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O 52:21::222.33;_,,._§_§_::_::_ mm TH 7:. inf. . 1“: u! .391- I , r A COMPARISON OF THE ELECTROCARDIOGRAPHIC MEASUREMENTS OF ACTIVE AND INACTIVE AGED ADULTS by NORMA MAE STAFFORD A.THESIS Submitted to the College of Education of Michigan State University of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Health, Physical Education, and ReCreation 1956 Ll Dedicated To: My Parents and all of my Instructors with gratitude and appreciation for their assistance and encouragement in all of my endeavors TH: E)! ACKNOWLEDC MENTS I wish to express my thanks to Dr. Henry Montoye for his helpful guidance throughout my research and in the preparation of this paper. I am also grateful to Dr. James Feurig of the Michigan State University Health Center and to the staff and residents of the Ingham County Rehabilitation Center for their assistance and COOperation. THE: L A COMPARISON OF THE ELECTROCARDIOGRAPHIC MEASUREMENTS OF ACTIVE AND INACTIVE AGED ADULTS by NORMA MAE STAFFORD AN.ABSTRACT Submitted to the College of Education of Michigan State University of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Health, Physical Education, and Recreation 1956 TABLE OF CONTENTS CHAPTER I. II. III. IV. V. INTRODUCTION . The Problem . Statement of Problem Limitations . . Definitions of Terms Used . . . . . Organization of Remainder of Thesis . . REVIEW OF LITERATURE. Electrocardiogram of the Aged . . . . Related Studies . DESIGN OF EXPERIMENT Instrument . . . Selection of Subjects. Preparation of Subject Measurement Procedure. Statistical Design. RESULTS. . . . . . SUMMARY, CONCLUSIONS, AND Summary . . . . . Conclusions . . Recommendations . BIBLIOGRAPHY. . . . . . APPENDICES. . . . . . . RECOMMENDATIONS. PAGE \OFUWW 10 10 13 21 21 22 22 23 24 25 38 38 38 39 Lu TH‘: LIST OF TABLES TABLE PAGE I. Minimal, Maximal and Mean () Values of 24 Normal 50-60 Year Olds at Rest . . . . . 11 II. Amplitudes and Durations of 100 30-50 Year Olds . . . . . . . . . . . . . . 14 III. Amplitudes and Durations of 200 20-35 Year Olds.............l5 IV. A Comparison of the Active and InactiVe in the Mean, Range and Standard Deviation . . . . 26 V. Significance Levels for the Comparison of the Electrocardiographic Measurements of Active and Inactive Aged Adults . . . . . . . 29 '4 . _ :vwww‘v .d CHAPTER I INTRODUCTION Kolliker and Muller demonstrated in 1856 that differences in electric potential were produced during the contraction of a frog heart.1 In 1887, Waller recorded these differences by using a capillary electrometer.2 This instrument was not accurate and Was replaced by Einthoven's galvanometer in 1903.3 With this Ltype of machine, which is still in use today, came the beginning of electrocardiography. Although a medical man should not make a positive diagnosis from an electrocardiogram alone, a cardiovascular examination is not complete without such a test. "The 1A. Kolliker and H. Muller, Nachweiq§_der negativen Schwankung des Muskelstrome gm Naturlich sich contrahierenden IMuskel, Verhandl. d. phys.-med. Gesellsch., zer Wurzb. 6:528, 1855). cited by J. Bailey Carter, Fundamentals 9;.Electrocardiographic Interpretation (Baltimore: Charles C. Thomas, l§36), p. j: 2A. D. Waller, "A Demonstration on Man or the Electromotive Changes Accompanying the Heart's Beat," 1‘ Ph 8101 , 8:229, 1887, cited by Carter, Ibid. 3W. Einthoven, "Ein neues galvanometer,‘ Ann, QL Phys, E; g1, 12:1059. 1903, cited by Carter, Ibid. electrocardiogram is the time record of the electrical events in the heart from which information concerning the locus of orgin of each beat and how the activity has spread can be obtained.“P A patient may have a normal tracing and still have heart disease. However, a definitely abnormal electrocardiogram is an indication of heart disease.5 During recent years certain researchers in physical education have become interested in electrocardiography 6 as a means of predicting athletic ability. Katz states that the electrocardiogram is not indicative of the vigor of the heart's contraction. However, there is some evidence that an athletic training program brings about a change in the electrocradiogram.7, Several studies have been made on normal subjects to aid in understanding the ranges of the normal electro- cardiogram, however, few have been devoted to the aged ULouis H. Katz, Electrocardiographx.(Philadelphia: Lea and Febiger, 1949), p. 80. 