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BackgroundCurrent data on the management of patients in cardiac rehabilitation (CR) after an acute hospital stay due to ST-segment elevation or non-ST segment elevation acute coronary syndromes (STE-ACS or NSTE-ACS) are limited. We aimed to describe patient characteristics, risk factor management, and lipid target achievement of patients in CR in Germany and compare the 2 groups.
HypothesisWith respect to the risk factor pattern and treatment effects during a CR stay, there are important differences between STE-ACS and NSTE-ACS patients.
MethodsComparison of 7950 patients by STE-ACS or NSTE-ACS status in the Transparency Registry to Objectify Guideline-Oriented Risk Factor Management registry (2010) who underwent an inpatient CR period of about 3 weeks.
ResultsSTE-ACS patients compared to NSTE-ACS patients were significantly younger (60.5 vs 64.4 years, P < 0.0001), and had diabetes mellitus, hypertension, or any risk factor (exception: smoking) less often. At discharge, in STE-ACS compared to NSTE-ACS patients, the low-density lipoprotein cholesterol (LDL-C) <100 mg/dL goal was achieved by 75.3% and 76.2%, respectively (LDL-C <70 mg/dL by 27.7% and 27.4%), the high-density lipoprotein cholesterol goal of >50 mg/dL in women and >40 mg/dL in men was achieved by 49.3% and 49.0%, respectively, and the triglycerides goal of <150 mg/dl was achievedby 72.3% and 74.3%, respectively (all comparisons not significant). Mean systolic and diastolic blood pressure were 121/74 and 123/74 mm Hg, respectively (P < 0.0001 systolic, diastolic not significant). The maximum exercise capacity was 110 and 102 W, respectively (P < 0.0001), and the maximum walking distance was 581 and 451 meters, respectively (P value not significant).
ConclusionsPatients with STE-ACS and NSTE-ACS differed moderately in their baseline characteristics. Both groups benefited from the participation in CR, as their lipid profile, blood pressure, and physical fitness improved.
Mueller, J, Mueller, S, Stoll, J, Baur, H, and Mayer, F. Trunk extensor and flexor strength capacity in healthy young elite athletes aged 11-15 years. J Strength Cond Res 28(5): 1328-1334, 2014-Differences in trunk strength capacity because of gender and sports are well documented in adults. In contrast, data concerning young athletes are sparse. The purpose of this study was to assess the maximum trunk strength of adolescent athletes and to investigate differences between genders and age groups. A total of 520 young athletes were recruited. Finally, 377 (n = 233/144 M/F; 13 +/- 1 years; 1.62 +/- 0.11 m height; 51 +/- 12 kg mass; training: 4.5 +/- 2.6 years; training sessions/week: 4.3 +/- 3.0; various sports) young athletes were included in the final data analysis. Furthermore, 5 age groups were differentiated (age groups: 11, 12, 13, 14, and 15 years; n = 90, 150, 42, 43, and 52, respectively). Maximum strength of trunk flexors (Flex) and extensors (Ext) was assessed in all subjects during isokinetic concentric measurements (60 degrees center dot s(-1); 5 repetitions; range of motion: 55 degrees). Maximum strength was characterized by absolute peak torque (Flex(abs), Ext(abs); N center dot m), peak torque normalized to body weight (Flex(norm), Ext(norm); N center dot m center dot kg(-1) BW), and Flex(abs)/Ext(abs) ratio (RKquot). Descriptive data analysis (mean +/- SD) was completed, followed by analysis of variance (alpha = 0.05; post hoc test [Tukey-Kramer]). Mean maximum strength for all athletes was 97 +/- 34 N center dot m in Flex(abs) and 140 +/- 50 N center dot m in Ext(abs) (Flex(norm) = 1.9 +/- 0.3 N center dot m center dot kg(-1) BW, Ext(norm) = 2.8 +/- 0.6 N center dot m center dot kg(-1) BW). Males showed statistically significant higher absolute and normalized values compared with females (p < 0.001). Flex(abs) and Ext(abs) rose with increasing age almost 2-fold for males and females (Flex(abs), Ext(abs): p < 0.001). Flex(norm) and Ext(norm) increased with age for males (p < 0.001), however, not for females (Flex(norm): p = 0.26; Ext(norm): p = 0.20). RKquot (mean +/- SD: 0.71 +/- 0.16) did not reveal any differences regarding age (p = 0.87) or gender (p = 0.43). In adolescent athletes, maximum trunk strength must be discussed in a gender- and age-specific context. The Flex(abs)/Ext(abs) ratio revealed extensor dominance, which seems to be independent of age and gender. The values assessed may serve as a basis to evaluate and discuss trunk strength in athletes.
