Effect of Circuit Exercise Training on Physical Fitness of Alcoholic Patients MARIJEAN PIORKOWSKI, MS, and LOIS A. AXTELL, BA
A group of patients with chronic alcoholism w h o participated in a circuit training exercise program were compared on a stair climbing task t o a group of patients w h o did not participate in the program. After three weeks, the patients in the exercise group had gained significantly in the number of stairs which they could c l i m b when compared to the patients in the nonexercise group. The time required to return t o the heart rate before stair climbing was significantly shorter for exercising patients than for nonexercising patients. The circuit training exercise program, therefore, appears to be an effective method for improving the fitness level of alcoholic patients.
r h e pervasive effect of alcohol on physical endurance can be demonstrated in nonalcoholic as well as alcoholic persons. Karvinen and colleagues investigated the ef fect of hangover on physical performance of thirty nonalcoholic men. 1 They found a sig nificant decrease in the amount of work per formed on a bicycle ergometer. Heart rate during the first two minutes of work as well as during a five-minute recovery was signifi cantly elevated in those with hangovers when compared to the same group performing without hangovers. Doctor and Bernal have stated that elevated heart rate is one of the enduring changes found in chronic alcohol ism. 2 Increased heart rate was also noted in chronic alcoholics. Frederiksen and Hed re ported that 36 of 121 chronic users under the age of 41 years had heart rates of 95 or more beats per minute. 3 In a study of 100 alcohol ics, Pader found 14 had resting sinus tachy cardia (over 100 beats per minute), 3 had premature ventricular contractions, 3 had
Mrs. Piorkowski is Instructor, Physical Therapy Depart ment, Long Beach General Hospital, Long Beach, CA
90806. Mrs. Axtell is Supervisor I, Physical Therapy Depart ment, Lonq Beach General Hospital, Long Beach, CA
90806.
premature atrial contractions, 2 had paroxys mal atrial fibrillation, and 3 had first degree atrioventricular dissociation. 4 Decreased cardiac efficiency is not the only culprit of inferior physical performance seen in chronic alcoholism. Wanamaker and SkiIman discovered that 33 percent of tested chronic alcoholics had slowed motor nerve conduction velocities. 5 This result was not found in an age-matched group of moderate drinkers. The slowed conduction time was found in both the ulnar and peroneal nerves. The authors concluded that the slowing was an effect of subclinical peripheral neurop athy. Carlsson and co-workers found a decrease in isometric muscle strength after complete regression of withdrawal symptoms." This de crease was found mainly in the antigravity muscles. The investigators also noted that these muscles did not gain strength unless weight-lifting exercises aimed at those spe cific muscles were administered. The effect of training on the postwithdrawal fitness level was rarely reported in the litera ture. Goldstein and associates administered the Heath Rail Walk test to alcoholics in the withdrawal phase. 7 They found on retest that persons who practiced rail walking between tests improved significantly more than those
Volume 56 / Number 4, April 1976
Downloaded from https://academic.oup.com/ptj/article-abstract/56/4/403/4568232 by Suffolk University user on 20 January 2018
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who did not practice. Both groups showed improvement o n retest, giving credence t o the notion of spontaneous recovery. Gary and Guthrie used a jogging program as the method for increasing fitness as meas ured by the Schneider physical fitness test. 8 The participating group improved signifi cantly i n exercise heart rate o n retest after four weeks of jogging. No increase in score was noted in the nonparticipating group. Our study was designed t o determine if the circuit training program of physical fitness affected the fitness level of alcoholic patients.
