1
|
Warneke K, Keiner M, Behm DG, Wirth K, Kaufmann M, Sproll M, Konrad A, Wallot S, Hillebrecht M. Can isometric testing substitute for the one repetition maximum squat test? Eur J Appl Physiol 2024:10.1007/s00421-024-05554-8. [PMID: 39098977 DOI: 10.1007/s00421-024-05554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/07/2024] [Indexed: 08/06/2024]
Abstract
When measuring maximum strength, a high accuracy and precision is required to monitor the training adaptations. Based on available reliability parameters, the literature suggests the replacement of the one repetition maximum (1RM) by isometric testing to save testing time. However, from a statistical point of view, correlation coefficients do not provide the required information when aiming to replace one test by another. Therefore, the literature suggests the inclusion of the mean absolute error (MAE), the mean absolute percentage error (MAPE) for agreement analysis. Consequently, to check the replaceability of 1RM testing methods, the current study examined the agreement of isometric and dynamic testing methods in the squat and the isometric mid-thigh pull. While in accordance with the literature, correlations were classified high r = 0.638-0.828 and ICC = 0.630-0.828, the agreement analysis provided MAEs of 175.75-444.17 N and MAPEs of 16.16-57.71% indicating an intolerable high measurement error between isometric and dynamic testing conditions in the squat and isometric mid-thigh pull. In contrast to previous studies, using MAE, MAPE supplemented by CCC and BA analysis highlights the poor agreement between the included strength tests. The recommendation to replace 1RM testing with isometric testing routines in the squat does not provide suitable concordance and is not recommended.
Collapse
Affiliation(s)
- Konstantin Warneke
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.
| | - Michael Keiner
- Institute of Exercise Science, German University of Sport and Health, Ismaning, Germany
| | - David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Klaus Wirth
- Institute of Exercise Science, University of Applied Sciences Wiener Neustadt, Wiener Neustadt, Austria
| | - Martin Kaufmann
- University Sports Center, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Mareike Sproll
- Department of Human Motion Science and Exercise Physiology, Friedrich Schuller University, Jena, Germany
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Sebastian Wallot
- Institute of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - Martin Hillebrecht
- University Sports Center, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| |
Collapse
|
2
|
Indrayan A. Assessing agreement between two methods of measuring blood glucose level without Bland-Altman limits. Diabetes Metab Syndr 2023; 17:102805. [PMID: 37329839 DOI: 10.1016/j.dsx.2023.102805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To describe a new method of assessing agreement between two methods of measuring blood glucose level in view of several problems with the currently used Bland-Altman method. METHODS Study the deficiencies in the Bland-Altman method and propose a simple method that overcomes these deficiencies. The simple method does not require the calculation of Bland-Altman limits. RESULTS Clinical tolerance limits, which are needed anyway, can be directly used to obtain the agreement by the percentage of differences within these limits. This method is simple, robust, and nonparametric. It is more flexible also as the clinical tolerance limits can be varied for different values of the measurement such as to have close agreement at critical values and relaxed agreement at other values. Non-symmetric limits can also be set up under the simple method. CONCLUSION The method of assessing agreement between two methods of measuring blood glucose level can be greatly improved by directly using clinical tolerance limits without calculating the Bland-Altman limits.
Collapse
|
3
|
Warneke K, Wagner CM, Keiner M, Hillebrecht M, Schiemann S, Behm DG, Wallot S, Wirth K. Maximal strength measurement: A critical evaluation of common methods-a narrative review. Front Sports Act Living 2023; 5:1105201. [PMID: 36873661 PMCID: PMC9981657 DOI: 10.3389/fspor.2023.1105201] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Measuring maximal strength (MSt) is a very common performance diagnoses, especially in elite and competitive sports. The most popular procedure in test batteries is to test the one repetition maximum (1RM). Since testing maximum dynamic strength is very time consuming, it often suggested to use isometric testing conditions instead. This suggestion is based on the assumption that the high Pearson correlation coefficients of r ≥ 0.7 between isometric and dynamic conditions indicate that both tests would provide similar measures of MSt. However, calculating r provides information about the relationship between two parameters, but does not provide any statement about the agreement or concordance of two testing procedures. Hence, to assess replaceability, the concordance correlation coefficient (ρ c) and the Bland-Altman analysis including the mean absolute error (MAE) and the mean absolute percentage error (MAPE) seem to be more appropriate. Therefore, an exemplary model based on r = 0.55 showed ρ c = 0.53, A MAE of 413.58 N and a MAPE = 23.6% with a range of -1,000-800 N within 95% Confidence interval (95%CI), while r = 0.7 and 0.92 showed ρ c = 0.68 with a MAE = 304.51N/MAPE = 17.4% with a range of -750 N-600 N within a 95% CI and ρ c = 0.9 with a MAE = 139.99/MAPE = 7.1% with a range of -200-450 N within a 95% CI, respectively. This model illustrates the limited validity of correlation coefficients to evaluate the replaceability of two testing procedures. Interpretation and classification of ρ c, MAE and MAPE seem to depend on expected changes of the measured parameter. A MAPE of about 17% between two testing procedures can be assumed to be intolerably high.
