Book Reviews

Essentials of Exercise Physiology Plus Student Study Guide and Workbook
William D. McCardle, Frank I. Katch, Victor L. Katch, 
Philadephia
Lippincott Williams and Wilkens,
2000, 697 pp., illus., index, $53.95
Workbook, 475 pp
ISBN: 0-683-30507-7

    The extensive text plus a Student Guide and Workbook is ostensibly devoted to revealing the authors’ passion for the science behind exercise physiology. Their focus is devoted to “understanding the inter-relationships among energy intake energy production during exercise, and physiologic systems that support physical activity and training responsiveness.” Although not specified, presumably the book and guide are intended for upper level undergraduate or an initial level graduate course in exercise physiology. However, others working in the field or who are investigating basic knowledge for clinical or other purposes could well profit from reviewing pertinent portions.

Division of the text is in sections which are: I) Introduction to Exercise Physiology; II) Nutrition and Energy Transfer; III) The Physiologic Support Systems; IV) Exercise Training and Adaptation in Functional Capacity; V). Factors Affecting Physiological Func-tion, Energy Transfer, and Exercise Performance; VI). Optimizing Body Composition, Aging and Health Related Exercise Benefits. Seven appendices supplement the text, providing information about pertinent journals, web sites, the metric system and conversion factors and metabolic computations. New to the second edition are chapters on the origins of exercise physiology and clinical exercise physiology for health related professionals. All told there are 21 chapters in the six sections with the largest number of chapters (eight) in the section on nutrition and energy transfer. Thus, an important emphasis throughout is nutritional science. The topics covered in each chapter are clearly identified in a prominent listing at the beginning. Selected references are provided that cover aspects of chapter content. Color pervades the book, including many of the illustrations. In regard to the illustrations, the source of the contained information is not always apparent and appropriate references are sometimes omitted.
With respect to the text in comparison to the several other books available to those teaching exercise physiology, coverage that includes extensive nutritional information and clinical aspects from health related professionals may turn selection to books with more limited coverage and more emphasis on the impact of exercise on the organism. Somehow, the basic underpinnings of physiology as exemplified by the work of those associated with the American Physiological Society have to some extent been underplayed. For example, on page 24 the statement made that, “Exercise has emerged as a field separate from physiology” can hardly be supported. In addition, a listing of the organizations devoted to exercise physiology does not include APS, nor is APS listed in the appendix as having a useful web site.

An interesting feature is a portion of a chapter devoted to discussion of scientific method. Such inclusion may be important for enlightening students, most of whom will never engage in research. Nevertheless this perspective, if emphasized by an instructor, should assist perpetuating understanding of the scientific approach—something that is frequently neglected in developing an informed citizenry.

Coverage of systems physiology as influenced by exercise is adequate and well-illustrated, as is the impact of regular exercise and training. Emphasis on body composition goes beyond the identification of components of body composition as useful references for physiological variables, i.e., fat-free body weight, skeletal muscle mass, etc. Body composition as related to health problems is emphasized, e.g., weight control and obesity. Absent from the book are newer emphases that have pervaded recent investigations, such as genetic impacts and microbiological issues. Nor is exercise covered as effecting physiological adjustments in outer space and the protection that occurs.

In summary, the wide coverage may appeal to some and the authors have improved and brought their contribution more up-to-date than their earlier version. Thus, the book will provide useful, informative and stimulating information for the students who study its offerings. Utilization of the supplemental study guide and workbook should also enhance the students’ knowledge by focusing on the essential points of emphasis in the various chapters.