5George Burch.and Travis Winsor, A Primer g; Elecgrocardiographx_(Philadelphia: Lea and Febiger, 19u5), p. 1 9. 6Katz,.gp. cit., p. 80. 7Thomas K. Cureton, Jr., ghysical Fitness 9: Champion Athletes (Urbana: University of Illinois Press, 1951), p. 1390 adult. Therefore, at the present time there are no available electrocardiographic standards for active and inactive aged adults. It is hoped that this study will contribute to the formation of such standards and also enable the author to show which of the standard leads gives the greatest variation between the two groups. If it can be shown that the active aged have electrocardiograms comparing more closely to those of athletes than the inactive, it may indicate a need for more carefully planned physical activity or recreation programs for the aged. Results may also be helpful in an evaluation of present day retirement standards. I. THE PROBLEM Statement The purpose of this study was to compare the g; the Problem electrocardiographic measurements of active and inactive aged adults. The measurements selected for comparison were: amplitude of the P wave, amplitude of the T wave, amplitude of the QRS complex, QRS interVal, PR interVal, PP interval, and QT interVal. Limitations Leads I, II, and III only were used in this study. The subjects included 15 men and 16 women residents of the Ingham County Rehabilitation Center. Their ages ranged from sixty to eighty—eight years. II. DEFINITIONS OF TERMS USED The following are a list of the terms to be used in this study: [Diagram p. 5.] g Egyg The P wave is caused by an impulse that originates in the sino-auricular node and Spreads through-out the aricular musculature causing contraction of the auricles. Normally it is not more than 0.1 second wide and ranges in amplitude from one to two millimeters.8 T.Kgxg The T wave represents the process of relaxation of the heart; the decline of the state of electrical excitation in the ventricular musculature. Normally it varies from one to five millimeters in height and has a maximum duration of 0.25 second.9 ESE Complex This stimulus normally requires less than 0.10 second to Spread through the auriculo—ventricular node, the bundle of His and its arborizations, and stimulate the ventricular muscle. Its height varies from five to 0 twenty millimeters.1 8Carter, QR. cit., p. 40. 91bid., p. 42. lOIbid., pp. 47-b3. DRAWING OF ACTUAL ELECTROCARDIOGRAM ENLARGED ABOUT FIVE TIMES R" 0"... -- “a“ ‘I.’ .9“- Q I“ “co-0 .Fo. “-uao—n *~#---- 0-. — .c we ~-—.‘-M- su~*-O~.c - 11L. H. Sigler, The Electrocardiogram (New York: Greene and Stratton, l9fih). Time The QT interval is the best measure for '21“ " a: Interval electrical ventricular systole. It varies with the heart rate; with a rate of 45 it is normally 0.h5 second and with 75 it is 0.35 second.12 Time This is the time necessary for the stimulus of £5 I_terval to epread from the sino-auricular node through the bundle of His and down to the upper reaches of the right and left bundle branches. It is normally less than 0.20 second in duration.13 Time This interVal represents the time from the are: Inte val completion of depolarization of the ventricular musculature to the completion of repolar- ization or relaxation. Its maximum duration is 0.39 second.lu Time The PP interval from beginning of P wave of _§ - Interval to the beginning of the next P wave represents one complete cardiac cycle. The number of cardiac cycles 12 Ibid., p. 43. 1h Burch and Winsor, 22. cit., pp. 15, 192-193. 7 occurring in one minute is commonly called the heart rate. This rate varies from 30 in well-trained athletesls to 16 130 in newly-born infants. Time This represents a period of iso—potentiality of S1 Segment between the end of R or S and the beginning of T. It is at or near the level of the baseline in the limb leads and has a maximum duration of 0.15 second. Work This is measured from the beginning of the (Contraction) Time ST segment to the end of the T wave. Rest This is the complete cardiac cycle minus the Time 19 work time or ST interVal. 15 S. Hoogerwerf, 'Electrokardiographische Untersuchungen der Amsterdamer Olympiadekampfer,” Arbeitsphysiologie, 2:61 (1929). 6 1 Charles H. Best and Norman E. Taylor, The Living Body, (New York: Henry Holt and 60., 1952), p. 201. 17 Burch and Winsor, 92. cit., pp. 15. 193. 