American Society of Exercise Physiologists
In This Issue
Editor's Corner
Ask the EP
Ads & Employment
Quick Links

Join Our List
Join Our Mailing List
Issue: #9September 2010
Thank you for being part of our community. ASEP is the specific voice for (historically under-represented) Exercise Physiologists. Please use this Newsletter as a link to ASEP resources from scientific journals to professional papers, to employment and related opportunities. And be sure to click on "More On Us" at the left for the ASEP-Newsletter's parent web site.
Yours in health, 
-Lonnie Lowery and Jonathan Mike, ASEP-Newsletter Editors 
 Editor's Corner

How Will You Stay Involved in EP?
I had an interesting discussion with a fairly advanced group of senior exercise physiology (EP) students last week.
Although these students can discuss the nuances of graded exercise tests and controversies surrounding advanced
exercise programming, I'm not 100% sure they've given much thought to something as important as post-graduation
employment strategies. I do, however, understand the typical student's view: study hard, take tests, get the grade, m
ove on to the next course in the curriculum. Staying focused is important.
In any case, we took some time to consider some real world professional basics. After discussing difficult issues
like accreditation, certifications in "exercise science" (or personal training)  and licensure, we had a guided
brainstorming session on how they will find gainful employment and stay involved in the EP profession. I thought
I'd share some of what we came up with: 
- Attend exercise physiology-specific and related conferences (local, regional and national) with the intention of 
networking. Approach speakers after their lectures and ask about how they became experts in their fields - or even 
ask about shadowing opportunities.
- Dig around the web sites of local or regional hospitals and find out when medical grand rounds are open to 
professionals or to the public. If possible, attend these, again with the intent to network as much as possible if 
given the opportunity.
- Stay in touch with old professors and peers from school, maintaining and updating your network. (Email, Facebook, Linked-In, in-person visits to your old lab, etc.)
- Be sure to sign up for email newsletters in related fields. These can bring anything from employment 
opportunities to advice to news on upcoming conferences, etc. At the very least, they'll keep you connected to your 
chosen profession.
- Browse the web sites of local hospitals and universities, looking for the department in which you are most 
interested. Be bold and reach out with an email to an individual who may be able to offer advice or a shadowing 
- Maintain your membership in EP-related groups, from ASEP to ACSM, the NSCA, the ISSN and others. Be creative in 
your thinking: organizations like YMCA / YWCA, Jewish Community Centers, and others may also benefit you. Those 
with entrepreneurial interests could also consider memberships, newsletters and trade shows related to the business 
side of EP, like raquet and fitness centers, etc. (IHRSA, National Fitness Trade Show, etc.)
A respectful but proactive approach can take you a long way, even if it's been a little while since you worked in 
the EP profession.
Lonnie Lowery, PhD,
ASEP-Newsletter Editor 
Ask the EP 
Q:   What are some of the insights to Understanding Mitral Valve Prolapse?
A:     Etiology and Pathophysiology
Mitral Valve Prolapse (MVP) is a cardiovascular disorder negatively impacting the mitral or bicuspid valve. Normally, the mitral valve allows blood flow from the left atrium into the left ventricle. The prolapse of the mitral valve is a pathologic abnormality affecting mitral leaflet motion (Bouknight 2000). It is estimated from recent community studies, that the prevalence of MVP is 2.4 % in the general population. (Freed 1999, 2002). However, other reports indicate MVP between 2% and 6% of the population (Texas Heart institute 2006; Women's Heart Foundation 2006). From this data, this represents approximately 7.2 million Americans and over 144 million individuals worldwide, and is the most common valvular disorder in the United States (Hayek 2005). Although common, the disorder is still a poorly understood clinical entity. Interestingly, it was believed to be more prevalent in women, however it is now known to affect both sexes and may be heredity (Nagle 1999, Scordo 1998, Grau 2007).
