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exercise. The belief that SV plateaus at a submaximal exercise level owing to a limited time for diastolic lling has dominated cardiovascular physiology literature. However, most authors have failed to consider the effects of the pericardium on left ventricular lling during exercise conditions. It is unlikely that a limited time for diastolic lling could explain these ndings, because the left ventricular diastolic pressure volume relation is only affected at HR greater than 170 beats min 1 (MorrisThurgood & Frenneaux 2000), a HR that is well above where the plateau in SV generally occurs. The invariant lling and SV at much lower HR is supportive of the conclusion that the pericardium limits left ventricular lling during moderate to strenuous exercise in healthy untrained humans (Janicki 1990; Morris-Thurgood & Frenneaux 2000). Additional support for this theory comes from research (including our own) that revealed that acute alterations in venous return via volume expansion or a change in postural position results in minimal changes in exercise SV, despite signi cantly larger elevations in resting SV (Robinson et al. 1966; Warburton et al. 1999). Perhaps the most compelling research supporting the signi cant role of pericardial constraint in limiting left ventricular SV during exercise comes from work with patients with chronic heart failure (Janicki 1990). The landmark work of Janicki (1990) revealed that there are three distinct SV responses to incremental exercise: 1 SV continues to increase throughout incremental exercise. In this group the increase in pulmonary capillary wedge pressure is approximately two- to threefold higher than the increase in right atrial pressure (i.e., minimal pericardial constraint). 2 SV increases at lower exercise intensities, but reaches a plateau at submaximal exercise intensities. This response is associated with equal changes in pulmonary capillary wedge pressure and right atrial pressure (i.e., pericardial constraint is present). 3 SV does not increase at any stage of exercise and is associated with equal changes in pulmonary capillary wedge pressure and right atrial pressure (i.e., pericardial constraint). In healthy humans, we also commonly observe three SV patterns to exercise (Fig. 2.19). Endurance-trained
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Audit committees have become crucial to the audit process. Also, the audit committee has been considered essential in an organizational approach to making boards of directors more effective in their interaction with financial management and chief executive officers as well as with internal audit staff and independent auditors.5
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Effect of training on physical performance in the HIV infected athlete Fewer studies have looked at the effect of exercise training on physical performance in patients with HIV infection. The use of both aerobic and resistance exercise has been shown to improve physiologic parameters such as strength, endurance, time to fatigue, and body composition in the HIV infected population (Dudgeon et al. 2004). Another study examined the effect of aerobic exercise on physiologic fatigue (measured by time on treadmill), dyspnea measured by rate of perceived exertion (RPE), forced expiratory volume in 1 second (FEV1), weight, and body composition in the HIV-infected individual (Smith et al. 2001). Sixty subjects were randomized into two groups, an experimental group who completed a 12-week supervised aerobic exercise program, and a control group who continued their usual activities from baseline to week 12, after which they were enrolled into an exercise program. The experimental group was able to exercise longer on the treadmill, lost weight, showed a decreased body mass index (BMI), subcutaneous fat, and abdominal girth when compared with controls. The improvement in weight and body composition occurred without a decrease in kilocalories consumed. The use of anabolic steroids has been shown to improve the bene ts of resistance training in individuals with AIDS wasting syndrome (AWS; Mulligan et al. 2005). This will have legal and ethical implications in sport and the need to apply for a therapeutic use exemption (TUE) would have to be considered against the need for patient con dentiality. For a TUE to be granted there needs to be full disclosure by the applicant. The conclusion that can be drawn from these studies is that the compromised exercise performance in the HIV infected athlete can be improved by aerobic and resistance exercise training. Effect of regular physical activity or exercise on the clinical outcome of HIV infection It is a well-documented fact that HIV infection affects the immune system directly. If exercise has
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Watch Out!
AN ANALYSIS OF THE AUDITING STANDARDS General Auditing Standards With respect to the general standards, adequate technical training and proficiency as an auditor implies that the individuals who are performing the audit are professional accountants (certified public accountants). Certified public accountants are requisite to the audit function since their major objective is to express an independent opinion on the financial statements. Their professional opinion is critically important to the users of the financial statements because such users need assurance on corporate management s financial accounting representations. Moreover, independent auditors have a duty of professional care whereby they must exercise their professional judgment with reasonable care and diligence. (Visit www.aicpa.org, Code of Professional Conduct.)
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