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J K Shoemaker

Publications and source records attributed to J K Shoemaker.

50 records · Page 3Linked to original sources
PubMed1996

Forearm blood flow by Doppler ultrasound during test and exercise: tests of day-to-day repeatability.

The between-day repeatability of simultaneous measures of brachial artery diameter (D) (echo Doppler) and mean blood velocity (MBV) (pulsed Doppler) was tested during rest and exercise. On 3 separate days, six volunteers performed one trial of 1-min rest followed by a step increase in dynamic handgrip exercise for 4 min which required the lifting and lowering of a 4.4-kg weight (approximately 8-12% MVC) in a 1s/2s (work/rest) cadence. Measures for MBV and D were collected continuously on a beat-by-beat basis during the transition from rest to end exercise. The mean rest values over one min, and single data points at 30, 60, 120, and 240 s of exercise were extracted from the time series data. At all exercise time points, MBV was greater than rest (P < 0.05), but these levels were not different across test days. Arterial D at all exercise time points ranged from 3.8 +/- 0.1 mm to 4.1 +/- 0.1 mm (mean +/- SEM) and did not differ from rest (3.9 +/- 0.1 mm) (P > 0.05), nor did D differ between days. The mean between-day coefficient of variation for D was 4.08 +/- 0.7% at rest and ranged from 2.90 +/- 0.4% to 3.96 +/- 0.5% during exercise. The coefficient of variation for MBV was 13.2 +/- 2.6% at rest and reached 20.2 +/- 3.1% during the final min of exercise; the exercise variability was reduced to 14.9 +/- 2.4% by averaging MBV over 3 s (the duration of a contraction/relaxation duty cycle) (P < 0.05) with no further advantage of averaging over ten 60-s sample periods. The data indicate that, for the six subjects tested, Doppler ultrasound measures of arterial MBV and diameter during both rest and exercise were reproducible across different test days and can be used as a reliable, noninvasive means of testing hypotheses pertaining to blood flow control.

Adult↗
PubMed1996

Failure of prolonged exercise training to increase red cell mass in humans.

The purpose of this study was to investigate the time-dependent effects of long-term prolonged exercise training on vascular volumes and hematological status. Training using seven untrained males [age 21.1 +/- 1.4 (SE) yr] initially consisted of cycling at 68% of peak aerobic power (VO2peak) for 2 h/day, 4-5 days/wk, for 11 wk. Absolute training intensity was increased every 3 wk. Red cell mass (RCM), obtained using 51Cr, was unchanged (P > 0.05) with training (2,142 +/- 95, 2,168 +/- 86, 2,003 +/- 112, and 2,080 +/- 116 ml at 0, 3, 6, and 11 wk, respectively) as were serum erythropoietin levels (17.1 +/- 4.3, 13.9 +/- 3.5, and 17.0 +/- 2.0 U/l at 0, 6, and 11 wk, respectively). Plasma volume measured with 125I-labeled albumin and total blood volume (TBV) were also not significantly altered. The increase in mean cell volume that occurred with training (89.7 +/- 0.95 vs. 91.0 +/- 1.0 fl, 0 vs. 6 wk, P < 0.05) was not accompanied by changes in either mean cell hemoglobin or mean cell hemoglobin concentration. Serum ferritin was reduced 73% with training (67.4 +/- 13 to 17.9 +/- 1 microgram/l, 0 vs. 11 wk, P < 0.05). Total hemoglobin (HbTot) calculated as the product of hemoglobin concentration and TBV was unaltered (P > 0.05) at both 6 and 11 wk of training. The 15% increase in VO2peak (3.39 +/- 0.16 to 3.87 +/- 0.14 l/min, 0 vs. 11 wk, P < 0.05) with training occurred despite a failure of training to change TBV, RCM, or HbTot.

Adult↗
PubMed1996

Vasodilation and muscle pump contribution to immediate exercise hyperemia.

