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Prediction of maximum oxygen uptake in paraplegics and quadraplegics using multiple regression equations 1981

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PREDICTION OF MAXIMUM OXYGEN UPTAKE IN PARAPLEGICS AND QUADRAPLEGICS USING MULTIPLE REGRESSION EQUATIONS B.P.E., The U n i v e r s i t y of B r i t i s h C o l u m b i a , 1975 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF THE FACULTY OF GRADUATE STUDIES Department of S p o r t S c i e n c e S c h o o l of P h y s i c a l E d u c a t i o n and R e c r e a t i o n We a c c e p t t h i s t h e s i s as c o n f o r m i n g to the r e q u i r e d s t a n d a r d by ALLEN ROBERT JAMES ROGERS MASTER OF PHYSICAL EDUCATION i n THE UNIVERSITY OF BRITISH COLUMBIA May 1981 l A l l e n Robert James Rogers, 1981 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and study. I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the head o f my department or by h i s or her r e p r e s e n t a t i v e s . I t i s understood t h a t copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n p e r m i s s i o n . Department of ^cAcc^^^J ~ S ^ ^ - ^ f ^ / ^ ^ ^ f ^J^a**, The U n i v e r s i t y of B r i t i s h Columbia 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 Date ABSTRACT Twenty p h y s i c a l l y d i s a b l e d s u b j e c t s p e r f o r m e d a p r o g r e s s i v e c o n t i n u o u s e x e r c i s e p r o t o c o l on a w h e e l c h a i r ergometer, t o maximum e x e r t i o n . C a r d i o - r e s p i r a t o r y r e s p o n s e s were m o n i t o r e d by means of d i r e c t ECG r e c o r d i n g , and HR was r e p o r t e d f o r the l a s t 30 seconds of each w o r k l o a d (WL). E x p i r e d gases were c o n t i n u o u s l y sampled and a n a l y z e d f o r 15 second d e t e r m i n a t i o n s of r e s p i r a t o r y gas exchange v a r i a b l e s . The l a s t 30 seconds a t each WL was averaged and assumed t o b e ' r e p r e s e n t a t i v e of s t e a d y s t a t e r e s p o n s e s t o t h a t WL. I n a d d i t i o n , body w e i g h t s , ages, and maximum b r e a t h - i n g c a p a c i t i e s were r e c o r d e d . Two s u b j e c t s were d e l e t e d from the s t u d y due t o i n c o m p l e t e d a t a . The i n a b i l i t y t o equate s t r u c t u r a l and f u n c t i o n a l c h a r a c t e r i s t i c s of q u a d r a p l e g i c s and p a r a p l e g i c s n e c e s s i t a t e d the d i v i s i o n of the t o t a l group i n t o p a r a p l e g i c s (N=13) and q u a d r a p l e g i c s (N=5). For each p a r a p l e g i c s u b j e c t , t h r e e submaximal WL and c o r r e s p o n d i n g c a r d i o r e s p i r a t o r y r e s p o n s e s were chosen f o r 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 on maximal oxygen upt a k e . The t h r e e w o r k l o a d s were s e l e c t e d on the b a s i s of HR r e s p o n s e s , i . e . , t h o s e w o r k l o a d s where HR was found t o be between 65% and 85% of maximum HR (max HR = 220 - a g e ) . The l o w e s t of t h e t h r e e w o r k l o a d s and c o r r e s p o n d i n g c a r d i o r e s p i r a t o r y r e s p o n s e s (CRR) f o r each sub- j e c t were a s s i g n e d t o the LHR group w h i l e the h i g h e s t w o r k l o a d s and CRR f o r each were a s s i g n e d t o the HHR group. The r e m a i n i n g WL and CRR f o r each s u b j e c t was a s s i g n e d t o the MHR group. Mean HR r e s p o n s e s f o r t h e i i LHR, MHR, and HHR groups were: 131, 139,, and 148, r e s p e c t i v e l y . These means c o r r e s p o n d e d t o a p p r o x i m a t e l y 70%, 75%, and 80% of maximum h e a r t r a t e . 2 The s q u a r e d m u l t i p l e c o r r e l a t i o n c o e f f i c i e n t s (R ) a d j u s t e d f o r b o t h 2 sample s i z e and number of v a r i a b l e s c o n t r i b u t i n g t o R , were found t o be .8761, .9218, and .9094 f o r LHR, MHR, and HHR, r e s p e c t i v e l y . The r e s p e c - t i v e s t a n d a r d e r r o r o f e s t i m a t e s were r e p o r t e d t o be .1397, .1101, and .1195 or + CV% e q u a l t o 6.5%, 5.2%, and 5.6%. Cr o s s v a l i d a t i o n was not pe r f o r m e d due t o th e - s m a l l sample s i z e . However, the a d j u s t e d p r e s s p r e d i c t i o n g i v e s an i n d i c a t i o n of how the equa- t i o n may p r e d i c t f o r s u b j e c t s o u t s i d e t he e x p e r i m e n t a l group. P r e d i c t i o n i s p e r f o r m e d i n t u r n f o r each s u b j e c t w i t h t he e f f e c t s of t h a t s u b j e c t ' s d a t a removed from the b e t a c o e f f i c i e n t s . The mean a b s o l u t e e r r o r s r e p o r t e d were 22.2%, 11.8%, and 13.2% f o r the LHR, MHR, and HHR g r o u p s , r e s p e c t i v e l y . 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 o f the q u a d r a p l e g i c d a t a was r e s t r i c t e d t o t he WL and CRR a t t h e f o u r t h minute of the p r o g r e s s i v e c o n t i n u o u s work- 2 l o a d p r o t o c o l . The a d j u s t e d R f o r the p r e d i c t i o n e q u a t i o n produced was .9992 w i t h a s t a n d a r d e r r o r o f e s t i m a t e o f .0058 L/min. The v a r i a b l e s 2 c o n t r i b u t i n g t o the R were: V e n t i l a t i o n , V02 ml/kg min., and WL. I t was c o n c l u d e d t h a t : 1. 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 appeared t o be a s u i t a b l e method of d e v e l o p - i n g a c c u r a t e p r e d i c t i o n e q u a t i o n s f o r MV02 L/min., i n p a r a p l e g i c s . The b e s t e q u a t i o n b e i n g : MV02 L/min. = 5.85 + 1.70(VC02 L/min.) - .026(age) - .0015(WL) - .008(HR) - 3.42(RQ). 2. The a c c u r a c y of p r e d i c t i o n of MV02 L/min. i n p a r a p l e g i c s i s i n c r e a s e d w i t h t h e i n c r e a s e i n the p h y s i o l o g i c a l s t r e s s (as r e f l e c t e d i n % maximum HR) . i i i 3. Due to the l i m i t e d sample s i z e , no c o n c l u s i o n s were reached r e g a r d i n g p r e d i c t i o n of MV02 L/min. w i t h i n the q u a d r a p l e g i c p o p u l a t i o n . i v TABLE OF CONTENTS ABSTRACT i i LIST OF TABLES v i i LIST OF FIGURES v i i ACKNOWLEDGEMENT v i i i C h apter I INTRODUCTION 1 Statement of the Problem 3 Subproblem 4 J u s t i f i c a t i o n 4 L i m i t a t i o n s 4 D e l i m i t a t i o n s 5 D e f i n i t i o n s 5 A b b r e v i a t i o n s 7 II REVIEW OF LITERATURE 8 D e s c r i p t i o n of the P o p u l a t i o n 8 P r e d i c t i o n of Maximum Oxygen Uptake 14 I I I METHODS AND PROCEDURES 24 S u b j e c t s 24 Data C o l l e c t i o n 24 Data A n a l y s i s 27 IV RESULTS AND DISCUSSION 29 R e s u l t s 29 D i s c u s s i o n 41 V SUMMARY AND CONCLUSIONS 50 Summary 50 C o n c l u s i o n s 51 Recommendations f o r F u r t h e r Research - 51 v REFERENCES 53 APPENDIX A The Wheelchair Ergometer 58 APPENDIX B I n d i v i d u a l C a r d i o r e s p i r a t o r y Responses t o the Workload P r o t o c o l 63 APPENDIX C C o r r e l a t i o n M a t r i c e s 71 v i LIST OF TABLES T a b l e 1 A Summary of I n v e s t i g a t i o n s i n t o the A c c u r a c y of P r e d i c t i n g Maximum Oxygen Uptake U t i l i z i n g t he Methods I n d i c a t e d 15 2 P r o t o c o l s f o r C o n t i n u o u s I n c r e a s i n g Workloads 26 3 S u b j e c t C h a r a c t e r i s t i c s 30 4 Means and S t a n d a r d D e v i a t i o n of V a r i a b l e C o r r e s p o n d i n g t o LHR, MHR, and HHR 31 5 Summary of C o r r e l a t i o n C o e f f i c i e n t s between P r e d i c t o r s and C r i t e r i o n MV02 L/min 32 6 Summary of 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 of P a r a p l e g i c Data .... 34 7 Summary of E r r o r A s s o c i a t e d w i t h the P r e d i c t i o n of MV02L from P r e d i c t i o n E q u a t i o n s f o r LHR, MHR, and HHR 47 8 Summary of U n i v a r i a t e S t a t i s t i c s f o r the 4 t h M i n u t e of E x e r c i s e ( Q u a d r a p l e g i c s ) 49 LIST OF FIGURES F i g u r e 1 Comparison of MV02L p r e d i c t e d ( u n a d j u s t e d ) vs Observed MV02L f o r LHR group 35 2 Comparison of MV02L p r e d i c t e d ( u n a d j u s t e d ) vs Observed MV02L f o r MHR group 36 3 Comparison of MV02L p r e d i c t e d ( u n a d j u s t e d ) vs Observed MV02L f o r HHR group 37 4 Comparison of MV02L p r e d i c t e d ( a d j . p r e s s ) vs Observed MV02L f o r LHR group 38 5 Comparison of MV02L p r e d i c t e d ( a d j . p r e s s ) vs Observed MV02L f o r MHR group 39 6 Comparison of MV02L p r e d i c t e d ( a d j . p r e s s ) vs Observed MV02L f o r HHR group 40 7 I n t e r n a l R e s i s t a n c e vs Weight i n W h e e l c h a i r 60 8 P h o t o g r a p h of W h e e l c h a i r Ergometer 61,62 v i i ACKNOWLEDGEMENT The author extends a p p r e c i a t i o n to the members of the committee, Dr. Ken C o u t t s [Chairman}, Dr. Stan Brown, Mr. Be r t H a l l i w e l l , and Dr. S. P i n k e r t o n , f o r t h e i r p a r t i c i p a t i o n i n t h i s i n v e s t i g a t i o n . S p e c i a l thanks to Mr. M. Walsh f o r h i s t e c h n i c a l a s s i s t a n c e i n the t e s t i n g s e s s i o n and Mr. Doug Dunwoody f o r h i s a i d i n the data r e s o l u t i o n . L a s t , but not l e a s t , s p e c i a l thanks t o my f a m i l y who have endured much, a l l o w i n g me to pursue my extended p e r i o d of study. v i i i CHAPTER I INTRODUCTION S e v e r a l s t u d i e s have d i r e c t l y a s s e s s e d the maximum a e r o b i c c a p a c i t i e s of p a r a p l e g i c s and q u a d r a p l e g i c s ( K n u t s s o n et a l . , 1973; Z w i r e n and B a r - o r , 1975; Wicks et a l . , 1977; Cameron et a l . , 1977; Ernes, 1977; H j e l t n e s , 1977). U n f o r t u n a t e l y , the d a t a t e l l s us l i t t l e about the c a r d i o r e s p i r a t o r y " f i t n e s s " of the i n d i v i d u a l s . W i t h o u t norms, i n t e r p r e t a t i o n s a r e l i m i t e d . The d a t a o b t a i n e d by the i n v e s t i g a t i o n s l i s t e d above, r e p r e s e n t o n l y a sub- p o p u l a t i o n , i . e . , t h o s e c a p a b l e and m o t i v a t e d enough t o p e r f o r m e x e r c i s e to maximum oxygen u p t a k e . The r e s u l t s o b t a i n e d from i n v e s t i g a t i o n s ( H e i g e n h a u s e r e t a l . , 1977; Z w i r e n and B a r - o r , 1975) i n d i c a t e d t h a t c a r d i o r e s p i r a t o r y c a p a c i t i e s of the i n a c t i v e p a r a p l e g i c s a re s i g n i f i c a n t l y lower t h a n s e d e n t a r y n o r m a l s . T h i s i n f o r m a t i o n s u p p o r t s the c o n c e r n e x p r e s s e d by o t h e r i n v e s t i g a t o r s who have i n d i c a t e d a need t o m o n i t o r the c a r d i o r e s p i r a t o r y f i t n e s s of the p h y s i c a l l y d i s a b l e d ( H j e l t n e s , 1977; E n g e l & H i l d e r b r a n d t , 1973; M a r i n c e k et a l . , 1977; K n u t s s o n et a l . , 1973). F o r such t e s t s t o be s u i t a b l e f o r the p h y s i c a l l y d i s a b l e d p o p u l a t i o n , the f o l l o w i n g c r i t e r i a a r e s u g g e s t e d : 1. The t e s t s h o u l d be submaximal i n n a t u r e . A l t h o u g h i n d i c a t i o n s a r e t h a t p a r a p l e g i c s and q u a d r a p l e g i c s who are s t a b i l i z e d , can p e r f o r m maximal t e s t s , t he u s e f u l n e s s of such t e s t s i s l i m i t e d t o t h i s s t a b i l i z e d segment of t he p o p u l a t i o n . D u r i n g the r e h a b i l i t a t i o n s t a g e , a e r o b i c t e s t i n g 1 2 would prove extremely v a l u a b l e . However, maximum e x e r t i o n i s i l l a d v i s e d s i n c e the s u b j e c t s are not s t a b i l i z e d and prone to d i z z i n e s s and f a i n t i n g . In a d d i t i o n , maximum e x e r t i o n i s not recommended f o r the e l d e r l y . 2. The t e s t s h o u l d be easy to a d m i n i s t e r and i t s d u r a t i o n r e l a t i v e l y s h o r t so t h a t l a r g e p o p u l a t i o n s t u d i e s w i l l not be o v e r l y l a b o r i o u s . 3. The t e s t s h o u l d be v a l i d and r e l i a b l e i n i t s p r e d i c t i o n of maximum oxygen uptake. D i r e c t assessment methods do not meet the f i r s t two c r i t e r i a above. Thus, i n d i r e c t methods are c o n s i d e r e d to be more p r a c t i c a l f o r the purpose of c a r d i o r e s p i r a t o r y f i t n e s s assessment w i t h the p h y s i c a l l y d i s a b l e d p o p u l a - t i o n . S e v e r a l i n d i r e c t t e s t s f o r the p r e d i c t i o n of maximum oxygen uptake are a v a i l a b l e to the normal p o p u l a t i o n . A summary of the p r e d i c t i v e capac- i t i e s of each i s p r o v i d e d i n T a b l e 1 .(page 1 5 ) . The most w i d e l y used i n d i r e c t t e s t s are those which employ e x t r a p o l a - t i o n of the p l o t of h e a r t r a t e v s . oxygen uptake ( A s t r a n d & Ryhming, 1954; M a r g a r i a et a l . , 1965; M a r i t z et a l . , 1 9 6 1 ) . S e r i o u s problems e x i s t w i t h these methods. Most of the problems can be a s c r i b e d to t h r e e b a s i c assump- t i o n s i n c o r p o r a t e d i n t o the e x t r a p o l a t i o n methods. These are as f o l l o w s : 1. A l i n e a r r e l a t i o n s h i p e x i s t s between h e a r t r a t e and oxygen uptake, at a l l l e v e l s of work. 2. There i s one maximum h e a r t r a t e v a l u e f o r a l l members of a g i v e n p o p u l a - t i o n . 