• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1040-1050
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• 1997

Pulmonary rehabilitation has been known to improve dyspnea and exercise tolerance in patients with chronic lung disease, although it does not improve pulmonary function. The mechanism of this improvement is not clearly explained till now; however some authors suggested that the improvement in the skeletal muscle metabolism after the rehabilitation could be a possible mechanism. The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation which causes early activation of anaerobic glycolysis and excess lactate production with exercise. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the improvement in the exercise tolerance after the rehabilitation, noninvasive $^{31}P$ magnetic resonance spectroscopy(MRS) of the forearm flexor muscle was performed before and after the exercise training in nine patients with chronic lung disease who have undertaken intensive pulmonary rehabilitation for 6 weeks. 31p MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntary contraction(MVC) force of the muscle was measured before the isometric exercise, and then 30% of MVC force was constantly loaded to each patient during the isometric exercise. After the exercise training, exercise endurance of upper and lower extremities and 6 minute walking distance were significantly increased(p<0.05). There were no differences of baseline intracellular pH (pHi) and inorganic phosphate/phosphocreatine(Pi/PCr). After rehabilitation pHi at the exercise and the exhaustion state showed a significant increase($6.91{\pm}0.1$ to $6.99{\pm}0.1$ and $6.76{\pm}0.2$ to $6.84{\pm}0.2$ respectively, p<0.05). Pi/PCr at the exercise and the recovery rate of pHi and Pi/PCr did not show significant differences. These results suggest that the delayed intracellular acidosis of skeletal muscle may contribute to the improvement of exercise endurance after pulmonary rehabilitation.

• Journal of muscle and joint health
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• v.8 no.1
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• pp.122-140
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• 2001

The aims of this study were to understand and to predict the determinent factors affecting the exercise behaviors and physical fitness by testing the Pender's revised health promotion model, and to help the patients with rheumatoid arthritis and osteoarthritis perform the continous exercise program, and to help them maximize the physical effect such as muscle strength, endurance, and functional status and mental effects including self efficacy and quality of life, and improve the physical and mental well being, and to provide a basis for the nursing intervention strategies. Of the selected variables in this study, the endogenous variables included the physical fitness, exercise score, exercise participation, perceived benefits of action, perceived barriers of action to exercise, activity-related affect(depression) and perceived self-efficacy, interpersonal influences(family support), situational factors(duration of arthritis, fatigue) and the exogenous variables included personal sociocultural factor(education level), personal biologic factor(body mass index), personal psychologic factor(perceived health status) and prior related behavior factors(previous participation in exercise, life-style). We analyzed the clinical records of 208 patients with rheumatoid arthritis and degenerative arthritis who visited the outpatient clinics at H university hospital in Seoul. Data were composed of self reported qustionnaire and good of fitness score which were obtained by padalling the ergometer of bicycle for 9 minutes. SPSS Win 8.0 and Window LISREL 8.12a were used for statistical analysis. Of 75 hypothetical paths that influence on physical fitness, exercise participation, exercise score, perceived benefits of action, perceived barriers of action to exercise, activity-related affect(depression) and perceived self-efficacy, interpersonal influences(family support), situational factors(duration of arthritis, fatigue), 40 were supported. The physical fitness was directly influenced by life-style, perceived health status, education level, family support, fatigue, which explained 12% of physical fitness. The exercise participation were directly influenced by life-style, education level, past exercise behavior, perceived benefits of action, perceived barriers of action, depression and duration of arthritis, which explained 47% of exercise participation. Exercise score were directly affected by perceived self efficacy. BMI, life-style, past exercise behavior, perceived benefits of action, family support, perceived health status. perceived barriers of action, and fatigue, which explained 70%. Perceived benefits of action was directly influenced by BMI, life-style, which explained 39%. Perceived barriers of action were directly influeced by past exercise behavior, perceived health status, which explained 7%. Perceived self efficacy were directly influeced by level of education, perceived health status, life-style, which explained 57%. Depression were directly influeced by past exercise behavior, BMI, life-style, which explained 27%. Family support were directly influeced by life-style, perceived health status, which explained 29%. Fatigue were directly influeced by BMI, life-style, perceived health status. which explained 41%. Duration of arthritis were directly influeced by life-style, past exercise behavior, BMI, which explained 6%. In conclusion, important variables for physical fitness were life-style, and variable affecting exercise participation were life-style. Perceived self-efficacy of exercise was a significant predictor of exercise score. BMI, Life-style, perceived benefits of action, family support, past exercise behavior showed direct effects on perceived self-efficacy. Therefore, disease related factor should be minimized for physical performance and well being in nursing intervention for patients with rheumatoid arthritis, and plans to promote and continue exercise should be seeked to reduce disability. In addition, Exercise program should be planned and performed by the exact evaluation of exercise according to the ability of the patients and the contents to improve the importance of exercise and self efficacy in self control program, dedicated educational program should be involved. This study suggest that the methods to reduce the disease related factors, the importance of daily life-style, recognition of benefit of exercise, and educational program to promote self efficacy should be considered in the exercise behavior promotion and nursing intervention for continous performance. The significance of this study is also thought to provide patients with chronic arthritis the specific data for maximal physical and mental well being through exercise, chronic therapeutic procedure, daily adaptation and confrontation in nursing intervention.

• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.495-501
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• 2000

Background : Cardiopulmonary exercise test is a useful test for the evaluation of the cardiovascular and respiratory systems. Obese subjects have an increased resting metabolic rate ($VO_2$) compared to non~obese subjects and the increase is more marked during dynamic exercise, which results in the limitation of maximal exercise in obese subjects. In this study, the influence of the obesity and fat distribution on the maximal exercise capacity were evaluated. Methods : Maximal exercise capacity was represented by maximam maximum oxygen uptake and $VO_2$ max in the cardiopulmonary test. Obesity, total fat content and abdomina1 obesity(waist to hip ratio, WHR) were measured by bioelectrical impedence method. Total of 42 volunteers (male 22, fema1e 20) were evaluated. Results : 1) Weight to height ratio (mean$\pm$SD) was 110$\pm$14.9% in men and 100$\pm$11.1% in women. 2) Fat ratio (mean$\pm$SD) was 23.3$\pm$5.2% in men and 27.55$\pm$3.9% in woman. 3) Waist to hip ratio (mean$\pm$SD) was 0.85$\pm$0.04 in men and 0.8$\pm$0.03 in woman. 4) In men, $VO_2$ max/min/Kg was negatively correlated with obesity, fat ratio, and abdominal fat distribution. 5) In woman, $VO_2$ max/Kg was negatively correlated with obesity and fat ratio, but did not show significant relationship with abdominal fat distribution. Conclusion : Obesity was a limiting factor for maximal exercise in both men and women. Abdominal obesity was a limiting factor for maximal exercise in men but its implication to women needs further evaluation.

• Journal of Life Science
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• v.20 no.3
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• pp.437-443
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• 2010

This study was designed to examine the aerobic capacity and ventilatory response during an incremental exercise in elite high school cyclists. Twelve boys ($17{\pm}1\;yr$, $175{\pm}5\;cm$, $70{\pm}9\;kg$) participated in anthropometric measurements, incremental exercise testing, and pulmonary function tests. During incremental exercise testing using a cycle ergometer, their maximal oxygen uptake ($VO_2max$), maximal power output, ventilation, ventilatory equivalents for oxygen ($V_E/VO_2$) and carbon dioxide ($V_E/VCO_2$), respiratory rate, and tidal volume were measured. Time variables such as inspiratory time (Ti), expiratory time (Te), breathing time (Tb), and inspiratory duty cycle (Ti/Tb), as well as inspiratory flow rate ($V_T$/Ti) were assessed. Pulmonary function of vital capacity (FVC), forced expiratory volume in one second ($FEV_1$), $FEV_1$/FVC, and peak expiratory flow were evaluated. Their $VO_2max$, maximal heart rate, and Wmax were $57.5{\pm}3.9\;ml{\cdot}kg^{-1}{\cdot}min^{-1}$, $194.1{\pm}8.6\;beat{\cdot}min^{-1}$, and 452 W, respectively. $VO_2max$ was not related to any anthropometric parameters. Most ventilatory variables progressively increased with exercise intensity. As intensity increased, Ti, Tb, Tb decreased while Ti/Tb was maintained. Below an intensity of 250 W, height, weight, body mass index, and body surface were highly correlated with $V_T$/Ti and Ti/Tb (p<0.05). Collectively, $VO_2max$ appeared to be lower than adult cyclists, suggesting a different pattern of ventilatory control as age advances. Morphological characteristics were not related to $VO_2max$ in the population. Time variables of ventilatory response seemed to be related only at an exercise intensity level of less than 250 W. $V_T$/Ti may be related to exercise endurance capacity, but Ti/Tb was similar to adult cyclists.

• Tuberculosis and Respiratory Diseases
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• v.43 no.6
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• pp.976-986
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• 1996

BACKGROUND : Dyspnea is common among patients with cardiopulmonary disease, and "daily disability" is defined as a functional impairment resulting from exercise intolerance. The maximal oxygen uptake(VO2max) during exhausting work is not only the best single physical indicator of the capacity of a man for sustaining hard muscular work, but also the most objective method by which one can determine the physical fitness of an individual as reflected by his cardiovascular system. However, the expense, time and personnel requirements make this procedure prohibitive for testing large group. The walking test is well-known type of exercise and it cost nothing to perform and have good reproducibility. Thus we performed the walking test and investigated correlations with spirometry, ABG and exercise test. METHOD: We observed the walking test and exercise test by cycle ergometer in 37 patients who visited our hospital because of dyspnea. Arterial blood gas analysis and spiromety, dyspnea index were performed, too. RESULT : (1) The VO2max was significantly lower in patients with COPD and cardiovascular disease than asthma and dyspnea on exertion group(p<0.05). The walking test distance was also lower in former. (2) The 12 minute walking test was significantly correlated with VO2max, PaCO2, FVC(%), FEV1(%) in all patients(p<0.05), and the walking test was only conelated with VO2max in patients with COPD(p<0.05). (3) In COPD patients, the VO2max was best correlated with FEV1(%) and FVC(%) and significantly correlated with walking test. But there was no correlation between walking test and FEV1(%) & FVC(%). (4) The 6 minute walking test was well correlated with 12 minute walking test(r=0.92. p<0.01). CONCLUSION : The walking test is the simple method for assessing exercise performance in patient with cardiopulmonary disease and a reliable indicator for VO2max. And the walking test is practical method for assessing on everyday disability rather than maximal exercise capacity. The 6 minute walking test is highly correlated with 12 minute walking test and a less exhausting for the patients and a time-saving for the investigator.