18 Cureton, pp. 01t.. p. 139. Ibid. Lead I, The spread of the action current from right to left in the heart and back from left-hand to right-hand by the connected electrodes is represented in the electro— cardiogram by deflection in the finished electrocardiogram whenever the right arm is relatively negative and the left 20 leg is relatively positive. .ngg_ll. The spread of the action current from the base towards the apex of the heart is conducted through the amplifier in such a manner as to produce an upward or positive deflection in the finished electrocardiogram whenever the right arm is relatively negative and the left leg is relatively positive.21 Legd 1_[_I_I_ The spread of the action current from above downward is conducted through the cardiotron so that it causes an upward or positive deflection in the finished electrocardiogram When the left arm is relatively negative 22 and the left leg is relatively positive. 0 Burch and Winsor, pp, cit., pp. 21-22. 21 Ibid., pp. 22-23. 22 Burch and Winsor,.gp. cit., pp. 22-23. Active The term active adult is used in this study to .AQEIE indicate a person who is able to walk about outside his own room. Ipactive A person confined to his room or a wheelchair AQEIE, for at least six weeks is termed an inactive adult. Aged The term aged as used in this study refers to Adult persons over sixty years of age. III. ORGANIZATION OF REMAINDER OF THESIS The second chapter includes a summary of research related to this problem. Chapter three deals with the selection of the subjects and a description and eXplanation of the instrument used. It also explains the measurement procedure and the statistical methods used. A complete analysis of the findings of the study is given in chapter four. The final chapter includes a summary of the research, conclusions, and recommendations for further related research. The bibliography gives a complete listing of the resource materials used in the study; charts and diagrams are included in the appendices. CHAPTER II REVIEW OF LITERATURE Physiological study of the electrocardiogram is comparatively new. Most of the research in this area has been'concerned with the comparison of athletes and non-athletes and as stated in the introduction there are two opposite beliefs in this field. One states that the electrocardiogram may be used to predict athletic ability1 while the other states that variation in this record is due only to variation in electrical currents and is no 2 The author could indication of physiological condition. find no previous studies concerning activity and inactivity of aged adults. Therefore, the review will include electrocardiographic research on aged adults and other literature directly related to the stated problem. Electrocardiogram Graybiel and White3 state that E: the Aged there are no characteristics peculiar 1 Thomas K. Cureton, Jr.. Physical Eitness 2; Champion Athletes (Urbana: University of Illinois Press, 1951), p.1h2, 2 Louis H. Katz, Electrocardiography (Philadelphia: Lea and Febiger, 1949), p. 80. 3Ashton Graybiel and Paul D. White, Electrocardiography 33 Practice (Philadelphia: W. B. Saunders Company, 1947), p. 56. + ill- ii 11 to the electrocardiogram of the aged, although most do show some abnormality. With increasing age, decrease but the time values increase. the wave magnitudes Katz4 (1949) says that there are changes in the electrocardiogram with increasing age. He states that the percentage of this due simply to the ageing process is unknown at the present and that there is considerable need of accumulating electrocardiographic measurements on the increasing senile pOpulation. Lepeschkin5 (1951) gives the range of the PR interval of persons over sixty years of age as .15~.23 second, the average as .172. He also gives the following tables of amplitudes in millimeters: MINIMAL, MAXIMAL AND MEAN () VALUES OF 2n TABLE I 6 NORMAL 50-60 YEAR CLDS AT REST P Q .f R S T I 0.5(0.7)0.9 0.7(1.0)1.3 o.o(o.6)1.u II III o.o(o.3)1.l 0.0(O.2)1.2 0.0(0.b)1.‘* 0.2(5.5)16.7 2.h(6.5)14.o 0.8(3.3)10.9 0.0(1.o)6.A 0.0(o.8)3.1 0.0(1.5)7.b 0.9(1.8)3.3 1.1{2.h)5.2 -0.8(0.7)2.2 “Katz’ 9-20 Cit. 9 pp. 136-.1370 5Eugene Lepeschkin, Modern Electrocardiography The Williams and Wilkins Company, 19513? p. 153. (Baltimore: 6 Ibid., p. 140. ' "‘" g 11 to the electrocardiogram of the aged, although most do show some abnormality. With increasing age, the wave magnitudes decrease but the time values increase. Eats” (1949) says that there are changes in the electrocardiogram with increasing age. He states that the percentage of this due simply to the ageing process is unknown at the present and that there is considerable need of accumulating electrocardiographic measurements on the increasing senile papulation. Lepeschkin5 (1951) gives the range of the PR interval of persons over sixty years of age as .15-.23 second, the average as .172. He also gives the following tables of amplitudes in millimeters: TABLE I MINIMAL, MAXIMAL AND MEAN () VALUES OF 246 NORMAL 50-60 YEAR OLDS AT REST v— P Q R S T I 0.5(o.7)0.9 0.0(o.3)1.l 0.2(5.5)16.7 0.0(1.0)6.b 0.9(1.8)3.3 II o.7(1.o)l.3 o.o(o.2)1.2 2.h(6.5)1u.o 0.0(0.8)3.1 1.162.b)5.2 III o.o_p_. cit., pp. 263-264. 