Heart failure is a major worldwide health concern and is the leading cause of hospitalization among elderly Americans. Approximately 50% of those diagnosed with heart failure have heart failure with preserved ejection fraction (HFPEF). HFPEF presents a therapeutic dilemma because pharmacological strategies that are effective for the treatment of heart failure and reduced ejection fraction have failed to show benefit in HFPEF. Long term moderate intensity exercise programs have been shown to improve diastolic function in patients HFPEF. High intensity interval training (HIIT) has been shown to improve diastolic function in patients with heart failure and reduced ejection fraction. However, the effects of high intensity interval training in patients with HFPEF are unknown. Fourteen patients with HFPEF were randomized to either: (1) a novel program of high-intensity aerobic interval training (n = 8), or (2) a commonly prescribed program of moderate-intensity (MOD) aerobic exercise training (n = 6). Before and after four weeks of exercise training, patients underwent a treadmill graded exercise test for the determination of peak oxygen uptake (VO2peak), a brachial artery reactivity test for assessment of endothelium-dependent flow-mediated dilation (BAFMD), aortic pulse wave velocity assessment as an index of vascular stiffness and two-dimensional echocardiography for assessment of left ventricular diastolic and systolic function. I hypothesized that (1) high-intensity aerobic interval training would result in superior improvements in FMD, aortic pulse wave velocity, VO2peak, diastolic function and, (2) changes in these parameters would be correlated with changes in VO2peak. The principal findings of the study were that a one month long high intensity interval training program resulted in significant improvements in diastolic function as measured by two-dimensional echocardiography [pre diastolic dysfunction (DD) grade - 2.13 + 0.4 vs. post DD grade - 1.25 + 0.7, p = 0.03]. The left atrial volume index was reduced in the HIIT group compared to MOD ( - 4.4 + 6.2 ml/m2 vs. 5.8 + 10.7 ml/m2, p = 0.02). Early mitral flow (E) improved in the HIIT group (pre - 0.93 + 0.2 m/s vs. post - 0.78 + 0.3 m/s, p = 0.03). A significant inverse correlation was observed between change in BAFMD and change in diastolic dysfunction grade (r = - 0.585, p = 0.028) when all the data were pooled. HIIT appears to be a time-efficient and safe strategy for improving diastolic function in patients with heart failure and preserved ejection fraction. These data may have implications for cardiovascular risk reduction in this population.

The effects of a long-term combat deployment on a soldier's physical fitness are not well understood. In active duty soldiers, combat deployment reduced physical fitness compared to pre-deployment status, but no similar research has been performed on Army National Guard soldiers. This study is the first to identify physical fitness changes in Arizona National Guard (AZNG) soldiers following deployment to a combat zone and to assess the relationships between physical fitness and non-combat injuries and illness (NCII). Sixty soldiers from the Arizona National Guard (AZNG) completed a battery of physical fitness tests prior to deployment and within 1-7 days of returning from a 12-month deployment to Iraq. Pre and post-deployment measures assessed body composition (Bod Pod), muscular strength (1RM bench press, back-squat), muscular endurance (push-up, sit-up), power (Wingate cycle test), cardiorespiratory fitness (treadmill run to VO2 peak), and flexibility (sit-and-reach, trunk extension, shoulder elevation). Post deployment, medical records were reviewed by a blinded researcher and inventoried for NCII that occurred during deployment. Data were analyzed for changes between pre and post-deployment physical fitness. Relationships between fitness and utilization of medical resources for NCII were then determined. Significant declines were noted in mean cardiorespiratory fitness (-10.8%) and trunk flexibility (-6.7%). Significant improvements were seen in mean level of fat mass (-11.1%), relative strength (bench press, 10.2%, back-squat 14.2%) and muscular endurance (push-up 16.4%, sit-up 11.0%). Significant (p < 0.05) negative correlations were detected between percentage change in fat mass and gastrointestinal visits (r = -0.37); sit-and-reach and lower extremity visits (r= -0.33); shoulder elevation and upper extremity visits (r= -0.36); and cardiorespiratory fitness and back visits (r= -0.31); as well as behavioral health visits (r= -0.28). Cardiorespiratory fitness changes were grouped into tertiles. Those who lost the greatest fitness had significantly greater number of NCII visits (8.0 v 3.1 v 2.6, p = .03). These data indicate a relationship between the decline in cardiorespiratory fitness and an overall increase in utilization of medical resources. The results may provide incentive to military leaders to ensure that soldiers maintain their cardiorespiratory fitness throughout the extent of their deployment.

Larger people generally have more muscle mass and are stronger than smaller people. Muscular strength usually decreases with age, possibly as a function of increases in body fat percentage. However, the effect of age, body fat, and lean mass on peak muscular strength or muscular fatigue is not clear. This was an observational study to determine: a) the relationship of fat mass (FM) and fat free mass (FFM) to peak knee extensor strength and fatigue in young (Y) and middle-aged (MA) women, and b) to determine differences in peak torque between Y and MA women. Participants included 132 women from two age cohorts (Y: 18-33 yrs, n = 70 and MA: 45-65 yrs, n = 62). Data from the MA cohort were collected as part of a previous study and combined with data from the Y group. Both cohorts completed physical activity questionnaires and were measured for body fat using bioelectrical impedance analysis. Both cohorts used identical procedures and machinery to assess isokinetic knee extensor peak torque (PT) at 60°/sec and to determine fatigue index (FI). FI was calculated as the percent decline of PT during 50 maximal repetitions at 240°/sec. Data were assessed for normality, and appropriate Pearson or Spearman correlations were used to compare PT and FI with body composition variables. A one-way ANOVA was used to examine differences in PT and body composition indices between age groups. In Y, FFM and FM were strongly correlated with peak torque. The correlation of FM to PT disappeared when controlling for FFM. There were no significant correlations between FFM or FM and PT in MA. PT was negatively correlated with FI in the combined groups. PT normalized for body mass and FFM were similar between age groups, but decreased with increasing size. In conclusion, PT was positively related to FFM in the combined age groups. Higher FM was not detrimental to absolute PT in Y or MA, but was detrimental to relative PT in both groups. These data suggest that perhaps FM may attenuate the normal relationship between PT and body mass.

The gold standard for bone measurement is DXA (dual energy X-ray absorptiometry). Typically, to observe changes in bone by DXA, a minimum of a 4-month intervention is required. Serum osteocalcin (OST) (a bone formation marker) and quantitative ultrasound (QUS) of the calcaneus can be used as indicators of bone change but the sensitivity and time course of these indices to short term interventions are unknown. The purpose of this study was twofold: to compare monthly changes in OST and QUS in response to jump training and to evaluate the relationship between DXA, OST and QUS. Young women with QUS t-scores less than 1.0 were randomized into a jump training (J) (n=16) or control (C) (n=16). J consisted of a progressive routine of 1 and 2-footed jumping performed 3 days per week for 4 months. Body composition, QUS and OST were measured at baseline, and monthly for 4 months. DXA and 24-hour dietary recalls were completed at baseline and 4 months. Low attrition rate (12.5%) and high compliance (98%) with the exercise intervention was recorded. No significant correlations between QUS and OST existed. No significant differences were observed between groups at baseline in body composition or bone variables. Monthly increases in OST were observed but there were no significant differences over time between groups in any bone variables. OST and QUS may be indicative of short term bone changes but these variables were not specifically sensitive to the jumping intervention in this population of women.