164. Cardio-Respiratory Response Of Interval Training

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164. Cardio-Respiratory Response Of Interval Training

CATEGORY: Fitness, Workout & Exercise 500 Courses

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Syllabus

ABSTRACT i
LIST OF FIGURES vii
LIST OF TABLES ix
ATTESTATION OF AUTHORSHIP x
ACKNOWLEDGEMENTS xi
ETHICAL APPROVAL xii
NOMENCLATURE xiii
CHAPTER 1: INTRODUCTION 1
1.1 Project context 1
1.2 Study rationale: What is known and gaps in knowledge 7
1.3 Project aims and objectives 8
1.4 Hypotheses 9
1.5 Methodological outline 9
1.6 Assumptions 9
1.7 Delimitations 10
1.8 Thesis structure 10
CHAPTER 2: THE PHYSIOLOGY, RELEVANCE AND ASSESSMENT OF ARTERIAL HEALTH 11
2.1 Cardiovascular disease (CVD) 11
2.1.1 Cardiovascular risk factors (CV RFs) and risk prediction 11
2.2 The arterial system and cardiovascular health 12
2.2.1 Normal arterial wall physiology and anatomy 13
2.3 Arterial health and early vascular ageing 14
2.3.1 The concepts of compliance and distensibility 15
2.4 Overview of arterial stiffness 16
2.4.1 The pathophysiology of arterial stiffening 17
2.4.2 The relevance and consequences of increased large artery stiffness 18
2.4.3 Clinical applications of AS assessment 19
2.5 Monitoring the status of arterial health 20
2.5.1 The assessment of AS: evaluation of pulse wave velocity, the pulse pressure
waveform and wave reflections 20
2.6 Pulse wave velocity (PWV) 21
2.6.1 Clinical applications of PWV 21
2.6.2 The assessment of PWV 22
2.7 Pulse wave analysis (PWA) and the pulse pressure waveform 22
2.7.1 Pulse pressure 24
2.7.2 Central haemodynamics and pressure amplification 24

2.7.3 The Augmentation index (AIx) 25
2.7.4 Non-invasive assessment of the AIx and central pressures 27
2.8 Flexibility and arterial stiffness 28
2.9 Intima-media thickness (IMT) 29
2.9.1 The physiology and speculated reasons behind intima-media thickening 30
2.9.2 The use of carotid IMT in CV risk stratification 30
2.9.3 The assessment of carotid IMT 32
2.10 The resistivity index 33
2.11 Arterial geometry and remodelling – arterial diameter and arteriogenesis 33
2.11.1 Carotid wall: lumen ratio (cWLR) 34
2.12 Associations between arterial stiffness, structural modifications and traditional CV risk
factors 34
2.12.1 Arterial stiffness and traditional CV risk factors 34
2.12.1.1 Abdominal obesity and vascular health 35
2.12.2 The association between atherosclerosis and arterial stiffness 35
CHAPTER 3:-THERAPEUTIC STRATEGIES AIMED AT OPTIMISING ARTERIAL HEALTH:
THE VASCULOPROTECTIVE ROLE OF EXERCISE 37
3.1 Goals of pharmacological therapies 37
3.2 Non-pharmacologic therapies used to improve arterial health 37
3.3 Physical activity status and arterial health 38
3.3.1 The effects of physical inactivity and deconditioning on arterial structure and function 38
3.4 Exercise and vascular health 39
3.4.1 Exercise modes considered in arterial health research 39
3.5 SUMMARY OF STUDIES INVESTIGATING RELATIONSHIPS BETWEEN PHYSICAL
ACTIVITY AND ARTERIAL HEALTH 40
3.6 The acute effects of exercise on arterial stiffness and structure 44
3.6.1 Summary: the acute effects of exercise on arterial health 46
3.7 Habitual exercise and arterial stiffness 51
3.7.1 Mechanisms underlying the effects of exercise on arterial stiffness 52
3.7.2 Summary: exercise and arterial stiffness 54
3.8 Structural adaptations of arteries to exercise – IMT 59
3.8.1 Mechanisms underlying the effects of exercise on IMT 60
3.8.2 Summary: exercise and IMT 60
3.9 Structural adaptations of arteries to exercise – Arteriogenesis 65
3.9.1 Proposed mechanisms underlying exercise-induced arterial remodelling 66
3.10 A novel hypothesis 67
3.11 Group-fitness classes 67

