A COMPARISON OF ELECTROCARDIOGRAM MEASUREMENTS or ATHLETES AND NON-ATHLEYES MICHIGAN sure uwwasmv Thesis for the Doqm of M. A. MICHlGEN STETE UNWERSETY Richard Lyle Skimin 1961 i L I B R A R Y Michigan State University ; A COMPARISON OF ELECTROCARDIOGRAM MEASUREMENTS OF ATHLETES AND NON-ATHLETES M CHIGAN STATE UNIVERSITY By Richard Lyle Skimin AN ABSTRACT OF A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS College of Education . Department of Physical Education Approved ABSTRACT A COMPARISON OF ELECTROCARDIOGRAM MEASUREMENTS OF ATHLETES AND NON-ATHLETES MICHIGAN STATE UNIVERSITY by Richard Lyle Skimin Statement of the Problem The purpose of the studyxwusto compare the electro- cardiograms of athletes and non—athletes of similar body builds. A vector analysis was used to help determine if body build was a factor in any differences found. Methodology Twenty—nine athletes were chosen because of their physical condition and training during the winter and spring seasons. The athletes were participating in the following Sports: basketball (R), track (1A), hockey (5), wrestling J (3), swimming (2). Twenty—nine healthy non—athletes were chosen from the students of the same university. The non— athletes were matched with the athletes according to a chest- width/sitting—height ratio. Each subject had two ECG‘s taken using three standard leads and six precordial leads. The second records of all Subjects were used in this study. The instrument used to record the electrocardiogram was the Sanborn model 60-200 recorder. Dividers were used for the measurement of amplitudes and time intervals. Richard Lyle Skimin An analysis was done on both groups to determine if there were any significant differences between them. Corre- lation coefficients were computed between the sitting-height/ chest—width ratio and the ECG measurements. The subjects were matched by sitting-height/chest-width ratio and the "t" test was used to determine if differences were significant. Correlations were computed between age and ECG measurements. Conclusions l. The highly significant lower pulse rate in the conditioned group tends to support the previous literature dealing with exercise and training. It may also show the benefits of athletic conditioning in this group. 2. The significantly slower conduction (PR Interval) and the significantly faster ventricular depolarization (QRS Interval) may be an indication of the increased cardiovascular efficiency. 3. The highly significant difference found in the amplitude of the T vector is an indication of a stronger Pepolarization of the ventricle. A COMPARISON OF ELECTROCARDIOGRAM MEASUREMENTS OF ATHLETES AND NON-ATHLETES MICHIGAN STATE UNIVERSITY By Richard Lyle Skimin A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of_ MAS TER OF AR TS College of Education Department of Physical Education 1961 ACKNOWLEDGMENT The writer wishes to express his sincere appreciation to Professor Henry J. Montoye for his interest and untiring efforts in guiding the preparation of this study. TABLE OF CONTENTS CHAPTER I. INTRODUCTION. The problem . . . . . . Importance of the study Limitations Definitions II. REVIEW OF THE LITERATURE. III. METHOD OF PROCEDURE Instrumentation Selection of subject Measurement procedure Statistical analysis IV. RESULTS AND ANALYSIS Results. Analysis V. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS Summary. Conclusions Recommendations BIBLIOGRAPHY. APPENDICES PAGE 12 12 12 13 13 14 IA 18 22 22 24 25 26 BO TABLE III. IV. VI. VII. LIST OF TABLES Statistical Analysis of the Differences Between Unmatched Groups. Pearson Product-Moment Correlation Coef- ficient Between Age and Statistically Significant Electrocardiogram Measurements. Pearson Product-Moment Correlation Coef- ficient Between Sitting—Height and Chest— Width Ratio and the Electrocardiogram Measurements. . . . . Statistical Analysis of the Difference Between Matched Pairs of Subjects. Statistical Analysis of the Differences Between the First and Second Records of the Athlete Statistical Analysis of the Differences Between the First and the Second Records of the Non—Athletes . . . . . . . Comparison of the Chest-Sitting Height Ratios of Matched Pairs of Athletes and Non— Athletes . . . . . TABLE 14 15 l6 l7 l7 CHAPTERiI THE PROBLEM AND DEFINITIONS OF TERMS USED It has been shown in the past that the cardiovascular function of the heart is improved with exercise. The many tests that have led to this conclusion have included pulse rate, blood pressure, cardiac output ratio, and heart rate as determined by the electrocardiogram.1 There have also been numerous studies on the comparison of the effects of training and exercise on the electrocardiogram of the athlete and the non-athlete.2 It is hoped that this thesis will contribute further to the knowledge of the effect of exercise and training on the athlete. I. THE PROBLEM Statement of the Problem It was the purpose of this study to compare the elec— trocardiograms of athletes and non-athletes. A vector analysis was used to help determine if body build was a factor in any differences found. 