CARDIOVASCULAR RESPONSES TO ISOMETRIC

CONTRACTION IN YOUNG AND ELDERLY INDIVIDUALS -

A QUASI-EXPERIMENTAL STUDY

BY

Mr. RAVISH .S. TAORI

Dissertation submitted to Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka

In partial fulfilment of the requirement of the degree of

MASTER OF PHYSIOTHERAPY (MPT)

In

PHYSIOTHERAPY IN CARDIO-RESPIRATORY DISORDERS

AND

INTENSIVE CARE

Under the guidance of

Mr. K. RAJMOHAN, M.P.T. (CARDIO RESPIRATORY)

Department of Cardio Respiratory Physiotherapy

KRUPANIDHI COLLEGE OF PHYSIOTHERAPY

BANGALORE

2010

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 Rajiv Gandhi University of Health Sciences
Bangalore, Karnataka

DECLARATION BY THE CANDIDATE

I hereby declare that this thesis entitled

“CARDIOVASCULAR RESPONSES TO ISOMETRIC

CONTRACTION IN YOUNG AND ELDERLY INDIVIDUALS -
A QUASI-EXPERIMENTAL STUDY”

is a bonafide and genuine research work carried out under the guidance of
Mr. K. RAJMOHAN MPT, Associate Professor Krupanidhi College of
Physiotherapy, Bangalore.

Date: Signature of the candidate

Place: Bangalore Mr. RAVISH .S. TAORI

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 CERTIFICATE BY THE GUIDE

THIS IS TO CERTIFY THAT THE DISSERTATION ENTITLED

“CARDIOVASCULAR RESPONSES TO ISOMETRIC

CONTRACTION IN YOUNG AND ELDERLY INDIVIDUALS -
A QUASI-EXPERIMENTAL STUDY”

IS A BONAFIDE RESEARCH WORK DONE BY Mr. RAVISH .S. TAORI

IN PARTIAL FULFILMENT OF THE REQUIREMENT OF THE
DEGREE OF MASTER OF PHYSIOTHERAPY

Mr. K. RAJMOHAN
ASSOCIATE PROFESSOR
H.O.D.Department of Cardiopulmonary
Place: Bangalore Krupanidhi College of Physiotherapy
Date: Bangalore-560037

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III
ENDORSEMENT BY PRINCIPAL/HOD OF THE INSTITUTION

THIS IS TO CERTIFY THAT THE DISSERTATION ENTITLED

“CARDIOVASCULAR RESPONSES TO ISOMETRIC
CONTRACTION IN YOUNG AND ELDERLY INDIVIDUALS -
A QUASI-EXPERIMENTAL STUDY”

a bonafide research work done by Mr. RAVISH .S. TAORI

under the guidance of MR. K. RAJMOHAN, ASSOCIATE
PROFESSOR, KRUPANIDHI COLLEGE OF PHYSIOTHERAPY,
BANGALORE.

Seal & Signature of H.O.D. Seal & Signature of PRINCIPAL

Mr. K. RAJMOHAN Mr. Masih Muhammad Khan.
Date: Date:
Place: Bangalore Place: Bangalore

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 COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Bangalore, Karnataka shall have the rights to preserve, use and

disseminate this dissertation/thesis in print or electronic format for

academic/research purposes.

Date: (Signature of the Candidate)

Place: Mr. RAVISH .S. TAORI

© Rajiv Gandhi University of Health Sciences, Karnataka.

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 ACKNOWLEDGEMENT

My knowledge has been enriched throughout the process of this study. I would

like to acknowledge all those well wishers who have guided me at every juncture and

have offered me their help and support whenever needed to help me complete my

project.

I would like to express my heartfelt wishes to my parents who have ever been

so instrumental in building the confidence in me and for their blessings and support

all throughout.

With due respect, I would like to thank Prof. Suresh Nagpal, Chairman and

Mr. Masih Muhammad Khan, Principal, Krupanidhi College of Physiotherapy for

giving me the freedom to access and make use of the facilities of the college and their

valuable guidance in course of this project.

I would like to take the honour to thank my guide Mr. K. Rajmohan,MPT,

Associate professor, HOD, Department of Cardiopulmonary, Krupanidhi college of

Physiotherapy, Bangalore, for his constant support and guidance throughout this

journey. His interest in the project from day one has been a great source of

inspiration and his continued encouragement all through the process has been a great

pillar of strength to help me complete my project.

I am grateful to all my lecturers for their support and encouragement

all throughout.

I express my heartfelt thanks to all my subjects who have been ever so

patient with me till completion of this study.

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 I would also like to thank Prof. Gangaboriah, Dept of Bio-Statistics, KIMS

College for helping me with the necessary statistical analyses and calculations.

Finally, I thank God for completion of this study and for his presence

and guidance at every step in life.

Date: Signature of the candidate

Place: Bangalore. Mr. RAVISH .S. TAORI

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VII
 LIST OF ABBREVIATION USED

BP : BLOOD PRESSURE

CVS : CARDIOVASCULAR SYSTEM

DBP : DIASTOLIC BLOOD PRESSURE

HR : HEART RATE

MVC : MAXIMUM VOLUNTARY CONTRACTION

SBP : SYSTOLIC BLOOD PRESSURE

WHO : WORLD HEALTH ORGANIZATION

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VIII
 ABSTRACT

Background and objectives: Activities that produce static or isometric muscular

contractions are common in many aspects of everyday life. Cardiac aging alters many

of the acute response to exercise stress, but the extent to which submaximal isometric

exercise or training can alter or improve the effects of aging in humans is unclear.

Thus, objective of this study was to examine the cardiovascular responses to isometric

contraction in young and elderly individuals. Method: 40 male subjects with age

group 20-30years and 60-70years satisfying the inclusion criteria were selected and

divided into two groups namely young and elderly group respectively. Resting HR

and BP were recorded followed by HR and BP responses to isometric exercise in both

the groups were assessed. Isometric contraction was held till 60seconds using the

hand held dynamometer at 40% of the maximal voluntary contraction (MVC). Pre and

post HR and BP were compared. Results: The older subjects had a lower heart rate

and a higher blood pressure response than their younger counterparts. Interpretation

and conclusion: The result indicates that increasing age is associated with an altered

heart rate and blood pressure response to isometric exercise.