            As previously mentioned, the mitral valve allows blood flow from the left atrium to the left ventricle, and has 2 leaflets. Prolapse occurs when 1 or both leaflets of the leaflets billow back into the left atrium during systole. Due to incomplete closing of the valve, mitral regurgitation occurs (Figure 1) (Bougknight 2000, Mulumudi 2001).Leaflet dysfunction is the most common form of MVP. However, a secondary form of MVP exists, although less common. With the secondary form, leaflet dysfunction is not affected. Secondary causes include but are not limited to rheumatic fever, myocardial infarction, cardiomyopathy, and ruptured chordae tendiae (Nagle 1999).
            Mitral Valve Prolapse is typically benign, however, more serious complications may arise that require critical care of the patient (table 1).
Summary of severe complications with MVP
  • Infectious Endocarditis
  • Cerebrovascular Incident
  • Heart Failure
  • Sudden Cardiac Death
  • Mitral Regurgitation
  • Ventricular Fibrillation
  • Atrial Fibrillation
  • Thromboembolic Event
(Bougknight 2000; Mulumudi 2001; Nagle 1999; Berbaric 2006; Hayes 1997)
 Symptoms and Clinical Application
MVP symptoms are multifactorial and range from none to mild to severe. Palpitations, chest discomfort, and dyspnea represent the most common symptoms. Other symptoms include paroxysmal supra ventricular tachycardia, nocturnal dyspnea, and fatigue. (Bougknight 2000; Mulumudi 2001; Nagle 1999; Women's Heart Foundation 2006).
The related chest discomfort can be traced to an increase adrenergic activity, thus increasing heart rate and oxygen demand of the tissues (Bouknight 2000). Associative symptoms include but are not limited too migraine headache, nausea, panic disorder, syncope, tingling, and anxiety (Bougknight 2000; Mulumudi 2001; Nagle 1999)
Clinical findings of MVP are presented in table 2.
Clinical summary of MVP (Sims, 2007)
  • Midsystolic Click
  • Late Systolic Murmur
  • EKG
  • T wave inversion
  • ST segment depression
  • Ventricular Tachycardia
  • Supraventricular Tachycardia
  • Premature Ventricular Contraction (PVC) 
The associated murmur with MVP occurs mid to late systole, but is not present in all patients. Due to blood leakage in the left atrium during systole, this results in the murmur taking place. The murmur is best heard with a stethoscope positioned at the apex of the heart at the left sternal border and may radiate to the axilla (Nagle 99; Hayes 1997).
Interestingly, a normal EKG may be present, but some patients experience abnormalities such as ST depression and other irregularities, as such presented in table 2.
            Today, the gold standard for diagnosis of MVP remains the echocardiogram. Two dimensional and Doppler imaging are the most common tools used. The echocardiogram shows posterior displacement of 1of both leaflets at least 2mm during systole (Bougknight 2000; Mulumudi 2001; Nagle 1999). Wu and colleagues (2004) explain the recent use of stress or exercise echocardiogram to diagnosis MVP patients. It is likely the stress echocardiogram could uncover exercise-induced mitral regurgitation for patients not yet diagnosis or with minimal symptoms. The authors explain that using stress echocardiogram may reveal hidden left ventricular dysfunction, thus increasing the risk for future cardiovascular episodes. 
            Currently, there is no cure for MVP. Therefore many patients require minimal treatment. The main function of the treatment is to alleviate the symptoms associated with MVP. Many individuals experience symptoms that affect their activities of daily living (ADL). For this reason, proper daily management and medication may be needed to ensure safety. Proper management techniques such as regular exercise, hydration, and limiting caffeine intake can be utilized (Sims 2007). Specific education is extremely important and critical for patients with MVP (table 3). Although some symptoms are more alarming than others, positive support and comfort should be used for MVP patients to guarantee reassurance and adherence.
Patient Education Tips
1. Patients with a click or a murmur should receive antibiotic
prophylaxis before any invasive medical or dental procedure.
2. Serial echocardiograms may be done every 3 to 5 years. For patients at high risk for complications, the echocardiograms may be done annually.
