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Key Terms
Cardiorespiratory system Cardiovascular system Heart Mediastinum Atrium Ventricle Blood Blood vessel Arteries Veins
Arterioles Capillaries Venules Respiratory system Inspiration Expiration Aerobic Anaerobic Bioenergetics Adenosine triphosphate
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HEART: A hollow muscular organ that pumps a circulation of blood through the body by means of rhythmic contraction.
The Heart
The heart is a muscular pump that rhythmically contracts to push blood throughout the body. It is positioned obliquely in the center of the chest (or thoracic cavity) lying anteriorly to the spine and posteriorly to the sternum.4 It is flanked laterally by the lungs.4 This area is called the mediastinum.6 The adult heart is approximately the size of a typical adult fist and weighs roughly 300 grams (approximately 10 ounces).4,6 Heart muscle is termed cardiac muscle and has similar characteristics to skeletal muscle. It is made up of myofibrils containing actin and myosin that
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crossbridge to cause contractions and is surrounded by a sarcolemma.1-3,6 Cardiac muscle is for the most part considered an involuntary muscle, meaning that it cannot typically be consciously controlled. Cardiac Muscle Contraction Cardiac muscle fibers are shorter and more tightly connected than skeletal muscle, thus enabling the contraction of one fiber to stimulate the others to contract synchronously.1-3 The conduction system (or means by which the muscle fibers are activated) is much different than in skeletal muscle. All cardiac muscle fibers have a built in contraction rhythm, and the fibers with the highest rhythm determine the heartbeat or heart rate.1-3 The typical discharge rate and thus, heart rate, is between 70-80 beats per minute.3,4,6,7 The specialized conduction system of cardiac muscle that provides the rhythm for heart rate includes several items (Figure 3-2).1-4,6,7 The sinoatrial (SA) node, which is located in the right atrium is termed the pacemaker for the heart, because it initiates the heartbeat. Internodal pathways transfer the impulse from the SA node to the atrioventricular (AV) node. The AV node delays the impulse before moving on to the ventricles.The atrioventricular (AV) bundle passes the impulse to the ventricles for contraction via the left and right bundle branches of the Purkinje fibers.
MEDIASTINUM: The space in the chest between the lungs that contains all the internal organs of the chest, except the lungs.
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ATRIUM: Either of the two chambers of the heart that receives blood from the veins and forces it into the ventricles.
Structure of the Heart The heart is comprised of four hollow chambers that are delineated into two interdependent (but separate) pumps on either side.These two pumps are separated by the interatrial septum (separates the atria) and interventricular septum (separates the ventricles).4-6 Each side of the heart has two chambers: an atrium and a ventricle (Figure 3-3).1-4,6,7 The atriums are smaller chambers, located superiorly on either side of the heart. They essentially gather blood coming to the heart, much like a reservoir.The right atrium gathers deoxygenated blood returning to the heart from the entire body, while the left atrium gathers re-oxygenated blood coming to the heart from the lungs (Figure 3-3).1-4,6-7
VENTRICLE: Either of the two chambers of the heart that receive blood from their corresponding atrium and, in turn, force blood into the arteries. 60
The ventricles are larger chambers located inferiorly on either side of the heart. They are the main pumps in the heart, as they pump blood out to the rest of the body. The right ventricle receives the deoxygenated blood from the right atrium and then pumps it to the lungs to be saturated with incoming oxygen.The left ventricle receives the re-oxygenated blood from the left atrium and proceeds to pump it to the entire body (Figure 3-3).1-4,6,7
Each chamber of the heart is separated from one another and major veins and arteries via valves in order to prevent a back flow or spillage of blood back into the chambers. These valves include the atrioventricular valves and the semilunar valves (Figure 3-3).1-4,6,7 Function of the Heart As previously mentioned, the heart is a hollowed mass of muscle that encompasses two separate pumps (left and right ventricles), each of which distributes blood to specific parts of the body.1-4,6,7 Each contraction of a ventricle pushes blood from the heart into the body. The amount of blood that is pumped out with each contraction of a ventricle is the stroke volume (SV).The stroke volume of a typical adult is approximately 75-80 milliliters per beat (ml/beat).1-3,5 The rate with which the heart pumps, is referred to as the heart rate (HR). The heart rate of the typical person is approximately 70-80 beats per minute (bpm).1-3,5 Together, the heart rate and the stroke volume make up the overall performance of the heart and are collectively termed cardiac output (Q). Cardiac output is the combination of how many times the heart beats per minute and how much blood is being pumped out with each beat (Table 3-1).
