Contents
`
`Summary
`
`Sports Medicine 5: 303-312 (1988)
`0112-1642/88/0005-0303/$04.50/0
`© ADIS Press Limited
`All rights reserved.
`
`Heart Rate and Exercise Intensity During
`Sports Activities
`Practical Application
`
`Juha Karvonen and Timo Vuorimaa
`Department of Clinical Physiology, University of Umea, Urnea, and Finnish Amateur
`Athletic Association, Helsinki
`
`Summary
`I. Methods for Measuring Heart Rate During Physical Exercise
`1.1 Radiotelemetry
`1.2 Continuous ECG Recording
`1.3 Microcomputer
`1.4 Experiences with the Use of These Methods
`2. Relative Heart Rate
`2.1 Heart Rate and Exercise Prescription
`2.2 Use of Relative Heart Rate in Training
`3. Use of Heart Rate in Controlling Individual Endurance Training
`3.1 Control of the Effectiveness of Training for the Long Distance Runner
`3.2 Determination of an Appropriate Heart Rate
`3.3 Use of %HRma, in Cross-Country and Alpine Skiing
`4. Conclusions
`
`303
`304
`304
`304
`304
`305
`305
`306
`306
`307
`307
`307
`308
`309
`
`Variations in heart rate during exercise correlate with changes of exercise intensity
`and may be measured directly by radiotelemetry and continuous ECG recording. The
`heart rate can also be recorded in the memory ofa microcomputer, which can be carried
`on the wrist as easily as a watch. The device has a transmitter and a receiver.
`By recording the heart rate during a training session or a segment of training, and
`calculating the average ofthe heart rate and comparing this average to both the maximum
`heart rate ofthe individual and his heart rate at rest, the relative heart rate to the intensity
`of the work load (% maximum heart rate) can be calculated. These results are useful in
`planning optimal training intensities for both the healthy and rehabilitating athlete.
`The use oftarget heart rate as a tool for exercise prescription is common. It represents
`the percentage difference between resting and maximum heart rate added to the resting
`heart rate. For calculating target heart rate there are also 2 other methods. The first
`represents the percentage of the maximum heart rate (%HRma.J calculated from zero to
`peak heart rate. The second represents the heart rate at a specified percentage ofmaximum
`MET (V02ma.J.
`An appropriate individual heart ratefor each level ofan endurance performance is best
`determined in the laboratory. This is carried out by increasing the speed ofthe runner in
`stages on a treadmill and b)' measuring the oxygen uptake, the lactic acid concentration
`
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`304
`
`in the bloodand corresponding variations in the heart rate. Fromtheseresults the running
`speedand heart rate corresponding to aerobic. partlyanaerobic or strongly anaerobic run(cid:173)
`ning can be determined.
`The %HRllla \ values obtained by continuous ECG recording and telemetry have been
`used to measurethe physical work load in alpine skiing. Alpine skiing has been recorded
`as exercise which improvesgeneralphysicalfitness and aerobic capacity. However. it has
`beenfound to increase more the anaerobic capacitythan the aerobic capacity. This should
`be taken into consideration whenplanningthe training of generalphysicalfitnessofalpine
`skiers.
`
`Heart rate monitoring is probably the most
`widely used method for exercise prescription of
`healthy adults and athletes. The variations in heart
`rate correlate with the variations in exercise inten(cid:173)
`sity. Under submaximal load the heart rate of a
`healthy person increases linearly with the increase
`in oxygen uptake and exercise intensity. The ex(cid:173)
`ercise intensity of sports training and work can be
`estimated by measuring heart rate during normal
`training with various apparatus. The purpose of this
`article is to discuss heart rate follow-up methods
`such as telemeter, continuous ECG (Holter-moni(cid:173)
`toring) and microcomputer recording in athletes'
`training. The use of relative heart rate for follow(cid:173)
`up of exercise intensity in various sports events
`based on our experiences will also be discussed.