A rapid (within 0-5 s) increase in skeletal muscle blood flow has been demonstrated following muscle contraction, yet the mechanism remains unresolved. Recently, it was suggested that the entire rapid exercise hyperemia could be attributed to the mechanical muscle pump effect. Other evidence indicates that the muscle pump cannot increase arterial flow. We measured human forearm blood flow with the arm positioned above or below heart level during 1) simulation of rhythmic muscle pump function via repeated inflation/deflation of a forearm cuff to 100 mmHg to achieve mechanical emptying of forearm veins, and 2) 1-s single-cuff inflations, 1-s voluntary forearm contractions, and 1-s contractions performed within a cuff inflation. Rhythmic cuff inflation increased blood flow with the arm below heart level (P < 0.05) but not above. Flow following single contractions was higher than flow following cuff inflation within 2 s (P < 0.05). Peak flow increases due to a single mechanical venous emptying (7.7 +/- 0.7 ml.100 ml(-1) min(-1)) could account for 60% of the peak flow increase due to muscle contraction (12.8 +/- 1.0 ml.100 ml(-1).min(-1)) with the arm below heart level, whereas above heart level mechanical venous emptying accounted for 46% of the flow increase due to contraction (3.0 +/- 0.4 vs. 6.5 +/- 0.6 ml.100 ml(-1).min(-1)). We conclude that a functional muscle pump does exist in the human forearm in vivo, but that a rapid vasodilation detectable within 2 s also contributes to the early exercise hyperemia.

Adult↗
PubMed1996

Failure of prostaglandins to modulate the time course of blood flow during dynamic forearm exercise in humans.

The time course and magnitude of increases in brachial artery mean blood velocity (MBV; pulsed Doppler), diameter (D; echo Doppler), mean perfusion pressure (MPP; Finapres), shear rate (gamma = 8.MBV/D), and forearm blood flow (FBF = MBV.pi r2) were assessed to investigate the effect that prostaglandins (PGs) have on the hyperemic response on going from rest to rhythmic exercise in humans. While supine, eight healthy men performed 5 min of dynamic handgrip exercise by alternately raising and lowering a 4.4-kg weight (approximately 10% maximal voluntary contraction) with a work-to-rest cycle of 1:1 (s/s). When the exercise was performed with the arm positioned below the heart, the rate of increase in MBV and gamma was faster compared with the same exercise performed above the heart. Ibuprofen (Ibu; 1,200 mg/day, to reduce PG-induced vasodilation) and placebo were administered orally for 2 days before two separate testing sessions in a double-blind manner. Resting heart rate was reduced in Ibu (52 +/- 3 beats/min) compared with placebo (57 +/- 3 beats/min) (P < 0.05) without change to MPP. With placebo, D increased in both arm positions from approximately 4.3 mm at rest to approximately 4.5 mm at 5 min of exercise (P < 0.05). This response was not altered with Ibu (P > 0.05). Ibu did not alter the time course of MBV or forearm blood flow (P > 0.05) in either arm position. The gamma was significantly greater in Ibu vs. placebo at 30 and 40 s of above the heart exercise and for all time points after 25 s of below the heart exercise (P < 0.05). Because PG inhibition altered the time course of gamma at the brachial artery, but not FBF, it was concluded that PGs are not essential in regulating the blood flow responses to dynamic exercise in humans.

Adult↗
PubMed1996

Dependence of muscle VO2 on blood flow dynamics at onset of forearm exercise.

The hypothesis that the rate of increase in muscle O2 uptake (VO2mus) at the onset of exercise is influenced by muscle blood flow was tested during forearm exercise with the arm either above or below heart level to modify perfusion pressure. Ten young men exercised at a power of approximately 2.2 W, and five of these subjects also worked at 1.4 W. Blood flow to the forearm was calculated from the product of blood velocity and cross-sectional area obtained with Doppler techniques. Venous blood was sampled from a deep forearm vein to determine O2 extraction. The rate of increase in VO2mus and blood flow was assessed from the mean response time (MRT), which is the time to achieve approximately 63% increase from baseline to steady state. In the arm below heart position during the 2.2-W exercise, blood flow and VO2mus both increased, with a MRT of approximately 30 s. With the arm above the heart at this power, the MRTs for blood flow [79.8 +/- 15.7 (SE)s] and VO2mus (50.2 +/- 4.0 s) were both significantly slower. Consistent with these findings were the greater increases in venous plasma lactate concentration over resting valued in the above heart position (2.8 +/- 0.4 mmol/l) than in the below heart position (0.9 +/- mmol/l). At the lower power, both blood flow and VO2mus also increased more rapidly with the arm below compared with above the heart. These data support the hypothesis that changes in blood flow at the onset of exercise have a direct effect on oxidative metabolism through alterations in O2 transport.

Adult↗
PubMed1996

Faster femoral artery blood velocity kinetics at the onset of exercise following short-term training.

