Pathophysiological significance of the global and regional left-ventricular ejection fraction (LV-EF) on ischaemic heart disease patients at rest and during ergometric exercise load (from radiocardio-cyclography (RKG-RCG) to parametric amplitude and phase scan)

As early as in the graphical RKG-RCG period a close inverse correlation could be established between the LV-EF and the serum myoglobin level during the acute course of myocardial infarction, in 10 patients in repeated follow up examinations. Corr. coeff. -0.91, p less than 0.01. In the mid seventies it could be shown by RKG-RCG, in 15 IHD patients with angina pectoris that the decrease of the basal LV-EF during ergometric load reflected the severity of IHD, compared with the increasing LV-EF tendency of 15 normal subjects. This fact could be verified on 19 middle age males (mean age, 41 years) by 99mTc RBC gamma camera ventriculography, i.e. that under modest load (100 W ergometry) a more than 10% decrease was a non-specific sign of main branch or three-vessel coronary heart disease. So in this extreme case our nuclear stethoscope-like RKG-RCG method alone may be satisfactory for staging and screening of coronary ischaemic heart disease (IHD) patients. All the 11 normal subjects belonged to the load-reaction group with more than 5% LV-EF increase, while the extensive anterior and inferior scar patients reacted without exception with more than 10% deficit (their basal LV-EF value was already under 45%). Supported by data in the literature in the comparison of load ECG and coronarography and two-step load, we could gain more refined data, but in accordance with the one-step load on the same patients. As regards the reproducibility of our global LV-EF investigations with gamma camera computer program Supersegams, it was within 5%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Determination of the anaerobic threshold by the rate of ventilation and cardio interval variability

The aim of this work is to develop methods for determining the anaerobic threshold according to the rate of ventilation and cardio interval variability during the test with stepwise increases load on the cycle ergometer and treadmill. In the first phase developed the method for determining the anaerobic threshold for lung ventilation. 49 highly skilled skiers took part in the experiment. They performed a treadmill ski-walking test with sticks with gradually increasing slope from 0 to 25 degrees, the slope increased by one degree every minute. In the second phase we developed a method for determining the anaerobic threshold according dynamics ofcardio interval variability during the test. The study included 86 athletes of different sports specialties who performed pedaling on the cycle ergometer "Monarch" in advance. Initial output was 25 W, power increased by 25 W every 2 min. The pace was steady--75 rev/min. Measurement of pulmonary ventilation and oxygen and carbon dioxide content was performed using gas analyzer COSMED K4. Sampling of arterial blood was carried from the ear lobe or finger, blood lactate concentration was determined using an "Akusport" instrument. RR-intervals registration was performed using heart rate monitor Polar s810i. As a result, it was shown that the graphical method for determining the onset of anaerobic threshold ventilation (VAnP) coincides with the accumulation of blood lactate 3.8 +/- 0.1 mmol/l when testing on a treadmill and 4.1 +/- 0.6 mmol/1 on the cycle ergometer. The connection between the measure of oxygen consumption at VAnP and the dispersion of cardio intervals (SD1), derived regression equation: VO2AnT = 0.35 + 0.01SD1W + 0.0016SD1HR + + 0.106SD1(ms), l/min; (R = 0.98, error evaluation function 0.26 L/min, p < 0.001), where W (W)--Power, HR--heart rate (beats/min), SD1--cardio intervals dispersion (ms) at the moment of registration of cardio interval threshold.     

Adaptation of human left ventricular volumes to the onset of supine exercise

The purpose of this study was to measure the changes and rates of adaptation of left ventricular volumes at the onset of exercise. Eight asymptomatic subjects, in whom intramyocardial markers had been implanted 3-6 years previously during aortocoronary bypass surgery, exercised in the supine position at a constant workload of 73.6 W for 5 min. Six also exercised first at 16.4 W, and then against a workload which progressively increased by 8.2 W every 15 s. Cardiac volumes were measured by computer assisted analysis of the motion of the implanted markers. In the constant workload test, cardiac output increased rapidly from 5.7 +/- 1 min-1 to 10.3 +/- 1.9 1 min-1 by 2 min and then increased more slowly to 10.8 +/- 2.0 1 min-1 by 5 min. The cardiac output increase was mainly due to an increase in heart rate from 68 +/- 12 beats min-1 to 120 +/- 16 beats min-1 with minimal changes in stroke volume. The time constant for the early increase in cardiac output was 45s and for heart rate, 35s. With progressively increasing workloads, there was an almost linear increase of heart rate and cardiac output, but these increased at a slower rate than during the early phase of the constant load exercise test. In conclusion: rapid changes in cardiac output during supine exercise were produced by changes in heart rate; changes in stroke volume provided minor adjustments to cardiac output; the end-diastolic volume was almost constant.     

