r the e x p e r i m e n t a l group were h e l d on t h r e e (3) mornings per week, on n o n - c o n s e c u t i v e  days f o r a 5 week p e r i o d a t the UBC  Aquatic  t o t a l o f seventeen  (17) s e s s i o n s were a t t e n d e d by the e x p e r i m e n t a l group.  Each e x e r c i s e s e s s i o n began w i t h 25 minutes o f s t r e n g t h and  Center.  A  flexibility  movements on d r y l a n d w h i c h i n c l u d e d t o r s o , arm and s h o u l d e r e x e r c i s e s w h i l e standing  and  mat  work where each  movements f o r the m u s c u l a t u r e period.  The  c h e s t depth torso,  of water.  e n t i r e body and  attempt  to  was  movements  stretching)  i n the back and  The  p o o l work began w i t h a warm-up f o r the arms  active  running/jogging  f o l l o w e d by  a slower  i n c o r p o r a t i n g the  A l l p o o l work was  temperatures  30 minutes, ranged  from  stretching  proceeded to a shoulder  with (and  or and  involved  the  paced cool-down w i t h s t r e t c h  and  sides  movements w h i c h  of  the  pool  (isometrics  and  p e r f o r m e d t o s e l e c t e d p r e - r e c o r d e d music i n an  t o d i c t a t e a cadence f o r the p a r t i c i p a n t s .  s e s s i o n was  additional  l e g s , e n d i n g w i t h a cool-down  s u b j e c t s then e n t e r e d the p o o l and  proceeding  strength  s u b j e c t performed  the e n t i r e were  T o t a l p o o l time f o r each  session lasting  controlled  at)  55  28.3°C  minutes.  Pool  (83°F) t o  30°C  (86°F). The  i n t e n s i t y o f e x e r c i s e was  r e c o r d e d as a r a d i a l p u l s e o b t a i n e d d u r i n g  each e x e r c i s e s e s s i o n ( r e c o r d e d as number o f b e a t s by 4 t o g i v e b e a t s p e r m i n u t e ) .  Two  i n 15 seconds, m u l t i p l i e d  h e a r t r a t e d e t e r m i n a t i o n s were o b t a i n e d  from each s u b j e c t p e r s e s s i o n . Those s u b j e c t s a s s i g n e d t o the c o n t r o l group proceeded w i t h t h e i r normal d a i l y a c t i v i t i e s d u r i n g the course o f the s t u d y .  - 38 EXPERIMENTAL DESIGN AND DATA ANALYSIS  D a t a a n a l y s i s was o f a r e p e a t e d (treatment  measures d e s i g n ;  one g r o u p i n g  and c o n t r o l ) and one w i t h i n f a c t o r ( t i m e ) .  was p e r f o r m e d u s i n g  t h e program  BMDP2V (BMDP:  Analysis  Statistical  factor  of variance  Software I n c . ,  C a l i f o r n i a ; r e v i s e d 1982). The model f o r t h i s r e p e a t e d measures d e s i g n i s d e t a i l e d i n Appendix D. Analysis determine  group, time  controlled variable,  of variance  was  performed  on each  and group x time e f f e c t s .  a t a predetermined the hypothesis  alpha  was t h a t  level  dependent  v a r i a b l e to  A l l hypothesis  o f 0.01 ( a = 0.01).  t h e (T1-T2) change  t e s t i n g was F o r each  i n the experimental  group w o u l d be d i f f e r e n t from t h e (T1-T2) change i n t h e c o n t r o l group, the n u l l h y p o t h e s i s b e i n g  MQ^QUPI  when P > 0.01, t h e n u l l  hypothesis  =  ^GR0UP2  a  t  a  =  u  -01-  was a c c e p t e d ,  F  o  r  A  H  dependent v a r i a b l e s a r e :  1.  SBPR:  2.  V E  3.  FEV ' :  f o r c e d e x p i r a t o r y volume ( i n 1 second)  4.  FVC:  forced v i t a l  5.  HRO:  e x e t c i s e h e a r t r a t e a t 0% t r e a d m i l l grade  6.  HR2:  7.  HR4:  e x e r c i s e h e a r t r a t e a t 4% t r e a d m i l l grade  8.  HR6:  e x e r c i s e h e a r t r a t e a t 6% t r e a d m i l l grade  9.  HR8:  e x e r c i s e h e a r t r a t e a t 8% t r e a d m i l l grade  10.  HR10:  e x e r c i s e h e a r t r a t e a t 10% t r e a d m i l l grade  11.  HR12:  e x e r c i s e h e a r t r a t e a t 12% t r e a d m i l l grade  MAX 1  s y s t o l i c blood pressure :  0  variables,  when P < 0.01, t h e n u l l  h y p o t h e s i s was r e j e c t e d . The  with  maximum v e n t i l a t i o n  capacity  e x e r c i s e h e a r t r a t e a t 2% t r e a d m i l l grade  - 39 -  12.  V0  13.  H R  14.  2MAX' j^x  HR^  m  a  x  i  m  u  m  oxygen uptake  maximum h e a r t r a t e  :  :  resting heart rate  - 40 RESULTS  The  physical  c h a r a c t e r i s t i c s and m e t a b o l i c parameters  are summarized i n T a b l e s I and I I . ANOVA t a b l e s E.  o f the subjects  are reproduced  i n Appendix  A summary o f v a r i a b l e a n a l y s i s i s g i v e n i n T a b l e I I I . A n a l y s i s o f v a r i a n c e y i e l d e d main (Time) e f f e c t s f o r HR^,^ (P = 0.001)  and  FEV^'^  (P = 0.002) d e m o n s t r a t i n g  that,  when averaged  over  s i g n i f i c a n t change from T ( l ) t o T(2) i s seen i n t h e s e v a r i a b l e s . interactions HR  REST ^  these  P =  between Group °-  003  variables  )  a  n  d  from  V0  2MAX ^ T(l)  ( e x p e r i m e n t a l and c o n t r o l ) . at T ( l ) .  and Time were P =  °-  0 0 7  seen  with,  1 0 FEV '  groups,  a  Significant (P =  0.001),  ) ' d e m o n s t r a t i n g t h a t t h e change i n  t o T ( 2 ) a r e n o t t h e same  f o r both  No s i g n i f i c a n t main (Group) e f f e c t s were  groups noted  T h e r e f o r e , t h e two groups d i d n o t show any s i g n i f i c a n t d i f f e r e n c e s  at T ( l ) f o r p h y s i c a l or metabolic c h a r a c t e r i s t i c s .  - 41 -  TABLE I  Mean and S t a n d a r d D e v i a t i o n s o f P h y s i c a l and M e t a b o l i c C h a r a c t e r i s t i c s ( E x p e r i m e n t a l and C o n t r o l Groups) Variable + 4.68  AGE ( y r s )  68..5  WEIGHT (kg)  77..57 + 18.70  HEIGHT (cms)  166..65 + 7.33  SYSTOLIC BP (REST) (mmHg)  136..00 + 10.57  VE  35..57 + 10.32  M A X a-^n" ) 1  FEV FVC  1 - 0  2..20 + 0.52  (l-sec" ) 1  3..49 + 0.96  (l^sec" ) 1  HR  MAX t ^ *  H R  REST  8  1 1 1 1 1 1  143..80 + 13.87  " ) 1  76..40 + 5.97  (b^- "^" ) 1  1  HR 0% ( b t s ' m i n " )  119,.40 + 13.88  HR 2% ( b t s ' m i n " )  124 .13 + 13.79  HR 4% ( b t s . m i n " )  131 .33 + 13.51  HR 6% ( b t s ' m i n " )  137 .00 + 12.74  HR 8% ( b t s ^ m i n " )  137 .77 + 11.89'  HR 10% (bts«min )  141 .14 + 16.69'  HR 12% ( b t s - m i n " )  167 .00 + 0.00  1  1  1  1  1  _1  1  V0  2MAX  ( m l  * S k  1  ,  m  l  n  1  )  24 .44 + 1.99  a l l v a l u e s a r e means ± SD a l l v a l u e s n = 15 e x c e p t where * (number i n b r a c k e t s i s n)  - 42 -  TABLE I I  Mean and Standard Deviations of Physical and Metabolic Control  Variable  Characteristics Exp e r imenta1  AGE ( y r s )  67.71 ± 5.38  69.12 ± 4.26  WEIGHT (kg)  75.41 ± 18.76  79.46 ± 19.72  HEIGHT (cms)  167.10 ± 7 . 8 2  116.25 ± 7.38  SYSTOLIC BP (REST) (mmHg)  132.43 ± 9.34  139.12 ± 11.17  VE  MAX  FEV  1 - 0  FVC H R  HR  a-**') 1  34.70 ± 11.64 2.31 ± 0.68  2.11 ± 0.37  3.35 ± 0.82  3.61 ± 1.10  ( ' ^' y  141.43 ± 17.93  145.87 ± 9.92  (bts' ^" )  77.00 ± 2.77  (l.sec" ) 1  (1-sec" ) 1  hts  MAX  REST  36.32 ± 9.77  mi  1  1  1  75.78 ± 8.01  HR 0% ( b t s - m i n " )  116.57 ± 11.12  121.87 ± 16.25  HR 2% ( b t s - m i n " )  119.42 ± 12.16  128.25 ± 14.57  HR 4% ( b t s - m i n " )  127.14 ± 12.06  135.00 ± 14.40  HR 6% ( b t s - m i n " )  134.43 ± 13.26  139.25 ± 12.70  HR 8% ( b t s - m i n " )  138.14 ± 16.12  137.33 ± 5.24* (6)  HR 10% ( b t s - m i n " )  142.50 ± 22.55* (4)  139.33 ± 8.02*  HR 12% ( b t s - m i n " )  167.00 ± 0.00* (1)  1  1  1  1  1  1  1  V0  2MAX  ( m l  ' S k  No. i n each  -1 *  m l n  -1 >  23.84 ± 1.99  (0) 24.98 ± 1.97  group  a l l values are means ± SD a l l values n = 15 except where * (number i n brackets i s n)  (3)  - 43 -  TABLE I I I Summary of Variable Analysis EXPERIMENTAL  CONTROL  P  Variable  T(l)  T(2)  T(l)  T(2)  TIME  AGE (YRS.)  69.,1  69.,1  67.,7  67.7  NS  NS  WEIGHT (Kg)  79..4  79.,4  75.,4  75.4  NS  NS  HEIGHT (cm)  116,.2  116.,2  167..1  167.1  NS  NS  SBPR (mmHG)  139..1  131.,5  132..4  133.4  NS  NS  36..3  36.,9  34..7  35.0  NS  NS  2,.1  2,.4  2,.3  2.2  3,.6  3..9  3,.3  3.3  NS  NS  )  145..8  144..6  141,.4  141.5  NS  NS  )  75 .8  71,.0  77,.0  76.6  HR 0% ( b t s - m i n " )  121,.8  116,.2  116,.5  115.8  NS  NS  HR 2% ( b t s - m i n " )  128,.2  123..3  119,.9  118.1  NS  NS  HR 4% ( b t s - m i n " )  135 .0  128,. 