Table 3-1: Functions of the Heart Terminology Action Average Measurement
The amount of blood that is pumped out with each contraction of a ventricle The rate with which the heart pumps The combination of how many times the heart beats per minute and how much blood is being pumped out with each beat
For a typical adult, approximately 75-80 milliliters per beat (ml/beat) For a typical adult, approximately 70-80 beats per minute (bpm)
Cardiac Output
While it is next to impossible for a health and fitness professional to gauge the stroke volume of a client, it is relatively easy to determine the heart rate. Monitoring heart rate during exercise provides a good gauge as to the amount of work the heart is doing at any given time.3,8 The proper procedure for manually monitoring heart rate can be seen in Figure 3-4. Another procedure commonly used is the heart rate monitor, which is worn on the body and automatically derives the beats per minute.
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How To Manually Monitor Heart Rate 1. Place index and middle fingers around the palm side of the wrist (about one inch from the top of wrist, on the thumb side). a. The carotid artery at the neck can also be used, but with caution as it can cause dizziness and/or an inaccurate measurement if too much pressure is applied. 2. Locate the artery by feeling for a pulse with the index and middle fingers. Apply light pressure to feel the pulse. Do not apply excessive pressure as it may distort results. 3. When measuring the pulse during rest, count the number of beats in 60 seconds. a. There are some factors that may affect resting heart rate, including digestion, mental activity, environmental temperature, biological rhythms, body position and cardiorespiratory fitness. Because of this, resting heart rate should be measured upon waking (or, at the very least, after you have had five minutes of complete rest). 4. When measuring the pulse during exercise, count the number of beats in six seconds and add a zero to that number.Adding the zero will provide an estimate on the number of beats in 60 seconds. Or one can simply multiple the number by 10 (17 x 10 = 170) and that will provide the health and fitness professional with the same number. a. Example: Number of beats in six seconds = 17. Adding a zero = 170. This gives a pulse rate of 170 BPM.
Figure 3-4: How to Manually Monitor Heart Rate
BLOOD: Fluid that circulates in the heart, arteries, capillaries and veins, which carries nutrients and oxygen to all parts of the body and also rids the body of waste products.
Blood
A properly functioning heart transports blood efficiently throughout the body. Blood acts as a medium to deliver and collect essential products to and from the tissues of the body.1,2,5 Blood is thicker and heavier than water and constitutes approximately eight percent of total body weight.1,2,5 The average person holds about five liters (roughly one and one-half gallons) of blood in his/her body at any given time.1,2,5 Blood is a vital support mechanism, which provides an internal transportation, regulation and protection system for the kinetic chain (Table 3-1).
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Transportation Blood transports life-giving oxygen to and collects waste products from all tissues. It also transports hormones that act as chemical messengers to various organs and tissues in the body. Nutrients from the gastrointestinal tract are delivered to specific tissues by way of the bloodstream as well. Blood also conducts heat throughout the body.1-2,5 Regulation Blood provides a means to regulate body temperature, due to the properties of its water content and its path of flow. As blood travels close to the skin it can give off heat or can be cooled depending on the environment.1-3,6 Blood is essential in the regulation of the pH levels (acid balance) in the body as well as water content of bodily cells.6 Protection Blood provides protection from excessive blood loss through its clotting mechanism, which seals off damaged tissue.1,2,5 It also provides specialized immune cells to fight against foreign toxins within the body, decreasing disease and sickness.1-3,5 Ironically, however, by this same mechanism, blood can also spread diseases and sickness.5
Table 3-2: Support Mechanisms of the Blood Mechanism Function
Transportation
Transports oxygen and nutrients to tissues Transports waste products from tissues Transports hormones to organs and tissues Carries heat throughout the body Regulates body temperature and acid balance in the body Protects the body from excessive bleeding by clotting Contains specialized immune cells to help fight disease/sickness
Regulation Protection
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BLOOD VESSEL: Any of the tubes through which blood circulates in the body.
