Biomedical subjects

W D Hiller

Publications and source records attributed to W D Hiller.

At least 19 recordsLinked to original sources

PubMed1999

Hematocrits of triathletes: is monitoring useful?

PURPOSE: The purpose of this manuscript was to provide a basis for establishing safety cutoffs for hematocrit levels in triathletes and background data for possible future medical control regulations. METHODS: Competitors from three different distance triathlons participated: Olympic (N = 118), half-Ironman (N = 87), and Ironman (N = 207). Blood samples were drawn within 24-36 h prerace (N = 412) and within minutes of race finish (N = 296). Prerace hematocrits approximated a normal distribution for men (X = 43.2 +/- 2.9) and women (X = 40.2+/-2.6). Prerace hematocrits decreased as competitive distance increased for men (X = 45.0, 43.4, 42.5; respectively; P < 0.01) but not for women (P > 0.05). RESULTS: Mean race day changes were small but statistically significant for Olympic and Ironman men and for half-Ironman women. Individual responses were more variable with hemoconcentration occurring in 57%, hemodilution in 43%, and no change in 2% of participants. The magnitude of individual responses was also variable with hematocrit changes ranging from -7.1 to + 10%. No athlete in this sample had a hematocrit that would place him/her in the "danger zone" (Hct > 55%). CONCLUSIONS: Cutoff values (3 SD above the means) of 52% for men and 48% for women are suggested by these data. However, the relationship of these cutoffs to either athlete safety or the ability to detect rules violations remains unknown.

Adolescent↗

PubMed1998

Use of heart rate monitors by endurance athletes: lessons from triathletes.

Heart rate monitors are commonly used but little is documented about their use. We have reviewed the available literature and supplemented it with data regarding heart rate responses of a large number of highly trained athletes during cycle ergometer and treadmill exercise tests as well as during and following prolonged exercise. The main findings pertinent to the use of heart rate monitors are 1) estimated maximal heart rates are too variable to be of use to precisely guide training pace during cycling or running, 2) during prolonged (> 6 h) cycling or running, a highly trained athlete may expect to exercise at an average intensity close 80% HRmax, but should also expect intensity to decline by 6-7% during the cycle ride or run, and 3) submaximal exercise heart rates following prolonged exercise are not useful for judging completeness of recovery. This information holds the following implications for athletes wishing to optimize use of their heart rate monitors in training and racing: 1) formal maximal exercise tests should be performed to determine true HRmax in each exercise mode, 2) athletes should expect their heart rates to decrease over the course of a long race, and 3) athletes should not assume they completely recovered from a strenuous workout if submaximal exercise heart rates are unchanged. Much remains to be clarified about the heart rate responses of ultraendurance athletes, particularly in relation to performance and the attainment of individual maximal potential.

Adult↗

PubMed1997

Left ventricular hypertrophy in athletes.

Left ventricular wall thickness >1.3 cm, septal-to-posterior wall ratios > 1.5, diastolic left ventricular size >6.0 cm, and eccentric or concentric remodeling are rare in athletes. Values outside of these cutoffs in an athlete of any age probably represent a pathologic state.

Adult↗

PubMed1995

Adequacy of a pre-participation examination form: a study of Hawaii physicians.

Many states currently require a medical screening prior to participation in organized sports. The purpose of this study was to examine the adequacy of the existing pre-participation examination form in Hawaii. One hundred forty-eight physicians who perform school health/pre-participation physical examinations were surveyed. The results indirectly suggest that these physicians agreed that the form should be modified and improved (p, .001).

Adolescent↗

PubMed1991

Pulmonary function in men after oxygen breathing at 3.0 ATA for 3.5 h.