5  127 .1  127.0  NS  NS  HR 6% ( b t s - m i n )  139,.2  132..3  134,.4  133.8  NS  NS  HR 8% ( b t s - m i n " )  137,.3  132..8  138..1  138.1  NS  NS (13)  V E  MAX  FEV  ( 1  1 - 0  *  m i n  "  1 )  (1-sec" ) 1  FVC ( 1 - s e c ' ) 1  HR  MAX  (  H R  REST (  b  t  s  ,  b t s  m  *  i  n  l  m i n 1  1  1  1  - 1  1  GROUPxTIME  0.001  0.002  .0.003  0.001  HR 10% ( b t s - m i n " )  _  (7)  HR 12% ( b t s - m i n " )  _  (1)  1  1  V0  2MAX  ( m l , k  S  -1 ,  m  i  n  -1 )  24,.9  25..8  23,.8  23.5  NS  a l l values n = 15 except where * (number i n brackets i s n) s i g n i f i c a n c e at P < 0.01 NS denotes non-significance (-) denotes i n s u f f i c i e n t data  0.007  - 44 TABLE IV Comparison of Selected Parameters  Thomas et a l . , 1985  VARIABLE AGE (YRS.)  62.6 ± 3.1  WEIGHT (kg)  79.8 ± 1.1  Seals e t a l . , 1984  Larson et a l . , 1984  63.3 ± 3.0  67.0 ± 0.00  68.5 ±  77.1 ± 10.7  77.57 ± 18.70  Jessop 1988  4.i  VO 2MAX (ml«kg  «min  )  29.6 ± 0.6  25.4 ± 4.6  83.4 ± 2.2  67.2 ± 16.4  24.44 ± 1.99  VE  MAX (l«min  )  HR, MAX (bts.min  FEV  )  155.3 ± 2.4  35.57 ± 10.32  143.80 ± 13.87  174 ± 10  1.0  (l'sec  )  2.80 ± 0.6  2.86 ± 0.05  100  a l l values are means ± SD (-) denotes data not available  24  644  2.20 ± 0.52 15  - 45 TABLE V  Summary of Hypothesis Testing  (ml»kg  «min  )  V  °2MAX  E X P T L  ( T 2 ) > °2MAX V  C T R L  (T2)  SUPPORTED  BP SYSTOLIC (RESTING) ( b t s - m i- n" I N)  BPSR E X P T L  MAX _ . (l«min )  VE  ( T 2 )  < BPSR C T R L  NOT SUPPORTED  ( T 2 )  VE  x  FEV  1 - 0  HR  FEV -  (1-sec" )  1  1  FVC ( l ^ s e c  REST ^  b t s  )  *  m i n  MAX  E X P T L  0  ( T 2 ) > MAX  EXPTL  FVC E X P T L  )  HR  REST  VE  E X P T L  ( T 2 )  C T R L  > FEV " 1  ( T 2 )  > FVC CTRL  ( T 2 ) < REST HR  Tl:  b a s e l i n e measurement  T2:  measurements t a k e n a t end o f s t u d y  EXPTL:  e x p e r i m e n t a l (GROUP 1)  CTRL:  c o n t r o l (GROUP 2)  NOT SUPPORTED  (T2) CTRL  0  ( T 2 )  NOT SUPPORTED  2  C T R L  SUPPORTED  (T2)  R e l a t i o n s h i p s s u p p o r t e d on b a s i s o f s i g n i f i c a n c e P < 0.01  SUPPORTED  - 46 DISCUSSION  Tables The  I and I I summarize t h e v a r i a b l e s f o r t h e s u b j e c t s i n t h e study.  s u b j e c t s were found t o r e p r e s e n t a homogeneous sample as i n d i c a t e d by the  relatively  s m a l l s t a n d a r d d e v i a t i o n s f o r most o f t h e v a r i a b l e s .  When some  s e l e c t p h y s i c a l and m e t a b o l i c parameters a r e compared w i t h v a l u e s o b t a i n e d by previous  investigators  parameters, found.  (Table  IV) , i t c a n be seen  that  there  a r e some  p a r t i c u l a r l y body.weight, i n w h i c h a l a r g e s t a n d a r d d e v i a t i o n i s  Standard  deviations  f o r v a r i a b l e s such  as w e i g h t , age, VO. , ° ° 2max maximum h e a r t r a t e and F E V ' ^ a r e comparable t o v a r i a b i l i t y found i n o t h e r 1  investigations are n o t e d the  ( i . e . Seals e t a l . ,  study  Thomas e t a l . ,  1985).  Differences  i n VE : a lower mean v a l u e o b t a i n e d i n t h i s s t u d y may be due t o max J  o l d e r mean  similar  1984;  age o f t h e s u b j e c t s .  training  appears  studies  involving  t o be b o t h  older  Generally,  elderly  i n comparison  subjects,  and e x h i b i t s  J  t o other  the subject  i n this  a greater v a r i a t i o n  i n body  weight.  I  CARDIOVASCULAR PARAMETERS  A.  Resting S y s t o l i c Blood Pressure The  systolic  experimental blood  group d i d n o t show a s i g n i f i c a n t  pressure  f i n d i n g s by S k i n n e r  (Table  III).  This  e t a l . , (1964) who found  decline i n resting  i s n o t i n a c c o r d a n c e w i t h the significant  reductions i n the  s y s t o l i c b l o o d p r e s s u r e o f p r e v i o u s l y s e d e n t a r y m i d d l e - a g e d s u b j e c t s and by Barry e t a l . ,  (1966) who found s i m i l a r r e d u c t i o n s i n e l d e r l y s u b j e c t s .  Ernes'  (1979) 12-week s t u d y a l s o demonstrated a r e d u c t i o n i n r e s t i n g s y s t o l i c  blood  pressure. I t i s known t h a t the body a d j u s t s a r t e r i a l p r e s s u r e by a l t e r i n g rate,  s t r o k e volume  and p e r i p h e r a l v a s c u l a r r e s i s t a n c e .  The major  heart factor  - 47 t h a t seems t o be a l t e r e d i n t h e a g i n g p r o c e s s  i s the increased r i g i d i t y of  the a r t e r i a l w a l l s , r e s u l t i n g i n an o v e r a l l i n c r e a s e d s y s t e m i c blood  flow  systolic  (Sebban  e t a l . , 1981).  and d i a s t o l i c  1981).  blood  I t i s unlikely  pressures  that training  increase i n the e l a s t i c constant resting  systolic  pressures  c a n be  (MCardle  lowered  significantly  Boyer, 1969) and h y p e r t e n s i v e subjects  1977)  showed  at rest. that  mean  i n the e l d e r l y  Both  (Sato  the gradual  systolic  resting et a l . ,  age-related  and d i a s t o l i c  by a r e g u l a r  program  blood  of exercise (Kasch and  (Boyer and Kasch, 1970; Choquette and Ferguson,  The Tecumseh M i c h i g a n  regardless  arterial  the higher  has been seen w i t h n o r m o t e n s i v e  study  o f age, a c t i v e men  s y s t o l i c and d i a s t o l i c p r e s s u r e s For  seen  by  o f t h e a r t e r i a l w a l l s and y e t r e d u c t i o n s i n  a r e seen.  This  i s seen  could reverse  pressures  e t a l . , 1981).  1973)  This  r e s i s t a n c e to  (Scheuer  and T i p t o n ,  had s i g n i f i c a n t l y  lower  t h a n l e s s a c t i v e men.  pressure  t o decrease,  both  c e n t r a l and p e r i p h e r a l  mechanisms t h a t c o n t r o l c a r d i a c o u t p u t and t o t a l p e r i p h e r a l r e s i s t a n c e must be  considered.  unchanged  T r a i n i n g has been r e p o r t e d t o be a s s o c i a t e d w i t h  or reduced  resting cardiac  o u t p u t has n o t been a s s o c i a t e d w i t h Tipton,  1977) .  increase others  Total  peripheral  i n some s t u d i e s  when compared  output  a fall  i n blood  resistance  (Mitchell  but the decrease  after  and W i l d e n t h a l ,  to control values,  although  pressure training  increased, i n cardiac  (Scheuer and was  seen t o  1974) and decrease i n an i n c r e a s e  i n cardiac  o u t p u t o b t a i n e d d u r i n g maximal e x e r c i s e w i t h t r a i n e d muscle groups g e n e r a l l y has been r e l a t e d t o a r e d u c e d p e r i p h e r a l r e s i s t a n c e and an i n c r e a s e d v a s c u l a r conductance ( C l a u s e n , Since resting  the l i t e r a t u r e  systolic  blood  1977).  g e n e r a l l y agrees w i t h pressure  with  the f i n d i n g  training,  this  o f a decreased  current  study  i n c o n c l u s i v e as i t may have been t o o s h o r t i n d u r a t i o n t o f a c i l i t a t e decline i n blood pressure  systemic  (Robinson,  1938).  was  such a  - 48 B.  R e s t i n g H e a r t Rate Resting  heart  r a t e was  seen t o  decrease s i g n i f i c a n t l y  s t u d y (P = 0.003) i n the e x p e r i m e n t a l exhibit  a  change  agrees w i t h  (Table  III).  5-week  group whereas the c o n t r o l group d i d not  This  C u p e l l i e t a l . (1984),  over the  6.43%  decline  in  r e s t i n g heart  Ernes (1979), G r a n a t h e t ' a l .  rate  (1970)  and  Z o n e r a i c h and Rhee (1977). It vagal  has  been  that  drive  combined  cholinergic  resulting  in a  populations, the  suggested  tonic  decreased  t r a i n i n g caused with  r e s t i n g heart  a rate  activity  of  the  i s m e d i a t e d by  sympathetic discharge. rate  of  the  sympathetic  I t has  centrogenic  sympathoinhibitory  mechanism,  (Astrand,  1977).  (accelerator)  In  younger  these  (SA)  are  is not  lend  parasympathetic a c t i v i t y . levels  of  atrial  myocardial  a c e t y l c h o l i n e per  parasympathetic  dominance.  