Is There a Threshold Intensity for Aerobic Training in Cardiac Patients?

Purpose: Recent guidelines have recommended the use of a percentage of oxygen uptake reserve ((V) over dot O2R) for prescribing aerobic exercise intensity for cardiac patients. Moreover, these guidelines suggest that a threshold intensity may exist, below which no improvement in peak oxygen uptake ((V) over dot O-2peak) occurs, The purpose. therefore. was to translate the intensity of aerobic exercise in previous training studies using cardiac patients into %(V) over dot O2R units, and determine whether a threshold intensity exists, Methods: Twenty-three studies, using 28 groups of aerobically trained cardiac patients. were identified in which (V) over dot O2peak was measured before and after training by gas exchange. Intensity of exercise was variously described as a percentage of (V) over dot O2peak. percentage of peak heart rate (HRpeak), percentage of heart rate reserve (HRR), or percentage of peak workload. These intensities were translated into equivalent units of %(V) over dot O2R. Results: Of the 28 groups of patients, three failed to show significant improvements in (V) over dot O2peak. These groups exercised at intensities corresponding to 47-55% of (V) over dot O2R. However, six other groups exercised at comparable intensities (i.e., 42% to 55% of (V) over dot O2R) and experienced significant increases in (V) over dot O2peak. Other confounding variables in these studies were similar, including the initial (V) over dot O2peak of the subjects, suggesting that the failure of three groups to significantly improve aerobic capacity was due to their small sample size. Conclusion: No threshold intensity for aerobic training was identified in cardiac patients, with the lowest intensity studied being approximately 45% of (V) over dot O2R. It is possible that intensities below this value may be an effective training stimulus. especially in extremely deconditioned subjects. but further research is needed to test that possibility and to determine whether a threshold exists

VO2 Reserve and the Minimal Intensity for Improving Cardiorespiratory Fitness

Purpose: The American College of Sports Medicine has stated that aerobic: training needs to occur at a minimum threshold intensity of 50% VO2max for most healthy adults and at 40% VO2max for those with a very low initial fitness. Recently, the concept of VO2 reserve (% VO2R, i.e., a percentage of the difference between maximum and resting VO2 has been introduced for prescribing exercise intensity, This analysis was designed to determine the threshold intensity for improving cardiorespiratory fitness expressed as %VO2R units. Methods: Previous studies in healthy subjects (N = 18) that evaluated the result, of training at low-to-moderate intensities (i.e., less than or equal to 60% VO2max) were identified. The original studies described the intensity of exercise variously as %VO2max, %HRR, %HRmax or as a specific HR value. In each case, the intensity was translated into %VO2R units. Results: Exercise training intensities below approximately 45% VO2R were consistently ineffective at increasing VO2max in studies that used subjects with mean initial VO2max values \u3e 40 mL.min-1 kg-1. In studies using subjects with mean initial VO2max values \u3c 40 mL.min-1.kg-1, no intensity A as found to be ineffective. For this latter group of subjects, the lowest intensities examined A ere approximately 30% VO2R. Conclusion: Although evidence for a threshold intensity was not strong, this analysis of training studies support the use of 45% VO2R as a minimal effective training intensity for higher fit subjects and 30% VO2R for lower fit subjects

Photographic Assessment of Change in Trichotillomania: Psychometric Properties and Variables Influencing Interpretation

Although photographic assessment has been found to be reliable in assessing hair loss in Trichotillomania, the validity of this method is unclear, particularly for gauging progress in treatment. The current study evaluated the psychometric properties of photographic assessment of change in Trichotillomania. Photographs showing hair loss of adults with Trichotillomania were taken before and after participating in a clinical trial for the condition. Undergraduate college students (N = 211) rated treatment response according to the photos, and additional archival data on hair pulling severity and psychosocial health were retrieved from the clinical trial. Photographic assessment of change was found to possess fair reliability (ICC = 0.53), acceptable criterion validity (r = 0.51), good concurrent validity (r = 0.30–0.36), and excellent incremental validity (ΔR2 = 8.67, p \u3c 0.01). In addition, photographic measures were significantly correlated with change in quality of life (r = 0.42), and thus could be considered an index of the social validity of Trichotillomania treatment. Gender of the photo rater and pulling topography affected the criterion validity of photographic assessment (partial η2 = 0.05–0.11). Recommendations for improving photographic assessment and future directions for hair pulling research are discussed