Key words: Isometric contraction, cardiovascular aging

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 TABLE OF CONTENTS

Serial No. Title Page no.

1 INTRODUCTION 1

2 OBJECTIVES 9

3 REVIEW OF LITERATURE 11

4 METHODOLOGY 20

5 RESULTS 28

6 DISCUSSIONS 35

7 CONCLUSION 39

8 SUMMARY 40

9 BIBLIOGRAPHY 41

10 ANNEXURES 46

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 LIST OF TABLES

Serial No. Title Page no.

1 MEAN OF PRE AND POST SYSTOLIC BLOOD 29

PRESSURE IN YOUNG AND ELDERLY

INDIVIDUALS

2 TO COMPARE THE SYSTOLIC BLOOD 29

PRESSURE BETWEEN YOUNG AND

ELDERLY SUBJECTS

3 MEAN OF PRE AND POST DIASTOLIC 31

BLOOD PRESSURE IN YOUNG AND

ELDERLY INDIVIDUALS

4 TO COMPARE THE DIASTOLIC BLOOD 31

PRESSURE BETWEEN YOUNG AND

ELDERLY SUBJECTS

5 MEAN OF PRE AND POST HEART RATE IN 33

YOUNG AND ELDERLY INDIVIDUALS

6 TO COMPARE THE HEART RATE BETWEEN 33

YOUNG AND ELDERLY SUBJECTS

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 LIST OF ILLUSTRATIONS

Serial No. Title Page no.

1 CARDIOVASCULAR SYSTEM 1

2 HEART RATE MONITOR 23

3 SPHYGMOMANOMETER AND 24
STETHOSCOPE

4 MANUAL HAND HELD DYNAMOMETER 25

5 SUBJECT PERFORMING ISOMETRIC 27

CONTRACTION

6 SUBJECT PERFORMING ISOMETRIC 27

CONTRACTION

7 GRAPH REPRESENTING PRE AND POST SBP 30

OF YOUNG AND ELDERLY INDIVIDUALS

GRAPH REPRESENTING PRE AND POST DBP

8 32
OF YOUNG AND ELDERLY INDIVIDUALS

GRAPH REPRESENTING PRE AND POST HR

9 34
OF YOUNG AND ELDERLY INDIVIDUALS

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XII
INTRODUCTION

The cardiovascular system is continuous vascular circuits that consists of a

pump, a high pressure distribution circuit, exchange vessels and a low-pressure

collection and return circuit.01 It consist of a heart, arteries, capillaries and veins. The

cardiovascular system serves to integrate the body as a unit and provides the muscles

with a continuous stream of nutrients and oxygen so that high-energy output can be

maintained for a considerable time period. Conversely, by-products of metabolism are

rapidly removed from the site of energy release.

FIG.1: CARDIOVASCULAR SYSTEM

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With modernization and changes in lifestyle, cardiovascular system is more severally

affected. Cardiovascular disease is the world's leading killer, accounting for 16.7

million or 29.2 per cent of total global deaths in 2003. In India in the past five

decades, rates of coronary disease among urban populations have risen from 4 per

cent to 11 per cent. The World Health Organization (who) estimates that 60 per cent

of the world's cardiac patients will be Indian by 2010.02 The American Heart

Association (AHA) considers ischemic (coronary) heart diseases, hypertensive

diseases, rheumatic fever/rheumatic heart diseases and cerebrovascular diseases

(stroke) to be major cardiovascular diseases. The WHO estimates that by 2020

cardiovascular diseases will account for up to 40% of all deaths worldwide.03 Looking

forward to this upcoming problem, cardiac rehabilitation has gain its importance.

The WHO has defined cardiac rehabilitation as the sum of activity

required to ensure cardiac patients the best possible physical, mental and social

condition so that they may by there own efforts regain as normal as possible a place in

the community and lead an active life.04 Cardiac rehabilitation is a medically

supervised exercise and counselling program designed to help overcome some of the

physical complications of heart disease, limit the risk of developing additional heart

trouble, help a person return to an active social or work schedule, and improve the

psychological well-being. It has four main components: Medical evaluation,

supervised exercise, lifestyle education and psychosocial support. Exercise does

remain a key component of rehabilitation. With onset of exercise, blood is directed

away from less essential areas of the body and redirected to the working muscles.

This is accomplished by a complex set of acute changes within cardiovascular system

that are controlled by cardiovascular centre in brain.05 Various chemical, neural, and

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hormonal adjustments takes place prior to and during exercise. At the onset of

exercise, cardiovascular changes are initiated from nerve centres above the medullary

region. These adjustments significantly increase the rate and pumping strength of the

heart, as well as predictable alterations in regional blood flow that are proportional to

exercise severity.01 Exercise that employs the larger muscle mass and greater relative

strain elicits the greater response.06

In the 1950s isometrics were popularised as an effective and efficient

means of developing strength. Hislop and Perrine (1967) described isometric exercise

as muscular contractions against a load which is fixed or immovable or is simply too

much to overcome. Isometric exercise can increase blood pressure and heart rate to

levels that would be dangerous for anyone with undiagnosed cardiac problems (Nagle,

Seals and Hanson 1988, White and Carrington 1993 and Baum et al. 1995). Because

of the characteristic cardiovascular responses, isometrics and other resistance

exercises are generally not recommended for some patient populations, i.e.,

individuals with hypertension, patients with heart failure, etc. However, over the last

decade, the value of resistance exercise training for maintaining normal

cardiovascular functioning in older adults and some patient groups has been

recognized. 07 Isometric exercise produces a characteristic pressor increase in blood

pressure, which may be important in maintaining perfusion of muscle during

sustained contraction. This response is mediated by combined central and peripheral

afferent input to medullary cardiovascular centres. In normal individuals the increase

in blood pressure is mediated by a rise in cardiac output with little or no change in

systemic vascular resistance.08

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 The central cardiac and hemodynamic responses to resistance exercise

are different than those seen with endurance exercise. As opposed to the volume

overload imposed on the heart by endurance exercise, resistance (i.e., dynamic or

static) exercise imposes a pressure overload. Accordingly, this form of exercise is

characterized by a disproportional increase in heart rate (HR) and blood pressure (BP)
06
for a given metabolic rate (i.e., VO2). The cardiovascular response to static

exercises are well established and includes increase in blood pressure and heart rate.09-
11
During isometric, peak systolic and diastolic blood pressures mirror the

hypertensive state and may pose a risk to individuals who have existing hypertension.