OBJECTIVE: The hypothesis that the adaptation to endurance exercise training included a faster increase in blood flow at the onset of exercise was tested in 12 healthy young men who endurance-trained (ET) 2 h/day, for 10 days at 65% VO2 peak on a cycle ergometer, and in 11 non-training control (C) subjects. METHODS: Blood flow was estimated from changes in femoral artery mean blood velocity (MBV) by pulsed Doppler. Beat-by-beat changes in cardiac output (CO) and mean arterial pressure (MAP) were obtained by impedance cardiography and a Finapres finger cuff, respectively. MBV, MAP and CO were measured at rest and during 5 min of dynamic knee extension exercise. Both legs worked alternately with 2 s raising and lowering a weight (15% maximal voluntary contraction) followed by 2 s rest while the other leg raised and lowered the weight. RESULTS: In the ET group the time to 63% (T63%) of the approximately exponential increase in MBV following 10 days of training (8.6 +/- 1.2 s, mean +/- s.e.) was significantly faster than the Day 0 response (14.2 +/- 2.1 s, P < 0.05). The T63% of femoral artery vascular conductance (VCfa) was also faster following 10 days of ET (9.4 +/- 0.9 s) versus Day 0 (16.0 +/- 2.5 s) (0.05). There was no change in the T63% of both MBV and VCfa for the C group. The kinetics of CO were not significantly affected by ET, but the amplitude of CO in the adaptive phase, and at steady state, were significantly greater (P < 0.05) at Day 10 compared to Day 0 for the ET group with no change in the C group. CONCLUSIONS: These data supported the hypothesis that endurance training resulted in faster adaptation of blood flow to exercising muscle, and further showed that this response occurred early in the training program.

Adult↗
PubMed1995

Effleurage massage, muscle blood flow and long-term post-exercise strength recovery.

Manual massage is commonly assumed to enhance long term muscle recovery from intense exercise, partly due to its ability to speed healing via enhanced muscle blood flow. We tested these assumptions by daily (for four days) massaging the quadriceps muscles of one leg on subjects who had previously completed an intense bout of eccentric quadriceps work with both legs. Immediate post-exercise isometric and dynamic quadriceps peak torque measures had declined to approximately 60-70% of pre-exercise values in both legs. Peak torques for both the massage and control leg tended to slowly return toward pre-exercise values through the subsequent four days (96 hrs). There was no significant difference between the isometric and dynamic peak torques between massage and control legs up to 96 hours post-exercise. Leg blood flow was estimated by determining femoral artery and vein mean blood velocities via pulsed Doppler ultrasound velocimetry. Massage of the quadriceps muscles did not significantly elevate arterial or venous mean blood velocity above resting levels, while light quadriceps muscle contractions did. The perceived level of delayed onset muscle soreness tended to be reduced in the massaged leg 48-96 hours post-exercise. It was concluded that massage was not an effective treatment modality for enhancing long term restoration of post-exercise muscle strength and its use for this purpose in athletic settings should be questioned.

Adult↗
PubMed1995

Vascular actions of insulin in health and disease.

Insulin has well known metabolic effects. However, depending on the magnitude and duration of the insulin stimulus, this hormone can also produce vasodilation and vascular smooth muscle growth. The association of hyperinsulinemia with the metabolic disorders of obesity and non-insulin-dependent diabetes, as well as with the cardiovascular pathologies of hypertension and atherosclerosis, has led to suggestions that perhaps elevated insulin levels are causally related to these diseases. Alternatively, insulin resistance may develop following an increase in skeletal muscle vascular resistance, with or without hypertension, such that a reduction in skeletal muscle blood flow leads to an attenuated glucose delivery and uptake. These hypotheses are explored in this review by examining the effects of insulin on vascular smooth muscle tissue during both acute and prolonged exposure. An interaction among hyperinsulinemia, hyperglycemia, and hyperlipidemia associated with the insulin resistant state is described whereby insulin resistance can be both a cause and a result of elevated vascular resistance. The association between blood flow and insulin stimulated glucose uptake suggests that therapeutic intervention against the development of skeletal muscle vascular resistance should occur early in individuals generally predisposed to cardiovascular pathology in order to attenuate, or avoid, insulin resistance and its sequelae.

Animals↗
PubMed1995

Beat-by-beat forearm blood flow with Doppler ultrasound and strain-gauge plethysmography.