Collapse
Affiliation(s)
- Konstantin Warneke
- Department for Exercise, Sport and Health, Leuphana University Lüneburg, Lüneburg, Germany
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. Johns, NL, Canada
| | - Carl-Maximilian Wagner
- Department of Training Science, German University of Health and Sport, Berlin, Baden-Württemberg, Germany
| | - Michael Keiner
- Department of Training Science, German University of Health and Sport, Berlin, Baden-Württemberg, Germany
| | - Martin Hillebrecht
- University Sports Center, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Stephan Schiemann
- Department for Exercise, Sport and Health, Leuphana University Lüneburg, Lüneburg, Germany
| | - David George Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. Johns, NL, Canada
| | | | - Klaus Wirth
- Faculty of Training and Sports Science, University of Applied Science Wiener Neustadt, Vienna, Austria
| |
Collapse
|
4
|
Sendino T, Sandúa A, Calleja S, González Á, Alegre E. Lactose tolerance test as an alternative to hydrogen breath test in the study of lactose malabsorption. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200102. [PMID: 37360621 PMCID: PMC10197344 DOI: 10.1515/almed-2020-0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 06/28/2023]
Abstract
Objectives Lactose malabsorption is generally assessed by hydrogen breath testing (HBT). However, this test is not recommended in patients with high baseline hydrogen concentrations (H2B). In addition, breath testing is not recommended in the current situation created by the COVID-19 pandemic, due to the potential infectiveness of the samples. The objective is to assess concordance between HBT and lactose tolerance test (LTT) depending on H2B concentrations. Methods A total of 430 patients (40 years, Q1-Q3 = 28-54 years; 66.7% women) suspected of lactose malabsorption were included in the study. Breath and heparinized blood samples were collected at baseline and sequentially after the intake of 50 g of lactose, to measure hydrogen in breath and glycemia in blood, respectively. Results H2B was <10 ppm in 69.5% of subjects; 10-20 ppm in 14.7%; and >20 ppm in 15.8% of subjects. In patients with H2B <20 ppm, concordance between HBT and LTT was moderate and consistently improved when the cut-off in LTT was set at 15 mg/dL. The increase in hydrogen and glucose correlated negatively (r=-0.389; p<0.05). The increase in glycemia during LTT was not influenced by H2B levels obtained in HBT. Conclusions LTT emerges as an alternative to HBT to assess lactose malabsorption in the presence of high H2B levels or when breath testing is not recommended by the circumstances. The best concordance was obtained when the cut-off for LTT was set at 15 mg/dL.
Collapse
Affiliation(s)
- Teresa Sendino
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
| | - Amaia Sandúa
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sofía Calleja
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
| | - Álvaro González
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Estibaliz Alegre
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| |
Collapse
|
5
|
Westerink F, Beijderwellen H, Huibregtse IL, De Hoog MLA, De Brauw LM, Brandjes DPM, Gerdes VEA. Lactose after Roux-en-Y gastric bypass for morbid obesity, is it a problem? Scand J Gastroenterol 2020; 55:1398-1404. [PMID: 33096008 DOI: 10.1080/00365521.2020.1837927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) can cause multiple food intolerances and gastrointestinal complaints are frequently reported after dairy consumption. We aimed to determine the prevalence of lactose malabsorption and intolerance, and complaints associated with dairy consumption in daily life, before and after RYGB. METHOD The lactose breath test (LBT) and lactose tolerance test (LTT) was performed in 84 patients awaiting RYGB surgery and 84 patients after surgery. Gastrointestinal symptoms at baseline and after testing were recorded. Lactose malabsorption was defined as a positive LBT and/or LTT. Lactose intolerance as a positive test combined with an increase of gastrointestinal complains. Dairy consumption in daily life and successive gastrointestinal complaints were registered via a questionnaire. Results of preoperative and postoperative patients were compared. RESULTS Lactose malabsorption was present in 15 (17.9%) of the preoperative patients and in 25 (29.8%) of the postoperative patients (OR 2.46; 95%CI: 1.08-5.59; p = .03). Of the preoperative patients 6 (7.1%) patients met the criteria for lactose intolerance, compared to 8 (9.5%) patients in the postoperative group (OR 1.48; 95%CI 0.48-4.57; p = .50). Twelve (14.3%) preoperative patients indicated to have gastrointestinal complaints after dairy consumption in daily life versus 45 (53.6%) postoperative patients (p < .01). CONCLUSION This study shows no increase in patients with proven lactose intolerance after RYGB compared to preoperative patients. Gastrointestinal complaints after dairy consumption in daily life were far more frequently reported by RYGB patients. It is unlikely that all reported gastrointestinal complaints are actually caused by lactose. Other ingredients in dairy, like fat, are possibly contributory.
Collapse
Affiliation(s)
- F Westerink
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - H Beijderwellen
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - I L Huibregtse
- Department of Gastroenterology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M L A De Hoog
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - L M De Brauw
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - D P M Brandjes
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - V E A Gerdes
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| |
Collapse
|
6
|
Misselwitz B, Butter M, Verbeke K, Fox MR. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut 2019; 68:2080-2091. [PMID: 31427404 PMCID: PMC6839734 DOI: 10.1136/gutjnl-2019-318404] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/15/2019] [Accepted: 06/21/2019] [Indexed: 12/16/2022]
Abstract
Lactose is the main source of calories in milk, an essential nutriedigestion, patients with visceral hypersensitivity nt in infancy and a key part of the diet in populations that maintain the ability to digest this disaccharide in adulthood. Lactase deficiency (LD) is the failure to express the enzyme that hydrolyses lactose into galactose and glucose in the small intestine. The genetic mechanism of lactase persistence in adult Caucasians is mediated by a single C→T nucleotide polymorphism at the LCTbo -13'910 locus on chromosome-2. Lactose malabsorption (LM) refers to any cause of failure to digest and/or absorb lactose in the small intestine. This includes primary genetic and also secondary LD due to infection or other conditions that affect the mucosal integrity of the small bowel. Lactose intolerance (LI) is defined as the onset of abdominal symptoms such as abdominal pain, bloating and diarrhoea after lactose ingestion by an individual with LM. The likelihood of LI depends on the lactose dose, lactase expression and the intestinal microbiome. Independent of lactose digestion, patients with visceral hypersensitivity associated with anxiety or the Irritable Bowel Syndrome (IBS) are at increased risk of the condition. Diagnostic investigations available to diagnose LM and LI include genetic, endoscopic and physiological tests. The association between self-reported LI, objective findings and clinical outcome of dietary intervention is variable. Treatment of LI can include low-lactose diet, lactase supplementation and, potentially, colonic adaptation by prebiotics. The clinical outcome of these treatments is modest, because lactose is just one of a number of poorly absorbed carbohydrates which can cause symptoms by similar mechanisms.
Collapse
Affiliation(s)
- Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland
| | - Matthias Butter
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland
| | - Kristin Verbeke
- Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
| | - Mark R Fox
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland,Digestive Function: Basel, Laboratory and Clinic for motility disorders and functional GI diseases, Center for integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland
| |
Collapse
|
7
|
Domínguez-Jiménez JL, Fernández-Suárez A. Diagnóstico de la intolerancia a la lactosa. Med Clin (Barc) 2017; 148:262-264. [DOI: 10.1016/j.medcli.2016.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 11/20/2016] [Indexed: 11/28/2022]
|