A new approach to assessing maximal aerobic power in children: the Odense School Child Study

In two experiments maximal aerobic power (VO2max) calculated from maximal mechanical power (Wmax) was evaluated in 39 children aged 9-11 years. A maximal multi-stage cycle ergometer exercise test was used with an increase in work load every 3 min. In the first experiment oxygen consumption was measured in 18 children during each of the prescribed work loads and a correction factor was calculated to estimate VO2max using the equation VO2max = 12.Wmax + 5.weight. An appropriate increase in work rate based on height was determined for boys (0.16 W.cm-1) and girls (0.15 W.cm-1) respectively. In the second experiment 21 children performed a maximal cycle ergometer exercise test twice. In addition to the procedure in the first experiment a similar exercise test was performed, but without measurement of oxygen uptake. Calculated VO2max correlated significantly (p less than 0.01) with those values measured in both boys (r = 0.90) and girls (r = 0.95) respectively, and the standard error of estimation for VO2max (calculated) on VO2max (measured) was less than 3.2%. Two expressions of relative work load (%VO2max and %Wmax) were established and found to be closely correlated. The relative work load in %VO2max could be predicted from the relative work load in %Wmax with an average standard error of 3.8%. The data demonstrate that calculated VO2max based on a maximal multi-stage exercise test provides an accurate and valid estimate of VO2max.     

Graded cutaneous vascular responses to dynamic leg exercise

The cutaneous vascular conductance-esophageal temperature (CVC-Tes) relationship was examined at five work loads (75-200 W) in each of four men to find whether there is a role for exercise intensity in the control of skin blood flow (SkBF). Several factors contributed to our evaluation of the CVC-Tes relationship during work. Laser-Doppler velocimetry (LDF) provided a continuous measure of SkBF that is not influenced by underlying muscle blood flow. Local warming to 39 degrees C at the site of measurement of SkBF provided a consistent skin temperature and facilitated observation of changes in LDF. Mean arterial pressure was measured noninvasively once per minute to calculate CVC. Supine exercise minimized baroreceptor-induced cutaneous vasoconstriction. Our major finding was that the internal temperature at which CVC began to rise during exercise (CVC threshold) was graded with work load beyond 125 W (P less than 0.05). In that range the CVC threshold increased by 0.16 degrees C for every increment of 25 W. The CVC threshold was never reached at the highest work load in three of the four subjects. There was no consistent effect of work load on the slope of the CVC-Tes relationship or on the internal temperature at which sweating began during exercise (sweat rate threshold). We conclude that the level of work beyond 125 W affects the CVC-Tes relationship in a graded fashion, principally through shifts in threshold.     

Mechanomyography of the human quadriceps muscle during incremental cycle ergometry

The mechanical activity of the human quadriceps muscle during maximal incremental cycle ergometry was investigated by mechanomyography (MMG). MMG and surface electromyography (EMG) recordings of vastus lateralis muscle activity were obtained from nine males. Cycle ergometry was performed at 60 rev/min and work load was incremented step wise by 20 W (3.2 Nm) every minute until volitional fatigue. The mean amplitudes of MMG (mMMG) and EMG (mEMG) during the contraction phase were calculated from the last six contractions in each load. The duration, load and work rate of exercise at exhaustion were 13.3 (1.6) min, 44.1 (5.5) Nm, 276.7 (34.7) W, respectively. A linear relationship between mMMG and load was evident in each subject (r = 0.868–0.995), while mEMG seemed to dissociate as the load became greater. In the grouped mean data, mMMG was linearly related to load whether aligned to the absolute (r = 0.995) or maximal (r = 0.995) load. Involvement of the noise component was further investigated by studying passive cycling by four subjects. Pedals were rotated passively for the first half of each stage (PAS) and the subject then pushed the pedals for the second half (ACT). In the lighter load region, the mMMG of ACT was as small as that of PAS. However, the change in the mMMG of PAS was very small compared with that of ACT. In conclusion, this study demonstrates a linear relationship between the mMMG of the quadriceps muscle and work load during maximal incremental cycle ergometry. The effect of movement noise was thought to be small and stable. Accepted: 22 April 1997     

