2 P H Y S / O T H E R A P Y EXERCISE PHYSIOLOGY AT A GLANCE SEPTEMBER, 1975 by A. J. van Rensburg M .S.C . IN T R O D U C T IO N E x e r c is e is f u n d a m e n t a l t o a h e a l t h y e x is te n c e : C a r l s te n a n d G r i m b y 2 h a v e b e e n c o n c e r n e d w ith th is a s p e c t o f e x e r c is e p h y s io lo g y a n d th e y s t a te t h a t : “ R e g u la r e x e r c is e a s le i s u r e a c t i v i t y is n e e d e d b y e v e r y in d iv id u a l. 'T h i s s t a t e m e n t a p p l i e s a ls o t o t h e m a j o r it y o f sic k p e o p l e . E x e r c is e p r o ­ g r a m m e s m u s t b e r e n d e r e d a t t r a c t i v e s o a s to m o t i v a t e i n d i v i d u a l s ' a n d g r o u p s . E v e r y p h y s i­ c ia n s h o u ld f e e l a r e s p o n s i b i li t y t o w a r d s th e e s t a b l i s h m e n t a n d m a i n t e n a n c e o f a n a p p r o p r i a t e p h y s ic a l w o r k i n g c a p a c it y o f h is p a t i e n t s . ” A n d , t h e v e r y l a s t s e n te n c e in t h e i r b o o k r e a d s a s f o llo w s : “ T h e t h e r a p e u t i c s c o p e o f e x e r c is e in t h e m e d ic a l r e h a b i l i t a t i o n o f th e s e p a t i e n t s is v e r y g r e a t i n d e e d . ” A s s u m in g t h a t th is c o n c l u d i n g s t a t e m e n t is c o r r e c t , t h e n i t f o llo w s t h a t a k n o w le d g e o f e x e r c is e p h y s io lo g y s h o u l d e x te n d th e s c o p e , a n d i n c r e a s e t h e e ffe c tiv e n e s s o f t h e r a p e u t i c e x e r c is e . T h e p u r p o s e o f th is a r t i c l e is t h e r e ­ f o r e t o p r e s e n t s o m e o f t h e b a s ic , a n d w e ll e s ta b lis h e d c o n c e p t s o f e x e rc is e p h y s io lo g y . T h e firs t o f t h e s e is t h e c o n c e p t o f a n i n d i v i d u a l ’s p h y s i c a l w o r k c a p a c ity . M A X I M U M O X Y G E N C A P A C IT Y (m ax. cap.) I t is w e ll k n o w n t h a t t h e h a r d e r a p e r s o n e x e r c is e s t h e m o r e o x y g e n h e c o n s u m e s . T h is i n c r e a s e i n o x y g e n c o n s u m p t i o n w ith e x e r c is e l o a d d o e s n o t c o n t i n u e i n ­ d e f in ite ly , a s , a p o i n t is r e a c h e d w h e n t h e o x y g e n c o n - Fl(a. 1 s u m p t i o n d o e s n o t in c r e a s e w ith f u r t h e r in c r e a s e s in e x e r c is e lo a d . T h is le v e l o f o x y g e n c o n s u m p ti o n is k n o w n a s t h e i n d i v i d u a l ’s m a x i m u m o x y g e n c o n s u m p ti o n , o r his m a x im u m a e r o b i c c a p a c it y . T h e c o n c e p t is d e sc rib e d g r a p h i c a l l y in F ig . 1. M a x C a p . is t h e r e f o r e t h e m a x im u m a m o u n t o f o x y g e n a n i n d i v i d u a l c a n u t i l i z e p e r m i n u t e A n a n a l o g o u s r e l a t i o n s h i p e x is ts b e tw e e n e x e r c is e lo a d a n d h e a r t r a t e . T h is l a t t e r r e l a t i o n s h i p f o r m s t h e b a s i‘ o f v a r i o u s te s ts w h ic h m a y b e u s e d t o in d i r e c t ly d eterm in jf a n i n d i v i d u a l ’s m a x i m u m o x y g e n c o n s u m p ti o n . T h ft c a p a c it y la r g e ly d e t e r m i n e s t h e p h