Simultaneous Doppler ultrasound estimates of brachial artery mean blood velocity (MBV) and venous occlusion strain-gauge plethysmography measures of forearm blood flow (FBF) were performed to determine the beat-by-beat relationship between the two methods and provide a method for flow calibration of Doppler MBV estimates. Such a calibration of Doppler MBV eliminates the need for knowledge of vessel cross-sectional area and angle of insonation while allowing for the quantification of limb blood flow. Six healthy subjects (5 men and 1 woman) performed 40 s of isometric forearm contraction at 35% maximal voluntary contraction with arterial inflow occluded. This resulted in elevated blood flow on relaxation and cuff deflation, and simultaneous beat-by-beat Doppler MBV and strain-gauge FBF measurements were then made over a period of 2-3 min as flow gradually decreased to resting levels. The r2 values for the fitted regression lines over a wide range of flows ranged from 0.87 to 0.98, and the mean square error terms ranged from 0.88 to 3.07 ml.100 ml-1.min-1. Significant day-to-day variation of the fitted regression parameters within subjects indicated that quantitative estimates of FBF from Doppler MBV require a calibration to be performed for each experiment. The finding of a strong linear relationship between Doppler MBV and venous occlusion strain-gauge plethysmography, as well as the marked beat-by-beat effect of cuff inflation on blood flow, confirms the importance of calibration on the same beats, not on adjacent segments of beats.

Adult↗
PubMed1995

Exercise with and without gravitational gradient: evaluation with the new random access mass spectrometer (RAMS).

Gravity adds about 40-50 mmHg perfusion pressure to the arterial supply of the quadriceps muscles in the upright posture. This could have important implications in supply of blood flow during exercise. Recently, we have shown that when subjects exercise in the supine posture the rate of increase in VO2 is considerably slower then when cycling exercise takes place in the upright posture. The most probable explanation for this slower adaptation was the altered perfusion gradient. Indeed, when the perfusion gradient from heart to legs was restored by placing the lower part of the body of supine subjects in a negative pressure chamber, the rate of increase in VO2 returned to upright values. The hypothesis advanced from these studies was that skeletal muscle blood flow was reduced at the onset of supine exercise. Exercise in the microgravity environment of space should be similar to that in the supine posture. The only experiments conducted in space to this date that have addressed the question of cardiorespiratory adaptation to changing work rates were performed on the German D2 mission using the methodology proposed by Stegemann and colleagues. To conduct these experiments, it is necessary to utilize sensitive breath-by-breath technology. Recently, NASA and the Russian space programs have commissioned a new mass spectrometer based system as part of the GASMAP project. It was the purpose of this study to evaluate the new mass spectrometer under conditions in which the gravitational effects on the cardiorespiratory response were being challenged.

Adult↗
PubMed1994

Cardiorespiratory kinetics and femoral artery blood velocity during dynamic knee extension exercise.

The kinetics of femoral artery mean blood velocity (MBV; measured by pulsed Doppler) and whole body oxygen uptake (VO2; measured breath by breath) were assessed from the time constant during the on (tau on) and off (tau off) transients to step changes in work rate between complete rest and dynamic knee extension (KE) exercise. Six healthy men performed 5 min of seated KE exercise, with each leg alternately raising and lowering a weight (10% maximum voluntary contraction) over a 2-s duty cycle. Because kinetic analysis of VO2 kinetics during KE exercise is a new approach, the VO2 responses were also evaluated during the on and off transitions to the more familiar upright cycling exercise in which the magnitude of increase in VO2 and cardiac output was similar to that during KE exercise. During KE exercise, VO2 tau on [mean 72.2 +/- 11.2 (SE) s] was slower than VO2 tau off (33.3 +/- 1.8 s; P < 0.01). Cardiac output, measured with impedance cardiography, was not different for tau on (67.1 +/- 20.0 s) compared with that for tau off (52.9 +/- 7.6 s). Likewise, MBV tau on (34.5 +/- 3.9 s) was not different from tau off (35.3 +/- 3.2 s). During cycling, the VO2 tau on (18.0 +/- 2.4 s) and tau off (30.7 +/- 1.2 s) were both faster than KE VO2 tau on (P < 0.01). Even though the MBV kinetics indicated a rapid adaptation of blood flow during KE exercise, there was a slow adaptation of VO2. A transient hyperemia immediately on cessation of KE exercise, indicated by both MBV and calculated systemic vascular conductance responses, suggested that blood flow might have been inadequate and could have contributed to the delayed adaptation of VO2 at the onset of exercise, although other explanations are possible.

Adult↗
PubMedDate not supplied

Nursing diagnosis in graduate curricula.

The concept of nursing diagnosis is included in most basic nursing programs; however, little attention has been paid to the inclusion of nursing diagnosis in graduate curricula. This article presents arguments supporting theoretical analysis, clinical applications, and research of nursing diagnoses in master's degree programs. Curriculum considerations and an example of an integrated approach to the inclusion of nursing diagnosis in a graduate curriculum are presented.

Clinical Competence↗