METHOD Twenty-six men selected for this study were inpatient participants in a three- t o four-week alcoholic rehabilitation program. Other crite ria for inclusion were that the patient should have ingested n o alcohol for 10 days. Physi cian clearance was required for participation i n the study. The patient had t o be able t o participate completely in the circuit program; if he missed three o r more exercise sessions, he was eliminated from the study. The patients were randomly assigned to one of two groups: exercise (n= 12) o r nonexercise (n= 14). All patients were informed that they would be participating in a study t o de termine the effectiveness of the circuit train ing program o n physical fitness. Information such as age, employment his tory, and drinking history, including type and amount of alcohol, was gathered from the intake interview in the medical chart. These factors were studied since they could have influenced performance o n the stair test and in the circuit. Although most patients were not working before admission, their trade, skill, o r profes sion was rated as light, moderate, or heavy. Light work pertained to jobs such as sales work or hotel clerking. Moderate work re ferred to jobs such as welding or working with tools. Heavy work was determined for jobs such as moving furniture or rigging oil wells. Testing was performed by a physical thera pist who was unaware of the group assign ment of each patient. Testing took place with the patient i n a standing position. Before the stair climb test, the tester recorded an apical
heart rate taken by stethoscope over a oneminute time period. All patients were asked t o climb a stair 28 c m in height. The instructions were to step up with the right foot, then the left foot, and step d o w n with the left foot and then with the right foot as fast as possible for one minute. Each repetition of this pattern was counted as one cycle. The tester demon strated the task, and the patient performed one or t w o practice cycles t o assure compre hension of the task. He then climbed the stair for one minute as the tester counted the num ber of cycles that he completed. The tester took the apical heart rate over a 6-minute period beginning immediately after the stair climbing task was completed. A pilot study showed that a 6-minute measurement period was adequate. The heart rates which returned t o resting level did so in 6 minutes; the heart rates which did not return t o resting level within 6 minutes were still elevated 15 t o 20 minutes after testing. The test was repeated three weeks after the initial testing session by the same tester. The patients who were assigned t o the ex ercise group participated in the circuit Mon day through Friday for three weeks. The exer cise program began with 10 minutes of calisthenic-type exercises for warming up. The circuit consisted of 22 exercise stations. The patients spent one minute at each station then moved t o the next station. Examples of the exercises included sit-ups o n a slant board, bench press, biceps curls, and station ary bicycle. The patients moved from station to station clockwise around the gym until ex ercises at all stations had been completed. At the beginning of each successive week, the exercising patients were encouraged t o pro gress themselves t o the next level. For exam ple, the first week level for sit-ups was 5 repe titions in one minute; the second week, 10 repetitions in one minute; the third week, 15 repetitions; and the fourth week, 20 repeti tions. The exercise period was about 45 min utes. During the same period, the nonparticipators were assigned t o table games such as cards or checkers. Both groups were allowed to participate in weekend sports activities such as baseball, volleyball, and horseshoe throwing. Because there were no stairs in o r outside the hospital, the patients could not practice stair climbing.
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Downloaded from https://academic.oup.com/ptj/article-abstract/56/4/403/4568232 by Suffolk University user on 20 January 2018
PHYSICAL THERAPY
TABLE 1 Age, Consumption of Alcohol, and Duration of Alcoholism in Exercised and Nonexercised Groups (n = 21) Nonexercise
Exercise Patient Variables Age Alcohol consumed per day (oz) Duration of drinking problem (yrs)
Mean
SD
Mean
SD
42.75
9.66
43.00
8.88
.07 a
30.83
14.76
30.71
14.90
.02 a
19.75
13.26
21.28
7.09
,34 a
Not significant.
TABLE 2 Differences between Exercised and Nonexercised Groups in Number of Step Cycles Accomplished Exercise Group Cycles
Initial num ber Final num ber
Mean
SD
Mean
SD
26.58
5.72
23.36
4.24
38.16
5.67
30.93
6.98
( t = 4.79) a Increase
11.58
3.29
(t = a h
Nonexercise Group
( t = 3.38) a 7.57
6.40
1.91) h
p < .05. p < .01.
RESULTS Although 41 patients were admitted to the study, only 26 completed the posttest. Rea sons for discontinuation were early dis charge, leaving against medical advice, and illness. These situations were equally distrib uted between the groups.
Job classification was compared by chisquare test which demonstrated no signifi cant difference between the groups, (x 2 = .74). No significant difference was found be tween the groups on choice of drink: whis key, vodka, beer, wine, or a combination of alcoholic beverages (x 2 = 2.18). Other variables such as age, consumption of alcohol, and duration of the drinking prob lem were checked for randomness. The t test demonstrated no significant differences be tween the two groups (Tab. 1). Both groups increased in the number of step cycles which could be accomplished in the final test. The exercise group, however, gained significantly more cycles than the nonexercising group (Tab. 2). Both groups retained a high apical heart rate before stair climbing, although the means were a few points lower. No significant difference was found between initial and final test for each group. In addition,-comparison of final heart rates before testing demon strated no significant difference between the exercise and nonexercise group (Tab. 3). The heart's ability to return to its rate be fore the stair climb showed a significant dif ference (p
A group of patients with chronic alcoholism w h o participated in a circuit training exercise program were compared on a stair climbing task t o a group of patients w h o did not participate in the program. After three weeks, the patients in the exercise group had gained significantly in the number of stairs which they could c l i m b when compared to the patients in the nonexercise group. The time required to return t o the heart rate before stair climbing was significantly shorter for exercising patients than for nonexercising patients. The circuit training exercise program, therefore, appears to be an effective method for improving the fitness level of alcoholic patients.
