Gender related differences in stress and health outcomes in college age students

Background and Purpose: Rates of obesity and metabolic disorders in young adults are becoming more prevalent in today’s society. To date, only a few investigators have compared the effect that stress may have on health and metabolic outcomes in college age adults. The purpose of this study is to determine the relationship between stress and cholesterol levels in male versus female college age students. Methods: Thirty-six adults ages 20 to 27 participated in this study. Total blood cholesterol, HDL, LDL, triglycerides, TC/HDL ratio, and glucose were measured one time using the Cholestech LDX® after either an overnight, or 4-hour fast. Subjects were then asked to complete two surveys, the Holmes-Rahe Life Stress Inventory® for adults, and the Holmes-Rahe Life Stress Inventory for Young Adults®. Independent t-test and linear regression were used to analyze differences between male and female responses. Significance was set at the 0.05 level. Results: Total Life Stress Inventory® score for adults was significantly higher in female subjects (F=166.8 ± 116.4; M=146.4 ± 123.2; p= 0.003). No significant differences were noted in cholesterol levels and reported stress between genders. However, trends were noted for BMI, body weight, and triglyceride levels. Individual relationships were evaluated between health parameters and each stress inventory question. Overall, both males and females reported higher stress related to the beginning and end of school, change in living conditions, and diet. Significant relationships between different stressors and measured health parameters are given in the table below. Stressor Yes Response No Response P-value Beginning or end of school Total cholesterol (mg•dL-1) 182 ± 36.3 164 ± 18.1 0.007 LDL cholesterol (mg•dL-1) 91.7 ± 34.7 84.6 ± 19.5 0.04 Triglycerides (mg•dL-1) 154.4 ± 111.7 102.5 ± 52.6 0.005 Change in living conditions BMI (kg•m2(-1)) 23.7 ± 4.1 23.6 ± 2.1 0.06 Change in eating habits BMI (kg•m2(-1)) 24.2 ± 4.2 23.4 ± 2.0 0.03 TC/HDL ratio 3.4 ± 1.8 3.3 ± 1.0 0.01 Vacation TC/HDL ratio 4.2 ± 1.7 3.0 ± 0.9 0.01 Conclusion: This preliminary investigation revealed that college age females report higher life stress levels than males. While there were no significant differences between genders regarding overall life stress and health parameters, several defined stressors were associated with negative health outcomes. More investigation incorporating physical activity level, dietary habits, and a larger sample size needs to be completed in the future

Case Presentation for Percutaneous Transluminal Coronary Angioplasty and Coronary Artery Disease

CASE HISTORY: The patient is a 70-year old who presented in September 2016 to a rural based cardiac and pulmonary rehabilitation program with occasional exertional hypotension and dizziness. He tolerated exercise well completing 550 meters in 6 minutes without symptoms. He consistently walked approximately 1 mile a day and reported occasional lightheadedness/dizziness with walking. He also was able to complete 12 minutes of interval training at 5-6 METs on the Sci-Fit with no symptoms, normal HR, SaO2, and BP response to exercise. He was not taking any medication. PHYSICAL EXAM: Patient came in with initial measurements as follows: weight- 212 lbs, height- 72 in, BMI- 28 kg∙m-2, resting heat rate- 77bpm, resting BP- 120/70mmHg, 95 SaO2 and a Duke Activity Status Index score of 27.4. DIFFERENTIAL DIAGNOSES: Exertional hypotension; arthritis; celiac disease. TESTS & RESULTS: Patient had CT performed that was negative for injury. In January while on vacation, he reported severe chest tightness and was admitted to the ER. He was referred for angiogram which showed 90 percent blockage of the right coronary artery. A stent was inserted, and he was prescribed Carvediol, Lisinopril, Pravastatin, Plavix, and Nitroglycerin. FINAL DIAGNOSIS: Coronary artery disease, percutaneous transluminal coronary angioplasty. DISCUSSION: Coronary heart disease is the process of damaged coronary arteries becoming hardened and narrow which causes a decrease in oxygen-rich blood flow to the heart. Coronary heart disease is usually caused by the build-up of plaque in the arteries. Percutaneous transluminal coronary angioplasty is a procedure in which blocked coronary arteries are opened to allow unobstructed blood flow to the heart. After sent placement, he returned to exercise with us. We performed a submaximal walk test with 12-ECG and noted multifocal PVCs (\u3e20 percent of cycles) at HR of 95-100. He tolerated exercise well, and did not report dizziness. The ventricular ectopy persisted at HR above 105, so for the following week he was given an exercise prescription of 1 mile at HR of 100-105. The patient then mentioned he smoked half a cigar in the mornings and the other half in the evenings. OUTCOME OF THE CASE: We had a discussion with the patient about his diagnosis and how we will proceed further with his treatment. We also advised him to not smoke a cigar before he came to cardiac rehab in the mornings. The next exercise session we noted only three unifocal PVCs for the entire workout. We have reviewed the importance of cardiovascular exercise as well as resistance exercise for his recovery and improvement. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Patient was told by physician to wear a cardiac event monitor for 30 days. He is performing 20 minutes of walking at 3.0 mph/2% grade and 15 minutes of steady state training at 4-5 METs on the Sci-fit

