PRINTER EMULATOR FOR TESTING - The California State University


PRINTER EMULATOR FOR TESTING - The California State University
A Thesis
to the Faculty of
California State University, Chico
In Partial Fulfillment
of the Requirements for the Degree
Master of Arts
Patrick William Cottini
Spring 2012
I would like to dedicate my thesis to my parents, William & Constance
Cottini. Without their support and perseverance to accomplish this goal in life, I cannot
repay them enough. Throughout the many years that it has taken me to finish, and not
without having many trials and tribulations, they stuck by my side no matter how I was
feeling at anytime, they were always there!
I would also like to dedicate this to my late service dog Olly. She also helped
me in a large and small way by making sure I made it to the college on time by pulling
me as fast as she could go. Sometimes this was not always a good thing, knowing when I
needed her help without even asking her for it. I owe her my gratitude for not only
performing an amazing service to me, but also being my best friend. You are missed
I would like to first acknowledge my thesis chair Dr. John Azevedo. Without
his guidance, knowledge, time, effort, and dedication that he spends with graduate
students and their thesis projects, I would have not been able to achieve this goal by
finishing my thesis.
I would also like to acknowledge my thesis committee Dr. Tom Fahey for
always keeping a smile on my face no matter what the circumstance. Every time we
would end a conversation he would say “Ok My Boy.” I will always remember that. To
Dr. David Swanson, for always keeping me feeling that everything always had a way of
working itself out. He would always make me feel important when I would stop by his
office, he would acknowledge me by saying “Dr. Cottini.” I still do not know the reason,
but I never questioned him because of the way it made me feel. I want to also give my
thanks to a few of my fellow grad students Martin, for reminding me “it’s your thesis,”
Carmen for helping me at stressful times, and Alesha for her guidance using the statistical
computer software.
Last but definitely not least, I would like to thank Josie Cline for her
dedication to the Bewell program. Without it I would have not been strong and healthy
mentally nor physically to get through my masters program!
Dedication ..................................................................................................................
List of Tables .............................................................................................................
List of Figures ............................................................................................................
Abstract ......................................................................................................................
Statement of the Problem...................................................................
Operational Definitions......................................................................
Limitations .........................................................................................
A Review of Literature ...............................................................................
Summary ............................................................................................
Methodology ...............................................................................................
Subjects ..............................................................................................
Anthropometric Measurements..........................................................
Aerobic Capacity ...............................................................................
Statistical Methods.............................................................................
Results and Discussion ...............................................................................
Discussion ..........................................................................................
Summary, Conclusions, and Recommendations .......................................
Summary ............................................................................................
Recommendations for Future Research .............................................
Informed Consent Letter .............................................................................
Medical and Exercise History.....................................................................
Human Subjects Clearance Letter...............................................................
Post Data Collection Questionnaire ............................................................
1. Subjects Characteristics...................................................................................
2. Mean Data of Female and Male Subjects........................................................
1. Maximal Power Output (Watts) for All 10 Subjects Across All
Four Trials .................................................................................................
2. Power Output Mean Results, Makes and Female Subjects in All
Four Trials .................................................................................................
3. Mean Ventilatory Response of All Subjects ...................................................
4. Maximum Ventilation Rate (L/Min) in Make and Female Subjects
in All Four Trials.......................................................................................
5. Heart Rate Response in Males and Females ...................................................
6. Maximal Heart Rate for All Ten Subjects for All Four Trials ........................
7. Response of Oxygen Consumption with Power Output..................................
8. Absolute maximal oxygen consumption VO2max, (L/min) for
all ten subjects in all four trails .................................................................
9. Absolute Consumption (VO2max, L/min) in Male and Female
Subjects for All Four Trails.......................................................................
10. Scaled Maximal Oxygen Consumption Per Kilogram Body Mass
(VO2max, ml/kg min) of Male and Female Subjects Across All
Four Trials .................................................................................................
11. Scaled Maximal Oxygen Consumption Per Kilogram Lean Body
Mass (VO2max, ml/kg min) of Male and Female Subjects
Across All Four Trials...............................................................................
12. Mean of All Ten Subjects in All Four Trials of Maximal Oxygen
Consumption Plotted As a Function of Maximal Power...........................
Patrick William Cottini
Master of Arts in Kinesiology
California State University, Chico
Spring 2012
The purpose of this study was to find if hand position (pronated v. semivertical) and/or crank configuration (synchronized v. asynchronized) had any effect on
maximal performance. The four trials investigated were synchronous prone (SP),
synchronous vertical (SV), asynchronous prone (AP), asynchronous vertical (AV). To
that end, maximal performance of 10 subjects was assessed in each of the four trials (in
random order). Performance variables were maximal power output (POmax), ventilatory
response (VEmax), oxygen consumption (VO2max), heart rate (HRmax), and respiratory
exchange ratio (RERmax).
No differences were observed across the four trials for all 10 subjects or when
comparing the four trials for males only or females only. Males had significantly higher
POmax, VEmax and VO2max than females. However, HRmax and RERmax were not
different between males and females. Lastly, VO2max was highly dependent upon
It may be concluded that hand position and crank configuration have no effect
on maximal arm crank performance.
Arm ergometry was first used during World War II for testing and training
wounded soldiers (Vanlandewijck & Thompson, 2011). Today, arm ergometry and upper
extremity training is popular for building cardiorespiratory fitness in individuals with
disabilities who rely on their upper extremities for mobility.
Upper body training for aerobic with arm ergometry, typically uses
asynchronous, (ie, reciprocal) arm cranking (Mossberg, Willman, Crook, & Patak, 1999).
The asynchronous crank movement in arm ergometry studies evolved from leg cycle
ergometers placed on table tops. Synchronous arm cranking was first used in patients
with ischemic heart disease (Shaw et al., 1974). Since the 1970’s, research has validated
arm cranking exercise as a tool for fitness evaluation and cardiovascular conditioning
(Casaburi, Barstow, Robinson, & Wasserman, 1992), particularly among individuals with
disabilities with impaired lower mobility.
Arm crank cycles evolved from the arm ergometers developed in the mid
1970’s. They are alternatives to wheelchair propulsion that can be enjoyed by
recreationally active individuals and elite athletes. Currently, hand cycling is the world’s
fastest growing wheelchair sport and recreational activity for people with lower limb
disabilities (Goosey-Tolfrey, 2010).
A disparity exists between contemporary hand cycling designs and arm
laboratory arm ergometers. The hand positions on hand cycles are more vertical than on
arm ergometers which supinates the forearms. This recruits the brachioradialis muscle
during elbow flexion, which increases force production. (Bressel, E., Bressel, M.,
Marquez, Heise, 2001). Laboratory arm ergometer design does not reflect changes in
hand cycles. The typical laboratory arm-crank ergometer has an asynchronous crank
arrangement. The hand holds are perpendicular to the crank, which puts the hands in
complete pronation. This position does not allow the recruitment of the brachioradalis
muscle, and thus reduces force production during elbow flexion (Bressel et al., 2001).
