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Official Journal of the American College of Sports Medicine Vol. 52 No. 5 Supplement S641 F-06 Thematic Poster - Cardiovascular Health in 2942 Board #2 May 29 1:00 PM - 3:00 PM Firefighters Firefighters With More Service Have Smaller Blood Pressure Surge When The Pager Sounds Friday, May 29, 2020, 1:00 PM - 3:00 PM Megan A. Carty1, Rachel L. Dickinson2, Emily H. Reeve3, Emily Room: CC-2009 N. Blaszkow1, Julia Gilpin1, Brian Varani1, Meghan Lashley1, Paige E. DeAlba1, Deborah L. Feairheller4. 1Ursinus College, Collegeville, PA. 2Pennsylvania Dermatology Group, Huntington 2940 Chair: Denise L. Smith, FACSM. Skidmore College, Saratoga Valley, PA. 3University of Oregon, Eugene, OR. 4University of Springs, NY. New Hampshire, Durham, NH. (Sponsor: Deborah Feairheller, (No relevant relationships reported) FACSM) (No relevant relationships reported) 2941 Board #1 May 29 1:00 PM - 3:00 PM Cardiac incidents cause over 50% of LODD in firefighters (FF) and may be related to Acute Effects Of Firefighting On Vascular Health And their BP responses. Also, years of service may affect FF stress and depression levels Blood Pressure and impair overall health. Using ambulatory BP (ABP) monitoring to quantify the BP surge with alarm is a novel way to assess risk, and preliminary data showed that newer 1 2 3 Robert M. Restaino , Gavin P. Horn , Steve Kerber , Kenneth FF have higher BP surge. PURPOSE: To compare changes in health between FF with 4 5 6 1 W. Fent , Bo Fernhall , Denise L. Smith, FACSM . Skidmore <10yr service (FF-10) and FF with >10yr service (FF+10) after a 6-wk Mediterranean 2 College, Saratoga Springs, NY. University of Illinois Fire diet & circuit training program. METHODS: We included 21 FF who completed Service Institute, University of Illinois at Urbana-Champaign, a 6-wk intervention. Pre- and post-intervention testing included ABP monitoring Champaign, IL. 3UL Firefighter Safety Research Institute, with pager activation, a fasted clinical appt, and fitness testing. Participants wore the Columbia, MD. 4National Institute for Occupational Safety ABP cuff for 12-hrs, during which they were paged by a pager app (OnPage) or by and Health, Cincinnati, OH. 5University of Illinois at Chicago, emergency service dispatch. When the pager sounded, they were instructed to force an Chicago, IL. 6Skidmore College, Saratoga Springs, NY; ABP reading to assess the BP surge. Average BP levels and surges were determined. University of Illinois Fire Service Institute, University of Illinois Fasted visit included BP, body fat, lipid panel, and vascular health measures. Fitness at Urbana-Champaign, Champaign, IL. (Sponsor: Denise L. test included a treadmill VO2peak and a battery of other fitness tests. Participants also Smith, FACSM) completed a health history form and the DASS-21 questionnaire assessing stress, Email: [email protected] anxiety, and depression. RESULTS: FF+10 (N=12, 45.7 ± 3yrs) had worse health and lower BP surges, but larger improvements with intervention compared to FF-10 (No relevant relationships reported) (N=9, 36.8 ± 6.2yrs), P<0.05 for differences. FF+10 had lower HDL levels (38.3 ± 2.2 vs 57.9 ± 9.7 mg/dl), were heavier (213.1 ± 8.6 vs 205.1 ± 8.6 lbs), had higher Firefighting is strenuous and dangerous work. Sudden cardiac death accounts for average SBP (136.6 ± 4.8 vs 126.9 ± 3.6 mmHg) and DBP (83.2 ± 2.8 vs 75.7 ± 2.8 approximately 50% of firefighter line of duty deaths. PURPOSE: To determine the mmHg) levels, higher pre-alarm and post-alarm BP, but had a smaller surge in SBP vascular and hemodynamic responses firefighting work across different positional (11.6 ± 3.2 vs 15.0 ± 3.3 mmHg) and DBP (4.1 ± 2.7 vs 7.3 ± 1.7 mmHg) when the assignments. METHODS: 40 experienced male firefighters completed a coordinated pager sounded. FF+10 also had worse overall