Case Presentation for Exercise Management of CAD Patient

CASE HISTORY: A 70-year-old female was referred to our cardiopulmonary rehabilitation exercise program in November of 2016. She had previously attended the Laboratory for Wellness and Motor Behavior to help with her spinal stenosis. The client began her exercise program at the LWMB in November of 2015 and attended consistently until May of 2016. Her exercise prescription consisted of 4-5 exercises a day, including a combination of cardiovascular and resistance training. The client had noticed improvement in her strength and overall range of motion but eventually started to have symptoms of weakness throughout her body, at which point she went to see her cardiologist. She had to stop attending the program due heart blockage, where she needed two new stents placed in September of 2016, which led her to our program. PHYSICAL EXAM: Medical history and initial baseline physical assessments were measured including resting 12-lead ECG, SaO2- 95 %, HR- 80 bpm, BP- 134/58 mmHg, weight- 78.75 kg, and the Duke Activity Status Questionnaire. She was cleared for exercise and given a basic orientation to exercise equipment including Nu-Step®, SciFit Pro2 Total Body Bariatric, and seated exercises including range of motion and band resistance exercises prescribed at 2 sets of 12 (RPE rating = 13). An exercise prescription for attending the program three days per week was developed for approximately one hour at 2 to 3 METs with intermittent exercise on the Nu-Step® and Total Body Bariatric at a 5:1 ratio at 80% of estimated max METs to 20 percent of estimated max METs. DIFFERENTIAL DIAGNOSES: 1. Hypertension, 2. Coronary Artery Disease (3 stents in ’99 and 2 stents in ‘16), 3. Carpal tunnel, 4. Spinal stenosis. TESTS & RESULTS: The clients cardiologist reports that she was having unstable angina. Heart cauterizations and angiograms were performed in order to find the extent of blockage. The cardiologist found 70-80% blockage in the right coronary artery and 90% blockage in the left circumflex. The client then had one stent placed in the RCA and one placed in the circumflex. Stenting was successful in both locations. FINAL DIAGNOSIS: A 12-lead exercise test was performed after the client returned to activity, upon joining our program. There were no signs of ischemia seen throughout the exercise. DISCUSSION: The client was cleared to perform activity while being supervised. Rhythm strips were monitored throughout cardiovascular exercise in follow-up of initial 12-lead. She has continued exercise consistently without any signs or symptoms of ischemia. There has been improvement in her resting vitals upon check-in from an average of 137/66 to 129/68. The client has also increased her cardiovascular exercise to 4 METS at a constant workload on both the Nustep and Total Body Bariatric. She continues to gain strength and has worked up to using dumbbells as well as higher resistance bands. OUTCOME OF THE CASE: The client has adjusted well to her return to exercise and continues to show improvement in her exercise tolerance, workloads, and range of motion. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The client consistently attends the program and tolerates exercise well. Workloads increased to level 5 on the Nustep at 4 METS and level 5 on the Total Body Bariatric at 3.8 METS

Exercise Management of Congestive Heart Failure Patient after Pace Maker Replacement