Blood Vessels
With each pump of each ventricle, blood is dispersed throughout the body. Concurrently, blood is also re-entering the heart. In order to circulate blood properly throughout the body and back to the heart, it must have a network through which it can travel.This network is comprised of blood vessels.1,2,4-7 Blood vessels form a closed circuit of hollow tubes that allow blood to be transported to and from the heart (Figure 3-5). Vessels that transport blood away from the heart are termed arteries. Vessels that transport blood back to the heart are termed veins.1,2,4-7 Arteries Arteries leaving the heart are initially large and elastic.4,6 These large arteries then branch out into medium-sized muscular arteries that extend to various areas throughout the body.1,2,4-6 The medium-sized arteries further divide into smaller arteries that are called arterioles.1,2,4-7 In turn, arterioles branch out into a multitude of microscopic vessels known as capillaries.1,2,4-7 It is here in the capillaries that substances such as oxygen, nutrients, hormones and waste products are exchanged between tissues.1,2,4-7 Veins Once substances are exchanged in the capillaries and waste products are gathered, they must then be transported to the proper area for cleaning and eventually back to the heart.The vessels that collect blood from the capillaries to perform this duty are called venules.1,2,4-7 Venules progressively merge with other venules and form veins. Veins then transport all of the blood from the body back to the heart.1,2,4-7
ARTERIES: Muscular and elastic tubes that carry blood from the heart through the body.
VEINS: Tubes that carry blood from the capillaries toward the heart.
CAPILLARIES: The smallest blood vessels, which connect venules with arterioles.
VENULES: The very small veins that connect capillaries to the larger veins.
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3. The right left atrium gathers deoxygenated blood returning to the heart from the entire body, while the right left atrium gathers re-oxygenated blood coming to the heart from the lungs. 4. The right left ventricle pumps blood back to the lungs.
6. What is the name of the blood vessel that collects blood from the capillaries?
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Respiratory Pump
The respiratory pump is located in the thorax or the thoracic (chest and abdominal) cavity. It is comprised of skeletal structures (bones) and soft tissue (muscles and pleural membranes). These systems, together with the nervous system, must work synergistically to allow for proper respiratory mechanics to occur much the same way as these systems work together to produce everyday functional movements.The skeletal structures provide the framework for the muscles to attach to as well as protection for the organs within the thorax (Table 3-3).While being strong enough to provide support, they are also flexible enough to allow for the expansion and compression needed for proper breathing.1,2,5,6,10 Breathing (or ventilation) is the actual process of moving air in and out of the body. It is divided into two phases: inspiration (or inhalation) and expiration (or exhalation). Inspiratory ventilation is active.This means that it requires active contraction of inspiratory muscles to increase the thoracic cavity volume, which decreases the intrapulmonary pressure (or pressure within the thoracic cavity) (Table 3-3). When the intrapulmonary pressure decreases below that of the atmospheric pressure (or the everyday pressure in the air), air is drawn into the lungs.1-3,10,11
INSPIRATION: The process of actively contracting inspiratory muscles in order to move air into the body.
EXPIRATION: The process of actively or passively relaxing inspiratory muscles in order to move air out of the body. 67
Bones Muscles
Sternum Inspiration
Ribs Vertebrae Diaphragm External intercostals Scalenes Sternocleidomastoid Pectoralis minor Internal intercostals Abdominals
Expiration
Inspiratory ventilation occurs in two forms: normal resting state (quiet) breathing and/or heavy (deep, forced) breathing. Normal breathing requires the use of the primary respiratory muscles while heavy breathing requires the additional use of the secondary respiratory muscles.1,2,5,6,10,12 Expiratory ventilation can be both active and passive. During normal breathing, expiratory ventilation is passive as it results from the relaxation of the contracting inspiratory muscles. During heavy or forced breathing, the expiratory ventilation relies on the activity of expiratory muscles to compress the thoracic cavity and force air out.1,2,5,6,10,13
Respiratory Passageways
The purpose of ventilation is to move air in and out of the body. However, the air must have passageways to funnel it in and out of the lungs for proper utilization.These respiratory passageways are divided into two categories, the conduction passageway and the respiratory passageway. The conduction passageway consists of all the structures that air travels through before entering the respiratory passageway (Table 3-4).The nasal and oral cavities, mouth, pharynx, larynx, trachea and bronchioles provide a gathering station for air and oxygen to be funneled into the body (Figure 3-7). These structures also allow the incoming air to be purified, humidified (or moisture added) and warmed or cooled to match body temperature.1-3,5,7,9,10 The respiratory passageway collects the channeled air coming from the conducting passageway (Figure 3-7).1,2,5,6,9 At the end of the bronchioles sit the alveoli, which are made up of clusters of alveolar sacs (Table 3-4).1,2,5,6,9 It is here, in the alveolar sacs, that gases such as oxygen and carbon dioxide (CO2) are transported in and out of the bloodstream through a process known as diffusion.1-3,6,9 This is how oxygen gets from the outside environment to the tissues of the body.