To date, no studies have examined the effects of hand position on heart rate,
oxygen consumption, and ventilation during synchronous and asynchronous arm
ergometry. This study measured the effects of hand position during synchronous and
asynchronous arm exercise on maximal oxygen consumption, maximal ventilation,
maximal heart rate, and maximal respiratory exchange ratio.
Statement of the Problem
The purpose of this study was to assess the effects of hand and arm crank
position during arm ergometry on maximal power output and cardiorespiratory responses.
The investigation attempted to determine if hand position (pronated v. semi-vertical) and
crank arm position (synchronous v. asynchronous) affected maximal performance as
measured by maximal oxygen consumption (VO2max), maximal ventilation (VEmax),
maximal respiratory exchange ratio (RERmax), maximal power output (POmax), and
maximal heart rate (HRmax).
Operational Definitions
The following operational definitions were used in this study:
1. AP – Asynchronized prone (crank style like on a bicycle, hands palm down on
2. SP – Synchronized (both crank arms pedal together, hands palm down on grips)
3. AV – Asynchronized vertical (crank style like on a bicycle, hand position like
shaking hands on grips)
4. SV– Asynchronized vertical (both crank arms pedal together, hand position like
shaking hands on grips)
5. VE – ventilations measured in liters per minute
6. Power – work/time, measured in watts
7. VO2max – the highest level of oxygen consumption achieved graded arm
exercise testing.
8. HR(bpm) – heart rate (beats per minute)
9. RER – respiratory gas exchange ratio; VCO2/VO2
10. Trials – each subject participated in 4 main trials (AP, SP, AV, SV)
11. BOD POD® - a device that measures body density
Subjects used in this study were healthy able-bodied under-graduate college
students. Subject size n=10 (female n=5, male n=5). Each subject participated in five
trials. The first trial familiarized the subjects with the various arm ergometry techniques
and allowed them exercise at various power outputs. The crank arms on the arm
ergometer had three positions to place the hand grips to vary crank arm length. In this
study, the most distal position was utilized for all subjects. Subjects were volunteers with
unknown levels of upper-body physical fitness or cardiovascular capacity. The study was
limited by a small sample size.
The study was delimited to able-bodied undergraduate college students with
no experience with hand cycling or arm ergometry. Able-bodied subjects were recruited
to reduce bias from past experience with arm exercise and hand positions during hand
cycling. All subjects were undergraduate Kinesiology majors.
The following assumptions were made during this study:
1. Subjects were able-bodied.
2. Self-reported levels of physical activity were accurate. (medical history form)
3. All subjects abstained from eating and drinking at least 9 hours prior to exercise
4. All subjects abstained from vigorous exercising 24 hours prior to exercise trial.
5. All subjects worked to exhaustion during each trial.
6. All subjects were motivated to try their best during each trial.
7. All subjects had no prior experience using an arm ergometer.
Oxygen is a necessary requirement for life. It is critical for performance
during aerobic exercise. Oxygen consumption is proportional to energy transformations
during exercise, which determines maximal aerobic performance. Ventilation increases
during exercise, which maintains an optimal diffusion gradient in the lungs for the
movement of oxygen and carbon dioxide into and out of the blood. The exchange of
gases takes place in the alveoli, small sacs where the diffusion of oxygen from air is
transferred into pulmonary blood. Oxygen is mainly transported by red blood cells that
contain hemoglobin, which carries the oxygen in the blood. The oxygenated blood is
carried from the lungs to the heart, which pumps the blood from the left ventricle. The
major arteries exiting the heart branch off into smaller arteries and arterioles and deliver
blood to capillaries. The capillaries serve as conduits between the blood stream and cells
that permit exchange of gases, substrates, and hormones. Oxygen enters the cells from the
capillaries where it diffuses into mitochondria, participating in energy transformations
reactions that produce adenosine triphosphate (ATP). Blood passes through the
capillaries to the venules and veins, which transports the blood back to the heart and
Maximum oxygen uptake or aerobic capacity has been a focus of research since
the 1920’s. English Nobel Laureate and physiologist Archibald V. Hill first presented the
concept (Boone & Warpeha, 2003). He determined that oxygen consumption reached a
ceiling at maximum exercise intensities.
Aerobic exercise consists of prolonged activity that, in general, uses large
muscle groups such as cross-country skiing, cycling, running, aerobic exercise and
swimming (Robergs & Roberts, 1997). Maximum oxygen uptake (VO2max) is defined as
the highest rate that oxygen can be consumed during intense exercise (Bassett & Howley,
1997). Aerobic performance or oxygen consumption is defined as the product of cardiac
output (Q) in liters per minute and arteriovenous oxygen difference ((a-v)O2).
Arteriovenous oxygen difference is dependent upon muscle mitochondrial content
(Bassett & Howley, 2000). Taken together, the above parameters make up the Fick
relationship (VO2 = Q x (a-v)O2). Thus, the relationship between central (Q) and
peripheral ((a-v)O2) factors contribute to oxygen consumption.
Limitations of Maximal Oxygen
Maximal oxygen consumption may be limited by any process involved in
delivering oxygen from the atmosphere to mitochondria in cells. Limiting factors include
pulmonary ventilation, pulmonary diffusion, ventilation-perfusion ratio, cardiac output,
heart rate, stroke volume, blood volume, mitochondrial density, and cell capillary density.
Oxygen consumption for able-bodied athletes increases with incremental aerobic exercise
until maximum. According to classic studies by Hill (1923) oxygen consumption levels
off even in the face of increasing exercise intensities (Hill, 1923). During aerobic
exercise when local fatigue occurs before central cardio respiratory fatigue, maximal
oxygen uptake level is reached (VO2max), which representing maximum effort (Brooks,
Fahey, & Baldwin, 2005).
Past studies devoted to examining factors that limit maximum oxygen uptake
usually focused on single factors to determine the upper limits of oxygen delivery and
uptake. There are normally two categories, both have greatly increased our understanding
of mammal respiratory systems: Oxygen flows through structures with O2 uptake by the
mitochondria, and O2 delivery by circulation or O2 uptake by the lungs, which are relative
resistance factors that can be estimated with the overall limit approximated.
Central Limitations: Ventilation and Cardiac
The central limitations to oxygen delivery are pulmonary diffusion, cardiac
output and blood volume (Bassett & Howley, 1997). Cardiac output, the volume of blood
pumped by each ventricle of the heart per minute, determines the volume of oxygen
delivered to the cells their mitochondria. Ultimately, cardiac output determines the
capacity to produce ATP.
