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RATIONALE Heart rate (HR) and oxygen consumption (VO(2)) are indicators of the intensity of exercise. Handrail support has been shown, during maximal treadmill testing, to blunt HR and VO(2) responses at a particular speed and grade, resulting in an increased treadmill time and overprediction in aerobic capacity. OBJECTIVES This study was designed to determine if handrail support would similarly blunt HR and VO(2) responses during steady-state treadmill exercise at intensities typical of exercise training. METHODS Healthy volunteers (age, 38-60 years; N = 10) performed maximal treadmill exercise to define VO2max (35.4 +/- 6.5 mL kg(-1) min(-1)) and ventilatory threshold (26.4 +/- 5.8 mL kg(-1) min(-1)). They also performed 3 random steady-state exercise bouts including free arm swing, handrail support-resting, and handrail support-gripping (HRS-G). Each test consisted of three 5-minute stages with intensity levels corresponding to 75%, 85%, and 95% of the speed and grade at ventilatory threshold. RESULTS There were significant (P < .05) differences in HR and VO2 at the 75%, 85%, and 95% ventilatory thresholds in HRS-G (108, 114, and 121 beats min and 17.2, 18.0, and 20.6 mL kg min, respectively) versus handrail support-resting (114, 126, and 137 beats min and 19.5, 21.8, and 23.9 mL kg min, respectively) and HRS-G versus free arm swing (120, 130, and 142 beats min and 20.3, 22.8, and 26.1 mL kg min, respectively). Rating of perceived exertion was significantly (P < .05) different between HRS-G (1.8, 2.4, and 3.1) and free arm swing (2.2, 2.9, and 3.6) at all intensities and between HRS-G (2.4 and 3.1, respectively) and handrail support-resting (3 and 3.7, respectively) at the 85% and 95% ventilatory thresholds. CONCLUSION Gripping and, to a lesser degree, resting the hands on the handrails during steady-state treadmill walking will blunt responses during exercise training and may result in less predictable exercise program.

Purpose Resistance training has become an accepted part of cardiac rehabilitation programs. Because of the potential for a high afterload to have a negative impact on left ventricular function, there has been concern regarding the safety of resistance training for patients with congestive heart failure. Methods This study addressed this concern by studying 12 healthy volunteers, 12 patients with stable coronary artery disease, and 12 patients with stable congestive heart failure during upright cycling at 90% of ventilatory threshold, and during one set of 10 repeated leg presses, shoulder presses, and biceps curls at 60% to 70% of 1-repetition maximum. Left ventricular function was measured by echocardiography. Results The pattern of changes in heart rate, blood pressure, left ventricular ejection fraction, wall thickness, and left ventricular internal diameters was similar across all three groups of subjects, although there were large differences in absolute values. Despite elevations in diastolic and mean arterial pressures during resistance exercise, there was no evidence of significant rest-to-exercise deterioration in left ventricular function during leg press (ejection fraction, 60%-59%, 56%-55%, and 38%-37%), shoulder press (66%-65%, 59%-53%, and 38%-35%), or biceps curls (63%-58%, 53%-54%, and 35%-36%), as compared with cycle ergometry (63%-69%, 51%-57%, and 35%-42%) in the healthy control subjects, the patients with coronary artery disease, and the patients with congestive heart failure, respectively. Conclusions Left ventricular function remains stable during moderate-intensity resistance exercise, even in patients with congestive heart failure, suggesting that this form of exercise therapy can be used safely in rehabilitation programs.

Purpose This study was designed to determine which of several body composition assessment methods was most accurate for patients with cardiac disease for the purpose of outcome measurement. Methods Six body composition assessment methods were administered to each of 24 men with cardiac disease. Methods included circumference measurement, skinfold measurement, near-infrared interactance via the Futrex-5000, bioelectrical impedance via the BioAnalogics ElectroLipoGraph and Tanita TBF-150, and hydrostatic weighing, the criterion measure. Results A repeated measures analysis of variance indicated no significant (P > .05) difference between circumference and skinfold measurements compared to hydrostatic weighing. Near-infrared interactance presented the best standard error of estimates (3.5%) and the best correlation (r = .84) with hydrostatic weighing; however, the constant error was 3.76%. Bioelectrical impedance measured by the ElectroLipoGraph and TBF-150 instruments significantly underestimated percent body fat by 8.81% and 4.8%, respectively. Conclusions In this study of middle-aged to older men with cardiac disease, the best method for determining body fat was circumferences. This technique was accurate, easy to administer, inexpensive, and had a lower error potential than the other techniques. Skinfold measurements were also closely related to hydrostatic weighing, but should be performed only by experienced practitioners because there is a greater potential for tester error in certain patients. In the future, near-infrared interactance measurements may be a viable technique for body composition assessment in patients with cardiac disease. However, algorithms specific to the population of patients with cardiac disease being tested must be developed before this technique can be routinely recommended for body composition assessment. Bioelectrical impedance assessment by either method is not recommended for patients with cardiac disease, as it consistently underestimated percent body fat when compared to hydrostatic weighing in this population.

PURPOSE: This study was designed to assess the safety and effectiveness of walking when using 1-lb walking poles in Phase III/IV cardiac rehabilitation patients. METHODS: Following instruction on the proper use of the poles and adequate time to practice, each subject completed two 8-minute walking trials on a level treadmill either with or without walking poles. Each trial was conducted at an identical speed for each subject in a randomized order. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and ratings of perceived exertion (RPE) were recorded every 2 minutes during each trial, while ECG responses (ST segment changes and dysrhythmias) were monitored continuously. RESULTS: Walking with poles significantly (P < .05) increased the energy cost of walking by 21% (3.8 mL/kg/min) compared to walking without poles. There were also significant (P < .05) increases in HR (14 bpm), SBP (16 mm Hg), and DBP (4 mm Hg) when comparing conditions. Calculated oxygen pulse (mL O2.heart beat) values indicated that changes in HR were consistent with the increase in VO2 and were not related to a pressor response mechanism. The only dysrhythmias noted were isolated PVCs, with no differences in the frequency of occurrence between trials. There were no adverse ST segment changes with either trial. CONCLUSIONS: These data demonstrate that at a given speed, the use of 1-lb walking poles can safely increase the intensity of walking exercise in Phase III/IV cardiac rehabilitation patients.

From a student's perspective, completing an internship program is the final, and maybe the most important step in his or her academic career. He or she finally gets a chance to put theory into practice and to see if he or she truly enjoys his or her chosen field. Through hard work and dedication, the efforts should provide her/himself with the practical skills and experiences necessary to propel her/himself into the work force. For the program, having interns can be viewed as just having an "extra hand," but with the proper commitment it can be much more rewarding. It is a unique opportunity to get a fresh new perspective on your own program, and a chance to mold students into eager young professionals. The internship experience truly is a "Win-Win" situation. Through the efforts of combined education--the internship site and the cardiopulmonary rehabilitation program working together--they can ensure that tomorrow's practitioners will be of the highest quality.

This study compared the responses of walking with 2.5-lb ankle weights (AW) and wrist weights (WW) to no additional weight (WN) in 16 patients in a Phase III and IV cardiac rehabilitation program (mean patient age, 59.3 years of age). After a practice session, each subject completed 8-minute trials