Standardized Loads Acting in Knee Implants

The loads acting in knee joints must be known for improving joint replacement, surgical procedures, physiotherapy, biomechanical computer simulations, and to advise patients with osteoarthritis or fractures about what activities to avoid. Such data would also allow verification of test standards for knee implants. This work analyzes data from 8 subjects with instrumented knee implants, which allowed measuring the contact forces and moments acting in the joint. The implants were powered inductively and the loads transmitted at radio frequency. The time courses of forces and moments during walking, stair climbing, and 6 more activities were averaged for subjects with I) average body weight and average load levels and II) high body weight and high load levels. During all investigated activities except jogging, the high force levels reached 3,372–4,218N. During slow jogging, they were up to 5,165N. The peak torque around the implant stem during walking was 10.5 Nm, which was higher than during all other activities including jogging. The transverse forces and the moments varied greatly between the subjects, especially during non-cyclic activities. The high load levels measured were mostly above those defined in the wear test ISO 14243. The loads defined in the ISO test standard should be adapted to the levels reported here. The new data will allow realistic investigations and improvements of joint replacement, surgical procedures for tendon repair, treatment of fractures, and others. Computer models of the load conditions in the lower extremities will become more realistic if the new data is used as a gold standard. However, due to the extreme individual variations of some load components, even the reported average load profiles can most likely not explain every failure of an implant or a surgical procedure.     

The effects of one- and two-legged exercise on the lactate and ventilatory threshold

The purpose of this investigation was to compare differences between one- and two-legged exercise on the lactate (LT) and ventilation (VT) threshold. On four separate occasions, eight male volunteer subjects (1-leg VO2max = 3.36 l X min-1; 2-leg VO2max = 4.27 l X min-1) performed 1- and 2-legged submaximal and maximal exercise. Submaximal threshold tests for 1- and 2-legs, began with a warm-up at 50 W and then increased every 3 minutes by 16 W and 50 W, respectively. Similar increments occurred every minute for the maximal tests. Venous blood samples were collected during the last 30 s of each work load, whereas noninvasive gas measures were calculated every 30 s. No differences in VO2 (l X min-1) were found between 1- and 2-legs at LT or VT, but significant differences (p less than 0.05) were recorded at a given power output. Lactate concentration ([LA]) was different (p less than 0.05) between 1- and 2-legs (2.52 vs. 1.97 mmol X l-1) at LT. This suggests it is VO2 rather than muscle mass which affects LT and VT. VO2max for 1-leg exercise was 79% of the 2-leg value. This implies the central circulation rather than the peripheral muscle is limiting to VO2max.     

Supramaximal test results of male and female speed skaters with particular reference to methodological problems

Six male and six female elite speed skaters were tested during two bicycle ergometer tests: a 30 s sprint test and a 2.5 min supra maximal test. During the 2.5 min test oxygen consumption was measured every 30 s. The males showed 30-31% higher mean power output values both during the sprint test (1103 versus 769 Watt) and during the 2.5 min test (570 versus 390 Watt). Maximal oxygen consumption was 31% higher for the males than for the females (5.10 versus 3.50 1.min-1). However, when expressed per kilogram lean body weight (LBM), power output and oxygen consumption was equal for both sexes. Differences between present and previous results are most likely due to methodological problems with the estimation of load during the supra maximal test. Subjects appear to experience difficulties in distributing their power output over the 2.5 min if they are tested for the first time. For experienced skaters and cyclists, fixed levels of 19 W.kgLBM-1 as initial load setting for the sprint test and 8 W.kg LBM-1 for the 2.5 min test are recommended.     

Continuous measurement of breathlessness during exercise: validity, reliability, and responsiveness.