3. The m e c h a n i c a l e f f i c i e n c y f o r a l l s u b j e c t s i s about 2 3 % (where V02 f o r submaximum workloads i s not measured d i r e c t l y ) . The v a l i d i t y of assumptions 1 and 2 has been q u e s t i o n e d by s e v e r a l i n v e s t i g a t o r s ( M a r i t z et a l . , 1961; F l a n d r o i s & LaCour, 1971; D a v i e s , 1968; G l a s s f o r d et a l . , 1965; Wyndham, 1967; Wyndham, 1959; Rowell 3 et a l . , 1964). A c o e f f i c i e n t of v a r i a t i o n of about 4-5% i n m e c h a n i c a l e f f i c i e n c y i s r e p o r t e d (Shephard, 1977). E r r o r of up t o 20% ( H e r m i s t o n & F a u l k n e r , 1971) can be a s c r i b e d t o v i o l a t i o n of one or more of t h e s e b a s i c a s s u m p t i o n s . The u n s a t i s f a c t o r y r e s u l t s o b t a i n e d u s i n g the e x t r a p o l a t i o n , has l e d t o the i n v e s t i g a t i o n of a l a r g e number of v a r i a b l e s and t h e i r r e l a t i o n s h i p s t o maximum oxygen u p t a k e . I n v e s t i g a t o r s have a t t e m p t e d t o improve p r e d i c - t i o n by i n c o r p o r a t i n g more v a r i a b l e s i n t o the p r e d i c t i o n p r o c e d u r e . T h i s i s a c c o m p l i s h e d t h r o u g h 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 and m u l t i p l e r e g r e s s i o n e q u a t i o n s ( H e r m i s t o n & F a u l k n e r , 1971; M a s t r o p a o l o , 1970; Bonen et a l . , 1979; Fox, 1973; J e s s u p et a l . , 1974; J e t t e et a l . , 1976; ' B e l l & H i n s o n , 1974). T a b l e 1 summarizes the m a j o r i t y of the r e s u l t s of t h e s e i n v e s t i g a - t i o n s . The v a r i a b i l i t y i n maximum HR found w i t h i n the p a r a p l e g i c p o p u l a t i o n , as w e l l as the l a c k of i n f o r m a t i o n r e l a t i n g o t h e r p h y s i o l o g i c a l v a r i a b l e s d u r i n g e x e r c i s e , s u g g e s t s t h a t e x t r a p o l a t i o n may not p r o v e a v i a b l e method of p r e d i c t i n g MV02L. M u l t i p l e r e g r e s s i o n appears t o be most s u i t a b l e f o r the development of maximum oxygen uptake p r e d i c t i o n t e s t s w i t h the p h y s i c a l l y d i s a b l e d . Statement of the Problem The purpose of t h i s i n v e s t i g a t i o n i s t o d e t e r m i n e w h i c h of c e r t a i n s t r u c t u r a l and f u n c t i o n a l measures of p h y s i c a l l y d i s a b l e d s u b j e c t s ( p r e d i c - t o r s ) a r e s i g n i f i c a n t l y r e l a t e d t o maximum oxygen uptake ( c r i t e r i o n ) and t o e s t a b l i s h the g r e a t e s t m u l t i p l e c o r r e l a t i o n c o e f f i c i e n t between the p r e - d i c t o r s and the c r i t e r i o n . 4 Subproblem To c o n s t r u c t a m u l t i p l e r e g r e s s i o n e q u a t i o n f o r the p r e d i c t i o n of maximum oxygen u p t a k e . J u s t i f i c a t i o n At p r e s e n t , no i n d i r e c t c a r d i o r e s p i r a t o r y f i t n e s s t e s t i s a v a i l a b l e f o r use w i t h the p h y s i c a l l y d i s a b l e d p o p u l a t i o n . D i r e c t t e s t s r e q u i r e e l a b o r a t e t e s t i n g equipment, maximum e f f o r t from the s u b j e c t s , and c o n s i d e r a b l e time to a d m i n i s t e r . P o p u l a t i o n s t u d i e s a r e not p r a c t i c a l w i t h t h e s e d i r e c t methods. I n a d d i t i o n , d i r e c t methods a r e not recommended f o r u n s t a b i l i z e d s u b j e c t s nor f o r the e l d e r l y . I n c o n t r a s t , i n d i r e c t t e s t s r e q u i r e l i t t l e equipment, t a k e a p p r o x i m a t e l y s i x m i n u t e s t o complete and o n l y submaximal e f f o r t s from the s u b j e c t s . I n f o r m a t i o n r e g a r d i n g p h y s i o l o g i c a l changes, as a r e s u l t of bed r e s t , a t r a i n i n g r e gime, or r e h a b i l i t a t i o n p r o c e d u r e s , can be made a v a i l a b l e t h r o u g h r e p e a t e d t e s t i n g . T h i s f eedback i s e x t r e m e l y i m p o r t a n t when m o n i t o r i n g an i n d i v i d u a l ' s r e h a b i l i t a t i o n , t o a s s i s t i n f u r t h e r e x e r c i s e p r e s c r i p t i o n and as a m o t i v a t i o n a l f a c t o r f o r the s u b j e c t . L i m i t a t i o n s 1. The r e s u l t s o f the 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 of the d a t a c o l l e c t e d on t h e t h i r t e e n p a r a p l e g i c s u b j e c t s may be i n f e r r e d t o s u b j e c t s w i t h i n the age range and l e v e l o f s p i n a l l e s i o n a s s o c i a t e d w i t h the sample i n v e s - t i g a t e d i n the p r e s e n t s t u d y . 2. The s m a l l sample s i z e of the q u a d r a p l e g i c group, does not a l l o w j u s t i f i e d i n f e r e n c e t o the p o p u l a t i o n o u t s i d e the e x p e r i m e n t a l group. 3. The as s u m p t i o n s a s s o c i a t e d w i t h the p r o t o c o l f o r w o r k l o a d a d j u s t m e n t s , i . e . , t he f i n a l 30 seconds a t each w o r k l o a d ( d u r a t i o n one mi n u t e ) 5 r e p r e s e n t s a s t e a d y s t a t e . 'h. The e q u a t i o n ( s ) d e v e l o p e d f o r the p r e d i c t i o n o f MV02L do not c o n s t i t u t e a " f i t n e s s t e s t . " MV02L i n d i c a t e s a e r o b i c power. I n a d d i t i o n , c r o s s v a l i d a t i o n was not p e r f o r m e d . D e l i m i t a t i o n s The p r e s e n t s t u d y i s d e l i m i t e d t o : 1. male p a r a p l e g i c s and q u a d r a p l e g i c s between the ages of 18 t o 53 2. the v a r i a b l e s ( p r e d i c t o r s ) s u b m i t t e d t o r e g r e s s i o n a n a l y s i s 3. the w h e e l c h a i r ergometer c o n s t r u c t e d f o r w o r k l o a d v a r i a t i o n s h. the Pearson-product-moment c o r r e l a t i o n a n a l y s i s 5. the method of e x p r e s s i o n of a e r o b i c c a p a c i t y , i . e . , MV02L. D e f i n i t i o n s 1. S t a b i l i z e d : A p o s t r e h a b i l i t a t e d s t a t e i n w h i c h t h e s u b j e c t ' s c a r d i o - v a s c u l a r system has been r e t u r n e d t o a s t a t e w h i c h reduces the chance of the o r t h o s t a t i c r e a c t i o n . T h i s i s a c c o m p l i s h e d v i a an i n c r e a s e i n c o n s t r i c t o r y vasomotor tone i n the v e s s e l s s e r v i n g t h e i m m o b i l i z e d s e g- ments of the body. 2. O r t h o s t a t i c r e a c t i o n : A c o n d i t i o n r e s u l t i n g from a l o s s o f tone i n b l o o d v e s s e l s s e r v i n g the upper and/or lower l i m b s . The c o n d i t i o n may be f u r t h e r compounded by l o s s of the s y m p a t h e t i c i n n e r v a t i o n t o the h e a r t and r e s u l t i n g b r a d y c a r d i a . The r e s u l t s of the above i s a hypo- k i n e t i c c i r c u l a t i o n of b l o o d and b l o o d p o o l i n g i n the e x t r e m i t i e s . 3. C l a s s i f i c a t i o n s f o r s p o r t i n g e v e n t s : C l a s s I A — U p p e r c e r v i c a l l e s i o n s w i t h t r i c e p s non f u n c t i o n a l a g a i n s t g r a v i t y . A p e r s o n w i t h t h i s d i s a b i l i t y cannot l i f t h i s arms above h i s head and cannot g r i p w i t h h i s hands. Class IB—Lower c e r v i c a l s w i t h good t r i c e p s and strong f i n g e r f l e x o r s or extensors of f u n c t i o n a l value. A person with t h i s d i s a b i l i t y can l i f t h i s arras above h i s head but not against r e s i s t a n c e and can g r i p w i t h some strength. Class IC—Lower c e r v i c a l s w i t h good t r i c e p s and strong f i n g e r f l e x o r s and extensors. No onter o s s e i or lumbr i c a l s of f u n c t i o n a l value. A person with t h i s d i s a b i l i t y can l i f t h i s arms above h i s head against r e s i s t a n c e arid can g r i p f i r m l y . Class I I — B e l o w Thl-Th5 i n c l u s i v e . No balance when s i t t i n g . This person has weak abdominal and back muscles but has f u l l use of h i s arms Class I I I — B e l o w Th5-Thl0 i n c l u s i v e . A b i l i t y to keep balance when s i t t i n g i g n o r i n g nonfunctional lower abdominal muscles (cannot act with out f a l l i n g over i f s l i g h t l y pushed). Class I V — T h l l - T h l 3 i n c l u s i v e . A person with t h i s d i s a b i l i t y i s a f f e c t e d from the hips down and i n some cases w i l l have some balance d i f f i c u l t i e s . Class V—Below L3-S5. This person i s u s u a l l y a f f e c t e d from the hip down and quite often only one l e g . Class V I — T h i s c l a s s f o r swimming competitions only. Below L5. This person i s able to k i c k w i t h some e f f e c t . 2 2 Adjusted R : R adjusted f o r both sample s i z e and number of subjects i n sample, i . e . , adj R = 1 - K yr- Y J (N - m) where: N = s i z e of the sample m = number of v a r i a b l e s on the problem (N-m) = degree of freedom K = (1 - R 2) 7 5. A d j u s t e d P r e s s P r e d i c t i o n : P r e d i c t e d v a l u e f o r the case a f t e r removing the e f f e c t s o f t h a t case removed from the r e g r e s s i o n c o e f f i c i e n t s . 6. D e l e t e d P r e s s R e s i d u a l : The r e s i d u a l e r r o r f o r each case from p r e d i c t i n g t h a t case by means of the A d j u s t e d P r e s s P r e d i c t i o n . A b b r e v i a t i o n s 1. MV02L: Maximum oxygen uptake i n L i t e r s / m i n u t e 2. MV02ml: Maximum oxygen uptake ml/kg.min. 3. V02L: The r a t e o f oxygen uptake L/min. 4. V02ml: The r a t e of oxygen uptake ml/kg;min. 5. VC02L: The r a t e o f c a r b o n d i o x i d e e x p i r e d L/min. 6. VC02ml: The r a t e of c a r b o n d i o x i d e e x p i r e d ml/kg-min. 7. Sub-RQ: Submaximum R e s p i r a t o r y Q u o t i e n t 8. V e n t . : V e n t i l a t i o n r a t e L/min. 9. HR: h e a r t r a t e b e a t s / m i n . 10. WIT.:-' Workload Kpm/min. CHAPTER I I REVIEW OF LITERATURE D e s c r i p t i o n of t h e P o p u l a t i o n L e s i o n of the s p i n a l c o r d r e s u l t s i n the l o s s of nervous s u p p l y t o the segments of the body below the l e v e l o f the l e s i o n . A t r o p h y o f the muscle s n o r m a l l y s e r v e d by the r e s p e c t i v e n e r v e s , i s a common o b s e r v a t i o n . Body w e i g h t s i n p a r a p l e g i c s and q u a d r a p l e g i c s have been r e p o r t e d t o average about 80% of p r e d i c t e d v a l u e s from h e i g h t t a b l e s ( H j e l t n e s , 1 9 7 7 ) . The l o s s o f i n n e r v a t i o n i s not r e s t r i c t e d t o the muscle t i s s u e . A l e s i o n a t any l e v e l r e s u l t s i n the l o s s of c e n t r a l c o n t r o l of s y m p a t h e t i c o u t f l o w t o p a r t s of the body below t h a t l e v e l . A l e s i o n at the l e v e l of the s p l a n c h n i c p l e x u s , t h o r a c i c 6 -7 v e r t e b r a e , r e s u l t s i n the g r e a t e r p a r t of the body and b l o o d v e s s e l s b e i n g d e p r i v e d of the normal s y m p a t h e t i c v a s o - motor c o n t r o l (Wolf & Magora, 1 9 7 6 ) . The l o s s of the s p l a n c h n i c o u t f l o w r e s u l t s i n re d u c e d c a p a c i t i e s o f the c i r c u l a t o r y system t o adapt t o s t r e s s , i . e . , changes i n body p o s i t i o n and/or e x e r c i s e ( K n u t s s o n et a l . , 1973 ; Wolf & Magora, 1 9 7 6 ) . E r e c t p o s i - t i o n c auses an a c c u m u l a t i o n of b l o o d i n the lower e x t r e m i t i e s . E x e r c i s e of the upper l i m b s causes a v a s o d i l a t i o n i n t h e s e m u s c l e s , thus b l o o d p o o l s i n t he e x t r e m i t i e s . R e d i s t r i b u t i o n of b l o o d from the c o r e t o the w o r k i n g m u s c l e s , v i a a v a s o c o n s t r i c t i o n i n the abdominal o r g a n s , i s absent or reduced. The 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 accompanied by the i n a b i l i t y t o r e d i s t r i b u t e b l o o d , r e s u l t s i n a re d u c e d r e t u r n t o the h e a r t . I n c r e a s e s 8 9 i n c a r d i a c output are l i m i t e d and a f a l l i n b l o o d p r e s s u r e o c c u r s . Wolf and Magora (1976), i n v e s t i g a t e d the e f f e c t s of p o s i t i o n change i n r e l a t i o n to s y s t o l i c b l o o d p r e s s u r e . V a r i o u s l e v e l s of s p i n a l l e s i o n s were observed. E i g h t e e n men, ages 18-62 (3 q u a d r a p l e g i c s , 5 h i g h t h o r a c i c p a r a p l e g i c s , 7 low t h o r a c i c , and 3 lumbar p a r a p l e g i c s ) were i n v e s t i g a t e d . S y s t o l i c b l o o d p r e s s u r e d e c r e a s e d markedly i n c e r v i c a l and h i g h t h o r a c i c p a t i e n t s i n the e r e c t p o s i t i o n . F u r t h e r d e c r e a s e s were seen d u r i n g e f f o r t . Low t h o r a c i c and lumbar groups showed l i t t l e change i n s y s t o l i c b l o o d p r e s - sure as a r e s u l t of change i n body p o s i t i o n . There was:-marked decre a s e i n s y s t o l i c b l o o d p r e s s u r e d u r i n g e f f o r t . With i n c r e a s e d time f o l l o w i n g the s p i n a l l e s i o n , an i n c r e a s e d t o l e r - ance to changes i n body p o s i t i o n o c c u r s . A change i n r e n i n r e l e a s e has been suggested to e x p l a i n the i n c r e a s e d t o l e r a n c e to v e r t i c a l p o s i t i o n (Knutsson et a l . , 1973; Guttman, 1946; Guttman, 1954; Jonason, 1947), - s i n c e i n c r e a s e d r e n i n r e l e a s e has been r e p o r t e d a f t e r a s e r i e s of r e p e a t e d changes i n body p o s i t i o n (Johnson et a l . , 1969). The i n c r e a s e d t o l e r a n c e to v e r t i c a l p o s i t i o n c o u l d not be accounted f o r by i n c r e a s e d b l o o d volume, as these are r e p o r t e d to be low i n c h r o n i c p a r a p l e g i a (Knutsson et a l . , 1973). The problem of c i r c u l a t o r y adjustment to s t r e s s i s f u r t h e r c o m p l i c a t e d w i t h h i g h s p i n a l l e s i o n s , those above the t h o r a c i c 6-7 v e r t e b r a e . High s p i n a l l e s i o n s d e p r i v e the upper and lower body of sympathetic o u t f l o w . The sympathetic a c c e l e r a t o r y i n f l u e n c e to the h e a r t i s reduced o r . a b o l i s h e d (Knutsson et a l . , 1973; F r e y s c h u s s & Knutsson, 1969: F r e y s c h u s s , 1970; Wolf & Magora, 1976). Knutsson et a l . (1973), r e p o r t e d s u b j e c t s w i t h l e s i o n s between c e r v i c a l v e r t e b r a e 5 (C5) to t h o r a c i c v e r t e b r a e 3 (Th3) incomplete and complete at 10 Th4, t o have maximum h e a r t r a t e s v a r y i n g between 100 and 130 b e a t s / m i n u t e . Wolf and Magora ( 1 9 7 6 ) , found i n two p a t i e n t s w i t h c e r v i c a l l e s i o n s , the h e a r t r a t e d i d not i n c r e a s e over 120 b e a t s / m i n u t e . Only s l i g h t i n c r e a s e s i n h e a r t r a t e were o b s e r v e d i n p a t i e n t s w i t h h i g h t h o r a c i c l e s i o n s . Normal p h y s i o l o g i c a l r e s p o n s e s of h e a r t r a t e were found i n b o t h low t h o r a c i c and lumbar g r o u p s . F r e y s c h u s s and K n u t s s o n ( 1 9 6 9 ) , o b s e r v e d i n p a t i e n t s w i t h complete c e r v i c a l c o r d t r a n s e c t i o n s t h a t h e a r t r a t e i n c r e a s e s n o r m a l l y seen d u r i n g v o l u n t a r y c o n t r a c t i o n i n a n o n - p a r e t i c muscle group, were c o m p l e t e l y a b o l - i s h e d by a t r o p i n b l o c k . The i n c r e a s e d h e a r t r a t e r e s p o n s e t o e f f o r t t o c o n t r a c t remained i n t a c t i n h e a l t h y normals a f t e r a t r o p i n b l o c k ( F r e y s c h u s s , 1970). I n c r e a s e d h e a r t r a t e r e s p o n s e must o r i g i n a t e from the s u p r a s p i n a l c e n t e r s and be e l i c i t e d by an i n h i b i t i o n of v a g a l o u t f l o w t o the h e a r t , ( K n u t s s o n et a l . , 1973). He c o n c l u d e d t h a t h e a r t r a t e r e g u l a t i o n i n com- p l e t e c e r v i c a l c o r d t r a n s e c t i o n s i s a t t a i n e d by v a r y i n g the v a g a l t o n e . Wicks e t a l . ( 1 9 7 7 ) , examined 72 a t h l e t e s at the 1976 Olympiad f o r the p h y s i c a l l y d i s a b l e d . The average maximum h e a r t r a t e s f o r p a r a p l e g i c s and q u a d r a p l e g i c s w i t h s p i n a l c o r d l e s i o n s were: 182 + 13 b e a t s / m i n u t e and 132 + 17 b e a t s / m i n u t e , r e s p e c t i v e l y . P a r a p l e g i c s , v i c t i m s o f p o l i o , d i d not d i f f e r from t h o s e w i t h s p i n a l i n j u r i e s . However, q u a d r a p l e g i c s , p o l i o v i c t i m s , had h e a r t r a t e s a v e r a g i n g 167 + 27 b e a t s / m i n u t e as compared t o the 132 + 17, found w i t h p a r a p l e g i c s w i t h s p i n a l c o r d l e s i o n s . N i l s s o n et a l . ( 1 9 7 5 ) , found i n two s u b j e c t s w i t h h i g h l e s i o n s (C6-7 and C7-Thl) had maximum h e a r t r a t e s of 165 and 150, r e s p e c t i v e l y . S i m i l a r r e s u l t s were r e p o r t e d f o r one s u b j e c t , age 24, w i t h a s p i n a l l e s i o n at Th2, whose maximum h e a r t r a t e was r e p o r t e d t o be o n l y 160. E i g h t o t h e r s u b j e c t s ( l o w t h o r a c i c ) had normal maximum h e a r t r a t e v a l u e s r e p o r t e d . 