Objectives-Sonography of muscle architecture provides physicians and researchers with information about muscle function and muscle-related disorders. Inter-rater reliability is a crucial parameter in daily clinical routines. The aim of this study was to assess the inter-rater reliability of sonographic muscle architecture assessments and quantification of errors that arise from inconsistent probe positioning and image interpretation.
Results-Inter-rater reliability was good overall (ICC, 0.77-0.90; IRV, 9.0%-13.4%; bias LoA, 0.2 +/- 0.2-1.7 +/- 3.0). Superior and inferior pennation angles showed high systematic bias and LoA in all setups, ranging from 2.0 degrees +/- 2.2 degrees to 3.4 degrees +/- 4.1 degrees. The highest IRV was found for muscle thickness (13.4%). "When the probe position was standardized, the SEM for muscle thickness decreased from 0.1 to 0.05 cm.
Conclusions-Sonographic examination of muscle architecture of the medial gastrocnemius has good to high reliability. In contrast to pennation angle measurements, length measurements can be improved by standardization of the probe position.
Reliability of ultrasound measurements for subcutaneous adipose tissue in elite canoe athletes
(2014)
Flexion-extension ratio of trunk peak torque measures and antagonistic activity in males and females
(2014)
Background: Cross-sectional studies detected associations between physical fitness, living area, and sports participation in children. Yet, their scientific value is limited because the identification of cause-and-effect relationships is not possible. In a longitudinal approach, we examined the effects of living area and sports club participation on physical fitness development in primary school children from classes 3 to 6.
Methods: One-hundred and seventy-two children (age: 9-12 years; sex: 69 girls, 103 boys) were tested for their physical fitness (i.e., endurance [9-min run], speed [50-m sprint], lower- [triple hop] and upper-extremity muscle strength [1-kg ball push], flexibility [stand-and-reach], and coordination [star coordination run]). Living area (i.e., urban or rural) and sports club participation were assessed using parent questionnaire.
Results: Over the 4 year study period, urban compared to rural children showed significantly better performance development for upper- (p = 0.009, ES = 0.16) and lower-extremity strength (p < 0.001, ES = 0.22). Further, significantly better performance development were found for endurance (p = 0.08, ES = 0.19) and lower-extremity strength (p = 0.024, ES = 0.23) for children continuously participating in sports clubs compared to their non-participating peers.
Conclusions: Our findings suggest that sport club programs with appealing arrangements appear to represent a good means to promote physical fitness in children living in rural areas.
Age-related changes in prefrontal activity during walking in dual-task situations: A fNIRS study
(2014)
Background: Previous studies suggest that the human gait is under control of higher-order cognitive processes, located in the frontal lobes, such that an age-related degradation of cognitive capabilities has a negative impact on gait.
Results: Our behavioral data partly confirm previous accounts on higher dual-task costs in stepping parameters (i.e., decreased step duration) in old age, particularly with a visual task and negative dual-task cost (i.e., improved performance) during the verbal task in young adults. Functional imaging data revealed little change of prefrontal activation from single- to dual-task walking in young individuals. In the elderly, however, prefrontal activation substantially decreased during dual-task walking with a complex visual task.
Conclusion: We interpret these findings as evidence for a shift of processing resources from the prefrontal cortex to other brain regions when seniors face the challenge of walking and concurrently executing a visually demanding task. (C) 2014 Elsevier B.V. All rights reserved.