Regular training can blunt hypertensive response.01

With aging there are changes in the cardiovascular system, which result in

alterations in cardiovascular physiology. The changes with age occur in everyone but

not necessarily at the same rate, therefore accounting for the difference seen in some

people between chronologic age and physiologic age. The changes in the

cardiovascular system associated with aging are a decrease in elasticity and an

increase in stiffness of the arterial system. This results in increased afterload on the

left ventricle, an increase in systolic blood pressure, and left ventricular hypertrophy,

as well as other changes in the left ventricular wall that prolong relaxation of the left

ventricle in diastole. There is a dropout of atrial pacemaker cells resulting in a

12-13
decrease in intrinsic heart rate. . The age-associated decline in cardiovascular

performance is more apparent during stress than at rest. The hallmarks of

cardiovascular aging are reduced maximal heart rate, ejection fraction, and, in most

studies, reduced maximal cardiac output with exercise, 14-20increased blood pressure

during exercise21, and an increase in isometric endurance22 The status of physical

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conditioning of the individual can radically affect the measurements of cardiovascular

function in the elderly and changes in physical activity can profoundly change

cardiovascular function.06

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NEED FOR STUDY:

Due to the large isometric component involved in daily tasks, it is important to

understand the cardiovascular responses to isometric exercises. This understanding

has implications for aging populations and for cardiac rehabilitation programs where

isometric exercises have often been discouraged due to potentially hazardous effects

on the cardiovascular system However, over the last decade, the value of resistance

exercise training for maintaining normal cardiovascular functioning in older adults

and some patient groups has been recognized. But controversies are still there.

Several researchers have described the relationship between intensity

of isometric contraction and cardiovascular responses, but previous studies on the

relationship of age to isometric contraction and cardiovascular responses are few.23

Therefore, the purpose of this study is to determine the comparative effects of

isometric contraction in young and elderly normal individuals.

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STATEMENT OF THE STUDY

In the present study an endeavour was made to know effects of isometric contraction

in young and elderly normal individuals. Thus the problem for the present study is

stated as – WEATHER ISOMETRIC EXERSISE CAN BE INCLUDED IN

ELDERLY NORMAL INDIVIDUALS FITNESS AND CARDIAC

REHABILITATION PROGRAMME.

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OPERATIONAL DEFINITIONS

For the purpose of this study the key terms are defined as follows:

• Isometric contraction: These are muscular contractions against a load which

is fixed or immovable or is simply too much to overcome. Thus there is no

visible change in joint angle.

• Blood pressure (BP): It is the lateral pressure exerted by blood on the vessels

walls while flowing through it. Systolic blood pressure (SBP) is the

maximum pressure during systole. Diastolic blood pressure (DBP) is the

minimum pressure during diastole.

• Heart rate (HR): Heart rate is the number of times per minute that the heart

contracts - the number of heart beats per minute (bpm).

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OBJECTIVES

• To study heart rate and blood pressure responses, to isometric

contraction in young normal individuals.

• To study heart rate and blood pressure responses, to isometric

contraction in elderly normal individuals.

• To compare the heart rate and blood pressure responses, to isometric

contraction in young and elderly normal individuals.

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HYPOTHESIS

NULL HYPOTHESIS:

• There is no significant difference in heart rate response to isometric

contraction in young and elderly normal individuals.

• There is no significant difference in blood pressure response to

isometric contraction in young and elderly normal individuals.

EXPERIMENTAL HYPOTHESIS:

• There is significant difference in heart rate response to isometric

contraction in young and elderly normal individuals.

• There is significant difference in blood pressure response to isometric

contraction in young and elderly normal individuals.

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 REVIEW OF LITERATURE

Daniel W. Jones; Lawrence J. Appel ; Sheldon G. Sheps; Edward J. Roccella,;

Claude Lenfant (2003) 24 said for more than 100 years, clinicians and researchers

have used the mercury sphygmomanometer, a simple, gravity-based instrument, for

blood pressure measurement. Because of its accuracy and reliability, the mercury

sphygmomanometer is generally regarded as the gold standard against which all other

devices for blood pressure measurement should be compared.

Virgil Mathiowetz (2002)25 compared the Jamar and Rolyan hydraulic

dynamometers to determine their concurrent validity with known weights as well as

their inter-instrument reliability and concurrent validity for measuring grip strength in

a clinical setting. Results showed that the Jamar and Rolyan dynamometers have

acceptable concurrent validity with known weights (that is, correlation coefficients

were r ≥0.9994), excellent inter-instrument reliability (that is, intraclass correlation

coefficients ranged from 0.90 to 0.97) and strong concurrent validity (that is, no

significant differences between dynamometers' scores). Data indicate that Jamar and

Rolyan dynamometers measure grip strength equivalently and can be used

interchangeably.

. Gervasoni JP, Bovet P, Rwebogora A, Mkamba M, Paccaud F (2001) 26 assessed

systematic difference in blood pressure (BP) readings measured with a mercury

sphygmomanometer (MS) and electronic sphygmomanometers and found that BP

readings were systematically lower with electronic sphygmomanometers than with a

mercury sphygmomanometer and differences tended to vary according to arm size and

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BP. These findings have important relevance as automatic devices are useincreasingly

often and considering that currently available data and recommendations on BP are

mainly based on readings with mercury sphygmomanometer.

27
Goodie, Jeffrey L.; Larkin, Kevin T.; Schauss, Scott (2000) examined the

validity of the Polar monitor for measuring heart rate. The Polar heart rate monitor

provides an ambulatory, inexpensive method of continuously measuring heart rate.

Heart rates were measured simultaneously using the Polar monitor and

electrocardiography (ECG) during a hand grip exercise . The correspondence between

observed mean heart rates from the Polar monitor and ECG suggest that the Polar

monitor provides a valid measure of heart rate during stationary laboratory tasks.