11 C o r b e t t et a l . ( 1 9 7 1 ) , r e p o r t e d t h a t h e a r t r a t e r e s p o n s e of qu a d r a - p l e g i c s t o head-up t i l t i n g was g r e a t e r than t h a t w h i c h c o u l d be e x p l a i n e d by v a r i a t i o n of v a g a l t o n e . The b e t a - r e c e p t o r r e f l e x a c t i n g t h r o u g h the i s o l a t e d s p i n a l c o r d has been s u g g e s t e d as an e x p l a n a t i o n f o r t h i s and the wel l - k n o w n h y p e r f l e x i a i n p a t i e n t s w i t h h i g h s p i n a l c o r d t r a n s e c t i o n s (Guttman, 1947; P o l l o c k et a l . , 1951; Cunningham e t a l . , 1953; W h i t t e r - i d g e , 1954; K u r n i c k , 1956; C o l e e t a l . , 1967). The mode of i n c r e a s i n g c a r d i a c o u t p u t d u r i n g e x e r c i s e i s m a i n l y v i a i n c r e a s e d h e a r t r a t e . S t r o k e volume has been found t o i n c r e a s e o n l y s l i g h t l y . H j e l t n e s ( 1 9 7 7 ) , i n v e s t i g a t e d the c a r d i o v a s c u l a r a d a p t a t i o n s t o work of n i n e p a r a p l e g i c s , Th6-Thl2 l e s i o n s . I n c r e a s e s i n c a r d i a c o u t p u t ranged from 54-1057° w i t h a mean of 677o. S t r o k e volume i n c r e a s e s a c c o u n t e d f o r 6-367= (mean 247=,) of the i n c r e a s e d c a r d i a c o u t p u t . At an oxygen uptake of 1 l i t e r / m i n u t e , the e x t r a p o l a t e d v a l u e s of s t r o k e volume i n p a r a p l e g i c s were 43-66ml. C o r r e s p o n d i n g v a l u e s i n seven h e a l t h y s u b j e c t s were 59-100ml. I n one s u b j e c t , oxygen uptake i n c r e a s e d 627., c a r d i a c o u t p u t i n c r e a s e d 277>, w h i l e s t r o k e volume d e c r e a s e d 127,. Lower s t r o k e volumes may be a c c o u n t e d f o r by d e c r e a s e d venous r e t u r n as a r e s u l t of h y p o k i n e t i c c i r c u l a t i o n . I n h i g h e r l e s i o n s , the r e d u c e d s y m p a t h e t i c i n o t r o p i c e f f e c t on the h e a r t m u s c l e , w h i c h n o r m a l l y r e s u l t s i n g r e a t e r f o r c e o f c a r d i a c c o n t r a c t i o n and lower end s y s t o l i c volumes, may be a f a c t o r . Few s t u d i e s have a t t e m p t e d t o a s s e s s the maximum oxygen uptake c a p a c - i t i e s o f w h e e l c h a i r s u b j e c t s . Wicks et a l . ( 1 9 7 6 ) , a s s e s s e d maximum oxygen uptake c a p a c i t i e s of 72 a t h l e t e s . The f i n d i n g s were c a t e g o r i z e d on the b a s i s o f I n t e r n a t i o n a l C l a s s i f i c a t i o n s , i . e . , IA, I B , I I , I I I , IV. The r e p o r t e d maximum c a p a c i t i e s a r e : .15.9, 15.8, 24.0, 31.1, 39.0 ml/kg-min., 12 r e s p e c t i v e l y . Cameron et a l . (1976), examined the a e r o b i c c a p a c i t i e s of 42 a t h l e t e s . C a t e g o r i z a t i o n was made on the b a s i s of the type of s p o r t p a r t i c i p a t e d i n . Wh e e l c h a i r t r a c k and swimming a t h l e t e s had maximum oxygen uptakes i n excess of 40 ml/kg-min. S k i l l a t h l e t e s had the lowest maximum c a p a c i t i e s , 24.4 + 6.2 ml/kg.min. S t r e n g t h a t h l e t e s had v a l u e s s l i g h t l y g r e a t e r , 25.6 + 4.5 ml/kg-min. Non s p e c i a l i z a t i o n i n s p o r t p a r t i c i p a t i o n made i t d i f f i c u l t to i d e n t i f y c h a r a c t e r i s t i c types f o r the above. Zwiren and Bar - o r (1975), compared f o u r groups: normal a t h l e t e s (NA), normal s e d e n t a r y (NS), w h e e l c h a i r bound a t h l e t e s (WA), and w h e e l c h a i r bound sed e n t a r y (WS). The WS s u b j e c t s were a l l w i t h l e s i o n s below the Th7 l e v e l . Arm work was performed w i t h no s i g n i f i c a n t d i f f e r e n c e found between NA and WA (MV02ml). S i g n i f i c a n t d i f f e r e n c e s were r e p o r t e d when maximum oxygen uptake was e x p r e s s e d as MV02L. The d i f f e r e n c e s i n lower body mass, between the two groups p r o b a b l y i s an important f a c t o r i n the i n t e r p r e t a t i o n s of these r e s u l t s . The author suggested t h a t WS and NS were d i f f e r e n t i n terms of maximum oxygen uptake, even though a s i g n i f i c a n t d i f f e r e n c e was not found. N i l s s o n et a l . (1975), examined the a e r o b i c c a p a c i t i e s of 12 r e h a b i l i - t a t e d p a r a p l e g i c s u b j e c t s and the e f f e c t s of t r a i n i n g on t h e i r a e r o b i c capac- i t i e s . Two s u b j e c t s w i t h c e r v i c a l l e s i o n s had maximum oxygen uptakes a v e r - a g i n g 16.8 ml/kg-min. ( p r e - t r a i n i n g ) . The re m a i n i n g s u b j e c t s w i t h t h o r a c i c l e s i o n s , p r e - t r a i n i n g v a l u e s averaged about 20.3 ml/kg-min. The s u b j e c t s v a r i e d c o n s i d e r a b l y i n age and h a b i t u a l p h y s i c a l a c t i v i t y l e v e l s . Only one of the s u b j e c t s w i t h a c e r v i c a l l e s i o n p a r t i c i p a t e d i n a t r a i n i g p r o - gram. H i s maximum oxygen uptake i n c r e a s e d 3.7 ml/kg-min. P h y s i c a l t r a i n i n g i n c r e a s e d i n the mean MV02ml, f o r the group w i t h t h o r a c i c ' l e s i o n s , to 26.9 ml/kg.min. H j e l t n e s ( 1 9 7 7 ) , examined n i n e p a r a p l e g i c s u b j e c t s , e i g h t w i t h low t h o r a c i c l e s i o n s (Th6-Thl2) and one w i t h a Th2 l e s i o n . S u b j e c t s v a r i e d i n age from. 17-46 y e a r s , mean 26.8. Maximum oxygen uptake ranged from I . 1 l / m i n . t o 1.7 l / m i n . (20.8 ml/kg-min. t o 36.6 ml/kg-min., mean 27.4 ml/kg-min.) S e v e r a l i n v e s t i g a t o r s have r e p o r t e d the e f f i c i e n c y w i t h w h i c h the s u b j e c t s p e r f o r m the work. B r u b a k e r e t a l . ( 1 9 7 9 ) , r e p o r t e d m e c h a n i c a l e f f i c i e n c i e s a t t h r e e d i f f e r e n t work l o a d s : .25, .33, and .50 w a t t s / k g o f body w e i g h t . The m e c h a n i c a l e f f i c i e n c i e s r e p o r t e d a r e : 9.33, 10.55, and I I . 49 per c e n t , r e s p e c t i v e l y . M e c h a n i c a l e f f i c i e n c i e s at two d i f f e r e n t speeds were a l s o i n v e s t i g a t e d , c o r r e s p o n d i n g t o w o r k l o a d s of 2.0 and 3.0 kpm/min. Mechanic e f f i c i e n c i e s were r e p o r t e d t o be 11.29% and 9.62%,, r e s p e c t i v e l y . B a r r and G l a s e r ( 1 9 7 7 ) , r e p o r t e d m e c h a n i c a l e f f i c i e n c y t o d e c r e a s e w i t h i n c r e a s e d w o r k l o a d . The v a l u e d e c r e a s e d from 9% t o 67o f o r w o r k l o a d s v a r y i n g from 50 t o 150 kpm/min. No men t i o n was made of how l o a d i n c r e a s e s were a c h i e v e d , i . e . , by i n c r e a s e s i n speed o r i n c r e a s e s i n r e s i s t a n c e . G l a s e r , Young, and S u r y a p r a s a d (1977) i n v e s t i g a t e d t he m e c h a n i c a l e f f i c i e n c y of v a r i o u s methods of s t r i d i n g , i . e . , n o r m a l - s y n c h r o n o u s v e r s u s asynchronous t e c h n i q u e . M e c h a n i c a l e f f i c i e n c i e s o f 4.7% and 7.47o, r e s p e c t i v e l y , were r e p o r t e d . M a r i n c e k and V o j k o ( 1 9 7 8 ) , u s i n g arm e y e l o e r g o m e t r y , r e p o r t e d mechan- i c a l e f f i c i e n c i e s of f i v e s u b j e c t s t o v a r y from 16.1 t o 20.77.= . These r e s u l t s agree w i t h the f i n d i n g s of B e v e r g a r d et a l . ( 1 9 6 6 ) , who r e p o r t e d m e c h a n i c a l e f f i c i e n c i e s of 18 and 23% f o r arm and l e g work, r e s p e c t i v e l y . N i l s s o n et a l . (1975), examined the e f f e c t s of t r a i n i n g on m e c h a n i c a l e f f i c i e n c y of 12 p a r a p l e g i c s . Arm c y c l o e r g o m e t r y was employed. P r e - t r a i n e d v a l u e s a v e r a g e d : 16.0 + 1.9% at submaximal work of 300-370 kpm/min. and 18.3 + 2.9% a t maximum e f f o r t . These v a l u e s were i n c r e a s e d t o 18.3 + 2.9%. and 21.5 + 2.9%, r e s p e c t i v e l y . The v a r i a t i o n i n magnitude of the r e p o r t e d m e c h a n i c a l e f f i c i e n c i e s f o r t he v a r i o u s s t u d i e s may r e s u l t from the use of d i f f e r e n t methods of c a l c u l a t i o n . I n most cases the method was not r e p o r t e d making i n t e r p r e - t a t i o n s d i f f i c u l t . P r e d i c t i o n of Maximum Oxygen Uptake P r e d i c t i o n o f maximum oxygen uptake has been and c o n t i n u e s t o be the c o n c e r n of many e x e r c i s e p h y s i o l o g i s t s . S e v e r a l methods have been d e v e l - oped. R e s e a r c h e r s have r e p o r t e d v a r y i n g degrees of s u c c e s s w i t h each. T a b l e 1 l i s t s the m a j o r i t y o f the methods r e p o r t e d t o d a t e , and the a c c u r - acy o f p r e d i c t i o n u s i n g the v a r i o u s methods. I t i s not the purpose of t h i s c h a p t e r t o do an i n - d e p t h r e v i e w of each method and/or the v a r i o u s s t u d i e s w h i c h have l o o k e d a t t h e s e . The r e a d e r i s r e f e r r e d t o A s t r a n d and Rodahl (1970) and D a v i e s (1968) f o r a more i n - depth r e v i e w o f the p r e d i c t i o n of maximum oxygen uptake by means of t h e e x t r a p o l a t i o n methods. The l i m i t a t i o n s o f each have been w e l l documented i n t h e s e and o t h e r e x e r c i s e p h y s i o l o g y t e x t s . An o v e r v i e w o f the more p o p u l a r methods w i l l be made here w i t h a more d e t a i l e d l o o k at p r e d i c t i o n of maximum oxygen uptake v i a m u l t i p l e r e g r e s s i o n e q u a t i o n s . A s t r a n d and Rhyming (1954) , ' . i n i t i a t e d one method w h i c h u t i l i z e d h e a r t r a t e and the measurement of or e s t i m a t e d oxygen uptake at a submaximum work- l o a d , t o p r e d i c t maximum oxygen uptake v a l u e s . A s t r a i g h t l i n e i s f i t t e d between a "common'1' h e a r t r a t e of 61 b e a t s / m i n . ( a t z e r o oxygen consumption) and the measured h e a r t r a t e a t the oxygen consumption f o r a p a r t i c u l a r sub- T a b l e 1. A Summary of I n v e s t i g a t i o n s i n t o the A c c u r a c y of P r e d i c t i n g Maximum Oxygen Uptake U t i l i z i n g the Methods I n d i c a t e d S t u d y * Sample d i s t r i b u t i o n P a r t i c u l a r s E r r o r A s t r a n d & Rhyming (1954) method A s t r a n d & Rhyming (1954) H e r m i s t o n & F a u l k n e r (1971) 28 Davi e s (1968) G l a s s f o r d et a l . (1965) 80 24 males males f e m a l e s f e m a l e s normals n o r m a l s , ages 20-50 p h y s i c a l l y a c t i v e males b i k e ergometry b i k e ergometry b i k e ergometry b i k e ergometry 900 kpm 1200 kpm 600 kpm 900 kpm MV02 de t e r m i n e d by t r e a d m i l l submaximal HR l e s s t h a n 140 (N=5) submaximal HR g r e a t e r than 140 (N=23) p r e d i c t i o n v i a nomogram b i k e ergometry submaximum HR 120-140 submaximum HR 140+ p r e d i c t i o n v i a nomogram p r e d i c t i o n v i a nomogram compared t o : MV02 ob s e r v e d b i k e ergometry M0V2 observed t r e a d m i l l " S t u d y — I n v e s t i g a t i o n s w h i c h have t e s t e d the a c c u r a c y of the i n d i c a t e d methods E r r o r s : A l l e r r o r s r e p o r t e d as mean % e r r o r o f p r e d i c t i o n + s t a n d a r d d e v i a t i o n s . „^ sum of r e s i d u a l e r r o r s -, n r i a , . M " " A b s o l u t e p e r c e n t v a r i a t i o n + SD, i . e . , ; , x iOO/o - N "''"'Coefficient of v a r i a t i o n , i . e . observed MV02 s t a n d a r d e r r o r of e s t i m a t e mean o b s e r v e d MV02' 100% 10.4%- 6.IV 14.4%- 9.4%-< 15% + 11 18% + 12 12% + 8 9% + 9 0% + 2 0 Table 1, c o n t i n u e d Study- Sample d i s t r i b u t i o n P a r t i c u l a r s E r r o r R o w e l l e t a l . (1964) Joseph et a l . (1973) D e V r i e s & K l a f s (1965) Verma (1977) Maritz-Wyndham (1967) method D a v i e s (1968) R o w e l l et a l . (1964) 10 10 12 20 80 10 n o n a t h l e t e s n o n a t h l e t e s a t h l e t e s males, ages 20-30 16 males, ages 20-26 45 n o r m a l s , ages 20-50 p r e - t r a i n i n g p o s t - t r a i n i n g p r e d i c t i o n v i a nomogram MV02 v i a b i k e ergometry p r e d i c t i o n v i a nomogram WL f o r a l l s u b j e c t s 750 kpm MV02 v i a b i k e ergometry p r e d i c t i o n v i a nomogram WL a l l s u b j e c t s 900 kpm MV02 determ i n e d v i a b i k e ergometry p r e d i c t i o n v i a nomogram . p r e d i c t i o n v i a e x t r a p o l a t i o n of the l i n e p roduced from two submaximum work r a t e s (sub HR between 130-170) b i k e ergometry endurance a t h l e t e s t r e a d m i l l e x e r c i s e ages 18-24 e x t r a p o l a t i o n t o MAX HR of 195 s e d e n t a r y males p r e - t r a i n i n g ages 20-30 p o s t - t r a i n i n g 27% + 7 14% + 7 6% + 4 5 % + 9 9.3%*" 11.62 + .72 12% + 9 15% + 8 23% + 7 18% + 8 Table 1, continued Study* Sample d i s t r i b u t i o n P a r t i c u l a r s Error Verma (1977) 45 moderately bike ergometry active WL: 600, 750, and 900 b e s t - f i t l i n e f i t t e d to three points; extrapolated to 180 Max HR 14% + 1** Margaria et a l . (1965) method Margaria et a l . (1965) Davies (1968) 80 males and females ages 9-47 normals, ages 20-50 step test (30-40) cm bench) prediction v i a nomogram step test prediction v ia nomogram 1% + 6 10% + 7 Issekutz et a l . (1962) method Issekutz et a l . (1962) 24 males, ages 20-65 females, ages 55-65 a l l untrained bike ergometry change i n RQ, i e . , log RQ vs V02L produces a straight line .0% + 4.86 DeVries & Kalfs (1965) 16 males, ages 20-26 MV02 determined via bike ergometry 8% + 18 Joseph et a l . (1977) 14 s o l d i e r s , ages 20-30 bike ergometry 18% + 11 T a b l e 1, c o n t i n u e d Study-' Sample d i s t r i b u t i o n P a r t i c u l a r s E r r o r Shephard (1967) 10 s e d e n t a r y p r o g r e s s i v e s t e p t e s t 07» + 8 . 