r h e pervasive effect of alcohol on physical endurance can be demonstrated in nonalcoholic as well as alcoholic persons. Karvinen and colleagues investigated the ef fect of hangover on physical performance of thirty nonalcoholic men. 1 They found a sig nificant decrease in the amount of work per formed on a bicycle ergometer. Heart rate during the first two minutes of work as well as during a five-minute recovery was signifi cantly elevated in those with hangovers when compared to the same group performing without hangovers. Doctor and Bernal have stated that elevated heart rate is one of the enduring changes found in chronic alcohol ism. 2 Increased heart rate was also noted in chronic alcoholics. Frederiksen and Hed re ported that 36 of 121 chronic users under the age of 41 years had heart rates of 95 or more beats per minute. 3 In a study of 100 alcohol ics, Pader found 14 had resting sinus tachy cardia (over 100 beats per minute), 3 had premature ventricular contractions, 3 had
Mrs. Piorkowski is Instructor, Physical Therapy Depart ment, Long Beach General Hospital, Long Beach, CA
90806. Mrs. Axtell is Supervisor I, Physical Therapy Depart ment, Lonq Beach General Hospital, Long Beach, CA
90806.
premature atrial contractions, 2 had paroxys mal atrial fibrillation, and 3 had first degree atrioventricular dissociation. 4 Decreased cardiac efficiency is not the only culprit of inferior physical performance seen in chronic alcoholism. Wanamaker and SkiIman discovered that 33 percent of tested chronic alcoholics had slowed motor nerve conduction velocities. 5 This result was not found in an age-matched group of moderate drinkers. The slowed conduction time was found in both the ulnar and peroneal nerves. The authors concluded that the slowing was an effect of subclinical peripheral neurop athy. Carlsson and co-workers found a decrease in isometric muscle strength after complete regression of withdrawal symptoms." This de crease was found mainly in the antigravity muscles. The investigators also noted that these muscles did not gain strength unless weight-lifting exercises aimed at those spe cific muscles were administered. The effect of training on the postwithdrawal fitness level was rarely reported in the litera ture. Goldstein and associates administered the Heath Rail Walk test to alcoholics in the withdrawal phase. 7 They found on retest that persons who practiced rail walking between tests improved significantly more than those
Volume 56 / Number 4, April 1976
Downloaded from https://academic.oup.com/ptj/article-abstract/56/4/403/4568232 by Suffolk University user on 20 January 2018
403
who did not practice. Both groups showed improvement o n retest, giving credence t o the notion of spontaneous recovery. Gary and Guthrie used a jogging program as the method for increasing fitness as meas ured by the Schneider physical fitness test. 8 The participating group improved signifi cantly i n exercise heart rate o n retest after four weeks of jogging. No increase in score was noted in the nonparticipating group. Our study was designed t o determine if the circuit training program of physical fitness affected the fitness level of alcoholic patients.