y s ic a l w o r k in g c a p a c itv o f a n in d iv id u a l. D E T E R M I N A T I O N O F M A X I M U M O X Y G E N CO N ­ S U M P T IO N F o r a n a c c u r a t e d e t e r m i n a t i o n o f m a x i m u m o x y g e n c o n s u m p ti o n , it is b e s t t o u s e a d i r e c t m e t h o d . H o w ­ e v e r , th is m a y n o t a lw a y s b e p o s s ib le a s a w e ll e q u ip p e d l a b o r a t o r y is e s s e n tia l. A d i s a d v a n t a g e o f t h e d ire c t m e t h o d s is t h a t th e y a r e n o t s u ite d t o t e s ti n g la r g e n u m ­ b e r s o f p e o p le in a s h o r t tim e . F u r t h e r m o r e , i t is n o t p o s s ib le t o u s e th e s e m e t h o d s o n i n c a p a c i t a t e d in d iv id u a ls . B rie fly , t h e d i r e c t m e t h o d s r e q u i r e a n i n d i v i d u a l to e x e r c is e a t p r o g re s s iv e ly h i g h e r w o r k r a t e s u n t i l a level is r e a c h e d a t w h ic h : ( a ) a f u r t h e r in c r e a s e in t h e r a t e o f w o r k d o e s n o t p r o d u c e a s ig n if ic a n t in c r e a s e in t h e r a t e of o x y g e n c o n s u m p ti o n , (b ) t h e tim e f o r o n s e t o f a c u t e f a t i g u e is s h o r t, a n d (c) t h e c o n c e n t r a t i o n o f la c tic a c id in t h e b l o q r is e s s h a r p l y . ' T h e e x e r c is e is u s u a l ly p e r f o r m e d o n a tr e a d m i ll or b ic y c le e r g o n o m e t e r . T h e s e m e t h o d s h a v e b e e n d e s c rib e d in d e ta il b y W y n d h a m e t a l . 10 T h e d i r e c t m e t h o d s a r e le ss a c c u r a t e b u t m o r e v e r s a tile a n d c o n v e n i e n t . T h e i n d i r e c t m e t h o d s m a y b e c la ssifie d a c c o r d i n g to t h e p h y s io lo g ic a l p a r a m e t e r s u p o n w h ich th e y a r e b a s e d . T h e s e a r e lis te d b e lo w : (a) h e a r t r a t e ( m a x im u m ) (b ) r e s p i r a t o r y q u o t i e n t (in e x c e s s o f 1) (c) r a t e o f r e s p i r a t o r y v e n t i l a t i o n ( d e v i a t i o n f ro m n o r m a l ) , a n d (d ) a r t e r i a l b l o o d a n a ly s is : c h a n g e s in t h e le v e ls o f la c tic a c i d , b l o o d p H , p a r t i a l p r e s s u r e o f o x y g e n a n d p a r t i a l p r e s s u r e o f c a r b o n d io x id e i n th e b l o o d . F o r e x a m p l e , t h e i n d i r e c t t e s t b a s e d o n h e a r t r a t e m a k e s u s e o f t h e c o r r e la ti o n w h i c h e x is ts b e tw e e n a n i n d i v i d u a l ’s m a x i m u m o x y g e n c o n s u m p ti o n a n d t h e h e a r t r a t e w h ic h is m e a s u r e d a f t e r t e n m i n u t e s o f e x e r c is e o f a p a r t i c u l a r in t e n s i t y . F u r t h e r d e t a i l s m a y b e o b t a i n e d f r o m p a p e r s b y W y n d h a m 8. 9 a n d b y M a r i t z e t a l .4 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) P H Y S I O L O G I C A L R E S P O N S E (S T R A IN ) TO E X E R ­ CISE T h e p h y s io lo g ic a l s t r a i n o f e x e r c is e is b e t t e r c o r r e la te d ith t h e r e l a t i v e o x y g e n c o n s u m p ti o n t h a n w i t h th e h so lu te o x y g e n c o n s u m p ti o n . R e la ti v e o x y g e n c o n s u m p - ? 