Boutcher S. H.;Stocker D.(1999)28 did study to compare the cardiovascular response

of young and older males during light handgrip isometric exercise. Blood pressure,

heart rate, rate pressure product, as well as pre-ejection period (derived from

impedance cardiography) were obtained for 15 young [mean (SE) age: 21 (0.7) years]

and 15 older males [59 (0.8) years] during and after light handgrip exercise. The

parasympathetic influence on the heart was also assessed through a time-series

analysis of heart period variability (HPVts). Both during and when recovering from

the handgrip exercise, the older subjects exhibited a significantly higher absolute

systolic and diastolic blood pressure, and rate pressure product, and a lower HRVts

than the young subjects. Relative to baseline, the change in pre-ejection period was

lower for the young subjects during the handgrip tasks. These results indicate that

although the sympathetic influence on both the myocardium and the vasculature was

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less pronounced in the older males, the aging cardiovasculature was under greater

hemodynamic stress both during rest and during exposure to light isometric challenge.

Smolander J, Aminoff T, Korhonen I, Tervo M, Shen N, Korhonen O,

Louhevaara V (1998) 29 did a study to examine the isometric endurance response and

the heart rate and blood pressure responses to isometric exercise in two muscle groups

in ten young (age 23-29 years) and seven older (age 54-59 years) physically active

men with similar estimated forearm and thigh muscle masses. Isometric contractions

were held until fatigue using the finger flexor muscles (handgrip) and with the

quadriceps muscle (one-legged knee extension) at 20%, 40%, and 60% of the

maximal voluntary contraction (MVC). Heart rate and arterial pressure were related to

the individual's contraction times. The isometric endurance response was longer with

handgrip than with one-legged knee extension, but no significant difference was

observed between the age groups. The isometric endurance response averaged 542

(SEM 57), 153 (SEM 14), and 59 (SEM 5) s for the handgrip, and 276 (SEM 35), 94

(SEM 10) and 48 (SEM 5) s for the knee extension at the three MVC levels,

respectively. Heart rate and blood pressure became higher during one-legged knee

extension than during handgrip, and with increasing level of contraction. The older

subjects had a lower heart rate and a higher blood pressure response than their

younger counterparts, and the differences were more apparent at a higher force level.

The results would indicate that increasing age is associated with an altered heart rate

and blood pressure response to isometric exercise although it does not affect isometric

endurance.

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R. Laukkanen and P. Virtanen. (1998) 30 Lightweight telemetric heart rate monitors

equipped with conventional electrodes have been proved to be accurate and valid

tools for heart rate monitoring and registering in field measurements. Polar Heart Rate

Monitors and their measurement accuracy compared to Holter ECG devices at rest

and during exercise.

John R. Stratton; Wayne C. Levy; Manuel D. Cerqueira; Robert S. Schwartz;

Itamar B. Abrass (1994) 31 conclude that there is an age-associated decline in heart

rate, ejection fraction, and cardiac output responses to exercise in healthy men.

Although the stroke volume responses of the young and old are similar, the old tend to

augment stroke volume during exercise more through cardiac dilatation, with an

increase in end-diastolic volume (+8%) but without much change in ejection fraction

(+3 ejection fraction units), whereas the young rely more on an increase in the

ejection fraction (+11 ejection fraction units) with no cardiac dilatation (-10%).

Despite the significant cardiovascular changes that occur in the response to a single

bout of exercise with aging, adaptations to chronic exercise training were not different

with aging and included improvements in maximal workload and increases in ejection

fraction, stroke volume index, and cardiac index at peak exercise.

Taylor and colleagues (1991) 32 did a study on 14 younger (26 ±1.0 years) and 14

older (66 ±1.0 years) healthy males perform a 30% maximal voluntary contraction

(MVC) isometric handgrip exercise to the point of exhaustion (inability to maintain

target force). MVC for the younger (402 ± 20 N) and older (392 ± 20 N) subjects was

similar, as was time to exhaustion (315 ± 27 seconds in younger vs. 339 ± 17 seconds

in older men). During the sustained trial, electromyography activity and ratings of

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perceived exertion were similar between groups, indicating comparable voluntary

efforts. HR rose above baseline within the first 20% of the exercise duration and

continued to increase (p < 0.05) throughout the handgrip in both groups. However, at

every point during the exercise, the absolute level of HR was lower and the magnitude

of the increase from control was less (p <0.05) in the older subjects. Taylor et al. also

reported no differences in BP responses between younger and older men while they

were executing isometric handgrip exercises to the point of fatigue.

S.C. Gandevia and S.F.Hobbs (1990) 33 concluded in there study that Blood pressure

and heart rate increased progressively during isometric contraction of 33 and 50%

maximal voluntary strength (for 120 and 75 s respectively).

Van Loan et al. (1989) 34 compared 24 younger (23.7 ±3.8 years) and 24 older (57.8

± 5.6 years) males performing small muscle (finger flexor) and large muscle (leg

extensor) isometric muscle contractions (45-second duration) at 4 different intensities

(15, 30, 45, and 60% MVC). Results indicated that higher HR responses were found

during leg extension exercises at each increase in % MVC workload and in the

younger subjects (with both muscle groups) at all exercise levels. Van Loan et al. (51)

found a significant but modest increase in BP (10 mm Hg for SBP and 7 mm Hg for

DBP) between the younger and older subjects.

35
Sagiv M, Hanson P, Goldhammer E, Ben-Sira D, Rudoy J (1988) Studied

echocardiographically cardiovascular responses in 10 young (23 +/- 3 years) and 10

elderly (67 +/- 4 years) men, during upright isometric handgrip and deadlift. During

handgrip and deadlift both groups showed significant increases in systolic and

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diastolic blood pressure. Those responses were significantly greater in both groups

during deadlift. Heart rate was significantly higher in both groups during deadlift than

resting and handgrip values. Oxygen uptake increased progressively and significantly

across conditions, and was significantly higher for the younger subjects. Ejection

fraction remained unchanged during handgrip in both groups. During deadlift it

remained unchanged in the elderly while it increased significantly in the younger.

Both groups increased significantly heart volumes from rest to handgrip. During

deadlift end systolic volume was significantly lower from resting and handgrip values

only in the young group. These data indicate a similar cardiovascular response to

acute pressure overload in both groups.