`
`1. Methods for Measuring Heart Rate
`During Physical Exercise
`
`1.1 Radiotelemetry
`
`Variations in heart rate with exercise may be
`measured directly by radiotelemetry. A radiotele(cid:173)
`meter consists of a radio transmitter connected to
`the subject by electrodes and a radio receiver of
`the signals, which may be connected to an ECG
`monitor, to a heart rate monitor and to an ECG
`recorder.
`The ECG electrodes relay the activity of the atria
`and ventricles by means of radio signals from the
`transmitter connected to the electrodes. These sig(cid:173)
`nals are transmitted to the receiver and trans(cid:173)
`formed into P-waves and to QRS-complexes relat(cid:173)
`ing to activity of the atria and ventricles. The signal,
`for subsequent analysis and measurement, are reg-
`
`istered by an ECG recorder connected to the te(cid:173)
`lemeter.
`The operating distance of a radiotelemeter var(cid:173)
`ies with the surroundings during measurement and
`the type of meter. For indoor facilities with many
`walls, the measuring can normally be carried out
`from one room to another or along a corridor. For
`outdoor measurements the terrain has an effect on
`the operating distance. With a good telemeter it is
`possible to measure heart rate in a flat forested area
`for a distance of I to I.5km. In an unforested ter(cid:173)
`rain this distance may be as great as 3km. The dis(cid:173)
`tance can be increased by adding additional aerials
`to the receivers.
`
`1.2 Continuous ECG Recording
`
`Continuous ECG recording has been developed
`for studying arrhythmia and coronary diseases
`(Goldberger 1961). The ECG electrodes are con(cid:173)
`nected to a lightweight recorder worn at the waist.
`Heart rate and ECG data are registered during the
`recording process on a tape which can be entered
`into and analysed with a computer (Hinkle et al.
`1967).
`By varying the analytical programmes, contin(cid:173)
`uous ECG recording can be used to measure the
`physical work load of an active, healthy person.
`Each heart beat during the performance is regis(cid:173)
`tered. Analytical programmes can be applied to
`calculate the mean heart rate continuously for each
`minute (Karvonen et al. 1985c).
`
`1.3 Microcomputer
`
`The heart rate can also be recorded in the mem(cid:173)
`ory of a microcomputer, which can be carried on
`the wrist as easily as a watch (Saynajakangas 1983).
`
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`Heart Rate Monitoring
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`305
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`The device has a transmitter and a receiver. The
`transmitter is worn on an electrode belt a little
`above the waist and transmits ECG signals caused
`by the heart beat into the receiver and into the
`memory ofthe microcomputer, where they can later
`be read (fig. I). Aspects of the telemeter and con(cid:173)
`tinuous ECG recording have been combined in the
`microcomputer recording of heart rate. A trans(cid:173)
`mitter connected to electrodes has a wireless con(cid:173)
`tact to the memory of the microcomputer, where
`it can be analysed later as in Holter monitoring.
`Instead of a printed recording the heart rate is stored
`in the microcomputer memory. The results of the
`heart rate obtained from information fed to the mi(cid:173)
`crocomputer and that obtained from the ECG re(cid:173)
`corder for the same time period are well correlated
`for both rest periods and work periods (Karvonen
`et al. 1984).
`
`1.4 Experiences with the Use of These
`Methods
`
`The telemeter is most useful in monitoring a
`single performance where rapid changes in heart
`rate are clearly observed. A negative factor is that
`it requires personal supervision at all times. Al(cid:173)
`though rapid changes in the intensity of the work
`cannot be detected by a continuous ECG recording
`as easily as with a telemeter, the overall stress of
`the workout and changes between easy and stren(cid:173)
`uous periods can be clearly determined. With con-
`
`Fig. 1. The electrodes of the microcomputer used to measure
`heart rate are placed on the chest. The microcomputer display(cid:173)
`ing the heart rate is on the wrist.