There is no pulmonary limitation to aerobic performance at sea level in people
with normal lung function. Ventilation can be increased further after achieving maximal
oxygen consumption. Also, oxygen partial pressure in the pulmonary vein is the same at
rest and during maximal exercise. This shows a remarkable ability to deliver oxygenated
blood to the blood from the lungs.
With reference to the present investigation, ventilation could be affected by
crank configuration. It was demonstrated that synchronous cranking tended to produce
higher ventilations during submaximal exercise. However this effect was observed only
in able-bodied subjects (Mossberg et al., 1999). Thus it is predicted that enhanced
ventilation may lead to higher oxygen consumptions in the synchronous crank
Cardiac output is the product of heart rate and stroke volume. It is commonly
identified as the principle limiting factors of oxygen delivery and VO2max (Bassett &
Howley, 2000). Some researchers have suggested that cardiac output accounts for 7085% of the limitations in VO2max (Cerretelli & DiPrampero, 1987).
This was elegantly shown by Ekblom, Goldbarg, and Gullbring (1972) who
artificially increased cardiac output by increasing the oxygen carrying capacity of blood.
They withdrew and stored two units (800 mL) of blood and then reinfused it one month
later. This was equivalent to increasing maximal cardiac output by nearly 20 percent.
Subjects experienced substantial increases in maximal oxygen consumption and
endurance. “Blood doping,” as it came to be called, is a banned procedure by the
International Olympic Committee because of its effects on performance.
Peripheral Limitations (Tissue Extraction of
Exercising muscles have an increased ability to extract and use oxygen that is
transported to it by the cardio respiratory system. Exercise scientists call this the
peripheral component of VO2max (Robergs & Roberts, 1997). Potential sites for VO2max
limitation in the peripheral component include muscle diffusion capacity, mitochondrial
enzyme levels (molecules that facilitate ATP production in mitochondria), capillary
density, cardiac output, hemoglobin concentration, and transport of oxygen between
blood, the muscle microcirculation, and mitochondria.
Oxygen Transport Across Cell Membranes
An oxygen pressure gradient (difference) exists between the blood and muscle
cells which also allow the transportation of oxygen from the red blood cells into the
mitochondria via diffusion (Kravitz, & Dalleck, 2002). Factors such as capillary density
and diffusion distance could limit oxygen transport.
Muscle Mitochondrial Content
Mitochondrial respiration relies on an adequate supply of oxygen. Aerobic
training increases mitochondrial enzymes levels, allowing working muscles to use more
oxygen. This results in a higher VO2max. It appears that peripheral factors present a potent
peripheral limitation to VO2max (Honig, Connett, & Gayeski, 1992). A 20% increase in
capillary density has been reported with aerobic training, indicating improved distribution
and extraction of blood within the muscle (Robergs & Roberts, 1997).
An early study of muscle properties including VO2max indicated that
mitochondrial volume density, was proportional to VO2max from sedentary individuals to
athletes (Hoppeler, Lothi, Claassen, Weibel, & Howald, 1973). Later studies appear to
contradict this proportionality showing a 40% increase in quadriceps with exercise
training but only a 15% increase in whole body VO2max (Hoppeler et al., 1985). Davies
and colleagues showed that mitochondrial mass was highly related to endurance
capacity—much more so than maximal oxygen consumption (Davies, Packer, & Brooks,
Heart Rate Response to Arm Exercise
It has been demonstrated that arm exercise elicits a greater heart rate response
than leg exercise (Mukherjee & Samanta, 2000; Powers & Howley, 2009). This is likely
due to a greater catecholamine response, both sympathetic as well as adrenal response
during arm exercise.
The heart rate and oxygen consumption response to exercise varies with the
activity and active muscle mass. For example Kimura, Yeater, & Martin (1990) reported
that during five experimental exercises (tethered swimming, simulated swimming, arm
cranking, treadmill running, and cycling) the mean maximal heart rate (HRmax) at VO2max
ranged from 182 beats per min (arm cranking) to 202 beats per min (running and
cycling). Results showed no apparent differences in HR max attained in any of the tests.
There was a significant difference for the mean absolute (l/min) and scaled (ml/kg min)
for VO2max for all tests. VO2max (ml/kg min) was lower during arm exercise and
swimming than running or cycling (Kimura et al., 1990).
Critical Muscle Mass (leg vs. leg + arm
Several studies have compared arm exercise to leg and arm + leg exercise.
Making the comparisons between arm exercise, leg exercise and arm + leg exercise
provides unique opportunities to examine limitations of maximal oxygen consumption as
a function of muscle mass and the volume of blood flow to support exercising limbs of
different masses. Gross mechanical efficiency to arm and leg as well as arm + leg
ergometry was evaluated by Eston & Brodie (1986). Efficiency was significantly lower
during arm work compared to leg work or combined. Further, ventilatory response was
higher during arm exercise compared to leg exercise (Eston & Brodie, 1986). Eston and
Brodie (1996) hypothesized that delivery of oxygenated blood to smaller upper body
muscle masses is adequate to perform arm exercise. However, lower limbs have larger
muscle mass that need to be supplied with oxygenated blood, thus in larger muscle
masses, distribution of blood supply, and therefore oxygen supply, appears to limit
oxygen consumption (Eston & Brodie, 1986).
Secher, Niels, Ruberg-Larsen, Binkhorst, Bonde-Petersen (1974) assessed
VO2max during arm exercise, leg exercise and arm + leg exercise. They found that the
addition of arm exercise to leg exercise increased whole body VO2max suggesting that the
addition of arm exercise to leg exercise added critical muscle mass to total exercising
muscle resulting in a redistribution of blood flow as well as increasing active tissue beds.
Taken together, the results cited above underscore the reliance on whole-body
oxygen consumption on a variety of factors, namely blood flow, active muscle mass and
muscle mitochondrial content.
Power Output
In an attempt to determine how additional exercising muscle mass may
contribute to increasing VO2max, Secher et al. (1974) also assessed power outputs in the
various exercise modalities as outlined above. Adding arm exercise to leg exercise
yielded increased power outputs compared to leg exercise alone. Interestingly, the
authors determined that arms accounted for 27% of total power during arm + leg
exercise; however when the arms were exercising alone they generated 42% of the total
power that legs were able to generate. The fact that arms alone could generate almost half
the power of legs, but contribute only approximately one fourth (1/4th) of the power
during arm + leg exercise indicate a high level of cardiorespiratory and metabolic control
over total exercising muscle mass. In other words, the body has to decide how to
distribute its resources.
Oxygen Consumption During Arm, Leg and
Arm + Leg Exercise
Previous studies have suggested that arm position could have an effect on
cardiovascular and metabolic adjustment to arm cycling. For example, Cummins and
Gladden (1983) examined heart rate during submaximal and maximal arm cycling with
arm positions at three different levels in relationship to the heart. Results indicated no
difference between arm exercise with arms positioned below, at or above the level of the
heart suggesting that the body is able to direct blood flow as needed regardless of the
position of the exercising limbs relative to the heart.