Inhibition of inducible nitric oxide synthase limits nitric oxide production and experimental aneurysm expansion

AbstractPurpose: Nitric oxide (NO), frequently cited for its protective role, can also generate toxic metabolites known to degrade elastin. Both abdominal aortic aneurysms (AAAs) and inducible nitric oxide synthase (iNOS) are associated with inflammatory states, yet the relationship between NO production by iNOS and AAA development is unknown. The current study examines iNOS expression, NO production, and the effects of selective inhibition of iNOS by aminoguanidine in experimental AAA. Methods: An intra-aortic elastase infusion model was used. Control rats received intra-aortic saline infusion and postoperative intraperitoneal saline injections (Group 1). In the remaining groups, intra-aortic elastase infusion was used to induce aneurysm formation. These rats were treated with intraperitoneal injections of saline postoperatively (Group 2), aminoguanidine postoperatively (Group 3), or aminoguanidine preoperatively and postoperatively (Group 4). Aortic diameter and plasma nitrite/nitrate levels were measured on the day of surgery and postoperative day 7. Aortas were harvested for biochemical and histologic analysis on postoperative day 7. Results: Infusion of elastase produced AAAs (P <.001) with significant production of iNOS (P <.05) and nitrite/nitrate (P <.003) compared with controls. Selective inhibition of iNOS with aminoguanidine in elastase-infused aortas significantly reduced aneurysm size (P <.01) compared with elastase infusion alone. Aminoguanidine-treated rats displayed suppression of iNOS expression and plasma nitrite/nitrate production not significantly different from the control group. Histologic evaluation revealed equivalent inflammatory infiltrates in elastase-infused groups. Conclusion: Expression of iNOS is induced and plasma nitrite/nitrate levels are increased in experimental AAA. Inhibition of iNOS limits NO production and iNOS expression, resulting in smaller aneurysm size. NO production by iNOS plays an important role with detrimental effects during experimental aneurysm development. (J Vasc Surg 2001;33:579-86.

Lightweight XML-based query, integration and visualization of distributed, multimodality brain imaging data

A need of many neuroimaging researchers is to integrate multimodality brain data that may be stored in separate databases. To address this need we have developed a framework that provides a uniform XML-based query interface across multiple online data sources. The development of this framework is driven by the need to integrate neurosurgical and neuroimaging data related to language. The data sources for the language studies are 1) a web-accessible relational database of neurosurgical cortical stimulation mapping data (CSM) that includes patient-specific 3-D coordinates of each stimulation site mapped to an MRI reconstruction of the patient brain surface; and 2) an XML database of fMRI and structural MRI data and analysis results, created automatically by a batch program we have embedded in SPM. To make these sources available for querying each is wrapped as an XML view embedded in a web service. A top level web application accepts distributed XQueries over the sources, which are dispatched to the underlying web services. Returned results can be displayed as XML, HTML, CSV (Excel format), a 2-D schematic of a parcellated brain, or a 3-D brain visualization. In the latter case the CSM patient-specific coordinates returned by the query are sent to a transformation web-service for conversion to normalized space, after which they are sent to our 3-D visualization program MindSeer, which is accessed via Java WebStart through a generated link. The anatomical distribution of pooled CSM sites can then be visualized using various surfaces derived from brain atlases. As this framework is further developed and generalized we believe it will have appeal for researchers who wish to query, integrate and visualize results across their own databases as well as those of collaborators