0 n is u s u a lly e x p r e s s e d a s a p e r c e n t a g e o f a n in d i v i d u a l ’s ^ a x im u m o x y g e n c o n s u m p ti o n . f o r th o s e ty p e s o f e x e r c is e r e q u i r i n g e n d u r a n c e , e.g. m a ra th o n r u n n i n g , a h ig h m a x i m u m o x y g e n c o n s u m p ti o n ■I a b a s ic r e q u i r e m e n t . A h ig h c a p a c it y f o r c o n s u m in g 'Lvygen w ill a llo w a n a t h l e t e t o p e r f o r m w e ll a t a r e la tiv e ly low er p e r c e n t a g e o f h is m a x i m u m c a p a c it y . H e is t h e r e ­ fore u n d e r le s s p h y s io lo g ic a l s t r a i n t h a n a p e r s o n e x e r ­ cising t h e s a m e r a t e b u t h a v in g a l o w e r m a x im u m c a p a c ity . F o r a p a r t i c u l a r r a t e o f e x e r c is e , a p e r s o n w i t h a nigh m a x c a p . w ill t h e r e f o r e b e le s s s u s c e p tib le t o fatigue t h a n h is f e llo w w ith a l o w e r m a x c a p . It is s a id t h a t a n o r m a l in d i v i d u a l s h o u l d n e v e r b e req u ired t o w o r k a t 5 0 % o r m o r e o f h is m a x c a p . f o r j n y e x t e n d e d p e r i o d o f tim e a s t h i s w o u ld le a d t o u n d u e i t i g u e . T h e r e f o r e , a s h a r d p h y s ic a l w o r k r e q u i r e s a n f x y g e n c o n s u m p ti o n o f 1,5 lit r e s p e r m i n u t e , th is ty p e of w o r k s h o u l d n o t b e u n d e r t a k e n f o r lo n g p e r io d s b y p erso n s h a v in g a m a x im u m o x y g e n c o n s u m p ti o n o f less than 3 litr e s p e r m in u te . A s im i l a r c o n s i d e r a t i o n w o u ld ap p ly t o a p r o g r a m m e o f e x e r c is e . C l e a r l y t h e r e f o r e , from t h e p o i n t o f v ie w o f a c c o m p l i s h in g h a r d w o r k , o r high le v e ls o f e x e r c is e , a n i n d i v i d u a l h a v in g a lo w m a x cap. is a t a d e f in ite d i s a d v a n t a g e . T h is c a n b e p a r t l y n e u ­ traliz ed b y t r a i n in g i.e . b y i m p r o v i n g a n i n d i v i d u a l ’s le v e l of fitn e s s .7 SEPTEMBER 1976 LACTATE (L A C T IC A C ID ) T U R N P O I N T T h e l a c t a t e t u r n p o i n t is a c o n c e p t w h ic h g iv e s a n i n d i ­ cation o f a n i n d i v i d u a l ’s le v e l o f fitn e s s .7 I t is k n o w n t h a t a s t h e i n t e n s i t y o f e x e r c is e i n c r e a s e s , the l a c t a t e c o n c e n t r a t i o n in t h e a r t e r i a l b l o o d r e m a in s , a t first, e s s e n tia lly c o n s t a n t , i.e ., e n o u g h o x y g e n is b e in g su p p lie d t o t h e w o r k i n g m u s c le s ( a e r o b ic m e ta b o lis m ) . H o w e v e r, e v e n t u a l l y a p o i n t is r e a c h e d w h e r e t h e s u p p ly of o x y g e n t o t h e w o r k i n g m u s c le s is in s u f f ic ie n t a n d t h e c o n c e n tr a tio n o f la c t i c a c id in t h e a r t e r i a l b l o o d i n c r e a s e s s h a rp ly , f a n a e r o b i c m e t a b o l i s m ) . T h e c o n c e p t is i l l u s t r a t e d g r a p h ic a lly in F ig . 