Contrary to the results cited above, it has been demonstrated that crank (arm)
position relative to the heart has an effect on the VO2 response to the onset of exercise
(Cerretelli, Pendergast, Paganelli, and Rennie, 1979). Cerretelli et al. found that when
crank above the heart there was an increased rate of rise of VO2 at the onset of exercise
compared to an upright position (crank at heart level) (Cerretelli et al., 1979). These
differences may have been caused by the increased vertical distance between the
exercising muscles and heart in the supine position. As a result, there were similar
differences between the heart and exercising muscles when the arms were placed in
various positions.
Muscle Recruitment as a Function of Hand
Position While Arm Cranking
Several upper body muscle groups are used during arm ergometry. In
addition, there are several smaller muscles in the shoulder and forearm that are crucial to
maximize arm crank performance. For example, Bressel et al. (2001) investigated the
effects of handgrip position during arm cranking exercise. They examined five different
muscles (biceps brachii (BB), lateral head of triceps brachii (TB), middle deltoid (DT),
infraspinatus (IS), and brachioradialis (BR) in the arm and measured the recruitment
using an EMG. They measured three different handgrip positions pronate, neutral, and
supinate. Brachioradialis muscle recruitment was 64% and 73% greater during the neutral
hand position than the supinated or pronated handgrip positions. There were no
differences between hand position in the four other muscle groups.
Other exercise modalities utilize upper body (arm) exercise. For example,
rowing engages muscles in the torso, back, arms and legs, thus crew athletes (rowing
exercise) can provide insight as to how the human body distributes resources (e.g., blood
flow distribution) during exercise to maximize power output. With an increase in interest
in rowing exercise, there have been developments in ergometers to mimic rowing. It has
been shown that differences during maximum exercise between rowing ergometry and on
water rowing are minimal (Vogler, Rice, & Gore, 2010). However, the data must be
carefully interpreted as maximal data were not normalized for power output during the
on-water exercise trial as it is technically difficult to quantify power output while rowing
in a rowing scull. Further, individuals tested found it difficult to reach their true
maximum during OW testing because of the technical aspects of on-water sculling
compared to ergometer rowing (Vogler, Rice, & Gore, 2010). The data cited above
demonstrates an additional example of arm-based exercise, but also allows investigators
to explore limitations of performance providing limbs could be isolated (e.g. arm only
exercise v. leg only exercise v. arm + leg exercise) again with the emphasis on how the
human body regulates the distribution of resources.
Three Wheel Crank Chair
The specific purpose of the present study was to assess physiological
responses as a function of different hand positions and crank configurations in
handcycling type exercise. The first hand cycle was simply a wheelchair converted to use
a bicycle crank mechanism on a third wheel for propulsion. It was called the armpropelled three-wheeled chair (APTWC). Not surprisingly, heart rate response was
similar to what is observed in able-bodied individuals (i.e., heart rate increases as speed
of locomotion increases). Further, Mukherjee and Samanta (2000) found that arm
cranking was more efficient than standard wheelchair propulsion. That is, subjects could
go faster using arm cranking compared to standard wheelchair propulsion at the same
metabolic cost. Conversely, at any given speed of propulsion, the metabolic cost of
propulsion (locomotion) is lower while utilizing arm cranking as opposed to standard
wheelchair propulsion. Based on the above data, Mukherjee and Samanta (2000)
developed the physiological cost index (PCI). These authors utilized PCI as a means to
quantify physiological strain as a function of mode of propulsion.
Lastly, Mukherjee & Samanta (2000) found that PCI was lowest at a moderate
speed of propulsion. In other words, at slow propulsion speeds, the PCI is greater than at
moderate propulsion speeds. Further, as expected, PCI increase with increasing
propulsion speeds. The PCI curve forms a “U”-shaped curve similar to the energetic cost
of locomotion observed while walking at different speeds when energetic cost of
locomotion is scaled according to distance traveled (Willis, Ganley & Herman, 2005).
Taken together, the data above indicate that the body self-selects to minimize the cost of
locomotion (or maximize economy) regardless of mode of locomotion.
Comparison of Synchronous v.
Asynchronous Arm
Several studies compared the differences between synchronous and
asynchronous cranking. Mossberg et al. (1999) found that there were significant
differences between the two crank configurations, with synchronous crank configuration
resulting in a higher oxygen output. Contrary to the above findings, it has also been
shown that oxygen consumption was greater during asynchronous arm cranking than
synchronous arm cranking (Dallmeijer, Ottjes, De Waardt & van der Woude, 2004).
When assessing maximal power output, it was found that synchronous crank
configuration yielded significantly higher maximum power compared to the
asynchronous crank configuration (Abel, Rojas-Vega, Bleicher, & Platen, 2003). We can
infer from these data that crank configuration affects oxygen consumption as well as
power output.
Hand Position (Prone v. Vertical)
Hand grip position has been shown to influence muscle recruitment during
arm crank exercise. Bressel et al. (2001) reported that the brachioradialis muscle was
recruited to a greater extent when the hands of subjects were in a neutral or vertical
position as opposed to the horizontal or prone position while arm cranking. These
findings suggest that arm cranking using the neutral, or vertical, hand position may result
in greater maximal power output and oxygen consumption by virtue of the availability of
the brachioradialis muscle to be recruited during arm cranking exercise.
Oxygen is a requirement for all life and directly relates to aerobic exercise
when using a arm crank ergometer. The oxygen delivery system and the process used to
measure VO2max through rigorous exercise are key factors in determining an individual’s
maximum effort. Though there are numerous limiting factors, the primary one is
matching the rate muscles consume oxygen with the rate oxygenated blood can be
delivered. When comparing arm and leg exercises results were parallel, indicating
exercise intensity were similar. Hand grip position in the neutral position displayed
greater muscle activity versus pronation hand grip.
The use and development of the arm ergometer has helped evolve into the arm
propelled three wheeled chairs that was a key factor in what is known today as the
The Human Subject Review board at California State University, Chico
approved this study. All subjects signed an informed consent and a medical history form
before participating in the study. The subject’s rights and confidentiality procedure were
explained before and during the trials. Each trial was in accordance to the approved protocol.
The purpose of this study was to assess the effects of hand and arm crank
position on maximal performance. The crank arms of hand cycles are synchronous as
opposed to asynchronous cranks used on bicycles. Further, the hand position on hand
cycles is "semi-vertical" (~75 degree angle). However the laboratory/rehabilitation
equipment designed to test metabolic and cardiovascular responses to arm exercise use
asynchronous crank arms with the hands in a horizontal or pronated position. This
investigation sought to determine the effects of hand position (pronated v. semi-vertical)
and crank arm position (synchronous v. asynchronous) on maximal oxygen consumption
(VO2max), maximal ventilation (Vemax), maximal respiratory exchange ratio (RERmax),
maximal power output (POmax), and maximal heart rate (HRmax). Subjects visited the
laboratory on five occasions. The first visit was to familiarize the subjects to arm
ergometry and upper body exercise. All subjects completed the orientation session in
order to familiarize themselves with the test procedures and instrumentation. The
remaining four visits were to assess the effects of crank configuration and hand position.