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Conduction
Nasal cavity Oral cavity Pharynx Larynx Trachea Right/left pulmonary bronchi Alveoli Alveolar sacs
Respiratory
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2. The external intercostals are muscles that act in which phase of breathing? Inspiration Expiration 3. In which structure does diffusion (oxygen and carbon dioxide being transported in and out of the bloodstream) occur?
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Concurrently, as the cells of the body are using oxygen, they produce an oxygen waste by-product known as carbon dioxide.1-3,5,6,9 Carbon dioxide is transported from the tissues back to the heart and eventually to the lungs in the de-oxygenated blood. In the alveolar sacs, it is diffused into the pulmonary capillaries and released through exhalation.1-3,5,6,9 In a simplistic overview, oxygen and carbon dioxide trade places in the tissues of the body, blood and lungs. As one is coming in, the other is going out.
Oxygen Consumption
The cardiovascular and respiratory systems work together to transport oxygen to the tissues of the body. Our capacity to efficiently use oxygen is dependent upon the respiratory systems ability to collect oxygen and the cardiovascular systems ability to absorb and transport it to the tissues of the body.14 The usage of oxygen by the body is known as oxygen uptake (or oxygen consumption).1-3,5,6,9,10 At rest, oxygen consumption (VO2) is estimated to be approximately 3.5 milliliters of oxygen per kilogram of body weight per minute (3.5 ml/kg-1/min-1), typically termed 1 metabolic equivalent or 1 MET. 3,5,7,10,14-16 It is calculated as: VO2 = Q x a - VO2 difference In the equation,VO2 is oxygen consumption, Q is cardiac output (HR SV) and a - VO2 difference is the difference in the O2 content between the blood in the arteries and the blood in the veins. From this equation, it is very easy to see how influential the cardiovascular system is on the bodys ability to consume oxygen, and that heart rate plays a major factor in VO2. Maximal oxygen consumption (VO2 max) is generally accepted as the best means of gauging cardiorespiratory fitness.3,5,7,15 Essentially, VO2 max is the highest rate of oxygen transport and utilization achieved at maximal physical exertion.10,14,15 VO2 max values can range anywhere from 40-80 ml/kg-1/min-1, or approximately 11-23 METs.7,15 Maximal testing, however, is not very practical for most clientele and, as such, many sub-maximal testing procedures have been established to estimate VO2 max.14,16 These include the treadmill, cycle ergometer, stepping and field protocols.14,16 While these protocols deliver a good generalization of a clients overall cardiorespiratory fitness level, they are based upon several assumptions that are rarely met and can contribute to estimate errors.14,16 However, given repeatedly over a period of weeks and/or months they may show a cardiorespiratory trend.
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BIOENERGETICS: The biology of energy transformations and exchanges within the body, and between it and the environment.
ADENOSINE TRIPHOSPHATE (ATP): A cellular structure that supplies energy for many biochemical cellular processes by undergoing enzymatic hydrolysis.
