The only measures that accurately distinguished NFO from OTS were increases in ACTH and PRL concentrations after a second maximal exercise bout. The OTS athletes showed a very small or no increase in ACTH and PRL concentrations after the second exercise bout; the NFO athletes showed very large increases. This is a confirmation of our previous studies with this protocol.10 22 The use of two bouts of maximal exercise to study neuroendocrine variations showed an adapted exercise-induced increase of ACTH, PRL and GH to a twoexercise bout.10
There are two other studies that have measured prolactin in relation to overtraining. Lehmann et al23 showed that an increase in training volume, rather than intensity, led to more symptoms associated with overtraining. They also observed a close-to-significant exercise-induced decrease in plasma prolactin in the increased intensity group but no change because of increased volume. Budgett et al24 observed a more marked plasma prolactin response to a neuroendocrine challenge in athletes with unexplained underperformance syndrome. They also observed a higher resting plasma prolactin in unexplained underperformance syndrome athletes than healthy controls. These authors also state that prolactin could prove useful in monitoring the individual response to training and recovery.
Eight healthy and moderately active (a minimum of 2 h of aerobic activity per week) adults (mean ± SD; age: 22 ± 2 yrs, height: 171 ± 8 cm, weight: 69 ± 8 kg, 5 males and 3 females) volunteered to participate in this study. None of the subjects had any known mental or somatic disorder. Each subject gave written informed consent prior to the study. Experimental protocol and procedures were approved by the local Ethics Committee of the School of Sport and Exercise Sciences, University of Kent at Medway (Ethic clearance Prop97_2013_14). The study conformed to the standards set by the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects” (2008). All subjects were given written instructions describing all procedures related to the study.
16.  Make sure you stay hydrated! Even mild dehydration hampers recovery. The drink of choice? Water! And for mineral replacement, especially sodium, I make sure my diet includes various amounts of celery, romaine lettuce, and a nutritional adjunct to the diet, a powdered barley grass juice called Daily Green Boost (if the foods I eat are grown in soils that are sodium insufficient, I won't get enough sodium, and if those foods that are supposed to be good sources of sodium don't taste savory, they are grown in sub-par soils).
When intensity is high, it is physiologically impossible to work out for a long time. Doing more exercise than is minimally necessary to stimulate adaptive changes (or to maintain a proper level of fitness) drains bodily resources and compromises recovery. A properly performed workout should take no longer than 45 minutes, which if done in a gym can also include some time spent on a treadmill at the end of the workout.
Indian yoga gurus started arriving to the West at the turn of the 20th century, however, yoga as it is known today only evolved as a popular method to ‘stay healthy and relaxed’ during the second half of the century.50 Syman S. The subtle body: the story of yoga in America. New York (NY): Farrar, Straus & Giroux; 2010. [Google Scholar] There was no contact found between the sporadic early yoga arrivals to the West and the MMB pioneers discussed within this research. However, Eastern mind–body practices profoundly influenced Randell and Morris, most probably via Vaughan, who had just returned from years of obstetric work and eye-opening behavioral observations in India prior to the inception of the St Thomas project in 1912.

Cutting drills, running through an agility ladder, using hurdles and cones to practice footwork—these all develop that combo of speed, coordination, balance, and power called agility. They all also require and build core strength. Do this drill for one minute: Place four cones (or plastic cups) eight feet apart in a square and run up, shuffle right, run back, and shuffle left around the square, then reverse the direction. Repeat.
Around thirty years ago, Andersen et al. [10] developed a novel exercise model (i.e. one leg dynamic exercise, OLDE) allowing dynamic isotonic contractions of the knee extensor muscles. This exercise model isolates the knee extensor muscles via an active knee extension and passive knee flexion, and due to the reduced muscle mass involved, this exercise is not limited by cardiorespiratory function [11]. Therefore, this model was extensively used to investigate the effect of OLDE on the cardiorespiratory system (e.g. [12]), skeletal muscle physiology (e.g. [13]) but also with patients suffering from cardiorespiratory limitations [14, 15] or for studying mechanisms regulating circulatory response to rhythmic dynamic exercise [6, 16]. More recently, high intensity OLDE has been used to investigate CNS processes involved in the regulation of muscle fatigue and endurance performance [8, 11, 17, 18]. Despite being recently used to investigate muscle endurance, the reliability of high intensity OLDE has not been tested. Reliability can be defined as the consistency of a performance measure, and should be established for any new measurement tool [19, 20]. Furthermore, reliability of a protocol can be used to estimate the sample size required for an appropriate statistical power [20]. The main aim of this study was to establish the reliability of high intensity OLDE as a measure of muscle endurance. Additionally, as the sensitivity of a protocol reflects its ability to detect small changes in performance, we also calculated the smallest worthwhile change as a measure of sensitivity [21].