The purpose of this study was to assess intrasession and intersession reliability of maximal and explosive isometric torque production of the elbow flexors and its respective neuromuscular activation pattern. Subjects (13 men, age: 24.8 +/- 3.1 years, height: 1.9 +/- 0.1 m, body mass: 83.7 +/- 12.7 kg; and 6 women, age: 26.5 +/- 1.4 years, height: 1.7 +/- 0.1 m, body mass: 62.7 +/- 7.0 kg) were tested and retested 2-7 days later performing unilateral maximal isometric elbow flexions. Absolute (coefficient of variation[CV], test-retest variability[TRV], Bland-Altman plots with 95% limits of agreement) and relative reliability statistics (intraclass correlation coefficient) were calculated for various mechanical (i.e., maximal isometric torque, rate of torque development, impulse) and electromyographical measures (i.e., mean average voltage) at different time intervals relative to onset of torque (i. e., 30, 50, 100, 200, 300, 400, 100-200 ms). Intraclass correlation coefficient values were >= 0.61 for all mechanical and electromyographical measures and time intervals indicating good to excellent intrasession and intersession reliability. BlandAltman plots confirmed these findings by showing that only 0-2 (<= 3.3%) data points were beyond the limits of agreement. Regarding torque and electromyographic measures, CV (11.9-32.3%) and TRV (18.4-53.8%) values were high during the early intervals of torque development (<= 100 ms) indicating high variability. During the later intervals (>100 ms), lower CV (i. e., 5.0-29.9%) and TRV values (i.e., 5.4-34.6%) were observed indicating lower variability. The present study revealed that neuromuscular performance during explosive torque production of the elbow flexors is reproducible in time intervals >100 ms after onset of isometric actions, whereas during earlier time intervals variability is high.
We sought to investigate the effects of wearing a mobile respiratory gas analysis system during a treadmill test on blood lactate (bLa) concentrations and commonly applied bLa thresholds. A total of 16 recreational athletes (31 +/- 3 years, V0205: 58 6 ml min(-1)-kg(-1)) performed one multistage treadmill test with and one without gas exchange measurements (GEM and noGEM). The whole bLa curve, the lactate threshold (LT), the individual anaerobic thresholds according to Stegmann(IAT(sr)) and Dickhuth (IAT(Di)), and a fixed bLa concentration of 4 mmob.l(-1) (OBLA) were evaluated. The bLa curve was shifted slightly leftward in GEM compared to noGEM (P<0.05), whereas the heart rate response was not different between conditions (P= 0.89). There was no difference between GEM and noGEM for LT (2.61 +/- 0.34 vs. 2.64 +/- 0.39 m(-1) s(-1) P=0.49) and IAT(st) (3.47 +/- 0.42 vs. 3.55 +/- 0.47m-s(-1), P=0.12). However, IATD(Di) (3.57 +/- 0.39 vs. 3.66 +/- 0.44m-s(-1), P<0.01) and OBLA (3.85 +/- 0.46 vs. 3.96 +/- 0.47m-s-1, P<0.01) occurred at slower running velocities in GEM. The bLa response to treadmill tests is mildly affected by wearing a mobile gas analysis system. This also applies to bLa thresholds located at higher exercise intensities. While the magnitude of the effects is of little importance for recreational athletes, it might be relevant for elite athletes and scientific studies.
Changes in performance parameters over four consecutive maximal incremental cycling tests were investigated to determine how many tests can be performed within one single day without negatively affecting performance. Sixteen male and female subjects (eight trained (T): 25 +/- 3 yr, BMI 22.6 +/- 2.5 kg center dot m(-2), maximal power output (P-max) 4.6 +/- 0.5 W center dot kg(-1); eight untrained (UT): 27 +/- 3 yr, BMI 22.3 +/- 1.2 kg center dot m(-2), P-max 2.9 +/- 0.3 W center dot kg(-1)) performed four successive maximal incremental cycling tests separated by 1.5 h of passive rest. Individual energy requirements were covered by standardised meals between trials. Maximal oxygen uptake (VO2max) remained unchanged over the four tests in both groups (P = 0.20 and P = 0.33, respectively). P-max did not change in the T group (P = 0.32), but decreased from the third test in the UT group (P < 0.01). Heart rate responses to submaximal exercise were elevated from the third test in the T group and from the second test in the UT group (P < 0.05). The increase in blood lactate shifted rightward over the four tests in both groups (P < 0.001 and P < 0.01, respectively). Exercise-induced net increases in epinephrine and norepinephrine were not different between the tests in either group (P 0.15). If VO2max is the main parameter of interest, trained and untrained individuals can perform at least four maximal incremental cycling tests per day. However, because other parameters changed after the first and second test, respectively, no more than one test per day should be performed if parameters other than VO2max are the prime focus.