Seals DR, Hurley BF, Hagberg JM, Schultz J, Linder BJ, Natter L, Ehsani AA.

(1985) 36 did a study to determine whether regular exercise improves left ventricular

(LV) contractile function in persons 60 years and older, systolic time intervals (STIs)

were measured in 10 healthy men and women (mean age 62 +/- 1 year [+/- standard

deviation]) before and after 6 months of intense endurance training. STIs, systolic and

diastolic blood pressure (BP) and heart rate (HR) were determined at rest and in

response to isometric handgrip exercise. Systolic BP, diastolic BP and HR increased

acutely from rest in response to handgrip (p less than 0.002). After training, systolic

and diastolic BP were reduced at rest (p less than 0.002) and, along with HR, were

lower in response to handgrip (p less than 0.002). However, training did not alter STIs

at rest or during handgrip. These findings indicate that healthy persons in their 60s

have a normal LV response to isometric exercise. Prolonged, intense endurance

training does not alter LV contractile function at rest or in response to isometric

exercise. However, training can significantly reduce BP at rest, and markedly lower

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the HR-systolic BP product attained during acute isometric stress, even in

normotensive older subjects.

37
Camus G, Thys H, Pigeon G, Dreezen E(1982) measured Blood pressure and

heart rate during static contraction of forearm muscles holding a tension of 30%

maximal voluntary strength for 5 mn. Eleven young men and eleven elderly male

subjects were used. Maximal voluntary strength is reduced by 19% in elderly subjects.

Relative mean cardio-vascular responses were unaffected by age.

J. S. Petrofsky and A. R. Lind (1975) 38 assessed the maximal handgrip strength, the

duration of a fatiguing handgrip contraction at a tension of 40% of maximal strength

and the heart rate and blood pressure during that contraction of 100 men aged from 22

to 62 yr. The subjects of this study were all men employed in a machine shop for a

large aircraft corporation. The homogeneity of their occupations may well explain

why, unlike previous reports, we found no change in muscular strength or muscular

endurance with age. However, although heart rate increased during the contraction in

all subjects, the increase in heart rate was greater in younger men. In contrast, while

both systolic and diastolic blood pressures increased during the contraction in all

subjects, the largest increase in systolic blood pressure was attained by the men in the

older decades; there was no difference due to age in the diastolic blood pressures.

39
Jerrold S. Petrofsky and Alexander R. Lind (1975) did a study where

relationship of sex, age, and body fat content were assessed on the maximal voluntary

strength (MCV), The endurance of a sustained contraction held at. 40% of the

subject's maximal strength and the associated changes in blood pressure and hears

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rate. Heart rate, which always increased during exercise, attained its highest

magnitude during exercise in the subjects who had the highest resting heart rates.

However, older subjects displayed a smaller increase in exercising heart rates than

younger subjects. The blood pressure at the end of the 40%MVC was directly related

to the resting blood pressure. However, aging increased the resting systolic blood

pressure; this aging effect was further exaggerated during the exercise.

J. S. Petrofsky and A. R. Lind. (1975) 40 has done a study to find out relationship of

sex, age, and body fat content on the maximal voluntary strength (MVC), the

endurance of a sustained contraction held at 40% of the subject's maximal strength,

and the associated changes in blood pressure and heart rate. Isometric handgrip

strength was, as expected, greater in men than in women; however, in both sexes, age

was inversely related to isometric strength, particularly in women. Body fat content,

however, was directly related to strength. In contrast, in both male and female

subjects aging was directly related to isometric endurance while body fat content was

now inversely related to isometric endurance. The increase in heart rate throughout a

fatiguing contraction at 40% MVC was strikingly similar in men and women. Heart

rate, which always increased during exercise, attained its highest magnitude during

exercise in the subjects who had the highest resting heart rates. However, older

subjects displayed a smaller increase in exercising heart rates than younger subjects.

The blood pressure at the end of the 40% MVC was directly related to the resting

blood pressure. However, aging and body fat content both increased the resting

systolic blood pressure in men and women; this aging effect was further exaggerated

during the exercise.

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Mcdermott, D.J., W.J. Stekiel, J.J. Barboriak, L.C.Kloth, and J.J. Smith (1974)41

did comparative investigation of 10 younger (25.3 ± 1.3 years) and 12 middle-aged

(46.8 ±0.8 years) men who performed 5-minute static forearm contractions at 33%

MVC demonstrated a comparable (but not a significant) HR. HR increased linearly

from mean resting values of 58.3 ± 1.9 bpm in the older group and 57.3 ± 3.6 bpm in

the younger group to 89.6 ± 4.9 bpm and 95.7 ± 5.5 bpm, respectively, at the fifth

minute of the contraction. McDermott et al. measured BP by auscultation each

minute during 5 minutes of isometric handgrip contraction at 33% MVC, observing

progressive increases from control levels (younger 5 128/83 mm Hg; older 5 117/87

mm Hg) to a peak level of 191/142 mm Hg and 191/137 mm Hg in younger and older

subjects, respectively.

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METHODOLOGY

POPULATION OF THE STUDY

40 subjects which includes normal males.

RESEARCH DESIGN

Quasi-Experimental study

SOURCE OF DATA

Subjects from Krupanidhi group of colleges, Bangalore and old age homes,

Bangalore.

SAMPLING TECHNIQUE

Purposive Sampling.

SAMPLE SIZE

Total 40 subjects were studied, randomly divided as 20 each into two groups.

The study groups were namely

Group 1: 20 subjects with young age group 20-30 years

Group 2: 20 subjects with elderly age group 60-70 years

-20-
STUDY DURATIION

One time study

SAMPLING CRITERIA:

Inclusion criteria

• Age group: 20-30 and 60-70 years.

• Subjects should be males.

• All subjects should be normotensive.

Exclusion criteria

• Subjects with chronic history of alcohol and smoking.

• Subjects with resting tachycardia (> 120 beats per min).

• Subjects with hypertension.

• Subjects with history of any other cardiovascular disorder

• Subjects with any peripheral vascular disease.

• Subjects should not be on any regular exercise program.

• Un-cooperative subjects.

