This research has revealed a forgotten chapter in recent history of physical rehabilitation, medicine, and sports. Independent MMB methods have enjoyed celebrated success since 1890 and the exercises have changed the lives of millions of individuals, from common citizens to athletic performers, celebrities and Royalty. The MMB methods have provided immense personal hope and also national pride, however, to date, they have not been communally recognized as an official clinical tool or as an independent sporting category. As the scope of this paper was limited to readily available published documents, resorting at times to third-source century-old information, it is hoped that the publication will instigate further investigations to the origins of MMB methods and the general history of movement-harmonizing exercises. As the six MMB pioneers were presented in this paper as part of a broad historic movement, it is expected that future research will expose multiple other like-minded exercise methods that were developed during the same era and in similar circumstances. This will provide current MMB educators and practitioners with a wealth of information and new angles of approach that remain applicable today. To support the official healthcare identification of MMB methods as an independent activity category besides aerobic training and weightlifting, high quality research through both prospective randomized and blinded investigations along with subsequent systematic reviews and meta-analysis will eventually be required. Standardized baseline measures and criteria will be needed with external standards including functional status outcomes and appropriate statistical analysis. As an independent category, the communal value of MMB methods can be validated scientifically and accepted as evidence-based healthcare.
Endurance performance (i.e. exercise duration > 1 min) is extensively studied in exercise physiology using cycling and/or running exercise (e.g. [1–4]). Despite being close to real competition events by involving the whole-body, the use of cycling and/or running exercise presents some important limitations to understand the role of the central nervous system (CNS) in the regulation of muscle fatigue and endurance performance. Indeed, as whole-body exercise involves greater systemic responses than isolated exercise [5], it is difficult to interpret some specific experimental manipulations aiming to understand CNS processes regulating muscle fatigue and endurance performance (e.g. manipulation of III-IV muscle afferents [6, 7]). Furthermore, due to the need to transfer the participant from the treadmill/bicycle to the ergometer, the true extent of muscle fatigue at exhaustion is underestimated [8], leading to inconclusive results on how peripheral (i.e. fatigue produced by changes at or distal to the neuromuscular junction [9]) and central (i.e. decrease in maximal voluntary activation level [9]) components of muscle fatigue might interact between each other’s (for review see [2, 9]). Therefore, due to the aforementioned limitations, the development of a new exercise model is required to better investigate the CNS processes regulating endurance performance.
A simple example of an eccentric contraction is to hold something in your hand with your elbow bent. Slowly allow your elbow to straighten out while holding the weight.  You can visualize your bicep muscle lengthening as you are holding the weight while you are slowly straightening your elbow.  This is an eccentric contraction or eccentric loading of your bicep muscle.
The exercises developed by Checkley, Müller, Randell, Alexander, Pilates, and Morris were secular in nature. The holistic unity between harmonious movements and beauty, health, performance and youth, between the body and mind, and between human and nature were all emphasized yet these universal concepts were unimpeded by religious, political, or commercial influences. The exercises were simply harmonious functional human movements learned from observations of nature.