History: In February of 2015 a 96 year old male started our rural-based cardiac and pulmonary exercise program. He was confined to a wheel-chair due to frequent episodes of extreme weakness and occasional syncope. An initial physical work-up, medical history, and exercise program was developed and he exercised without incident from Feb. to August. By September of 2015, he had increased his functional capacity by 1-2 METsand was regularly walking 50-100 meters with a walker during his exercise sessions. Differential Diagnosis: 1. Congestive Heart Failure; 2. Anemia, 3. chronic heart failure (CHF), 4. chronic obstructive pulmonary disease (COPD), 5. coronary artery disease (CAD), 6. Deep vein thrombosis (DVT), 7. Pacemaker. Physical examination and symptomology: In October, he reported feeling weak and experiencing chest pain off and on for a few weeks. During exercise, he developed recurring episodes of atrial fibrillation with aberrancy with regular exercise, and chronotropic incompetence. Hemoglobin levels were normal and left ventricular function was stable. Tests and Results: The client’s cardiologist was contacted to check the pacemaker replacement date and see if it needed to be moved up and also to inquire to check medication levels. Rhythm strips and vitals for the month of October were sent as well. The client continued to exercise until December without a change in medication or pacemaker at which time he developed pneumonia and stopped exercising. Final management plan: The decision was made to move up the original pacemaker replacement date from February to January, and he returned to exercise program in early February. Exercise Prescription and Physical Function Outcomes: He returned to exercise February 5th and was placed on low intensity (2 – 2.5 METs) exercise on arm-leg ergometry and chair resistance exercise. To date he has been without incident during exercise with normal HR and BP response and no shortness of breath or chest discomfort. He reports having more strength and has not had any fainting spells

Case Study: Exercise Management of CHF Patient after Debilitating Fall

History: A 64-year-old male (160.5 kg) was referred to our cardiopulmonary rehabilitation exercise program in October of 2015. Medical history and initial baseline physical assessments were measured including resting 12-lead ECG, SaO2- 95 %, HR- 65 bpm, BP- 146/82 mmHg, glucose- 128 mg/dL, weight- 160.5 kg, and the Duke Activity Status Questionnaire and HSQ-SF36® quality of life questionnaire. He was cleared for exercise and given a basic orientation to exercise equipment including Nu-Step® and six different band resistance exercises prescribed at 2 sets of 20 (RPE rating = 13). An exercise prescription for attending the program three days per week was developed for approximately one hour at 2 to 3 METs with intermittent exercise on the Nu-Step® at a 4:1 ratio at 80% of estimated max METs to 20 percent of estimated max METs. Differential Diagnosis: Hypertension Third degree heart block (Pacemaker) Atrial flutter Type II diabetes Congestive heart failure Physical Examination and Symptomology: The client was consistently attending the program, tolerating exercise well, increased his workload on the Nu-Step to a level 5, as well as improved his MET capacity up to 3.2 until the 2015 holiday break. He fell while leaving a restaurant and spent two weeks recovering from the injury. Tests and Results: He declined being admitted to the ER. After his fall the participant went to see his primary care physician for his injury to be examined where he received an x-ray which was negative for fracture. The entire left leg was contused and swollen with excessive swelling at the knee. Once he was cleared to exercise, January 27th, severe bruising and edema in the left leg continued, and he reported significant knee pain. Final Management Plan: The participant was placed on the Nu-Step® (1.5 METs) for 15 minutes. He returned to seated resistance exercises with a slow progression into the use of his left leg. He has since worked his way back up to 2.1 METs for 15 minutes

Gender and Stress Related Effects on Cardiovascular Health Outcomes

Title[j1] : Gender and stress related effects on cardiovascular health outcomes Authors: Michael Cedeño – Master’s, (Tarleton State University), Jennifer Blevins-McNaughton (Tarleton State University) Background and Purpose: To date, only a few investigators have compared the effect that stress may have on health and metabolic outcomes in college age adults. The purpose of this study was to determine the extent to which gender may play a role in self-reported stress and cardiovascular and metabolic outcomes in college age students. Methods: Thirty-eight (N = 38) adults ages 18 to 28 participated in this study. Height, weight, supine resting heart rate and supine blood pressure were measured. Subjects completed the Institute of HeartMath® Stress and Well-Being Survey™ to measure psychological stressors, total stress score, total well-being, and emotional vitality. Total blood cholesterol, HDL, LDL, triglycerides, TC/HDL ratio, and glucose were measured in a randomly selected subset of 13 subjects (N = 13; 7 females and 6 males) using the Cholestech LDX®. Independent t-test and Pearson correlations were used to analyze differences between male and female responses. Results: Males reported significantly higher systolic (P \u3c 0.05) and diastolic (P \u3c 0.05) blood pressures than females as well as glucose levels (P \u3c 0.01). Males also reported higher amounts of work related stress (P \u3c 0.01). Conclusion: This preliminary investigation revealed that college age males reported significantly higher systolic and diastolic blood pressures as well as glucose levels than their female counterparts. Females had significantly higher HDL than males, but this is common in college age adults. There were no significant differences regarding stress components, cardiovascular or metabolic health outcomes and gender. Stress components such as work and finances were shown to correlate with systolic and diastolic blood pressure in both genders, but a larger sample size is needed to find a relationship. [j1