`
`tinuous ECG and microcomputer recording per(cid:173)
`sonal supervision is not required since the heart
`rate is recorded on tape.
`The telemeter can be used for follow-up of heart
`rate in short performances such as sprint, speed
`skiing and alpine skiing performances. Continuous
`ECG and microcomputer recording are most use(cid:173)
`ful for endurance performances, i.e. skiing, endur(cid:173)
`ance running or canoeing. Microcomputer record(cid:173)
`ing is best
`for
`follow-up exercise intensity in
`recreational sport, because it is easy, accurate and
`rather cheap to use.
`
`2. Relative Heart Rate
`
`By recording the heart rate during a training ses(cid:173)
`sion or a segment of training, and calculating the
`average of the heart rate and comparing this av(cid:173)
`erage to the maximum heart rate of the individual
`and at rest, the relative heart rate to the intensity
`ofthe workload (% HR max) can be calculated. These
`results are useful in planning optimal training in(cid:173)
`tensities for both the healthy and rehabilitating
`athlete. There is much research concerning the re(cid:173)
`lationship of the heart rate, oxygen consumption
`and the intensity of exercise (Kamon & Kent 1972;
`Maritz et al. 1961; Nagel 1971; Verma et al. 1979).
`According to Aunola et al. (1978) and Rosenblat
`(1967) the relative heart rate and relative oxygen
`uptake (%V02ma x) are well correlated during light
`exercise. During strenuous endurance exercise at
`the anaerobic threshold of 4 mrnol/L lactic acid
`concentration in capillary blood described by
`Jacobs et al. (1981) as onset of blood lactic acid
`accumulation (OBLA), %HRmax ofathletes has been
`87 ± 4 and 82 ± 5% of V02max (Karvonen 1983),
`quite similar values. Under maximum load the dif(cid:173)
`ference between values of %HR ma x and %V02max
`may be great because the oxygen uptake of some
`individuals under maximum load increases rela(cid:173)
`tively more than the heart rate (fig 2).
`Heart rate and %HR max indicate the relative
`work load in comparison with maximum load.
`%HR max can be calculated with the following equa(cid:173)
`tion:
`
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`Heart Rate Monitoring
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`306
`
`200
`
`o
`
`o
`
`250
`
`50
`
`150
`Physical work load (W)
`I - -L - -J
`I
`I
`!
`2.0
`1.0
`3.0
`Oxygen uptake (L/min)
`
`Interrelation between heart rates (beats/min), physical
`Fig. 2.
`work load (W) and oxygen uptake (i/02)' The heart rate of per(cid:173)
`son A increases linearly up to the maximum with physical work
`load and V02. The V02 of person B increases, on the other
`hand, even after the maximal heart rate level (the points indicate
`the heart rate and the line, the increase in V02. With the maximal
`heart rate of 195 beats/min (person B) the estimated V02max is
`2.9 L/min, which is in reality 3.2 L/min (Astrand & Rodahl 1970).
`
`%HRmax =
`
`HR work - HR res!
`HR max - HRres!
`
`Using this equation %HRma x, indicating training
`intensity, approaches 100% under maximum load.
`
`2.1 Heart Rate and Exercise Prescription
`
`%HRmax has often been used to calculate the
`exercise intensities for athletes, for persons under(cid:173)
`going physical conditioning and in recreational
`sports. The use of target heart rate (see fig. 5 and
`the example) as a tool for exercise prescription
`(Karvonen et al. 1957; Karvonen 1975) is com(cid:173)
`mon. It represents the percentage difference be(cid:173)
`tween resting and maximum heart rate added to
`the resting heart rate.
`For calculating target heart rate there are also 2
`other methods. The first represents the percentage
`of the maximum heart rate calculated from zero to
`
`peak heart rate. The second represents the heart
`rate at a specified percentage of maximum METs
`(V02max).