Methods: We approached a group of 61 male competitive bodybuilders and collected urine samples for biochemical testing. The pictorial doping Brief Implicit Association Test (BIAT) was used for attitude measurement. This test quantifies the difference in response latencies (in milliseconds) to stimuli representing related concepts (i.e. doping-dislike/like-[health food]).
Zusammenfassung
Hintergrund: Patienten mit koronarer Herzkrankheit verfugen uber eine altersentsprechend reduzierte korperliche Leistungsfahigkeit. Um in Abhangigkeit bestehender Patientencharakteristika ein zielgruppenspezifisches Training wahrend kardiologischer Rehabilitation zu ermoglichen, ist die Kenntnis von Einflussgro ss en auf die Steigerung der Leistungsfahigkeit wunschenswert.
Methodik: In einem bundesweiten Register (TROL) wurden 47286 Patienten (mittleres Alter: 6411,62 Jahre; 74,5% Manner) eingeschlossen. Alle Patienten absolvierten zu Beginn und zum Ende der Rehabilitation einen fahrradergometrischen Belastungstest. Als abhangige Variable fur die univariate Analyse und die multivariate logistische Regression galt die Steigerung der Belastbarkeit, die uber einen Cut-off-Wert von 15 Watt Leistungszuwachs definiert wurde. Als Einflussfaktoren gingen Komorbiditaten und eine vor dem Index-Ereignis bestehende korperliche Aktivitat von>90Min/Woche in die Analyse ein.
Ergebnisse: Die Leistungssteigerung aktiver im Vergleich zu inaktiven Patienten war signifikant hoher (21,84 Watt vs. 16,35 Watt; p<0,001). Korperliche Aktivitat vor dem Ereignis (Odds Ratio - OR 1,85 [95% Konfidenzintervall - CI: 1,75-1,97]) sowie mannliches Geschlecht (OR 1,62 [95% CI: 1,51-1,74]) konnten als positive, Komorbiditaten und Alter (OR 0,82 [95% CI: 0,74-0,90]) als negative Pradiktoren identifiziert werden.
Schlussfolgerung: Zukunftig sollten in kardiologischen Rehabilitationseinrichtungen zielgruppenspezifische Trainingsprogramme eingesetzt werden, die die eingeschrankte Leistungsfahigkeit alterer und durch Komorbiditat limitierter Patienten berucksichtigt.
Abstract
Objective Patients who suffered from an acute coronary syndrome (ACS) boast a low exercise capacity (EC). To enhance EC is a core component of cardiac rehabilitation (CR). The aim of the study was to investigate predictors of exercise capacity to optimize the rehabilitation process in untrained subgroups.
Method: 47286 patients (mean age 6411.62, 74.5% male) were enclosed in the TROL registry. All patients underwent a bicycle stress test at admission and discharge. The dependent variable for the univariate analysis and multivariate logistic regression was the increase of EC during CR, with a cutoff of 15 Watts (pre/post design). Furthermore comorbidities and physical activity before the index event were analyzed.
Results: Exercise capacity enhancement differs between active and inactive patients significantly (21.84 Watt vs. 16.35 Watt; p<0.001). While a male gender (OR 1.62 [95% CI: 1.51-1.74]) and physical activity before rehabilitation (OR 1.85 [95% CI: 1.75-1.97]) were positive, comorbidities and age (OR 0.82 [95% CI: 0.74-0.90]) were negative predictors.
Conclusion: In cardiac rehabilitation settings special exercise training programs for elderly and comorbid patients are needed, to enhance their exercise capacity sufficiently.
Potential cost-effectiveness of therapeutic drug monitoring in patients with resistant hypertension
(2014)
Background: Nonadherence to drug therapy poses a significant problem in the treatment of patients with presumed resistant hypertension. It has been shown that therapeutic drug monitoring (TDM) is a useful tool for detecting nonadherence and identifying barriers to treatment adherence, leading to effective blood pressure (BP) control. However, the cost-effectiveness of TDM in the management of resistant hypertension has not been investigated.
Results: In the age group of 60-year olds, TDM gained 1.07 QALYs in men and 0.97 QALYs in women at additional costs of (sic)3854 and (sic)3922, respectively. Given a willingness-to-pay threshold of (sic)35 000 per QALY gained, the probability of TDM being cost-effective was 95% or more in all age groups from 30 to 90 years. Results were influenced mostly by the frequency of TDM testing, the rate of nonresponders to TDM, and the magnitude of effect of TDM on BP.