2. PERCENT OF MAX. 0 t CONSUMPTION FIG. Z 3 W h e n a n i n d i v i d u a l e x e r c is e s a t a le v e l b e lo w t h is t u m - p o i n t , h e s h o u l d b e a b l e to w o r k f o r e x t e n d e d p e r i o d s o f t im e . A b o v e th is t u r n p o i n t h is e n d u r a n c e c a p a c it y f a lls o ff r a p i d l y a n d t h e i n d i v i d u a l w ill e x p e r ie n c e f a t i g u e d u e t o a n a e r o b i c m e t a b o l i s m . T h r o u g h t r a i n in g , i t is p o s s ib le t o m o v e t h i s t u r n p o i n t to t h e r i g h t th e r e b y e x t e n d i n g t h e s c o p e o f a e r o b i c m e t a b o l i s m . 7 A s e d e n t a r y in d i v i d u a l w ill u s u a l ly h a v e a l a c t a t e t u m - p o i n t w h ic h o c c u r s a t le s s t h a n 4 0 % o f h i s m a x c a p : a v e r y h ig h ly t r a i n e d a t h l e t e c a n h a v e a t u r n p o i n t o c c u r s a t 9 0 % o f h is m a x c a p . 7 B E D R E S T M a x c a p . a n d l a c t a t e t u r n p o i n t a r e b o t h a d v e r s e ly a f fe c te d b y i n a c t i v i t y , s u c h a s t h e b e d r e s t w h ic h f o llo w s a n i n j u r y o r o t h e r illn e s s . R e t u r n to p r e v i o u s le v e ls is f a i r l y r a p i d , d e p e n d i n g o n t h e p e r i o d o f in a c t i v i t y a n d t h e s u b s e q u e n t e x e r c is e p r o g r a m m e . B L O O D FLO W E x e r c is e w ill c a u s e s u b s t a n t i a l c h a n g e s in b lo o d flo w . T h e s e c h a n g e s a r e d is c u s s e d in d e ta il b y C a r l s te n a n d G r i m b y 2 a n d b y S h e p h e r d . 5 T h e p r i n c i p a l e ffe c ts o f e x e r c is e o n b l o o d flo w a r e s u m m a r i s e d b e lo w : (a) S k i n b l o o d flo w I t is i m p o r t a n t t o n o t e t h a t t h e r e a r e b a s i c d iffe re n c e s b e tw e e n t h e c o n t r o l m e c h a n is m s o f t h e s k in b l o o d flo w in g e n e r a l , a n d t h a t w h ic h , o c c u r s in th e h a n d s a n d f e e t. T h e c e n t r a l n e r v o u s c o n t r o l o f t h e c i r c u l a t i o n in t h e h a n d s , f e e t , e a r s a n d lip s is m e d i a t e d b y v a s o c o n s t r i c t o r fib re s o f t h e s y m p a th e ti c n e r v o u s sy s te m . C e n t r a l c o n t r o l o f t h e v e s s e ls e ls e w h e r e , i.e ., in m o s t o f t h e b o d y i n t e g u ­ m e n t , in t h e s k in o f t h e c h e e k s , t r u n k a n d p r o x i m a l p a r t s o f t h e lim b s , is m e d i a t e d in th e m a i n b y t h e s y m p a th e ti c “ v a s o d i l a t o r ” fib re s . E v id e n c e s u g g e s ts t h a t th e s e v a s o ­ d i l a t o r fib re s a r e t h e s y m p a th e ti c fib re s w h ic h s u p p l y t h e s w e a t g l a n d s ( B r a d y k i n i n m e c h a n is m ) . T h is d if fe r e n c e m a y , a t tim e s , h a v e s ig n if ic a n t im p l i c a t i o n s . I n h o t e n v i r o n m e n t s s k in b l o o d flo w p la y s a m a j o r r o le in t h e t h e r m o r e g u l a t i o n o f a n in d i v i d u a l , e x e r c is in g o r a t r e s t . A t a i r t e m p e r a t u r e s b e lo w 19 d e g re e s c e n t i ­ g r a d e , s k in b lo o d flo w p la y s n o r o l e in t h e t h e r m o ­ r e g u l a t i o n o f a r e s t i n g in d iv id u a l. D u r i n g e x e r c is e t h e m a j o r c h a n g e s w h ic h