`All 3 techniques are acceptable for use in de(cid:173)
`termining the target heart rate or exercise intensi(cid:173)
`ties or both. In comparison Pollock et al. (1979)
`has shown that the target heart rate calculated by
`the percentage of heart rate maximum method was
`approximately 25 to 13 beats/min lower than that
`calculated by the other 2 methods (the method of
`Karvonen and METs) at 70 and 85%of maximum,
`respectively. The recommendations for exercise
`prescription designed for the general population are
`an intensity of 60 to 90% of maximum heart rate
`(the method of Karvonen) and duration of 15 to
`60 minutes (continuous) 3 to 5 days per week
`(American College of Sports Medicine 1978).These
`recommendations are not designed for endurance
`athletes or persons in poor health. However, ac(cid:173)
`cording to Roitman et al. (1978) these means of
`calculating an exercise prescription for athletes may
`be below the ideal training heart rate.
`Since the resting heart rate increases with in(cid:173)
`creasing age, whereas the maximal heart rate de(cid:173)
`creases, %HRmax is a better indicator of exercise
`intensity than heart rate alone because the effect
`of age and other individual factors is minimal.
`
`2.2 Use of Relative Heart Rate in Training
`
`Relative heart rate is a method to estimate the
`exercise intensity during outdoor endurance train(cid:173)
`ing. Running speed during training is increased in
`stages. The average time per kilometre correspond(cid:173)
`ing to the speed at each stage is calculated (time/
`km) and simultaneously the heart
`rates corre(cid:173)
`sponding to each stage and to the average time per
`kilometre is measured by the telemeter. The
`%HRmax indicating the intensity of running speed
`for each stage is calculated when the heart rate at
`rest and the maximal heart rate are known (Kar(cid:173)
`vonen 1975, 1976a,b).
`For example,
`the heart rate of an endurance
`runner at rest (HR res!) is 80 beats/min and the
`maximal heart rate (HR ma x) is 198 beats/min. The
`average time per kilometre at maximal running
`
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`Heart Rate Monitoring
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`307
`
`3. Use of Heart Rate in Controlling
`Individual Endurance Training
`
`In most sports events endurance is one of the
`factors affecting performance. In events where en(cid:173)
`durance is not
`the most decisive factor, the en(cid:173)
`durance factor in training is usually called 'general
`conditioning'. Relative heart rates are useful in(cid:173)
`dicators of the effectiveness of general condition(cid:173)
`ing.
`In sports where endurance is the most decisive
`factor and where the competition performance
`mostly depends on the development of endurance,
`the control of the effectiveness of endurance train(cid:173)
`ing is of utmost importance.
`
`3.1 Control of the Effectiveness of Training
`for the Long Distance Runner
`
`As speed in long distance running increases to
`maximum endurance running speed, the produc(cid:173)
`tion of aerobic energy increases linearly with the
`increase in running speed until maximum speed is
`approached, when the oxygen uptake begins to in(cid:173)
`crease at a greater rate than the running speed.
`The production of anaerobic energy also in(cid:173)
`creases with increased running speed and causes
`variations in pH levels as the anaerobic threshold
`of 4 mrnol/L (Jacobs et aI. 1981) is reached. As the
`long distance runner exceeds the running speed
`corresponding to the anaerobic threshold and ap(cid:173)
`proaches the maximal oxygen uptake the heart rate
`no longer accurately indicates the real responses to
`training.
`
`3.2 Determination of an Appropriate
`Heart Rate
`
`An appropriate individual heart rate for each
`level of an endurance performance is best deter(cid:173)
`mined in the laboratory. This is carried out by in(cid:173)
`creasing the speed of the runner in stages on a
`treadmill and by measuring the oxygen uptake, the
`lactic acid concentration in the blood and corre(cid:173)
`sponding variations in the heart rate. From these
`results the running speed and heart rate corre-
`
`speed in normal training circumstances is 286 sec(cid:173)
`onds and the heart rate 198 beats/min. During run(cid:173)
`ning at constant speed on medium exercise inten(cid:173)
`sity the average time per kilometre is 333 seconds
`and the heart rate 184 beats/min.