1T. K. Cureton, The Physical Fitness of Champion Athletes (Urbana: The University of Illinois Press, 1951). 21bid. Importance of the Study The use of vectorcardiography has not yet been applied to the field of athletics. It is the contention of the author that this study will give further evidence as to the value of exercise and training in the field of Physical Education and Athletics. The process of vectorcardiography offers a truer and more objective picture of the heart and its location which is also important in one of the biggest problems in the field of Physical Education, the assessment of physical fitness. Some light may be shed upon methods of determining the physical fitness of an individual. Limitations The element of human error in the measurement of the ECG may cause inaccurate figures from which to work. The small number of subjects used limits the interpre- tation of the data from this study. The lack of precision of the vector measuring instru— ment within five degrees limits the accuracy of the results of this study. II. DEFINITIONS OF TERMS USED Definitions Electrocardiogram. ”Electrocardiogram is the time record of the electrical events in the heart from which information concerning the locus of origin of each beat and how activity is spread can be obtained.”3 (Standard ECG will be found in the Appendix) The nomenclature used to describe the realm of electrocardiography has been standard- ized by a committee established by the American Heart Association}L These standard definitions will therefore be used in this thesis to avoid confusion of terms. Amplitude of the P Wave. The P wave is produced by the spread of the excitation wave over the auricles. Amplitude of the R Wave. The R wave occurs during the beginning of the electrification of the main mass of the walls of the ventricles. Amplitude of the S Wave. The S wave is produced during the electrification of the rest of the ventricular muscle. Amplitude of the T Wave. The T wave represents the repolarization of the sinus node and the action currents from the heart muscle. PR Interval. This interval represents the auriculo~ ventricular conduction time, or the time required for the excitation wave to travel from the sinus node through the auricular musclature to the auricular ventricular node, through this node, the His bundle, and down the upper reaches of the right and left branches. 3Louis H. Katz, Electrocardiography (Philadelphia: Lea and Febiger, 1949), p. SO. uThe Standardization of ECG Nomenclature, Standard~ ization of Precordial Leads, Second Supplementary Report. Official reports of the American Heart Association, 1790 Broadway, New York. QRS Duration. This represents the time interval for depolarization wave to travel through the ventricle. Lead I. Standard lead taken from the left arm and the right arm. Lead II. Standard lead taken from the right arm and the left leg. Lead III. Standard lead taken from the left arm and the left leg. Precordial Leads. Six leads. Located on the frontal area of the ribs as prescribed by the American Heart Associ- ation. Mean Spatial QRS and T Vectors. ”The electrical forces produced by the QRS and the T processes are directed from the endocardium to the epicardium at each region of the heart. The QRS or T force for a given region of the ventricular heart can therefore be represented by a vector which is directed perpendicularly to the surface of the heart at that f— . 3 region.” Vector. A vector is any quantity, such as a force, which has a known magnitude and direction. The mathematical symbol for a vector resembles an arrow: the length of the arrow represents the force, its inclination or direction indicates the direction in which the force is exerted, and the caret or arrowhead indicates the “sense" of the force which for an electrical force is the orien~ tation of electrical positivity of the force.6 5R. Grand and E. H. Estes, Spatial Vector Electrocardi- Qgggphy (Philadelphia, New York, and Toronot: The Blakiston CO” 1951): p0 5- 6Ibid. Conditioned athletes in training. A subject who was participating in a varsity sport that required "top" cardiac efficiency. He was well into his sports season at the time the ECG was taken. Non—athlete. A subject who had never played a varsity sport in high school or in college and has never had to do any physical training which required "top" cardiac efficiency. Matched pairs. Subjects were matched by their sitting- height/chest—width radio. CHAPTER II iREVIEW OF THE LITERATURE The author has found a very good review of the liter- ature on athletics and the electrocardiogram in The Physical 1 -s-—— i , 2 studies by Tuttle and Korns (1941) and Krause and Nicolai (1910)3 reported that the T wave of the ECG of trained athletes were higher at rest, but otherwise no differences 4 ) were noticed. Messerlee (1928 reported that training not only caused the T wave to become higher but lowered the ventricular peaks, greatly increased the duration of the QRS and slowed the pulse rate, all attributed to vagal influence. 