A continuous method for recording changes in breathlessness (dyspnea) during exercise is introduced and compared with the traditional discrete method. In study 1, a category-rating scale was presented on a computer screen, and 14 healthy, young female subjects exercised on a cycle ergometer until exhaustion. Two approaches were used to obtain ratings of breathlessness: a discrete method, in which subjects gave single judgments every minute, and a continuous method, in which subjects throughout exercise moved the mouse so that a bar on the screen extended to the desired location along the scale. Psychophysical results relating measures of breathlessness and the variables of work, oxygen consumption, and minute ventilation were statistically indistinguishable with the two methods, and both methods were highly reliable across test sessions. In study 2, both measurement methods were employed, and the subjects were 14 healthy, young males. In each of two sessions (discrete or continuous method), subjects first rated their breathlessness during an incremental test in which the workload was increased over time and levels of work, and minute ventilation were recorded. Subjects then exercised for 10 min at 60% of the maximal oxygen consumption achieved during the incremental test. At two points during steady-state exercise, a respiratory load was introduced that lasted for 1 min. It was possible to determine the responsiveness of subjects to onset and offset of the respiratory load for the continuous method but not for the discrete method. In study 3, patients with chronic obstructive pulmonary disease employed both methods, and it was found that the continuous method was better at determining whether subjects showed a significant positive slope of the regression line between breathlessness ratings and physiological variables.     

A comparison of methods for estimating the kinetic parameters of two simple types of transport process

Sets of experimental data, with known characteristics and error structures, have been simulated for the Michaelis-Menten equation plus a second term, either for linear transport or for competitive inhibition. The Michaelis-Menten equation plus linear term was fitted by several methods and the accuracy and the precision of the parameter estimates from the several methods were compared. The model-fitting methods were: three for least-squares non-linear regression, computer versions of two graphical methods and of two non-parametric methods. The most precise and accurate method was that of D.W. Marquardt (J. Soc. Ind. Appl. Math. 11 (1963) 431–441). The Michaelis-Menten equation with competitive inhibition was also fitted by several methods, viz., two for least-squared non-linear regression, a non-parametric method and four variants of the Preston-Schaeffer-Curran plot (Preston, R.L. et al. (1974) J. Gen. Physiol. 64, 443–467). The most precise and accurate of these was the non-linear regression method of W.W. Cleland (Adv. Enzymol. 29 (1967) 1–32). For both these models, the various graphical methods and non-parametric methods gave poor results and are not recommended.     

Oxygen consumption and metabolic strain in rowing ergometer exercise

Oxygen consumption (VO2) when rowing was determined on a mechanically braked rowing ergometer (RE) with an electronic measuring device. VO2 was measured by an open spirometric system. The pneumotachograph valve was fixed to the sliding seat, thus reducing movement artefacts. A multi-stage test was performed, beginning with a work load of 150 W and increasing by 50 W every 2 minutes up to exhaustion. Serum lactate concentrations were determined in a 30 s break between the work stages. 61 examinations of oarsmen performing at maximum power of 5 W X kg-1 or more were analysed VO2 and heart rate (HR) for each working stage were measured and the regression line of VO2 on the work load (P) and an estimation error (Sxy) were calculated: VO2 = 12.5 X P + 415.2 (ml X min-1) (Sxy = +/- 337 ml, r = 0.98) Good reproducibility was found in repeated examinations. Similar spiroergometry was carried out on a bicycle ergometer (BE) with 10 well trained rowers and 6 trained cyclists. VO2 of rowing was about 600 ml X min-1 higher than for bicycling in the submaximal stages for both groups. The VO2max of RE exercise was 2.6% higher than for oarsmen on BE, and the cyclists reached a greater VO2 on BE than the oarsmen. No differences were found between RE and BE exercise heart rate. The net work efficiency when rowing was 19% for both groups, experienced and inexperienced: when cycling it was 25% for cyclists and 23% for oarsmen.     

Method and computer-aided system of intensive health recovery for estimation and correction of the psychophysical condition of an individual

A method for evaluating psychophysical condition and behavioral optimization of lifestyle, including selection of training loads, was developed on the basis of questionnaire data and simple physiological parameters such as muscle strength, load intensity, blood pressure, heart rate, and expiratory breath holding time at rest, during graded exercises, and during recovery. For evaluating the functional condition, an original variant of the bicycle ergometric test or step test was used as the basic method and standard tests with training equipment and routine exercises were used as additional methods. The method was implemented as a computer program, Health Regulator.     

