Healthcare practitioners, whom perform accurate sub-maximal exercise tests in healthy individuals, need to understand the physiological demands and normal cardiovascular (CV) responses with exercise. Exercise testing delivers valid information about the physiological systems of individuals that may identify healthy individuals at risk of developing future cardiovascular disease (CVD). Exercise is a common way to assess physiological stress experienced by an individual, because CV abnormalities that are not present at rest, can be elicited during exercise testing and be used to determine the adequacy of cardiac function. Cardiovascular markers like, resting heart rate (HR) and systolic blood pressure (SBP) have been used as simple non-invasive and useful biomarkers of the fundamental status of blood circulation and the CV system in healthy individuals. Studies have contributed to exercise under sub-maximal and maximal stress testing. Modern- day literature lacks information on the safe HR and SBP responses to an increase in workload during a sub-maximal exercise protocol in healthy individuals. Consequently, the first purpose of this study was to identify the current evidence in the literature on CV response during a sub-maximal incremental exercise protocol. Different protocols and modalities contribute to various CV responses over a wide age group and gender. Heart rate and SBP increases in a linear fashion with an increase in workload, irrespective of protocol and modality. The amount of this increase, or the response of these markers, is still a grey area in the literature, especially in healthy individuals. The second purpose of this study was to analyse the HR and SBP response in healthy adults during a sub-maximal incremental exercise test, with an increase in workload (watt). The systematic review found mean changes from baseline for HR and SBP to be 75.7% and 63.5% respectively, on bicycle protocols (N = 3). The treadmill protocols (N = 2) found similar mean changes from baseline of 113.3% for HR and 36.1% for SBP. Descriptive measures as well as Linear regression analyses were performed, using Generalised estimated equations (GEE). An independent t-test was used to compare the males with the female participants: HR and SBP response to an increase in workload (watt). GEE adjustments were made for age, body mass index (BMI) and workload (watt). Significant difference levels were set at p ≤ 0.05. The present once-off subject availability results revealed that male subjects were heavier and taller than their female counterparts (p ≤ 0.05). They also had a noteworthy higher SBPrest, as well as BMI (p ≤ 0.05). The results from the GEE analyses we presented prediction equation, with all variables significant, except for the BMI (p = 0.972 females; p = 0.169 males). In conclusion, the literature review indicated a lack of information on the HR and SBP response with workload in healthy adults. It is advised that further research is needed to test the prediction equations in healthy individuals to determine the validity and reliability. They need to be tested in a controlled clinical environment, where the participants are monitored more thoroughly. By putting these predicted equations to the test, healthcare practitioners will be able to identify an exaggerated HR and SBP response with an increase in workload. If the individual’s response is exaggerated, the healthcare practitioner can intervene to prevent future cardiovascular events. / Thesis (MSc (Biokinetics))--North-West University, Potchefstroom Campus, 2013

Healthcare practitioners, whom perform accurate sub-maximal exercise tests in healthy individuals, need to understand the physiological demands and normal cardiovascular (CV) responses with exercise. Exercise testing delivers valid information about the physiological systems of individuals that may identify healthy individuals at risk of developing future cardiovascular disease (CVD). Exercise is a common way to assess physiological stress experienced by an individual, because CV abnormalities that are not present at rest, can be elicited during exercise testing and be used to determine the adequacy of cardiac function. Cardiovascular markers like, resting heart rate (HR) and systolic blood pressure (SBP) have been used as simple non-invasive and useful biomarkers of the fundamental status of blood circulation and the CV system in healthy individuals. Studies have contributed to exercise under sub-maximal and maximal stress testing. Modern- day literature lacks information on the safe HR and SBP responses to an increase in workload during a sub-maximal exercise protocol in healthy individuals. Consequently, the first purpose of this study was to identify the current evidence in the literature on CV response during a sub-maximal incremental exercise protocol. Different protocols and modalities contribute to various CV responses over a wide age group and gender. Heart rate and SBP increases in a linear fashion with an increase in workload, irrespective of protocol and modality. The amount of this increase, or the response of these markers, is still a grey area in the literature, especially in healthy individuals. The second purpose of this study was to analyse the HR and SBP response in healthy adults during a sub-maximal incremental