Comorbidity and Quality of Life in Adults with Hair Pulling Disorder

Hair pulling disorder (HPD; trichotillomania) is thought to be associated with significant psychiatric comorbidity and functional impairment. However, few methodologically rigorous studies of HPD have been conducted, rendering such conclusions tenuous. The following study examined comorbidity and psychosocial functioning in a well-characterized sample of adults with HPD (N=85) who met DSM-IV criteria, had at least moderate hair pulling severity, and participated in a clinical trial. Results revealed that 38.8% of individuals with HPD had another current psychiatric diagnosis and 78.8% had another lifetime (present and/or past) psychiatric diagnosis. Specifically, HPD showed substantial overlap with depressive, anxiety, addictive, and other body-focused repetitive behavior disorders. The relationships between certain comorbidity patterns, hair pulling severity, current mood and anxiety symptoms, and quality of life were also examined. Results showed that current depressive symptoms were the only predictor of quality of life deficits. Implications of these findings for the conceptualization and treatment of HPD are discussed

Factor Analysis of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version

The Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A; Flessner et al., 2008) measures the degree to which hair pulling in Trichotillomania (TTM) can be described as “automatic” (i.e., done without awareness and unrelated to affective states) and/or “focused” (i.e., done with awareness and to regulate affective states). Despite preliminary evidence in support of the psychometric properties of the MIST-A, emerging research suggests the original factor structure may not optimally capture TTM phenomenology. Using data from a treatment-seeking TTM sample, the current study examined the factor structure of the MIST-A via exploratory factor analysis. The resulting two factor solution suggested the MIST-A consists of a 5-item “awareness of pulling” factor that measures the degree to which pulling is done with awareness and an 8-item “internal-regulated pulling” factor that measures the degree to which pulling is done to regulate internal stimuli (e.g., emotions, cognitions, and urges). Correlational analyses provided preliminary evidence for the validity of these derived factors. Findings from this study challenge the notions of “automatic” and “focused” pulling styles and suggest that researchers should continue to explore TTM subtypes

Clarifying the Relationship Between Trichotillomania and Anxiety

Although research has consistently linked unidimensional anxiety with Trichotillomania (TTM) severity, the relationships between TTM severity and anxiety dimensions (e.g., cognitive and somatic anxiety) are unknown. This knowledge gap limits current TTM conceptualization and treatment. The present study examined these relationships with data collected from ninety-one adults who participated in a randomized clinical trial for TTM treatment. Based on prior research, it was hypothesized that TTM severity would be related to the cognitive anxiety dimension and that psychological inflexibility would mediate the association. Hypotheses were not made regarding the relationship between TTM severity and somatic anxiety. Regression analyses indicated that only cognitive dimensions of anxiety predicted TTM severity and that psychological inflexibility mediated this relationship. Implications for the conceptualization and treatment of TTM are discussed

Trauma and Trichotillomania: A Tenuous Relationship

Some have argued that hair pulling in trichotillomania (TTM) is triggered by traumatic events, but reliable evidence linking trauma to TTM is limited. However, research has shown that hair pulling is associated with emotion regulation, suggesting a connection between negative affect and TTM. We investigated the associations between trauma, negative affect, and hair pulling in a cross-sectional sample of treatment seeking adults with TTM (N=85). In the current study, participants’ self-reported traumatic experiences were assessed during a structured clinical interview, and participants completed several measures of hair pulling severity, global TTM severity, depression, anxiety, experiential avoidance, and quality of life. Those who experienced trauma had more depressive symptoms, increased experiential avoidance, and greater global TTM severity. Although the presence of a trauma history was not related to the severity of hair pulling symptoms in the past week, depressive symptoms mediated the relationship between traumatic experiences and global TTM severity. These findings cast doubt on the notion that TTM is directly linked to trauma, but suggest that trauma leads to negative affect that individuals cope with through hair pulling. Implications for the conceptualization and treatment of TTM are discussed