Choose 10 different exercises - For cardio, focus on exercises with different levels of intensity. For example, you might alternate a high-intensity exercise (such as jumping jacks or burpees) with an easier move (such as marching in place). For strength training, choose compound exercises such as squats, lunges, pushups and dips to work the entire body. Exercise ideas: Step by Step Cardio Exercises, Step by Step Body Weight Exercises
Along with prenatal vitamins and regular doctor’s appointment, The Bloom Method should be an essential part of your prenatal experience. Brooke’s knowledge and passion for pre and postnatal health and wellness is unmatched. Thanks to the regular workouts and the prenatal exercises that Brooke taught me, I feel amazing. The Bloom Method is a fundamental investment in baby and mommy’s health.
It’s not an exact science, but when you hear the term plyometric, you can go ahead and think jumping and breathlessness. Examples would include squat jumps, box jumps, broad jumps, and burpees. One of the main purposes of these explosive exercises is increasing power, says Laferrera. Having more power means you can recruit muscle fiber faster and more efficiently, which pays off when you’re moving heavy objects or working on sprinting drills in the gym, adds Lefkowith. Plus, because these moves get your heart rate up, they’re big calorie-burners. Here are seven plyometric moves you can do at home.
You won’t find another person like Brooke, in this whole world. The inspiration and motivation she carries is way beyond what most people hold. the knowledge she has about pregnancy and post pregnancy exercise is something you will want to connect with, and continue to work with. Taking a step to work with Brooke is making a choice to support your whole life: family, baby, body, mind, spirit. thank you Brooke for making exercise and fitness such an essential and safe part of pregnancy.
I'm a professional weight loss coach and was chosen as "Canada's Top Fitness Professional." Each of my workouts found at makeyourbodywork.com will challenge your entire body and will include elements of cardio, strength, and core conditioning. The uniqueness of these workouts are the "difficulty levels" that provide up to four distinct options for every single move. This makes each workout very accessible for newbies, yet challenging for super-fit users.
Degenhardt B [Internet]. Once upon a time: the evolution of Pilates mat work. 2012 Nov 21 [cited 2015 Aug 30]. Available from: http://benjamindegenhardt.com/once-upon-a-time/.  He was later moved to the Isle of Man where he had duties training the injured inmates in their wards. It was there that Pilates started to connect springs to the hospital bed frames modifying them into effective and comfortable exercise devices which later evolved to become modern Pilates equipment.43 Hessel J [Internet]. Joseph H. Pilates biography. 2015 Jul 8 [cited 2015 Aug 30]. Available from: http://www.jillianhessel.com/pilates_biography.html. [Google Scholar]
* Strength building exercises will improve cardiopulmonary efficiency. The cardiopulmonary system exists to service the musculature (among other things). You "get at" the cardiopulmonary system through the skeletal muscles. When demands are made of the musculature which strengthen it, all systems that service the musculature will be strengthened accordingly. The cardiopulmonary system doesn't care what exercise you do. (However, the joints, ligaments, and tendons do; and while they don't mind the occasional sprint, they'd rather you not pound them with high-force activities for hours-on-end.) If the exercise protocol outlined above results in excellent cardiopulmonary fitness, why would you want to do more than you need to do? (And there are studies which suggest that doing more than you need is actually harmful to the heart!)
Flexibility exercise, or stretching, is a vital component of any exercise regimen. The primary purpose of flexibility training is to increase your range of motion, especially when it comes to muscles and joints. Although flexibility exercise will not improve your endurance or strength as cardio or anaerobic exercise would, flexibility training helps your body maintain its natural alignment. By doing so, flexibility exercise makes your body significantly less prone to injury during cardio or anaerobic exercise. Additionally, practicing flexibility training will increase your freedom of movement in a way that makes everyday activities easier. Tasks such as reaching up for an object on a shelf, getting up from a chair, or even sitting in confined spaces for long periods of time will greatly benefit from flexibility training.