Include strength training at least 2 days per week. Also known as resistance training, strength training involves using free weights, resistance bands, or your own body weight to strengthen your muscles. If you’re just starting out, try doing upper and lower body workouts 1 day a week each. In time, gradually work your way up to including 3 to 4 strength training days in your weekly routine.[4]
Your body clock, that is. Try to work out at the time you have the most energy, suggests Jason Theodosakis, MD, exercise physiologist at the University of Arizona College of Medicine. If you're a morning person, schedule your fitness activities early in the day; if you perk up as the day goes along, plan your activities in the afternoon or evening.
I read "Superslow: The Ultimate Exercise Protocol" back in 2000. Then relatively new to learning about exercise and bodybuilding I found it to be a truly fascinating and very challenging read. Not only was the material challenging in the intellectual sense but also in a philosophical sense. It was turning much of what I believed about "exercise" upside down. So meatheads and gym-rats be warned, "Superslow" is a highly technical book that the typical bodybuilder or exercise enthusiast would find "boring" (see other reviews here on Amazon) because it isn't full of ridiculous promises about gigantic, ripped muscles and marketing jargon for selling supplements. What it is is a very thorough analysis of the variety of benefits one can derive (regardless of their limited genetics) from properly performed exercise and the many proven pitfalls associated with a low-intensity and high workload/volume. The book also provides an in-depth history lesson on the continually evolving refinements to Arthur Jones' Nautilus principles. Hutchins' dogged determination to continually seek a safer and more effective way for people to exercise is admirable and shows his devotion to sound scientific principles.
I must confess: the title of this section is misleading, because while most of us associate the first home workouts with fitness icons Jane Fonda and Richard Simmons, they were not the first ones to bring workouts inside our homes. In fact, before there were VHS tapes, before there were even televised workouts, there were the audio-only vinyl record workouts, nicknamed vinylcise.
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].
Rotator cuff impingement syndrome (RCIS) is a multifactored disease that can lead to functional limitations and an inability to participate in work, leisure, and sporting activities. This syndrome can be caused by many factors, such as weakness of the rotator cuff and periscapular muscles, decreased pectoral and rotator cuff muscle flexibility, abnormal motion patterns, extrinsic factors (eg, vibration exposure, use of hand tools, work-station height), and trauma. Kuhn provided a valuable synopsis of randomized controlled clinical trials in which the benefit of exercise for individuals with RCIS was examined. Substantial evidence1 exists to support the use of exercise for the management of this patient population. In addition, manual therapy has been shown1 to augment the effectiveness of exercise. However, we believe it is premature to label the proposed rehabilitation protocol as a criterion standard because of the lack of specific exercise descriptions, variability in the exercise programs, and inability to separate the effects of specific exercises on the measured outcomes that Kuhn noted. Furthermore, because RCIS is multifactored, use of the same exercise protocol to treat everyone with RCIS might not be the best standard of care.
Now that you understand the vast amount of categories available to you, you can start narrowing the field of choices down by looking at the specifics of exercise videos and deciding which ones will be something you will not only enjoy but continue to use long term. If you are starting out as a beginner to exercise, then you should expect to upgrade your exercise videos as your fitness levels increase. You don’t have to stay with a beginner video when your fitness level advances to intermediate or advanced. Below are some factors to look at when looking at individual videos.