5 Fox (1973) method Fox (1973) 87 u n t r a i n e d c o l l e g e males MV02L = 6,300 - 19.26 (HR) HR: h e a r t r a t e response t o 150 w a t t s (work r a t e d u r i n g b i k e e r g . ) l i n e a r r e g r e s s i o n .01 + 7. 9.6%*** H e r m i s t o n & F a u l k n e r (1971) method H e r m i s t o n & F a u l k n e r (1971) 36 36 m a l e s , a c t i v e m a l e s , i n a c t i v e t r e a d m i l l m u l t i p l e r e g r e s s i o n s e p a r a t e e q u a t i o n s f o r each group p r e d i c t i o n a c c u r a c y i n c r e a s e d over t o t a l group p r e d i c t i o n e q u a t i o n a n t h r o p o m e t r i c and c a r d i o r e s p i r a t o r y v a r i a b l e s 27, + 8 M a s t r o p a o l o (1970) method M a s t r o p a o l o (1970) 13 m i d d l e - a g e d males b i k e ergometry m u l t i p l e r e g r e s s i o n a n t h r o p o m e t r i c and c a r d i o r e s p i r a t o r y v a r i a b l e s 57> + 3 6.67*- Co 19 maximum w o r k l o a d . Maximum oxygen uptake i s o b t a i n e d from the e x t r a p o l a - t i o n of the s t r a i g h t l i n e t o a p o p u l a t i o n maximum h e a r t r a t e (195 b e a t s / m i n ) . Nomograms have been d e v e l o p e d f o r - b o t h s t e p - t e s t s and b i k e ergometry. M a r i t z et a l . (1962) u t i l i z e d f o u r submaximal r a t e s o f work. V02L and HR f o r each w o r k l o a d were p l o t t e d and a s t r a i g h t l i n e f i t t e d t o f o u r p a i r s of v a l u e s . E x t r a p o l a t i o n was made t o a maximum h e a r t r a t e of 180 b e a t s / m i n . Work was pe r f o r m e d on a b i k e ergometer. M a r g a r i a e t a l . ( 1 9 5 6 ) , employed two r a t e s of work ( s t e p p i n g up and down, on and .off a bench) w h i c h produced a h e a r t r a t e between 100-150 b e a t s / min. A d j u s t m e n t s were i n c o r p o r a t e d f o r the v e r y young and v e r y o l d , i . e . , t h r e e maximum h e a r t r a t e l i n e s a r e g i v e n i n the nomogram t o ta k e i n t o a ccount the e f f e c t s of age on maximum h e a r t r a t e . A l l t h r e e of t h e s e e x t r a p o l a t i o n methods r e l y on a s s u m p t i o n s : 1. A l i n e a r r e l a t i o n s h i p e x i s t s between h e a r t r a t e and oxygen u p t a k e . 2. I n t e r - i n d i v i d u a l v a r i a t i o n s o f h e a r t r a t e about the p o p u l a t i o n mean i s s u f f i c i e n t l y s m a l l f o r the p o p u l a t i o n mean t o be used as the maximum h e a r t r a t e f o r a l l s u b j e c t s . 3. The m e c h a n i c a l e f f i c i e n c y f o r a l l s u b j e c t s i s about 23% (when oxygen uptake f o r submaximum work i s assumed). The v a l i d i t y o f 1 and 2 has been q u e s t i o n e d by many i n v e s t i g a t o r s , as n o t e d i n Chap t e r I . The c o e f f i c i e n t of v a r i a t i o n i n m e c h a n i c a l e f f i c i e n c y of 4-5%, r e p o r t e d by Shephard ( 1 9 7 7 ) , i s s u g g e s t e d t o be 6% by A s t r a n d and Rodahl ( 1 9 7 0 ) . The a c c u r a c y of p r e d i c t i o n i s dependent on a number of f a c t o r s w h i c h r e f l e c t t he v a l i d i t y of the above a s s u m p t i o n s . F i t n e s s l e v e l s a r e of prime c o n c e r n . D a v i e s ( 1 9 6 8 ) , n o t e s t h a t o n l y i n s u b j e c t s w i t h a h i g h o b s e r v e d maximum oxygen uptake (where the d e c l i n e i n maximum h e a r t r a t e tends t o 20 compensate f o r the a s y m p t o t i c n a t u r e of h e a r t r a t e ) , does the p r o c e d u r e of e x t r a p o l a t i o n of the l i n e HR v e r s u s V02 t o a mean p o p u l a t i o n p u l s e of 190, produce r e a l i s t i c r e s u l t s . U n d e r e s t i m a t i o n of maximum oxygen uptake i s the t r e n d f o r more s e d e n t a r y s u b j e c t s . R o w e l l et a l . ( 1 9 6 4 ) , r e p o r t e d s i m i l a r c o n c l u s i o n s . I n the case o f younger s u b j e c t s , any method w h i c h employs a maximum h e a r t r a t e o f 170 or 180 w i l l u n d e r e s t i m a t e the t r u e maximum oxygen u p t a k e . Age a d j u s t m e n t s have been made i n some ca s e s ( A s t r a n d & R o d a h l , 1970; M a r g a r i a , 1965). P r e d i c t i o n i s a l s o dependent on many e n v i r o n m e n t a l f a c t o r s . Ambient t e m p e r a t u r e , h u m i d i t y , and the p a r t i a l p r e s s u r e o f oxygen ( e l e v a t i o n ) can a l l i n f l u e n c e the p h y s i o l o g i c a l s t r e s s p l a c e d on the body and i n so d o i n g , i n f l u e n c e the submaximal r e s p o n s e ( A s t r a n d & R o d a h l , 1970). R o w e l l et a l . ( 1 9 6 4 ) , l i s t e d s e v e r a l f a c t o r s t h a t w i l l cause h e a r t r a t e t o v a r y independent of oxygen u p t a k e . These i n c l u d e p h y s i c a l c o n d i - t i o n i n g , e l a p s e d t i m e a f t e r p r e v i o u s meal, t o t a l c i r c u l a t i n g h e m o g l o b i n , the degree of h y d r a t i o n of the s u b j e c t , and h y d r o s t a t i c a l l y i n d u c e d changes r e s u l t i n g from p r o l o n g e d e r e c t p o s i t i o n . I s s e k u t z et a l . ( 1 9 6 2 ) , i n v e s t i g a t e d an a l t e r n a t i v e method t o e x t r a p o - l a t i o n , i . e . , the change i n the r e s p i r a t o r y q u o t i e n t . They r e p o r t e d the v a l u e : w o r k i n g RQ - .75, i n c r e a s e d l o g a r i t h m i c a l l y w i t h t h e w o r k l o a d and maximum oxygen uptake was re a c h e d when t h i s v a l u e became e q u a l t o .40. V a r y i n g degrees of s u c c e s s have been r e p o r t e d u s i n g t h i s method. T a b l e 1 may be r e f e r r e d t o f o r a summary of the v a r i o u s r e s u l t s . The v a r i a b i l i t y i n s u c c e s s found w i t h the p r e c e d i n g methods, has l e d i n v e s t i g a t o r s t o the use of more v a r i a b l e s f o r t h e p r e d i c t i o n of maximum oxygen u p t a k e . M u l t i p l e r e g r e s s i o n e q u a t i o n s have been d e v e l o p e d by 21 s e v e r a l a uthors ( B e l l & Hinson, 1974; Bonen & Babineau, 1977; F a l l et a l . , 1966; Fox, 1973; Hermiston & F a u l k n e r , 1971; Jessup et a l . , 1974; J e t t e et a l . , 1976; M a s t r o p a o l o , 1970). M a s t r o p a o l o (1970), o b t a i n e d a simple r e g r e s s i o n by stepwise 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 . T h i r t e e n middle aged men were e x e r c i s e d to maximum oxygen uptake. Submaximal and maximal h e a r t r a t e , s y s t o l i c b l o o d p r e s s u r e , e x p i r e d volumes, e x p i r e d carbon d i o x i d e and oxygen were determined. In t h i s study submaximum RQ and maximum oxygen uptake were found to be h i g h l y c o r r e l a t e d , r=.89 and a s t a n d a r d e r r o r of e s t i m a t e of .175. The a d d i t i o n of work r a t e r a i s e d the m u l t i p l e c o r r e l a t i o n to .92 and d e c r e a s e d the s t a n d - a r d e r r o r of e s t i m a t e : t o .156 L/min. The m u l t i p l e r e g r e s s i o n e q u a t i o n d e v e l - oped from these two submaximum v a r i a b l e s i s as f o l l o w s : MV02L = 11.158 - 0.007(WL) - 4.517(RQ). The r e p o r t e d b e s t p r e d i c t i o n e q u a t i o n was: MV02L = 14.703 - 4.909(RQ) - 0.008(WL) - 0.004(blood p r e s s u r e ) + 0.018 (Vent) - 16.083(V02L), o b t a i n e d at 600 kpm/min. The m u l t i p l e r e g r e s s i o n c o r r e l a t i o n c o e f f i c i e n t was r e p o r t e d to be .93 w i t h a s t a n d a r d e r r o r of e s t i m a t e of .172 L/min. D e v i a t i o n s from the t r u e v a l u e s ranged from -87« to + 11%, mean of +.37o, a b s o l u t e mean of 5.47o w i t h a s t a n d a r d d e v i a t i o n of 3%. Of the 13 s u b j e c t s , 3 t r a i n e d f o r 12 weeks and were t e s t e d a g a i n . P r e - t r a i n i n g v a l u e s r e s u l t e d i n an e s t i m a t e between -57o and +470 of t r u e MV02L, w h i l e post t r a i n i n g p r e d i c t i o n u n d e r e s t i m a t e d MV02L by 87o. I t i s noted t h a t M a s t r o p a o l o r e p o r t e d the second m u l t i p l e r e g r e s s i o n e q u a t i o n as the " B e s t . " The s t a n d a r d e r r o r of e s t i m a t e was g r e a t e r and 2 the a d j u s t e d R would be c o n s i d e r a b l y l e s s than t h a t r e p o r t e d f o r the equa- t i o n u s i n g o n l y RQ and WL. When s m a l l sample s i z e s are used, i t i s 2 important to r e p o r t the a d j u s t e d R v a l u e . Small sample s i z e s tend to i n f l a t e the m u l t i p l e c o r r e l a t i o n c o e f f i c i e n t , as does the use of a l a r g e 22 number of v a r i a b l e s . H e r m i s t o n and F a u l k n e r ( 1 9 7 1 ) , l o o k e d at 25 a n t h r o p o m e t r i c and c a r d i o r e s p i r a t o r y submaximal v a r i a b l e s . Data were c o l l e c t e d on 60 men. The o v e r a l l group was d i v i d e d on the b a s i s of p h y s i c a l a c t i v i t y l e v e l s i n t o two i n t e r l o c k i n g g r o u p s , a p h y s i c a l l y a c t i v e group (N=36) and a p h y s i c a l l y i n a c t i v e group (N=36). Data on 12 b o r d e r - l i n e s u b j e c t s were i n c l u d e d i n b o t h g r o u p s . P r e d i c t i o n equations.; were d e v e l o p e d f o r : t o t a l group d a t a ; as w e l l as f o r each group. The r e g r e s s i o n e q u a t i o n f o r the t o t a l group d i d not p r o v i d e an a c c u r a t e p r e d i c t i o n of maximum oxygen u p t a k e , R=.54. R e g r e s s i o n e q u a t i o n s f o r each of the s u b - g r o u p i n g s r a i s e d t he R t o .90 i n each c a s e . The p e r c e n t e r r o r f o r p r e d i c t i o n u s i n g e i t h e r e q u a t i o n was r e p o r t e d as 2+8%. Fox ( 1 9 7 3 ) , found a m u l t i p l e c o r r e l a t i o n of .78, u t i l i z i n g body w e i g h t , h e i g h t , and submaximal h e a r t r a t e a t a w o r k l o a d o f 150 w a t t s . T h i s d i d not s i g n i f i c a n t l y p r e d i c t MV02ml b e t t e r t h a n the use of h e a r t r a t e r e s p o n s e a l o n e . The p r e d i c t i o n e q u a t i o n ( u t i l i z i n g o n l y t h e h e a r t r a t e r e s p o n s e d u r i n g the f i f t h m inute of e x e r c i s e at a work r a t e of 150 w a t t s ) i s as f o l l o w s : MV02ml = 6300 - 19.26(HR), s t a n d a r d e r r o r of e s t i m a t e : 246 ml/min. (7.8%,). P r e d i c t i o n o f MV02ml made on a group of s u b j e c t s t a k e n from the l i t e r a t u r e , was not s i g n i f i c a n t l y d i f f e r e n t from measured v a l u e s b e f o r e and a f t e r t r a i n i n g , o r w i t h age v a r i a t i o n (X + SD : 3.13 + .43 L/min., measured: 3.1 + .36 L/min., p r e d i c t e d [ r = . 8 3 ] ) . T h i s method does not r e l y on the pre m i s e t h a t HR i n c r e a s e s l i n e a r l y w i t h oxygen consumption and w o r k l o a d over the e n t i r e range of w o r k l o a d s t o maximum e f f o r t . J e t t e et a l . ( 1 9 7 6 ) , i n v e s t i g a t e d the p o s s i b i l i t y t h a t maximum oxygen uptake c o u l d be p r e d i c t e d from independent v a r i a b l e s measured d u r i n g the a d m i n i s t r a t i o n o f the Canadian Home F i t n e s s T e s t . F i f t y - n i n e s u b j e c t s , 23 a g e s 15-74 y e a r s , u n d e r w e n t t h e f i t n e s s t e s t a n d p r o g r e s s i v e e x e r c i s e t r e a d - m i l l t e s t f o r d i r e c t d e t e r m i n a t i o n o f v o l i t i o n a l maximum o x y g e n u p t a k e . The f o l l o w i n g m u l t i p l e r e g r e s s i o n e q u a t i o n was f o u n d t o p r o d u c e a m u l t i p l e R o f . 9 0 5 : MV02ml = 42.5 +• 1 6 . 6 ( V 0 2 L ) - . 1 2 ( W t ) - . 1 2 ( p o s t e x e r c i s e h e a r t r a t e ) - . 2 4 ( A G ) . V 0 2 L as u s e d i n t h i s e q u a t i o n , r e p r e s e n t s t h e a v e r a g e o x y g e n c o s t f o r t h e l a s t c o m p l e t e d e x e r c i s e s t a g e o f a s t e p t e s t ( t a b l e v a l u e s ) . B o n e n e t a l . (1979), i n v e s t i g a t e d t h e u s e o f m u l t i p l e r e g r e s s i o n e q u a - t i o n s f o r t h e p r e d i c t i o n o f maximum o x y g e n u p t a k e i n b o y s , a g e s 7-15. D a t a w e r e c o l l e c t e d on 100 s u b j e c t s . P r e d i c t i o n e q u a t i o n s f o r MV02L w e r e o b t a i n e d f r o m s u b j e c t s h e i g h t , V 0 2 L , a n d HR o b s e r v e d d u r i n g t h e t h i r d m i n u t e o f a t r e a d m i l l w a l k , R = .95, CV = + 9.77o. When j u s t s u b j e c t h e i g h t , w e i g h t , a n d age w e r e u s e d , s i m i l a r r e s u l t s w e r e o b t a i n e d . MV02ml was a l s o p r e d i c t e d f r o m a g e , HR, V C 0 2 L , a n d V C 0 2 m l . S l i g h t l y b e t t e r a c c u r a c y was t h e r e s u l t , c o e f f i c i e n t o f v a r i a t i o n e q u a l t o 8.47c C r o s s - v a l i d a t i o n on 39 b o y s ( t r a i n e d ) r e s u l t e d i n a p r e d i c t i o n e r r o r o f a b o u t l-27» + 97„. The u s e o f j u s t a g e , h e i g h t , a n d w e i g h t was f o u n d t o u n d e r e s t i m a t e b o t h MV02L a n d : MV02ml. J e s s u p e t a l . (1974), i n c o r p o r a t e d t h e r e s u l t s o f a 1 2 - m i n u t e r u n , A s t r a n d - R h y m i n g t e s t , a g e , h e i g h t , w e i g h t , d i a s t o l i c b l o o d p r e s s u r e , a n d l e g l e n g t h t o p r e d i c t maximum o x y g e n u p t a k e . F o r t y m a l e v o l u n t e e r s w e r e s t u d i e d . The b e s t p r e d i c t i o n e q u a t i o n was: MV02L = 1.46 + 0 . 0 0 5 ( A G ) - 0 . 