I t i s believed  parasympathetic a c t i v i t y  node  findings  increased  vagal  and  a l s o been s u g g e s t e d t h a t the  concentrations  1977);  increases  increased  sino-atrial  cholinesterase Tipton,  increased  the l i t e r a t u r e s t a t e s t h a t t r a i n i n g c r e a t e s an imbalance between  ( d e p r e s s o r ) neurons i n f a v o r o f a g r e a t e r that this  an  decreased affected  credence  by  a decreased  intrinisc  training.  by  to  and  training  the  theory  Myocardial (Scheuer  that  A l t h o u g h a n i m a l s t u d i e s have  choline  acetyltransferase  gram o f t i s s u e w i t h c h r o n i c  firing  and  training indicated  activity  and  more  exercise  (Williams  e t a l . , 1984;  Wyatt e t a l . , 1978), the l i t e r a t u r e h o l d s t h a t p a r a s y m p a t h e t i c  activity  the  to  decreases w i t h C.  myocardium  and  resting  sympathetic  activity  training.  M a x i m a l H e a r t Rate Neither  maximal  experimental  heart  rate  or c o n t r o l groups showed any  over  the  e f f e c t s have been d e s c r i b e d have  increases  been  seen  to  cause  course as b e i n g  a  decline  of  the  study  s i g n i f i c a n t change i n  (Table  III).  Training  n e g l i g i b l e i n some i n v e s t i g a t i o n s in  maximal  heart  rate  in  and  others.  - 49 M a z z a r e l l a e t a l . (1966) r e p o r t e d e x e r c i s e program and S k i n n e r  no s i g n i f i c a n t change f o l l o w i n g a 2 month  e t a l . (1964) r e p o r t e d  r e s u l t o f a 6 month program w i t h m i d d l e - a g e d men. Z o n e r a i c h and Rhee (1977) d e s c r i b e d rate following training.  similar findings  G r a n a t h e t a l . (1970) and  i n d i c a t i o n s o f a d e c r e a s e d maximal  6-12 mos. i n o t h e r  literature  subjects  has n o t shown any changes  (65 y e a r s  investigations  rate  ( i . e . 5 weeks  i n v e s t i g a t i o n s ) o r t h e age o f t h e s u b j e c t s  advanced t o produce such a change, r e g a r d l e s s The  heart  I t i s p o s s i b l e t h a t t h e d u r a t i o n o f t h i s s t u d y was  too s h o r t t o produce s i g n i f i c a n t changes i n maximal h e a r t vs.  as a  of  age  implicate  and  an a g e - r e l a t e d  o f t h e d u r a t i o n o f t h e study.  i n maximum h e a r t  older),  was too  and  decline  the m a j o r i t y  rate  i n older  of  previous  i n maximum h e a r t  rate  as  being u n a l t e r a b l e by e x e r c i s e . E a r l y papers d e s c r i b i n g younger s u b j e c t s  s t a t e t h a t t r a i n i n g caused an  i n c r e a s e d s t r o k e volume a t a g i v e n submaximal VG^ and a p r o p o r t i o n a l decrease i n heart  rate.  I t became common knowledge t h a t t h e d e c r e a s e d h e a r t  secondary t o the increase t h a t an i n c r e a s e d (Clausen,  1977) .  stroke  i n stoke  volume a l t h o u g h l a t e r  studies  r a t e was indicated  volume i s n o t e s s e n t i a l t o a d e c r e a s e d h e a r t  The p o t e n t i a l  importance  of peripheral  rate  cardiovascular  a d j u s t m e n t s was suggested. In  contrast  to studies  involving e l d e r l y subjects,  training  d e s c r i b i n g younger s u b j e c t s have i n d i c a t e d a d e c r e a s e i n maximal h e a r t regardless control,  o f t h e mode o f e x e r c i s e  endogenous c a t e c h o l a m i n e s ,  volume have been s u g g e s t e d  ( S c h a i b l e and Scheuer, 1985). CNS a d a p t a t i o n s  as c a u s a t i v e  factors.  p e r i p h e r a l o r c e n t r a l components o f t h e b a r o r e c e p t o r the p e r i p h e r a l v a s c u l a r increases  r e s i s t a n c e and h e a r t  rate.  t h e c o n t r a c t i l i t y o f t h e myocardium.  may be met w i t h i n t r a c a r d i a l o r b a r o r e c e p t i v e  studies rate,  Autonomic  o r an i n c r e a s e d  stroke  Training  may a l t e r the  reflex,  thus a f f e c t i n g  Also,  Increased  t r a i n i n g probably c o n t r a c t i l e forces  r e f l e x e s w h i c h cause a d e c l i n e  - 50 i n heart  r a t e , b u t no e x p e r i m e n t a l  evidence to account rate  f o r the p o s s i b i l i t y  following chronic  who a r e 60 y e a r s  evidence supports t h i s .  o f no change i n t h e maximal  e x e r c i s e , b u t some s t u d i e s  o f age and o l d e r ,  There i s l i t t l e  suggest t h a t  t h e changes o f c a r d i a c  younger  subjects  1982).  Port  exercise  f o l l o w i n g acute bouts  of exercise  e t a l . , (1980) suggest t h a t  (Kuikka  the l e f t  i s changed i n t h e s e v e n t h decade o f l i f e  chronic  exercise  stroke  l e s s than i n  and  Lansimies,  v e n t r i c u l a r response t o and by t h e e i g t h  t h e r e i s p r a c t i c a l l y no i n c r e a s e i n e j e c t i o n f r a c t i o n . that  i n subjects  output,  volume and l e f t v e n t r i c u l a r e j e c t i o n f r a c t i o n a r e c o n s i d e r a b l y  heart  decade  I t i s p o s s i b l e , then,  may n o t r e s u l t i n an enhanced s t r o k e  volume  i n the  e l d e r l y s u b j e c t as t h e myocardium cannot r e s p o n d t o t h e e f f e c t s o f t r a i n i n g . This  could  e x p l a i n why maximal h e a r t  rate  does n o t change  i n the e l d e r l y  s u b j e c t and may r e - e s t a b l i s h t h e r e l a t i o n s h i p between s t r o k e volume and h e a r t r a t e , p a r t i c u l a r l y i n the e l d e r l y . D.  Heart Rate at Changing Treadmill Elevations D u r i n g t h e t r e a d m i l l t e s t , h e a r t r a t e was c o n t i n u o u s l y  e l e v a t i o n was i n c r e a s e d . significant  decreases  The e x p e r i m e n t a l i n exercise  m o n i t o r e d as the  and c o n t r o l groups d i d n o t show  heart  rate  at  treadmill  elevations  c o r r e s p o n d i n g t o 0, 2, 4, 6, 8, 10 and 12 p e r c e n t grades (Table I I I ) . I t has been shown w i t h - t r a i n i n g t h a t h e a r t  rate  decreases  w o r k l o a d ( B a r r y e t a l . , 1966; S k i n n e r  e t a l . , 1963), b u t t h e r e s u l t s o f t h i s  c u r r e n t s t u d y appear t o be i n c o n c l u s i v e as a p p r o p r i a t e  at a given  subrnaximal  declines i n heart  rate  were n o t seen a t any o f t h e w o r k l o a d s . whether  a  decline  pheripheral adaptations, increase  i n VO. . 2max  experimental  in  exercise  heart  rate  occurs  by  central  or  t h e degree o f change seems t o be a s s o c i a t e d w i t h an  Since  a  significant °  increase  i n t h e VO. 2max  o f the  group was seen i n t h i s s t u d y , one would e x p e c t a d e c l i n e i n the  e x e r c i s e h e a r t r a t e a t a l l w o r k l o a d s as a r e s u l t o f c e n t r a l and/or p e r i p h e r a l  - 51 adaptations.  I t i s p o s s i b l e that p e r i p h e r a l adaptations  may account f o r the  change i n VO. ; t r a i n i n g has been shown t o a f f e c t t h e a r t e r i o v e n o u s (a-v) 2max oxygen  difference.  increase  Longitudinal  increase  can  younger  (Scheuer and T i p t o n , 1977).  i n (a-v)G-2 d i f f e r e n c e i n c l u d e :  number o f m i t o c h o n d r i a , fiber  with  subjects  i n t h e (a-v)C-2 d i f f e r e n c e a t maximal e x e r c i s e and t h i s  increases with t r a i n i n g the  studies  type  recruitment  increase  affinity  increased  changes  oxidative  o f hemoglobin  to extract  (aerobic)  f o r oxygen  oxygen by: at  l o w PC^  These l o c a l m u s c u l a r a d a p t a t i o n s  difference  t h a t can cause  enzymes,  changes i n  The w o r k i n g muscle  (1) a d e c r e a s e tensions,  (3) e l e v a t e d m y o g l o b i n c o n c e n t r a t i o n s ,  the number and/or f u n c t i o n o f m i t o c h o n d r i a  (2)  i n the increased  o r (4) changes i n  i n active cells  (Astrand,  1977).  c o u l d e x p l a i n t h e i n c r e a s e d VC^max i -  absence o f unchanged e x e r c i s e h e a r t r a t e s .  an  i n t h e f u n c t i o n and  and i n c r e a s e d c a p i l l a r y d e n s i t y .  i t sability  c a p i l l a r y density,  Factors  show  n t n e  I t remains t o be seen whether a  l o n g e r s t u d y would e l i c i t d e c r e a s e s i n t h e e x e r c i s e h e a r t r a t e s .  