Academic Achievement and Health Related Fitness Outcomes Among Kinesiology Majors

BACKGROUND AND PURPOSE: Academic achievement has been shown to be related to health related fitness (HRF) performance among grade school and middle school children. However, very little is known about this relationship in college age students. The authors are not aware of any data available concerning HRF performance and those students seeking degrees in kinesiology. The purpose of this study was to determine if a relationship exists between academic achievement and HRF outcomes among kinesiology majors. METHODS: Health related fitness measurements were taken on 104 undergraduate Tarleton kinesiology majors. Students overall GPA was obtained by the supervising faculty member through approved methods and with any identifying information removed. Fitness measures included body composition, blood pressure, cardiorespiratory endurance (1.5 mile time), flexibility (sit-n-reach), and muscular strength and endurance. One and half mile run, sit ups, bench press, leg press, and the sit and reach were administered and ranked according to ACSM Guidelines (9th ed). Differences in HRF outcomes were analyzed using independent t-tests with significance set at p\u3c0.05. Pearson product correlation was used to evaluation relationships between GPA and HRF rankings. RESULTS: Relationships between HRF and GPA are presented in the table below. GPA and Health-Related Fitness Percentile Rankings (p\u3c0.05)* Student Characteristics Males (N=44) Females (N=50) GPA* 2.74 ± 0.49 2.95 ± 0.53 1.5 Mile Run (% Rank)* 59.1 ± 29.9 41.9 ± 28.9 Body Fat (% Rank)* 53.6 ± 30.4 34.5 ± 24.1 Leg Press Ratio (% Rank)* Flexibility (% Rank) Bench Press Ratio (% Rank) Sit-ups (% Rank) Systolic Blood Pressure* Diastolic Blood Pressure 83.8 ± 8.9 69.3 ± 17.3 49.5 ± 19.9 57.8 ± 24.1 126.3 ± 11.1 78.5 ± 7.6 87.6 ± 5.9 69.4 ± 16.1 46.5 ± 24.8 54.9 ± 24.5 117.6 ± 10.9 73.3 ± 10.0 CONCLUSION: In this subset, although females ranked higher relative to GPA, males performed better on several HRF measures. Further analysis to investigate HRF and GPA relationships

Tribulus terrestris: A Study of its Effects on Strength, Body Composition, and Cardiovasuclar Health

The study of ergogenic aids and their influence results in many uncertainties that have yet to be answered or explained. There is speculation about the effectiveness of Tribulus terrestris (TT) as an ergogenic aid and its effectiveness for increasing power and strength. Little research has been completed to monitor its effects on cholesterol and blood pressure. The purpose of this study was to evaluate the effect of TT on muscular strength, blood pressure, and cholesterol in a sedentary population. Eighteen males (18 - 24 yrs,) were randomly assigned using a double-blind protocol into either TT group (n=9) or placebo (n=9), while subjects participated in an 8-week resistance training program. Each group either ingested a 650mg TT pill or a wheat grass equivalent pill with no change in diet. Strength outcomes were measured by having participants perform a 10-rep max strength test. Body fat outcomes were analyzed by including 7-site skinfold measurements and upper and lower body circumferences. Blood lipids and glucose were measured using the Cholestech LDX machine. The training protocol consisted of Smith machine bench press, Smith machine squat, Hammer Strength lat-pulldown, and Hammer Strength seated bicep curl with a ten percent progressive overload rate each week. Baseline body composition, cardiovascular health including cholesterol, and strength were not significantly different. Two-by-two repeated measures ANOVA was used to analyze differences between the control and TT groups for all dependent measures. There was a 100% adherence rate as all subjects completed the training protocol for the entire eight weeks. Although changes did exist such as decrease in body fat percentage (TT- 14.4 ± 6.0 to 11.9 ± 6.1; Control-14.0 ± 5.4 to 11.3 ± 4.7) and total cholesterol (TT- 173.4 ± 30.8 to 167.2 ± 28.2; Control- 171.6 ± 30.4; TT- 155.6 ± 24.8), there were no significant differences after 8 weeks between the two groups. There was however, a significant decrease in overall cholesterol for the TT group after training (167.2 ± 28.2) (F = 10.24; P = .006). Individual variables of cholesterol such as LDL, HDL, triglycerides and blood pressure were not significantly different between groups. The results indicated no significant interaction due to TT use for all measurements in a sedentary population while under an 8-week resistance training program. Suggestions for future studies should focus on long term intervention such as a twelve to fifteen week study

Energy Drinks: Ergolytic or Ergogenic?