`During walking in the same training circum(cid:173)
`stances the average time is 429 seconds and the
`heart rate 159 beats/min. In order to determine the
`heart rate and the speed at which one has to run
`so that
`the physical work load in training would
`correspond to 80% HR max, the corresponding heart
`rate (HR worb i.e. target heart rate) is calculated with
`the following equation:
`HR work = (HR max - HR rest) x %HR max + HR rest
`where the HR work will be 174 beats/min. The av(cid:173)
`erage time per kilometre corresponding to this heart
`rate is obtained from figure 3 and is 370 seconds.
`Soviet scientists have used this method to meas(cid:173)
`ure the physical work load in ski training (Mihalev
`1983).
`
`-------
`
`200
`
`190
`
`180
`
`170
`
`160
`
`150
`
`140
`
`CI
`
`'";;;
`B-
`
`Q>
`
`~ 1
`
`;;
`
`Q>
`I
`
`500
`
`400
`
`300
`
`Average time/km (sees)
`
`Fig. 3. The determination of average time per kilometre cor(cid:173)
`responding to the relative heart rate of 80% HRmax• indicating
`the physical work load.
`
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`Heart Rate Monitoring
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`308
`
`Maximum heart rate
`
`Anaerobic threshold
`
`200
`
`180
`
`160
`
`140
`
`120
`
`C
`I<Jl
`(;j
`(IJe
`
`s~ ~(
`
`IJ
`
`I
`
`10
`
`20
`
`30
`
`40
`
`50
`
`60
`
`70
`
`80
`
`Time (min)
`
`Fig. 4. Heart rate curves taken from typical
`long distance training. 20km run (_). 2 x 6km run with 10-minute recovery (0) and 5 x
`1km run of 95% V02max with 2-minute recovery (e).
`
`sponding to aerobic, partly anaerobic or strongly
`anaerobic running can be determined.
`The upper
`limit for mainly aerobic running
`speed is the aerobic threshold of 4 mmol/L lactic
`acid concentration in capillary blood (Jacobs et al.
`1981) which is normally 30 to 50 beats/min below
`the maximal heart rate for a long distance runner.
`The critical limit for partly anaerobic running, i.e.
`the anaerobic threshold, is generally IOto 20 beats/
`min below the maximal heart rate.
`At higher heart rates, running for longer than 2
`minutes always causes some variations in pH lev(cid:173)
`els. This is, however, necessary in order to increase
`the maximal aerobic capacity. The entire maximal
`aerobic capacity is in use when the heart rate is at
`its maximum.
`An adult long distance runner in good physical
`condition is capable of running approximately LO
`minutes at V02max and about 60 minutes at a speed
`corresponding to the anaerobic threshold.
`Corresponding running speeds and heart rates
`
`can be estimated by running tests for distances of
`3000m and 15 to 20km. During the shorter per(cid:173)
`formance the heart rate reaches its maximum and
`during the longer the average heart rate is nearly
`that corresponding to the anaerobic threshold.
`As heart rates corresponding to various levels
`of endurance performance are either determined in
`the laboratory or estimated in field tests, the effec(cid:173)
`tiveness of daily endurance exercises can be con(cid:173)
`trolled and, if necessary, corrected (see fig. 4).
`
`3.3 Use of %HRmax in Cross-Country
`and Alpine Skiing
`
`The physical workload during training is nor(cid:173)
`mally described with terms such as easy, medium
`and strenuous. Subjective feelings of exercise in(cid:173)
`tensity are often misleading. This has been shown
`by using %HRmax in intensity measurements dur(cid:173)
`ing training exercises (Karvonen et al. 1982). Dur(cid:173)
`ing snow-free periods the endurance training of
`
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`Heart Rate Monitoring
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`309
`
`skiers consists of walking, running and roller(cid:173)
`skating.