3.12 Summary: exercise and arterial health 67
3.13. CONCLUSION 68
CHAPTER 4: PROJECT METHODOLOGY AND EQUIPMENT 69
4.1 Experimental design and cohort description 69
4.2 Definitions used in the current study 69
4.3 Exclusion criteria: as indicated in the advert and re-assessed during the initial session 71
4.4 Assessment schedule for outcome measures 72
4.5 Questionnaires and anthropometric, clinical, fitness and psychological measures 73
4.6 Measures of arterial health derived using an automated oscillometric device 74
4.7 Ultrasound assessments 75
4.7.1 Resting carotid-femoral pulse wave velocity (cfPWV) 75
4.7.1.1 The evaluation of cfPWV 76
4.7.2 Resting intima-media thickness (IMT) 77
4.7.2.1 Resting common carotid artery intima-media thickness (cIMT) assessment 77
4.7.2.2 Resting common femoral artery intima-media thickness (fIMT) assessment 78
4.7.3 Resting common carotid artery end-diastolic intra-luminal diameter (cEDD) 79
4.7.4 Calculations of resting common carotid artery wall:lumen ratio (cWLR) 79
4.8 Structure of study 79
4.8.1 Recruitment and group allocation 79
4.8.2 Control group 80
4.8.3 Intervention group and nature of exercise intervention 80
4.9 Statistical analysis 82
CHAPTER 5: RESULTS 83
5.1 Intervention compliance, training intensity and daily training loads 83
5.2: Between and within-group effects 88
5.3: Exploration of relationships between selected physiological variables 97
CHAPTER 6: DISCUSSION 106
6.1 Intervention characteristics 106
6.2 Primary measures 107
6.2.1 Main findings 107
6.2.1.1 Cardiorespiratory fitness (CRF) 107
6.2.1.2 Carotid-femoral pulse wave velocity (cfPWV) 107
6.2.1.3 Augmentation index (AIx, [email protected]) 108
6.2.1.4 Central haemodynamics 109
6.2.2 Relationships between arterial stiffness indices 110
6.2.3 RELATIONSHIPS BETWEEN Cardiorespiratory fitness, arterial stiffness and wave
reflections 111

6.2.4 Proposed mechanisms underlying the relationship between aerobic exercise and
arterial stiffness 111
6.3 Secondary outcome measures: Arterial structural remodelling parameters 112
6.3.1 Possible reasons behind the systemic arterial structural adaptations observed 113
6.3.2 Potential mechanisms underlying the observed arterial remodelling 115
6.3.2.1 Relationships between and amongst primary and secondary outcome measures 116
6.3.2.2 Could RPMTM have a resistance exercise component? 117
6.4 Tertiary outcome measures 118
CHAPTER 7: CONCLUSIONS, IMPLICATIONS AND FUTURE DIRECTIONS 120
7.1 Perspectives and contribution to knowledge: What this study adds 120
7.2 Practical implications 121
7.3 Recommendations for further work 122
7.4 Limitations 124
7.5 Conclusions 126
REFERENCES 127
APPENDIX A: Ethics approval letter 156
APPENDIX B: Indices used to assess arterial stiffness and wall thickness 157
APPENDIX C: Techniques and equipment used to assess the arterial health indices assessed
in the present study 162
APPENDIX D: International Physical Activity Questionnaire – Long form 166
APPENDIX E: Justification of ‘sedentary’ definition as used in the present study 173
APPENDIX F: Physical Activity Readiness Questionnaire 174
APPENDIX G: Modified sit-and-reach trunk flexibility test 175
APPENDIX H: Study advertisement flyer 176
APPENDIX I: Participant information sheet 177
APPENDIX J: Consent form 187
APPENDIX K: Example of activity log for intervention group 188
APPENDIX L: Official description of an RPMTM class 191
APPENDIX M: Example of raw heart rate data from Polar Team2 192
APPENDIX N: Average weekly intensity data for each subject over all 8 weeks 193

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