exercise test, with an increase in workload (watt). The systematic review found mean changes from baseline for HR and SBP to be 75.7% and 63.5% respectively, on bicycle protocols (N = 3). The treadmill protocols (N = 2) found similar mean changes from baseline of 113.3% for HR and 36.1% for SBP. Descriptive measures as well as Linear regression analyses were performed, using Generalised estimated equations (GEE). An independent t-test was used to compare the males with the female participants: HR and SBP response to an increase in workload (watt). GEE adjustments were made for age, body mass index (BMI) and workload (watt). Significant difference levels were set at p ≤ 0.05. The present once-off subject availability results revealed that male subjects were heavier and taller than their female counterparts (p ≤ 0.05). They also had a noteworthy higher SBPrest, as well as BMI (p ≤ 0.05). The results from the GEE analyses we presented prediction equation, with all variables significant, except for the BMI (p = 0.972 females; p = 0.169 males). In conclusion, the literature review indicated a lack of information on the HR and SBP response with workload in healthy adults. It is advised that further research is needed to test the prediction equations in healthy individuals to determine the validity and reliability. They need to be tested in a controlled clinical environment, where the participants are monitored more thoroughly. By putting these predicted equations to the test, healthcare practitioners will be able to identify an exaggerated HR and SBP response with an increase in workload. If the individual’s response is exaggerated, the healthcare practitioner can intervene to prevent future cardiovascular events. / Thesis (MSc (Biokinetics))--North-West University, Potchefstroom Campus, 2013

Motivation: Recently, with urbanisation becoming an increasing trend, the African population have been introduced to the westernised lifestyle. This contributed to severe health implications and a rapid increase in cardiovascular morbidity and mortality in the African population. In South Africa and other sub–Saharan African countries, the prevalence of cardiovascular disease is increasing rapidly. The African population is thus regarded as a high risk group, and we deem it necessary and important to investigate additional possible cardiovascular risk markers in the attempt to improve the diagnosis of cardiovascular diseases and the treatment thereof. We investigate double product as a possible cardiovascular risk marker in African and Caucasian men from South Africa. Recent studies have suggested that increased double product values might be an independent predictor of cardiovascular morbidity and mortality. However, investigations on double product and endorgan damage are limited in this population group. The strength of associations between double product and various measurements of end–organ damage, including intima–media thickness, left ventricular hypertrophy and albumin–to–creatinine ratio, are compared with the associations between the more traditional risk factor, systolic blood pressure, and the measurements of end–organ damage. Aim: The aim of this study is to investigate the usability of double product as a possible cardiovascular risk marker in African and Caucasian men from South Africa. Methodology: The manuscript presented in Chapter 3 made use of the cross–sectional SABPA (Sympathetic Activity and Ambulatory Blood Pressure in Africans) study, where 101 urbanised African and 101 Caucasian male school teachers from the North West Province of South Africa were recruited. Anthropometric measurements were taken in triplicate using standard methods. The cardiovascular measurements included 24–hour ambulatory blood pressure and electrocardiogram measurements. Double products were calculated as the product of 24–hour, daytime and night–time mean systolic blood pressure and mean heart rate values. The carotid intima–media thickness was also obtained following the prescribed protocols. A registered nurse collected blood samples and the biochemical measurements were performed by independent laboratories, blinded to the subject’s cardiovascular profile. Means and proportions were compared by standard t–tests and the x2 –tests, respectively. The association between markers of end–organ damage and double product were investigated using single, partial and multiple regression analyses. All p–values <= 0.05 were deemed significant. Results and conclusions: Results from this study showed that Africans displayed significantly higher systolic blood pressure values, heart rate values and subsequent double product values compared to the Caucasians. Despite these significant differences, double product only showed borderline significant correlations with the markers of end–organ damage in African men, while no correlations were evident in Caucasian men. In African men, systolic blood pressure displayed stronger and significant correlations with intimamedia thickness, left ventricular hypertrophy, and albumin–to–creatinine ratio than double product. These findings suggest that double product may not be a good marker of increased risk for end–organ damage and subsequent cardiovascular–related mortality. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2011.