1T. K. Cureton and Associates, The Physical Fitness of Champion Athletes (Urbana: The University of IllinOis Press, 1951), pp. l40—lA7. 2W. W. Tuttle and H. M. Korns, "Electrocardiographic Observations on Athletes before and after Season of Physical Training," American Heart Journal, 21:104-107, January, 1941. 3S. Krause and G. Nicolai, Das Electrokardiogramm des Gesunden and Kranken Menschen (Leipzig: 1910). 4 " ' . . ° E1 ktrokardiogramm N. Messerlee, Die Verandeiungen im e bei Korperarbeit," gtschr, f.d. ges. EXP. M89. V01- 60 (1928), p. 490. Hoogerwerf (1925)5 found that the T wave in general, becomes higher with exercise, but with all-out work it will become much smaller, possibly one—half as high° The QRS complex in general tends to decrease to about one—half after exercise. )6 Broustet and Eggenberger (1936 from the examination of thirty-five men who participated regularly in boxing, rewing, Rugby, and cycling in competition, concluded that the ECG of an athlete presented a fine, full, regular tracing, without claiming that the amplitude of the R and T waves were directly affected by the vigor of the heart. They still believe that there is a relation between the form tracing and the functional state of the heart. McFarland, Graybiel, Liljencrantz, and Tuttle (1938- 1939)7 did a study on 173 Civil air line pilots and concluded that: 1. No age difference was observed. The average duration of the QRS being no different in the older groups than in the younger. 58. Hoogerwerf, HElektrokardiographische Untersuchungen der Amsterdamer Olympiade,” Arbeitsphysiologie, Vol. 2 (1929 , p. 61. 6 i e E Orenber er, "L'electrocardio— P. Bioustell and H. go a deaux £2 gramme des Sportifs,” Journel de Medicine de Bor §E§;Qg§t, Vol. 113 (1936). 7 Y .a biel, Eric Liljencrantz, and R. A. McFarland, A. Gr y ’cal and phySio— ' ' logi A. D. Tuttle, 'An analySis of the psycho. . . H logical characteristics of Two Hundred Air Line Pilots, Jr. of Aviation Medicine, 9—lOzl60-2lO (1938-1939). 2. Low voltage seemed to be common in exceptionally healthy persons who showed no significant devia— tions in body weight and basal metabolic rate from the group as a whole. 3. Elevation of the diaphragm may cause right or left axis displacement. Doliopolus and Bagou,8 in a study of 24 athletes, found higher T waves in the EC}. Vectocardiography is not a new area, it is about as old as the ECG itself. Since Einthoven9 revealed his theory with the three limb leads in 1911, the field of spatial vectors was given a boost. Eintnoven introduced these stan- dard leads with the belief that frontal plane projections of electrical forces of the heart could be measured from these leads. This theory is now quoted in almost all of the literature that is related to mean spatial vectors and vectorcardiography. The study of the vector is a step closer to precision and mathematical objectivity in clinical inter- pretations of the ECG. 8T. Doliopolus and Bagou, "Uni olar ECG's in Athletes," Cardiologia (Basel), Vol. 22:3 (1953 , pp. 169-176. 9W. Einthoven, G. Fahr, and A. DeWaart, ”Uber de reichtung und die manifeste grosse der potential schwankungon in meneschelen Herzen und uber der einfluss der Herzlage auf der form des Elektrokardiogramms," Arch. f. d. ges Physiol, 150:308 (1913). Grant and EsteslO believe that the vector method of interpretation is advantageous in many ways over the "pattern” or empirical interpretations. a. It greatly simplifies clinical analysis of the Electrocardiogram because it eliminates the need to memorize deflection patterns. b. It is more accurate and objective than the empirical methods. c. Changes in wave forms due to changes in position of the heart are easily separated from changes due to myocardial abnormalities. d. The criteria for the normal and abnormal tracing become simple, rational, and relatively precise. I r 11. I C Simonson and Reyes reported in the American Heart Journal changes in the mean QRS and T vectors in two types of exercise. They used Spatial QRS and T vector norms from 178 midd1e~aged men.12 This is believed to be the first comparison of mean spatial QRS and T vectors for different relative body weights and exercise tests. Five out of seven items showed highly significant changes. 