Before beginning any workout program, it’s always a good idea to consult your physician. Individuals with pre-existing injuries or medical conditions or those who don’t have an accurate knowledge of their current physical fitness level should always begin cautiously. It’s also extremely important to perform all workouts, no matter what fitness method you’re doing, under the supervision of a certified instructor. Their guidance and knowledge of proper form and technique will help you to achieve maximum results while avoiding injuries. They can also help you to safely modify workout activities to match your current fitness levels and goals. Whether you attend classes in a studio or at home through DVDs or streamed videos, the presence of a trained instructor is imperative.
A Polar (www.polar.fi) heart rate monitor (belt and watch) is used to measure heart rate continuously. A transmitter belt is fastened around the chest while the watch is held by a nearby observer. If at any time during the experiment the heart rate exceeds the predetermined ceiling (85% of age-predicted max heart rate) the experiment should be stopped immediately.
In an earlier study, we found that in order to detect signs of OTS and distinguish them from normal training responses or FO, this method may be a good indicator not only of the recovery capacity of the athlete but also of the ability to normally perform the second bout of exercise.10 The test could, therefore, be used as an indirect measure of hypothalamic–pituitary capacity. It was hypothesised that on the NFO–OTS continuum, a hypersensitivity of the pituitary is followed by an insensitivity or exhaustion afterwards.10 22 Results from the present study confirm this hypothesis. The NFO athletes showed a very high response to the second exercise bout, at least in ACTH and PRL, whereas the OTS athletes showed suppression.
Bodyrock.tv is one of the forerunners in online fitness. This popular health and exercise blog is dedicated to weight loss, fitness, beauty, food, love and relationships. "Bodyrockers" find daily workouts that are either laid out with descriptions and pictures, or that are instructed in video format. All of the workouts can be done at home with minimal equipment.
Jump up ^ Rhodes, J. S; Van Praag, H; Jeffrey, S; Girard, I; Mitchell, G. S; Garland Jr, T; Gage, F. H (2003). "Exercise increases hippocampal neurogenesis to high levels but does not improve spatial learning in mice bred for increased voluntary wheel running". Behavioral Neuroscience. 117 (5): 1006–16. doi:10.1037/0735-7044.117.5.1006. PMID 14570550.
Take the stairs. You know, some people pay to use stairs (read: they buy a stair stepper machine), so if you work or live above the first floor, consider using your stairs as a privilege. Using the stairs is great cardiovascular exercise, and also tones your calves, hamstrings, glutes, quadriceps, and abs. Next time you're about to take the elevator or escalator, take the stairs instead. If you have some time to spare, take an extra trip up and down. Or, try a stair-based workout like this one.
14.  If you don't feel like working out, don't! Listen to your body. Just because it's your "scheduled day" doesn't mean you must work out. If your body is taking a little longer to recover than usual, so be it. It won't hurt you to lay off for an additional day or two; you will not lose anything you've gained. If your body isn't ready, it's better to skip days than to work out anyway. Every seven days is only a target (some people have found every eight or nine days reap the same benefits).

This gymnastics move is for the advanced CrossFitter. Hailing from gymnastics, the ring muscle-up is one of the hardest moves a CrossFitter can complete. HOW TO DO IT: Start with either a false grip or regular grip. For the false grip, hook your wrists into the ring. This position, while uncomfortable, shortens the lever of the arm, creating less distance for you to travel. Most CrossFitters kip this move because of its degree of difficulty, but it can be done strict as well. Swing your body back to gain momentum and thrust your hips into the air while pulling with all your upper body strength (similar to a pull-up) so that the body raises to ring height or above. Always keep the rings as close to your body as possible to have the most control and strength on the rings. Once you are at ring height, quickly push your head and chest through the rings into a dip position. Then push up out of the dip position with a kip from the legs or from strict strength. MUSCLES USED: Back, shoulders, core and triceps.


To start toning your abs by hitting up the lower abdominal muscles, Riggins suggests 30 seconds of leg raises. Here’s how: Turn on your back with legs straight and your feet and ankles together. Raise your legs up and down in a vertical position from your body, while keeping your belly button. Slowly bring legs back down, but if that is too difficult, tuck your knees. (And be careful not to strain your lower back!)