Motivation: Recently, with urbanisation becoming an increasing trend, the African population have been introduced to the westernised lifestyle. This contributed to severe health implications and a rapid increase in cardiovascular morbidity and mortality in the African population. In South Africa and other sub–Saharan African countries, the prevalence of cardiovascular disease is increasing rapidly. The African population is thus regarded as a high risk group, and we deem it necessary and important to investigate additional possible cardiovascular risk markers in the attempt to improve the diagnosis of cardiovascular diseases and the treatment thereof. We investigate double product as a possible cardiovascular risk marker in African and Caucasian men from South Africa. Recent studies have suggested that increased double product values might be an independent predictor of cardiovascular morbidity and mortality. However, investigations on double product and endorgan damage are limited in this population group. The strength of associations between double product and various measurements of end–organ damage, including intima–media thickness, left ventricular hypertrophy and albumin–to–creatinine ratio, are compared with the associations between the more traditional risk factor, systolic blood pressure, and the measurements of end–organ damage. Aim: The aim of this study is to investigate the usability of double product as a possible cardiovascular risk marker in African and Caucasian men from South Africa. Methodology: The manuscript presented in Chapter 3 made use of the cross–sectional SABPA (Sympathetic Activity and Ambulatory Blood Pressure in Africans) study, where 101 urbanised African and 101 Caucasian male school teachers from the North West Province of South Africa were recruited. Anthropometric measurements were taken in triplicate using standard methods. The cardiovascular measurements included 24–hour ambulatory blood pressure and electrocardiogram measurements. Double products were calculated as the product of 24–hour, daytime and night–time mean systolic blood pressure and mean heart rate values. The carotid intima–media thickness was also obtained following the prescribed protocols. A registered nurse collected blood samples and the biochemical measurements were performed by independent laboratories, blinded to the subject’s cardiovascular profile. Means and proportions were compared by standard t–tests and the x2 –tests, respectively. The association between markers of end–organ damage and double product were investigated using single, partial and multiple regression analyses. All p–values <= 0.05 were deemed significant. Results and conclusions: Results from this study showed that Africans displayed significantly higher systolic blood pressure values, heart rate values and subsequent double product values compared to the Caucasians. Despite these significant differences, double product only showed borderline significant correlations with the markers of end–organ damage in African men, while no correlations were evident in Caucasian men. In African men, systolic blood pressure displayed stronger and significant correlations with intimamedia thickness, left ventricular hypertrophy, and albumin–to–creatinine ratio than double product. These findings suggest that double product may not be a good marker of increased risk for end–organ damage and subsequent cardiovascular–related mortality. / Thesis (M.Sc. (Physiology))--North-West University, Potchefstroom Campus, 2011.