1 1 8 ( h e i g h t ) + 0 . 0 1 4 ( W T ) . + 0 . 0 0 7 ( d i a s t o l i c b l o o d p r e s s u r e ) + 0 . 0 9 9 ( l e g l e n g t h ) + 0 . 2 3 2 ( 1 2 - m i n u t e r u n ) + A s t r a n d ( 0 . 3 4 5 ) . The m u l t i p l e c o r r e l a t i o n c o e f f i c i e n t was r e p o r t e d a s : 0.814 w i t h a s t a n d a r d e r r o r o f e s t i m a t e e q u a l t o 0.188 l / m i n . CHAPTER I I I METHODS AND PROCEDURES S u b j e c t s Twenty male s u b j e c t s v o l u n t e e r e d t o t a k e p a r t i n the s t u d y . The group c o n s i s t e d o f 5 q u a d r a p l e g i c s and 15 p a r a p l e g i c s . Ages ranged from 17 t o 53. A l l s u b j e c t s were s t a b i l i z e d and had spent a minimum of s i x months i n t h e i r w h e e l c h a i r s . Two s u b j e c t s were e v e n t u a l l y r e j e c t e d from the s t u d y f o r two r e a s o n s : 1) premature t e r m i n a t i o n of the work s e s s i o n , i . e . , RQ .86; 2) ECG was l o s t d u r i n g the work s e s s i o n . Data C o l l e c t i o n T e s t i n g took p l a c e i n the Buchanan F i t n e s s and R e s e a r c h C e n t e r , U n i v e r - s i t y of B r i t i s h C o l u mbia. H e a r t r a t e was m o n i t o r e d by d i r e c t ECG u t i l i z i n g an A'vionic 4000 c a r d i o g r a p h w i t h o s c i l l o s c o p e and ST d e p r e s s i o n computer and d i s p l a y . H e a r t r a t e r e s p o n s e s were measured d u r i n g the f i n a l 15 seconds of each minute o f b o t h r e s t and e x e r c i s e . E x p i r e d gases were c o n t i n u o u s l y sampled and a n a l y z e d by a Bechman M e t a b o l i c Measurement C a r t (BMMC) i n t e r f a c e d i n t o a H e w l e t t P a c k a r d 3052A Data A c q u i s i t i o n system f o r 15 second d e t e r m i n a t i o n s o f r e s p i r a t o r y gas exchange v a r i a b l e s . Each s u b j e c t r e p o r t e d t o the l a b on the day of t e s t i n g . Body w e i g h t s were measured i n a v a r i e t y o f ways, depending on the s u b j e c t . L i g h t e r sub- j e c t s ( u n a b l e t o s t a n d ) were h e l d by one of the t e s t e r s and the t o t a l o f 24 25 the two i n d i v i d u a l s was measured. The t e s t e r ' s w e i g h t was the n s u b t r a c t e d from the t o t a l . W i t h l a r g e r i n d i v i d u a l s , t he w e i g h t s c a l e was p l a c e d on a t a b l e . S u b j e c t s , w i t h the a i d of the t e s t e r s ^ , l i f t e d t h e m s e l v e s out of t h e i r c h a i r s . ' onto the ; s c a l e . F i n a l l y , s u b j e c t s w i t h v e r y low s p i n a l l e s i o n s or o t h e r i n c a p a c i t a t i o n w h i c h l e f t them a b l e t o s t a n d ( w i t h a s s i s t a n c e ) , were weighed s t a n d i n g on the s c a l e s . A l l body w e i g h t s were a s s e s s e d w i t h s u b j e c t s w e a r i n g p a n t s or sweat p a n t s l e s s shoes and s h i r t s . Maximum b r e a t h i n g c a p a c i t i e s were a s s e s s e d p r i o r t o the m e t a b o l i c measures. A C o l l i n s 13.5 l i t e r r e s p i r o m e t e r was used f o r t h i s measurement. Two 12-second t r i a l s were p e r m i t t e d . The f i r s t u s u a l l y s e r v i n g / a s a p r a c t i c e t r i a l and the second as the r e c o r d e d measure. I n a l l c a s e s , the b e s t s c o r e was r e c o r d e d . D u r i n g a p r o g r e s s i v e c o n t i n u o u s work s e s s i o n , c a r d i o r e s p i r a t o r y d a t a were c o l l e c t e d . The p r o t o c o l f o r l o a d i n c r e a s e s v a r i e d between q u a d r a p l e - g i c s and p a r a p l e g i c s . I n i t i a l l o a d i n c r e a s e s were a c h i e v e d by i n c r e a s e s i n r e s i s t a n c e . I n c r e a s e s of 1 kg were a p p l i e d each minute u n t i l v a l u e s of 4.5kg and 7.5kg were a c h i e v e d f o r q u a d r a p l e g i c s and p a r a p l e g i c s , r e s p e c - t i v e l y . Subsequent l o a d i n c r e a s e s were a r r i v e d a t by i n c r e a s e d speed. I n i t i a l speed was s e t a t 20 rpm of t h e w h e e l c h a i r wheels and i n c r e a s e d 5 rpm/min. u n t i l t he s u b j e c t c o u l d no l o n g e r match the r e q u i r e d work r a t e or the s u b j e c t t e r m i n a t e d the work bout. T a b l e 2 i l l u s t r a t e s the work p r o t o - c o l f o r the two gr o u p s . F o r each w o r k l o a d the l a s t two of the f o u r r e s p i r a t o r y gas exchange d e t e r m i n a t i o n s were a v e r a g e d , i . e . , the l a s t 30 seconds a t each w o r k l o a d . H e a r t r a t e was r e c o r d e d d u r i n g the l a s t 15 seconds a t each w o r k l o a d . M a x i - mum oxygen uptake was r e p o r t e d as the h i g h e s t of the 30 second averaged v a l u e s . Work was pe r f o r m e d on a w h e e l c h a i r ergometer. A d e t a i l e d Table 2. Protocols for continuous increasing workloads Paraplegics Quadraplegics Time resistance speed resistance speed 0-1 i n t e r n a l 20 rpm i n t e r n a l 20 rpm 1-2 i n t e r n a l 20 rpm i n t e r n a l 20 rpm 2-3 3.5 kg 20 rpm 3.5 kg 20 rpm 3-4 4.5 kg 20 rpm 4.5 kg 20 rpm 4-5 5.5 kg 20 rpm 4.5 kg 25 rpm 5-6 6.5 kg 20 rpm 4.5 kg 30 rpm 6-7 7.5 kg 20 rpm 4.5 kg 35 rpm 7-8 7.5 kg 25 rpm 4.5 kg 40 rpm 8-9 7.5 kg 30 rpm 4.5 kg 45 rpm 9-10 7.5 kg 35 rpm 4.5 kg 50 rpm 10-11 7.5 kg 40 rpm 11-12 7.5 kg 45 rpm 12-13 7.5 kg 50 rpm 13-14 7.5 kg 55 rpm 14-15 7.5 kg 60 rpm 27 d e s c r i p t i o n of t h i s ergometer appears i n Appendix A. Data A n a l y s i s D i f f i c u l t y i n e q u a t i n g w o r k l o a d s t o f u n c t i o n a l and s t r u c t u r a l c h a r a c - t e r i s t i c o f the combined group of p a r a p l e g i c s and q u a d r a p l e g i c s , n e c e s s i - t a t e d the d i v i s i o n o f the t o t a l group. Two sub-groups were produced .para- p l e g i c s (N=13) and q u a d r a p l e g i c s (N=5). Three l i n e s o f d a t a were s e l e c t e d f o r each p a r a p l e g i c . Each l i n e r e p r e s e n t e d the c a r d i o r e s p i r a t o r y r e s p o n s e s t o a w o r k l o a d , where the h e a r t r a t e v a l u e was found t o be between 65% and 85% of maximum h e a r t r a t e ( m a x i - mum h e a r t r a t e = 220 - a g e ) . I n cases where l e s s than t h r e e v a l u e s o f sub- maximum HR were found w i t h i n t h i s range, the c l o s e s t HR v a l u e ( s ) o u t s i d e the l i m i t s , were added. Where more tha n t h r e e submaximum HR v a l u e s f e l l w i t h i n the l i m i t s , the WL and c o r r e s p o n d i n g c a r d i o r e s p i r a t o r y ' v a l u e s were d e l e t e d , u s i n g t h e - f o l l o w i n g c r i t e r i a : 1. where two HR r e s p o n s e s were found t o be v e r y c l o s e i n n u m e r i c a l v a l u e s , the l o w e s t was d e l e t e d , 2. where the HR r e s p o n s e was v e r y c l o s e t o the lower l i m i t , i t was d e l e t e d . A ppendix B l i s t s c omplete d a t a s e t s f o r a l l s u b j e c t s . The t h r e e l i n e s o f d a t a s e l e c t e d from each s u b j e c t ' s d a t a s e t , a r e i n d i c a t e d . Each of the t h r e e l i n e s were a s s i g n e d t o one of t h r e e g r o u p i n g s : LHR: d a t a l i n e c o r r e s p o n d i n g t o the l o w e s t HR MHR: d a t a l i n e c o r r e s p o n d i n g t o the mi d d l e HR HHR: d a t a l i n e c o r r e s p o n d i n g t o the h i g h e s t .HR 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 was c a r r i e d out on each of the LHR, MHR, and HHR g r o u p s . The UBC Computing Center's:BMD P:2R ( s t e p w i s e m u l t i p l e r e g r e s s i o n ) and BMD P: 9R ('.'Best" s u b s e t m u l t i p l e r e g r e s s i o n ) programs were employed f o r the a n a l y s i s . 28 The data a n a l y s i s f o r the q u a d r a p l e g i c s was arr a n g e d d i f f e r e n t l y . P r e d i c t i o n of maximum HR was not p o s s i b l e at the time of the p r e s e n t study and no r e s e a r c h has been conducted to determine the range between r e s t i n g h e a r t r a t e and maximum h e a r t r a t e where p r e d i c t i o n of maximum oxygen uptake w i l l be most a c c u r a t e . T h e r e f o r e , one WL and c o r r e s p o n d i n g c a r d i o r e s p i r a - t o r y responses was s e l e c t e d from each s u b j e c t ' s data s e t . T h i s l i n e of data r e p r e s e n t e d the f o u r t h minute of work f o r each s u b j e c t . Stepwise mul- t i p l e r e g r e s s i o n a n a l y s i s was performed on t h i s d a t a , UBC Computing C e n t e r ' s P:2R. CHAPTER IV RESULTS AND DISCUSSION R e s u l t s Twenty male s u b j e c t s were t e s t e d . Two were d e l e t e d from the st u d y f o r r e a s o n s n o t e d i n Chap t e r I I I . The f i n a l group o f 18 p h y s i c a l l y d i s a b l e d i n d i v i d u a l s were d i v i d e d i n t o two groups: p a r a p l e g i c s (N=13) and q u a d r a p l e - g i c s (N=5). S u b j e c t s s t r u c t u r a l c h a r a c t e r i s t i c s appear i n T a b l e 3. I n d i - v i d u a l p h y s i o l o g i c a l r e s p o n s e s t o t h e p r o g r e s s i v e c o n t i n u o u s w o r k l o a d p r o t o - c o l , appears i n Appendix B. M u l t i p l e c o r r e l a t i o n a n a l y s i s was pe r f o r m e d on the p a r a p l e g i c s ' p h y s i o - l o g i c a l r e s p o n s e s t o each of t h r e e work i n t e n s i t i e s , (LHR, MHR, and HHR). R e s p e c t i v e mean h e a r t r a t e s were a p p r o x i m a t e l y : 70%, 75%, and 80% of the p r e d i c t e d maximum h e a r t r a t e f o r the'.group, i . e . , 220 - the mean age of the group. T a b l e 4 l i s t s t he mean v a l u e s f o r the w o r k l o a d s and p h y s i o l o g i c a l r e s p o n s e s t o each work i n t e n s i t y . C o r r e l a t i o n c o e f f i c i e n t s between the 11 p r e d i c t o r s and the c r i t e r i o n at the t h r e e work i n t e n s i t i e s , a r e r e p o r t e d i n T a b l e 5. At the l o w e s t work i n t e n s i t y , s i x v a r i a b l e s were found t o be s i g n i f i c a n t l y c o r r e l a t e d t o the c r i t e r i o n a t the .05 l e v e l o f s i g n i f i c a n c e . O nly two v a r i a b l e s , WL and V02L c o r r e l a t e d s i g n i f i c a n t l y t o e h e - . c r i t e r i o n , at the .01 l e v e l . The MHR i n t e n s i t y produced f i v e v a r i a b l e s c o r r e l a t e d t o MV02L ( s i g n i f i c a n t a t t h e ' . 0 5 r i e v e l ) . S i x v a r i a b l e s were s i g n i f i c a n t (.05 l e v e l ) f o r the HHR i n t e n - s i t y . Three and f o u r v a r i a b l e s were s i g n i f i c a n t l y r e l a t e d t o the c r i t e r i o n 29 30 Table 3. Subject C h a r a c t e r i s t i c s Subjects Age (yrs) Weight (kg) Type of Injury 01 38 79.4 lesion ThlO 02 38 78.0 lesion Th5-6 03 53 95.5 les i o n L4-5 04 38 87.5 lesion C6 05 18 56.0 06 22 54.0 lesion C6-7 07 29 70.6 les i o n Thl2-Ll 08 25 61.7 lesion C7 09 31 69.0 lesion LI 10 26 70.0 Polio 11 48 91.8 lesion Th5 12 22 62.1 le s i o n Th4-5 13 52 65.0 lesion ThlO 14 37 66.9 lesion C5 15 33 84.0 16 21 64.0 17 21 60.0 les i o n C6-7 18 35 53.0 Polio Paraplegics Mean 34 72.0 Std Dev 11.5 13.0 Quadraplegics Mean 28.6 66.0 Std Dev 8.3 12.9 31 Table 4. Means and Standard Deviation of Variable Corresponding to LHR, MHR, and HHR LHR MHR HHR Variables Means Std Dev Means Std Dev Means Std Dev WL 421 102 451 122 529 123 HR 131 12 139 12 149 13 V02L 1.25 .303 1.37 .357 1.60 .399 V02ml 18.3 5.80 19.0 5.36 22.6 8.22 VC02L 1.12 .318 1.31 .416 1.60 .484 VC02ml 15.7 4.98 18.2 6.34 22.5 6.78 RQ .89 .09 .94 .11 1.00 .11 Vent L 29.8 7.59 33.4 10.1 43.4 11.8 Table 5. Summary of Correlation c o e f f i c i e n t s between predictors and c r i t e r i o n MV02 L/min •Work Intensity Wt MBC AG WL HR V02L V02ml VC02L VC02ml RQ Vent L LHR .013 .530 -.513 .816 .600 .873 .718 .714 .586 .065 .535 MHR .013 .530 -.513 .784 .667 .763 .767 .588 .552 -.051 .507 HHR .013 .530 -.513 .834 .525 .873 .718 .714 .586 -.066 .651 Correlation i c o e f f i c i e n t required for sig nifi c a n c e : 0. 553 @ .05; 0.684 @ .01 Quadraplegics .775 -.443 .665 -.515 .493 .774 -.402 .843 -.033 .499 .852 Correlation c o e f f i c i e n t required for s i gnificance: 0 .805 @ .10; .878 @ .05 ro 33 (.01 l e v e l ) f o r the MHR and the HHR i n t e n s i t i e s , r e s p e c t i v e l y . Complete c o r r e l a t i o n m a t r i c e s appear i n Appendix C. 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 r e v e a l e d s i g n i f i c a n t a d j u s t e d m u l t i p l e 2 c o r r e l a t i o n c o e f f i c i e n t s ( a d j R ), between the f i v e b e s t p r e d i c t o r s and the c r i t e r i o n . T h i s was observed at a l l t h r e e work i n t e n s i t i e s . A sum- mary of the r e s u l t s of the 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 s p r o v i d e d i n T a b l e 2 6. At the two h i g h e r work i n t e n s i t i e s an i n c r e a s e i n the adj R and a reduced s t a n d a r d e r r o r of e s t i m a t e were observed. S i g n i f i c a n c e of these d i f f e r e n c e s was not determined. F i g u r e s 1-3 g r a p h i c a l l y i l l u s t r a t e the p r e d i c t i o n a c c u r a c y of the m u l t i p l e r e g r e s s i o n e q u a t i o n s developed f o r the t h r e e work i n t e n s i t i e s . A comparison which may b e t t e r i n d i c a t e the a c c u r a c y of the p r e d i c t i o n of MV02L f o r s u b j e c t s o u t s i d e the e x p e r i m e n t a l group, i s i l l u s t r a t e d i n F i g u r e s 4-6 (Observed vs A d j u s t e d P r e s s P r e d i c t e d MV02L). P r e d i c t i o n i s made, i n t u r n f o r each s u b j e c t w i t h the e f f e c t s of h i s data removed from the r e g r e s s i o n c o e f f i c i e n t s . Over a l l work i n t e n s i t i e s , the d e l e t e d p r e s s r e s i d u a l e r r o r was found to be g r e a t e r than the r e s i d u a l e r r o r r e s u l t i n g from the u n a d j u s t e d m u l t i p l e r e g r e s s i o n e q u a t i o n s . The g r e a t e s t s c a t t e r i n g of p l o t s about the l i n e of u n i t y , was observed at the LHR i n t e n s i t y . Both the MHR and HHR e q u a t i o n s produced much l e s s s c a t t e r i n g and d i d not appear to d i f f e r from each o t h e r . T a b l e 7 summarizes the r e s i d u a l e r r o r s f o r each e q u a t i o n (page 47). The use of the UBC Computing S e r v i c e ' s P:2R program f o r ste p w i s e mul- t i p l e r e g r e s s i o n a n a l y s i s , r e v e a l e d s i g n i f i c a n t l i m i t a t i o n s of the s t e p p i n g p r o c e s s . The s t e p p i n g procedure does not always s e l e c t the be s t combina- t i o n of v a r i a b l e s . S i n c e a l l o t h e r steps are a f f e c t e d by the p r e c e d i n g s t e p s and c o r r e s p o n d i n g v a r i a b l e s e n t e r e d , c e r t a i n v a r i a b l e combinations 34 Table 6. Summary of multiple regression analysis of paraplegic data Work Inten- Contribution Std Error s i t y Variables C o e f f i c i e n t s to R 2 R 2(adj) of est. Sign. HHR Wt 0.0261173 0.323542 0.9094 0.1195 0.0002 MBC 0.0035206 0.135327 AG -0.0533642 0.325075 HR -0.0340337 0.150292 VC02ml 0.0428753 0.285904 Intercept 5.56273 MHR AG -0.0264823 0.083831 0.9218 0.1101 0.0001 WL -0.0015175 0.021833 HR -0.0080279 0.015104 VC02L 1.69754 0.202779 RQ -3.42073 0.311303 Intercept 5.84850 LHR Wt 0.023374 0.415916 0.8761 0.1397 0.0007 AG -0.0263043 0.202233 HR -0.0116148 0.031783 VC02ml 0.1083700 0.307697 RQ -2.85780 0.110529 Intercept 3.32762 1.00 1.50 2.00 2.50 3.00 PREDICTED V02 max (l/min) Fi g u r e 1. Comparison of MV02L p r e d i c t e d (unadjusted) vs observed MV02L f o r LHR group 36 MHR OBSERVED vs PREDICTED (unadjusted) 3.00+ 2.50 2.0 0+ 1.50+ 1. 