E.  Maximum Oxygen Uptake The  subjects  i n this  comparable  to other  significant  increase  control  group  study  investigators  VO. o v e r 5 weeks o f t r a i n i n g . 2max ° a  ^  t e r  showed a 17% i n c r e a s e  greater  increases  age-adjusted  maximum  monitored during  (P =  s n o w e <  i  t h a t were strong  a  0.007)  whereas the  A 3.4% i n c r e a s e  was seen i n  M a z z a r e l l a e t a l . (1966) demonstrated a 10%  duration  i n VC^max'  (117 ±  ^2max  group  III).  i n VO. after 2max  program o f g r e a t e r  obtained  (Table  IV) .  values  ^ months o f endurance t r a i n i n g and R o b i n s o n (1938)  aquatic  rates  (Table  i n the experimental  showed no change  increase i n V^max  exhibited baseline  3.0  heart  During beats rate.  6 months.  I t i s possible  t h a t an  ( i . e . 6-12 months) c o u l d produce the exercise sessions, p e r min.) r e p r e s e n t e d Since  the exercise sessions,  heart  rate  was  even  t h e mean h e a r t 77.5  not  %  o f the  continuously  i t i s assumed t h a t t h e h e a r t  rates  - 52 did  n o t drop  significantly  active pool a c t i v i t i e s .  below t h i s  There  have  determination  t h e 30 minutes o f  group's a c t u a l mean b a s e l i n e  (145.8 ± 9.9),  t h e mean e x e r c i s e h e a r t r a t e s  80% o f t h e mean maximum h e a r t r a t e .  been  few s t u d i e s  o f VC^max ^  (1969) r e p o r t e d  throughout  When t h e e x p e r i m e n t a l  maximal h e a r t r a t e i s c o n s i d e r e d a c t u a l l y represented  level  n  to i n v e s t i g a t e the adaptations  o l d e r i n d i v i d u a l s ( S e a l s , 1984).  t h a t a 14 p e r c e n t  increase  in  i n the  Hartley et a l .  following training i n  e l d e r l y s u b j e c t s was due p r i m a r i l y t o an i n c r e a s e i n maximal s t r o k e volume and  resulting  percent  c a r d i a c output.  i n c r e a s e i n VC^max f o l l o w i n g t r a i n i n g i n younger men, s t a t e d t h a t an  i n c r e a s e d maximal  (a-v)02 d i f f e r e n c e and r e s u l t i n g  were r e s p o n s i b l e then,  These same i n v e s t i g a t o r s , r e p o r t i n g on a 15  f o r t h e enhanced ^ 2 m a x '  H  a r t  that e l d e r l y subjects could not e l i c i t  maximal (a-v)02 d i f f e r e n c e . v°2max i n t h e i r e l d e r l y  l' y e  increased cardiac  output  e t a l . (1969) b e l i e v e d ,  significant  increases  i n their  S e a l s e t a l . (1984) s u g g e s t e d t h a t t h e i n c r e a s e d  s u b j e c t s was i n f a c t  due t o a d a p t a t i o n s  i n muscle,  r e s u l t i n g i n an improved a b i l i t y t o e x t r a c t oxygen, as r e f l e c t e d i n a h i g h e r maximal  (a-v)02  difference.  Clearly, this  is little  agreement  as t o t h e  mechanism(s) r e s p o n s i b l e f o r , o r c o n t r i b u t i n g t o , i n c r e a s e s i n VO. i n the zmax elderly weight  subject. loss  experimental thereby  Since  neither  over  t h e course  group  increased  increasing  the t o t a l  experimental  of  this  study,  or control  i t i s possible  i t s muscle mass and d e c r e a s e d lean  body  mass.  group  This  exhibited that  the  i t s body f a t ,  relative  increase i n  muscle mass c o u l d account f o r t h e i n c r e a s e i n VO. (Brooks and Fahey, 1984; zmax M c A r d l e e t a l . , 1981).  - 53 II  RESPIRATORY PARAMETERS and c o n t r o l groups showed no change i n F V C (Table  Both t h e e x p e r i m e n t a l III).  This  agrees w i t h  the f i n d i n g s o f Niinimaa  and Shephard  (1978) and  P o l l o c k e t a l . (1976) who a l s o c o u l d n o t demonstrate p o s i t i v e change i n v i t a l capacity  i n a short-term  aerobic  program.  Heikkenen  (1978),  however, d i d  show an i n c r e a s e i n the v i t a l c a p a c i t y o f young and m i d d l e - a g e d men and women during  an 8 week program.  At this  point  i n time,  i t i s n o t known how  d e c r e a s e d l e v e l s o f a c t i v i t y c o n t r i b u t e t o t h e known a g e - r e l a t e d d e c l i n e i n respiratory function.  Presumably, e x e r c i s e p r i m a r i l y a f f e c t s t h e muscles o f  v e n t i l a t i o n , so i n c r e a s e s i n the s t r e n g t h o f t h e s e and a c c e s s o r y muscles augment measures o f f l o w r a t e . exercise  will  (ventilation:  do  much  perfusion  to  will  I t i s d o u b t f u l t h a t t h i s form o r any form o f significantly  inequalities)  alter  pulmonary  and i t i s r e a l i z e d  hemodynamics  t h a t much o f the  b e n e f i t from e x e r c i s e w i l l be i n the way o f improved r e s p i r a t o r y mechanics. Saltin  and Grimby  inspired  and e x p i r e d  athletes  and former  (1968) during  demonstrated  that  the t o t a l  a maximum v e n t i l a t o r y  a t h l e t e s than  their  sedentary  effort  volume  i s greater i n  counterparts  at similar  ages.  P o l l o c k e t a l . (1976) showed t h a t t h e amount o f a i r f o r c i b l y  during  a maximum  attempt  was found  t o be h i g h e r  of a i r  i n athletes  expired  and former  a t h l e t e s , and t h a t t r a i n i n g e f f e c t s h a d n o t been shown.  S i m i l a r l y , Thomas e t  al.  The s u b j e c t s  (1985)  could  n o t demonstrate  experimental  group  demonstrated  a significant  FEV ' 1  0  i s dependent  (Whitbourne,  1985),  i n this  upon  changes  present increase  1  study  1 - 0  t o Thomas's  (P = 0.001).  components  i n this  0  i n contrast  i n FEV  the e l a s t i c  any i n c r e a s e  i n FEV ' .  Again,  o f the lung  i n the study since  parenchyma  measurement must be due t o t h e  augmentation o f the r e s p i r a t o r y musculature.  V e n t i l a t o r y f l o w has been seen  to  i n c r e a s e i n m i d d l e - a g e d and o l d e r a d u l t s w i t h t r a i n i n g (Whitbourne, 1985).  It  i s possible that  the strength  components o f t h e program  increased the  - 54 strength  of  the  involved  musculature  FEV '^, a l t h o u g h  specific  t e s t s t o d e t e c t changes i n m u s c u l a r s t r e n g t h were  1  not i n c o r p o r a t e d i n t h i s p r e s e n t Maximum v e n t i l a t i o n has 1973;  de  V r i e s , 1970)  frequency  to  demonstrate any  study being  be  as  increase with  b  a result  max  o v e r the  in  of  an  (Astrand,  increased  breathing  may  be  due  1970;  group were seen  5 week p e r i o d .  i n c r e a s e i n VE  discrepancy  increase  training  N e i t h e r the c o n t r o l or e x p e r i m e n t a l  however showed a 15%  reason f o r t h i s  an  or an i n c r e a s e d t i d a l volume (de V r i e s ,  change i n VE  J  (1985),  may  ( S a l t a n e t a l . , 1969)  facilitating  study.  been seen t o  This  R o b i n s o n e t a l . , 1973).  thereby  Thomas e t a l .  over a 12 month p e r i o d .  max t o the  d u r a t i o n o f the  too s h o r t i n d u r a t i o n t o produce any  changes i n VE  study; a  .  One this  Another  p o s s i b i l i t y i s t h a t the low average b a s e l i n e VE ° max  ( f o r combined c o n t r o l and  experimental  of  r  J  subjects.  groups) I t had  (Table  I)  is a  reflection  been n o t e d p r e v i o u s l y  that  subjects  d i f f e r e d from comparably aged s u b j e c t s i n o t h e r g r e a t v a r i a t i o n seen i n body w e i g h t . can  hinder  factor. of  chest  c o n d i t i o n of i n this  the  experiment  studies with respect  to  the  A d d i t i o n a l w e i g h t , i n the form o f f a t . compliance  and  may  be  a contributing  S i n c e age has not been shown t o a f f e c t t i d a l volume under c o n d i t i o n s  maximal  frequency  w a l l m o b i l i t y and  the  exercise,  i t i s possible  o f r e s p i r a t i o n due  that  the  resulting  d e c r e a s e d maximum  t o a d e c r e a s e d c h e s t w a l l c o m p l i a n c e may  augment  the known a g e - r e l a t e d l o s s i n maximum v e n t i l a t o r y r a t e . A n o t h e r p o t e n t i a l f a c t o r i n the low v e n t i l a t i o n v a l u e s study  c o u l d be  w i t h age shown t o  the  general  d e c l i n e of  ( P e t e r s e n e t a l . , 1981). exist  i n the  older  the  r e s p i r a t o r y response  An i n c r e a s e d s y m p a t h e t i c  individual,  yet  the  not/cannot respond to t h i s increase i n sympathetic may  obtained  lungs  to  i n this hypoxia  a c t i v i t y has been and  chest  stimulation.  