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ATP-CP Anaerobic (Creatine Phosphate) Glycolysis (Lactic Acid) Oxidative (Oxygen) Anaerobic
Aerobic
High-intensity, short-duration Up to activity such as heavy approximately weight training 10 seconds of activity Moderate- to high-intensity, 30-50 seconds moderate-duration activities of activity such as a typical set of 8-12 repetitions Lower intensity, longer Activities greater duration activities such than 2 minutes as walking on the treadmill for 20-30 minutes
ATP-CP (Creatine Phosphate) Together, ATP and CP are called phosphagens and therefore, this system is sometimes referred to as the Phosphagen System.18 The ATP-CP system provides energy for primarily high intensity, short duration bouts of exercise or activity. This would be seen in power and strength forms of training where heavy loads are used with only a few repetitions, or during short sprinting events. However, this system is activated at the onset of activity, regardless of intensity, due to its ability to produce energy very rapidly in comparison to the other systems.3,18,21 This bioenergetic system provides energy through the interactions of ATP and CP with enzymes (chemical catalysts that cause a change) such as myosinATPase and creatine kinsase. The enzyme myosin ATPase causes the breaking off of one of the phosphate bonds from ATP. This results in ADP (adenosine diphosphate, meaning that there are now two phosphates instead of three). By breaking one of the high-energy phosphate bonds, energy is released.3,18,21 This system is limited in its capacity to sustain energy production (approximately 10 seconds) because it must rely on the minimal storage of ATP and CP within the cells (Table 3-5).3,18,21 Glycolysis (Anaerobic/Lactic Acid) Glycolysis (anaerobic system) utilizes the breakdown of carbohydrates (glucose) to rapidly produce ATP.3,18,21 Here, one glucose molecule will produce 2 ATP through anaerobic glycolysis. One of the byproducts of this process is pyruvate. If pyruvate cannot
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be utilized fast enough by the muscle cell, a buildup of lactic acid will occur. Excess lactic acid causes an increase in the acidity of the muscle cell and will interfere with muscle contractions.3,18,21 While this system can produce a significantly greater amount of energy than the ATP-CP system, it too is limited to approximately 30-50 seconds of duration.3,18,21 Most fitness workouts will place a greater stress on this system than the other systems because a typical repetition range of eight to 12 falls within this timeframe (Table 3-5). Oxidative (Oxygen) The oxidative system relies primarily on carbohydrates and fats for the production of ATP. This system is the slowest producing of the three systems because it requires increased amounts of oxygen to match the muscular requirement of the exercise. Oxygen must be supplied through respiration and it takes a while to elevate the respiration rate to consume appropriate amounts of oxygen. Needless to say, this system results in a greater amount of ATP. The oxidative system uses a somewhat similar process to anaerobic glycolysis. Glucose supplied from the glycogen stores within the body is broken down in the presence of oxygen.With the presence of oxygen, pyruvate is not converted to lactic acid and becomes a usable substrate for ATP production.3,18,21 Here, one glucose molecule will produce 36 ATP. Depending on the specific substrates and pathways, it is possible for one glucose molecule to produce 38 ATP. 3,18,21 This system becomes more involved in activities longer than 30 seconds and is the predominant system in activities over two minutes (Table 3-5).3
Dysfunctional Breathing
The importance of all systems in the body working synergistically can be further demonstrated in the intimacy between the cardiorespiratory system and the kinetic chain.The cardiorespiratory system is a major support system for the kinetic chain. However, it is also the kinetic chain that provides essential support for the cardiorespiratory system. Muscles, bones and the nervous system are all essential components of the cardiorespiratory system that enable it to function optimally. Thus, if there is a dysfunction in the cardiorespiratory system, this can directly impact the components of the kinetic chain and perpetuate further dysfunction. Alterations in breathing patterns are a prime example of this relationship. 75
Breathing dysfunction is a very common predecessor to kinetic chain dysfunction.22 It often results from breathing associated with high stress and/or anxiety. As a result of this altered breathing pattern, the follow scenarios can occur:23
The breathing pattern becomes more shallow, using the secondary respiratory muscles more predominantly than the diaphragm.This shallow, upper-chest breathing pattern becomes habitual causing overuse to the secondary respiratory muscles such as the scalenes, sternocleidomastoid, levator scapulae and upper trapezius. These muscles also play a major postural role in the kinetic chain, all connecting directly to the cervical and cranial portions of the body. Their increased activity and excessive tension often result in headaches, lightheadedness and dizziness. Excessive breathing (short shallow breaths) can lead to altered carbon dioxide/oxygen blood content that stimulates various sensors. This can lead to feelings of anxiety that further initiate an excessive breathing response. Increased nociceptor activity (pain receptors) can create increased pain. Inadequate oxygen and retention of metabolic waste within muscles can create fatigued stiff muscles. Inadequate joint motion of the spine and rib cage, due to improper breathing, causes joints to become restricted and stiff.