METHOD Twenty-six men selected for this study were inpatient participants in a three- t o four-week alcoholic rehabilitation program. Other crite ria for inclusion were that the patient should have ingested n o alcohol for 10 days. Physi cian clearance was required for participation i n the study. The patient had t o be able t o participate completely in the circuit program; if he missed three o r more exercise sessions, he was eliminated from the study. The patients were randomly assigned to one of two groups: exercise (n= 12) o r nonexercise (n= 14). All patients were informed that they would be participating in a study t o de termine the effectiveness of the circuit train ing program o n physical fitness. Information such as age, employment his tory, and drinking history, including type and amount of alcohol, was gathered from the intake interview in the medical chart. These factors were studied since they could have influenced performance o n the stair test and in the circuit. Although most patients were not working before admission, their trade, skill, o r profes sion was rated as light, moderate, or heavy. Light work pertained to jobs such as sales work or hotel clerking. Moderate work re ferred to jobs such as welding or working with tools. Heavy work was determined for jobs such as moving furniture or rigging oil wells. Testing was performed by a physical thera pist who was unaware of the group assign ment of each patient. Testing took place with the patient i n a standing position. Before the stair climb test, the tester recorded an apical
heart rate taken by stethoscope over a oneminute time period. All patients were asked t o climb a stair 28 c m in height. The instructions were to step up with the right foot, then the left foot, and step d o w n with the left foot and then with the right foot as fast as possible for one minute. Each repetition of this pattern was counted as one cycle. The tester demon strated the task, and the patient performed one or t w o practice cycles t o assure compre hension of the task. He then climbed the stair for one minute as the tester counted the num ber of cycles that he completed. The tester took the apical heart rate over a 6-minute period beginning immediately after the stair climbing task was completed. A pilot study showed that a 6-minute measurement period was adequate. The heart rates which returned t o resting level did so in 6 minutes; the heart rates which did not return t o resting level within 6 minutes were still elevated 15 t o 20 minutes after testing. The test was repeated three weeks after the initial testing session by the same tester. The patients who were assigned t o the ex ercise group participated in the circuit Mon day through Friday for three weeks. The exer cise program began with 10 minutes of calisthenic-type exercises for warming up. The circuit consisted of 22 exercise stations. The patients spent one minute at each station then moved t o the next station. Examples of the exercises included sit-ups o n a slant board, bench press, biceps curls, and station ary bicycle. The patients moved from station to station clockwise around the gym until ex ercises at all stations had been completed. At the beginning of each successive week, the exercising patients were encouraged t o pro gress themselves t o the next level. For exam ple, the first week level for sit-ups was 5 repe titions in one minute; the second week, 10 repetitions in one minute; the third week, 15 repetitions; and the fourth week, 20 repeti tions. The exercise period was about 45 min utes. During the same period, the nonparticipators were assigned t o table games such as cards or checkers. Both groups were allowed to participate in weekend sports activities such as baseball, volleyball, and horseshoe throwing. Because there were no stairs in o r outside the hospital, the patients could not practice stair climbing.
404
Downloaded from https://academic.oup.com/ptj/article-abstract/56/4/403/4568232 by Suffolk University user on 20 January 2018
PHYSICAL THERAPY
TABLE 1 Age, Consumption of Alcohol, and Duration of Alcoholism in Exercised and Nonexercised Groups (n = 21) Nonexercise
Exercise Patient Variables Age Alcohol consumed per day (oz) Duration of drinking problem (yrs)
Mean
SD
Mean
SD
42.75
9.66
43.00
8.88
.07 a
30.83
14.76
30.71
14.90
.02 a
19.75
13.26
21.28
7.09
,34 a
Not significant.
TABLE 2 Differences between Exercised and Nonexercised Groups in Number of Step Cycles Accomplished Exercise Group Cycles
Initial num ber Final num ber
Mean
SD
Mean
SD
26.58
5.72
23.36
4.24
38.16
5.67
30.93
6.98
( t = 4.79) a Increase
11.58
3.29
(t = a h
Nonexercise Group
( t = 3.38) a 7.57
6.40
1.91) h
p < .05. p < .01.
RESULTS Although 41 patients were admitted to the study, only 26 completed the posttest. Rea sons for discontinuation were early dis charge, leaving against medical advice, and illness. These situations were equally distrib uted between the groups.
Job classification was compared by chisquare test which demonstrated no signifi cant difference between the groups, (x 2 = .74). No significant difference was found be tween the groups on choice of drink: whis key, vodka, beer, wine, or a combination of alcoholic beverages (x 2 = 2.18). Other variables such as age, consumption of alcohol, and duration of the drinking prob lem were checked for randomness. The t test demonstrated no significant differences be tween the two groups (Tab. 1). Both groups increased in the number of step cycles which could be accomplished in the final test. The exercise group, however, gained significantly more cycles than the nonexercising group (Tab. 2). Both groups retained a high apical heart rate before stair climbing, although the means were a few points lower. No significant difference was found between initial and final test for each group. In addition,-comparison of final heart rates before testing demon strated no significant difference between the exercise and nonexercise group (Tab. 3). The heart's ability to return to its rate be fore the stair climb showed a significant dif ference (p