As a pulmonary component of Predictive Studies V, designed to determine O2 tolerance of multiple organs and systems in humans at 3.0-1.5 ATA, pulmonary function was evaluated at 1.0 ATA in 13 healthy men before and after O2 exposure at 3.0 ATA for 3.5 h. Measurements included flow-volume loops, spirometry, and airway resistance (Raw) (n = 12); CO diffusing capacity (n = 11); closing volumes (n = 6); and air vs. HeO2 forced vital capacity maneuvers (n = 5). Chest discomfort, cough, and dyspnea were experienced during exposure in mild degree by most subjects. Mean forced expiratory volume in 1 s (FEV1) and forced expiratory flow at 25-75% of vital capacity (FEF25-75) were significantly reduced postexposure by 5.9 and 11.8%, respectively, whereas forced vital capacity was not significantly changed. The average difference in maximum midexpiratory flow rates at 50% vital capacity on air and HeO2 was significantly reduced postexposure by 18%. Raw and CO diffusing capacity were not changed postexposure. The relatively large change in FEF25-75 compared with FEV1, the reduction in density dependence of flow, and the normal Raw postexposure are all consistent with flow limitation in peripheral airways as a major cause of the observed reduction in expiratory flow. Postexposure pulmonary function changes in one subject who convulsed at 3.0 h of exposure are compared with corresponding average changes in 12 subjects who did not convulse.

Adult↗

PubMed1991

Sports medicine in Hawaii: care of the high school athlete in Oahu's public schools.

A recent study by the National Athletic Trainers Association indicated that injuries occur more often during practice than during games in high school athletics. Results of the 3-year study indicated that 60% of basketball injuries occurred in boys and young men during practice and 59% occurred in women. About 2/3 of the estimated 120,000 injuries suffered by prep wrestlers each year happen during practice. The study found that an average of 331,865 high school football players (1/3 of the million who play football each year) were sidelined by an injury at least once. With these statistics in mind, our study looks at the approach to the management of injury in the public schools that make up the Oahu Inter-scholastic Association (OIA) in the state of Hawaii. The estimated number of student athletes that participate in organized athletics in the OIA is 7,960 and the number of coaches is 1,189.

Adolescent↗

PubMed1990

Different effects of prolonged exercise on the right and left ventricles.

To examine the functional consequences of the greater increase in right ventricular work with exercise, the effects of prolonged exercise on the right and left heart chambers were compared in 41 athletes before, at the finish (13 min) and after recovery (28 h) from the Hawaii Ironman Triathlon (3.9 km swim, 180.2 km bike ride, 42.2 km run). Two-dimensional and Doppler echocardiograms were analyzed for left and right atrial and ventricular areas at end-diastole and end-systole, right and left ventricular inflow velocities and mitral and tricuspid regurgitation. After exercise, left ventricular and left and right atrial sizes were reduced, whereas right ventricular size increased (diastole: 21.4 to 24.2 cm2; systole: 15.8 to 18.2 cm2; p less than 0.01). The emptying fraction of all chambers was unchanged. Left but not right ventricular inflow showed an increase in peak velocity of rapid filling, whereas both atrial systolic velocities increased (26 to 38 cm/s tricuspid; 38 to 54 cm/s mitral; both p less than 0.01). Overall, the right ventricular early to atrial velocity ratio was reduced after exercise (1.56 to 1.17; p less than 0.05) and the left ventricular pattern was unchanged. The prevalence of tricuspid regurgitation was statistically unchanged (86% to 52%), although that of mitral regurgitation was greatly reduced (76% to 0%). Changes in all variables returned toward prerace values during recovery. Thus, in highly trained athletes, prolonged exercise causes differing responses of the right and left ventricles. These differences may be due to changes in right ventricular function, shape or compliance.

Adult↗

PubMed1989

Prevalence of multivalvular regurgitation in athletes.

To assess the effects of exercise training on the prevalence of valvular regurgitation, 2-dimensional echocardiography and Doppler flow mapping were performed in 45 athletes and 26 sedentary control subjects of similar age and sex. Mitral, tricuspid, aortic and pulmonic regurgitations were sought in all possible views and mitral and tricuspid flow velocities were recorded. Mitral and tricuspid anulus diameters and the maximal areas of regurgitant flow were planimetered. Regurgitation of at least one of the cardiac valves was found in 91% of athletes but in only 38% of control subjects (p less than 0.001). Mitral and tricuspid regurgitation occurred more commonly in athletes than in control subjects (mitral 69 vs 27%; tricuspid 76 vs 15%). The prevalence of aortic and pulmonic regurgitation was similar. Although athletes and sedentary normal subjects differed with respect to heart rate, right and left ventricular filling patterns and tricuspid and mitral anulus diameters, none of these variables was related to the presence or severity of regurgitation. Thus, exercise training is associated with an increased prevalence of mitral and tricuspid regurgitation and altered ventricular inflow patterns. The mechanism of these findings is unclear. Multivalvular regurgitation is common in athletes and does not imply structural valvular abnormalities.