e x e r t more o f an e f f e c t on v e n t i l a t i o n i n o l d e r s u b j e c t s .  wall  do  This f a c t o r  - 55 In  any J  event, '  the  (mean  35.57  investigation  baseline ±  values -  10.32  for  VE  -1  l«min  )  obtained  max  are  lower  r e p o r t e d by Thomas e t a l . (1985) o r S e a l s e t a l . (1984). VE  values  max  52.9%  of  t h a t were o n l y 42.6%  those  reported  by  o f those  Seals  et  remains a t t h i s time i s whether the o l d e r age (mean 68.5  ± 4.7  y r s . ) accounts  i n Thomas e t a l . (mean 62.6  values  IV).  Thomas e t a l . and The  question  o f the s u b j e c t s i n t h i s  f o r some o f the d i s c r e p a n c y i n V  ± 3.1  the  y r s . ) or Seals  this  This, study reported  r e p o r t e d by  a l . (Table  than  in  that study  v a l u e s seen  £  e t a l . (mean 63.3  ±  3.0  yrs.). None  of  the  subjects  pulmonary d i s e a s e .  The  demonstrated  a  history  pulmonary  function.  chronic obstructive  r a t i o FEV^'^/FVC ( p r o v i d i n g a f r a c t i o n o f the  e x p i r e d volume d e l i v e r e d i n 1 second) can f u n c t i o n (West, 1985).  of  An  g i v e an  FEV^'^/FVC o f 80%  Less  than  80%  indication  of  total  pulmonary  i s c o n s i d e r e d t o denote normal  i s considered  as  being  indicative  of  o b s t r u c t i v e changes and v a l u e s g r e a t e r than 80% i s c o n s i d e r e d as r e p r e s e n t i n g restrictive mean  FEV °/FVC 1-  obstructive due  (fibrotic)  to  of  lung disease. 63%  (exhibiting  alveolar  which,  by  The  definition,  increased airway  collapse).  Indeed,  subjects i n this denotes  r e s i s t a n c e and  i n the  study y i e l d e d a  elderly,  them  limited  a general  l u n g e l a s t i c i t y promotes premature a i r w a y c l o s u r e i n e x p i r a t i o n . is  a  trapping  Brandstetter  and  of  air  Kazenni  within (1983),  the  lung  and  Lynne-Davies  a  slight  (1977)  as  expiration decrease The  surface  area.  These  a g e - r e l a t e d changes  are  in  result  hyperinflation.  and  Reid  (1967) a l l  d e s c r i b e changes i n a l v e o l a r s t r u c t u r e w i t h age w h i c h cause a decrease alveolar  being  continuous  i n the  with  an  obstructive process. The  r e s u l t s o f the h y p o t h e s i s t e s t i n g are g i v e n i n T a b l e  I t i s apparent and  the  elderly  V.  t h a t the m a j o r i t y o f e x e r c i s e s t u d i e s c o n c e r n i n g e x e r c i s e  involve a c t i v i t i e s  other  than  aquatic,  in-pool exercise  56 programs.  I t is difficult  exercise are d i f f e r e n t .  to meaningfully  compare d a t a  Some m e a n i n g f u l comparisons c a n be made i n g e n e r a l  terms as some s t u d i e s have been done t o show some acute exercise.  Vickery  when t h e modes o f  e t a l . (1983) demonstrated  that  e f f e c t s of aquatic  30 minute  sessions  of  "Aqua Dynamics" p r o d u c e d e x e r c i s e h e a r t r a t e s o f 145 ± 3.0 b e a t s p e r minute i n 21-year o l d c o l l e g e women. h e a r t r a t e o f these the  considerably  examined  This heart rate represented  subjects.  older  t e n women  A s i m i l a r l e v e l o f i n t e n s i t y was a t t a i n e d by  subjects  i n this  (mean age 54.7 ±  e x e r c i s e programs f i v e  77% o f t h e maximum  study.  1.0  Johannessen e t a l . (1986)  yrs.)  during  days a week f o r . t e n weeks.  moderate-intensity  Actual aerobic  activity  c o m p r i s e d 20 t o 35 minutes o f each s e s s i o n and d i f f e r e n t modes o f a e r o b i c e x e r c i s e were u s e d each week t h r o u g h o u t  t h e t e n weeks  (brisk  walking/slow  j o g g i n g , ergometry, swimming and w a t e r c a l i s t h e n i c s and a e r o b i c d a n c i n g ) . 20%  increase  i n VOwas found a f t e r t h e t e n weeks. 2max  A  Whether t h e s u b j e c t s  i n t h i s s t u d y c o u l d have a t t a i n e d s i m i l a r i n c r e a s e s i n ° 2 v  a m a x  f  t  e  r  a  similar  p e r i o d o f time o r w i t h d a i l y e x e r c i s e i s open t o c o n t e n t i o n . One a s p e c t  of aquatic  e x e r c i s e t h a t has n o t been a d d r e s s e d i n t h i s o r  r e l a t e d s t u d i e s i s t h e e f f e c t o f water on t h e m e t a b o l i s m and c a r d i o v a s c u l a r adjustment. per  minute  levels  lower  i n 23°C w a t e r  o f VO^.  bradycardia Bergh  C r a i g and Dvorak (1969) r e p o r t e d h e a r t r a t e s a v e r a g i n g  These  d u r i n g water  (1974) found  that  same  than  i n warmer w a t e r o r i n a i r a t s i m i l a r  investigators also  immersion a t b o t h at similar  lower  (1976) s t a t e t h a t w i t h cardiac  output  peripheral  i s shunted  observations  and r e s t .  swimming speeds, VO^ was  i n c o l d e r water immersion  reported  exercise  h i g h e r i n c o l d e r w a t e r compared t o warmer w a t e r . was s i g n i f i c a n t l y  10 b e a t s  to the s k i n  a smaller  f o r heat  v a s o c o n s t r i c t i o n and h y d r o s t a t i c  Holmer and significantly  I n a d d i t i o n ; the heart rate  a t t h e same VO^.  i n c o l d water  of  McArdle e t fraction  dissipation.  pressure  on t h e body  al.  o f the  Increased surface  - 57 causes  an  increase  i n both  c e n t r a l volume  r e s u l t i n g i n a l a r g e r s t r o k e volume. rate  observed  volume.  return,  therefore  I t i s p o s s i b l e that a decreased  i n c o l d w a t e r would be b a l a n c e d  Therefore,  VC>2 i n w a t e r  and venous  by t h e i n c r e a s e  heart  i n stroke  t h e c a r d i a c o u t p u t would be t h e same a t s i m i l a r l e v e l s o f  of different  temperatures.  McArdle  e t a l . (1976),  using  s u c c e s s i v e i n c r e m e n t s o f d i s c o n t i n u o u s work w i t h arm-leg ergometry found t h a t d u r i n g work i n 25 and 18°C w a t e r , (400  ml) h i g h e r ,  t h e VC> averaged 9.0% (150 ml) and 25.3% 2  r e s p e c t i v e l y , than  values  observed  i n 33°C water.  VO^  averaged 250-700 ml h i g h e r i n c o l d water compared t o a i r and 33°C water a t a mean h e a r t greater  rate.  A t s i m i l a r l e v e l s o f V 0 , s t r o k e volume was  significantly  2  i n 25 and 18°C w a t e r  than  i n a i r o r 33°C w a t e r .  I t i s apparent,  t h e n , t h a t a r e d u c t i o n i n h e a r t r a t e d u r i n g work i n c o l d w a t e r i s compensated for  by  a  concluded  proportionate that  cardiac  increase output  i n stroke  i s maintained  expenditure  i n a i r , 18, 25 and 30°C w a t e r .  this  ranged from 28.3°C  study  heart  exercise  and were n o t i n f l a t e d v a l u e s  there  rates  was l i k e l y  were  likely  true  The  at similar  investigators  levels  o f energy  Pool temperatures recorded  (83°F) t o 30°C  exercise  volume.  (86°F).  Therefore,  during recorded  i n d i c a t i o n s of the i n t e n s i t y  due t o c o l d w a t e r  no d i s c r e p a n c i e s between  the heart  rates  of  t e m p e r a t u r e s and and V 0  2  during  exercise. Energy e x p e n d i t u r e type o f e x e r c i s e .  i s another area  that requires  exploration i n this  V i c k e r y e t a l . (1983) r e p o r t e d average energy  o f 5.9 t o 6.5 K c a l s p e r minute d u r i n g "Aqua Dynamics" s e s s i o n s . expenditure  This  energy  i s g r e a t e r t h a n t h e q u a n t i t y o f energy expended i n a b r i s k l e v e l  w a l k and i s s i m i l a r t o t h e r a t e o f energy e x p e n d i t u r e 12  expenditures  minute m i l e  women a t t h i s  pace  and c y c l i n g  bodyweight.  