`The exercise intensity of walking depends on
`technical skills. This is why a skier's walking done
`at maximal speed has a lower physical workload
`than running at constant speed (Karvonen 1977,
`1980). Young skiers' subjective estimates of the ex(cid:173)
`ercise intensity during their training are often in(cid:173)
`accurate. Easy training at constant speed is done
`with an intensity of 60 to 70% of the maximum
`but medium training is often done with 90% of the
`maximum which is in fact already strenuous and
`exceeds the medium training level (Karvonen
`1982). Rollerskiing and running at slow or medium
`speed correlate well with each other but
`in the
`maximal rollerskiing training the same physical
`work load is not reached as in maximal skiing, even
`if in rollerskiing the muscles of the upper body in(cid:173)
`cluding the arms are used (Pekkarinen et al. 1984).
`This is often because of poor rollerskiing tech(cid:173)
`nique. Thus, running exercises are more effective
`in improving the aerobic capacity of skiers than
`rollerskiing.
`The %HRma x values obtained by continuous
`ECG recording and telemetry have been used to
`measure the physical work load in alpine skiing
`(Karvonen et al. 1984; Rauhala & Karvonen 1984;
`Rauhala et al. 1987a,b). Alpine skiing utilises in(cid:173)
`terval exercises with varying rest and load phases.
`The exercise intensity during downhill skiing is, in
`general, of short duration and, depending on the
`slope, radius oftums and on individual skills, quite
`intense. The energy production is mainly anaero(cid:173)
`bic, especially at the end of the performance. In
`downhill skiing on a slope of 600 metres in length
`and with a drop of 130 metres in height, with I
`run every 10 minutes during 2 hours,
`the total
`physical work load is approximately 55 to 57
`%HRmax (Nagel 1971). The physical work load of
`each separate run may vary between 65 and 95%
`HR max (fig. 5).
`Alpine skiing has been regarded as exercise
`which improves general physical fitness and aero(cid:173)
`bic capacity. However,
`it has been found to in(cid:173)
`crease more the anaerobic capacity than the aero(cid:173)
`bic
`capacity. This
`should be
`taken
`into
`
`consideration when planning the training of gen(cid:173)
`eral physical fitness of alpine skiers (Karvonen et
`al. I985a,b,c).
`
`4. Conclusions
`
`Heart rate measurements with a telemeter, con(cid:173)
`tinuous ECG (Holter monitoring) or microcom(cid:173)
`puter recording are widely used for estimation of
`exercise intensity during normal outdoor training,
`because these apparatus are easy to use and they
`allow a subject to make his exercises freely during
`follow-up period. In determination of target heart
`rate and %HRmax there are differences between dif(cid:173)
`ferent methods. The method representing the per(cid:173)
`centage of the maximum heart rate calculated from
`zero to peak heart rate gives lower heart rate values
`at the same exercise intensity than the method of
`Karvonen and METs.
`The use of target heart rate and %HRmax is ap(cid:173)
`propriate for follow-up of exercise intensity in
`training of endurance athletes, in recreational sport
`and in rehabilitation after sicknesses.
`The exercise intensity determined by %HRmax
`may differ from the one determined by %V02ma x•
`During strenuous endurance exercise at the aerobic
`threshold of 4 mmol/L lactic acid, the %HRmax of
`athletes determined by the method of Karvonen or
`METs corresponds well to the %V0 2max' Under
`maximum load the difference between values of
`%HRmax and %V02max may be great, because the
`oxygen uptake of some individuals under maxi(cid:173)
`mum load increases relatively more than the heart
`rate.