Adult↗

PubMed1989

Protein and energy metabolism during prolonged exercise in trained athletes.

UNLABELLED: Eight elite triathlon athletes participated in a laboratory study of the effects of endurance exercise on protein and energy metabolism. The study consisted of 3 h of cycling and 5 h of treadmill running; 3.5 h before beginning the exercise, a primed constant infusion of 1-13C leucine and 6,6(-2)H glucose was begun. Serial blood samples were collected during the rest and exercise periods for isotopic analysis. Respiratory gas exchange was determined every half hour. RESULTS: the subjects exercised at an average of 53% +/- 3% of peak VO2. During the 8-h exercise period there was a decline in glucose utilization and an increase in lipid oxidation. For the first part of the exercise, most of the glucose oxidized was of muscle origin. Hepatic glucose production increased with exercise from 20 g/h to a maximum of about 60 g/h after 4 h of exercise and then decreased toward the pre-exercise rate. The plasma urea concentration was unchanged during the study. The leucine flux decreased during the first 4 h of exercise and then attained a new plateau about 20% lower than the pre-exercise value indicating an adaptive reduction in protein turnover.

Adult↗

PubMed1989

Lactate, oxygen uptake, and cycling performance in triathletes.

To assess the relationship of exercise test variables to each other and to bike race times in an ultra-distance triathlon, we studied 24 participants (14 men, 10 women) in the 1985 Hawaii Ironman Triathlon, using a graded, maximal cycle ergometer test with gas exchange and blood lactate (LA) measurements at each work load. Exercise test variables were oxygen uptake (VO2) and heart rate (HR) at the lactate and ventilatory thresholds. Lactate threshold (LT-1) was defined as the exercise intensity that elicited a 1 mM increase in blood lactate concentration above the value measured during the first work load for each subject. Variables were also examined at the lactate thresholds of 2 mM and 4 mM. Ventilatory thresholds (VT) were identified as the points at which the ventilatory equivalent of oxygen (VE/VO2) increased without a corresponding increase in the ventilatory equivalent of carbon dioxide (VE/VCO2). Mean peak oxygen uptake (peak VO2) for this sample of Ironman triathletes was 57.4 ml.kg-1.min-1. Cycle peak VO2 was inversely correlated, r = 0.68 (P less than 0.0002) with bike finish time. VO2 and HR as well as the respective percentages of maximum were higher at all lactate thresholds than at VT (P less than 0.0001). Therefore VT should not be used to identify a lactate threshold in ultra-endurance triathletes. VO2 values at the lactate and ventilatory thresholds were not highly related to bike finish time (r = -0.26 to -0.58). Fractional utilization of peak VO2 (% peak VO2), HR, and % peak HR at thresholds were not related to bike finish time (r = -0.01 to 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Endurance exercise in the presence of heart disease.

Although patients with heart disease have successfully completed marathon runs, the immediate cardiac effects of similar and greater distance endurance exercise competition are unknown. Two such cases are presented, demonstrating that vigorous exercise and extreme levels of fitness are not precluded in the cardiac patient.

Coronary Artery Bypass↗

PubMed1989

Applied physiology of a triathlon.