psychometric scores: higher DASS-21 fire attack in a wood frame residential structure. Responding personnel were classified 11.2 ± 5.3 vs 7.6 ± 1.3; depression 3.4 ± 1.3 vs 1.4 ± 0.3; and stress 5.4 ± 1.7 vs 3.3 based upon four separate positions (assignments), including: Outside Command, ± 0.5; but similar anxiety scores 2.4 ± 1.0 vs 3.0 ± 0.9. With intervention, in FF+10 Outside Vent, Inside fire suppression and search and rescue, Overhaul. Subjects we found that BP lowered, fitness improved, and psychosocial constructs improved. were equipped with an automated blood pressure and pulse wave analysis device for CONCLUSION: With this subset of baseline data, we show that FF+10 have smaller measurement of cardiovascular variables (Mean Arterial Pressure, Total Vascular BP surge, worse CV health, stress, and depression levels, but larger improvements with Resistance, Cardiac Output, Stroke Volume, Pulse-Wave Velocity). Measurements intervention compared to FF-10. Data confirms the importance of wellness programs were made before, immediately after, and 30 minutes after fire suppression activities for FF. in a single-story residential structure. RESULTS: Increased mean arterial pressure (MAP) measured prior to the exercise indicates an anticipatory rise in sympathetic activation across all positions (Table 1). Those performing Inside suppression/search 2943 Board #3 May 29 1:00 PM - 3:00 PM and rescue exhibited the greatest increase in MAP across all groups, with MAP Perturbations In Heart Rate And Heart Rate Variability remaining elevated immediately following the training exercise and a return to baseline Of Volunteer Firefighters Responding To Nighttime conditions occurring 30 minutes post training (Table 1). This group also exhibited the Calls greatest excursion in systolic blood pressure in response to training (Pre: 130.7 ± 12.7, 1 2 2 Post: 134.6 ± 17.3). : The vascular changes evidenced during acute Cory J. Coehoorn , Thomas W. Service , Jodie R. Gawryluk , CONCLUSIONS 2 1 firefighting may play a mechanistic role in the increased risk of sudden cardiac death Lynneth A. Stuart-Hill . Louisiana State University Shreveport, 2 with firefighting. Additional research is needed to better understand how these changes Shreveport, LA. University of Victoria, Victoria, BC, Canada. are related to myocardial blood flow. (No relevant relationships reported) Table 1, Data are expressed as Average (SD) Firefighters (FFs) can increase their risk of cardiovascular (CV) events >100-fold Outside Outside Inside Overhaul during emergency response. FF research has tended to analyze career FFs or a Command/Pump Vent career-volunteer blend, while neglecting to provide specific results for the volunteer 34.0 population. This leaves a gap in literature that seeks to understand the magnitude Age (years) 47.0 (3.9) 33.1 (6.8) 37.9 (8.6) (6.8) and duration of call-related perturbations. Autonomic tone (AT), measured by heart rate variability (HRV) is a non-invasive measure providing insight into CV risk and 26.9 BMI (kg/m2) 28.5 (3.2) 27.3 (3.4) 27.1 (2.9) resiliency, and stress response. PURPOSE: To identify the magnitude and duration (3.7) of changes in volunteer FFs’ autonomic CV control during night time emergency 103.6 103.8 response. METHODS: Eight male FFs (36.9 ± 12.1 years) wore monitors to track 2020 29, MAY FRIDAY, MAP (mmHg) Pre 107.6 (10.7) 103.1 (8.5) (5.7) (9.3) heart rate (HR) and R-R intervals from 1900-0700 on nights with, and without call response for a total of 12 calls. Data filtering preceded HRV analysis in both time 102.0 105.9 MAP (mmHg) Post 105.3 (10.6) 98.6 (9.5) and frequency domain. Data was organized into 15-minute epochs, focusing on: 15-0 (7.9) (9.8) (PRE) pre-dispatch, 0-15 (PC1) and 75-90 (PC2) post-dispatch, and 0-15 (WAKE) MAP (mmHg) 30min 102.3 when waking without a call. RESULTS: Compared to PRE, increases in