-21-
MATERIALS USED

• Hand held dynamometer

• Stop watch

• Chair

• Table

• Towel

Measurement tools:

• Mercury sphygmomanometer

• Stethoscope

• Heart rate monitor

DESCRIPTION OF TOOLS:

Heart rate monitor: A heart rate monitor is a device that allows a user to measure

their heart rate in real time. It usually consists of two elements: a chest strap

transmitter and a wrist receiver (which usually doubles as a watch).

The chest strap has electrodes in contact with the skin to monitor the electrical

voltages in the heart. When a heartbeat is detected a radio signal is transmitted,

which the receiver uses to determine the current heart rate. This signal can be a

simple radio pulse or a unique coded signal from the chest strap; the latter prevents

one user's receiver from using signals from other nearby transmitters (known as

cross-talk interference).

-22-
There are a wide number of receiver designs, with all sorts of advanced features.

These include average heart rate over exercise period, time in a specific heart rate

zone, calories burned etc.

FIG.2: HEART RATE MONITOR: Chest strap transmitter and a

wrist receiver

Sphygmomanometer: A sphygmomanometer or blood pressure meter is a device

used to measure blood pressure comprising an inflatable cuff to restrict blood flow,

and a mercury or mechanical manometer to measure the pressure. Manual

sphygmomanometers are used in conjunction with a stethoscope. An arterial blood

pressure reading consists of two numbers, which typically may be recorded as x/y.

The x is the systolic pressure, and y is the diastolic pressure. Systole refers to the

contraction of the ventricles of the heart, when blood is forced from the heart into the

pulmonary and systemic arterial circulation, and diastole refers to the resting period.

-23-
 FIG.3: SPHYGMOMANOMETER AND STETHOSCOPE

Hand held dynamometer: Is an instrument for measuring the force of muscular

contraction. It measures the gross grip strength of the hand muscles. Also called

ergometer. The device features an adjustable handle with five positions to

accommodate any hand size. The indicator remains at the individual's maximum

reading until reset. The device registers up to 200 pounds.

-24-
FIG.4: HAND HELD DYNAMOMETER

-25-
PROCEDURE:

• Based on selection criteria, 40 subjects were selected from the population.

• The subjects were allocated into two groups with 20 subjects each, namely

experimental group one and experimental group two with purposive

sampling.

• Both the experimental group1 and group2, which received isometric exercise

for forearm

• A written consent has been cleared with subjects after receiving full details of

the protocol.

• Pre-test evaluation was done for heart rate and blood pressure and the results

were recorded.

• Isometric contraction was performed by a hand-held dynamometer in the

seated position with trunk supported, with the arm at approximately 30o of

abduction, with the elbow flexed 90 rested on the arm rest of the chair and

the wrist rested on rolled towel 8 cm in diameter. The forearm was in neutral

pronation/supination

• Subjects underwent several preliminary session during which they were

taught and carefully trained to perform maximum voluntary contraction

(MVC) of forearm. MVC was determined as the highest force developed by

the subject in previous 5-seconds maximal contraction trials.

• Subjects were instructed to breathe normally and avoid holding breath.

• Each subject gripped hand dynamometer at 40% (MVC) with the dominant

hand for 60 seconds.

• Post exercise Heart rate and blood pressure were taken and recorded.

-26-
FIG.5 AND FIG.6: SUBJECTS PERFORMING ISOMETRIC

CONTRACTION.

-27-
RESULTS AND DATA ANALYSIS

This chapter deals with the most important and crucial aspect of investigating

the data to answer the data through suitable statistical treatment. Analysis means a

critical examination of the assembled and grouped data for studying the

characteristics of the object under study and for determining the patterns of

relationships among the variables relating to it.

Samples of 40 individualscomprising of both young and elderly subjects were

selected. Subjects were made to perform the isometric exercise with hand held

dynamometer for period of 1 min. Heart rate and blood pressure were measured.

Emphasis has been given to the examination of data where various appropriate

analytical techniques have been used to synthesize the research data. The data were

put into suitable statistical techniques. Data collected during the study was analyzed

using appropriate statistical tests and results are given in terms of test material, figures

and tables in the subsequent pages.

The Statistical software namely SPSS 11.0, was used for the analysis of data

STATISTICAL ANALYSIS

The results obtained were analyzed statistically by using the following test:

• Paired‘t’ test- used for the comparison of pre and post values of heart rate and

blood pressure within the group.

• Unpaired‘t’ test used.

-28-
 TABLE 1: MEAN OF PRE AND POST SYSTOLIC BLOOD PRESSURE IN

YOUNG AND ELDERLY INDIVIDUALS

GROUP MEAN SD t-value p-value

YOUNG PRE SBP 121.40 5.80 10.40 p<0.01

POST SBP 127.10 6.34

ELDERLY PRE SBP 132.50 4.19 9.60 p<0.01

POST SBP 143.60 7.06

In the study it is observed that the Mean ± SD of PRE SBP of the young group during

Pre test is 121.40± 5.80 and during Post test is 127.10±6.34.In elderly subjects, mean

PRE SBP was 132.50±4.19 and in post test it was 143.60±7.06. The t-test shows that

there is high significant increase in SBP among young and elderly subject as p<0.01

for both the groups.

TABLE 2: TO COMPARE THE SYSTOLIC BLOOD PRESSURE BETWEEN

YOUNG AND ELDERLY SUBJECTS

GROUP MEAN SD t-value p-value

Diff. SBP YOUNG 5.70 2.452 4.221 p<0.01

ELDERLY 11.10 5.17

The result shows that the mean change in SBP among young was 5.7±2.4 that of

elderly was 11.1±5.1 this difference is significantly higher in elderly compare to

young subjects as p< 0.01.

-29-
GRAPH 1: TO COMPARE THE SYSTOLIC BLOOD PRESSURE BETWEEN
YOUNG AND ELDERLY SUBJECTS

-30-
 TABLE 3: MEAN OF PRE AND POST DIASTOLIC BLOOD PRESSURE IN

YOUNG AND ELDERLY INDIVIDUALS

GROUP MEAN SD t-value p-value

YOUNG PRE DBP 77.50 4.39 6.33 p<0.01

POST DBP 79.80 4.15

ELDERLY PRE DBP 83.90 3.81 7.76 p<0.01

POST DBP 89.40 4.40

In the study it is observed that the Mean ± SD of PRE DBP of the young group during

Pre test is 77.50± 4.39 and during Post test is 79.80±4.15.In elderly subjects, mean

PRE DBP was 83.9±3.8, and in post test it was 89.4±4.40. The t-test shows that there

is high significant increase in DBP among young and elderly subject as p<0.01 for

both the groups.