18 of 49 year—Olds exceeded that of 26 year-Olds by 0.002 second. The voltage of T Waves in athletes was found elevated in the majority of cases, especially in young persons with low heart rates. The QT duration was elevated especially in long distance track men; the increase of QT could be observed during the course of training. Referring to the review of literature by Cureton15 (1951), Krause and Nicolai16 (1910) are reported to have found one difference between athletes and non—athletes, that being a higher T wave in some of the athletes at rest. Messerle17 (1926) reported that training caused the T wave to'become higher, greatly increased the duration of QRS and slowed the pulse rate. Prolonged PR interVals on several athletes were noted by Von Csinady18 (1930). He lsCure ton, 92. c it .,ppl40—143. l6F. Kraus and G. Nicolai, Das Elektrokardiogramm des gesunden und Kranken Menschgg'FEEipzig, 1910), cited by Thomas K. Cureton, Jr., Physical Fitness 3: Champion athletes (Urbana: University of Illinois Press, 1951), p. 140. 17N. Messerle, "Die Veranderungen im.Elektrokardio— gramm bei Korperarbeit,” Ztschr. g. g, see. Exp. Med. 60: 490, 1928, cited by Cureton, Ibid. 18E. Von Csinady, "Sportzartzlische Untersuchungen, III. Mitteilung: vergleichende elektrokardiographische Untersuchungen an Sporttreibenden bei besonderer Beruck- sichtegung der EKG-Zeitwerte,"“Aggeilsphysiologie, 3: 57995 (October, 1930), cited by Cureton, Ibid. 19 also stated there was no relationship between the height of the T wave and physical performance, although no correlations were computed in his work. Broustet and Eggenberger19 (1936) examined 35 athletes and stated that the electrocardiogram of an athlete gives a fine, full, regular tracing. They believed that there was some relationship between the form of the tracing and the anatomical and functional state of the heart. However, they did not claim any changes in amplitude of Specific waves. Reindell20 (1937), found a marked lengthening of the PR interval in his study of athletes. Sensenbach21 maintained that good physical condition was shown by a relatively low P wave, high R wave, high T wave, and short PQ and QRS times. He suggested a moderate relationship of T waves to endurance. Cureton22 (1951) in a comparison of 81 normal young men with 53 athletes of national championship caliber, 19P. Broustet and H. Eggenberger, "L'electrocordio- gramme des Sportifs," Journal fig Medecine gg_Bordeaux‘g£'dg Sud-Quest, 113: 126-27, 1935. cited by Cureton, Ibid., p. 141. 20H. Reindell, "Kymographische and Elektrokardio- graphische Befunde am Sportherzen,” qutches Orchir fur gginische Medizin, 131: 485-514, 1937. cited by Cureton, Ibid., p. 141. 21W. Sensenbach, "Some Common Conditions, Not Due to Primary Heart Disease. That May Be Associated with Changes in the ECG,“ Annals Internal Medicine, 25:632-647,0ctober, 1946. 22Cureton,.gp. cit., pp. 155-162. 20 stated that trained athletes have smaller P Waves, larger T waves, lower pulse rates and shorter PR intervals than the normal individuals. In a study of 12 varsity cross country runners, Wolf23 (1950) found that during 16 weeks of training 21 of 3b increased P2, 33 of 3“ increased R2, 23 of 25 increased 82, and 20 of 33 increased T2. Foerch,24 (1951) compared 20 athletes during their peak of training with 20 non-athletes and found the following results: athletes have a greater T1 wave amplitude, a shorter QR33 duration, a longer PRl,3' a longer QT interval, and a slower pulse rate than the 1,2,3 non-athletes. These findings were significant at the 0.01 level. 2 3J. Grove Wolf, "Effects of Posture and Muscular Exercise on the Electrocardiogram," The Research Quarterly, 24:4:475-490, December, 1953. 