Equipment Needed? – Some exercise videos require equipment so this is something you will want to know ahead of time. Don’t wait until you buy the video, get it home and get ready to work out only to find out that you don’t have the stability ball or rubber bands required. Any equipment needed will be on the video case. Examples of equipment sometimes required in exercise videos are:
You’ve been cleared to exercise but now what? Don’t worry, we’ve got you covered. Our expert guidance will provide you with the foundational strength needed to get you feeling like yourself again while adding an angle of rehabilitative care to re-connect, heal, & re-strengthen your postpartum body. We will safely progress you through exercises that are meant to challenge your body and stimulate your mind while gearing you up to be the strong mom you’re aiming to be. We guarantee that with our training, your fitness regimen will be more effective than ever before.
For active types, nagging injuries nag a little louder; hard workouts deplete you a bit more. For serious recreational athletes, performance begins to drop, even if you maintain your training regimen. Whatever your sport of choice — be it distance running, competitive cycling, or pick-up basketball — you can expect your performance to plateau and recovery to take a bit longer.
Strength (or “weight”) training exercises build muscle. One’s body naturally grows muscle until the age of 25. As we age, our body progressively loses muscle— unless you make an effort to maintain or build it. Strength is good for everyone, regardless of gender or age and helps in everyday activities. Muscle mass can significantly decrease your chances of obesity, diabetes, cancer, and osteoporosis. Gender does not affect one’s ability to grow muscle, but men can develop more muscle mass than women because men naturally have a higher percentage of lean muscle. Women, you will not turn into the Incredible Hulk by strength training — I say this because many women don’t do strength training out of a fear of getting “big.” I wish it were that easy!
I've always wanted to try out the trendy fitness classes at Physique 57 in NYC, but they run a pretty penny. Now, the infamous Physique 57 technique (certain muscles are targeted, overloaded to point of fatigue and then stretched for relief) is available to all in this 30-minute workout. It was just enough to make me realize why people are obsessed with the classes and left me — especially my glutes — sore the next day.
Around 1900, Tasmanian-born Australian professional reciter and theatrical producer Frederick Alexander developed a novel methodology to harmonize full-body functional movements. As a child, Alexander suffered respiratory ailments, leading to the initial purpose of developing the method – to normalize his personal voice function in order to materialize a stage performance dream. In 1902, Alexander established the Sydney Dramatic and Operatic Conservatorium and in 1904, moved to London to spread his teaching method. During the first years, Alexander focused on teaching ‘full chest breathing’ techniques mainly to stage artists and people with breathing pathologies.19 Staring J. Frederick Matthias Alexander 1869-1955. The Origins and History of the Alexander Technique. A medical historical analysis of F.M. Alexander’s life, work, technique, and writings. Nijmegen: Radboud Universiteit; 2005. [Google Scholar] However, he soon discovered that retrieving the natural ‘conscious control’ via mindful postures and movements resulted in benefits not only for the vocal health and performance but also the health and performance of the whole body and mind.20 Alexander FM. Man's supreme inheritance. London: Methuen; 1910. [Google Scholar] This holistic evolvement transformed the newly formed ‘Alexander Technique’ into a general remedy and preventative tool suitable for all populations. Alexander explained in his 1910 book ‘Man’s Supreme Inheritance:’20 Alexander FM. Man's supreme inheritance. London: Methuen; 1910. [Google Scholar]
Whenever I’m feeling overwhelmed and super busy, the first thing that always falls off my schedule is hitting the gym—even though I know making the extra time to sweat it out will make me feel better and more centered. But I’ve realized that you can always find a way to prioritize the things that matter, even if you have to get creative with the way you fit them in.
Stuck in the strength training doldrums? Our best piece of fitness advice is that "Variety is key." Greatist has shared all sorts of ways to take workouts from "hum drum" to "hot stuff." We're now turning our eye to eight effective strength training techniques. So grab that workout log and a pen, because here are some great ways to challenge the status quo and add a little variety to the normal gym routine.
The severity of angina and the effects of therapeutic interventions in patients with coronary artery disease have been assessed by determining changes in both exercise performance and the triple product (TP) of heart rate, systolic pressure, and ejection time occurring at angina. However, the validity of conclusions based on such changes is uncertain since the effects of different exercise protocols on these variables have not been determined. Twelve patients with angina were studied during upright bicycle exercise; repeated bouts of exercise using a standard protocol of 20-w increments every three minutes produced no consistent changes in TP at angina. When exercise began 20 to 60 w above the work load of the standard protocol that produced angina, exercise capacity was reduced (average 1'40'' vs. 4'40'', P < 0.001), and triple product at angina exceeded control anginal values (average 4,840 vs. 4,150, P < 0.001). In the control studies nitroglycerin (TNG) and carotid sinus nerve stimulation (CSNS) enabled patients to exercise to a higher level, although the triple product at angina was unaltered. However, at the higher work load TNG and CSNS exerted only minimal effects on exercise capacity, indicating that if the work load is excessive, a reduction in myocardial oxygen consumption produced by a therapeutic intervention may be comparatively minor so that a potentially salutary effect would be masked. We conclude that work loads causing angina in less than three minutes cannot reliably be used for studying the effects of therapy. However, if progressive work loads are chosen which cause angina in the control studies in three to six minutes, exercise capacity and triple product at angina provide important information about the efficacy and mechanism of action of a therapeutic intervention.
Burpees: One of the most dreaded moves in fitness, burpees make up a cornerstone of CrossFit workouts. Starting from standing, athletes bend down and plant their hands, kick back into a plank position, and perform a push-up. The legs are then brought back in, and the movement culminates with a slight jump up and hands clapped overhead. (The feet have to leave the ground for it to count!) Now repeat 100 times, just for funsies.
Amazing workout but it takes hard work and serious dedication! THE hardest workout Ive done, hands down. I never thought a dvd workout you see on late night infomercials would be legit, but this is seriously no joke. If you want your body in serious shape fast and youre willing to make the life changes, this will work! Keep going and just dont stop! Life changing product!
Simply put, progressive overload means that you are consistently lifting or pulling a little more each week (or progressively on a schedule that aligns with your capacity). Lifting weight will break down your muscles. However — and this is where the magic happens — when the muscles grow back, they grow back stronger, but only if you are subjecting them to progressive overload.