All of these situations can lead to a decreased functional capacity that may result in headaches, feelings of anxiety, fatigue, poor sleep patterns, as well as poor circulation. As a health and fitness professional, it is not your job to try to diagnose these problems. If a client presents any of these scenarios, refer them immediately to a medical professional for assistance.
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transport and utilization achieved at maximal physical exertion. It is generally accepted as the best means of gauging cardiorespiratory fitness. Values can range anywhere from 11-23 METs. Oxygen is the necessary catalyst for aerobic activity prolonged for periods of greater than 30 seconds. Anaerobic activities that last for only a few seconds are not dependent upon oxygen for proper execution.To generate either form of activity, however, the body must still produce sufficient energy. The study of how chemical energy (food) is converted into mechanical energy (work) is known as bioenergetics. Typically, energy is gathered by adenosine triphosphate (ATP) and is transferred to a site that can utilize this energy (muscle contraction). ATP has the ability to store large the amounts of energy needed for muscle contraction in order to perform physical activity. However, the supply of ATP in each cell is limited, and cells must produce more through the bioenergetic continuum, which consists of ATP-Creatine Phosphate and the Glycolysis pathways (anaerobic systems), and the Oxidative pathway (an aerobic system). The ATP-CP system provides energy for high intensity, short bouts of activity. This system relies on the minimal storage of ATP and CP within the cells and thus is limited to energy production of approximately 10 seconds. Glycolysis uses the breakdown of carbohydrates to rapidly produce ATP. This system is limited to 30-50 seconds of duration. The oxidative system relies primarily on carbohydrates and fats and results in a higher production of ATP, allowing for activities longer than 30 seconds. Alterations in breathing patterns can directly impact the components of the kinetic chain and lead to further dysfunction. If the breathing patterns become more shallow, the body uses secondary respiratory muscles more than the diaphragm, which can negatively impact posture.This may create excessive muscular tension, resulting in headaches, lightheadedness and dizziness. Short shallow breaths can also lead to altered carbon dioxide/oxygen blood content which causes feelings of anxiety. Inadequate oxygen and retention of metabolic waste within muscles can create stiff muscles and joints. If a client complains of headaches, feelings of anxiety, fatigue, poor sleep patterns or poor circulation, refer them immediately to a medical professional for assistance.
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4. Which system(s) of the bioenergetic continuum is/are aerobic? ATP-CP Glycolysis Oxidative 5. Which pathway of the bioenergetic continuum would most likely be used during heavy weight training? ________________________________
6. When a breathing pattern becomes more shallow, the body may use secondary respiratory muscles more than the ___________________.
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References
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15. Franklin BA.Cardiovascular responses to exercise and training.Chapter 8.In:Garrett WE, Kirkendall DT (eds). Exercise and sport science. Philadelphia: Lippincott Williams & Wilkins; 2000. 16. American College of Sports Medicine. ACSMs guidelines for exercise testing and prescription. 5th edition. Philadelphia:Williams & Wilkins; 1995. 17. Greenhaff PL,Timmons JA. Interaction between aerobic and anaerobic metabolism during intense muscle contraction. In: Holsey JO (ed). Exercise and sport science reviews. Volume 26. Baltimore:Williams & Wilkins; 1998. pp 1-30. 18. Stone MH, Conley MS. Bioenergetics. Chapter 5. In: Baechle TR (ed). Essentials of strength training and conditioning. Champaign, IL: Human Kinetics; 1994. 19. Volek JS. Enhancing exercise performance: nutritional implications. Chapter 32. In: Garrett WE, Kirkendall DT (eds). Exercise and sport science. Philadelphia: Lippincott Williams & Wilkins; 2000. 20. Clark MA. Integrated training for the new millennium. Thousand Oaks, CA: National Academy of Sports Medicine; 2001. 21. Billeter R, Hoppeler H. Muscular basis of strength. Chapter 3. In: Komi PV (ed). Strength and power in sport. London: Blackwell Scientific Publications; 1992. 22. Chaitow L. Cranial manipulation theory and practice: osseous and soft tissue approaches. London: Churchill Livingstone; 1999. 23. Timmons B. Behavioral and psychological approaches to breathing disorders. New York: Plenum Press; 1994.
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