00 OBSERVED V02 max (l/min) 1.00 2.50 1.50 2.00 PREDICTED V02 max (l/min) Figure 2. Comparison of MV02L predicted (unadjusted) vs observed MV02L f o r MHR group 3.00 37 HHR OBSERVED vs PREDICTED (unadjusted) 3.00+ 2.50 + 2.0 0+ 1.50 + 1.00 OBSERVED V02 max (l/min) 1.00 2. 50 1.50 2.00 PREDICTED V02 max (l/min) Figure J. Comprison of MV02L predicted (unadjusted) vs observed MV02L f o r HHR group 3.00 38 LHR OBSERVED vs PREDICTED (ADJ. Press) 3.00+ 2.50 + 2.0 0+ 1. 50 + 1.00 OESEFVED VC2 max (l/min) 1.00 1.50 2.00 2.50 PREDICTED V02 max (l/min) F i g u r e k. Comparison of MV02L p r e d i c t e d (adj. press) vs observed MV02L f o r LHR group 3.00 39 MHR OBSERVED vs PREDICTED (ADJ. Press) 3.00+ OBSERVED V02, max (l/min) 2.50 + 2.0 0+ 1.50 + 1.00 1.00 2. 50 1.50 2.00 PREDICTED V02 max (l/min) F i g u r e 5. Comparison of MV02L p r e d i c t e d (adj. press) vs observed MV02L f o r MHR group 3.00 HHR OBSERVED vs PREDICTED (ADJ. Press) PREDICTED V02 max (l/min) F i g u r e 6. Comparison of MV02L p r e d i c t e d (adj. press) vs observed MV02L f o r HHR group 41 are n o t t e s t e d . T h i s problem was n o t e d w i t h the LHR e q u a t i o n . The P:2R program's b e s t f i v e p r e d i c t o r s i n c l u d e d : Wt, AG, WL, HR, and V02L produced 2 2 an a d j R =.8343 as compared t o an a d j R of .8761 r e p o r t e d i n T a b l e 6, a r e s u l t of the P:9R program. The P:9R program t e s t s a l l c o m b i n a t i o n s of the v a r i a b l e s i n v a r y i n g numbers. The o n l y p r o b l e m found w i t h t h i s program was the r e s t r i c t i o n s o f the v a r i a b l e s w h i c h can be s u b m i t t e d t o the program f o r a n a l y s i s . V a r i - a b l e s w h i c h a r e h i g h l y i n t e r c o r r e l a t e d w i t h each o t h e r cannot a l l be sub- m i t t e d . An improper c h o i c e t o d e l e t e one or more v a r i a b l e s , may not a l l o w the b e s t subset t o be d e t e r m i n e d . I t was found n e c e s s a r y t o make s e v e r a l runs w i t h d i f f e r e n t v a r i a b l e s u b s e t s . D i s c u s s i o n A n a l y s i s of the c o r r e l a t i o n c o e f f i c i e n t s , at t h r e e work i n t e n s i t i e s , s u g g e s t e d i n c r e a s e d a c c u r a c y i n p r e d i c t i o n may be a s s o c i a t e d w i t h the h i g h e r work i n t e n s i t i e s , i . e . , a p p r o x i m a t e l y 70-75% of p r e d i c t e d maximum h e a r t r a t e . T h i s r e s u l t i s s u p p o r t e d by f i n d i n g s w h i c h d i c t a t e the p r o t o c o l s f o r submaximal t e s t s c u r r e n t l y a p p l i e d t o a b l e b o d i e d s u b j e c t s ( D a v i e s , 1968; A s t r a n d & Rhyming, 1954; H e r m i s t o n & F a u l k e r , 1971). Many v a r i a b l e s were found t o be s i g n i f i c a n t l y c o r r e l a t e d t o maximum oxygen uptake (MV02L), however, not a l l appear i n the p r e d i c t i o n e q u a t i o n . When two o r more v a r i a b l e s a r e i n t e r c o r r e l a t e d , the i n f o r m a t i o n c o n t a i n e d i n each i s s i m i l a r . The h i g h e r the i n t e r c o r r e l a t i o n c o e f f i c i e n t s , t he g r e a t e r the s i m i l a r i t y . The a d d i t i o n o f two or more of t h e s e i n t e r c o r r e l a t e d v a r i - a b l e s t o the p r e d i c t i o n e q u a t i o n w i l l have l i t t l e e f f e c t on t h e m u l t i p l e 2 c o r r e l a t i o n c o e f f i c i e n t and may d e c r e a s e t h e a d j u s t e d R v a l u e . D u r i n g the s t e p p i n g p r o c e d u r e of 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 , once one of t h e s e 42 i n t e r c o r r e l a t e d v a r i a b l e s e n t e r s the e q u a t i o n the p a r t i a l 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 re m a i n i n g v a r i a b l e and the c r i t e r i o n f a l l s , as does the F v a l u e to e n t e r . V a r i a b l e s which are not n e c e s s a r i l y s i g n i f i c a n t l y c o r r e l a t e d to MV02L and not i n t e r c o r r e l a t e d w i t h o t h e r v a r i a b l e s , may e n t e r the e q u a t i o n and 2 c o n t r i b u t e o p t i m a l l y to the a d j u s t e d R , i . e . , MBC, Wt, AG, and RQ. I t i s w e l l documented t h a t the v a r i a b l e s V02L, WL, and HR are s i g n i f - i c a n t l y i n t e r c o r r e l a t e d when workload i s v a r i e d over a wide range of submaximal workloads ( A s t r a n d & Rodahl, 1970). These r e l a t i o n s h i p s p r o v i d e the b a s i s f o r the e x t r a p o l a t i o n methods of p r e d i c t i n g MV02L f o r a b l e b o d i e d s u b j e c t s ( A s t r a n d & Rhyming, 1954; M a r i t z et a l . , 1962; M a r g a r i a et a l . , 1965; Hermiston & Faulkner, 1971; D a v i e s , 1968). S i m i l a r r e l a t i o n s h i p s have been r e p o r t e d f o r arm work by both p h y s i c a l l y d i s a b l e d and a b l e b o d i e d sub- j e c t s (Wicks et a l . , 1973; G l a s e r e t a l . , : 1 9 7 8 a , 1978b). However, a c u r v i - l i n e a r r e l a t i o n s h i p between V02L and workload has a l s o been r e p o r t e d (Wicks et a l . , 1977; V 0 k a c et a l . , 1975; Sten b e r g , 1967; Davies & Sa Nrgeant, 1974). T h i s r e l a t i o n s h i p i s suggested to be due to the r e c r u i t m e n t of trunk muscles to p r o v i d e s t a b i l i z a t i o n of the s h o u l d e r s , a l l o w i n g the sub- j e c t s to e x e r t g r e a t e r f o r c e s a g a i n s t the wheels of the c h a i r (Vokac et a l . , 1975; G l a s e r et a l . , 1978, 1977; Wicks et a l . , 1977; Engel & H i l d e r b r a n d t , 1973). T h i s produces a f a l l i n me c h a n i c a l e f f i c i e n c y at h i g h e r r e l a t i v e w orkloads. V e n t i l a t i o n , VC02L, and RQ tend to be c u r v i l i n e a r l y r e l a t e d to workload, when the workload i s v a r i e d over a wide range of submaximal workloads ( A s t r a n d & Rodahl, 1970; Davis et a l . , 1976; Wasserman et a l . , 1973). In t h e o r y , lower c o r r e l a t i o n s s h o u l d be found between these v a r i a b l e s and v a r i a b l e s which are l i n e a r l y r e l a t e d to workload. The i n t e r c o r r e l a t i o n c o e f f i c i e n t s o bserved i n t h i s study do not appear to support the above. Very h i g h 43 c o r r e l a t i o n s are observed at a l l the t h r e e work i n t e n s i t i e s , i . e . , VC02 (L or ml) vs Vent, Vent vs V02L. An e x p l a n a t i o n f o r these o b s e r v a t i o n s r e l a t e s to the f a c t t h a t c o r r e - l a t i o n a n a l y s i s was performed on p h y s i o l o g i c a l responses t o the same work i n t e n s i t y f o r each s u b j e c t . The i n t e r c o r r e l a t i o n c o e f f i c i e n t s r e f l e c t how the r e l a t i o n s h i p s between the p h y s i o l o g i c a l responses to the p a r t i c u l a r work i n t e n s i t y v a r y over the 13 s u b j e c t s . T h i s d i f f e r s from the d e t e r m i n - a t i o n of how the p o p u l a t i o n ' s p h y s i o l o g i c a l responses are r e l a t e d t o each o t h e r over a wide range of workloads, i . e . , i n t h i s study c o r r e l a t i o n a n a l - y s i s i s performed on t h r e e s m a l l segments of the continuum from r e s t t o maximum e x e r t i o n . W i t h i n the l i m i t s of each segment, l i n e a r i t y between v a r i a b l e s may be found. Body weight was found to be n o n s i g n i f i c a n t l y r e l a t e d to MV02L. T h i s has been r e p o r t e d e l s e w h e r e . ( J e t t e et a l . , 1976). The r e v e r s e has a l s o o c c u r r e d ( J e s s u p et a l . , 1974; Bonen & B e l c a s t r o , 1977; Hermiston & Faulkner, 1971), the d i f ference.-being:' r e l a t e d to the n a t u r e of the p o p u l a t i o n i n each study. In c h i l d r e n and i n young, h e a l t h y , l e a n s u b j e c t s t h e r e i s a good c o r r e l a t i o n between body weight and MV02L ( A s t r a n d , 1952). The d i s t r i b u t i o n of body weights a s s o c i a t e d w i t h the s u b j e c t s of the p r e s e n t study, would suggest a heterogeneous sample and c o r r e s p o n d i n g s i g - n i f i c a n t r e l a t i o n s h i p between body weight and MV02L. T h i s was not found. The r e l a t i o n s h i p appears t o be obsc u r e d by the v a r i a b i l i t y i n the degree of a t r o p h y of lower limb muscles, the v a r y i n g degrees of o b e s i t y , and the age r e l a t e d d e t e r i o r a t i o n of the oxygen t r a n s p o r t system, which i s not r e f l e c t e d i n the dimensions of an i n d i v i d u a l ( A s t r a n d & Rodahl, 1970). Age was found to be n e g a t i v e l y c o r r e l a t e d w i t h the c r i t e r i o n . T h i s i s a common o b s e r v a t i o n ( A s t r a n d & Rodahl, 1970; Hermiston & F a u l k n e r , 1971; 44 J e t t e et a l . , 1976). Where c h i l d r e n are i n v o l v e d the t r e n d may be r e v e r s e d (Bonen & B e l c a s t r o , 1977). R e s p i r a t o r y q u o t i e n t d i d not c o r r e l a t e s i g n i f i c a n t l y w i t h the c r i t e r - i o n at any of the t h r e e work i n t e n s i t i e s . V a r y i n g r e s u l t s have been r e p o r t e d , r e g a r d i n g the use of submaximum RQ or the change i n RQ i n b o t h s i m p l e r e g r e s - s i o n ( R o w e l l e t a l . , 1964; I s s e k u t z & R o d a h l , 1961; D e V r i e s & K l a f s , 1965; I s s e k u t z e t a l . , 1962; Shephard, 1967; Joseph et a l . , 1972), and m u l t i p l e r e g r e s s i o n e q u a t i o n s ( H e r m i s t o n & F a u l k n e r , 1971; M a s t r o p a o l o , 1970). R o w e l l et a l . ( 1 9 6 4 ) , c o n c l u d e d the use of submaximum RQ was l i m i t e d s i n c e the l e v e l of t r a i n i n g i s a p r i m a r y d e t e r m i n a n t i n how RQ changes w i t h V02 d u r i n g submaximum work. No r e l a t i o n s h i p between RQ and MV02L was r e p o r t e d . The use of submaximal RQ i n m u l t i p l e r e g r e s s i o n e q u a t i o n s has l e n t s u p p o r t t o the u s e f u l n e s s of t h i s v a r i a b l e i n p r e d i c t i o n of maximum oxygen u p t a k e . M a s t r o p a o l o ( 1 9 7 0 ) , r e p o r t e d a c o r r e l a t i o n c o e f f i c i e n t of .89 between submaximum RQ and MV02L. H e r m i s t o n and F a u l k n e r ( 1 9 7 1 ) , d i d not r e p o r t a s i g n i f i c a n t c o r r e l a t i o n between RQ and maximum oxygen u p t a k e . However, i n the two e q u a t i o n s r e p o r t e d , the change i n submaximum RQ a l o n e were found t o be i m p o r t a n t v a r i a b l e s i n each of t h e m u l t i p l e r e g r e s s i o n e q u a t i o n s . I n the p r e s e n t s t u d y , the c o r r e l a t i o n c o e f f i c i e n t s between submaximum RQ and MV02L were n o n s i g n i f i c a n t . N e v e r t h e l e s s , submaximum RQ was i n c o r - p o r a t e d i n t o two of the t h r e e m u l t i p l e r e g r e s s i o n e q u a t i o n s . I n each equa- 2 t i o n , submaximum RQ c o n t r i b u t e s s u b s t a n t i a l l y t o the R v a l u e s . Maximum RQ v a l u e s f o r s u b j e c t s 02, 16, and 17 were n o t e d t o be c o n s i d - e r a b l y h i g h e r t h a n t h a t n o r m a l l y seen a t t e r m i n a t i o n o f a maximum work bout. E x p l a n a t i o n s f o r t h i s o b s e r v a t i o n may be r e l a t e d - t o the o b s e r v e d g r e a t e r p r o p o r t i o n o f w h i t e ( g l y c o l y t i c ) muscle f i b r e s i n the muscl e s of the upper 45 l i m b s . T h i s g r e a t e r p r o p o r t i o n of w h i t e f i b r e s s u g g e s t s t h a t a g r e a t e r r a t e of l a c t a t e may be produced by a g i v e n muscle mass. H y p e r v e n t i l a t i o n , to blow o f f CC>2 from the body's b i c a r b o n a t e b u f f e r i n g s t o r e s , o c c u r s i n an e f f o r t t o b u f f e r the l a c t a t e p r o duced d u r i n g e x e r c i s e . Peak p r o d u c t i o n at t e r m i n a t i o n o f the maximum work b o u t , may be p r o p o r t i o n a l l y g r e a t e r t o t h a t o f oxygen consumption n o r m a l l y found w i t h l e g work. Vokac e t a l . ( 1 9 7 5 ) , compared the p h y s i o l o g i c a l r e s p o n s e s of a b l e b o d i e d male s u b j e c t s t o arm and l e g work. R e s p i r a t o r y q u o t i e n t s were found t o be s i g n i f i c a n t l y h i g h e r f o r arm work, V02L e q u a l t o 1.9 L/min. R e s p i r - a t o r y f r e q u e n c y was r e p o r t e d t o be h i g h e r and t i d a l volume lower d u r i n g arm work, f o r the same pulmonary v e n t i l a t i o n r a t e . S u b j e c t s were o b s e r v e d t o s y n c h r o n i z e b r e a t h i n g w i t h s t r o k i n g f r e q u e n c y . B l o o d l a c t a t e l e v e l s have been r e p o r t e d t o be s i m i l a r d u r i n g b o t h arm and l e g work a t maximum e f f o r t . P a r a p l e g i c s r e a c h maximum oxygen up- t a k e a t a much lower V02L t h a n i s found w i t h l e g work. However, b l o o d l a c t a t e l e v e l s a r e r e p o r t e d t o be s i m i l a r (Vokac e t a l . , 1975). The VC02L s h o u l d be e q u i v a l e n t t o t h a t found d u r i n g l e g work, w h i l e oxygen uptake i s r e p o r t e d t o be about 66% of t h a t found d u r i n g l e g work. S i n c e RQ i s a s i m p l e r a t i o of VC02L t o V02L, t h i s r a t i o may t h e o r e t i c a l l y be h i g h e r d u r i n g arm work. H e a r t r a t e was found t o be s i g n i f i c a n t l y c o r r e l a t e d t o MV02L a t a l l work i n t e n s i t i e s . The n u m e r i c a l v a l u e of the c o r r e l a t i o n f e l l w i t h i n c r e a s e d work i n t e n s i t i e s . As no t e d p r e v i o u s l y , HR and many o t h e r v a r i a b l e s a r e i n t e r c o r r e l a t e d . The e f f e c t s of t h i s was n o t e d i n the s m a l l c o n t r i b u t i o n 2 t o the R v a l u e s i n each c a s e . S u b j e c t s w i t h s p i n a l l e s i o n below the t h o r a c i c 6-7 l e v e l , showed normal maximum HR v a l u e s . T h i s s u p p o r t s the o b s e r v a t i o n of o t h e r i n v e s t i g a t o r s 46 ( K n u t s s o n et a l . , 1973; Wolf & Magora, 1976; F r e y s c h u s s & K n u t s s o n , 1969; F r e y s c h u s s , 1970; N i l s s o n et a l . , 1975). S u b j e c t 02 w i t h a l e s i o n at the Th 5-6 l e v e l had an o b s e r v e d maximum h e a r t r a t e of 189. T h i s i s v e r y c l o s e t o the p r e d i c t e d v a l u e f o r h i s age, i . e . , 220 - age. A l t h o u g h the l e s i o n i s above the Th 6-7 l e v e l , the i n t e r - i n d i v i d u a l v a r i a t i o n s w i t h r e g a r d t o the l e v e l o f e x i t of s p i n a l n e r v e s , or the a n g l e of the l e s i o n may have l e f t some n e r v e s i n t a c t at t h a t l e v e l , may account f o r t h i s o b s e r v a t i o n . S u b j e c t s 11 and 12, l e s i o n s Th 5 and Th 4-5, r e s p e c t i v e l y , showed what appeared t o be p a r t i a l l o s s of the s y m p a t h e t i c s t i m u l a t i o n t o the h e a r t ( o b s e r v e d 161, p r e d i c t e d 172; o b s e r v e d 180, p r e d i c t e d 198, r e s p e c t i v e l y ) . 