Yoga, which when translated from Sanskrit means “to control” or “to unite,” is said to have originated in India thousands of years ago. While its origins are based upon religion, many yoga classes today focus more on the connection between mind, body and spirit and achieving a balance within the body. Yoga concentrates heavily on body awareness, breathing and stretching.

Length of the Workout – How long is the workout on the video you are looking to get? If you want to work out 30 minutes a day, getting an exercise video that is 60 minutes long will only cause frustration. Most people don’t want to do half a workout and since they are designed to include a warm up, workout and cool down, only watching half gives you an incomplete workout.


Stability moves train your core to stay strong and steady. They also target your transverse abdominis, the deep ab muscle that does a 360 around your waist and draws it in, says Brent Brookbush, president of the Brookbush Institute of Human Movement Science in New York City. Try this stabilizer: Hold a dumbbell in your right hand and balance on your left leg. Squat on your left leg as you lower the weight toward your left foot. (More moves to try: grab a Bosu ball and challenge your core with this stability workout. Or you can snag one of these balance boards to work on your core as you watch your favorite TV show.)

This is the first study that has followed older adults instructed to perform MCT or HIIT over a one-year period, collected data from each exercise session they performed and provided important knowledge about their exercise patterns. This novel information may help researchers and clinicians to develop tailored exercise programs in an ageing population.
I'm a professional weight loss coach and was chosen as "Canada's Top Fitness Professional." Each of my workouts found at makeyourbodywork.com will challenge your entire body and will include elements of cardio, strength, and core conditioning. The uniqueness of these workouts are the "difficulty levels" that provide up to four distinct options for every single move. This makes each workout very accessible for newbies, yet challenging for super-fit users.