During each session there was constant supervision to observe exercise
tolerance and to terminate the tests when subjects could not sustain a cadence of 70 rpm.
After informed consent is obtained, subjects reported to the human performance lab
(HPL) between 0700 and 1000 after an overnight fast. Able-body rather than disabled
people were used as subjects to avoid bias impose by previous hand cycling experience.
An arm crank ergometer (Monark, 881E) which allows for adjustment of the crank arms
to the synchronous or asynchronous positions as well as separate hand holds to allow for
the prone and vertical hand positions mounted to an adjustable table and a upright chair
that is also adjustable to accommodate different arm lengths. Subjects were seated in
front of the ergometer (with the center of arm crank level with top of armpit (Van
Drongelen, Maas, Scheel-Sailer, & van der Woude, 2009). They wore a wide elastic belt
around the abdominal region for upper body stabilization and to prevent excess
recruitment of other muscle groups such as abdominal muscles and hip flexors. The feet
were suspended in straps so that their knees were extended and their hips flexed (sitting
with legs straight out). This was done so that subjects were not able to use their legs to
assist in exercise performance. Subjects were requested to maintain the arm crank
cadence at 70 RPM throughout the test (a metronome helped pace the cadence).
Resistance of the arm ergometer was increased 10 watts every two minutes until subject
could no longer maintain the cadence. VO2, VE, and RER were measured continuously by
a metabolic cart (Parvomedics, TrueMax 2400) approximately every 10-second heart rate
was obtained from a Polar heart rate monitor and recorded during each two-minute
exercise stage.
Ten ambulatory subjects volunteered to participate in this study. All subjects
met the recommended ACSM guidelines for physical exercise, exercising at least one to
two hours a day, three days per week. Subjects were within a normal, healthy weight
range. None of the subjects had any adverse health conditions that would prevent them
from completing the four trials. Characteristics of all 10 subjects are shown in Table 1. It
was noted that there were clear differences between male and female subjects upon
examination of several of the physiological parameters. Thus, mean subject characteristic
data for males and females are shown in Table 2.
Table 1
Subject Characteristics
Age (yrs)
22.2 ± 3.0
Height (in)
68.9 ± 3.4
Weight (kg)
67.8 ± 12.4
Body fat %
21.0 ± 6.5
LBM (kg)
53.5 ± 9.9
Table 2
Mean Data of Female and Male Subjects
Age (yrs)
Height (in)
Weight (kg)
Body Fat (%)
LBM (kg)
Undergraduate college students were recruited. Informed consent was
obtained from all subjects in accordance with the established human subjects’ protocol at
California State University, Chico (Appendix A).
Anthropometric Measurements
Body composition was obtained using a BOD POD®. Weight was measured
to the nearest kilogram using a load cell on-line with the BOD POD®. Height was selfreported.
Aerobic Capacity
Maximum oxygen uptake (VO2max), maximal ventilation (VEmax), maximal power
output (POmax), maximal respiratory exchange ratio (RERmax), and maximal heart rate
(HRmax) were all assessed during graded exercise tests to volitional fatigue using an arm
crank ergometer (Monark 881E, Sweden) in four separate trials. The four trials, carried
out in random order, were asynchronous vertical (AV), asynchronous prone (AP),
synchronous vertical (SV) and synchronous prone (SP). The arm ergometer was adjusted
specifically to each subject. The crank axis was set to the height of the top of the
subjects’ arm pits with arm extended straight out with a 15 to 30 degree bend in elbows.
Subjects were seated with legs extended and suspended using a strap with loops at both
ends and one around their waist and back of chair to minimize lower body support as well
as trunk movement. While subjects were seated, an abdominal strap a heart monitor
sensor was located on their chest just below the zyphoid process. Subjects were seated
three minutes to obtain resting values for VO2 and HR (VO2rest and HRrest). After the
initial three minutes, the subjects cranked at one of four trials at a cadence of 70 rpm and
the power output started at 10 watts and increased 10 watts every two minutes.
Statistical Methods
Two factor ANOVA with repeated measures to determine differences between
treatments with the second factor to determine differences between males and females.
Statistical analysis was not performed on any of the “response” or time-course data (i.e.
VE, HR and VO2 response curves) as the focus of the study was to evaluate maximal data
only. Significance was set at p < 0.05.
The maximal PO(watts), VO2(L/min), VE (L/min), RER(VCO2/VO2), and
HR(bpm) were achieved during the progressive arm crank ergometer test ranging
between 50 and 150 watts. Overall no differences were observed across the four trials for
all 10 subjects or when comparing the four trials for males only or females only. Maximal
power outputs were 89, 88, 95 and 97 watts for SP, SV, AP and AV trials respectively
(Figure 1). There were no differences across trials in maximal power output. However,
males produced almost twice the maximal power output than females (Figure 2). When
maximal power outputs were subdivided by sex there was clear dichotomy between
males and females (p < 0.001). Maximal power output in males was 118, 112, 124 and
128 watts in SP, SV, AP and AV, respectively while in females it was 60, 64, 66 and 60
watts in SP, SV, AP and AV, respectively (Figure 2).
Ventilatory response to incremental exercise was curvilinear across all four
trials for all subjects (Figure 3). Maximal ventilation in females was not statistically
different across the four trials (Figure 4). However maximal ventilation rate was nearly
twice as great in men than in women (p < 0.001), though as in female subjects, there was
no difference in maximal ventilation rate observed in males (Figure 4).
Figure 1. Maximal power output (watts) for all 10 subjects
across all four trials. Values are means ± SE. No statistical
difference existed between trials.
Figure 2. Power output mean results, males and female
subjects in all four trials. Values are means ± SE.
* p < 0.001 between males and females.
Figure 3. Mean ventilatory response of all subjects. Data are
means of four trials for males and means of four trials for females.
Figure 4. Maximum ventilation rate (L/min) in male and female
subjects in all four trials. Values are means ± SE.
* p < 0.001 between males and females.
Heart rate increased more rapidly in females than males (Figure 5).
That is, at any given power output heart rates in females are higher than in
males. This is consistent with the concept that females tend to have smaller
hearts. Thus to maintain cardiac output and oxygen delivery, heart rates must be
higher to compensate for the smaller stroke volumes (cardiac output = heart rate
x stroke volume, Q = HR x SV). Maximal heart rates (HRmax) were
approximately 174 bpm across all four trials. No significant differences were
observed across the four trials, further there were no differences in maximal
heart rates between males and females for any of the trials thus there was no
need to divide the data by sex as with ventilation (Figure 6).