The potential to track changes in training status and fitness levels of especially team sport participants by making use of more time efficient and accessible methods such as heart rate variability (HRV) and heart rate recovery (HRR) cannot be overlooked and needs to be considered. However, studies that have investigated this aspect in team sport participants are scarce. It is against this background that the main objectives of this study were firstly, to determine the relationships between HRV and HRR as well as the fitness levels of a cohort of university-level rugby players. The second objective was to determine the validity of the BioForce Heart Rate Variability System to determine the HRV of a cohort of university-level rugby players. Twenty-four university-level rugby players (age: 20.1 ± 0.41 years; body stature: 182.7 ± 6.2 cm; body mass: 89.7 ± 12.7 kg) of a South African university’s Rugby Institute participated in the first part of the study. During the test day players’ fasting baseline HRV (baseline HRV) values were taken. This was followed by the measurement of the post-breakfast HRV (Pre-Yo-Yo IR1 HRV). Players were then required to perform the Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo IR1) while they were fitted with a portable Cosmed K4b2 gas analyser apparatus and a Fix Polar Heart Rate Transmitter Belt. After completion of the test, HRR was taken on 1 and 3 minutes and followed by the measurement of HRV (Post-Yo-Yo IR1 HRV). For the second part of the study a group of twenty u/21 university-level rugby players (age: 20.06 ± 0.40 years; body stature: 181.8 ± 5.5 cm; body mass: 91.1 ± 10.7 kg) of a South African university’s Rugby Institute were recruited to participate in this study. HRV was measured simultaneously by the Actiheart monitor system as well as the BioForce Heart Rate Variability System over three times periods: during the morning in a fasting state just after players had woken up (baseline); in the morning just after the players ate breakfast (pre-anaerobic); after completion of a high-intensity anaerobic training session (post-anaerobic) and after completion of a 20 min recovery session (post-recovery). Significant correlations (p ≤ 0.05) were found between Pre-Yo-Yo IR1 HRV and heart rate (HR) at the respiratory compensation point (RCP-HR (bpm)) (r = -0.468) as well as oxygen uptake at the RCP (RCP- 2max VO (% of 2max VO )) (r = 0.476), respectively. A forward stepwise regression analysis showed that HR at ventilatory threshold 1 (VT1-HR (bpm)) contributed significantly (p ≤ 0.05) to the post-Yo-Yo IR1 HRV with a variance of 39.8%. Final Yo-Yo IR1 level also contributed significantly (p ≤ 0.05) to 3 minute post-Yo-Yo IR1 HRR with a variance of 16.5%. For the second part of the study the majority of significant relationships (p < 0.05) between the Actiheart and Bioforce obtained HRV results were observed for the post-recovery period (Mean RR, SDNN, RMSSD and Peak LF power), followed by the pre-anaerobic period (Mean R-R and SDNN) and the baseline period (LF:HF ratio). No significant relationships were observed between the HRV results of the two apparatuses during the post-anaerobic period. In conclusion, HRV and HRR may have the potential to act as affordable and easy measurement tools of team sport participants’ fitness levels. However, the study results suggested that the BioForce Heart Rate Variability System that is used to obtain team sport participants’ HRV is especially valid to determine HRV after recovery periods that follow hard training sessions. The results do however cast a shadow of doubt over the accuracy of this apparatus when used directly after hard training sessions. / MSc (Sport Science), North-West University, Potchefstroom Campus, 2014

The potential to track changes in training status and fitness levels of especially team sport participants by making use of more time efficient and accessible methods such as heart rate variability (HRV) and heart rate recovery (HRR) cannot be overlooked and needs to be considered. However, studies that have investigated this aspect in team sport participants are scarce. It is against this background that the main objectives of this study were firstly, to determine the relationships between HRV and HRR as well as the fitness levels of a cohort of university-level rugby players. The second objective was to determine the validity of the BioForce Heart Rate Variability System to determine the HRV of a cohort of university-level rugby players. Twenty-four university-level rugby players (age: 20.1 ± 0.41 years; body stature: 182.7 ± 6.2 cm; body mass: 89.7 ± 12.7 kg) of a South African university’s Rugby Institute participated in the first part of the study. During the test day players’ fasting baseline HRV (baseline HRV) values were taken. This was followed by the measurement of the post-breakfast HRV (Pre-Yo-Yo IR1 HRV). Players were then required to perform the Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo IR1) while they were fitted with a portable Cosmed K4b2 gas analyser apparatus and a Fix Polar Heart Rate Transmitter Belt. After completion of the test, HRR was taken on 1 and 3 minutes and followed by the measurement of HRV (Post-Yo-Yo IR1 HRV). For the second part of the study a group of twenty u/21 university-level rugby players (age: 20.06 ± 0.40 years; body stature: 181.8 ± 5.5 cm; body mass: 91.1 ± 10.7 kg) of a South African university’s Rugby Institute were recruited to participate in this study. HRV was measured simultaneously by the Actiheart monitor system as well as the BioForce Heart Rate Variability System over three times periods: during the morning in a fasting state just after players had