10R. P. Grant and R. Estes, Spatial Vector Electro— Cardiography (Philadelphia, New York, and Toronto: The BIakiston Co., 1951), p. viii. llE. Simonson and A. Keyes, "The ECG Exercise Test," American Heart Journal, 51:1 (July, 1956), 83-105. 12E. Simonson and A. Keyes,”The Spatial QRS and T chtor in 178 Normal Middle—aged Men," Circulation, 9:05, 54. 10 Howard and Gertler13 correlated the electrical axis of 144 normal men and several of their anthopometric measure— ments and indices. Each subject was somatotyped by the method proposed by Sheldon and associates. The measurements that were taken included: chest width, chest depth, chest ratio, height, weight, and sterno ensiform. Correlations were not significant between axis deviations and height and sternal ensiform measurements. There were moderate significant neg— ative correlations between axis deviation and chest depth and chest ratio. Highly significant negative correlation between axis deviation and chest width and weight existed, and the ponderal index showed a highly significant positive correlation with axis deviation. There was highly signifi— cant inverse correlation between axis deviation and endomorphy so a positive correlation with ectomorphy is what may be ex— pected from the anthropometric data. Simonsonlllr also found that there was a right axis shift in the T wave after exercise in older men. Seven items Showed a significant difference of the mean changes between 13R. Howard and M. Gertler, ”Axis Deviation and Body Build," American Heart Journal, 44:1 (July, 1952), 35—41. . 14E. Simonson, “Effect of moderate Exercise on the ECG 1n Healthy Young and Middle Aged Men,” Journal of Applied Ebysiolosv, 5:19 (April, 1953). 584—588. 11 the younger and older men. Urschel and Abbey,15 from a selection of fifty men and fifty women in the adult age group, desired a normal range of distribution for QRS and T vectors. The subjects were set in age groups. The data clearly showed that there is a progression towards a more horizontal vector as the age of the subjects increases. Sex differentiation was very negligible as far as the mean QRS vector was con— cerned. In relation to body build, it was found generally that the marked thin and the marked obese correlated with the anticipated directions. This was not precise enough for statistical evaluation. It was concluded that the higher the diaphragm, the more horizontal must be the axis of the heart. 15D. Urschel and D. C. Abbey, “Influence of Age, Sex, BOdy Build and Chest Configuration on the QRS Vector in Normal Individuals,” American Heart Journal, 46 (October, 1953), 496. CHAPTER III METHODS OF PROCEDURE Instrumentation A Sanborn ECG two channel direct writer (model 60—200) was used for recording. A calipers was necessary for more precise measurement of the waves from the baseline. All of the measurements were taken from the baseline. Vector ampli- tude and degrees were determined by methods described in an . . 1 article by Jackson and Winsor. Selection of Subjects The athletes were selected from the varsity teams at Michigan State University—-twenty~nine men who were in seasonal training at the time of the study. These men were chosen because of their physical condition and training during the winter and spring seasons. The athletes partici- pated in the following sports: Track (14), Basketball (5), Hockey (5), Wrestling (3), Swimming (2). Twenty—nine non—athletes were chosen from the students at the same university. They were normal men as far as the examiner could determine. The non—athletes were matched 1Charles E. Jackson and Travis Winsor, "Aids for Determining Magnitude and Direction of Electric Axis of the ECG,"-_C_i_rculation, 1:4 (April, 1950), Part 11. 13 with the athletes according to a chest—width and sitting— height ratio. See Table VII in the Appendix. Measurement Procedure Two ECG's were taken of each subject. The second record was used for making all measurements for the analysis. The first test was an orientation and served the purpose of eliminating the novelty of the instrument in the minds of the sibjects. The method of determining the frontal vectors is described in an article by Jackson and Winsor. Each individual who was tested was asked to walk slowly or to ride in an automobile when reporting for his examination. He was also asked to refrain from drinking any alcoholic and cold beverages at least two hours prior to the examination. Upon arrival, the examinee was asked to lie quietly on a cot for a period of fifteen minutes. The cot was within a few steps of the testing area so that a minimum of steps would be taken just previous to the examination. Statistical Analysis An analysis was done to find any significant differ- ences between the groups. Correlation coefficients were computed between the sitting—height, chest—width ratio and the ECG measurements. The subjects were matched by the Sitting—height/chest—width ratio and the ”t” test was used to determine if differences were significant. Correlations were Computed between age and ECG measurement. __.__. 2ibid. CHAPTER IV RESULTS AND ANALYSIS Results The following tables contain the results of the statistical analysis. TABLE I STATISTICAL ANALYSIS OF THE DIFFERENCES BETWEEN UNMATCHED GROUPS Non— Conditioned Conditioned Subjects Subjects Student Measurement Mean Mean ”t” Age 20.88 19.70 2.37* Weight 156.50 157.90 .28 Sitting Height 90.29 90.65 .45 Chest Width 30.78 30.47 .54 Chest Depth 19.97 19.56 1.05 Ratio (Sitting height a chest width) 2.95 2.98 .64 PR Interval 4.26 3.91 2.06* QRS Interval 1.58 1.81 2.30* QT Interval 7.75 7.38 1.29 T Amplitude-—Lead I 3.46 2.20 2.90* T Amplitude—-Lead III 1.21 1.66 .86 QRS Amplitude-—Lead 1 4.06 3.44 .72 QRS Amplitude——Lead 111 9.31 7.67 1.26 T Vector Degrees 43.10 52-89 1-46 QRS Vector Degrees 71.13 67.90 -02 T Vector Amplitude 5.05 8-1“ 2.52* QRS Vector Amplitude 14.08 12.32 1.20 Heart Rate 56.89 70.75 5.41* ____# *Significant at a probability of 0.01. 15 TABLE II PEARSON PRODUCT MOMENT CORRELATION COEFFICIENT BETWEEN AGE AND STATISTICALLY SIGNIFICANT ELECTROCARDIOGRAM MEASUREMENTS ECG Measurement r* T Amplitude Lead I .162 PR Interval .01 T Vector Amplitude .06 QRS Interval — 019 *None of the r3s were statistically Significant. TABLE III PEARSON PRODUCT MOMENT CORRELATION COEFFICIENTS BETWEEN SITTING HEIGHT AND CHEST WIDTH RATIO AND THE ELECTROCARDIOGRAM MEASUREMENTS ECG Measurement r T Amplitude Lead I .11 T Vector Degrees 27* QRS Interval -023 -.O5 PR Interval *Significant at a probability of .01. 16 TABLE IV STATISTICAL ANALYSIS OF THE DIFFERENCE BETWEEN MATCHED PAIRS OF SUBJECTS Mean Student ECG Measurement Difference "t" PR Interval .35 2.06 QRS Interval .23 2.30* OT Interval .37 1.42 T Amplitude Lead I 1.26 3.09* T Amplitude Lead 111 .45 1.15 QRS Amplitude Lead I .62 .64 QRS Amplitude Lead III 1.64 1.43 T Vector Degrees 9.79 1.34 T Vector Amplitude .91 2.63* QRS Vector Degrees 3.53 .42 QRS Vector Amplitude 1.76 1.32 Heart Rate 13.69 5.92* *Significant at a probability of 0.01. TABLE V STATISTICAL ANALYSIS OF THE DIFFERENCES BETWEEN THE FIRST AND THE SECOND RECORDS OF THE ATHLETES leasurement Coefficient of Reliability PR Interval QRS Interval QT Interval T Amplitude Lead I T Amplitude Lead III QRS Amplitude Lead I QRS Amplitude Lead III TABLE VI STATISTICAL ANALYSIS OF THE DIFFERENCES BETWEEN THE FIRST AND THE SECOND RECORDS OF THE NON—ATHLETES Measurement Coefficient of Reliability PR Interval QRS Interval QT Interval T Amplitude Lead I T Amplitude Lead III QRS Amplitude Lead I QRS Amplitude Lead III .90 .82 .84 .99 .99 .99 .99 17 18 Analysis In this study the fitness of the athletes may be readily seen by the low pulse rate. Karpovicn reports that "the effect of training on the heart rate may be well observed during physical reconditioning of convalescents. With the regaining of physical fitness, their pulse rates, in response to a standard exercise, gradually decrease." Montoye shows that there is a significant correlation between pulse rate and success in cross—country running.2 Cureton reports a significantly lower pulse rate in well— conditioned champion athletes, with the normal pulse rates ranging from thirty~eight to one hundred and ten, and the average about sixty—four beats. Champion Track and Field athletes have slower pulse rates than swimmers and divers or the controls.3 As can be seen in Table I, the athletes have a sig- nificantly lower heart rate than the non—athletes. The mean difference being 14.4 beats per minute. We may, therefore, lPeter V. Karpovich, Physiology of Muscular Fitness (Philadelphia and London: W. B. Saunders Company, July, 1949). p. 15. 2Henry J. Montoye, William Mack, and John Cook, The Efiediction Performance in the N. C. A. A. Cross—CountryERun £39m the Brachial SphngEgram. Presented at the—44th Annual Convention of the Mid—West Association of the A.A.H.P.E.R., Milwaukee, Wisconsin, April 17, 1958. 3Thomas K. Cureton and Associates, The Physical Fitness Of _hampion Athletes (Urbana: The University of Illinois -—— ress, 1951), pp. 140-147. l9 justify the separation of conditioned and non—conditioned subjects. As both groups were members of the same student body at Michigan State University, with very similar environ- ment, it appears that the great difference in their heart rate is a result of one group‘s training or conditioning through daily physical exercise. Reindell found a longer PR interval in Sportsmen. Jvuve and Sivan, in observing records of professional ath- letes found the same phenomenon in approximately 60 per cent of the cases.5 Meyer observed a much prolonged PR interval in one athlete.6 Von Scinady witnessed analogous evidence of prolonged PR interval on a large number of athletes and found several examples of it.7 Hoogerwerf explains, ”A PR interval of .24 seconds is not at all unusual in athletes 4H. Reindell, ”Kymographische und Elektrokardiograph— ische Befund am Sportherzen,” Deutches Archiv fur Klinische Medizin, 131:485—514, 1937. r 3A. X. Jouve and O. Sivan, "L‘examen electrocardio— SPaphique du sportif; Ses Conditions,” Marseille—Medical, 1 70—80 (January 30, 1940). P. Meyer, Archives des Maladies du Coeur et des Vaisseaus, 27:772, 1924} Cited by Thomas K. CuretoHTIPhysical filingss of Champion Athletes.v (Urbana: The University of IllinoisEPreSS, 1951), pp. 140-147. (E. Von Scinady, "Sportzartzlische Untersuchungen, III. Mitteilung: Verggleichende elektokardiographische Unter— suchungen an Sporttreibenden bei besonderer Berucksichtingung Egg EKG-Zweitwerte," Arbeitphysiologie, 32579—595 (October, 0 . 20 which the author believes is due to strong vagus tone. In— creased vagus tone exerts its influence be decreasing the rate of transmission of the contractile wave and also by 8 slowing down the rate of propagation in the bundle of His." As may be seen in Table I, this study supports the evidence found in literature showing a prolonged PR interval. As may be observed from Table I, there is a signifi— cantly higher T amplitude in lead I. Krause and Nicolai, Hoogerwerf,lO and Messerlee,ll all reported higher T wave in exercise groups. T. K. Cureton12 also reports that athletes seem to have a higher T wave. It was the purpose of this study to determine whether higher T waves are present in athletes and if so, was it possibly due to body build or chest configuration. The vector technique of analysis used showed a significantly greater amplitude in the T vector of athletes. Pm . . . Jo. Hoogerwerf, Ergebnisse der sportarzlichen Unter— suchungen, bei den IX Olympischen Spielen, pp. 118-138, Berlin, 1929: “Elektrokardiographische Untersuchungen der Amsterdamer Olympiade,” Arbeitphysiology, 2:61, 1929. 9S. Krause and G. Nicolai, Das Elektrokardiogramm des Gesunden und Kranken Menschen (Leipzig: 1910). lOHoogerwerf, S., 10c. cit. llN. Messerlee, ”Die Verunderungen im Elektrokardio— gramm bei korroperabeit,” Zstchr. F. d. ges Exp. Med., 60 (1928), 490. 12T. K. Cureton, The Physical Fitness of Champion Athletes (Urbana: The University of Illinoi§_Press, 1951), p, 158.— 21 A height/Width ratio correlation with the T vector degrees shows that there is a relationship between body build and axis deviation; this is shown in Table 111. Howard and 13 Gertler, in their study of "Axis Deviation and Body Build," reported that coefficients of correlation between measurable variations of physique and axis deviation have been estab- lished. In the subjects studied they found an association tetween the degree of compactness of the individual and the tendency to a left axis deviation. Table IV, which compares 1 matched pairs of subjects 01 athletes and non-athletes, shows significant differences in the same measurements as those found in Table 1. Tables V and VI, which are a statistical analysis of the difference in the first and second records of the athletes and non—athletes, show a reliability coefficient ranging from .82 to .99. Table I shows a significant difference in the age of the two groups. This may be explained in that the conditioned athletes tended to be the juniors and seniors while the non—conditioned group were mainly freshmen and Sophomores. l3Richard Howard and Menard Gertler, "Axis Deviation anduBody Build,” American Heart Journal, 44:1 (July, 1952), 35— 1. CHAPTER V SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS Summary The problem in this study was: "Do the Electrocardio— grams of conditioned athletes differ significantly from those of non—conditioned students?" A vector analysis as well as matching by sitting height-width ratio was used to help determine whether the differences were due to conditioning rather than body build. Significant differences have been found in electro— cardiograms of athletes as compai d to those of non—athletes. 'e 1 - - 2 . . 3 T. K. Cureton, Tuttle and Korns, Krause and Nicolai, and 4 . . . . -. . HOOSGPWGPf, have reported Significant difierences. In previous studies that compared the ECG of athletes to non— athletes, factors of chest size and configuration were not considered. 1T. K. Cureton, Physical Fitness of Champion Athletes (Urbana: University of Illinois Press, 1951). 2W. W. Thttle and H. M. Korns, "Electrocardiographic Observations on Athletes before and after Season of Physical Training,” American Heart Journal, 21:104—107 (January, 1941). 3S. Krause and G. Nicolai, Das Electrokardiogramm des Gesunden and Kranken Menschen (Leipzig: 1910). 4 _ S. Hoogerwerf, ”Elektrokardiographische Untersuchangen der Amsterdamer Olympiade," Arbetsphysiologie, 2 (1929), 61. 