The triathlon is an endurance contest in which contestants must compete in 3 consecutive events, usually swimming, cycling and running. Success in a triathlon depends upon the ability of the triathlete to perform each of the sequential events at optimal pace without creating fatigue that will hinder performance in the next event. The successful triathlete must, therefore, have highly developed oxygen transport and utilisation systems as well as the ability to efficiently produce a high energy output for prolonged periods without creating metabolic acidosis. Accordingly, mean VO2max values for groups of triathletes during treadmill running have been reported to range from 52.4 to 72 ml/kg/min in men; 58.7 to 65.9 ml/kg/min in women. VO2max values during cycle ergometry were 3 to 6% less than treadmill running values; tethered swimming maximums 13 to 18% less. Predictable and well-known adaptations occur in the cardiovascular systems of triathletes. Structural adaptations of the heart that have been documented in triathletes include increased left ventricular cavity size or wall thickness, or both. Morphological characteristics of the triathlete's heart appear to be unrelated to success in triathlon races. Following the acute stress of triathlon competition, alterations in both systolic and diastolic function have been observed. Heart muscle fatigue is the most likely reason for these changes, since there is a rapid return to normal with rest. Like the cardiovascular system, the musculoskeletal system responds to triathlon training. Peripheral adaptations occur that lead to increased muscle respiratory capacity and to modifications in substrate utilisation. The musculoskeletal system is the site of most injuries to triathletes, and non-traumatic overuse injuries account for 80 to 85% of the musculoskeletal injuries. Maintenance of fluid and electrolyte balance is of primary importance for the triathlete both in day-to-day training and during races. Water may be an adequate replacement fluid for short distance triathlons, but some combination of carbohydrate, electrolyte and fluid replacement is necessary for longer races. Although the physiological bases for success in a triathlon are not well understood at present, the ability to maintain minimal alterations in the homeostasis of cardiovascular, haemodynamic, thermal, metabolic, and musculoskeletal functions are of obvious importance.

Adolescent↗

PubMed1989

Dehydration and hyponatremia during triathlons.

In ultraendurance triathlons, dehydration and electrolyte balance are important factors in race completion and level of performance. Dehydration is the most common reason for a triathlete in the Hawaii Ironman Triathlon to need medical assistance. Hyponatremia is the predominant electrolyte disturbance. We have previously described exercise-induced hyponatremia and documented its incidence as a function of race length and state of hydration. This syndrome, dehydration plus hyponatremia, is extremely rare in races lasting less than 4 h but becomes common in races lasting longer than 8 h. Recommendations are made to help ultraendurance athletes understand and maintain proper fluid and electrolyte balance.

Bicycling↗

PubMed1988

Electrocardiographic diagnosis of exercise-induced left ventricular hypertrophy.

To assess the prevalence of physiologic left ventricular hypertrophy and the usefulness of ECG criteria for its diagnosis, we compared ECGs and M-mode echocardiograms from 44 ultraendurance athletes and 20 similarly aged sedentary control subjects. Left ventricular mass was elevated in 25 of 44 (57%) athletes including 17 of 29 (59%) men greater than 134 gm/m2 and 8 of 15 (53%) women greater than 110 gm/m2. The sensitivity and specificity of the three ECG criteria used to diagnose left ventricular hypertrophy were: Sokolow-Lyon voltage (S-V1 + R-V5 greater than or equal to 3.5 mV), 65% and 61%; Romhilt-Estes score (greater than or equal to 4), 16% and 84%; and Cornell voltage (R-aVL + S-V3 greater than 2.8 mV in men and greater than 2.0 mV in women), 8% and 95%, respectively. Left ventricular mass, mass index, posterior wall thickness, chamber diameter, and relative wall thickness were not related to any measurement of QRS voltage. Nonvoltage ECG criteria for left ventricular hypertrophy were rare in athletes. Thus hypertrophy is a common but not universal adaptation to exercise. It is only moderately well detected by standard voltage criteria for left ventricular hypertrophy and is not reflected in nonvoltage criteria.

Adult↗

PubMed1988

Hemolysis during triathlon races: its relation to race distance.