Conclusion: Therapeutic drug monitoring presents a potential cost-effective healthcare intervention in patients diagnosed with resistant hypertension. Importantly, this finding is valid for a wide range of patients, independent of sex and age.
The goals of this study were to test whether exercise-related stimuli can elicit automatic evaluative responses and whether automatic evaluations reflect exercise setting preference in highly active exercisers. An adapted version of the Affect Misattribution Procedure was employed. Seventy-two highly active exercisers (26 years +/- 9.03; 43% female) were subliminally primed (7 ms) with pictures depicting typical fitness center scenarios or gray rectangles (control primes). After each prime, participants consciously evaluated the "pleasantness" of a Chinese symbol. Controlled evaluations were measured with a questionnaire and were more positive in participants who regularly visited fitness centers than in those who reported avoiding this exercise setting. Only center exercisers gave automatic positive evaluations of the fitness center setting (partial eta squared = .08). It is proposed that a subliminal Affect Misattribution Procedure paradigm can detect automatic evaluations to exercising and that, in highly active exercisers, these evaluations play a role in decisions about the exercise setting rather than the amounts of physical exercise. Findings are interpreted in terms of a dual systems theory of social information processing and behavior.
Background
It has been demonstrated that core strength training is an effective means to enhance trunk muscle strength (TMS) and proxies of physical fitness in youth. Of note, cross-sectional studies revealed that the inclusion of unstable elements in core strengthening exercises produced increases in trunk muscle activity and thus provide potential extra training stimuli for performance enhancement. Thus, utilizing unstable surfaces during core strength training may even produce larger performance gains. However, the effects of core strength training using unstable surfaces are unresolved in youth. This randomized controlled study specifically investigated the effects of core strength training performed on stable surfaces (CSTS) compared to unstable surfaces (CSTU) on physical fitness in school-aged children.
Methods
Twenty-seven (14 girls, 13 boys) healthy subjects (mean age: 14 ± 1 years, age range: 13–15 years) were randomly assigned to a CSTS (n = 13) or a CSTU (n = 14) group. Both training programs lasted 6 weeks (2 sessions/week) and included frontal, dorsal, and lateral core exercises. During CSTU, these exercises were conducted on unstable surfaces (e.g., TOGU© DYNAIR CUSSIONS, THERA-BAND© STABILITY TRAINER).
Results
Significant main effects of Time (pre vs. post) were observed for the TMS tests (8-22%, f = 0.47-0.76), the jumping sideways test (4-5%, f = 1.07), and the Y balance test (2-3%, f = 0.46-0.49). Trends towards significance were found for the standing long jump test (1-3%, f = 0.39) and the stand-and-reach test (0-2%, f = 0.39). We could not detect any significant main effects of Group. Significant Time x Group interactions were detected for the stand-and-reach test in favour of the CSTU group (2%, f = 0.54).
Conclusions
Core strength training resulted in significant increases in proxies of physical fitness in adolescents. However, CSTU as compared to CSTS had only limited additional effects (i.e., stand-and-reach test). Consequently, if the goal of training is to enhance physical fitness, then CSTU has limited advantages over CSTS.