Wall sit while you brush your teeth. You should be brushing your teeth for two minutes at least twice a day, so take advantage of that precious time by doing some wall sits. At first, you'll probably only last for around 20 seconds, but make it a goal to work up to wall sitting for the whole two minutes that you're brushing your teeth. You might surprise yourself!
Your heart rate refers to how many beats per minute (BPM) your heart is pumping, and when it comes to working out, knowing your heart rate can help determine if you’re working at the right intensity. You have your resting heart rate, which is how fast your heart is beating when you’re doing nothing (the best way to measure this is to take your pulse first thing in the morning). Generally speaking, this gets lower as you get more fit because your heart doesn’t have to work as hard to pump out blood (although if you have a naturally low resting heart rate thanks to genetics, it may not get much lower, and that’s totally fine, says Lefkowith). According to the American Heart Association, the average is 60-100 BPM. You also have your maximum heart rate, which is the hardest your heart can work efficiently.
The baseline characteristics of the study participants are presented in Table 1. No differences between the training groups existed at study entry. In both groups, men spent more hours in sedentary behavior and had significantly higher weight, height, and VO2peak compared to women. Contrary, more women than men performed at least 30 min of daily physical activity (Table 1). The included participants had higher VO2peak (11%) compared to those with no exercise logs. They also had higher VO2peak (17%) and height (1.7%) compared to dropouts, but a lower BMI (3.7%) (p < 0.05). A higher proportion of the included participants performed 30 min of daily physical activity compared to the dropouts (77.3% vs. 66.1%, p < 0.05).
Also, my favorite workouts might not be yours. “It's like asking someone for the best musician, or the best craft beer,” says Daniel Freedman, co-founder of online fitness site, BurnAlong. He recommends trying several of the apps out to see which one works best for you. “Who is going to inspire you?” Freedman says, “find who you'll stick with week in and week out.”
The exercise videos became a series, and Fonda eventually released 23 workout videos. Fonda's exercise videos were such a success because they were the first media of their time to send the message that it was socially acceptable for women to participate in exercise culture and become muscular. Fonda's videos also helped to spark the aerobic exercise trend of the 1980s, not to mention the period's iconic fashion trend: a neon exercise outfit with a leotard and leg warmers. The aerobic exercise craze became so widespread that a Muppets parody tape titled Miss Piggy's Aerobique Exercise Workout Album was released in 1982. The album cover featured Miss Piggy in a Fonda-esque exercise outfit, complete with leg warmers and a leotard, in a pose imitating that which was famously modeled by Jane Fonda on the cover of her first tape.
I've given this program a good 6 weeks so far. I'm 5-10 pounds overweight with some physical issues and a history of car crash injuries. I have a medical degree and a background in nutrition and fitness with several years of yoga (various disciplines) under my belt. Overall, I do like the program, but there are some VERY important things you should know before purchasing and participating..
The plank is a yoga position that is basically a push up at the top of the action; you're suspending your body in a straight line from your toes while holding your body at an incline with your arms pressing straight up from the ground. Better yet, you're squeezing your abdominal muscles while you're holding the position. This works the transverse abdominis, the deepest-lying of the abdominal muscles. Though not visible, strengthening it will enhance your core stability and posture, both of which add to the effect of an upright profile.
Cross-training means mixing in different workouts and training methods rather than focusing on just one type of workout. Not only does this help create a well-balanced fitness plan, but it can help you reach specific goals, too. For example, if you’re getting ready to run a race, you’ll want to cross-train with strength and yoga workouts, which will complement your running and help improve your performance and decrease the chance of injury by building muscle and increasing flexibility. “If you only include one form of training, you may be holding yourself back from the results you deserve,” says Lefkowith.

For Ready-Made or Make Your Own Workouts: Fitness Builder (iPhone or iPad)- This is one of my favorite exercise apps, offering a variety of ways to exercise. You can choose workouts based on the equipment you have, the muscle groups you want to work or the type of workout you're looking for. There are a range of ready-made workouts and you can also create your own workouts from the amazing database of exercises included.
The snatch is one of the two current olympic weightlifting events (the other being the clean and jerk). The essence of the event is to lift a barbell from the platform to locked arms overhead in a smooth continuous movement. The barbell is pulled as high as the lifter can manage (typically to mid [ chest] height) (the pull) at which point the barbell is flipped overhead. With relatively light weights (as in the "power snatch") locking of the arms may not require rebending the knees. However, as performed in contests, the weight is always heavy enough to demand that the lifter receive the bar in a squatting position, while at the same time flipping the weight so it moves in an arc directly overhead to locked arms. When the lifter is secure in this position, he rises (overhead squat), completing the lift.

The severity of angina and the effects of therapeutic interventions in patients with coronary artery disease have been assessed by determining changes in both exercise performance and the triple product (TP) of heart rate, systolic pressure, and ejection time occurring at angina. However, the validity of conclusions based on such changes is uncertain since the effects of different exercise protocols on these variables have not been determined. Twelve patients with angina were studied during upright bicycle exercise; repeated bouts of exercise using a standard protocol of 20-w increments every three minutes produced no consistent changes in TP at angina. When exercise began 20 to 60 w above the work load of the standard protocol that produced angina, exercise capacity was reduced (average 1'40'' vs. 4'40'', P < 0.001), and triple product at angina exceeded control anginal values (average 4,840 vs. 4,150, P < 0.001). In the control studies nitroglycerin (TNG) and carotid sinus nerve stimulation (CSNS) enabled patients to exercise to a higher level, although the triple product at angina was unaltered. However, at the higher work load TNG and CSNS exerted only minimal effects on exercise capacity, indicating that if the work load is excessive, a reduction in myocardial oxygen consumption produced by a therapeutic intervention may be comparatively minor so that a potentially salutary effect would be masked. We conclude that work loads causing angina in less than three minutes cannot reliably be used for studying the effects of therapy. However, if progressive work loads are chosen which cause angina in the control studies in three to six minutes, exercise capacity and triple product at angina provide important information about the efficacy and mechanism of action of a therapeutic intervention.
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