Elsworth R. Buskirk
Penn State University

Noninvasive Positive Pressure Ventilation: Principles and Applications
Nicholas S. Hill, (Editor). Amonk, NY: Futura Publishing Company, Inc., 2000, 256 pp., illus., index, $70.00
ISBN: 0-87993-459-X

    Noninvasive mechanical ventilation, especially noninvasive positive pressure ventilation, has had a major impact in the care of patients presenting with acute or chronic respiratory failure over the past two decades. Most recently, noninvasive positive pressure ventilation (NPPV) has been found valuable in decreasing the need for endotracheal intubation and mechanical ventilation in patients who present with COPD exacerbation and development of acute respiratory failure. Moreover, there has been a marked increase in the prescription of domiciliary ventilation in the United States over the past decade, and nearly 50% of that growth can be attributed to NPPV in the home setting. As with the development of new therapies, application of NPPV is broadening before the technique has been thoroughly studied or before the technique is well described in textbooks providing overviews of respiratory care. Practitioners are then required to search through multiple sources of information (e.g., general publications, scientific meetings, personal experience, personal communication, etc.) which sometimes fail to provide substantial information in a comprehensive and organized manner. This textbook, one of the first totally devoted to NPPV, provides a practical, useful and comprehensive guide to the pitfalls and practices of NPPV therapy.

The editor, Dr. Hill, is a well-known and respected international authority in the development and scientific application of NPPV. He has incorporated as co-authors other well-known experts with a heavy international flavor. This textbook provides a more global picture of NPPV which serves to broaden the application of this technology to different patient groups.

Overall, the textbook is comprehensive, well-written, and easy to read. It offers evidence-based medicine to support the application of NPPV in different patient groups and in different clinical scenarios. In areas where evidence-based medicine does not exist to support its application, the authors offer personal experience or expert opinion regarding the use of NPPV. It is to their credit that the authors and editor are quick to point out and qualify statements regarding the use of NPPV where information is scanty, or not supported by randomized, controlled trial data.

The textbook’s strength is its comprehensive nature, practical suggestions, and easy to read format. Its weaknesses, however, are that it is unnecessarily redundant on some issues, such as the choice of interface or ventilator settings, monitoring of NPPV and inclusion and exclusion criteria, which, in most cases, is extremely similar, if not identical, across different patient groups. The physiological effects of noninvasive positive pressure ventilation on gas exchange, work of breathing, and electrical activation of the respiratory muscles also are not dealt with in any significant detail. A comprehensive review of the pathophysiologic effects of NPPV would have been a welcome addition to the textbook.

Nonetheless, the textbook stands as a practical guide to the practitioners of NPPV, and up-to-date, comprehensive and easy to understand clinical textbook describing the implementation and use of NPPV.

Gerard J. Criner
Temple Lung Center

Rome II: The Functional Gastrointestinal Disorders Diagnosis, Pathophysiology and Treatment A Multinational Consensus. 2nd Edition Douglas A. Drossman, Enrico Corazziari, Nicholas J. Talley, W. Grant Thompson, William E. Whitehead (Editors).
McLean, VA: Degnon Associates, 2000, 764 pp., illus., index, $79.95
ISBN: 0-9656837-2-9.

    Views as to the pathogenesis, diagnosis and treatment of functional gastrointestinal disorders have undergone many changes during the last century. An approach to these disorders from conceptual and clinical points of view has been hampered by a paucity of understanding how the functions of gastrointestinal tract are organized and controlled by the enteric nervous system. In addition, the pathways through which the central nervous system modulates this control as well as the sensory pathways involved are only beginning to be unraveled. This new and clearer view requires a new fresh appraisal to functional gastrointestinal disorders. In the past, a patient presenting with symptoms suggesting a gastrointestinal origin was studied with the aim of finding the structural changes or disease process causing the symptoms. When no anatomic or pathologic changes were found the patients' disorder was considered “functional” which to many meant that it was a psychological rather than medical disorder.

This book, The Functional Gastrointestinal Disorders, is the product of the Rome II project, a four-year endeavor by a coordinating committee and over 50 international investigators. It is a continuation of the Rome I project, an effort to define and categorize functional gastrointestinal disorders analogous to efforts, which led to diagnostic criteria in psychiatry (DNSIII) and rheumatology (ARA criteria). 