2 The v a r i a b l e s t h a t c o n t r i b u t e d t o the R v a l u e s o f each e q u a t i o n were s i m i l a r . The l o g i c d e t e r m i n i n g the use of one v a r i a b l e r a t h e r t h a n a n o t h e r appears t o be m a t h e m a t i c a l i n n a t u r e , r a t h e r t h a n based on p h y s i o l o g i c a l p r i n c i p l e s . The P9R program l i s t s many c o m b i n a t i o n s of v a r i a b l e s w h i c h a r e o n l y s l i g h t l y l e s s a c c u r a t e i n the p r e d i c t i o n of MV02L, as compared t o the " B e s t " s u b s e t . The b e s t e q u a t i o n s d e v e l o p e d a t each i n t e n s i t y compared f a v o u r a b l y w i t h s i m i l a r p r o c e d u r e s a p p l i e d t o the a b l e b o d i e d p o p u l a t i o n ( H e r m i s t o n & F a u l k n e r , 1971; M a s t r o p a o l o , 1970; Bonen & B a b i n e a u , 1977; Metz & A l e x a n d e r , 1971; Bonen et a l . , 1979; Fox, 1973). The s i z e o f t h e sample 2 may c a s t some doubt on the v a l i d i t y o f the R v a l u e s . However, the a d j 2 R v a l u e s a r e g r e a t e r and the s t a n d a r d e r r o r s of e s t i m a t e a r e l e s s t h a n t h o s e r e p o r t e d f o r normal s u b j e c t s (Bonen et a l . , 1977; Fox, 1973; B e l l et a l . , 1974; H e r m i s t o n & F a u l k n e r , 1971; J e s s u p e t a l . , 1974; M a s t r o p a o l o , 1970; J e t t e et a l . , 1976). Cro s s v a l i d a t i o n o f the r e s u l t i n g e q u a t i o n s was not p o s s i b l e w i t h 47 the sample s i z e a v a i l a b l e t o the s t u d y . The use of the d e l e t e d p r e s s r e s i d u a l gave some i n d i c a t i o n of the a c c u r a c y of p r e d i c t i o n t h a t may be found i n the p o p u l a t i o n o u t s i d e the e x p e r i m e n t a l group. A summary of t h e s e e r r o r s a r e a v a i l a b l e i n T a b l e 7 . I t i s n o t e d t h a t t he LHR i n t e n s i t y d i d not r e s u l t i n as a c c u r a t e a p r e d i c t i o n as e i t h e r the MHR and HHR i n t e n s i t i e s . The a b s o l u t e mean e r r o r was a p p r o x i m a t e l y d o u b l e t h a t found w i t h t he e q u a t i o n s p r o duced from t h e h i g h e r work i n t e n s i t i e s . T a b l e 7 . Summary of e r r o r a s s o c i a t e d w i t h t he p r e d i c t i o n o f MV02L from p r e d i c t i o n e q u a t i o n s f o r LHR, MHR, and HHR Mean Mean a b s o l u t e I n t e n s i t y Method Res i d u a l E r r o r CV HHR adj d e l 0.015 13.2% unad j 0.000 6.77, 5.67, MHR adj d e l 0.010 11.87, unad j 0.000 6.67, 5.27, LHR adj d e l 0.020 22.27, unadj 0.000 9.07, 6.57, The r e s u l t s of a n a l y s i s of t he q u a d r a p l e j ; i c d a t a must be view e d w i t h the l i m i t a t i o n o f the sample s i z e t a k e n i n t o c o n s i d e r a t i o n . The P:9R p r o - gram was not u t i l i z e d f o r the 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 . D i f f i c u l t y was found w i t h t he s e l e c t i o n of v a r i a b l e s w h i c h c o u l d be e e n t e r e d i n t o the program. S t e p w i s e m u l t i p l e c o r r e l a t i o n a n a l y s i s was p e r f o r m e d and o n l y t h e s e r e s u l t s were r e p o r t e d ( T a b l e 5 ) . C o r r e l a t i o n a n a l y s i s s u g g e s t e d p h y s i o l o g i c a l r e l a t i o n s h i p s , i . e . , l i n e a r r e l a t i o n s h i p s between p h y s i o l o g i c a l p a r a m e t e r s , o b s e r v e d i n a b l e b o d i e d as w e l l as p a r a p l e g i c s u b j e c t s , may e x i s t w i t h i n t h e q u a d r a p l e g i c 48 sample. S i g n i f i c a n t c o r r e l a t i o n c o e f f i c i e n t s between HR and RQ, HR and V02ml, Vent and V02L, Vent and VC02L, were found ( s i g n i f i c a n t at .05 l e v e l ) . MBC was of p a r t i c u l a r i n t e r e s t i n t h i s group. S i n c e the r e s p i r a t o r y m u s c l e s of the abdomen and t h o r a c i c cage are i n n e r v a t e d by n e r v e s e x i t i n g from t h e s p i n a l c o r d , l o s s of or r educed c a p a c i t y t o v e n t i l a t e the l u n g s ( a s ' . r e f l e c t e d i n MBC), may r e f l e c t l o s s of nervous s u p p l y t o the h e a r t . I n a d d i t i o n , o t h e r f u n c t i o n a l c a p a c i t i e s may a l s o be r e f l e c t e d i n t h i s measure. The r e s u l t s suggest s i g n i f i c a n t r e l a t i o n s h i p s between MBC and RQ, MBC and HR, MBC and VC02L. A l t h o u g h t h e s e r e s u l t s must be viewed w i t h the l i m i t a t i o n s s p e c i f i e d , t h e y do p o i n t t o some v e r y i n t e r e s t i n g d i f f e r - ences i n the r e l a t i o n s h i p s between MBC and c e r t a i n p h y s i o l o g i c a l measures not r e p o r t e d f o r normals nor p a r a p l e g i c s . For the q u a d r a p l e g i c s , the m u l t i p l e r e g r e s s i o n e q u a t i o n d e v e l o p e d f o r the f o u r t h minute of the p r o g r e s s i v e work p r o t o c o l ( T a b l e 8) p r o duced 2 an a d j u s t e d R of .9992, w i t h a s t a n d a r d e r r o r of e s t i m a t e of .0058 l / m i n . The v a r i a b l e s c o n t r i b u t i n g t o the e q u a t i o n were: Ve n t , V02ml, and WL. 2 A l t h o u g h the a d j u s t e d R i s f o r m u l a t e d t o t a k e i n t o account b o t h sample s i z e and the number of v a r i a b l e s used i n the p r e d i c t i o n , i t i s f e l t t h a t the v a l u e i s i n f l a t e d . 4 9 Table 8. Summary of Univariate S t a t i s t i c s for the 4th Minute of Exercise (Quadraplegics) Variable Mean Standard Deviation MBC 130.4 16.1 WL 206.6 17.6 HR 105.0 18.4 V02L 0.606 0.057 V02ml 9.35 1.30 VC 02L 0.531 0.081 VC02ml 8.25 1.41 RQ 0.886 0.087 Vent 20.1 5.17 CHAPTER V SUMMARY AND CONCLUSIONS Summary The purposes of t h i s i n v e s t i g a t i o n were, f i r s t l y , t o determine which of c e r t a i n s t r u c t u r a l and f u n c t i o n a l c h a r a c t e r i s t i c s of q u a d r a p l e g i c s and p a r a p l e g i c s were s i g n i f i c a n t l y r e l a t e d to MV02L. Secondly, to u t i l i z e 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 t o determine and combine the be s t f i v e p r e d i c - t o r s i n t o a m u l t i p l e r e g r e s s i o n e q u a t i o n f o r the p r e d i c t i o n of MV02L. P r e l i m i n a r y i n v e s t i g a t i o n i n d i c a t e d t h a t the two subgroups, quadra- p l e g i c s and p a r a p l e g i c s c o u l d not be equated on e i t h e r submaximal workloads or the p h y s i o l o g i c a l responses to t h e s e . The group of 18 p h y s i c a l l y d i s a b l e d s u b j e c t s were d i v i d e d i n t o two sub-groups f o r a n a l y s i s . A n a l y s i s of t h r e e work i n t e n s i t i e s was c a r r i e d out on the p a r a p l e g i c d a t a . These c o r r e s p o n d e d t o : 70%, 757», and 807, of the mean maximum h e a r t r a t e f o r the group. I n c r e a s i n g numbers of v a r i a b l e s were found to be s i g - n i f i c a n t l y r e l a t e d to MV02L, w i t h i n c r e a s e d work i n t e n s i t i e s . 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 supported these f i n d i n g s . The two h i g h e r work i n t e n - s i t i e s produced more a c c u r a t e p r e d i c t i o n e q u a t i o n s than the lowest i n t e n s i t y . The a d j u s t e d p r e s s a b s o l u t e mean e r r o r , i l l u s t r a t e d t h a t the e r r o r f o r sub- j e c t s o u t s i d e the e x p e r i m e n t a l group w i l l average 227o, w i t h the LHR e q u a t i o n . T h i s e r r o r was reduced to 13.2% and 11.8% f o r HHR and MHR, r e s p e c t i v e l y . The a n a l y s i s of the q u a d r a p l e g i c data was r e s t r i c t e d to the 50 51 p h y s i o l o g i c a l r e s p o n s e s t o the WL a t t h e f o u r t h minute o f the p r o g r e s s i v e c o n t i n u o u s w o r k l o a d p r o t o c o l . Due t o the s m a l l sample s i z e , i n t e r p r e t a t i o n s and c o n c l u s i o n s are not j u s t i f i e d . However, some i n t e r e s t i n g r e l a t i o n s h i p s were r e p o r t e d . C o n c l u s i o n s 1. 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 appeared t o be a s u i t a b l e method of d e v e l o p - i n g a c c u r a t e p r e d i c t i o n e q u a t i o n s f o r MV02L, i n p a r a p l e g i c s u b j e c t s . 2. A c c u r a c y i n p r e d i c t i o n of maximum oxygen uptake i n the p a r a p l e g i c popu- l a t i o n , i s i n c r e a s e d w i t h the i n c r e a s e i n p h y s i o l o g i c a l s t r e s s (as r e - f l e c t e d i n % of maximum h e a r t r a t e ) the s u b j e c t i s s u b j e c t e d t o . 3. Due t o the l i m i t e d sample s i z e , no c o n c l u s i o n s were made r e g a r d i n g p r e - d i c t i o n of MV02L w i t h i n the q u a d r a p l e g i c p o p u l a t i o n . Recommendations f o r F u r t h e r R e s e a r c h The a r e a o f p r e d i c t i o n of maximum oxygen uptake w i t h the p h y s i c a l l y d i s a b l e d p o p u l a t i o n i s v i r t u a l l y u n e x p l o r e d . The p r e s e n t s t u d y i s the f i r s t of i t s k i n d . Thus the a r e a i s wide open. Some s p e c i f i c r e s e a r c h i s s u g g e s t e d : 1. D e t e r m i n a t i o n of a ' v a l i d method of e s t i m a t i n g f a t f r e e w e i g h t , i s r e q u i r e d . Many of the s u b j e c t s were o v e r w e i g h t c a u s i n g problems w i t h the i n t e r p r e - t a t i o n of MV02ml and the c o r r e l a t i o n c o e f f i c i e n t s i n v o l v i n g body w e i g h t s . 2. I t i s recommended t h a t the p r o t o c o l f o r w o r k l o a d a d j u s t m e n t be m o d i f i e d to i n c r e a s e the d u r a t i o n t o 2 mi n u t e s a t each w o r k l o a d . 3. V a l i d a t i o n o f the p r e d i c t i o n e q u a t i o n s d e v e l o p e d f o r the p a r a p l e g i c s i s n e c e s s a r y . 4. The r e s u l t s of the a n a l y s i s o f the q u a d r a p l e g i c d a t a has i n d i c a t e d p r o m i s - i n g r e s u l t s . T h i s s t u d y s h o u l d be c o n t i n u e d w i t h g r e a t e r numbers of 52 q u a d r a p l e g i c s , so t h a t c o n c l u s i o n s a r e p o s s i b l e . 5. D i f f e r e n c e s , i f any s h o u l d be d e t e r m i n e d f o r the p r e d i c t i o n of maximum oxygen uptake w i t h i n d i v i d u a l s who v a r y i n the ty p e of d i s a b i l i t y , i . e . , p o l i o , bone d i s e a s e s , amputees, e t c . 6. The above s h o u l d be c o n d u c t e d f o r p h y s i c a l l y d i s a b l e d f e m a l e s . 53 REFERENCES A s t r a n d , P. 0. E x p e r i m e n t a l s t u d i e s of p h y s i c a l work c a p a c i t y i n r e l a t i o n t o sex and age. 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W o l f , E., & Magora, A. O r t h o s t a t i c and e r g o m e t r i c e v a l u a t i o n of c o r d - i n j u r e d p a t i e n t s . Scand. J . Rehab. Med., 1976, 8, 93-96. Wyndham, C. M., Stydom, N. B., M a r i t z , J . S., M o r r i e s , J . P., P e t e r , J . , & P o t g i e t e r , Z. U. Maximum oxygen i n t a k e and maximum h e a r t r a t e d u r i n g s t r e n u o u s work. J . A p p l . P h y s i o l . , 1959, 14, 927-936. Z w i r e n , L. D., & B a r - o r , 0. Responses t o e x e r c i s e o f p a r a p l e g i c s who d i f f e r i n c o n d i t i o n i n g l e v e l . Med. S c i . S p o r t , 1975, _7, 94-98. 