How was it discovered that there is no such thing as an overall, general, cardiopulmonary fitness? Out of shape college kids were recruited for a study where they trained on a stationary bike for 90 days, but only one leg did the pedaling. Before they started training, their VO2max was tested, first using both legs, then only the left leg, and then just the right leg. (VO2max is a measurement of cardiopulmonary efficiency.) As you might imagine, all three results were the same. Then one leg was worked out for 90 days on the bicycle; the other leg got to continue to be a couch potato. At the end of the 90 days, you could tell by looking which leg had been exercised. Now for the revealing part. When VO2max was tested for the leg that had been trained, its VO2max improved as expected. But what do you think happened when the unexercised leg was tested? Do you think its VO2max also improved along with the other leg, or do your think there was no improvement. It's shocking how many personal trainers and exercise physiologists that I put this question to got it wrong. There was no improvement. Proving that cardiopulmonary efficiency is muscle specific. This means that when you get less winded, and your heart rate no longer rises as much after you've trained to do something, it's not your heart or lungs that accounted for the improvement, it's the muscles involved.
After trying many different workout "schemes" with limited success, I bought this book and began doing Super Slow workouts. I'm now working out 6 times a month, spending less than 30 minutes in the gym for each workout, and I'm stronger than I've ever been. I've never experienced progress like this before. At 45 years old, my leg press has gone from 400 to 820 lbs. in a couple of months. The workouts aren't easy, but they're over quickly, and I'm able to spend more time with my family without feeling like I'm compromisng my health and fitness.
The Canadian Society for Exercise Physiology has published "The Canadian Physical Activity, Fitness & Lifestyle Approach", which details fitness assessment protocols. One such protocol, the mCAFT, is designed to give information about the aerobic fitness of a person, while using minimal equipment. The subject works by lifting its own body weight up and down double steps (40.6 cm in height total) while listening to set cadences from a compact disc. The end-stage of the age and gender specific stepping rate requires 85% of the age-predicted maximum heart rate. The heart rate increases approximately in a linear fashion from 50% to 100% of maximal oxygen intake. The heart rate does not decrease significantly during the first fifteen seconds of recovery. Thus, one can predict an aerobic fitness using the heart rate right after exercise of a known sub-maximal rate of working.
Lauren Duhamel, a trainer for modelFIT says doing 30 seconds of sumo squats will transform the glutes and inner thighs. “Take a wide stance with your feet turned out instead of facing straight forward. Keep all your weight on your heels and slowly bend your knees and sit your booty back and down,” she explains. “Then, press back up without locking out your knees. Do ten of these then hold in a low squat for ten seconds.”
I have used the standard protocol (10 seconds plus or minus two for both concentric and eccentric contractions) of this method, although sometimes I prefer going a bit faster such as 4/4, 6/6 or 8/8 seconds respectively. It is not easy and even a bit painful to do a single set of each exercise and "inroad" the muscles. Moving from machine to machine between exercises with no rest, one experiences tremendous cardio-respiratory workload (experiences counterpulsation due to very large venous return to the heart) and some feel extreme fatigue when finished. A workout can last as little as 10-12 minutes, based on 5 basic compound exercises (ie: ankle raise, trunk extension, squat, shoulder or chest press, pulldowns), and personally, I found I needed 2 workouts/week in order to achieve the strength gains I desired. Some think only one session per week is needed and I believe this is a personal and time management choice.
For variety, convenience, and more structured home exercise, you can't beat exercise videos. There are workouts for every age, gender, goal and interest and you can workout anytime you like in the privacy of your own home. The best thing about exercise videos: There are thousands upon thousands to choose from, so almost anyone can find a video they like. The worst thing about exercise videos: There are thousands upon thousands to choose from, making the search for the perfect video an overwhelming process.
Active recovery is recommended after participating in physical exercise because it removes lactate from the blood more quickly than inactive recovery. Removing lactate from circulation allows for an easy decline in body temperature, which can also benefit the immune system, as an individual may be vulnerable to minor illnesses if the body temperature drops too abruptly after physical exercise.[142]
Tabata training is a form of high-intensity interval training. It consists specifically of eight rounds of high-intensity exercise using a 20 seconds on (at full capacity) and 10 seconds off (rest) format. The goal is to push yourself as hard as you can during the 20 second on period. Tabata only requires one exercise, but you can combine different strength and aerobic exercises to make your own Tabata routine. Here’s a simple example of Tabata for one exercise:

Jump up ^ Silverman MN, Deuster PA (October 2014). "Biological mechanisms underlying the role of physical fitness in health and resilience". Interface Focus. 4 (5): 20140040. doi:10.1098/rsfs.2014.0040. PMC 4142018. PMID 25285199. Importantly, physical exercise can improve growth factor signalling directly or indirectly by reducing pro-inflammatory signalling [33]. Exercise-induced increases in brain monoamines (norepinephrine and serotonin) may also contribute to increased expression of hippocampal BDNF [194]. In addition, other growth factors—insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor—have been shown to play an important role in BDNF-induced effects on neuroplasticity [33,172,190,192], as well as exerting neuroprotective effects of their own [33,214,215], thereby contributing to the beneficial effects of exercise on brain health.


Perhaps one of the best benefits of barre is that it’s fun! It incorporates the use of upbeat music and engaging choreography. When working out is fun and enjoyable, your chances of staying with the program greatly increase. The barre method also offers quick results. Barre helps strengthen and tone your muscles without increasing bulk, and it improves your posture. It also increases cardiovascular endurance and metabolism, which helps to quickly burn calories.

Go online for more information, recommends certified personal trainer Paula Zurowski. Web sites like collagevideo.com or Zurowski's exercisevideosreviews.com offer detailed descriptions and ratings of fitness videos. Collage even offers a one-minute clip of most videos, so you can get a feel for the level of the workout and whether you're going to like the instructor.
One way repeated ANOVA was used to compare time to exhaustion between sessions (S1, S2 and S3). Relative reliability was calculated with the intraclass correlation (ICC) model (3, 1) [27]. Absolute reliability was calculated with the typical error of measurement (the standard deviation of the change scores divided by [28, 29]). Bland and Altman’s 95% limits of agreement were also used (calculated for S1 vs S2, S1 vs S3 and S2 vs S3) as an additional representation of measurement error and to identify the presence of heteroscedasticity [19]. As data were heteroscedastic, both raw data and log transformed Bland and Altman’s plots are presented. Limit of agreement ratio (LOA) was also calculated from the log transformed data as follow: LOA = (1.96 × SDdiff / grand mean) × 100; where “SDdiff” represents the SD of the differences between tests (S1 vs S2, S1 vs S3, S2 vs S3) and “grand mean” represents (mean S1 + mean S2 + mean S3)/3. As time to exhaustion data were heteroscedastic, we also calculated the coefficient of variation (CV) for each subject as follow: CV = 100×(SD of the three measurements)/(mean of the three measurements). Mean CV for all subjects were also calculated. We also calculated the smallest worthwhile change (0.2 × between subjects SD) [21].
Matt Sauerhoff, owner of The LIV Method says one of his favorite, fastest and easiest to do on the go moves is the wall squat. “Start with your back against the wall and your heels about a foot off the wall. Bend your knees and slide down the wall until your legs create a 90-degree angle,” he says. “Make sure your knees are aligned over your toes/laces. Press heels into the floor and focus on contracting your abs, pressing lower back into the wall so it’s flat. Hold for 30 seconds.” Combine it with these 30 Fat-Burning Foods and you’ll be melting the fat in no time!

Just shy of an hour long, this video is a killer aerobic kickboxing workout. You’ll throw punches and kicks in supercharged sequences as you follow along with the ebullient Billy Blanks. Don’t be surprised if you start talking back to the screen, especially when Blanks looks straight into the camera and declares, “I see you at home! Keep going!” Talk about motivation.
Major variants: reverse ~ (curling the pelvis towards the shoulders), twisting ~ or side ~ (lifting one shoulder at a time; emphasis is on the obliques), cable ~ (pulling down on a cable machine while kneeling), sit-up ~ (have [chest] touch your knees), vertical crunch (propping up to dangle legs and pulling knees to the [ chest] or keeping legs straight and pulling up legs to a 90 degree position). Reverse hanging crunch (using gravity boots or slings to hang head down and pulling to a 90 or 180 degree form)
Jump up ^ Lees C, Hopkins J (2013). "Effect of aerobic exercise on cognition, academic achievement, and psychosocial function in children: a systematic review of randomized control trials". Prev Chronic Dis. 10: E174. doi:10.5888/pcd10.130010. PMC 3809922. PMID 24157077. This omission is relevant, given the evidence that aerobic-based physical activity generates structural changes in the brain, such as neurogenesis, angiogenesis, increased hippocampal volume, and connectivity (12,13). In children, a positive relationship between aerobic fitness, hippocampal volume, and memory has been found (12,13). ... Mental health outcomes included reduced depression and increased self-esteem, although no change was found in anxiety levels (18). ... This systematic review of the literature found that [aerobic physical activity (APA)] is positively associated with cognition, academic achievement, behavior, and psychosocial functioning outcomes. Importantly, Shephard also showed that curriculum time reassigned to APA still results in a measurable, albeit small, improvement in academic performance (24).  ... The actual aerobic-based activity does not appear to be a major factor; interventions used many different types of APA and found similar associations. In positive association studies, intensity of the aerobic activity was moderate to vigorous. The amount of time spent in APA varied significantly between studies; however, even as little as 45 minutes per week appeared to have a benefit.