• The Korean Journal of Physiology
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• v.2 no.2
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• pp.101-135
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• 1968

As physical fitness measured was muscle strength (hand grips, leg extention, back lift, and arm pull and thrust), skinfold thickness (5 different sites), circulatory function (resting heart rate and blood pressure), speed (kinesiological analysis during 100m sprint, record, maximal and final speed), motor function (50 meter dash, ball throwing, standing broad jump, and pull-ups), maximal aerobic power (maximum oxygen intake by field running method), muscle power (leg and arm by inertia ergometer), and general endurance (maximum endurance running time on the treadmill at the speed of 5 MPH and grade of 15.5%) of 1131 Korean children (boys 572, girls 559) aged of 6 to 17 years, who were randomly sampled from 24 primary, middle and high schools at the two districts of Seoul and KyungKi. The results are summarized as follows: 1) The status (height and weight) of the children was almost same as that of the previously reported Korean and Japanese children of same ages. 2) Muscle strength was a gained linearly with geting age in the boys and girls but there was a little improvement in girls aged of 13 years or more. 3) The mean skin fold thickness was increased linearly with geting ages in both sexes, but the girls from 12 to 17 years of age were increased rapidly, and maximum value was 17mm, while boys was 7.0 mm. 4) In the circulatory function, the resting heart rate was decreased, but the blood pressure was increased with ages in both sexes within the normal limits. 5) The maximum and final speed during 100 meter sprint increases with age in boys but girls who are 12 years old or older, were not improved any mere. The patterns of running were same in both sexes, and maximum speed reached at about 30 meters from starting line. 6) The motor function was increased with age in both sexes, but there was no improvement in 12 years of age or older girls. More over records of all functions except standing broad jump was less than those of Japanese in the same age, respectively. 7) The maximum oxygen intake (MOI) was increased considerably with ages and maximum values were 2.93 L/min (boys) and 2.09 L/min (girls) at the age of 17years. This result was almost same as that of the Japanese and Easter Island population, but the value was lower than that of Europe. The average of the maximum oxygen intake per kg body weight per minute from 9 to 17 years of age were around 53 ml in the boys and 42 ml in the girls. 8) Muscle power was increased linearly with ages in boys while there was relatively a little increment in girls. The maximum values of leg muscle in boys and girls at the 17 years of age were 0.168 and 0.088 horse power, respectively. 9) The maximum endurance running time was increased considerably from the age of 9 in boys, while there was no improvement in girls. The maximum values were 6.0 min and 1.8 min, respectively.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.795-802
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• 1999

Objective : Cardiopulmonary exercise test is a useful tool to evaluate the operative risk and to plan exercise treatment for the patients with chronic obstructive pulmonary disease(COPD). In cardiopulmonary exercise test, most of the measured parameters are recorded at the time of peak exercise, which are hard to attain in COPD patients. So we evaluated the usefulness of the parameter, breathing reserve index(BRI=minute ventilation [$V_E$]/maximal voluntary ventilation[MVV]) at the time of anaerobic threshold($BRI_{AT}$) for the differentiation of COPD patients with normal controls. Methods : Thirty-six COPD patients and forty-two healthy subjects underwent progressive, incremental exercise test with bicycle ergometer upto possible maximal exercise. All the parameters was measured by breath by breath method. Results : The maximal oxygen uptake in COPD patients (mean$\pm$SE) was $1061.2{\pm}65.6ml/min$ which was significantly lower than $2137.6{\pm}91.4ml/min$ of normal subjects(p<0.01). Percent predicted maximal oxygen uptake was 54.3% in COPD patients and 86.0% in normal subjects(p<0.01). Maximal exercise(respiratory quotient; $VCO_2/VO_2{\geq}1.09$) was accomplished in 7 of 36 COPD patients(19.4%) and in 18 of 42 normal subjects(42.9%). The $BRI_{AT}$ of COPD patients was higher($0.50{\pm}0.03$) than that of control subject($028{\pm}0.02$, p<0.01), reflecting early hyperventilation in COPD patient during exercise. The correlation between $BRI_{AT}$ and BRI at maximal exercise in COPD patients was good(r=0.9687, p<0.01). Conclusion : The $BRI_{AT}$ could be a useful parameter for the differentiation of COPD patients with normal controls in the submaximal cardiopulmonary exercise test.