23 There have been studies in the field of electrocardio- graphy which have shown the influence of age and body build on electrocardiograms of normal individuals.5 Age and body build have been found to be significant on the froital vector measurements. The frontal vectors in turn influence the amplitude measurement. A study by Howard and Gertler6 cor— related the electrical axis of 144 normal men and several of their anthropometric measurements and indices. There were moderate significant negative correlations between axis deviation and chest depth and chest ratio. Each subject was given two electrocardiograms. Three limb leads and six precordial leads were used for each test. A calipers was used to determine more precise measure— ments of the electrocardiograms from the base line. Vector amplitude and degrees were determined by methods found in the literature on vectorcardiography.7 All subjects used were students at the Michigan State University. The conditioned subjects were the varsity 5D. L. Urschell and D. C. Abbey,"Mean Spatial Vector— cardiography," American Heart Journal, 46:3 (October, 1953), 496—506. 6R. Howard and M. Gertler, "Axis Deviation and Body Build,” American Heart Journal, 44:1 (July, 1952), 35—41. 7cnaries E. Jackson and Travis Winser, "Aids for Determining Magnitude and Direction of Electric Axes of the ECG,” Circulation, 1:4 (April, 1950), Part II. 24 athletes training for an in season sport which required vigorous conditioning. The Pearson—Product Moment Cor- relation and the Student‘s "t” were used to determine the statistical analysis. Conclusions The following are the conclusions reached by the authors of this study: 1. The highly significant lower pulse rate in the conditioned group tends to support the previous literature dealing with exercise and training. It may also show the benefits of athletic conditioning in this group. The results agree with previous studies by Montoyem and Cureton.9 The significantly slower conduction (PR interval) and the significantly faster depolarization (QRS interval) may be an indication of increased cardiovascular efficiency. The highly significant difference found in the amplitude of the T wave and T vector is an indica— tion of a stronger depolarization of the ventricle. Montoye, op. cit. 9Cureton, op. cit., pp. 104—147. 25 The difference helps to substantiate the findings of . ‘1 “ '. . 1‘0 “,7 (i 11 T -n - - v 1.2 studies by Klane and Nicolai, Messerlee, Hoogerwerf, and Cureton.13 Recommendations 1. This study should be repeated using a larger number of subjects. Further studies may be done between active non— athlete groups of students. Further studies may be done between athletes of The use of X—rays to determine a true anatomical position of the heart would aid the precision of A longitudinal study of a group of non—athletes undertaking an exercise program using the electro— cardiogram and vector measurements to determine if any changes have taken place. 2. 3. different sports. 4. measurement. 5. 10 11 Krause and Nicolai, op. cit. Messerlee, op. cit. l2Hoogerwerf, op. cit. 1qureton, op. cit. BIBLIOGRAPHY BIBLIOGRAPHY American Heart Association. The Standardization of ECG Nomenclature. The report on the standardizaTiSH_of precordial leads. Second Supplementary Report. Official Reports of the American Heart Association, 1790 Broadway, New York. Angle, W. D. "Vectorcardiography,’I Nebraska Medical Journal, 39 (February. 1954). pp. 53—59. Becker, Feyseng,and Fischer. ”Construction and Calculation of ECG,” Arch. Kreislaufforsch, August, 1953, p. 342. Broustet, P. and H. Eggenberger. "L'electrocardiogramme des Sportifs," Journal de Medicine de Bordeaux dc Sud—Oust, 113:126—27 U936). I Burch, G. E., Albidskov, J. A., and Cronvich, J. A. . "Spatial Vectorcardiogram in Normal Man, Circulation, Vol. 7, pp. 558-572. hampion Athletes‘. Cureton, T. K. The Physical Fitnes ,5 9 ss, 1951. .——o_ Urbana: University of Illino O H) (DO Doliopulus and Bagou. Cardiologia, (Basel), 23:2:169-176 (1953). Fowler, N. 0., and Helm, R. A. "Spatial Angle Between Long Axis of Loop and Longitudinal Axis of Ventricles,f American Heart Journal, 46:821—829 (December, 1953). Frank, E. "General Theory of Heart Vector Projection," Circulation Research. New York: May, 1954, p. 258. Grant, R. B. ”Relationship Between Anatomic Position of the Heart and ECG," Circulation, 7 (June, 1953), 890—902. Grant, Robert B. and E. H. Estes. Spatial Vector Electro— cardiography. Philadelphia, New York, Toronto: The Blakston Company, 1951. ' ' ' T Waves in Gross, D. "Correlations Between R and Positive. . . Their Standard Leads and Their Clinical Significance, American Heart Journal, March, 1956, pp. 301-305- 28 Helm, R. A. and Fowler, N. 0. ”Simplified Method for