TABLE 4: TO COMPARE THE DISTOLIC BLOOD PRESSURE BETWEEN

YOUNG AND ELDERLY SUBJECTS

GROUP MEAN SD t-value p-value

Diff. DBP YOUNG 2.30 1.62 4.017 P<0.01

ELDERLY 5.50 3.17

The result shows that the mean change in DBP among young was 2.3±1.6 that of

elderly was 5.5±3.1 this difference is significantly higher in elderly compare to young

subjects as p< 0.01.

-31-
GRAPH 2: TO COMPARE THE DIASTOLIC BLOOD PRESSURE

BETWEEN YOUNG AND ELDERLY SUBJECTS.

-32-
 TABLE 5: MEAN OF PRE AND POST HEART RATE IN YOUNG AND

ELDERLY INDIVIDUALS

GROUP MEAN SD t-value p-value

YOUNG PRE HR 75.50 5.32 15.04 p<0.01

POST HR 85.25 7.19

ELDERLY PRE HR 74.65 4.38 28.21 p<0.01

POST HR 82.55 5.02

In the study it is observed that the Mean ± SD of PRE HR of the young group during

Pre test is 75.5±5.3 and during Post-test is 85.2±7.1. In elderly subjects, mean PRE

HR was 74.6±4.3, and in post test it was 82.5±5. The t-test shows that there is high

significant increase in HR among young and elderly subject as p<0.01 for both the

groups

TABLE 6: TO COMPARE HEART RATE BETWEEN YOUNG AND

ELDERLY SUBJECTS

GROUP MEAN SD t-value p-value

Diff. HR YOUNG 9.75 2.90 2.619 .013

ELDERLY 7.90 1.25

The result shows that the mean change in HR among young was 9.7±2.9 that of

elderly was 7.9±1.2 this difference is significantly higher in young compare to elderly

subjects as p< 0.01

-33-
GRAPH 3: TO COMPARE THE HEART RATE BETWEEN YOUNG AND

ELDERLY SUBJECTS.

-34-
DISCUSSION:

Over the last decade, the value of isometric exercise training for maintaining normal

cardiovascular functioning in older adults and some patient groups has been

recognized. But a cardiovascular response to isometric contraction in young and

elderly individuals is still debating.

It has been found that compared to dynamic exercise, isometric contractions

elicit marked increases in both systolic and diastolic blood pressures, while the rise in

heart rate is less pronounced (Lind et al. 1966). When comparing young and older

individuals, some studies have found comparable responses in heart rate to isometric

exercise (McDermott et al. 1974; Sagiv et al. 1988), whereas others have observed a

lower heart rate in the aged persons (Petrofsky and Lind 1975; Taylor et al. 1991,

1995). In contrast, it has been shown that the older persons exhibit either a similar

(McDermott et al.1974; Sagiv et al. 1988; Taylor et al. 1991) or a greater (Petrofsky

and Lind 1975) blood pressure response to isometric contractions. These differences

in readings may have arisen from variation in subject population, in experimental

protocol (fatiguing vs. non fatiguing contractions), or in the muscle group tested.

Comparisons of younger and older age groups may also have been confounded by

age-related changes in physical activity and reductions in skeletal muscle mass and

muscle strength (Evans 1995).

The present study examined the heart rate and blood pressure responses

to 40% MVC in two age groups of healthy men. The major findings of this study

suggest age-related differences exist in cardiovascular responses to isometric

contraction.

-35-
 Results within the group comparison showed significant increase in heart rate

and blood pressure after 60 seconds of 40% MVC. Among young subjects mean pre

SBP was 121.4±5.8, and in post test it was 127.1±6.3, in elderly subjects mean pre

SBP was 132.5±4.1, and in post test it was 143.6±7.0, Further there is high significant

increase in SBP among young and elderly subject as p<0.01 for both the groups.

Where as mean pre DBP among young subjects was 77.5±4.3, and in post test it was

79.8±4.1, in elderly subjects mean pre DBP was 83.9±3.8, and in post test it was

89.4±4.4, Further there is high significant increase in DBP among young and elderly

subject as p<0.01 for both the groups. Mean pre HR among young subjects was

75.5±5.3, and in post test it was 85.2±7.1, and in elderly subjects mean pre HR was

74.6±4.3, and in post test it was 82.5±5, Further there is high significant increase in

HR among young and elderly subject as p<0.01 for both the groups

However inter group comparison indicate mean change in SBP

among young was 5.7±2.4 that of elderly was 11.1±5.1 this difference is significantly

higher in elderly compare to young subjects as p< o.o1. Mean change in DBP among

young was 2.3±1.6 that of elderly was 5.5±3.1 this difference is significantly higher in

elderly compare to young subjects as p< o.o1. Mean change in HR among young was

9.7±2.9 that of elderly was 7.9±1.2 this difference is significantly higher in young

compare to elderly subjects as p< o.o1.

Thus, significant difference in heart rate and blood pressure response to

isometric contraction in young and elderly normal individuals exist. The older

subjects had a lower heart rate and a higher blood pressure response than their

younger counterparts. These results are concordant with studies done by Petrofsky

and Lind 1975; Taylor et al. 1991, 1995.

-36-
 Findings from the study & supporting review suggest that acute

cardiovascular responses to isometric contraction are not similar in healthy young and

elderly individuals. Study opposes the inclusion of isometric exercise as part of an

overall fitness program designed for healthy elderly individuals. Since the fastest

growing segment of the population consists of elderly individuals i.e. those over 60

years of age. Exercise professionals are encouraged to reach out to these members of

society with exercise programs that may improve bodily function and quality of life.

Attention has must paid to the influence of inherent factors such as aging, which

might modify cardiovascular responses to isometric exercise, while exercise

prescription.

-37-
LIMITATIONS:

1. This is an experimental study and relies on self reported information.

2. The study did not make use of confounding variables such as muscle mass, muscle

strength and environmental factors.