The book covers topics ranging from neurogastroenterology to psychosocial aspects of functional gastrointestinal disorders in the first four chapters. The remaining nine chapters deal with functional disorders by anatomic region, that is, esophageal disorders, gastric disorders, bowel disorders, biliary tract and pancreatic disorders, anal-rectal disorders and functional pain. There is a chapter on childhood functional disorders and chapters on the design and interpretation of treatment trials in functional gastrointestinal disorders. In addition, there is a 20-page glossary of the terms used in the book to minimized misinterpretation of the discussions by the reader. Four appendices contain tables listing criteria for the different functional disorders discussed, questions to be included in research questionnaires in the study of function al disorders, such as, questions to define functional dyspepsia, so that research from one institution can be more readily compared with research from a different research group.

The chapter on fundamentals of neurogastroenterology is outstanding. In 41 pages the author covers in an integrated fashion the innervation of the digestive tract, enteric nervous system control, interaction with the central nervous system, properties of enteric smooth muscles, immunoneural communication, sensory neurophysiology of digestive tract and how abnormal central processing of sensory signals may contribute to
the clinical manifestations of functional gastrointestinal disease.

The chapter on applied neurogastroenterology focuses on studies of altered motility patterns and sensorimotor dysfunction in functional gastrointestinal disease. These discussions refer to a host of studies done in the past, but are presented without attempting to put them in a current neurophysiologic framework. The authors do recognize the limitations of the studies discussed and conclude that there is a disappointing lack of correlation between sensorimotor dysfunction and symptoms in studies in patients with functional gastrointestinal disorders. This suggests that the rationale behind these studies is faulty or current measures are imprecise or both. This should have been emphasized so the resources available to study these prevalent and costly clinical problems are not wasted on unproductive research hypotheses.

The last half of the book is devoted to discussion of the various functional gastrointestinal disease, each chapter dealing with one anatomic segment of the alimentary tract, ranging from esophageal disorders through to disorders of the anus and rectum.

This book presents recommendations for diagnostic criteria, clinical evaluation, physiologic features and treatment for each category. The chapter on the design of treatment trial presents an orderly approach to trial design emphasis on defining population to be studied, use of placebo and/or control group data, data collection and analysis, and outcome definition. This book, the culmination of the work of the Rome II project. is a consensus statement emphasizing standard characterization of functional gastrointestinal disorders, clinical management of these disorders and design of clinical trials to improve the rationale and outcome of therapy. It is not presented with a specific audience in mind. For that reason, there is material included in this volume relevant to the interest of the physiologist, clinical investigator and clinician, but there is considerable material that each category of reader will want to skip over. The book is exhaustively referenced with 100 to over 400 references at the end of each chapter. This book should be read by everyone anticipating studying and doing research on functional gastrointestinal disorders. In this day when practice guidelines receive so much attention, the chapters on specific diagnoses have useful information and provide a yardstick by which to measure current practices. Finally, the chapter on the fundamentals of neurogastroenterology gives a clear overview alimentary tract control, infonnation that all with an interest in functional disorders of the gastrointestinal tract should make his own. 

Thomas R. Hendrix
Johns Hopkins University 

Books Received

Body Composition Analysis of Animals: A Handbook of Non-Destructive Methods.
John R. Speakman (Editor).
New York: Cambridge Univ. Press, 2001, 242 pp., illus., index, $74.95.
ISBN: 0-521-66338-5.

Development of the Human Spinal Cord.
Joseph Altman and Shirley A. Bayer.
New York: Oxford Univ. Press, 2001, 
542 pp., illus., index, $185.00.
ISBN: 0-19-514427-9.

Fetal Growth and Development.
Richard Harding and Alan D. Bocking (Editors).
New York: Cambridge Univ. Press, 2001, 284 pp., illus., index, $28.95.
ISBN: 0-521-64543-3. 

The Geometry of Biological Time, 2nd Edition.
Arthur T. Winfree.
Interdisciplinary Applied Mathematics.
New York: Springer-Verlag, 2001, 777 pp., illus., index, $89.95.
ISBN: 0-387-98992-7. 

Variability-Entropy Theory. 
Robert M. Peters, M.D.
Lewiston, ID, 2001, 68 pp., illus., $12.95.
ISBN: 0-9713107-0-X.

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