o c c u r in s k in b lo o d flo w a r e 6: 1. a t t h e o n s e t o f e x e r c is e , a n im m e d i a t e r e d u c t i o n in th e s k in b l o o d flo w , 2 . a s b o d y t e m p e r a t u r e b e g in s t o in c r e a s e (a s a r e s u l t o f t h e e x e r c is e ) t h e r e is a c o r r e s p o n d i n g in c r e a s e i n t h e s k in b lo o d flo w , 3. w h e n b o d y t e m p e r a t u r e s t a b ilis e s t h e s k in b lo o d flo w a ls o s ta b ilis e s , b u t a t a n e w i n c r e a s e d le v e l, a n d 4 . u l t i m a t e l y , t h e r e is a p h a s e o f d e c r e a s in g b lo o d flo w ( a t le a s t in t h e h a n d ) in r e s p o n s e t o t h e h i g h e r d e m a n d s o f t h e w o r k i n g m u s c le s f o r m o r e o x y g e n . I t is i m p o r t a n t t o n o t e t h a t t h e b l o o d flo w t h r o u g h t h e s k in d e p e n d s o n b o d y t e m p e r a t u r e 1 w h ile t h e flo w o f b l o o d t h r o u g h t h e m u s c le s d e p e n d s o n t h e r a t e o f e x e r ­ c ise . ( N o t e : D o n a l d e t a l 3 h a v e s h o w n a d e c r e a s e d s k in b l o o d flo w t o b e a s s o c i a t e d w i t h r h e u m a t i c h e a r t d is e a s e .) (b) M u s c l e b l o o d flo w P h y s ic a lly , b l o o d flo w t h r o u g h m u s c le is m o r e c o m p le x t h a n t h a t w h ic h o c c u r s t h r o u g h t h e s k in . D u r i n g m u s c le c o n t r a c t i o n t h e a r t e r i a l b lo o d flo w is d e c r e a s e d , th e s t r o n g e r t h e c o n t r a c t i o n t h e le s s t h e flo w . T h e in flo w o f a r t e r i a l b l o o d t o t h e m u s c le in c r e a s e s d u r i n g m u s c le r e l a x a t i o n . C o n v e r s e l y , v e n o u s o u tf lo w is e n h a n c e d b y m u s c le c o n t r a c t i o n ( t h e w e ll k n o w n m u s c le p u m p ) . T h e n e t r e s u l t o f a c y c le o f m u s c le c o n t r a c t i o n a n d r e l a x a t i o n is a n in c r e a s e in b lo o d flo w t h r o u g h t h e w o r k i n g m u s c le . F I S I O T E R A P I E R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 4 P H Y S I O T H E R A P Y SEPTEMBER, 1976 C O N C L U S I O N T h is a r t i c l e p r o v id e s a b r i e f g l a n c e a t t h e s u b je c t o f e x e r c is e p h y s io lo g y . I t s p u r p o s e h a s b e e n t o i n t r o d u c e a fe w o f t h e f u n d a m e n t a l c o n c e p t s in e x e r c is e p h y s io lo g y , to th o s e w h o h a v e n o t p r e v io u s ly s t u d i e d t h e s u b je c t. R E F E R E N C E S 1. B a r c r o f t , H . , K . D . B o c k , H . H e n s e i a n d A . H . K i t c h e n . D i e M u s k e l d u r c h b l u t u n g d e s M e n s c h e n b e i in d ir e k - t e r E r w a r m i n g u n d A b k i i h l u n g . P flu g e rs . A r c h . 261: 19 9 -2 1 0 , 1955. 2. C a r l s t e n , A . a n d G . G r im b y . T h e c i r c u l a t o r y r e s p o n s e t o m u s c u la r e x e r c is e in m a n . C h a r l e s C . T h o m a s I llin o is a n d F l o r i d a , U .S .A . 1966. 3. D o n a l d , K . W ., J . M . B is h o p a n d O . L . W a d e . C h a n g e s i n t h e o x y g e n c o n t e n t o f a x i l l a r y v e n o u s b lo o d d u r i n g le g e x e r c is e in p a t i e n t s w ith r h e u m a t i c h e a r t d is e a s e . C lin . S ci. 14: 5 3 1 , 1955. 