2“Richard L. Foerch, "A Comparison of Electrocardio- graphic Measurements of Athletes and Non-Athletes at Michigan State College," (unpublished Master's Thesis, Michigan State College, East Lansing, 1951). CHAPTER III DESIGN OF EXPERIMENT Instrument The PC-2 Cardiotron used in this study is a direct-writing electrocardiograph which produces permanent records instantaneously on an abrasion~resistant, thermo-sensitive paper. It incorporates such features as automatic instantaneous compensation during the switching of leads without pushing knobs or buttons, a fifteen lead selector switch, absolute elimination of power line, broadcast station, and most diathermy interference, automatic time marking, complete freedom from the effects of power line voltage changes, and an automatic protection circuit for the stylus. This instrument uses a vacuum tube amplifier which amplifies the heart voltages approximately 10,000 times without distortion and operates an accurate, permanent magnet, electrodynamic galvanometer. The movement of the galvanometer is directly transmitted to a stylus whose electrically heated Jewel tip inscribes the permanently recorded graph. Standards have been set up so that records taken in any part of the world can be read and compared, if necessary. Two of these standards are the speed of the paper drive and the deflection sensitivity. The paper is ruled in one millimeter squares. The required speed of the paper movement is twenty-five millimeters per second. The speed of the paper is controlled by a synchronous motor. Deflection sensitivity is the response of the apparatus to a known voltage. The sensitivity for standard electrocardiographic records is set so that an injected voltage of one millivolt will produce a stylus deflection of one centimeter. gglection The subjects included all Ingham County of Efibfiects Rehabilitation Center residents over the age of sixty who had no known cardiac conditions that would have influenced the validity of the study. Thisselection was made on the basis of the hospital's records and the recommendations of Dr. James Feurig, Michigan State University staff physician. The thirty-one subjects were divided as follows: active women, eight; inactive women, eight; active men, ten; and inactive men, five. The active group included those persons able to walkflabout outside their own rooms; the inactive group included those who had been confined to their own rooms or in wheelchairs for at least six weeks. Preparation The subjects were asked to refrain from 2!. Subject smoking, eating, or drinking any stimulant for the two hours immediately preceding the test. They 23 also rested on their beds for fifteen minutes prior to the examination. One electrode was placed on each limb after an application of electrode Jelly. These were strapped into place and the lead wires connected. After connection of these wires to the machine, the test was administered. Measurement The measurements were taken as recommended Procedure by Cureton.1 Three representative cycles from each lead were selected on the basis of regularity; they were not necessarily consecutive. Vernier calipers were used to measure deflections; this distance was measured by the outer edges of the pointed blades. Each wave was measured in each of the three cycles, and the one having the greatest amplitude was recorded. A wave deflected downward was indicated by a negative sign; other waves were considered positive and represent upward deflections. The interVals recorded were taken from those three cycles concluded to be of longest duration. Each interval was measured in all three cycles and the longest recorded. In cases of extreme irregularities a second electro- cardiogram was administered. When this tracing was 1Thomas K. Cureton, Jr., Physical Fitness 2: Champion Athletes (Urbana: University of Illinois Press, 1951T. pp. 138-139. 24 immeasurable, the case was eliminated. These cases were usually bed patients who were unable to relax due to their particular affliction. Statistical Each amplitude and interval was measured Design in all three leads and these measurements recorded. The means and standard deviations of the two groups were computed and may be found in tabular form in Chapt er IV. The differences between the two groups were computed, and the student's ”t" used to determine their'significances. CHAPTER IV RESULTS The results of the statistical analysis are given in tabular form on pages 26 through 31. In lead one the amplitude of the P wave was higher in the inactive group; this was significant at the 0.01 level. The P wave in lead two was also greater in the inactive group, although not significantly so. The P wave is caused by the spreading of the electrical impulse throughout the auricular musculature. Cureton1 states that trained athletes have smaller P waves than the normal 2 agrees with this statement and individual. Lepeschkin says that a small P wave is indicative of a thinner auricular'wall and the resulting smalltirea of activation front in comparison to the surrounding short circuit tissue. The active adult's small P wave may be due to a relative underdevelOpment of his auricles as compared to his ventricles. 