woken up (baseline); in the morning just after the players ate breakfast (pre-anaerobic); after completion of a high-intensity anaerobic training session (post-anaerobic) and after completion of a 20 min recovery session (post-recovery). Significant correlations (p ≤ 0.05) were found between Pre-Yo-Yo IR1 HRV and heart rate (HR) at the respiratory compensation point (RCP-HR (bpm)) (r = -0.468) as well as oxygen uptake at the RCP (RCP- 2max VO (% of 2max VO )) (r = 0.476), respectively. A forward stepwise regression analysis showed that HR at ventilatory threshold 1 (VT1-HR (bpm)) contributed significantly (p ≤ 0.05) to the post-Yo-Yo IR1 HRV with a variance of 39.8%. Final Yo-Yo IR1 level also contributed significantly (p ≤ 0.05) to 3 minute post-Yo-Yo IR1 HRR with a variance of 16.5%. For the second part of the study the majority of significant relationships (p < 0.05) between the Actiheart and Bioforce obtained HRV results were observed for the post-recovery period (Mean RR, SDNN, RMSSD and Peak LF power), followed by the pre-anaerobic period (Mean R-R and SDNN) and the baseline period (LF:HF ratio). No significant relationships were observed between the HRV results of the two apparatuses during the post-anaerobic period. In conclusion, HRV and HRR may have the potential to act as affordable and easy measurement tools of team sport participants’ fitness levels. However, the study results suggested that the BioForce Heart Rate Variability System that is used to obtain team sport participants’ HRV is especially valid to determine HRV after recovery periods that follow hard training sessions. The results do however cast a shadow of doubt over the accuracy of this apparatus when used directly after hard training sessions. / MSc (Sport Science), North-West University, Potchefstroom Campus, 2014

Worldwide research regarding the movement patterns, heart rate recordings and work–to–rest ratios of rugby union referees is very limited. It is therefore very important to extend research regarding this topic. The first objective of this dissertation was to determine the frequency, duration and intensity of movement patterns and work–to–rest ratio of different refereeing panels of South African Rugby Union referees during match–refereeing at the National Club Rugby Championship in Stellenbosch during 2007. The second objective was to compare the two halves of the match with regard to the frequency, duration and intensity of the different movement patterns and the work–to–rest ratios of various of SARU referees during match–refereeing at the National Club Rugby Championship in Stellenbosch during 2007. The South African Rugby Union referees were monitored during match–refereeing by means of video and heart rate recordings for a total of 16 matches within a week tournament. The frequency and duration of the different movement patterns during both halves of the matches were analysed using a Dartfish TeamPro analysis software package. Heart rates were recorded during the matches to determine the movement pattern intensities of the referees for the duration of each match using a Suunto Team pack heart rate monitoring system. The work–to–rest ratios were determined by comparing the time (in seconds) spent working (lateral movements and sprinting) to the time spent resting (standing still, walking and jogging). The results revealed a moderate practical significant difference (d=0.51) between the mean frequency of jogging movement patterns for the different refereeing panels. A moderate practical significant difference was also found between the mean duration of jogging (d=0.43) and sprinting (d=0.43) movement patterns of different refereeing panels. The mean intensity of the movement patterns by the different refereeing panels showed large practical significant differences between the anaerobic threshold (d=3.68) and sub–threshold (d=1.36) levels and a moderate practical significant difference for the maximal heart rate zones (d=0.43). Both the provincial and contender panel referees had work–to–rest ratios of 1:4 during match–refereeing. In comparing the two halves of rugby match–refereeing, a large practical significant difference was found between the mean frequency of movement pattern values for standing still (d=2.53), walking (d=2.50), jogging (d=2.42), lateral movements (d=2.86) and sprinting (d=1.31) as well as for mean duration of movement pattern values for standing still (d=2.05), lateral movements (d=0.76) and sprinting (d=0.77). Large practical significant difference were found between the time spent in the maximal threshold (d=2.07), anaerobic threshold (d=0.92) and sub–threshold (d=7.90) heart rate zones measured during the two halves of match–refereeing. Average work–to–rest ratios of 1:3.5 and 1:5 were found for the first and second halves of rugby match–refereeing, respectively. The information gained regarding the activity profile of SARU referees could be used to determine the influence of rugby refereeing experience on the movement patterns and work–to–rest ratio of rugby referees. It can also provide information for constructing specific training programmes and drills in the development of rugby match–required fitness standards for referees. A key component of a rugby union referee’s game is positioning. Being in the right place at the right time is vital. The results of this study suggest that movements associated with positioning ? namely standing still, walking and lateral movements are the major components of the game of referees’ movement during match–refereeing. However, further research is required on this topic of research. / Thesis (M.A. (Sport Science))--North-West University, Potchefstroom Campus, 2012.