The aims of the present study were to assess the reliability of a novel high intensity OLDE protocol to measure muscle endurance, and to describe the isokinetic muscle fatigue induced by high intensity OLDE and its recovery. We demonstrated that our novel high intensity OLDE protocol can be used as a reliable measure of muscle endurance, and that isokinetic muscle fatigue recovers and plateaus within ~ 30 s following exhaustion. Therefore, the novel high intensity OLDE protocol tested in this study might provide an interesting tool to investigate muscle fatigue and muscle endurance.


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.
Jump up ^ Möhlenkamp S, Lehmann N, Breuckmann F, Bröcker-Preuss M, Nassenstein K, Halle M, Budde T, Mann K, Barkhausen J, Heusch G, Jöckel KH, Erbel R (200). "Running: the risk of coronary events : Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners". Eur. Heart J. 29 (15): 1903–10. doi:10.1093/eurheartj/ehn163. PMID 18426850.

It's hard to pinpoint the first time exercise appeared visually on-screen—meaning on film or video, something that you could see, as opposed to hear—but one of the earliest is the 1928 film Exercise: A Film Lesson in Health and Hygiene. It isn't exactly instructional, but features a bunch of boy scouts showing off some rather bizarre group exercise routines. Check out the bit that starts around 1:22, where they ride each other like human chariots. Anyhow, this film is significant in that its primary purpose is to display and broadcast forms of exercise to an audience, and it seems to be the first to have done so.


Mix-and-match interval training works magic in Natalie Jill's Rev4 Rev It Up. The four 10-minute routines hit different trouble zones so you can do them as stand-alones—"I definitely felt I got a good workout after each," one tester said—or combine them for a total-body session. Testers loved that they could "switch things up for time-pressed mornings" and gave props to instructor Jill's "nice energy." Expect a variety of planks and booty-shaping moves.
Start by lying on your back with your feet flat on the floor and your head resting in the palm of one hand and the other hand reaching toward your knees. Press your lower back down. Contract your abdominal muscles (abs) and in one smooth move, raise your head, then your neck, shoulders, and upper back off the floor. Tuck in your chin slightly. Lower back down and repeat.
Hormonal responses to the two exercise bouts are presented in fig 4A–D. Visual inspection led to the conclusion that there are no differences in relative cortisol response between the NFO and the OTS group. ACTH, PRL and GH responses are higher in the NFO group compared with the OTS group, especially in the second exercise bout. However, the SE of GH in the NFO group was probably too large to draw clear conclusions. Indeed, the main effect of group gave an F ratio of F1,7=1.4 for GH. For ACTH and PRL, F ratios were F1,7=5.1 and F1,6=14.7, both significant at p<0.05, confirming larger responses for the NFO group. Visual inspection led to the conclusion that this larger response was much more pronounced after the second exercise bout. Indeed, parametric results pointed in the direction of an interaction effect between test and group for ACTH and PRL (F1,7=4.1; p=0.084; F1,6=4.0; p=0.092).

It features 12 different 30-second exercises, with five seconds of rest in between. It’s great for beginners and athletes, syncs with your iPhone Health App to take your other daily movement into account, and the workout library has 22 presets that you can customize to create thousands of variations. You can swipe right or left during the exercises to see how much time you have left, watch the instructor, or listen to music from your iTunes.
We’ve gone on the record with our love of MMA conditioning exercises, and that’s why we bookmarked this video. Even the warm-up is jam-packed with explosive movements that’ll get your heart pumping (think high knees and walking front kicks). And once you move into the actual workout, you’re in for even more high-energy exercises, like hopping front kicks, that are sure to condition your body from head to toe.
DC-based personal trainer Chris Perrin says to do hip bridges if you want to get your derriere round and toned. “Lie on the floor. With bent legs, place both feet flat on the floor. Both arms down, hands on each side of your hips,” he explains. “Raise your low back off the floor by pushing through the heels of the feet. Once your hips are at their highest point—without straining your back—pause and return your lower back to the floor.” And squeeze those glutes the entire time!
Stand with feet shoulder-width apart. Lift right leg straight back and up; at same time, hinge at waist and bring hands or fingertips to floor in front of left foot. Bend both knees, bringing right knee behind left knee. Press back up through left foot to return to previous position. Do 15 reps, keeping leg raised, then switch sides and repeat. Do 3 sets.
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.
When you go to purchase an exercise video, check the description to see if they offer anything else along with it. Many videos come with nutrition plans, workout calendars or journals, quick start guides and other bonuses that help the user get the most from their purchase. Some exercise videos have access to online tools as well such as websites and support forums that users can participate in. Don’t let the bonuses overshadow the importance of the video being what you want and need, but having these extras is always a nice bonus.

Begin this starter sit-up with your legs straight in front of you. Extend your arms over your legs and lower your head between your arms. Curl backward, bending your knees, and stop halfway down. Raise your arms straight up and pull your abs in tightly. Exhale and lower your arms as you curl back up. Do 6-8 reps at a moderate pace. As you become more advanced, try lowering all the way to the floor.
Stretching helps maintain flexibility. We often overlook that in youth, when our muscles are healthier. But aging leads to a loss of flexibility in the muscles and tendons. Muscles shorten and don't function properly. That increases the risk for muscle cramps and pain, muscle damage, strains, joint pain, and falling, and it also makes it tough to get through daily activities, such as bending down to tie your shoes.
Jump up ^ Gomez-Pinilla F, Hillman C (January 2013). "The influence of exercise on cognitive abilities". Compr. Physiol. 3 (1): 403–428. doi:10.1002/cphy.c110063. ISBN 9780470650714. PMC 3951958. PMID 23720292. Abundant research in the last decade has shown that exercise is one of the strongest promoters of neurogenesis in the brain of adult rodents (97, 102) and humans (1,61), and this has introduced the possibility that proliferating neurons could contribute to the cognitive enhancement observed with exercise. In addition to BDNF, the actions of IGF-1 and vascular endothelial growth factor (VEGF) (54) are considered essential for the angiogenic and neurogenic effects of exercise in the brain. Although the action of exercise on brain angiogenesis has been known for many years (10), it is not until recently that neurovascular adaptations in the hippocampus have been associated with cognitive function (29). Exercise enhances the proliferation of brain endothelial cells throughout the brain (113), hippocampal IGF gene expression (47), and serum levels of both IGF (178) and VEGF (63). IGF-1 and VEGF, apparently produced in the periphery, support exercise induced neurogenesis and angiogenesis, as corroborated by blocking the effects of exercise using antibodies against IGF-1 (47) or VEGF (63).
Fibro-Girl’s Notes: As conditioning increases, using free weights can allow us to work up slowly in pushing weight and intensity. Using free weights requires focus and also allows us to control the "angle" at which we are pushing the weight. This is important, as many machines in the gym or fitness centers, are not fibro appropriate due to the "pushing angle"

Do you even lift, bro? While putting away groceries, do bicep curls with cans, bottles, or other objects. You can also try holding these objects above your head for ten seconds before putting them away. Alternately, when grocery shopping, opt for a basket instead of a cart when you can. You'll be working out your upper body without even thinking about it.


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.

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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