1Thomas K. Cureton, Jr., Physical Fitness 9; Champion Athletes (Urbana: University of Illinois Press, 1951), p. 162. 2 Eugene Lepeschkin, Modern Electrocardiography (Baltimore: The Williams and Wilkins Company, 1951), 26 oma. u omo. sac mamo. oma. n mmo. mam. ammo. am as mafia mam. n 000. see omma. mmm. u 000. mmo. moms. Ham so made mmo. . smo. aao. ommo. mas. n ooo. amm. mama. amm no mass moo. a smo. omo ammo. ooa. n mmo. Ham. ommo. Hmmo so made mos. u 0mm. omo amen. ems. : mam. mmo. mamm. Had mo made :8. .. as. as RR. me. .. 8:. mo. RR. at ,s 95 0mm. 1 mom. omo mamm. sen. n.3ma. :Ha. Hmom. Has so made mam. : osm. mmo. omam. cos. n com. mo. mmam. 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I mam mo maaa mo.o coop mace mm. mo.o cm£p mpoe H:.H Mme mo mEaB mo.o coop mace MH.H mo.o soap whoa 3mm. I mam mo maae mo.o coup mpoa mo.H mo.o £639 @908 mi. I mMm mo mama mo.o ammo woos ma.a ao.o can» mama a.oaI a mo maaa mo.o ammo macs mm. mo.o swap woos am.aI ma mo mospaaoem mo.o ammo whoa mo.a ao.o ammo mmoa mm.mI mm mo mospaaoem mo.o ammo once om.a mo.o coop whoa am.aI mm mo mospaaoam ao.o comp mama a.ma mo.o swap mace mo. I ma mo mospaaoam mo.o mono mace mm.a mo.o can» once ama. mm mo mosoaaoam oocooaanMam m cocooawacwam p no Hm>mq R no Hm>mA R omscdpcoo I! > mdmda 32 Active adults had a significantly higher T wave in lead one at the 0.01 level. The lead two T wave was also higher in the active group. This wave represents the decline of the state of electrical excitation in the ven- tricular musculature. Hoogerwerf3 states that athletes have higher T waves than non-athletes at rest. Foerchu found that athletes have significantly higher T waves than non—athletes. Sensenbachs maintained that good physical condition was shown by high T waves and he suggested a moderate relationship or T waves to endurance. Cureton agreed that trained athletes have higher T waves than the normal individual. The higher T waves of the active group may be an indication of thicker ventricular walls. The QRS duration is significantly longer in lead two of the inactive group at the 0.02 level. The QRS interval was also longer in lead one of the inactive group, 3S. Hoogerwerf, "Electrokardiographische Untersuchungen der Amsterdamer Olympiadekampfer,' Agpeitsphysiologie, 2:61 1929). *Richard L. Foerch, “A Comparison of Electrocardio— graphic Measurements of Athletes and Non-Athletes at Michigan State College,” (unpublished Master‘s Thesis, Michigan State College, East Lansing, 1951). 5W. Sensenbach, ”Some Common Conditions, Not Due to Primary Heart Disease, That May Be Associated with Changes in the ECG," Annals Internal Medicine, 25:632-647, October, 19u6. Cureton, loc. cit. 33 although not significantly so. The QRS duration is the time required for the stimulus to Spread through the auriculo-ventricular node, the bundle of His and its arborizations and stimulate the ventricular muscle. Sensenbach7 said that a relatively short QRS time was an indication of good physical condition. Forech's8 study also found athletes to have a shorter QRS interval than the nonpathlete. The ventricular systole may be shorter in the active group due to the better muscle tone thus providing a more efficient contraction. The duration of QT in lead two was significantly increased at the 0.01 level in the active group. It was also increased in lead one. Carter9 says this is the best measure available for the duration of electrical ventricular systole. Lepeschkinlo observed the increase of QT during training. Foerch11 found this increase significant at the 7 Sensenbach, loc. cit. 8Foerch, loc. cit. J. Bailey Carter, Fundamentals gf‘glectrocardio- graghic Interpretation (Baltimore: Charles C. Thomas, l9fl6), p. o loLepeschkin, loc. cit. 11Foerch, loc. cit. 34 0.01 level in all three leads of the athletes. He states that the QT interval is related to the