Figure 5. Heart rate response in males and females. Data are means
of four trials for males and means of four trials for females.
Oxygen consumption increased linearly with power output in all four
trials (Figure 7). Because there were no differences in oxygen consumption
Figure 6. Maximal heart rate for all ten subjects for all four trials.
Values are means ± SE. There were no statistical differences between
males and females, therefore grouped data are presented.
either between trials or between males and females, VO2 response is plotted as
the mean of four trials for all 10 subjects. Oxygen consumption was about 0.25
L/min at rest for all four trials and increased to about 2.5 L/min. It must be noted
that the data up to about 60 to 80 watts represent all ten subjects while above 80
watts only males are represented as the female subjects could not maintain
power outputs above 80 watts. The data from 120 watts up to 150 watts
represents fewer and fewer subjects as each subject could attain his respective
maximal capacity.
Absolute maximal oxygen consumption was not statistically different
across the four trials. It was 1.6, 1.6, 1.7 and 1.6 L/min in SP, SV, AP and AV
trials, respectively (Figure 8). The same pattern observed between males and
females with POmax was also observed with VO2max (p < 0.001, Figure 9).
Maximal oxygen consumption in males was 2.1, 2.1, 2.2 and 2.2 L/min in SP,
Figure 7. Response of oxygen consumption with power output. Data are
means of all ten subjects for all four trials. No difference existed in
oxygen consumption between subjects up to each subject’s maximal
oxygen consumption thus data are grouped.
SV, AP and AV trials, respectively (Figure 7) while VO2max in females was 1.1,
1.1, 1.2 and 1.1 L/min in SP, SV, AP and AV trials, respectively (Figure 9).
Scaling VO2max to body weight reduced the difference between males
and females, however scaled VO2max in males was still significantly greater than
in females (p < 0.01). However no differences existed across trials in either
males or females (Figure 10). Scaled VO2max values were 27.3, 29.0, 30.9 and
31.5 ml/kg min in SP, SV, AP and AV trials, respectively in males while scaled
VO2max values were 18.0, 18.0, 19.7 and 17.6 ml/kg min in SP, SV, AP and AV
trials, respectively in females (Figure 10).
Figure 8. Absolute maximal oxygen consumption VO2max (L/min) for
all ten subjects in all four trails. Values are means ± SE.
Figure 9. Absolute maximal oxygen consumption (VO2max, L/min) in
male and female subjects for all four trials. Values are means ± SE.
* p < 0.001 between males and females.
Figure 10. Scaled maximal oxygen consumption per kilogram body
mass (VO2max, ml/kg min) of male and female subjects across all four
trials. Values are means ± SE. * p < 0.01 between males and females.
Scaling VO2max per kilogram lean body mass (LBM) further closed
the gap between males and females (p < 0.01, Figure 11). Scaled VO2max per kg
LBM was 34.4, 34.8, 36.6 and 36.5 ml/kg LBM min in SP, SV, AP and AV
trials, respectively in males while in females it was 24.1, 24.0, 26.3 and 23.4
ml/kg LBM min in SP, SV, AP and AV trials, respectively (Figure 11).
Respiratory exchange ratio increased more rapidly in females than in
males, similar to the VO2 response (data not shown). However, maximal
respiratory exchange ratios (RER) were not different between trials or due to
sex. Maximal RER values were 1.05, 1.04, 1.02 and 1.05 in SP, SV AP and AV
trials, respectively. The lack of difference in maximal RER values indicates that
gross fuel utilization was not different between sexes or due to hand position or
crank configuration.
Figure 11. Scaled maximal oxygen consumption per kilogram lean
body mass (VO2max, ml/kg min) of male and female subjects across
all four trials. Values are means ± SE. * p < 0.01.
Because of the disparity between males and females with observed
POmax and VO2max the data from all four trials for each subject were averaged
then plotted to evaluate the relationship between maximal oxygen consumption
and maximal power output. There was a very strong (r2 = 0.96) relationship
between maximal power output and VO2max (Figure 12). This relationship
addresses the importance of power output on oxygen consumption.
This study examined the effect of crank configuration and hand
position during arm ergometry on maximal power output and maximal oxygen
consumption. Previous studies comparing asynchronous and synchronous, crank
configuration found conflicting results and few studies addressed the effects of
hand position. However, through an extensive literature review, there were no
Figure 12. Mean of all ten subjects in all four trials of maximal
oxygen consumption plotted as a function of maximal power. Each
point was generated as a mean of maximal power output for all four
trials for both VO2max and POmax for each subject.
studies comparing physiological response to the interaction of hand position and
crank configuration.
The study compared synchronous and asynchronous cranking and
prone and vertical hand positions. Measurements included maximal oxygen
consumption (VO2max), power output, and heart rate. The study did not measure
pulmonary diffusion, ventilation perfusion ratio, cardiac output, heart rate, stroke
volume, mitochondrial density, and cell capillary density. The cardiorespiratory
system provides the necessary oxygen to the upper body muscles to perform arm
exercise, which is noted as the peripheral component of VO2max (Robergs &
Roberts, 1997). Oxygen is then transported by red blood cells to the
mitochondria via diffusion (Kravitz & Dalleck, 1984). A greater mitochondrial
content allows working muscles to use more oxygen which results in higher
VO2max levels.
Muscle groups that are recruited during arm ergometry/hand cycling,
consist of the major upper body muscles such as shoulder, upper and lower arm,
latissimus dorsi, rhomboids, trapezius, all of the neck muscles. The chest and
abdominal muscle groups are also recruited, provided they are fully innervated.
In light of previous work evaluating muscle recruitment patterns
using various hand positions while performing arm-crank ergometry, it might
have been anticipated that the neutral, or vertical, hand position, regardless of
crank configuration may have elucidated higher VO2max values. If functional,
this would be due to the finding by Bressel et al. (2001) that the vertical hand
position allows for the recruitment of the brachioradialis muscles during from
approximately 120 degrees of crank angle to approximately 260 degrees of crank
angle, i.e. when the elbows are going through the flexion phase of the cranking
cycle. However the present study did not find any differences in maximal
oxygen consumption or maximal power output as a function of hand position.
This might be attributed to the fact that the brachioradialis is relatively small
thus does not represent a significant addition to working muscle mass during arm
crank ergometry. This may have several effects on the observed, or lack thereof,
physiological responses in the present study. Firstly the additional working
muscle of the brachioradialis would not likely place a burden on the
cardiovascular system. Though not measured, the increased blood flow required
by the recruitment of the brachioradialis muscle would not tax the cardiovascular
system as is observed when comparing leg exercise with arm plus leg exercise.