Worldwide research regarding the movement patterns, heart rate recordings and work–to–rest ratios of rugby union referees is very limited. It is therefore very important to extend research regarding this topic. The first objective of this dissertation was to determine the frequency, duration and intensity of movement patterns and work–to–rest ratio of different refereeing panels of South African Rugby Union referees during match–refereeing at the National Club Rugby Championship in Stellenbosch during 2007. The second objective was to compare the two halves of the match with regard to the frequency, duration and intensity of the different movement patterns and the work–to–rest ratios of various of SARU referees during match–refereeing at the National Club Rugby Championship in Stellenbosch during 2007. The South African Rugby Union referees were monitored during match–refereeing by means of video and heart rate recordings for a total of 16 matches within a week tournament. The frequency and duration of the different movement patterns during both halves of the matches were analysed using a Dartfish TeamPro analysis software package. Heart rates were recorded during the matches to determine the movement pattern intensities of the referees for the duration of each match using a Suunto Team pack heart rate monitoring system. The work–to–rest ratios were determined by comparing the time (in seconds) spent working (lateral movements and sprinting) to the time spent resting (standing still, walking and jogging). The results revealed a moderate practical significant difference (d=0.51) between the mean frequency of jogging movement patterns for the different refereeing panels. A moderate practical significant difference was also found between the mean duration of jogging (d=0.43) and sprinting (d=0.43) movement patterns of different refereeing panels. The mean intensity of the movement patterns by the different refereeing panels showed large practical significant differences between the anaerobic threshold (d=3.68) and sub–threshold (d=1.36) levels and a moderate practical significant difference for the maximal heart rate zones (d=0.43). Both the provincial and contender panel referees had work–to–rest ratios of 1:4 during match–refereeing. In comparing the two halves of rugby match–refereeing, a large practical significant difference was found between the mean frequency of movement pattern values for standing still (d=2.53), walking (d=2.50), jogging (d=2.42), lateral movements (d=2.86) and sprinting (d=1.31) as well as for mean duration of movement pattern values for standing still (d=2.05), lateral movements (d=0.76) and sprinting (d=0.77). Large practical significant difference were found between the time spent in the maximal threshold (d=2.07), anaerobic threshold (d=0.92) and sub–threshold (d=7.90) heart rate zones measured during the two halves of match–refereeing. Average work–to–rest ratios of 1:3.5 and 1:5 were found for the first and second halves of rugby match–refereeing, respectively. The information gained regarding the activity profile of SARU referees could be used to determine the influence of rugby refereeing experience on the movement patterns and work–to–rest ratio of rugby referees. It can also provide information for constructing specific training programmes and drills in the development of rugby match–required fitness standards for referees. A key component of a rugby union referee’s game is positioning. Being in the right place at the right time is vital. The results of this study suggest that movements associated with positioning ? namely standing still, walking and lateral movements are the major components of the game of referees’ movement during match–refereeing. However, further research is required on this topic of research. / Thesis (M.A. (Sport Science))--North-West University, Potchefstroom Campus, 2012.