4. M a r i t z , J . S ., J . F . M o r r i s o n , J . P e t e r , N . B. S tr y d o m a n d C . H . W y n d h a m . A p r a c t i c a l m e th o d o f e s tim a tin g a n in d i v i d u a l ’s m a x i m a l o x y g e n i n t a k e . E r g o n o m i c s 4 : 9 7 -1 2 2 , 1961. 5. 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C . R o g e r s , J . S. G r e y s o n a n d W . H . v a n d e r W a l t . W a lk o r jo g f o r h e a l t h 11: E s t i m a t i n g t h e m a x im u m a e r o b i c c a p a c it y f o r e x e r c is e . S .A . M e d . J . 4 5 : 5 3 -5 7 / 1971. \ 10. W y n d h a m , C . H . , N . B . S t r y d o m , C . G . W illia m s , A . M u n r o a n d A . H e y n s , C o m p a r i s o n o f e s t im a t e s o f m a x im u m o x y g e n i n ta k e o b t a i n e d f r o m a t r e a d m i ll , a b ic y c le e r g o n o m e t e r a n d a s t e p te s t. I n t e r n a t i o n a l S y m p o s . o n E n v ir o n m e n t a l p h y s io l. K y o t o , J a p a n , 1 7 0 -1 8 2 , 1965. VACANCY P R O V I N C I A L A D M I N I S T R A T I O N O F T H E C A P E O F G O O D H O P E H O S P I T A L S D E P A R T M E N T A p p l i c a t i o n s a r e in v i t e d f r o m s u i t a b l y q u a lif ie d c a n d i d a t e s f o r a p p o i n t m e n t t o th e f o llo w in g v a c a n t p o s t s a t th e : CONRADIE HOSPITAL, PINELANDS \ P o s t: S e n i o r P h y s i o t h e r a p i s t . S a la r y : T h e m i n i m u m c o m m e n c in g s a l a r y is R 3 8 4 0 p e r a n n u m . * P o st: P h y s i o t h e r a p i s t . S a la r y : T h e m in im u m a n d m a x im u m c o m m e n c in g s a l a r y is R 3 0 0 0 / 3 6 6 0 p e r a n n u m . Q u a lific a tio n s : Q u a l i f i c a t i o n i n P h y s i o t h e r a p y a c c e p ta b le t o th e S o u t h A f r i c a n M e d ic a l a n d D e n t a l C o u n c il. I n a d d i t i o n t o th e s a l a r y s h o w n , s u b j e c t t o c o m p l i a n c e w ith c e r t a i n c o n d i t i o n s , t h e s u c c e s s fu l a p p l i c a n t s a r e e n t i t l e d t o a n a n n u a l t r a v e l c o n c e s s io n , m e d ic a l a id s c h e m e a n d h o l i d a y a n d sic k le a v e p r iv ile g e s . A p p l i c a t i o n s h o u l d b e m a d e o n t h e p r e s c r i b e d f o r m (S ta ff 23) in d u p l i c a t e , w h ic h is o b t a i n a b l e f r o m t h e D i r e c t o r o f H o s p i t a l S e rv ic e s , P .O . B o x 2 0 6 0 , C a p e T o w n 8 0 0 0 , o r f r o m t h e M e d ic a l S u p e r i n te n d e n t o f a n y p r o v i n c i a l h o s p i t a l in t h e C a p e P ro v in c e . * A p p l i c a t i o n s s h o u l d b e f o r w a r d e d t o t h e M e d i c a l S u p e r i n te n d e n t o f t h e h o s p i t a l c o n c e r n e d . U n le s s o th e r w is e s t a t e d , a p p l i c a t i o n s s h o u l d b e f o r w a r d e d t o t h e D i r e c t o r o f H o s p i t a l S e rv ic e s a t t h e a b o v e a d d r e s s . T h e c lo s in g d a t e f o r t h e r e w i p t o f a p p l i c a t i o n is 17 S e p t e m b e r , 1976. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )