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Topic:Treadmill Exercise

Treadmill exercise for horses involves the use of a controlled mechanical platform to simulate various gaits and intensities of physical activity. This form of exercise allows for consistent and measurable training conditions, which can be used for rehabilitation, fitness assessment, and performance enhancement. Treadmill exercise facilitates the study of equine locomotion, respiratory function, and cardiovascular response under standardized conditions. It is also utilized in research to evaluate the effects of different training regimens and to investigate metabolic and physiological responses to exercise. This page compiles peer-reviewed research studies and scholarly articles that explore the methodology, applications, and implications of treadmill exercise in equine practice.
Respiratory mechanics of horses during stepwise treadmill exercise tests, and the effect of clenbuterol pretreatment on them.
Australian veterinary journal    September 1, 1992   Volume 69, Issue 9 221-225 doi: 10.1111/j.1751-0813.1992.tb09929.x
Slocombe RF, Covelli G, Bayly WM.Normal Standardbred horses were given an incremental exercise test on a horizontal treadmill to evaluate the influence of exercise on gas exchange, resistance, dynamic compliance and inertance of the respiratory system. The exercise test consisted of 2 min exercise steps at each of the following speeds: 2.4 m/sec (walk), 4.5 m/sec (slow trot), 7.0 m/sec (fast trot) and 10 m/sec (gallop). At rest and after 1 min of exercise at each step, airflow, tidal volume, respiratory frequency, pharyngeal, mid-oesophageal and transdiaphragmatic pressures and arterial blood gas tensions were measured. The s...
Plasma renin activity and aldosterone and vasopressin concentrations during incremental treadmill exercise in horses.
American journal of veterinary research    August 1, 1992   Volume 53, Issue 8 1290-1293 
McKeever KH, Hinchcliff KW, Schmall LM, Reed SM, Lamb DR, Muir WW.Six untrained mares were subjected to incremental treadmill exercise to examine exercise-induced changes in plasma renin activity (PRA) and plasma aldosterone (ALDO) and plasma arginine vasopressin (AVP) concentrations. Plasma renin activity, ALDO and AVP concentrations, and heart rate (HR) were measured at each step of an incremental maximal exercise test. Mares ran up a 6 degree slope on a treadmill set at an initial speed of 4 m/s. Speed was increased 1 m/s each minute until HR reached a plateau. Plasma obtained was stored at -80 C and later was thawed, extracted, and assayed for PRA and AL...
Bronchial circulation during prolonged exercise in ponies.
American journal of veterinary research    June 1, 1992   Volume 53, Issue 6 925-929 
Manohar M, Duren SE, Sikkes BP, Day J, Baker JP.Tracheal, bronchial, and renal flow were studied in 8 healthy ponies at rest and during exercise performed on a treadmill at a speed setting of 20.8 km/h and 7% grade (incline) for 30 minutes. Blood flow was determined with 15-microns-diameter radionuclide-labeled microspheres that were injected into the left ventricle when the ponies were at rest, and at 5, 15, and 26 minutes of exertion. Heart rate and mean aortic pressure increased from resting values (40 +/- 2 beats/min and 124 +/- 3 mm of Hg, respectively) to 152 +/- 8 beats/min and 133 +/- 4 mm of Hg at 5 minutes of exercise, to 169 +/- ...
Influence of furosemide on hemodynamic responses during exercise in horses.
American journal of veterinary research    May 1, 1992   Volume 53, Issue 5 742-747 
Olsen SC, Coyne CP, Lowe BS, Pelletier N, Raub EM, Erickson HH.Four hours prior to exercise on a high-speed treadmill, 4 dosages of furosemide (0.25, 0.50, 1.0, and 2.0 mg/kg of body weight) and a control treatment (10 ml of 0.9% NaCl) were administered IV to 6 horses. Carotid arterial pressure (CAP), pulmonary arterial pressure (PAP), and heart rate were not different in resting horses before and 4 hours after furosemide administration. Furosemide at dosage of 2 mg/kg reduced resting right atrial pressure (RAP) 4 hours after furosemide injection. During exercise, increases in treadmill speed were associated with increases in RAP, CAP, PAP, and heart rate...
Pulmonary artery and aortic pressure changes during high intensity treadmill exercise in the horse: effect of frusemide and phentolamine.
Equine veterinary journal    May 1, 1992   Volume 24, Issue 3 215-219 doi: 10.1111/j.2042-3306.1992.tb02818.x
Erickson BK, Erickson HH, Coffman JR.Intravenous frusemide (1.0 mg/kg bwt) or phentolamine (0.33 mg/kg bwt) was given to 7 horses 1 h before exercise and their effects on pulmonary artery and aortic pressure changes during strenuous exercise were examined. Short-term near-maximal treadmill exercise (10 m/sec, 3 degrees incline) produced increases in heart rate, mean pulmonary artery pressure (PAP), mean aortic pressure (AP), and packed cell volume (PCV). Frusemide did not affect heart rate, PAP or PCV during exercise. Frusemide significantly decreased mean AP by 10 to 15 mmHg during exercise. Phentolamine produced an increase in ...
Plasma potassium and lactate concentrations in thoroughbred horses during exercise of varying intensity.
Equine veterinary journal    May 1, 1992   Volume 24, Issue 3 220-225 doi: 10.1111/j.2042-3306.1992.tb02819.x
Harris P, Snow DH.To investigate the effect of moderate to high intensity exercise of up to 6 min duration on plasma potassium and lactate concentrations, 6 Thoroughbred horses were studied using a treadmill at a 5 degree incline. Each test consisted of an 8-min standardised warm-up followed by an exercise bout at 8, 9, 10 or 12 m/sec. The horses were galloped at each speed for up to a maximum of 6 min or until signs of fatigue were present. The horses were then walked at 0 degree incline. Carotid arterial blood samples were taken during and after the exercise. At 8, 9 and 10 m/sec there was a general pattern o...
Ultrastructural changes in skeletal muscle after fatiguing exercise.
Journal of applied physiology (Bethesda, Md. : 1985)    March 1, 1992   Volume 72, Issue 3 1111-1117 doi: 10.1152/jappl.1992.72.3.1111
McCutcheon LJ, Byrd SK, Hodgson DR.Thoroughbred horses were exercised to fatigue at 40, 85, and 100% of their maximal oxygen consumption (VO2max) on a treadmill and completed a 1,600-m gallop on a track to identify the effect of exercise of various durations and intensities on the ultrastructure of mitochondria and sarcoplasmic reticulum (SR) from the middle gluteal muscle. The percentage of the total area occupied by mitochondria and SR increased in electron micrographs of muscle samples collected at the termination of exercise and at 30 and 60 min of recovery compared with those collected before exercise. Mitochondrial area i...
Mathematical modelling of post-exercise heart rate recovery in ponies.
Biomedical sciences instrumentation    January 1, 1992   Volume 28 151-156 
Rugh KS, Jiang B, Hatfield DG, Garner HE, Hahn AW.Using a recently developed nonlinear algorithm which identifies reference points on left ventricular pressure waveforms and other waveforms, we analyzed heart rate recovery in ponies after strenuous treadmill exercise. Each pony performed exercise tests with and without premedication with atropine methyl nitrate. Resting and exercise heart rates were 54 +/- 3 and 209 +/- 6 beats/min, respectively, without premedication and 85 +/- 8 and 212 +/- 5 beats/min, respectively, following atropine premedication. Post-exercise heart rate recovery without premedication was best described by a biexponenti...
Adenine nucleotide degradation in the thoroughbred horse with increasing exercise duration.
European journal of applied physiology and occupational physiology    January 1, 1992   Volume 65, Issue 3 271-277 doi: 10.1007/BF00705093
Sewell DA, Harris RC.Adenine nucleotide (AN) degradation has been shown to occur during intense exercise in the horse and in man, at or close to the point of fatigue. The aim of the study was to compare the concentrations of muscle inosine 5'-monophosphate (IMP) and plasma ammonia (NH3) during intense exercise with the concentrations of muscle and blood lactate. Seven trained thoroughbred horses were used in the study. Each exercised on a treadmill for periods of between 30 s and 150 s, at 11 and/or 12 m.s-1. Blood and muscle samples were taken and analysed for lactate and NH3 and adenosine 5'-triphosphate (ATP), ...
Effects of treadmill exercise on cortical bone in the third metacarpus of young horses.
Research in veterinary science    January 1, 1992   Volume 52, Issue 1 28-37 doi: 10.1016/0034-5288(92)90054-6
McCarthy RN, Jeffcott LB.The effects of exercise and relative inactivity on cortical bone were compared in young horses. Two groups were used; one was given a 14-week programme of exercise (n = 6) and the other kept as unexercised controls (n = 6). The first nine weeks of exercise involved trotting and cantering (2 to 4 km d-1 at speeds up to 12 m s-1) on a treadmill set at an incline of 3 degrees. Over the next five weeks the horses were trained at near maximal speeds (that is, up to 14.5 m s-1) with no incline of the treadmill. At the end of the programme marked differences in cortical porosity and distribution of s...
Exercise-induced phospholipid degradation in the equine skeletal muscle and erythrocytes.
The Journal of veterinary medical science    December 1, 1991   Volume 53, Issue 6 1001-1007 doi: 10.1292/jvms.53.1001
Matsuki N, Tamura S, Ono K, Watari T, Goitsuka R, Yamanobe A, Hiraga A, Kubo K, Takagi S, Hasegawa A.To understand the pathogenesis of equine exercise-induced myopathies and hemolysis, changes of phospholipid peroxidation products in the equine middle gluteal muscle and erythrocytes following the high-speed treadmill exercise were studied. In the skeletal muscle, the peroxidized phosphatidylethanolamine (PE) were increased at 24 hours after the exercise. The malondialdehydes (MDAs) were also increased as the protein-bound MDAs following exercise. In the erythrocytes, the peroxidized PE were significantly decreased at 24 hours after the exercise. The protein-bound MDAs were significantly incre...
Plasma beta-endorphin and adrenocorticotrophin in young horses in training.
Australian veterinary journal    November 1, 1991   Volume 68, Issue 11 359-361 doi: 10.1111/j.1751-0813.1991.tb00736.x
McCarthy RN, Jeffcott LB, Funder JW, Fullerton M, Clarke IJ.A controlled period of submaximal exercise on a treadmill was used as a standardised stress test in 6 young horses to monitor the effects of training. Circulating plasma concentrations of immunoreactive beta-endorphin (IR beta-EP) were measured before, during and after the exercise period. The stress test was conducted on 3 occasions during an intensive training program lasting 14 weeks. In week 3 a marked increase in plasma IR beta-EP (P = 0.003) was demonstrated as a result of training, but by the last exercise test performed in week 9 no significant increase in plasma IR beta-EP concentrati...
Metabolic responses to ammonium acetate infusion in exercising horses.
The Cornell veterinarian    October 1, 1991   Volume 81, Issue 4 397-410 
Miller-Graber P, Lawrence L, Fisher M, Bump K, Foreman J, Kurcz E.The relationship between elevated plasma ammonia (NH3) levels, fatigue development and muscle metabolism were examined in horses during a submaximal fatigue test. Eight Quarter Horse mares were intravenously infused prior to exercise with either sodium acetate (control) or ammonium acetate (AMINF), and exercised to fatigue on an 11% grade treadmill, carrying 27 kg of lead. Time to fatigue was not different (P greater than 0.05) between groups. Intramuscular NH3 and lactate increased (P less than 0.001) during exercise; however, the treatment did not (P greater than 0.05) affect either. A treat...
Clenbuterol plasma concentrations after repeated oral administration and its effects on cardio-respiratory and blood lactate responses to exercise in healthy Standardbred horses.
Journal of veterinary pharmacology and therapeutics    September 1, 1991   Volume 14, Issue 3 243-249 doi: 10.1111/j.1365-2885.1991.tb00833.x
Kallings P, Ingvast-Larsson C, Persson S, Appelgren LE, Förster HJ, Rominger KL.To evaluate the effects of clenbuterol on cardio-respiratory parameters and blood lactate relation to exercise tolerance, experimental horses performed standardized exercise tests on a high-speed treadmill before and after administration of the drug. Clenbuterol was administered in feed to six healthy Standardbreds at a dose rate of 0.8 micrograms/kg b.wt twice daily for 5.5 days. Each horse was tested twice, without and with a respiratory mask, during two consecutive days. One week elapsed between the baseline tests without drug and the tests with clenbuterol treatment (each horse served as i...
Treatment of left laryngeal hemiplegia in standardbreds, using a nerve muscle pedicle graft.
American journal of veterinary research    September 1, 1991   Volume 52, Issue 9 1461-1467 
Fulton IC, Derksen FJ, Stick JA, Robinson NE, Walshaw R.The efficacy of a nerve muscle pedicle (NMP) graft in restoring upper airway function was evaluated in exercising horses with induced left laryngeal hemiplegia. The NMP graft was created from the first cervical nerve and the omohyoideus muscle and transplanted into the left cricoarytenoideus dorsalis muscle. Seven adult Standardbreds were trained to exercise on a treadmill inclined at 6.38 degrees. With the horses at rest and exercising at 4.2 and 7.0 m/s, the following variables were recorded: peak inspiratory and expiratory transupper airway pressures (defined as the pressure difference betw...
Studies of meclofenamic acid and two metabolites in horses–pharmacokinetics and effects on exercise tolerance.
Journal of veterinary pharmacology and therapeutics    September 1, 1991   Volume 14, Issue 3 235-242 doi: 10.1111/j.1365-2885.1991.tb00832.x
Johansson IM, Kallings P, Hammarlund-Udenaes M.The pharmacokinetics and the effects on treadmill exercise of the anti-inflammatory drug meclofenamic acid were studied in seven Standardbred horses after single intravenous and/or oral doses. The decline in plasma concentration after a single intravenous dose of meclofenamic acid (2.2 mg/kg b.wt) was described by a two-compartment open model. The average elimination half-life was 1.4 h, the apparent volume of distribution 0.14 l/kg and the plasma clearance 0.12 l/h kg. Absorption was the rate-limiting step after oral administration. Non-compartmental analysis showed a mean absorption time of ...
Dietary protein level and energy metabolism during treadmill exercise in horses.
The Journal of nutrition    September 1, 1991   Volume 121, Issue 9 1462-1469 doi: 10.1093/jn/121.9.1462
Miller-Graber PA, Lawrence LM, Foreman JH, Bump KD, Fisher MG, Kurcz EV.Six conditioned Quarter Horse mares were used in a crossover design to assess the effect of the dietary protein level on intramuscular and hepatic glycogen and lactate, oxygen uptake and blood lactate, pyruvate and free fatty acids. After a 2-wk adaptation period to either a 9.0% (control) or an 18.5% crude protein diet, each horse performed an exercise test. The horses were exercised for 15 min on an 11% grade treadmill at 4.5 m/sec. The exercise test was performed 3-4 h after a meal. Venous, arterial and mixed-venous blood samples were taken simultaneously at rest and during exercise. Muscle...
Renal tubular function in horses during submaximal exercise.
The American journal of physiology    September 1, 1991   Volume 261, Issue 3 Pt 2 R553-R560 doi: 10.1152/ajpregu.1991.261.3.R553
McKeever KH, Hinchcliff KW, Schmall LM, Muir WW.Exercise-induced changes in renal function were examined during steady-state submaximal treadmill exercise in six unfit mares. Horses were randomly assigned to either an exercise or parallel control (no exercise) trial on day 1 and the alternate trial 1 wk later. The mares ran on a treadmill, set at a 6 degrees incline, for 1 h at 55-60% of maximal heart rate. Exercise significantly (P less than 0.05) increased plasma osmolality, plasma [K+], urine flow (+ 45%), Na+ excretion (+ 371%), K+ excretion (+ 57%), osmotic clearance (+ 32%), Na+ clearance (+ 391%), K+ clearance (+ 33%), and fractional...
The use of high-speed treadmills for lameness and hoof balance evaluations in the horse.
The Veterinary clinics of North America. Equine practice    August 1, 1991   Volume 7, Issue 2 271-309 doi: 10.1016/s0749-0739(17)30501-1
Seeherman HJ.Examination for lameness remains the most important component of the clinical evaluation for poor performance. Although conventional examinations can be used to diagnose many causes of lameness, treadmill video gait analysis and dynamic hoof balance evaluations have proved to be useful not only for evaluating lameness but also for maintenance of long-term soundness. Treadmill lameness evaluations offer a major advantage compared to conventional evaluations because of the stationary position of the exercising horse relative to the people performing the examination. Lameness is suspected if asym...
Treadmill exercise testing. Treadmill installation and training protocols used for clinical evaluations of equine athletes.
The Veterinary clinics of North America. Equine practice    August 1, 1991   Volume 7, Issue 2 259-269 doi: 10.1016/s0749-0739(17)30500-x
Seeherman HJ.The use of motorized treadmills has made it possible to evaluate equine poor performance with sophisticated diagnostic techniques during peak exercise. Treadmill exercise tests currently being used for clinical evaluations include treadmill gait analysis, dynamic hoof balancing, endoscopic evaluation of upper airway function, and exercise performance profiling. Large motorized treadmills (1 to 1.5 m in width and 4 to 5 m in length) are best suited for clinical evaluations. Ideally, the treadmill should be installed in-ground using a pit. This type of installation results in the tread surface b...
Dynamic evaluation of the equine upper respiratory tract.
The Veterinary clinics of North America. Equine practice    August 1, 1991   Volume 7, Issue 2 403-416 doi: 10.1016/s0749-0739(17)30506-0
Morris E.Each case of suboptimal equine athletic performance should be evaluated in a comprehensive manner, including physical examination; clinical pathologic analysis; and evaluation of the neurologic system, the musculoskeletal system, and the upper and lower respiratory system. A vital part of this examination is the clinical evaluation of dynamic upper respiratory tract function of the horse during treadmill exercise, which allows the observation of upper respiratory tract function during conditions simulating competitive racing. It generally is agreed that the endoscopic identification of an uppe...
Ventilatory compensation for lactacidosis in ponies: role of carotid chemoreceptors and lung afferents.
Journal of applied physiology (Bethesda, Md. : 1985)    June 1, 1991   Volume 70, Issue 6 2619-2626 doi: 10.1152/jappl.1991.70.6.2619
Erickson BK, Forster HV, Pan LG, Lowry TF, Brown DR, Forster MA, Forster AL.We investigated changes in arterial PCO2 (PaCO2) and pulmonary ventilation (VE) in normal, carotid chemoreceptor-denervated, and hilar nerve-denervated ponies during intravenous lactic acid infusion at rest and treadmill exercise at 1.8 mph-5% grade (mild) and 1.8 mph-15% grade (moderate). Lactic acid, (0.5 M) infusion of 0.10, 0.13, and 0.20 ml.min-1.kg-1 at rest and mild and moderate exercise increased arterial [H+] linearly throughout the 10 min of acid infusion. At 10 min of infusion, arterial [H+] had increased approximately 20 nmol/l (0.2 pH units) for each condition and group. Under mos...
Technique for continuous stride analysis of horses exercising on a treadmill.
Research in veterinary science    May 1, 1991   Volume 50, Issue 3 360-361 doi: 10.1016/0034-5288(91)90141-a
Williams RB, Clark CG, Young SS.A technique for continuous computerised recording and analysis of the stride of horses on a treadmill is described. Advantages of the system are low cost, the use of normal shoes and the calculation of stride parameters in real time.
Clinical evaluation of poor performance in the racehorse: the results of 275 evaluations.
Equine veterinary journal    May 1, 1991   Volume 23, Issue 3 169-174 doi: 10.1111/j.2042-3306.1991.tb02749.x
Morris EA, Seeherman HJ.A clinical sports medicine evaluation was applied to 275 racehorses with a history of poor racing performance. The poor performance evaluation included a) general physical examination and basic laboratory screening; b) respiratory examination including auscultation, thoracic radiographs, ventilation-perfusion lung scintigraphy and upper airway endoscopy at rest and during maximal treadmill exercise c) examination of the musculoskeletal system including lameness examination, video gait analysis at high speed, post exercise serum chemistry to identify obvious as well as sub-clinical myopathies, ...
Additional diagnostic procedures.
The Veterinary clinics of North America. Equine practice    April 1, 1991   Volume 7, Issue 1 197-199 doi: 10.1016/s0749-0739(17)30523-0
Reed SM, Robertson JT.This article reviews recent diagnostic procedures that have arisen over the last 10 years. Videoendoscopy of horses on a high-speed treadmill allows observation of some of the changes that take place in a horse's airway during exercise. Measurements of upper airway airflows and transupper airway pressure, the use of an esophageal balloon and a Ventigraph to measure changes in pleural pressure, and pulmonary function testing are new techniques that aid the researcher in understanding the mechanics and pathologic characteristics of airway diseases and help the practitioner in assessing the sever...
Arytenoid cartilage movement in resting and exercising horses.
Veterinary surgery : VS    March 1, 1991   Volume 20, Issue 2 122-127 doi: 10.1111/j.1532-950x.1991.tb00319.x
Rakestraw PC, Hackett RP, Ducharme NG, Nielan GJ, Erb HN.Endoscopic examinations of the larynx were recorded on 49 horses at rest and while exercising on a 5% inclined high-speed treadmill for 8 minutes at a maximum speed of 8.5 m/sec. Subjective laryngeal function scores at rest and while exercising were based on the degree and synchrony of arytenoid abduction. Arytenoid abduction was expressed as a left:right ratio of rima glottidis measurements. Horses with arytenoid cartilage asynchrony at rest (grade 2) could not be distinguished from normal horses (grade 1) when exercising because full abduction was maintained throughout the exercise period. F...
Muscle ATP loss and lactate accumulation at different work intensities in the exercising Thoroughbred horse.
European journal of applied physiology and occupational physiology    January 1, 1991   Volume 62, Issue 4 235-244 doi: 10.1007/BF00571546
Harris RC, Marlin DJ, Snow DH, Harkness RA.The effect of 2 min treadmill exercise, at speeds of 6-12 m.s-1 on an incline of 5 degrees, upon muscle adenine nucleotide loss and lactate accumulation was studied in six Thoroughbred horses. Minimal change occurred in the adenosine triphosphate (ATP) content of the middle gluteal muscle at speeds of 10 m.s-1 or less, but significant loss (up to 47%) had occurred in all horses by 12 m.s-1. The decline in ATP significantly correlated with the accumulation of muscle lactate, beginning shortly after the accumulation of 40 mmol.kg-1 dry muscle lactate. Decline in muscle ATP was mirrored closely b...
Mechanics of breathing during strenuous exercise in Thoroughbred horses.
Respiration physiology    December 1, 1990   Volume 82, Issue 3 279-294 doi: 10.1016/0034-5687(90)90098-j
Art T, Anderson L, Woakes AJ, Roberts C, Butler PJ, Snow DH, Lekeux P.The changes induced by exercise on the mechanics of breathing, as well as the simultaneous changes occurring in arterial blood gas tensions and in respiratory gas exchange were investigated in 6 healthy thoroughbred horses, performing a treadmill exercise of increasing intensity. Respiratory airflow and tidal volume (VT) were measured with ultrasonic flowmeters. Pleural pressure changes were measured by an oesophageal balloon catheter. Gas concentration of the expired air was analysed with a mass spectrometer; the oxygen consumption (VO2) and the carbon dioxide output (VCO2) were computed brea...
Effect of partial spinal cord ablation on exercise hyperpnea in ponies.
Journal of applied physiology (Bethesda, Md. : 1985)    November 1, 1990   Volume 69, Issue 5 1821-1827 doi: 10.1152/jappl.1990.69.5.1821
Pan LG, Forster HV, Wurster RD, Murphy CL, Brice AG, Lowry TF.We addressed the role of spinal afferent information in the exercise hyperpnea. Arterial PCO2 (PaCO2) was assessed in 10 normal ponies during low (1.8 mph 7% or 17% grade) or moderate (6 mph 7% grade) treadmill exercise. After control studies, bilateral spinal ablation (SA) of the dorsolateral sulcus and dorsolateral funiculus at L2 was performed in seven ponies. In normal ponies within the first 90 s of exercise, PaCO2 initially decreased 2.7, 4.1, and 5.2 Torr below rest at the three work loads, respectively (P less than 0.05). PaCO2 thereafter increased toward resting levels but remained 1....
Clinical exercise testing in the normal thoroughbred racehorse.
Australian veterinary journal    October 1, 1990   Volume 67, Issue 10 345-348 doi: 10.1111/j.1751-0813.1990.tb07394.x
Rose RJ, Hendrickson DK, Knight PK.To evaluate normal cardiorespiratory and metabolic responses of Thoroughbred horses to a standardised treadmill exercise test, we examined 28 horses ranging in age from 1 to 4 years. The group consisted of eight yearlings, eight 2-year-olds and twelve 3 and 4-year-olds. All horses except the yearlings were in training, and either racing or ready to race, at the time of examination. None of the horses had histories of performance problems. On the first day the horses received a full physical examination, resting electrocardiogram, upper respiratory tract endoscopy and either one or two acclimat...
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