The vascular system is able to distribute blood flow to very large muscle masses
when arms and legs are exercising simultaneously. A more likely explanation for
the lack of any observed change in maximal, or peak, oxygen consumption is
more likely due to the fact that the bulk of elbow flexion is more likely attributed
to the biceps brachii muscles. However, more importantly, the majority of force
generation during arm crank ergometry is during the extension portion of the
cranking cycle of each arm. Thus to summarize, it is not that the brachioradialis
muscle is not recruited during arm cranking while the hands are in the vertical
position, it most certainly is, but it simply does not add a significant mass of
muscle to the overall working muscle of the arms during arm cranking.
Additionally most force generation during arm cranking is during the extension
portion of arm cranking (Bressel et al., 2001).
In addition to any difference as a function of hand position in either
the synchronous as well as asynchronous crank configuration, no differences
were observed as a function of crank configuration. This is consistent with
previous findings in which not only is there no difference in oxygen
consumption as a function of synchronous and asynchronous crank
configuration, there is also no difference between paraplegic and able-bodied
subjects (Mossberg et al., 1999).
The lack of difference between synchronous and asynchronous crank
configurations might have been unexpected in both the previous research as well
as the present study. It might have been predicted that the asynchronous crank
configuration would yield higher oxygen consumptions because of the reciprocal
motion and therefore muscle recruitment patterns that are necessary for the
asynchronous crank configuration (Bafghi, Abbasi, De Haan, Horstman, & van
der Woude, 2007). While one half of the torso and the associated arms are
contributing to extension movements, the opposite side of the torso and its
associated arm is contributing to flexion motions. The most basic motions in life
are reciprocal, walking, swimming, climbing stairs. Thus in arm cranking it
might have been predicted that by virtue of motor control, subjects might reach
higher power outputs and therefore higher maximal oxygen consumption.
Additionally simultaneous extension and flexion motions may lead to the use of
the trunk to aid in the force generation. Indeed this was observed in some
subjects, however similar to the lack of muscle mass of the brachioradialis
muscle adding to overall power output as well as oxygen consumption. Perhaps
total trunk muscle mass recruited during synchronous arm cranking is
comparable to total muscle mass recruited during asynchronous arm cranking. It
must be noted that muscle recruitment patterns were not measured in the present
study, thus any conclusions about recruitment patterns and magnitude between
synchronous and asynchronous arm cranking are purely speculative.
Further, the present study attempted to restrict trunk movement by
utilizing a wide elastic belt that was strapped around each subject for each trial.
The belt restricted, but did not completely eliminate, the ability of subjects to
perform trunk flexion. Given this restriction of trunk flexion, this might have
contributed to greater maximal power output as well as maximal oxygen
consumption values during the asynchronous trials as the belt was not able to
restrict rotational motion of the trunk while exercising. This became especially
apparent during the higher power outputs. Each subject utilized an exaggerated
amount trunk rotation to generate force during the higher power outputs
regardless of hand position. Additionally, while the abdominal strap did assist to
restrict trunk motion, it did not completely eliminate it. Indeed subjects were
observed incorporating a substantial amount of trunk flexion while performing
the synchronous trials, again, regardless of hand position.
Also significant to the present study are the findings of Mossberg et
al. (1999), that there are no differences in the metabolic response between
paraplegic and able-bodied subjects. Paraplegia, by definition is, paralysis
characterized by motor or sensory loss in the lower limbs and trunk after a
thoracic spinal cord injuries. The recruitment of arm as well as trunk muscles are
not affected in paraplegic subjects compared to able-bodied subjects. Thus in the
present study, the utilization of able-bodied subjects would have direct
application to the paraplegic population. Additionally, because most able-bodied
subjects do not engage in arm-based exercise (with the exception of swimmers)
they would not have a pre-determined bias of synchronous as opposed to
asynchronous arm cranking whereas experienced hand-cyclists may have a bias
toward synchronous arm cranking as most hand cycles are set up in a
synchronous manner.
The present study found that maximal oxygen consumption is highly
related to maximal power output (Figure 12). These data illustrate important
issues in maximal performance. Classically, aerobic performance was thought to
be the major predictor of athletic performance (Fitchett, 1985) as the focus of
exercise physiology focused on endurance type exercise. However recently, it
has been shown that even in a classically categorized activity, the five thousand
meter run that increasing power was able to increase performance in the form of
decreasing run times (Pollock, Mengelkoch, Graves, Lowenthal, Limacher,
Foster, & Wilmore, 1997). This occurred in the face of decreasing VO2max
values. Thus an event that lasts 12 to 14 minutes can be positively affected with
power training. Further, that aerobic capacity is not the limiting factor in athletic
performance in the five thousand meter run, again a classically identified aerobic
activity (Pollock et al., 1997).
The present study showed a very strong relationship between
maximal power output and maximal oxygen consumption (Figure12). Further,
there is a clear dichotomy between subjects. The lower cluster of data points in
Figure 12 are females while the upper cluster of data points are the males.
Further, two of the males were swimmers, one being a “pure” swimmer while
the other being a water polo player. Both exhibited superior upper body power as
well as maximal oxygen consumption. The swimmer reached the highest power
output as well as maximal oxygen consumption while the water polo player
reached the second highest power and maximal oxygen consumption of all
subjects. The findings of the present study are in agreement with the findings of
(Reybrouck, Heigenhauser, & Faulkner, 1975) who studied arm v. leg v. arm +
leg exercise with regard to recruitment of greater muscle mass leads greater
maximal oxygen uptake values. Firstly, in general, and in the present study,
males tend to have more muscle mass than females, hence the sex differences
observed in maximal power output as well as maximal oxygen consumption.
Thus the ability to attain a higher power output by virtue of greater upper body
strength easily explains the findings in the present study of males reaching
higher maximal oxygen consumption values. Further, within the males, the two
swimmers reached the highest power output as well as maximal oxygen
consumption values. Given the regularity of upper-body exercise performed by
these two subjects, it may be assumed that the muscles in their torsos and arms
have undergone the adaptations that are typically observed in muscles (e.g.,
elevated mitochondrial content and increased capillary content as well as
increased strength likely due to increased muscle mass) it is not surprising that
they reached the highest maximal power output as well as the highest maximal
oxygen consumption values. Thus in the present study the fact that maximal
oxygen consumption is highly dependent on how much external power may be
attributed to increased muscle mass in males, enhanced strength and oxidative
capacity (though not measured) in the two swimmers indicates that performance,
per se, is not dependent on aerobic capacity, but quite the contrary, in the present
study aerobic capacity is dependent upon maximal strength and power.
No differences were found between crank configuration and hand position in
POmax, HRmax, VEmax, VO2max and RERmax. This study found no differences in the
physiological responses to crank configuration or hand position. However, significant
differences were found between males and females in maximal power output, ventilation
and oxygen consumption. Lastly, aerobic performance was highly dependent on power
Hand position and crank configuration had no effect on POmax, HRmax, VEmax,
VO2max and RERmax. Maximal oxygen consumption was limited by maximal power
output (Figure 12).