3. Teach the patient about any medications given to relieve or control
symptoms such as beta-blockers, antiplatelet therapy, calcium
channel blockers, or digoxin.
4. Avoid caffeine.
5. Aerobic exercise is recommended.
6. Follow a heart healthy diet.
7. Increase fluid intake if orthostatic symptoms are present. Fluid
intake should be at least 64 oz of liquids not containing caffeine,
sugar, or alcohol.
8. Avoid extreme heat and humidity.
9. Join a support group.
10. Avoid over-the-counter medications that contain ephedrine
or ephedra.
11. Maintain good dental hygiene.
12. Do not limit salt intake unless required for another condition.
13. Avoid extreme diets.
(Nagle 1999; Hayes 1997; Scordo 1998)
MVP is a common clinical entity. Its entire etiology has yet to be completely elucidated. Although serious complications are rare, upon occurrence, they lead to severe and progressive morbidity and mortality. Management requires a combination of follow-up, medication, and regular adherence to activities of daily living.
1: Berbarie RF, Roberts WC.Frequency of atrial fibrillation in patients having mitral valve repair or replacement for pure mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol. 2006 Apr 1;97(7):1039-44.
2: Bouknight DP, O'Rourke RA.Current management of mitral valve prolapse.
Am Fam Physician. 2000 Jun 1;61(11):3343-50, 3353-4. Review.
3: Freed LA, Levy D, Levine RA, Larson MG, Evans JC, Fuller DL, Lehman B, Benjamin EJ. Prevalence and clinical outcome of mitral-valve prolapse.
N Engl J Med. 1999 Jul 1;341(1):1-7.
4: Freed LA, Benjamin EJ, Levy D, Larson MG, Evans JC, Fuller DL, Lehman B, Levine RA. Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham Heart Study. J Am Coll Cardiol. 2002 Oct 2;40(7):1298-304
5: Hayek E, Gring CN, Griffin BP. Mitral valve prolapse. Lancet. 2005 Feb 5-11;365(9458):507-18. Review.
6: Hayes DD. Mitral valve prolapse revisited. Nursing. 1997 Oct;27(10):34-9; quiz 40. Review.
7: Grau JB, Pirelli L, Yu PJ, Galloway AC, Ostrer H. The genetics of mitral valve prolapse. Clin Genet. 2007 Oct;72(4):288-95. Review.
8: Mulumudi MS, Vivekananthan K. Mysteries of mitral valve prolapse. Proper treatment requires consideration of all clues. Postgrad Med. 2001 Aug;110(2):43-4, 47-8, 53-4.
9: Nagle BM, O'Keefe LM. Closing in on mitral valve disease Nursing. 1999 Apr;29(4):32cc1-7.
10: Sims JM, Miracle VA. An overview of mitral valve prolapse. Dimens Crit Care Nurs. 2007 Jul-Aug;26(4):145-9. Review.
11: Scordo KA. Mitral valve prolapse syndrome: interventions for symptom control.
Dimens Crit Care Nurs. 1998 Jul-Aug;17(4):177-86. Review.
12: Texas Heart Institute. Heart Conditions - Mitral Valve Prolapse. July 2006.
13: Women's Heart Foundation. Mitral Valve Prolapse. December 2006.
14: Wu WC, Aziz GF, Sadaniantz A. The use of stress echocardiography in the assessment of mitral valvular disease. Echocardiography. 2004 Jul;21(5):451-8. Review.
Jonathan Mike, MS, CSCS, USAW, NSCA-CPT, Doctoral Student, Assistant Editor 
Advertisements & Announcements

Opportunities Related to Exercise Physiology

Community Announcement: Iron has issued a call for brief submissions from EP students or professionals interested in getting their first involvement in legitimate Internet / pod casting settings. Opinions on professional issues or micro reviews and recent research are welcomed. Students' audio submissions (see National Public Radio (NPR]) and / or the Iron web site for examples) will be editor-reviewed by ASEP-Newsletter Editors Dr. Lonnie Lowery and Jonathan Mike. The submissions should be 300-500 word essays read aloud and recorded with Windows Sound Recorder or similar software and sent via email to Iron is not ASEP-affiliated.

The Department of Kinesiology at the University of New Hampshire... is currently seeking applicants for a tenure track appointment in Exercise Science at the Assistant or Associate Professor level. ...more information...
NOTE: ASEP Board of Directors with approval of The Center for Exercise Physiology-online developed the "EPC Petition Guidelines" for doctorate exercise physiologists to become Board Certified.

Thank you for perusing our opinions, facts and opportunities in this edition of the ASEP-Newsletter.

Lonnie Lowery
American Society of Exercise Physiologists

All contents are copyright 1997-2010 American Society of Exercise Physiologists.