a t approximately  Costill  (1971) , u s i n g  f o r slow j o g g i n g a t a  10 mph  f o r college-aged  l e g ergometry  i n water  r a n g i n g i n t e m p e r a t u r e from 24.6 t o 25.0°C d i s c o v e r e d t h a t when comparing the  - 58 c a l o r i c r e q u i r e m e n t s o f subrnaximal work i n t h e w a t e r t o those o f e x e r c i s i n g on l a n d , w a t e r e x e r c i s e was found t o i n c r e a s e t o 42 p e r c e n t f o r any g i v e n work l e v e l .  I n response t o t h e i n c r e a s e d  r e q u i r e m e n t s a t each o f t h e e x e r c i s e l e v e l s , also higher  i n t h e water t h a n on l a n d .  energy e x p e n d i t u r e and a q u a t i c The  t h e energy r e q u i r e m e n t s by 33  the s u b j e c t s ' heart  exercise.  of the f a m i l i a r i t y o f the subjects w i t h walking  older subjects  f o r t h i s s t u d y because  (as opposed t o c y c l i n g ) and  i n v e s t i g a t i o n s have a l s o u t i l i z e d t r e a d m i l l t e s t i n g f o r  (Drinkwater  e t a l . , 1975; McDonough e t a l . , 1970; P o l l o c k e t  a l . , 1974; S i d n e y and Shephard, 1977). f a c i l i t a t e d the comparison o f data.  The use o f t h e t r e a d m i l l d a t a  unnatural  g a i t s during  perceived  fear  subjects,  due t o o b e s i t y ,  the t e s t i n g .  had d i f f i c u l t y  appeared t o be c o n t i n u a l l y a d j u s t i n g clearly  adjusting  to the t r e a d m i l l .  bearing  n o t used  exaggerated  was due i n some cases gait  problems.  a t t a i n i n g a "steady-state";  s t r i d e length  to walking  and/or f r e q u e n c y .  any d i s t a n c e ,  also  had  to a Some they Some  difficulty  I t i s d i f f i c u l t t o a s c e r t a i n how much o f a  t h e s e problems h a d on t h e t e s t r e s u l t s .  choice o f t e s t i n g apparatus should elderly:  This  o f t h e t r e a d m i l l o r due t o genuine  subjects,  also  I t was s u b s e q u e n t l y found, however, t h a t  some s u b j e c t s h a d d i f f i c u l t i e s w i t h t h e t r e a d m i l l , o f t e n a d o p t i n g or  r a t e s were  More s t u d y i s r e q u i r e d i n t h e a r e a o f  t r e a d m i l l was chosen as a t e s t i n g d e v i c e  because many p r e v i o u s  energy  consider  Decisions  c o n c e r n i n g the  t h e c o n d i t i o n s o f t e n seen i n the  o b e s i t y , o s t e o a r t h r i t i s and r h e u m a t o i d a r t h r i t i s i n a d d i t i o n t o any  o t h e r g a i t problems.  - 59 CONCLUSIONS  I t was t h e purpose o f t h i s exercise  s t u d y t o determine t h e e f f i c a c y o f a q u a t i c  f o r the e l d e r l y p a r t i c i p a n t .  independently o f p a r t i c i p a n t s ' s k i l l injury This  from  overuse  syndromes  Water e x e r c i s e p r o v i d e s  l e v e l s and i t reduces t h e l i k e l i h o o d o f  and h e a t  s t u d y has i n d i c a t e d t h a t  i t s benefits  r e l a t e d problems  a supervised  (Koszuta,  1986).  and c o n t r o l l e d a q u a t i c  exercise  program i s c a p a b l e o f p r o v i d i n g a p o s i t i v e s o u r c e o f a e r o b i c c o n d i t i o n i n g f o r the e l d e r l y as c a n be e v i d e n c e d by t h e outcome o f h y p o t h e s i s mode o f e x e r c i s e aging  may be p r e s c r i b e d  by the primary  care  i n d i v i d u a l knowing t h a t t h e c r i t e r i a f o r a e r o b i c  testing.  physician  This  for  the  b e n e f i t s c a n be met.  R e s e a r c h , u s i n g o t h e r modes o f e x e r c i s e , i n d i c a t e s t h a t t h e minimum i n t e n s i t y required  f o r t h e development  of physical  work  capacity  in  unconditioned  a d u l t s i s a p p r o x i m a t e l y 50 t o 60% o f maximum oxygen uptake o r a p p r o x i m a t e l y 70%  o f t h e maximum h e a r t r a t e .  w e l l above t h i s minimum v a l u e aquatic  The h e a r t  and, l i k e V i c k e r y  e x e r c i s e has s u f f i c i e n t  work c a p a c i t y  r a t e responses i n t h i s  s t u d y were  e t a l . (1983), suggest  that  i n t e n s i t y t o p o s i t i v e l y change t h e p h y s i c a l  o f e l d e r l y p a r t i c i p a n t s who a r e t y p i c a l l y  poorly  conditioned  and/or have l o w l e v e l s o f p h y s i c a l work c a p a c i t y . A n o t h e r i m p o r t a n t c o n c e r n i n t h e p r e s c r i p t i o n o f e x e r c i s e i s compliance. The  i n v e s t i g a t o r found  due  to the perception  activity study  initial that  recruitment  many  elderly  of subjects  i n d i v i d u a l s maintain  ( p a r t i c u l a r l y when g a i t problems a r e a p p a r e n t ) .  was 100%; f u l l  found t h e s e e x e r c i s e  turn  out f o r every  sessions  difficult,  session.  no doubt concerning  Compliance f o r t h i s  Participants  generally  b e n e f i c i a l and r e w a r d i n g , r e p o r t i n g t h a t  " f e l t b e t t e r " as a r e s u l t o f p a r t i c i p a t i o n . The " f u n f a c t o r " s h o u l d discounted;  they  n o t be  a l t h o u g h p a r t i c i p a n t s were c o n t i n u a l l y u r g e d t o work as h a r d as  - 60 i  they c o u l d w i t h each s e s s i o n , i t i s the i m p r e s s i o n o f t h i s i n v e s t i g a t o r t h a t p a r t i c i p a n t s d i d n o t r e g a r d t h i s as e x e r c i s e as The  elderly  individual  a l s o tends  such.  t o show marked decreases  in  social  i n t e r a c t i o n and i t i s f e l t t h a t t h i s mode o f e x e r c i s e w i l l do much t o improve t h i s s i t u a t i o n t h r o u g h the n o n - t h r e a t e n i n g n a t u r e o f the e x e r c i s e i t s e l f the e n c o u r a g i n g c o m p l i a n c e .  and  P s y c h o l o g i c a l and s o c i a l i n t e r a c t i o n f a c t o r s are  d i f f i c u l t t o measure and were beyond the scope o f t h i s s t u d y , b u t they s h o u l d be  regarded  as  being  no  less  important  than  the  cardiorespiratory  considerations. I n a g e n e r a l scope, the ongoing debate c o n c e r n i n g d u r a t i o n and  intensity  i n a e r o b i c t y p e s o f e x e r c i s e must be r e - e v a l u a t e d ; t h i s s t u d y i n d i c a t e d t h a t s u p e r v i s e d a q u a t i c e x e r c i s e a t o r above the recommended i n t e n s i t y o f e x e r c i s e performed  t h r e e times weekly  c a p a c i t y i n the e l d e r l y . to  daily  exercise  can  show s i g n i f i c a n t  changes i n p h y s i c a l  work  The e l d e r l y p a r t i c i p a n t s need n o t r e s i g n themselves  f o r extended  periods  of  time  in  order  for  measurable  b e n e f i t s t o o c c u r ; a l t h o u g h c o n t i n u e d p a r t i c i p a t i o n s h o u l d be encouraged, i t i s i m p o r t a n t f o r the e l d e r l y and t h e i r p h y s i c i a n s t o r e c o g n i z e the r e s i l i e n c e and a d a p t i v e c a p a c i t y o f the e l d e r l y i n d i v i d u a l so t h e y themselves s o u r c e o f encouragement f o r p a r t i c i p a t i o n and p r e s c r i p t i o n .  can be  the  - 61 RECOMMENDATIONS  I t i s t h e s i n c e r e hope t h a t t h i s s t u d y w i l l s e r v e t o s t i m u l a t e i n t e r e s t i n the f i e l d  o f e x e r c i s e and t h e e l d e r l y .  Specifically,  continued there are  some a r e a s t h a t m e r i t f u r t h e r i n v e s t i g a t i o n : 1.  There a r e o t h e r components o f t h i s type o f e x e r c i s e t h a t s h o u l d b e e v a l u a t e d , such as changes i n range o f m o t i o n , m u s c u l a r s t r e n g t h , body c o m p o s i t i o n and p s y c h o l o g i c a l / s o c i a l f a c t o r s .  2.  A d d i t i o n a l s t u d i e s a s s e s s i n g changes i n c a r d i a c o u t p u t as a r e s u l t o f t h i s type o f e x e r c i s e ( i . e . CO^ r e b r e a t h i n g ) .  3.  A d d i t i o n a l i n v e s t i g a t i o n s concerning aquatic exercise should be u n d e r t a k e n t o e v a l u a t e t h e f i n d i n g s i n t h i s s t u d y and t o b u i l d a d a t a base upon w h i c h m e a n i n g f u l comparisons c a n be made between s t u d i e s o f t h i s type.  4.  Longer term ( d u r a t i o n ) s t u d i e s a r e recommended t o determine l o n g e r e x e r c i s e p r o t o c o l w i l l produce b e t t e r r e s u l t s .  5.  Continued e f f o r t s are required components of the exercise cardiorespiratory benefit.  6.  A l a r g e r s c a l e s t u d y (more s u b j e c t s ) i s n e c e s s a r y t o determine whether t h e r e s u l t s o f t h i s s t u d y have l a r g e r , g e n e r a l i m p l i c a t i o n s for the e l d e r l y population.  7.  When d e a l i n g w i t h an e l d e r l y group o f s u b j e c t s , one must c a r e f u l l y d e c i d e on t h e t e s t i n g a p p a r a t u s t o be used: a d e c i s i o n t h a t must t a k e g a i t , bodyweight and m o t i v a t i o n a l f a c t o r s among o t h e r s i n t o account.  i fa  t o determine which specific program provide the • most  62 APPENDIX A  Comparison of Means at Baseline (Tl) and 5 Weeks Later (T2)  Time E f f e c t :  (Experimental Group, n = 8)  Variable  T(D 139.12 ± 11.17  SBPR (mmHg)  T(2) 131.50 ± 7.44  36.32 ± 9.77  36.91 ± 1.54  2.11 ± 0.37  2.42 ± 0.18  3.61 ± 1 . 1 0  3.94 ± 0.37  145.87 ± 9.92  144.62 ± 2 . 1 9  75.87 ± 8 . 0 1  71.00 ± 2.75  HR 0% ( b t s - m i n " )  121.87 ± 16.25  116.25 ± 16.19  HR 2% ( b t s - m i n  )  128.25 ± 14.57  123.37 ± 10.83  HR 4% ( b t s - m i n  )  135.00 ± 14.40  128.50 ± 8.73  HR 6% ( b t s - m i n " )  139.25 ± 12.70  132.37 ± 7.77  HR 8% ( b t s - m i n " )  137.33 ± 5 . 2 4  132.83 ± 2.74 (6)  VE (1-min MAX  )  M A V  FEV  1 - 0  (1-sec" ) 1  FVC (1-sec HR  MAX  H R  REST  )  (bts-min" ) 1  (bts-min" ) 1  1  1  1  V  °2MAX  (  n i l  * g~ ' k  1  n l i n  ~ ) 1  a l l values are means ± SD  24.98 ± 1.97  25.83 ± 0.213  - 63 APPENDIX B  Time E f f e c t :  Comparison of Means at Baseline (Tl) and 5 Weeks Later (T2) (Control Group, n = 7)  Variable SBPR (mmHg) VE„. ( l . m i n MAX FEV FVC  1 - 0  T(2)  132.,43 + 9.34  133.,43 + 2. 31  34.,70 + 11.64  )  V  nil  (1-sec" ) 1  (l-sec" ) 1  HR„.„ (bts«min MAX  2..31 + 0.68  2..29 + 0. 09  3,.35 + 0.82  3..35 + 0. 09  141.,43 ± 17.93  )  35.,04 + 0. 56  141.,57 + 1. 57  77..00 + 2.77  76..57 + 1. 72  HR 0% ( b t s . m i n " )  116,.57 + 11.12  115,.86 + 4. 23  HR 2% (bts«min" )  119..42 + 12.16  118,.14 + 11..18  HR 4% ( b t s . m i n " )  127..14 + 12.06  127,.00 + 2. 54  HR 6% ( b t s . m i n " )  134,.43 + 13.26  133,.86 + 2. 51  HR 8% ( b t s . m i n " )  138,.14 + 16.12  138 .14 + 3. 32  23 .84 + 1.99  23 .52 + 0. 82  HR  REST  (bts.min" ) 1  1  1  1  1  V0  2MAX  ( m l  * S k  1  ,  m  i  n  1  )  a l l values are means ± SD  64 APPENDIX C  Means o f E x p e r i m e n t a l and C o n t r o l Groups a t B a s e l i n e ( T l ) and 5 Weeks L a t e r (T2)  T(l)  T(2)  VARIABLE  EXPTL (n=8)  CONTROL (n=7)  EXPTL (n=8)  CONTROL (n=7)  SBPR (mmHg)  139.12-± 11.17  132.43 ± 9.34  131.50 ± 7.44  13-3.43 ± 2.31  2.11 ± 0.37  2.31 ± 0.68  2.42 ± 0.18  2.29 ± 0.09  3.61 ± 1.10  3.35 ± 0.82  3.94 ± 0.37  3.35 ± 0.09  139.25 ± 12.70  134.43 ± 13.26  132.37 ± 7.77  133.86 ± 2.51  137.33 ± 5 . 2 4  138.14 ± 16.12  132.83 ± 2 . 7 4  138.14 ± 3.32  23.84 ± 1.99 -  25.83 ± 0.60  23.52 ± 0.82  77.00 ± 2.77  71.00 ± 2.75  76.57 ± 1.72  FEV " 1  0  (1-sec" ) 1  FVC (1-sec" ) 1  HR  6%  (bts-min" ) 1  HR 8% (bts-min' ) 1  V  0  2MAX  (ml-kg  HR  .  -min  REST (bts-min")  ) 24.98 ± 1.97  75.87 ± 8.01  a l l v a l u e s a r e means ± SD underlined P values are s i g n i f i c a n t  (P <  0.05)  - 65 APPENDIX  ljk  p  1  k(i)  ' j  D  ^ jk(i)  Where: r e p r e s e n t s t h e g r o u p i n g f a c t o r ( i . e . : t r e a t m e n t and c o n t r o l )  *k(i)  r e p r e s e n t s s u b j e c t s w i t h i n t h e g r o u p i n g f a c t o r (used t o o b t a i n t h e e r r o r term f o r t h e g r o u p i n g  factor)  r e p r e s e n t s t h e w i t h i n f a c t o r ( i . e . t h e time  effect)  r e p r e s e n t s t h e i n t e r a c t i o n between t h e g r o u p i n g f a c t o r and the w i t h i n  ^>jk(i)  factor  r e p r e s e n t s t h e i n t e r a c t i o n o f t h e w i t h i n f a c t o r and t h e s u b j e c t s w i t h i n t h e g r o u p i n g f a c t o r (used t o o b t a i n t h e e r r o r term f o r t h e w i t h i n  factor  g r o u p i n g f a c t o r and w i t h i n Program i s BMDP2V (BMDP: 1982) .  and f o r t h e i n t e r a c t i o n o f t h e factor).  S t a t i s t i c a l Software I n c . , C a l i f o r n i a ; USA, R e v i s e d  - 66  APPENDIX E ANOVA TABLES Resting S y s t o l i c Blood Pressure  df  SOURCE  537251.10060  Mean  Group  Error  13  Time ( P r e / P o s t )  Time By Group  Error  3714.31  0.0000  0.29  0.5972  81.92917  5.07  0.0422  138.86250  8.60  0.0117  42.4339  (Control/Exptl)  13  Prob  Ms  144.64354  16.14904  - 67 -  Maximum V e n t i l a t i o n  SOURCE  df  Mean  Group ( C o n t r o l / E x p t l )  1  Error  13  Prob  Ms  38161.17135  175.94  0.0000  22.72688  0.10  0.7513  216.90425  Time ( P r e / P o s t )  1.60829  2.27  0.1555  Time By Group  0.10466  0.15  0.7067  Error  13  0.70735  - 68  Forced Expiratory Volume ( i n 1 second)  Ms  F  Prob  SOURCE  df  Mean  1  155.87357  266.97  0.0000  1  0.00929  0.02  0.9016  Error  13  0.58385  Time ( P r e / P o s t )  1  0.15990  14.36  0.0023  Time By Group  1  0.20306  18.23  0.0009  Error  13  0.01114  Group  (Control/Exptl)  underlined P values are s i g n i f i c a n t (P < 0 . 0 1 )  - 69 -  Forced V i t a l  Capacity  df  SOURCE  Mean  Group  (Control/Exptl)  Error  13  Prob  Ms  379.63923  158.72  0.0000  1.32947  0.56  0.4692  2.39186  Time ( P r e / P o s t )  0.20328  5.19  0.0403  Time By Group  0.20328  5.19  0.0403  Error  13  0.03919  - 70  Maximum Heart Rate  SOURCE  df  613950.86667  Mean  Group ( C o n t r o l / E x p t l )  1  105.00000  Error  13  375.38462  Time  (Pre/Post)  Time By Group  Error  13  Prob  Ms  1635.52.  0.0000  0.28  0.6058  2.28810  1.23  0.2875  3.62143  1.95  0.1863  1.85989  - 71  R e s t i n g Heart Rate  SOURCE  df  Ms  Mean  1  168500..37202  2832..69  0. 0000  Group ( C o n t r o l / E x p t l )  1  83..70536  1..41  0.,2568  Error  13  59..48420  1  52..50536  19.. 34  0..0007  Time By Group  1  36..90536  13 .59  0,.0027  Error  13  Time  (Pre/Post)  underlined P values are s i g n i f i c a n t  2..71497  (P <  0.01)  F  Prob  - 72  ( E x e r c i s e ) H e a r t R a t e a t 0% Grade  SOURCE  df  Mean  Prob  Ms  413318.57202  1794.46  0.0000  0.26  0.6167  Group ( C o n t r o l / E x p t l )  1  60.57202  Error  13  230.33036  Time ( P r e / P o s t )  75.01488  1.00  0.3345  Time By Group  45.01488  0.60  0.4514  Error  13  74.6652  - 73 ( E x e r c i s e ) H e a r t Rate a t 2% Grade  df  SOURCE  Mean  Group  (Control/Exptl)  Error  13  Prob  Ms  446717.87202  1777.14  368.67202  1.47  0.000  0.2474  251.36882  Time ( P r e / P o s t )  70.84821  1.35  0.2655  Time By Group  24.04821  0.46  0.5097  Error  13  52.31937  - 74 -  (EXERCISE)  HEART RATE AT 4%  GRADE  F  SOURCE  df  Ms  Mean  1  500181.03810  1780.28  0.0000  Group ( C o n t r o l / E x p t l )  1  163.43810  0.58  0.4593  Error  13  280.95604  Time ( P r e / P o s t )  1  82.37143  3.74  0.0752  Time By Group  1  75.43810  3.42  " 0.0871  Error  13  22.03297  Prob  - 75 -  ( E x e r c i s e ) H e a r t R a t e a t 6% Grade  SOURCE  df  Mean  Group  (Control/Exptl)  Error  13  Time ( P r e / P o s t )  Time By Group  Error  13  Prob  Ms  544140.01488  2045.85  0.0000  20.81488  0.08  0.7841  103.50536  5.84  0.0311  74.17202  4.19  0.0615  265.97321  17.71497  - 76 -  ( E x e r c i s e ) H e a r t R a t e a t 8% Grade  SOURCE  df  Ms  Mean  1  482370.33059  1747.64  0.0000  1  60.48443  0.22  0.6488  Group  (Control/Exptl)  11  Error  F  Prob  276.01190  1  32.71154  6.95  0.0231  Time By Group  1  32.71154  6.95  0.0231  Error  11  4.70455  Time  (Pre/Post)  a l l v a l u e s n = 13  - 77 -  (Exercise) Heart Rate at 10% Grade  Prob  SOURCE  df  Ms  F  Mean  1  270001.33929  427.17  1  73.33929  0.12  0.7472  Error  5  632.07500  Time ( P r e / P o s t )  1  5.00595  3.73  0.1113  Time By Group  1  7.29167  5.43  0.0671  Error  5  1.34167  Group  (Control/Exptl)  a l l values n = 8  s  0.0000  - 78  Maximum Oxygen Uptake  Ms  F  Prob  SOURCE '  df  Mean  1  17988.21272  2011.46  0.0000  1  22.23870  2.49  0.1388  Group  (Control/Exptl)  13  8.94287  1  0.54324  2.15  0.1665  Time By Group  1  2.54671  10.07  0.0073  Error  13  0.25289  Error  Time  (Pre/Post)  underlined P value i s significant (P <  0.05)  - 79 -  APPENDIX F Contraindications f o r Exercise and Exercise Testing (Out-of-Hospital Setting)  A.  