International Journal of Exercise Science 5(3) : 214-222, 2012. Despite the growing popularity of energy drinks, many do not realize the negative effects on the cardiovascular system. The purpose of this study was to examine the effects of energy drink ingestion on estimated VO2max, heart rate (HR), systolic and diastolic BP (SBP and DBP, respectively), rate pressure product (RPP), and RPE at rest and during exercise. Seven healthy adults (age: 24.3 ± 3.5 yrs; body mass: = 66.0 ± 2.2 kg) participated in this randomized double blind, crossover study. Subjects ingested a placebo (PL) or Redline (RL) energy drink (240ml; 250 mg caffeine) 40 minutes before maximal graded exercise test (GXT). Estimated maximal oxygen consumption (VO2max) was lower in the RL trial (37.9±5.7 ml∙kg-1∙min-1) compared to the PL trial (39.7±6.5 ml∙kg-1∙min-1; P= 0.02). Although no significant differences were noted for the number of ectopic beats (ETB) between the trials, a five to one ratio for the RL and PL existed (RL = 106 total ectopic beats; PL = 21 total ectopic beats). Sub-maximal exercise heart demand (RPP: systolic BP x HR) at the same workload was considerably higher in the RL trial (224.9 ± 39.9 mmHg∙bts∙min-1; P=0.04) compared to PL (195.8 ± 22.9 mmHg∙bts∙min-1). Recovery DBP was significantly higher at one min. in the RL trial (51.6 ± 25.1 mmHg) compared to PL (25.4 ± 33.8 mmHg; P=0.05). Based on the results of this study, it was determined that energy drinks lowered estimated VO2max while elevating RPP and recovery DBP

The effect of a caffeine energy drink on cardiovascular responses during intense exercise

Background and Purpose: Despite the growing popularity of energy drinks, many do not realize the negative effects on the cardiovascular system. Little research has investigated the electrocardiographic effects of energy drinks. The purpose of this study was to examine the effects of energy drink ingestion on the cardiovascular system at rest and during exercise. Methods: Seven healthy adults (24.3 ± 3.5 yrs; wt = 66.0 ± 2.2 kg) participated in this double blind study. Subjects ingested a placebo (PL) or Redline (RL) energy drink (240ml; 316 mg caffeine) 40 minutes before maximal graded exercise test (GXT). Subjects were asked to fast for 8 hours and withhold from caffeine for 24 hours. Subjects were tested no more than one week apart at the same time of day. Resting HR, BP, and ECG were taken in the supine position. Exercise HR, BP, ECG, RPE, and rate-pressure-product (RPP) were monitored continuously during exercise. Recovery HR, BP, and ECG were taken every min for 4 minutes. Dependent t-test was used to measure differences between trials. Significance was set at the 0.05 level. Results: Maximal oxygen consumption was lower in the RL trial (37.9±5.7 ml•kg-1•min-1) compared to the PL trial (39.7±6.5 ml•kg-1•min-1; p= 0.02). Trends were noted for the number of ectopic beats (ETB) between the trials with a five to one ratio for the RL and PL, respectively (RL = 106 total ectopic beats; PL = 21 total ectopic beats). Sub-maximal exercise heart demand (RPP, mmHg•bts•min-1) at the same workload, was considerably higher in the RL trial (224.9 ± 39.9 mmHg•bts•min-1; p=0.04) compared to PL (195.8 ± 22.9 mmHg•bts•min-1). Recovery DBP was significantly higher at one min. in the RL trial (51.6 ± 25.1 mmHg) compared to PL (25.4 ± 33.8 mmHg; p=0.05). Three and four min recovery DBP were not significantly different yet showed a trend for the RL trial to stay elevated by a mean of 11 mmHg above the PL trial. Conclusion: Based on the results of this study, we found that energy drinks lowered estimated fitness levels while elevating heart demand and recovery BP. Future research should include a larger sample size, use of gas exchange, and evaluation of racial differences in cardiovascular demand during exercise after energy drink consumption