pulse and varies with its rate. The inactive group had a faster heart rate; this was significant between 0.05 and 0.01. Foerch12 found the non—athletes to have a faster heart rate than the athletes. It would seem that the active group's hearts and cardiovascular systems were in better condition, and thus more efficient. This could be due to delivery of more blood with each systole or more efficient exchange of oxygen and carbon dioxide in the cells of the body including those in the lungs or to both of these reasonS. The inactive group had a higher QRS amplitude than the active group. This was significant at the 0.01 level. The QRS is the Spreading of the electrical impulse through the auriculo-ventricular node, and the bundle of His and its arborizations to stimulate the ventricular muscle. This does not agree with results of previous studies and should be further investigated in similar research. Other findings significant at the 0.01 level were 81 higher in active group, 52 higher in inactive group, 12 Ibid. 35 and a longer ST segment in the active group. Katz.13 says that the duration of SE is not a significant measurement. Using tables by Jackson and Winsorlu , the author determined the magnitude and direction of the electrical axes of the electrocardiograms of both groups. These magnitudes and directions are given in the Appendixes. Differences between the electrical axes of the two groups significant at the 0.01 level were found in direction of QRS, direction of T and magnitude of QRS. Both groups were within the range of normal left axis deviationls with the active group being farthest to 16 the left. Carter states that the most common cause of right axis deviation is preponderance of right ventricle enlargement due to disease. Left axis deviation is occasionally associated with the senile heart and is more 13Louis H. Katz, Electrocardiography_(Philadelphia: Lea and Febiger, 1949), p. 116. luCharles E. Jackson and Travis Winsor, "Aids for Determining Magnitude and Direction of Electric Axes cf the Electrocardiogram,” Circulation, Vol. 1, No. #, Part II, April, 1950. lSJ. Bailey Carter, The Fundamentals 2; Electro- cardiographic Interpretation (Baltimore: Charles C. Thomas, 1914’6) , p. 58. 16Ibid.. pp. 59-61. 36 commonly caused by a change in heart position. Changes in heart position may be due to the muscle tone of the dia- phragm and abdominal wall.17 Heart position may also be different in different body types. The author did not do any body typing in this study therefore, no comparisons concerning body typing can be made. The magnitude of QRS was greater in the inactive group. This is not in agreement with other studies and should be further investigated in future research on related problems. Similarity The following show the comparison of in the Three Leads amplitudes and interVals in the three leads. 1. The P wave amplitude was greatest in lead two for both the active and inactive groups. 2. The T wave amplitude was greatest in lead two for both groups. 3. The QRS complex amplitude was greatest in lead two for both groups. l7Schlomka and Rademacher, "AufstechsEkg," g, Klin. ‘Mgd., 135, 745, 1939, cited by Max Holzmann, Clinical Electrocardiography trans. Douglas Robertson New York: Staples Press, 19525, p. 132. 37 b. The QRS time was greatest in lead two for the inactive group. 5. The QRS time was greatest in lead three for the active group. 6. The QT time was greatest in lead two for the inactive group. CHAPTER V SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS Summary The purpose of this study was to compare the electrocardiographic measurements of active aged adults with those of inactive aged adults. The author gave electrocardiograms to all Ingham County Rehabilitation Center residents who were over the age of sixty and who did not have cardiac conditions that would have influenced the results of the study. These subjects were divided into two groups according to their daily activities. The active group included those able to walk about outside their own rooms; it was made up of eight women and ten men. The inactive group of eight women and five men included those who had been confined to their own rooms or in wheel- chairs for at least six weeks. The PC~2 Cardiotron Was used by the author to obtain the three standard leads of each subject. Wave amplitudes and time intervals in each of these leads were measured with vernier calipers and these measurements recorded. The