Synchronisationsphänomene myotendinöser Oszillationen interagierender neuromuskulärer Systeme
(2014)
Muskeln oszillieren nachgewiesener Weise mit einer Frequenz um 10 Hz. Doch was geschieht mit myofaszialen Oszillationen, wenn zwei neuromuskuläre Systeme interagieren? Die Dissertation widmet sich dieser Fragestellung bei isometrischer Interaktion. Während der Testmessungen ergaben sich Hinweise für das Vorhandensein von möglicherweise zwei verschiedenen Formen der Isometrie. Arbeiten zwei Personen isometrisch gegeneinander, können subjektiv zwei Modi eingenommen werden: man kann entweder isometrisch halten – der Kraft des Partners widerstehen – oder isometrisch drücken – gegen den isometrischen Widerstand des Partners arbeiten. Daher wurde zusätzlich zu den Messungen zur Interaktion zweier Personen an einzelnen Individuen geprüft, ob möglicherweise zwei Formen der Isometrie existieren. Die Promotion besteht demnach aus zwei inhaltlich und methodisch getrennten Teilen: I „Single-Isometrie“ und II „Paar-Isometrie“. Für Teil I wurden mithilfe eines pneumatisch betriebenen Systems die hypothetischen Messmodi Halten und Drücken während isometrischer Aktion untersucht. Bei n = 10 Probanden erfolgte parallel zur Aufzeichnung des Drucksignals während der Messungen die Erfassung der Kraft (DMS) und der Beschleunigung sowie die Aufnahme der mechanischen Muskeloszillationen folgender myotendinöser Strukturen via Mechanomyo- (MMG) bzw. Mechanotendografie (MTG): M. triceps brachii (MMGtri), Trizepssehne (MTGtri), M. obliquus externus abdominis (MMGobl). Pro Proband wurden bei 80 % der MVC sowohl sechs 15-Sekunden-Messungen (jeweils drei im haltenden bzw. drückenden Modus; Pause: 1 Minute) als auch vier Ermüdungsmessungen (jeweils zwei im haltenden bzw. drückenden Modus; Pause: 2 Minuten) durchgeführt. Zum Vergleich der Messmodi Halten und Drücken wurden die Amplituden der myofaszialen Oszillationen sowie die Kraftausdauer herangezogen. Signifikante Unterschiede zwischen dem haltenden und dem drückenden Modus zeigten sich insbesondere im Bereich der Ermüdungscharakteristik. So lassen Probanden im haltenden Modus signifikant früher nach als im drückenden Modus (t(9) = 3,716; p = .005). Im drückenden Modus macht das längste isometrische Plateau durchschnittlich 59,4 % der Gesamtdauer aus, im haltenden sind es 31,6 % (t(19) = 5,265, p = .000). Die Amplituden der Single-Isometrie-Messungen unterscheiden sich nicht signifikant. Allerdings variieren die Amplituden des MMGobl zwischen den Messungen im drückenden Modus signifikant stärker als im haltenden Modus. Aufgrund dieser teils signifikanten Unterschiede zwischen den beiden Messmodi wurde dieses Setting auch im zweiten Teil „Paar-Isometrie“ berücksichtigt. Dort wurden n = 20 Probanden – eingeteilt in zehn gleichgeschlechtliche Paare – während isometrischer Interaktion untersucht. Die Sensorplatzierung erfolgte analog zu Teil I. Die Oszillationen der erfassten MTG- sowie MMG-Signale wurden u.a. mit Algorithmen der Nichtlinearen Dynamik auf ihre Kohärenz hin untersucht. Durch die Paar-Isometrie-Messungen zeigte sich, dass die Muskeln und die Sehnen beider neuromuskulärer Systeme bei Interaktion im bekannten Frequenzbereich von 10 Hz oszillieren. Außerdem waren sie in der Lage, sich bei Interaktion so aufeinander abzustimmen, dass sich eine signifikante Kohärenz entwickelte, die sich von Zufallspaarungen signifikant unterscheidet (Patchanzahl: t(29) = 3,477; p = .002; Summe der 4 längsten Patches: t(29) = 7,505; p = .000). Es wird der Schluss gezogen, dass neuromuskuläre Komplementärpartner in der Lage sind, sich im Sinne kohärenten Verhaltens zu synchronisieren. Bezüglich der Parameter zur Untersuchung der möglicherweise vorhandenen zwei Formen der Isometrie zeigte sich bei den Paar-Isometrie-Messungen zwischen Halten und Drücken ein signifikanter Unterschied bei der Ermüdungscharakteristik sowie bezüglich der Amplitude der MMGobl. Die Ergebnisse beider Teilstudien bestärken die Hypothese, dass zwei Formen der Isometrie existieren. Fraglich ist, ob man überhaupt von Isometrie sprechen kann, da jede isometrische Muskelaktion aus feinen Oszillationen besteht, die eine per Definition postulierte Isometrie ausschließen. Es wird der Vorschlag unterbreitet, die Isometrie durch den Begriff der Homöometrie auszutauschen. Die Ergebnisse der Paar-Isometrie-Messungen zeigen u.a., dass neuromuskuläre Systeme in der Lage sind, ihre myotendinösen Oszillationen so aufeinander abzustimmen, dass kohärentes Verhalten entsteht. Es wird angenommen, dass hierzu beide neuromuskulären Systeme funktionell intakt sein müssen. Das Verfahren könnte für die Diagnostik funktioneller Störungen relevant werden.