the LF/ 105.1 (8.2) 99.3 (3.9) 97.4 (7.8) Post (9.2) HF ratio were observed at both PC1 (1.784 ± 1.345, p= .014), and PC2 (1.265 ± 1.238, p= .046) η2=.505 in the call condition. PRE-PC1 comparisons showed increases in HRMEAN (43 ± 13 bpm, p<.0005, η2=.837) and HRMAX (60 ± 22 bpm, p<.0005, η2=.923) at PC1, though only HRMEAN remained elevated from PRE values at PC2 (12 ± 8 bpm, p=.005). RMSSD and HF Power (HFp) decreased at PC1 (RMSSD:16.868 ± 8.100 ms, p=.001, η2=.781; HFp: 552.057 ± 311.930 ms2, p=.002, η2=.758), returning within PRE ranges by PC2. Comparisons of PC1 to normal WAKE revealed decreased HFp (234.726 ± 163.721 ms2, p=.002, η2=.577) and increases in both LF/HF (6.920 ± 5.044, p= .013, η2=.556) and HRMEAN (18 ± 13 bpm, p=.012, η2=.564). CONCLUSION: Results from the current study show sympathetic activation and parasympathetic withdrawal at PC1 and PC2 compared to Abstracts were prepared by the authors and printed as submitted. S642 Vol. 52 No. 5 Supplement MEDICINE & SCIENCE IN SPORTS & EXERCISE® PRE. This facilitated a rapid spike in HR to 85% of age-adjusted HRMAX. Compared and post- seasonal values. RESULTS: There were no seasonal effects observed on to waking normally, waking for call response evokes a distinctly different response resting heart rate variability, PWV, 3-nitrotyrosine, 8-isoprostane, TC, TG, LDL, blood where perturbations in AT tend to persist 90-minutes. This persistent ANS imbalance glucose, SBP, or DBP (p>0.05). A significant reduction occurred in HDL (Pre: 53 mg/ may indicate physiological perturbations that could explain increased atherosclerosis dL ± 14, Post: 45 mg/dL ± 18, p=0.043) and HbA1c increased (Pre: 5.2% ± 0.2 , Post: and CVD risk for FFs.
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  • Female Chronic Pelvic Pain Syndromes 1 Standard of Care

    Female Chronic Pelvic Pain Syndromes 1 Standard of Care

    BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Physical Therapy Standard of Care: Female Chronic Pelvic Pain Syndromes ICD 9 Codes: 719.45 Pain in the pelvic region 625.9 Vulvar/pelvic pain/vulvodynia/vestibulodynia (localized provoked vestibulodynia or unprovoked) 625.0 Dyspareunia 595.1 Interstitial cystitis/painful bladder syndrome 739.5 Pelvic floor dysfunction 569.42 Anal/rectal pain 564.6 Proctalgia fugax/spasm anal sphincter 724.79 Coccygodynia 781.3 Muscular incoordination (other possible pain diagnoses: prolapse 618.0) Case Type/Diagnosis: Chronic pelvic pain (CPP) can be defined as: “non-malignant pain perceived in structures related to the pelvis, in the anterior abdominal wall below the level of the umbilicus, the spine from T10 (ovarian nerve supply) or T12 (nerve supply to pelvic musculoskeletal structures) to S5, the perineum, and all external and internal tissues within these reference zones”. 1 Specifically, pelvic pain syndrome has been further defined as: “the occurrence of persistent or recurrent episodic pelvic pain associated with symptoms suggestive of lower urinary tract, sexual, bowel or gynecological dysfunction with no proven infection or other obvious pathology”.1 Generally, female pelvic pain has been defined as pain and dysfunction in and around the pelvic outlet, specifically the suprapubic, vulvar, and anal regions. A plethora of various terms/diagnoses encompass pelvic pain as a symptom, including but not limited to: chronic pelvic pain (CPP), vulvar pain, vulvodynia, vestibulitis/vestibulodynia (localized provoked vestibulodynia or unprovoked vestibulodynia), vaginismus, dyspareunia, interstitial cystitis (IC)/painful bladder syndrome (PBS), proctalgia fugax, levator ani syndrome, pelvic floor dysfunction, vulvodynia, vestibulitis/vestibulodynia dyspareunia, vaginismus, coccygodynia, levator ani syndrome, tension myaglia of the pelvic floor, shortened pelvic floor, and muscular incoordination of the pelvic floor muscles.