Recommendations for Future Research
Future endeavors might include the use experienced hand cyclists. The
biomechanical and metabolic effects of a wide (shoulder-width) hand position as well as
crank arm length may have an impact on performance. Future research might examine the
effects of seat position relative to crank arms on performance.
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California State University, Chico
Kinesiology Department
Informed Consent
My name is Patrick W. Cottini. I am a graduate student in the Kinesiology and Exercise Science
department at California State University, Chico and the primary investigator for this study. I am
conducting this study for my thesis for the Master’s degree requirement at CSU, Chico.
The purpose of the present investigation is to assess maximal performance (i.e. maximal power
output (POmax), maximal oxygen consumption (VO2max), maximal heart rate (HRmax), maximal
ventilation (VEmax), and maximal respiratory exchange ratio (RER). The effects of hand position
during maximal arm crank ergometry. While placing the cranks in a synchronized vs.
asynchronized position, and whether hand position effects maximal performance.
The following procedures have been demonstrated and explained to me and I agree to voluntarily
participate in the following with the supervision of the primary or co-investigator:
1. I understand that I will be wearing headgear with a mouthpiece in my mouth for each
trial as well as a nose clip on my nose to assure that all airflow goes into the mouth
piece. I understand that this may cause some discomfort while using the arm crank
ergometer (e.g. excessive production of saliva, mouth may become dry). I understand
that the entire experimental protocol will take approximately 8 to 15 min.
2. I understand that my participation is strictly voluntary and I may choose to withdraw
or not participate at any time and that there is no penalty for non-participation or
withdrawing from the study.
3. I understand that the data will be published but all names, consent forms, and other
identifiable information will be kept confidential under lock and key. After the
publication of the study, all information will be destroyed.
4. I understand that, if I choose, I will receive a copy of the results.
5. I understand that the study will be performed at the California State University,
Chico Exercise lab on five separate days. I understand the risks and discomforts
involved with the study.
6. I will pedal on an arm crank ergometer four different times. Each time (and it
will vary between hand position and crank position). I will be allowed to warm up on
the arm crank for three to five minutes prior to the start of the trials. I will crank on
the arm ergometer at the following power output (Watts) and time for two (2)
minutes per stage. Power output watts will increase in10 Watt increments until
volitional fatigue (e.g. 10, 20, 30, 40, 50, etc. until 2, 4, 6, 8, 10, etc. minutes.
I understand that the exercise may be uncomfortable and there are risks related with any
exercise. Although rare, the risk of muscle or ligament strain, sprain or heart attack can
occur due to maximal exercise. There will be slight discomfort due to finger stick for the
blood draw prior to and at the end of each exercise bout.
There will be no direct benefit to you as a participant in this study. However, the results
and conclusions from this study will be available to you upon request.
As a subject, you will be assigned a code number and the key to that code will be kept by
the principal investigator. Records of this study will be stored in a locked file cabinet in
room 134 Yolo Hall and destroyed two years after publication or five years after the
study (i.e. after the investigators have exhausted all publication options). You will not be
personally identified in any reports or publications that may result from this study.
Participation is voluntary. There is no penalty for non-participation. You may choose to
participate or withdraw from the study at anytime without penalty or reprisal.
If you have any questions, please feel free to contact me (530-570-3947). You may also
report any comments regarding the manner in which this study is being conducted to the
Human Subjects Research Committee at CSUC (898-4766).
Participant name (print name)______________________________Date_____________
Participant name (signature)__________________________________
Investigator (print name)___________________________________Date____________
Investigator (signature)______________________________________
Primary Investigator: Patrick W. Cottini
Co-Investigator: John L. Azevedo, Jr.
NAME__________________________ DATE_____________________
BIRTHDATE______________ AGE_____ HEIGHT_______ WEIGHT______
How many days do you exercise in a week? (circle one) 1-2 3-4 5+
On average, what is the duration of a typical exercise session for you?
(circle one) 10-20 30-60 60+ min/session
Describe the intensity of your exercise (circle one)
1 = none
2 = light (e.g. casual walking, golf)
3 = moderate (e.g. brisk walking, jogging, cycling, swimming)
4 = heavy (e.g. running, high intensity sport activity)
What types of exercise do you engage in and how much do you do each session?
(circle all that apply)
1 = none
2 = walking
3 = jogging/running
4 = swimming
5 = cycling
6 = team sports (basketball, softball, soccer, etc.)
7 = racquet sports
8 = weight training
9 = other ________________________________________________________________
Do you measure your heart rate during exercise? 1 = yes 2 = no
How long have you had a regular exercise program?_________Months - Years
What condition or shape do you consider yourself to be in now (in terms of physical fitness)?
1 = poor
2 = fair
3 = good
4 = excellent
Do you smoke? 1 = yes 2 = no
Has a close blood relative had or died from heart disease or related disorders (Heart Attack, Stroke,
High Blood Pressure, Diabetes etc.)?
3=Brother - Sister
4=Aunt - Uncle
5=Grandmother - Grandfather
If yes- Give ages at which they died or had the problems.
Indicate which of the following apply to you (circle all that apply).
1 = high blood pressure
2 = high blood fats or cholesterol
3 = cigarette smoking
4 = known heart disease or abnormalities
5 = family history of heart disease (parents or siblings before age 50)
6 = sedentary lifestyle
7 = stressful lifestyle at home or at work
8 = diabetes mellitus
9 = gout (high uric acid)
10 = obesity
Any medical complaints now (illness, injury, limitations, neurological symptoms)?
1 = yes If yes, describe completely__________________________________________
2 = no ________________________________________________________________
Any major illness in the past?
1 = yes If yes, describe completely__________________________________________
2 = no _______________________________________________________________
Any surgery or hospitalization in the past?
1 = yes If yes, describe completely_________________________________________
2 = no ______________________________________________________________
Are you currently taking any medications (prescription or over-the-counter: including birth
1 = yes If yes, list drugs and dosages _________________________________________
2 = no _______________________________________________________________
Have you ever had any neurological problems?
1 = yes If yes, describe completely__________________________________________
2 = no _______________________________________________________________
Do you now have, or have you ever had, any of the following? (circle all that apply)
1 = heart murmurs
2 = any chest pain at rest
3 = any chest pain upon exertion
4 = pain in left arm, jaw, neck
5 = any palpitations
6 = fainting or dizziness
7 = daily coughing
8 = difficulty breathing at rest or during exercise
9 = any known respiratory diseases
10 = any bleeding disorders or problems with bleeding
Please describe fully any items you circled:______________________________________
Do you now have, or have you ever had, any of the following? (circle all that apply)
1 = any bone or joint injuries
2 = any muscular injuries
3 = muscle or joint pain following exercise
4 = limited flexibility
5 = any musculoskeletal problems which might limit your ability to exercise
Please describe fully any items you circled:___________________________________________