58 APPENDIX A The Wheelchair Ergometer 59 W h e e l c h a i r Ergometer The ergometer was d e s i g n e d so t h a t each s u b j e c t c o u l d u t i l i z e h i s own w h e e l c h a i r . I t c o n s i s t e d o f t h r e e s t e e l r o l l e r s 3 i n c h e s i n d i a m e t e r and 30 i n c h e s i n l e n g t h . The c e n t e r r o l l e r was f i x e d i n p o s i t i o n w h i l e the o u t e r two were suspended by s p r i n g s . The two o u t e r r o l l e r s s e r v e d the purpose of a c c e p t i n g much of the w e i g h t o f the s u b j e c t and c h a i r and to s t a b i l i z e the c h a i r a g a i n s t f o r w a r d and backwards r o c k i n g d u r i n g the s t r o k i n g . The l o a d i n g system of a Monarch b i k e was adapted and u t i l i z e d t o a p p l y r e s i s t a n c e t o the m i d d l e r o l l e r . The f r i c t i o n s t r a p w h i c h n o r m a l l y was p l a c e d around the f l y w h e e l o f the b i k e was p l a c e d around the c e n t e r r o l l e r of the w h e e l c h a i r ergometer. R e s i s t a n c e was a d j u s t e d and r e a d from t h e pendulum i n d i c a t o r as i t would be w i t h the normal b i k e ergometer. However, i n t e r n a l r e s i s t a n c e had t o be t a k e n i n t o a c c o u n t . I n t e r n a l r e s i s t a n c e i s t h a t w i t h i n the r o l l e r system and the i n d e n - t a t i o n of the pneumatic t i r e c aused by the r o l l e r s . T h i s v a l u e i s v a r i e d on b o t h t i r e p r e s s u r e and w e i g h t of the s u b j e c t . T h i s r e s i s t a n c e was mea- s u r e d a t a c o n s t a n t t i r e p r e s s u r e of 50 pounds per square i n c h . The f o r c e r e q u i r e d t o cause movement of the w h e e l c h a i r wheels was d e t e r m i n e d f o r a v a r i e t y of w e i g h t s p l a c e d i n t h e w h e e l c h a i r . I n c r e a s i n g w e i g h t was hung v e r t i c a l l y a t a r i g h t a n g l e from the o u t e r p e r i m e t e r of one wheel u n t i l movement was i n i t i a t e d . I n t e r n a l r e s i s t a n c e was p l o t t e d a g a i n s t w e i g h t i n the w h e e l c h a i r . T h i s produced a c u r v i l i n e a r l i n e . F o r each s u b j e c t i n t e r n a l r e s i s t a n c e was r e a d from the gr a p h . E x e r c i s e r e s i s t a n c e s were a c h i e v e d by a d d i n g the n e c e s s a r y r e s i s t a n c e v i a the l o a d a d j u s t e r , t o the i n t e r n a l r e s i s t a n c e . D u r i n g e x e r c i s e t h e w h e e l c h a i r had t o be f u r t h e r s e c u r e d w i t h s m a l l gauge c h a i n s t o p r e v e n t r o c k i n g as the s u b j e c t s s t r o k e d a t h i g h e r w o r k l o a d s . The c h a i n s were s e c u r e d around the f r o n t c a s t e r s o f the w h e e l c h a i r and f a s t e n e d t o the wooden frame of the ergometer. -3- CM o 0"\ CN CN CO VO CM 00 OJ CM CM CM CM TH «H   63 APPENDIX B I n d i v i d u a l C a r d i o r e s p i r a t o r y Responses t o the Workload P r o t o c o l 64 Sub Wt MBC AG WL HR V02L V02ml VC02L VC02ml RQ Vent L MV02 L 01 79.3 168 38 110 189 208 231 228 280 352 *368 *409 *423 : 564 568 511 02 78.0 180 38 106 157 158 215 *269 *360 *420 595 579 600 03 95.5 250 53 138 117 106 226 089 0.491 06. 19 0.186 092 0. 724 09. 12 0.406 090 0. 638 08. 03 0.399 096 0. 788 09. 93 0.510 098 0. 757 09. 54 0.534 102 0. 826 10. 40 0.628 110 0. 961 12. 10 0.751 122 1. 135 14. 30 0.969 130 " 1. 278 16. 10 1.143 145 1. 532 19. 30 1.461 165 1. 858 23. 40 2.088 175 1. 898 23. 90 2.390 185 1. 842 23. 20 2.342 088 0. 440 05. 64 0.250 092 0. 499 06. 40 0.300 095 0. 548 07. 03 0.356 106 0. 693 08. 89 0.497 118 0. 771 09. 89 0.555 132 0. 970 12. 44 0.797 142 1. 009 12. 94 0.906 159 1. 225 15. 70 1.169 175 1. 440 18. 46 1.580 185 1. 774 22. 75 2.338 084 1. 030 10. 79 0.858 090 0. 945 09. 90 0.783 096 0.864 09. 05 0.640 105 1. 024 10. 72 0.784 03. 60 0.58 O i l . 10 1.912 05. 12 0.56 014. 70 05. 03 0.63 012. 80 06. 43 0.65 015. 70 06. 72 0.71 014. 90 07. 91 0.77 016. 90 09. 46 0.78 019. 40 12. 20 0.86 025. 25 14. 40 0.90 019. 00 18. 40 0.96 038. 00 26. 30 1.13 080. 00 30. 10 1.28 076. 00 29. 65 1.29 085. 00 03.20 0.57 010.40 1. 774 03.84 0.60 011.14 04.56 0.65 012.80 06.37 0.72 016.70 07.12 0.72 017.60 10.22 0.82 023.33 11.62 0.90 025.38 14.99 0.96 032.94 20.26 1.10 046.48 29.97 1.32 084.24 08.98 0.82 024.90 2. 158 08.20 0.76 023.80 06.70 0.75 021.60 08.21 0.76 024.90 ^ I n d i c a t e s l i n e s of d a t a s e l e c t e d f o r r e g r e s s i o n a n a l y s i s 65 Sub Wt MBC AG WL HR V02L V02ml VC02L VC02ml RQ Vent L MV02 L 04 87.5 129 38 05 56.0 186 18 188 100 1. 290 13. 51 0.987 10.34 0.77 029. 71 275 125 1. 226 12. 84 1.012 10.60 0.82 029. 80 *318 125 1. 220 12. 78 1.003 10.50 0.82 028. 20 *340 130 1. 369 14.34 1.203 12.60 0.84 032. 15 *445 135 1. 662 17. 40 1.413 14.80 0.86 041. 50 511 140 1. 583 16. 60 1.375 14.40 0.86 042. 40 530 150 1. 891 19; 80 1.671 17.50 0.88 050. 40 500 160 2. 063 21. 60 1.900 19.90 0.92 056. 90 368 165 2. 158 22. 60 1.995 •20.90 0.92 061. 30 127 101 0. 630 07. 20 0.595 06.80 0.94 023. 60 127 102 0. 800 09. 14 0.744 08.50 0.90 026. 60 148 102 0. 656 07. 50 0.595 06.80 0.90 024.00 191 106 0.621 07. 10 0.586 06.70 0.94 021. 80 233 121 0. 770 08. 80 0.674 07.70 0.86 023. 80 292 130 1. 085 12. 40 1.083 12.38 1.01 037. 74 275 142 1. 251 14.30 1.444 16.50 1.16 046. 80 398 142 1. 108 12. 67 1.278 14.60 1.16 039. 70 072 111 0. 558 09. 97 0.402 07.19 0.72 012.90 105 116 0.611 10. 91 0.470 08.40 0.77 014. 90 148 125 0. 683 12. 20 0.538 09.60 0.78 016. 40 191 135 0.796 14. 22 0.633 11.30 0.80 019. 00 233 139 0. 900 16. 07 0.706 12.60 0.78 020. 03 292 143 0. 963 17. 20 0.773 13.80 0.80 022. 50 *350 145 1. 114 19. 90 0.907 16.20 0.82 024.80 *413 153 1. 170 20. 90 1.002 17.90 0.86 027. 00 *477 162 1. 428 25. 50 1.254 22.40 0.88 033. 40 556' 172 1. 579 28. 20 1.602 28.60 1.01 040. 70 636 181 1. 725 30. 80 1.860 33.21 1.08 048. 00 715 192 2. 005 35. 80 2.261 40.37 1.13 060. 00 795 192 2. 110 37. 69 2.486 44.40 1.18 068. 20 874 202 2. 285 40. 80 2.620 46.80 1.15 074.30 66 Sub Wt MBC AG WL HR V02L V02ml VC02L VC02ml RQ Vent L MV02 L 06 54.0 138 22 07 70.6 125 29 086 082 0. 442 08.18 0.380 07.04 0.86 010.10 0.792 081 087 0. 511 09.46 0.441 08.16 0.85 012.00 144 094 0. 513 09.50 0.454 08.40 0.89 012.80 233 099 0. 520 09.63 0.455 08.43 0.88 013.30 289 099 0. 759 14.05 0.657 12.16 0.88 018.00 326 104 0. 792 14.67 0.772 14.30 0.97 021.70 268 105 0. 750 13.90 0.801 14.84 1.11 034.40 091 090 0. 395 05.60 0.282 04.00 0.70 008.76 1.673 115 086 0. 504 07.14 0.266 05.18 0.72 O i l . 1 2 152 097 0. 443 06.27 0.336 04.76 0.76 010.10 209 098 0.518 07.34 0.394 05.58 0.76 011.40 262 109 0. 591 08.37 0.459 06.50 0.78 013.80 284 115 0. 788 11.17 0.641 09.08 0.82 016.60 366 130 0. 870 12.33 0.768 10.88 0.89 020.40 443 132 1. O i l 14.23 1.005 14.23 1.00 026.10 504 161 1. 334 18.89 1.461 20. 70 1.09 039.60 598 175 1. 358 19.23 1.627 23.40 1.20 047.80 602 180 1. 553 22.14 1.920 27.20 1.22 063.40 738 181 1. 673 23.70 2.066 29.26 1.24 068.70 08 61.7 106 25 080 120 0.750 12.15 0.648 10.50 0.86 024.00 1.185 099 130 0.580 09.40 0.600 09.72 1.03 023.90 211 134 0.586 09.50 0.584 09.46 0.99 024.80 204 135 0.654 10.60 0.645 10.45 0.99 027.30 225 136 0.827 13.40 0.823 13.34 0.99 032.60 239 140 0.833 13.50 0.913 14.80 1.09 037.10 286 140 1.012 16.40 1.174 19.03 1.16 048.70 264 139 1.185 19.20 1.252 20.30 1.25 048.30 67 Sub Wt MBC AG WL HR V02L V02ml VC02L VC02ml RQ Vent L MVO2 L 09 69.0 206 31 10 70.0 243 26 154 095 0.545 06.90 0.321 04.06 0.60 011.30 2.280 175 101 0.664 08.40 0.389 04.92 0.68 012.40 218 101 0.742 09.39 0.465 05.89 0.62 014.80 267 111 0.890 11.26 0.590 07.47 0.66 017.90 353 118 0.059 13.40 0.717 09.08 0.68 021.40 438 131 1.270 16.07 0.940 11.90 0.74 027.80 *459 133 1.480 18.70 1.160 14.70 0.79 032.22 •-536 140 1.550 19.60 1.340 16.93 0.86 037.20 *592 146 1.720 21.80 1.580 20.00 0.92 044.90 727 160 1.710 21.60 1.596 20.20 0.94 045.60 636 167 1.960 24.80 1.830 23.20 0.94 055.60 693 176 2.280 28.80 2.430 30.78 1.08 077.50 149 085 0.728 10.40 0. 495 07.04 0.68 012.60 2.849 254 101 0.927 13.24 0. 666 09.52 0.72 018.10 300 101 0.987 14.10 0. 802 11.46 0.82 020.20 387 107 1.078 15.40 0. 854 12.20 0.80 021.10 417 113 1.211 17.30 1. 029 14.70 0.84 025.00 427 117 1.246 17.80 1. 106 15.80 0.89 026.80 481 121 1.435 20.50 1. 274 18.20 0.89 030.20 *527 135 1.582 22.60 1. 484 21.20 0.94 034.60 *573 154 1.834 26.20 1. 834 26.20 1.00 041.60 -670 165 2.219 31.70 2. 380 34.00 1.08 053.50 680 170 2.303 32.90 2. 555 36.50 1.11 058.50 793 180 2.583 36.90 3. 045 43.50 1.18 073.80 772 185 2.849 40.70 3. 346 47.80 1.18 083.10 68 Sub Wt MBC AG WL HR V02L V02ml VC02L VC02ml RQ Vent L MV02 L 11 91.8 106 48 136 088 0.863 09.40 0. 780 08. 50 0.90 021. 40 1.970 150 087 0.964 10.50 0.815 08. 88 0.85 022. 80 138 090 0.861 09.38 0.688 07. 50 0.89 018. 50 203 089 0.863 09.40 0.732 07. 97 0.85 018. 40 280 101 0.909 09.90 0.799 08. 70 0.88 020. 50 *356 111 0.991 10.80 0.909 09. 90 0.92 023. 30 *532 132 1.320 14.40 1.240 13. 50 0.94 031. 10 --404 148 1.560 17.00 1.625 17. 70 1.04 040. 80 400 161 1.970 21.50 2.313 25. 20 1.17 072. 00 12 62.1 198 22 13 65.0 156 52 139 088 0.766 12. 34 0.545 08.78 0.72 014.90 2.640 189 095 0.900 14.50 0.621 10.00 0.69 016.70 197 095 0.807 13. 00 0.602 09.70 0.75 015.70 226 098 0.851 13. 70 0.658 10.60 0.78 016.80 292 106 1.049 16. 90 0.795 12.80 0.76 017.77 388 116 1.186 19. 10 0.919 14.80 0.78 022.00 392 125 1.292 20. 80 1.059 17.06 0.82 024.90 434 129 1.534 24. 70 1.298 20.90 0.85 029.70 523 132 1.590 25. 60 1.453 23.40 0.92 033.50 *550 149 . 1.652 26. 60 1.528 24.60 0.94 035.00 *654 160 1.906 30. 70 1.913 30.80 1.02 045.00 *718 166 2.322 37. 40 2.496 40.20 1.08 061.10 757 179 2.360 38. 00 2.875 46.30 1.24 081.00 782 180 2.640 42. 50 3.173 51.10 1.22 092.00 089 087 0.748 11. 50 0.500 07.70 0.66 014.90 1.580 156 089 0.693 10. 60 0.533 08.20 0.76 013.90 160 093 0.783 12. 50 0.670 10.30 0.76 019.40 203 094 0.741 11. 40 0.658 10.12 0.89 018.40 290 102 1.060 17. 46 1.060 16.31 0.93 026.00 339 110 1.222 18. 80 1.313 20.20 1.09 034.20 *368 116 1.262 19. 40 1.378 21.20 1.09 036.20 69 Sub Wt MBC AG WL HR V02L V02ml VC02L VC02ml RQ Vent L MV02 L 14 66.9 150 37 15 84.0 150 33 16 64.0 129 21 *348 130 1. 398 21. 50 1.684 25. 90 1.21 045. 90 *409 137 1. 436 22. 10 1.801 27. 70 1.26 055. 50 438 145 1. 580 24. 30 1.944 29. 09 1.23 062. 00 089 068 0. 278 05. 76 , 0.268 04.00 0.70 013. 00 092 073 0. 506 07. 57 0.332 04. 96 0.66 014. 00 164 078 0. 530 07. 92 0.389 05. 82 0.74 016. 40 241 083 0. 656 09. 80 0.476 07. 42 0.76 020. 00 227 085 0. 763 11. 40 0.594 08. 88 0.78 023. 80 262 091 0. 727 10. 87 0.605 09. 05 0.83 025. 60 277 094 0. 777 11. 61 0.726 10. 86 0.94 031. 40 177 095 1. 024 15. 31 1.084 16. 20 1.06 050.80 143 086 0. 659 07. 84 0.512 06. 10 0.79 014. 90 124 083 0. 659 07. 84 0.521 06. 20 0.80 015. 40 175 092 0. 692 08.24 0.554 06. 60 0.81 016. 20 224 094 0. 756 09. 00 0.618 07. 36 0.83 018. 00 267 098 0. 916 10. 90 0.753 08. 96 0.83 021. 00 347 105 0.949 11. 30 0.774 09. 22 0.82 021. 10 377 112 1. 151 13. 70 0.943 11. 22 0.82 025. 00 515 118 1. 235 14.70 1.075 12. 80 0.88 029. 00 561 120 1. 445 17. 20 1.302 15. 50 0.90 035. 00 *582 130 1. 579 18. 80 1.478 .17. 60 0.94 039. 00 -592 133 1. 730 20. 60 1.630 19. 40 0.95 044.50 -704 145 1. 982 23. 60 1.966 23. 40 1.00 057. 00 861 168 2. 453 29. 20 2.755 32. 80 1.14 090. 00 850 180 2. 612 31. 10 3.167 37. 70 1.23 111. 50 085 080 0.387 06. 04 0.336 05. 25 0.87 010. 70 127 084 0. 454 07. 09 0.371 05. 80 0.82 012. 10 148 093 0. 561 08. 76 0.461 07. 20 0.82 014.30 191 102 0.531 08. 30 0.420 06. 56 0.79 013. 50 1.024 70 Sub Wt MBC." AG WL HR V02L V02ml VC02L VC02ml RQ Vent L MV02 L 17 60.0 129 21 18 53.0 134 35 233 118 0.730 11. 40 0.580 09. 07 0.79 017. 40 291 125 0.890 13. 90 0. 705 11. 02 0.79 020. 60 350 130 1.152 18. 00 1. 004 15. 69 0.87 027. 60 413 131 1.197 18. 70 1. 119 17. 42 0.94 031. 10 *477 144 1.264 19. 74 1. 196 18. 69 0.94 031. 90 -557 150 1.330 20. 80 1. 307 20. 42 0.98 035. 30 *636 165 1.754 27. 40 1. 843 28. 80 1.05 051. 00 716 182 1.933 30. 20 2. 500 39. 06 1.30 077. 10 795 202 2.195 34.30 3. 268 51. 06 1.50 124.00 072 075 0.332 05. 54 0. 245 04.08 0.74 020. 21 106 083 0.416 06. 93 0. 322 05. 36 0.88 014. 16 149 091 0.494 08. 23 0. 681 05. 99 0.78 016. 89 191 100 0.580 09. 66 0. 494 08. 24 0.86 017. 64 233 109 0.847 14.12 0. 868 14.47 1.03 027. 50 291 114 0.846 14. 10 0. 973 16. 21 1.16 033. 46 349 110 0.742 12. 36 1. 080 18. 00 1.46 028. 40 087 098 0.143 02. 70 0. 099 01. 87 0.69 005. 80 087 098 0.378 07. 14 0.251 04. 73 0.66 O i l . 60 148 107 0.514 09. 70 0. 343 06. 48 0.67 012. 60 191 113 0.659 12. 43 0. 463 08. 75 0.70 015. 72 *233 118 0.668 12. 61 0. 531 10. 02 0.80 016. 70 *291 131 0.960 18. 11 0.814 15. 36 0.85 025. 22 *350 135 1.090 20.56 1. 00 18. 86 0.92 030.00 413 170 1.510 28. 49 1. 535 28. 97 1.02 045. 50 477 175 1.600 30. 18 1. 866 35. 20 1.16 059. 12 557 180 1.780 33. 58 2. 120 40. 01 1.19 070. 86 636 180 1.716 32. 38 1. 913 35. 90 1.11 068. 20 APPENDIX C C o r r e l a t i o n M a t r i c e s C o r r e l a t i o n M a t r i x : LHR Group 72 1 2 3 4 5 6 7 8 9 Wt MBC AG WL HR V02L V02ml VC02L VC02ml 1 1.000 2 0 . 1 1 5 1.000 3 0 . 6 3 2 - 0 . 0 2 3 1. 000 4 0 . 2 1 8 0 . 4 3 9 - 0 . 220 1.000 5 - 0 . 4 1 1 0 . 4 3 2 - 0 . 683 0 . 5 4 2 6 0 . 1 1 9 0 . 6 2 0 - 0 . 104 0 .926 7 - 0 . 5 1 7 0 . 2 0 5 - 0 . 560 0 .602 8 0 . 0 8 1 0 .456 - 0 . 017 0 . 8 8 9 9 - 0 . 4 5 5 0 . 3 0 1 - 0 . 332 0 . 6 4 0 10 - 0 . 0 6 9 - 0 . 2 0 7 o . 187 0 .372 11 0 . 1 8 7 0 .503 0 . 167 0 . 8 2 5 12 0 . 0 1 3 0 . 5 3 0 - 0 . 513 0 .826 13 - 0 . 6 5 6 0 . 2 8 9 - 0 . 796 0 . 4 0 9 1.000 0.528 1.000 0.740 0.624 1.000 0.405 0.947 0.660 1.000 0.559 0.737 0.864 0.834 1. 000 -0.068 0.370 0.425 0.642 0. 660 0.393 0.914 0.563 0.932 0. 695 0.600 0.784 0.571 0.673 0. 569 0.749 0.445 0.763 0.406 0. 721 10 11 12 13 RQ Vent L MV02L MV02ml 10 1.000 11 0.520 s 1.000 12 0.065 0.535 1.000 13 0.106 0.232 0.713 1.000 73 C o r r e l a t i o n M a t r i x : MHR Group 1 2 3 4 5 6 7 8 9 Wt MBC AG MV02L MV02ml WL HR V02L V02ml 1 1.000 2 0.115 1.000 3 0.632 -0.023 1. 000 4 0.013 0.530 -0. 513 1.000 5 -0.656 0.290 -0. 796 0.713 6 -0.028 0.195 -0. 588 0.784 7 -0.152 0.217 -0.576 0.667 8 0.276 0.375 -0. 102 0.763 9 -0.308 0.314 -0. 471 0.767 10 0.212 0.216 0. 005 0.588 11 -0.249 0.191 -0. 283 0.552 12 -0.017 -0.269 0. 179 -0.051 13 0.169 0.141 0. 055 0.507 1.000 0.526 1.000 0.630 0.713 1.000 0.332 0.801 0.658 1. 000 0.731 0.783 0.784 0. 809 1. 000 0.259 0.706 0.613 0. 950 0. 816 0.565 0.688 0.695 0. 790 0. 957 -0.036 0.279 0.282 0. 469 0. 506 0.211 0.634 0.526 0. 858 0. 730 10 11 12 13 VC02L VC02ml RQ Vent L 10 1.000 11 0.880 1.000 12 0.714 0.728 1.000 13 0.924 0.811 0.700 1.000 74 C o r r e l a t i o n M a t r i x : HHR Group 1 2 3 4 5 6 7 8 9 wt • MBC AG MV02L MV02ml WL HR V02L V02ml 1 1.000 2 0.115 1.000 3 0.632 -0.023 1.000 4 0.013 0.530 -0.513 1.000 5 -0.656 0.289 -0.796 0.713 1.000 6 0.034 0.161 -0.528 0.834 0.537 1.000 7 -0.48,4 0.174 -0.878 0.525 0.716 0.603 1.000 8 0.007 0.481 -0.384 0.873 0.602 0.860 0.558 1.000 9 -0.525 0.316 -0.659 0.718 0.885 0.690 0.750 0.827 1.000 10 -0.118 0.328 -0.347 0.714 0.564 0.809 0.585 0.924 0.854 11 -0.506 0.219 -0.540 0.586 0.765 0.656 0.708 0.791 0.962 12 -0.284 -0.915 0.001 -0.066 0.100 0.244 0.286 0.315 0.423 13 -0.083 0.490 -0.244 0.651 0.497 0.539 0.460 0.694 0.609 10 11 12 13 VC02L VC02ml RQ Vent L 10 1.000 11 0.902 1.000 12 0.610 0.649 1.000 13 0.743 0.647 0.441 1.000 75 C o r r e l a t i o n M a t r i x : Q u a d r a p l e g i c Group Wt MBC AG WL HR V02L V02ml VC02L VC02ml 1 1.000 2 0.012 1.000 3 0.823 0.375 1.000 4 -0.596 0.398 -0.224 1.000 5 -0.025 -0.978 -0.310 -0.247 1.000 6 0.458 -0.225 0.610 -0.459 0.261 1.000 7 -0.860 -0.197 -0.596 0.404 0.236 0.055 1.000 8 0.427 -0.854 0.160 -0.524 0.873 0.596 -0.091 1.000 9 -0.629 -0.729 -0.656 0.173 0.768 0.079 0.792 0.433 1.000 10 0.185 -0.906 -0.239 -0.293 0.912 0.035 -0.126 0.822 0.506 11 0.384 -0.648 0.338 -0.500 0.682 0.881 0.100 0.892 0.397 12 0.775 -0.443 0.665 -0.515 0.493 0.774 -0.402 0.843 -0.033 13 -0.218 -0.711 -0.417 0.049 0.807 0.534 0.590 0.705 0.843 10 11 12 13 RQ Vent L MV02L MV02ml 10 1.000 11 0.489 1.000 12 0.499 0.852 1.000 13 0.524 0.768 0.448 1.000

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