Relation between the change of slope of heart rate and second lactic and ventilatory thresholds in muscular exercise with large load]

The time-course of heart rate, blood lactate, and ventilatory gas exchange was studied during an incremental exercise test on cycloergometer in order to ascertain whether heart rate deflection occurred at the same load as the second lactate S[La]2) and ventilatory (SV2) thresholds. Twelve moderately trained subjects, 22 to 30 years old, participated in the study. The initial power setting was 30 W for 3 min with successive increases of 30 W every min except at the end of the test where the increase was reduced to 20 and 10 W.min-1. Ventilatory flow (VE), oxygen uptake (VO2), carbon dioxide production (VCO2, ventilatory equivalents of O2 (EO2 = VE/VO2) and CO2 (ECO2 = VE/VCO2), and heart rate (HR) were determined during the last 20 s of every min. Venous blood samples were drawn at the end of each stage of effort and analyzed enzymatically for lactate concentration ([La]). The HR deflection, S[La]2, and SV2 were represented graphically by two investigators using a double blind procedure. Following the method proposed by Conconi et al. 1982, the deflection in HR was considered to begin at the point beyond which the increase in work intensity exceeded the increase in HR and the linearity of the work rate/HR relationship was lost. S[La]2 corresponded to the second breaking point of the lactate time-course curve (onset of blood lactate accumulation) and SV2 was identified at the second breaking point in the increase in VE and ventilatory equivalent for O2 uptake accompanied by a concomitant increase in ventilatory equivalent for CO2 output. We observed that the deflection point in HR was present only in 7 subjects. The work load, VO2, HR, and [La] levels at which heart rate departed from linearity did not differ significantly from those determined with S[La]2 ans SV2. The VO2 and HR values at HR deflection point were significantly correlated with those measured at S[La]2 and SV2. It is concluded that deflection in heart rate does not always occur, and when it does, it coincides with the second lactate and ventilatory gas exchange thresholds. It can thus be used for the determination of optimal intensity for individualized aerobic training.     

光润金线蛭种群数量动态与水体化学因子关系的研究

1994－1998年,在广州市郊菜田水沟每月观察淡水码磺光润金线蛭种群数量。测定水体10个化学因素,用逐步回归分析方法研究光润金线蛭种群数量和化学因素关系。结果表明,每年种群数量动态不同,每年种群数量最多是4－6月份,占全年种群数量的57．14％－71．18％,影响每年种群数量变化的主要化学因素为pH,PO4^3-,Na^ ,Ca^2 ,Mg^2 ,影响5年种群动态的主要化学因素为Fe^3 。     

Force-velocity test: effect of a heavy-load start on maximal anaerobic power and blood lactate levels

The purpose of this study was to determine the effect of starting the force-velocity test with a heavy load on both maximal anaerobic power and blood lactate concentration. Nine male subjects aged 23.4 +/- 1.3 yr (mean +/- sem) participated in a first force-velocity test (FV1) which had an initial load of 1 kg (classical protocol). Then a week later in a second force-velocity test (FV2) which had an initial load corresponding to maximal power developed during FV1 (W1). The increase in load was of 1 kg for FV1 and FV2. Our results show that during FV2, compared to FV1: 1) maximal anaerobic power developed (W2) is superior to W1 (W1 = 1,165.2 +/- 70.4 W; W2 = 1,278.6 +/- 92.3 W; p less than 0.02); 2) blood lactate concentration after the first load is inferior (p less than 0.001); 3) blood lactate concentration is not significantly different at the peak of power. Thus, starting the force-velocity test with a heavy load allows an increase of maximal anaerobic power until a blood lactate concentration which may be compared to the one obtained during the classic force-velocity test. In conclusion, maximal anaerobic power measured during the force-velocity test seems to depend on protocol used.     

Effects of loading on maximum vertical jumps: Selective effects of weight and inertia

A novel loading method was applied to explore selective effects of externally added weight (W), weight and inertia (W+I), and inertia (I) on maximum counter-movement jumps (CMJ) performed with arm swing. Externally applied extended rubber bands and/or loaded vest added W, W+I, and I corresponding to 10-40% of subjects' body mass. As expected, an increase in magnitude of all types of load was associated with an increase in ground reaction forces (GRF), as well as with a decrease in both the jumping performance and power output. However, of more importance could be that discernible differences among the effects of W, W+I, and I were recorded despite a relatively narrow loading range. In particular, an increase in W was associated with the minimal changes in movement kinematic pattern and smallest reduction of jumping performance, while also allowing for the highest power output. Conversely, W+I was associated with the highest ground reaction forces. Finally, the lowest maxima of GRF and power were associated with I. Although further research is apparently needed, the obtained finding could be of potential importance not only for understanding fundamental properties of the neuromuscular system, but also for optimization of loading in standard athletic training and rehabilitation procedures.     