Ninety-five triathletes were evaluated for evidence of hemolysis during triathlon races of two different distances. Thirty competitors (11 males, 19 females) were studied before and after the United States Triathlon Series (USTS) National Championship Race (1.5K swim, 40K bike, and 10K run). Pre- and post-race venous blood samples showed that 93% of the USTS athletes had decreased serum haptoglobin, post-race (mean decrease = 20%). Seven of 30 of the USTS triathletes (3 males, 4 females) were found to have occult blood in their urine, post-race. Only two of the USTS triathletes (1 male, 1 female) were anemic as judged by pre-race hemoglobin levels. Similar data were collected on 65 triatheletes (46 males, 19 females) at the Hawaii IRONMAN Triathlon World Championship (3.9K swim, 180.2K bike, and 42.2K run). Pre- and post-race venous blood samples showed that 95% of the IRONMAN athletes had decreases in serum haptoglobin, post-race (mean decrease = 32%). Occult blood was found in the post-race urine of 19 (12 males, 7 females) of the IRONMAN competitors. Nineteen IRONMAN triathletes (18 males, 1 female) were judged to be anemic from pre-race hemoglobin measurements. Data from two different length triathlons suggest that nearly all triathletes break down red blood cells during a race, and that the extent of the hemolysis is related to race distance.

Female↗

PubMed1987

Determination of energy expenditure during heavy exercise, normal daily activity, and sleep using the doubly-labelled-water (2H2 18O) method.

Energy expenditure of four subjects was measured by the doubly-labelled-water (2H2 18O) method to determine if energy expenditure could be determined over short periods. Three subjects were studied while they performed 8 h of heavy exercise in a laboratory environment. Urine and blood samples were taken before and after exercise. Estimated energy expended during 8 h of high-intensity exercise (55% VO2 max) for three subjects was 757 +/- 118 kcal/h by the doubly-labelled-water method using urine and a two-point calculation, which compared favorably with 735 +/- 82 kcal/h obtained by respiratory gas exchange. For the fourth subject, daytime, nighttime, and daily energy expenditure was calculated by both the two-pair method and decay-curve analysis of urine and saliva samples collected in the morning and at night. Daytime and nighttime energy expenditures differed significantly (p less than 0.05).

Activities of Daily Living↗

PubMed1987

Cardiac fatigue after prolonged exercise.

To determine the effects of prolonged exercise on systolic and diastolic left ventricular function, we studied 21 athletes before, at the finish (within 11 +/- 5 min), and during recovery (28 +/- 9 hr) after the Hawaii Ironman Triathlon (2.4 mile swim, 112 mile bike, 26.2 mile run). Two-dimensionally guided M mode echocardiograms were digitized for wall thickness, cavity dimension, fractional shortening, and peak rates of cavity enlargement and wall thinning. Pulsed Doppler left ventricular inflow recordings were analyzed for peak early and late velocities and their ratio. Left ventricular diastolic dimension was reduced at race finish (5.4 +/- 0.6 to 5.1 +/- 0.6 cm) and remained reduced after 1 day of recovery (5.2 +/- 0.6 cm, p less than .05). Fractional shortening fell at race finish (39 +/- 5% to 35 +/- 5%), although systolic blood pressure was unchanged, and rose to 40 +/- 4% after recovery (p less than .05). The return to prerace shortening values after recovery occurred despite continued reduction in diastolic size. Peak circumferential shortening did not change significantly. Individual reductions in fractional shortening were correlated with increases in systolic cavity size (r = -.64, p less than .01), but not with decreases in diastolic size. The stress-shortening relationship was displaced downward at race finish, but returned toward baseline after 1 day of recovery, despite a persistent reduction in cavity size. This suggests that the decrease in shortening was due to impaired contractility as well as altered preload.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

Treatment of the septic hip with total hip arthroplasty.

Forty-three patients, 23 with definite infection and 20 with probable infections before total hip arthroplasty (THA), were compared to 41 matched uninfected patients. The 43 infected patients were treated by 45 operative procedures: eight Girdlestone resections, 12 revisions of total hips, and 25 conversions from infected nontotal hip surgery to total hip arthroplasties. (Two revision THAs were converted to Girdlestones). The average follow-up period was 38.8 months, with a range of six-118 months. The statistically significant negative prognosticators were gross sepsis at surgery, number of previous operations, and elevated erythrocyte sedimentation rate (ESR). The type of infecting organism did not affect the outcome. The prosthesis survival rate for total hip arthroplasties revised for sepsis was 83%. The prosthesis survival rate for other infected hips treated by total hip arthroplasty was 100%. All groups except Girdlestone resections improved postoperatively. While Girdlestone resection offered acceptable pain relief, total hip arthroplasty provided unequivocally superior function (p = 0.0001).

Adult↗