Deter— mining Angle Between Spatial Vectors," American Heart Journal, 45:835-8AO, June 1953. Hoogerwerf, S. "Elektrokardiographische Untersuchunger der Amsterdamer Olympiade,” Arbeitsphysiologie, 2:61 (1929). Howard, R. and Gertler, M. M. ”Axis Deviation and Body Build," American Heart Journal, A4:l:35—A1, July, 1952. Hurst, J. W. and Woodson, G. C. Atlas oi Spatial Vector ECG. New York: The Blakston Company, 1953. Katz, Louis H. Electrocardiography. Philadelphia: Lea and Febiger, 1939. Kraus, S. and Nicolai, G. Das Elektrokardiogramm des Gesunden Und Kranken Menschen. Leipzig: 1910. Kuhn, w., Eckert, W., and Gartner, W. ”Usefulness of Vector- cardiography,“ Medizinsche, January 9, 1954, pp. 92-9A. Langler, P. H. ”A Geometric Model for Determining the Mean Spatial Vectors," Americoo Heart Journal, Aflz3z378-383, September, 1952. McFarland, F. A., Graybiel, A., Liljencrantz, E., and Tuttle, A. D. ”An analysis of the Psychological and Physiolog- ical Characteristics of 200 Airline Pilots,” Journal o2 Aviation Medicioo, 9:10:180-210. Messerlee, N. ”Die Veranderungen im Elektrokardiogramm Bei korrperarbeit,” Zstchr, f.d. ges Exp. Med., (1928), 490. Silver, H. M. and Landowne, M. "The Relation of Age to Certain ECG Responses of Normal Adults to a Standard Exercise,“ Journal oi the American Heart AsSOC1ation, October, 1953, pp. 510—5207” ’— Simonson, E. ”A Spatial Vector Analyzer for the Conventional ECG,” Circulation, March, 1953, pp. 403—412. . "Effect of Moderate Exercise on the ECG in Healthy Young and Middle—Aged Men,” Journal o: Applied Physio— logy, 5:10:58A—588, April, 1953. and Keyes, A. "Electrocardiographic ExerCise Si ~ . ' monson, E 51:1:83_105, July,1956o Tests," American Heart Journal, . "The Spatial QRS and T Vectors in 178 Normal -—_——_7Middle—Aged Men," Circulation, 9 105, 195A. 29 Tuttle, W. W. and Korns, H. M. "Electrocardiographic Obser- vations on Athletes Before and After Session of Training,” American Heart Journal, 21, January, 1951. Ukely, H. "A Model for the Automatic Determination of the Relationship Between the Cardiac Vector and the Three Standard Limb Leads,” Journal of Applied Physiology, 6:4:260, October, 1953. ‘— Urschel, D. L. and Abbey, D. C. ”Influence of Age, Sex, Body Build, and Chest Configuration on the QRS in Normal Individuals,” American Heart Journal, 46, October, 1953. "Modification of a Vector Model to Provide Accurate Recording of Mean Vector Positions in ”hree Planes of ' '1 ’“r‘ - r- Space," American Heart Journal, 44:3(2, 1952. Wolff, L., Richman, J., and Soffe, A. M. ”Spatial Vector- cardiography, Review and Critique," New England Journal of Medicine, 248:19z810, May, 1953. HEffect of Heart Position and Rotation on Cardiac Vector: Experimental Study,” American Heart Journal, 47:161-173, February, 1954. APPENDIX 31 TABLE VI I COMPARISON OF THE CHEST—SITTING HEIGHT RATIOS OF MATCHED PAIRS OF ATHLETES AND NON—ATHLETES Pair Chest-Sitting No. Athletes Height Ratios Non—Athletes 1 Kennedy. H. 2.857 2.921 Vandenburo 2 Kenedy. C. 3.142 3.077 Miller 3 Reynolds 3.192 2.934 Macek A McLaughlin 3.360 2.892 s111 P Lean 3.249 2.711 Nielson 6 Hruby 2.845 3.033 Abraham 7 Ferrari 2.910 3.003 Phillips 8 Whebler 3.000 3.106 Lindberg 9 Crowell 2.857 2.818 Bridge 10 Horan 3.063 2.885 Olson 11 Hoffman 2.802 2.966 Swerdfeger 12 Polano 2.761 2.969 Rupp 13 Rand 2.651 3.067 McDonald 14 Lindholm 3.241 3.262 Newhouse l5 McCue 3.087 3.032 Shadwick 16 Smith 2.949 2.892 Fiacable 17 Hamilton 2.765 3.069 Chlpka 18 Quiggle 2.779 3.064 Pressel 19 Jennings 2.819 2.731 Clayton 20 Kellogg 3.000 2.862 Stewart 21 Dafoe 3.087 2.917 Fife 22 Grable 2.825 2.889 Johnson 23 Lake 2.967 3.034 Sherman 24 Arslanian 2.792 3.333 StOltZ 5 Green 2.924 2.900 Chelmedos 26 Hotchkiss 3.050 3.254 Smith 27 Manissto 2.676 3.211 Stenberg 28 Carr 3.100 3.227 Lamsa 29 Turak 2.671 2.932 Bimms Mean* 2.945 2.984 SD* 0.2 0.22 *No significant difference shown. 32 TT "TT’ 0.2 sec. 0.04 see. 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223...) .2: 23:0.) INSTRUCTIONS FOR SUBJECTS You are an important part of a research study and your full cooperation and compliance with these few simple instruc- tions are essential to make this study valid and sound. Please adhere to these few rules prior to reporting for your 33G: Do not engage in any vigorous activity on the day of your testing until after the ECG is recorded. Refrain from alcohol and tobacco at least two hours before the test. If you do not drive a car, then walk slowly to the lab or allow me to pick you up from a designated area- Avoid drinking cold fluids at least one hour prior to recording ECG- All testing will be done in quonset lab #79. If for some reason you cannot keep your appointment phone Ed 2-1511, extension 2945 (or) 2929. Evenings--Dick Skimin, Ed 2-0158 Cole Genn, Ed 7—0804 OM UCE ONLY