Physical fitness of the Czechoslovak population between the ages of 12 and 55 years. Pulmonary ventilation.

Examination of ventilation function in an average population showed that maximum minute ventilation in adults fell with advancing age. Males had higher values than females, the highest values being attained, in both sexes, at 18 (117 and 83 1/min respectively). Tidal volume during loading, expressed as a percentage of vital capacity, rose with advancing age in all groups of males and females (from 53% at 18 to 64% at 55 in males and from 51% to 59% in females). The ventilation equivalents for O2 and CO2 attained optimum values at a load of 100 W in males and at 50 W in females. On increasing the load they rose in both sexes--in females more than in males. Percentual utilization of O2 from the inspired air was greatest in males at a load of about 100 W (4.8--5%) and in females at about 50 W (4.3--4.8%). At higher loads it fell faster in females than in males. In males, the respiratory quocient attained the value 1 at a load of about 2 W/kg body weight and in females at 1.5 W/kg. At maximum loading it was over 1 in all the age categories. No differences between males and females were observed, but males, in maximum loading, gave the greatest absolute and the greatest relative performance.     

Precision of ventilatory and gas exchange alterations as a predictor of the anaerobic threshold

Anaerobic threshold has been defined as the oxygen uptake (VO2) at which blood lactate (La) begins to rise systematically during graded exercise (Davis et al. 1982). It has become common practice in the literature to estimate the anaerobic threshold by using ventilatory and/or gas exchange alterations. However, confusion exists as to the validity of this practice. The purpose of this study was to examine the precision with which ventilatory and gas exchange techniques for determining anaerobic threshold predicted the anaerobic threshold resolved by La criteria. The anaerobic threshold was chosen using three criteria: (1) systematic increase in blood La (ATLa), (2) systematic increase in ventilatory equivalent for O2 with no change in the ventilatory equivalent for CO2 (ATVE/VO2), and (3) non-linear increase in expired ventilation graphed as a function of VO2 (ATVE). Thirteen trained male subjects performed an incremental cycle ergometer test to exhaustion in which the load was increased by 30 W every 3 minutes. Ventilation, gas exchange measures, and blood samples for La analysis were obtained every 3rd min throughout the test. In five of the thirteen subjects tested the anaerobic threshold determined by ventilatory and gas exchange alterations did not occur at the same VO2 as the ATLa. The highest correlation between a gas exchange anaerobic threshold and ATLa was found for ATVE/VO2 and was r = 0.63 (P less than 0.05). These data provide evidence that the ATLa and ATVE do not always occur simultaneously and suggest limitations in using ventilatory or gas exchange measures to estimate the ATLa.     

The effects of high intensity exercise on muscle and plasma levels of alpha-ketoisocaproic acid

Alpha-ketoisocaproic acid (KIC) is the product of the transamination of the indispensable amino acid leucine, which is the first step in the complete degradation of leucine. To determine the effects of intense exercise on muscle and blood levels of KIC, 7 male volunteers performed cycle exercise to exhaustion. After pedaling at an intensity of 90 W for 3 min, the load was increased by 60 W every 3 min until volitional fatigue. Muscle biopsies were obtained prior to and immediately after exercise and rapidly frozen for later determination of KIC. During exercise, blood lactate levels increased as expected, while plasma KIC levels did not change. Following exercise, plasma KIC levels rose significantly with peak values occurring 15 min after exercise and did not return to pre-exercise values until 60 min after exercise. In contrast, muscle KIC levels increased during exercise from a pre-exercise mean of 49.4 +/- 4.1 mumol X kg-1 wet wt to 78.1 +/- 6.5 mumol X kg-1 after exercise, an average increase of 48% (P less than 0.05). These data indicate that during intense exercise, leucine transamination in muscle may continue at a faster rate than the decarboxylation of KIC. In addition, plasma levels of KIC did not reflect the intracellular accumulation of KIC during exercise, suggesting a delay in the diffusion of KIC from muscle.