Contraindications 1. Acute m y o c a r d i a l i n f a r c t i o n 2. Unstable or a t - r e s t angina p e c t o r i s 3. Dangerous arrhythmias (ventricular t a c h y c a r d i a o r any rhythm s i g n i f i c a n t l y compromising c a r d i a c f u n c t i o n ) 4. History suggesting excessive medication effects (digitalis, d i u r e t i c s , p s y c h o t r o p i c agents) 5. Manifest c i r c u l a t o r y i n s u f f i c i e n c y (congestive heart f a i l u r e ) 6. Severe a o r t i c s t e n o s i s 7. Severe l e f t v e n t r i c u l a r o u t f l o w t r a c t o b s t r u c t i v e d i s e a s e (IHSS) 8. S u s p e c t e d o r known d i s s e c t i n g aneurysm 9. A c t i v e o r s u s p e c t e d m y o c a r d i t i s o r cardiomyopathy ( w i t h i n the past year) 10. Thrombophlebitis--known o r s u s p e c t e d 11. Recent embolism, s y s t e m i c o r pulmonary 12. Recent o r a c t i v e i n f e c t i o u s e p i s o d e s ( i n c l u d i n g upper r e s p i r a t o r y infections) 13. H i g h dose o f p h e n o t h i a z i n e agents  B.  Relative Contraindications  1.  U n c o n t r o l l e d or high-rate s u p r a v e n t r i c u l a r arrhythmias 2. R e p e t i t i v e or frequent v e n t r i c u l a r ectopic a c t i v i t y 3. U n t r e a t e d s e v e r e s y s t e m i c o r pulmonary h y p e r t e n s i o n 4. V e n t r i c u l a r aneurysm 5. Moderate a o r t i c s t e n o s i s 6. Severe m y o c a r d i a l o b s t r u c t i v e syndromes ( s u b v a l v u l a r , muscular, or membranous o b s t r u c t i o n s ) 7. Marked c a r d i a c enlargement 8. U n c o n t r o l l e d m e t a b o l i c d i s e a s e ( d i a b e t e s , t h y r o t o x i c o s i s , myxedema) 9. Toxemia  C.  Condition Requiring Consideration and/or Precautions 1. Conduction disturbances a. Complete a t r i o v e n t r i c u l a r b l o c k b. L e f t bundle b r a n c h b l o c k c. W o l f f - P a r k i n s o n - W h i t e anomaly o r syndrome d. Lown-Ganong-Levine syndrome e. B i f a s c i c u l a r b l o c k ( w i t h o r w i t h o u t 1 s t b l o c k ) 2. C o n t r o l l e d arrhythmias 3. F i x e d - r a t e pacemaker 4. M i t r a l v a l v e p r o l a p s e ( c l i c k - m u r m u r ) syndrome  1  I n t h e p r a c t i c e o f m e d i c i n e , t h e b e n e f i t s o f e v a l u a t i o n o f t e n exceed the r i s k s f o r p a t i e n t s w i t h these r e l a t i v e c o n t r a i n d i c a t i o n s .  - 80 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.  A n g i n a p e c t o r i s and o t h e r m a n i f e s t a t i o n s o f c o r o n a r y i n s u f f i c i e n c y C e r t a i n medications a. D i g i t a l i s , d i u r e t i c s , p s y c h o t r o p i c drugs b. B e t a - b l o c k i n g and drugs o f r e l a t e d a c t i o n E l e c t r o l y t e disturbance C l i n i c a l l y s e v e r e h y p e r t e n s i o n ( d i a s t o l i c above 110, g r a d e I I I retinopathy) Cyanotic heart disease I n t e r m i t t e n t o r f i x e d r i g h t - t o - l e f t shunt Severe anemia (hemoglobin below 10 gm/d.) Marked o b e s i t y (20% above o p t i m a l body w e i g h t ) R e n a l , h e p a t i c , and o t h e r m e t a b o l i c i n s u f f i c i e n y Overt p s y c h o n e u r o t i c d i s t u r b a n c e s r e q u i r i n g t h e r a p y Neuromuscular m u s c u l o s k e l e t a l , o r t h o p e d i c , o r a r t h r i t i c d i s o r d e r s w h i c h would p r e v e n t a c t i v i t y Moderate t o s e v e r e pulmonary d i s e a s e Intermittent claudication Diabetes  A f t e r American College of Sports Medicine, Guidelines f o r Graded T e s t i n g and Exercise  - 81 -  APPENDIX G Non-Weight B e a r i n g Water E x e r c i s e : Cardiopulmonary J.E. Taunton, M.D., D.J. J e s s o p , B.Sc.  E.C.  Changes i n  F u n c t i o n i n E l d e r l y Men  Rhodes, Ph.D., R.J. Ham,  and Women  M.D.,  P.R.  Grantham,  M.D.,  The purpose o f t h i s i n v e s t i g a t i o n i s t o examine the c a r d i o v a s c u l a r and pulmonary responses t o non-weight b e a r i n g i n - p o o l e x e r c i s e ( t r a i n i n g ) i n the elderly. The p r o j e c t e d aims o f the s t u d y are to determine: 1)  the e f f i c a c y o f a r e p r e s e n t a t i v e , e s t a b l i s h e d program o f e x e r c i s e f o r the elderly,  2)  the a d a p t a t i o n s o f the e l d e r l y c a r d i o v a s c u l a r system f o l l o w i n g 1 month of exercise,  3)  the a d a p t a t i o n s i n pulmonary f u n c t i o n i n the e l d e r l y f o l l o w i n g 1 month of exercise,  4)  whether such a program o f prescriptive.  e x e r c i s e c o u l d be  clinically  a p p l i c a b l e and  You w i l l p e r f o r m a graded e x e r c i s e t e s t on a b i c y c l e ergometer and/or a motor-driven t r e a d m i l l . The purpose o f t h i s t e s t i s t o examine the response o f your h e a r t and l u n g s t o e x e r c i s e . The t e s t c o n s i s t s o f r u n n i n g , o r r i d i n g the ergometer a t one o r more l e v e l s o f d i f f i c u l t l y . Your e l e c t r o c a r d i o g r a m w i l l be m o n i t o r e d throughout the e x e r c i s e and r e c o v e r y p e r i o d s . It is e x p e c t e d t h a t you w i l l complete t h i s e x e r c i s e t e s t w i t h no c o m p l i c a t i o n s . Because o f the v e r y uncommon, u n p r e d i c t a b l e response o f some i n d i v i d u a l s to exercise, unforeseen difficulties may arise which would necessitate treatment. C o m p l i c a t i o n s have been few d u r i n g e x e r c i s e t e s t s and these u s u a l l y c l e a r q u i c k l y w i t h l i t t l e o r no t r e a t m e n t . You a r e asked to r e p o r t any u n u s u a l symptoms d u r i n g the t e s t . We may s t o p the t e s t a t any time because o f s i g n s o f f a t i g u e o r you may s t o p when you w i s h t o because o f p e r s o n a l f e e l i n g s of f a t i g u e or discomfort. Every e f f o r t w i l l be made to conduct the t e s t i n such a way as t o m i n i m i z e d i s c o m f o r t and r i s k . However, t h e r e e x i s t s the p o s s i b i l i t y o f p o t e n t i a l r i s k s such as; abnormal b l o o d p r e s s u r e , f a i n t i n g , d i s o r d e r s o f h e a r t b e a t , and v e r y r a r e i n s t a n c e s o f h e a r t attack. You w i l l a l s o p e r f o r m a t e s t o f l u n g c a p a c i t y . The e x e r c i s e program w i l l be p e r f o r m e d t h r e e (3) times p e r week f o r a maximum o f 1 month. You are reminded t o take a l l n e c e s s a r y p r e c a u t i o n s when i n the p o o l , p a r t i c u l a r l y when e n t e r i n g and l e a v i n g the p o o l and s u r r o u n d i n g a r e a . I n s i g n i n g t h i s consent form you s t a t e t h a t you have r e a d and u n d e r s t a n d the d e s c r i p t i o n o f the t e s t s , the experiment and t h e i r c o m p l i c a t i o n s . You e n t e r  - 82 -  the battery of tests and the experiment willingly and may withdraw at any time. Additionally, your identity and test results w i l l be kept in confidence and w i l l become the property of the above investigators. Consent I have read the above comments and understand the explanation, and I wish to proceed with the test. I hereby acknowledge the receipt of a copy of this consent form.  subject (signature)  witness (signature)  date  - 83 REFERENCES  1.  Adams, W.C., Bernauer, E.M. and McHenry, M.M. The e f f e c t o f age upon c a r d i o - r e s p i r a t o r y response t o a m u l t i s t a g e t r e a d m i l l w a l k t e s t . The P h y s i o l o g i s t 12:156 ( A b s t r a c t ) , 1969.  2.  Alexander, R. 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