means and standard deviations of the amplitudes and intervals were computed, and the student's "t" used to determine the significance of any differences between the two groups. Conclusions According to the evidence set forth in this study the following conclusions are made concerning the 39 electrocardiograms of active aged adults as compared with those of the inactive aged adults: 1. lower P wave 2. higher T wave 3. shorter QBS duration a. longer QT interval 5. lower QRS amplitude 6. longer ST segment 7. slower pulse rate Other conclusions are: 8. The electrocardiograms of active aged adults compare more closely with those of athletes than do the electrocardiograms of inactive aged adults. 9. Wave amplitudes decrease with age. Recommendatign§_ The following are recommendations to be for Eurther Study taken into consideration in further study of electrocardiographic measurements of active and inactive aged adults: 1. The study should be repeated using a cross section of aged adults. 2. This same study could be repeated on a larger number of individuals. b0 3. Make a study of fracture cases of the aged, taking electrocardiograms during first and last weeks of their confinement and six weeks after their return to normal routine. 4. Make a comparison of the electrocardiographic measurements of persons over the age of sixty who had been active in athletics with the measurements of those who had not. 5. Make a comparison of electrocardiographic measurements of persons over age sixty before and after six months of prescribed exercise. BIBLIOGRAPHY BIBLIOGRAPHY Books Best, Charles H. and Norman B. Taylor. The Living Body. New York: Henry Holt and Company, 1952. Burch, George and Travis Winsor. A_Primer 9; Electro- cardiography. Philadelphia: Lea and Febiger, 1945. Carter, J. Bailey. The Fundamentals 9: Electrocardiographic Interpretation. Baltimore: Charles C. Thomas, 19U6: Cureton, Thomas K., Jr. Physical Fitness 2: Champion AthleteS. Urbana: University of Illinois Press, 1951. Graybiel, Ashton and Paul D. White. Electrocardiography 3g Practice. Philadelphia and London: W. B. Saunders Company, 1947. Hotzmann, Max. Clinical Electrocardiography. Trans. Douglas Robertson. New York: Staples Press, 1952. Katz, Louis H. Electrocardiography. Philadelphia: Lea and Febiger, 1949. Lepeschkin, Eugene. Modern Electrocardiography. Baltimore: The Williams and Wilkins Company, 1951. Periodical Articles Hoogerwerf, S. "Elektrokardiographische Untersuchungem der Amsterdamer Olympiadekampfer,' Arbeitsphysiologie, 2:61, 1929. Jackson, Charles and Travis Winsor. ”Aids for Determining Magnitude and Direction of Electric Axes of the Electrocardiogram,“ Circulation, Vol. 1, No. 4, Part II, April, 1950. Jensen, Julius, Milton Smith, and E. D. Cartwright. "The Electrocardiogram in Late Middle Life," American Heart Journal, 7:718—724, 1932. Johnson, Harry J. "A Study of 2400 Electrocardiograms of Apparently Healthy Males," Journal 2: the American Medical Assodation, 11h:561~563, February, l9h0. .3 Larsen, Kaj. and Th. Skulason. "The Normal Electrocardio— gram," American Heart Journal, 22:625-6b4, 1991. Sensenbach, W. "Some Common Conditions, Not Due to Primary Heart Disease, That May Be Associated with Changes in the Electrocardiogram," Annals Interngl Medicine, 25:632-647, October, 1946. Shipley, R. A. and W. R. Hallaron. "The Four-Lead Electro- cardiogram in 200 Normal Men and Women," American Heart Journal, 11:325. 1936. Tuttle, W. and H. Korns. "Electrocardiographic Observations on Athletes Before and After Season of Physical Training,” American Heart Journal, 21:10h-107, January, 19Hl. Wolf, J. G. "Effects of Posture and Muscular Exercise on the Electrocardiogram,” The Research Quarterly, 20:#:475-b90, December, 1953. Unpublished Materials Foerch, Richard L. "A Comparison of Electrocardiographic Measurements of Athletes and Non-Athletes at Michigan State College.“ Unpublished Master's Thesis, Michigan State College, East Lansing, 1951. APPENDIXES : am Mafia. . .... I ...w \. ...aI - I...II a ...\ I m.a. S} i ...u1 n. «us. ....I .... III I- a -I I a.-- -.IIa an 1 III was. ab... .. -..x . ...») I...\ fix umaI no Nam. I‘m. mo.o. in". 3%. K 3 om.-- . 8. .sI - III II III II InI waIIII I . - I a. El IIIII ITIooo. Odoc moon. icuu. act»; 11.5 ....oco- Wk. occo QIfiuIQ mhxxa \ ”1.: \Gh. \Jew cNN NMNN I a.“ “I Am I 2.3. ma.\c_ race Soc 1.5 9...... ..aon ..I «I. manic. 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