`Coaches and athletes who control training and
`exercise intensity by heart
`rate measurements
`should avoid testing in each training session, as it
`may also be disruptive for the athlete. These tools
`are most useful as a check, when an athlete's phys(cid:173)
`ical performance capacity is expected to change or
`a coach wants to control the effect of training in
`normal circumstances. Currently the heart
`rate
`measurements are almost the only common meth(cid:173)
`ods for estimation of the exercise intensity. In the
`future, when ambulatory oxygen uptake testing
`methods are better developed heart rate measure-
`
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`310
`
`lh 21 min
`
`100
`
`80
`
`60
`
`40
`
`20
`
`Highest work load
`
`Lowest work load
`25% HRmax
`
`Time
`
`.
`
`E
`a:
`
`I -
`
`,R.0
`
`Fig. 5. Variations in the relative heart rate (%HRmax) of a subject during 3 hours and 11 minutes of slalom training. For the first 1h
`21min the mean exercise intensity was 63% HRmax and for 3h llmin 55% HRmax .
`
`ments will have less importance, especially in top
`sports.
`
`References
`
`American College of Sports Medicine. Position statement on the
`recommended quantity and quality of exercise for developing
`and maintaining fitness in healthy adults. Medical Sciences in
`Sports 10: 7-10, 1978
`Astrand PO, Rodahl K. Physical work capacity; textbook of work
`physiology. 2nd ed., pp. 290-292, 352. McGraw-Hili Book
`Company, New York, 1970
`Aunola S, Nykyri R, Rusko H. Strain of employers in the ma(cid:173)
`chine industry in Finland. Ergonomica 21: 510-514, 1978
`Goldberger E. Long period continuous electrocardiography of ac(cid:173)
`tive persons. American Journal of Cardiology 8: 603, 1961
`Hinkle Jr, LE, Meyer J, Stevens M. Tape recordings of the ECG
`of active men: limitations and advantages of the Holter-Avion(cid:173)
`ics instruments. Circulation 36: 752-765, 1967
`Jacobs J, Sjodin B, Kaiser P, Karlsson J. Onset of blood lactate
`accumulation after prolonged exercise. Acta Physiologica
`Scandinavica 114: 461, 1981
`Kamon E, Kent PP. Maximal aerobic power during treadmill
`running, uphill climbing and cycling. Journal of Applied Phys(cid:173)
`iology 32: 467, 1972
`Karvonen J. Follow-up of training of an endurance runner. Sta(cid:173)
`dion 6: 76-79. 1975
`Karvonen J. Koristenje telernetriskog mjerenja kod vjezbaiz(cid:173)
`drzajnosti. Proceedings of II Kongres Sportske Medicine Bal(cid:173)
`kana, Nis, Jugoslavia, 27-31 October, 1976a
`Karvonen J. Keskimaaraisten kilometriaikojen laskeminen kes-
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`TomTom Exhibit 1014, Page 8 of 9
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`Heart Rate Monitoring
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`311
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`
`Authors' address: Dr Juha Karvonen. Department of Medicine.
`Ambrose Cardiorespiratory Research Unit. McMaster Univer(cid:173)
`sity, 1200 Main Street West, Hamilton, Ontario L8N 3Z5 (Can(cid:173)
`ada).
`
`The Laerd I Foundation for Acute Medicine
`
`The Laerdal Foundation for Acute Medicine has been instituted with the purpose of providing financial
`support to research or development projects in the field of acute medicine.
`
`The foundation is governed by a board of appointed members from the following organisations: The
`Faculty of Medicine of the University of Oslo, The Scandinavian Society of Anaestheslologlsts, The
`Society of Critical Care Medicine (USA), and The Asmund S. Laerdal Company.
`
`Projects to be considered for support may include experimental or clinical studies, educational activities,
`practical Improvements of patient transport, and publication of ideas and finding . Pre-hospital projects
`may be preferred.
`Deadlines for applications are bi-annually by Oct . 1 and April 1.
`
`Application form and further Information may be obtained from:
`Mr Olav Ekkje,
`The Manager,
`The Laerdal Foundation for Acute Medicine,
`P.O. Box 377,
`N4001 Stavanger,
`orway .
`
`TomTom Exhibit 1014, Page 9 of 9
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