3. Some subjects tend to do valsalva manoeuvre, which further increases pressor

response.

SUGGESTION:

1. The subject’s functional limitations can be made as a part of the study.

2. Number of subjects can be increased.

3. Study can be extended for longer duration and for multi session.

4. Intensity of isometric contraction can be varied.

5. Further study can be performed on different muscle groups and different position.

-38-
CONCLUSION

The result indicates that increasing age is associated with an altered heart rate and

blood pressure response to isometric exercise. There was an increase in heart rate and

blood pressure with isometric exercise in both young and elderly group but the older

subjects had a lower heart rate and a higher blood pressure response than their

younger counterparts.

-39-
SUMMARY

The purpose of this study was to compare the acute cardiovascular responses to

isometric contraction in healthy young and elderly individuals. 40 male subjects with

age group 20-30years and 60-70years satisfying the inclusion criteria were selected

and divided into two groups namely young and elderly group respectively. Resting

HR and BP were recorded followed by HR and BP responses to isometric exercise in

both the groups were assessed. Isometric contraction was held till 60seconds using the

hand held dynamometer at 40% of the maximal voluntary contraction (MVC). Pre and

post HR and BP were compared. After appropriate statistical analysis result shows

that there is age associated alteration in heart rate and blood pressure response to

isometric exercise.

The older subjects had a lower heart rate and a higher blood pressure response than

their younger counterparts. Thus study opposes the inclusion of isometric exercise as

part of an overall fitness program designed for healthy elderly individuals.

-40-
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21. Petrofsky JS, Lind AR. Aging, isometric strength and endurance and the

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39. Jerrold S. Petrofsky and Alexander R Lind. Isometric Strength, Endurance, and

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-45-
 ANNEXURE-1

CONSENT FORM

TITLE:

“CARDIOVASCULAR RESPONSES TO ISOMETRIC CONTRACTION IN

YOUNG AND ELDERLY INDIVIDUALS ”

INVESTIGATOR:
Mr. RAVISH TAORI

PURPOSE OF THE STUDY:

I …………………………………………………. have been informed that this study

will help clinicians, therapists to design exercise programs, that will help in the

rehabilitation of the elderly and cardiac population

PROCEDURE:

I understand that I’ll be given isometrics exercise of forearm using the hand held

dynamometer, under the direct supervision of the physiotherapist. I am aware that I

have to follow therapist’s instructions as has been told to me.

RISK AND DISCOMFORT:

I understand that there is some potential risks associated with this procedure, and
understand that Mr. RAVISH TAORI will accompany me during this procedure.

-46-
CONFIDENTIALITY:

I understand that the medical information produced by this study will be confidential.

If the data are used for publication in the medical literature or for teaching purpose, no

names will be used and other literatures such as photographs and audio or videotapes

will be used only with permission.

REQUEST FOR MORE INFORMATION:

I understand that I may ask any question about the study at any time.

Mr. RAVISH TAORI available to answer my question. Copy of this concern form

will be given to me to keep for my careful reading.

REFUSAL OR WITHDRAWAL OF PARTICIPATION:

I understand that my participation is voluntary and I may withdraw consent and

discontinue participation at any time. I also understand that he may terminate my

participation in the study at anytime after he has explained the reasons for doing so.

INJURY STATEMENT:

I understand that the exercise, which I am going to perform under the guidance of my

therapist, may cause discomfort. In such case medical attention will be provided, but

no compensation will be provided. I understand my agreement to participate in this

study and I am not waiving any of my legal rights.

-47-
I confirm that Mr. RAVISH TAORI has explained me the purpose of the study, the

study procedure and the possible risk that I may experience. I have read and I have

understood this concern to participate as a subject in this study.

……………. …………………

SUBJECT DATE

……………………………. …………………

WITNESS TO SIGNATURE DATE

I have explained to Mr.………………………………………….. the purpose of the

research, the required and the possible risks and benefits, to the best of my ability.

…………………… …………………….

INVESTIGATOR DATE

-48-
 ANNEXURE 2

PROFORMA FOR DATA COLLECTION TO BE ANALYSED

NAME:

AGE: GROUP:

CARDIOVASCULAR
RESPONSE HEART RATE BLOOD PRESSURE

PRE TEST

POST TEST

-49-
 ANNEXURE-3

MASTER CHART FOR GROUP 1 (YOUNG)

Sr.No. BLOOD PRESSURE HEART RATE

PRE TEST POST TEST PRE TEST POST TEST
1. 130/80 134/80 82 91
2. 118/76 130/80 76 89
3. 120/80 124/80 74 83
4. 120/82 126/84 64 72
5. 118/70 126/74 80 94
6. 126/86 130/86 77 85
7. 120/74 124/76 71 77
8. 118/72 122/74 70 81
9. 110/70 110/70 65 69
10. 124/78 132/80 80 92
11. 112/74 120/80 78 84
12. 122/78 128/80 75 83
13. 122/80 130/84 69 78
14. 130/80 136/82 74 86
15. 114/76 120/78 78 90
16. 126/84 130/86 83 92
17 122/76 126/78 78 87
18 118/74 124/78 81 97
19 130/82 136/84 78 89
20 128/78 134/82 77 86

-50-
 ANNEXURE-4

MASTER CHART FOR GROUP 2 (ELDER)

Sr.No. BLOOD PRESSURE HEART RATE

PRE TEST POST TEST PRE TEST POST TEST
1. 126/80 134/84 77 84
2. 128/86 136/90 75 83
3. 136/80 142/86 78 87
4. 130/78 136/82 71 79
5. 138/80 146/84 75 81
6. 130/82 138/86 69 74
7. 136/86 144/88 70 80
8. 130/84 138/90 70 78
9. 128/78 138/82 74 81
10. 128/78 148/92 77 85
11. 132/90 146/90 71 80
12. 138/86 142/94 72 79
13. 128/86 136/90 66 72
14. 136/88 152/96 80 88
15. 138/86 148/92 76 85
16. 134/90 152/96 81 90
17 128/86 140/90 72 80
18 138/84 162/96 81 90
19 132/84 144/88 78 87
20 136/86 150/92 80 88

-51-