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Mitropoulos A, Anifanti M, Koukouvou G, Ntovoli A, Alexandris K, Kouidi E. Exploring the effects of real-time online cardiac telerehabilitation using wearable devices compared to gym-based cardiac exercise in people with a recent myocardial infarction: a randomised controlled trial. Front Cardiovasc Med 2024; 11:1410616. [PMID: 38903965 PMCID: PMC11188591 DOI: 10.3389/fcvm.2024.1410616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Background Exercise-based cardiac rehabilitation (CR) is a non-pharmacological multidisciplinary programme for individuals after myocardial infarction (MI) that offers multiple health benefits. One of the greatest barriers to CR participation is the travel distance to the rehabilitation centre. Remotely monitored CR appears to be at least as effective in improving cardiovascular risk factors and exercise capacity as traditional centre-based CR. Nevertheless, the efficacy of remotely monitored CR in individuals with a recent MI has yet to be examined. Methods A total of 30 individuals (8 women, 22 men) after a recent (i.e., <4 weeks) MI were randomly allocated into two groups (online home-based and gym-based groups). Both groups underwent a 26-week CR programme three times per week. All patients performed baseline and 24-week follow-up measurements where peak oxygen uptake (VO2peak), mean daily steps, distance, and calories were assessed. Results The online group showed an improvement in mean daily steps (p < 0.05) and mean daily distance (p < 0.05) at 24 weeks compared to the gym-based group. The paired-sample t-test showed that all the assessed variables were statistically (p < 0.001) improved for both groups at 24 weeks. Pearson's r demonstrated positive correlations between VO2peak and mean daily distance (r = 0.375), and negative correlations between VO2peak and muscle (r = -0.523) and fat masses (r = -0.460). There were no exercise-induced adverse events during the study. Conclusion Our findings might indicate that a real-time online supervised CR exercise programme using wearable technology to monitor the haemodynamic responses in post-MI patients is equally effective as a gym-based exercise programme.
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Affiliation(s)
- A. Mitropoulos
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Lifestyle, Exercise and Nutritional Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, United Kingdom
| | - M. Anifanti
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G. Koukouvou
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A. Ntovoli
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Physical Education, Sports Sciences Frederick University, Nicosia, Cyprus
| | - K. Alexandris
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E. Kouidi
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Sans Menéndez S, Bosch J. The fitter you become, the less likely to get hospitalized. Eur J Prev Cardiol 2024; 31:434-435. [PMID: 38113065 DOI: 10.1093/eurjpc/zwad385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Affiliation(s)
| | - Joan Bosch
- Basic Science Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona 08017, Spain
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Blinnikova K, Cohen CW, McKeag ID. Lifestyle Intervention for the Prevention of Cardiovascular Disease. Prim Care 2024; 51:13-26. [PMID: 38278567 DOI: 10.1016/j.pop.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Lifestyle medicine is a cornerstone of cardiovascular disease prevention and early disease intervention. A leading cause of death in developed countries, modifiable risk factors of cardiovascular disease like diet, exercise, substance use, and sleep hygiene have significant impacts on population morbidity and mortality. One should address these amendable risks in all patients, independently, and stress the importance of intervention adherence while avoiding the sacrifice of patient trust. One must also understand a patient's psychological well-being can be compromised by organic chronic disease states, and poor psychological well-being can have a negative impact on patient compliance and overall health.
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Affiliation(s)
- Ksenia Blinnikova
- Department of Family and Community Medicine, University of Alabama at Birmingham, AL, USA; Division of General Internal Medicine in the Medicine Service at Massachusetts General, Hospital, Instructor at Harvard Medical School, 50 Staniford Street, 9th Floor, Boston MA 02114, USA
| | - Caroline W Cohen
- Community Health Services Building, Office 378, 1720 2nd Avenue South, Birmingham, AL 35294-2042, USA.
| | - Ian D McKeag
- Department of Family and Community Medicine, University of Alabama at Birmingham, Community Health Services Building, Office 372, 1720 2nd Avenue South, Birmingham, AL 35294-2042, USA
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Sanchez-Lastra MA, Ding D, Del Pozo Cruz B, Dalene KE, Ayán C, Ekelund U, Tarp J. Joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease: a prospective cohort study. Br J Sports Med 2024; 58:196-203. [PMID: 37940366 PMCID: PMC10894840 DOI: 10.1136/bjsports-2023-107252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To examine the joint associations between physical activity and abdominal obesity with the risk of cardiovascular disease (CVD) events. METHODS We included 70 830 UK Biobank participants (mean age±SD=61.6 ± 7.9 years; 56.4% women) with physical activity measured by wrist-worn accelerometers and without major chronic diseases. Participants were jointly categorised into six groups based on their physical activity level (tertiles of total volume and specific intensity levels) and presence or absence of abdominal obesity based on measured waist circumference. Associations with incident CVD (fatal and non-fatal events) were determined using proportional subdistribution hazard models with multivariable adjustment. RESULTS After excluding events during the first 2 years of follow-up, participants were followed for a median of 6.8 years, during which 2795 CVD events were recorded. Compared with the low abdominal adiposity and highest tertile of physical activity, abdominal obesity was associated with higher risk of incident CVD, especially in those with low levels of vigorous-intensity physical activity (HR 1.42, 95% CI 1.22 to 1.64). Approximately 500 min per week of moderate-to-vigorous intensity and approximately 30-35 min of vigorous-intensity physical activity offset the association of abdominal obesity and the risk of having a CVD event. CONCLUSION Physical activity equivalent to approximately 30-35 min of vigorous intensity per week appears to offset the association between abdominal obesity and incident CVD. About 15 times more physical activity of at least moderate intensity is needed to achieve similar results.
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Affiliation(s)
- Miguel Adriano Sanchez-Lastra
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Special Didactics, University of Vigo Faculty of Education and Sports Sciences, Pontevedra, Spain
- Wellness and Movement Research Group (WellMove), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Ding Ding
- Prevention Research Collaboration, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Camperdown, New South Wales, Australia
| | - Borja Del Pozo Cruz
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Centre for Active and Healthy Ageing, Odense, Denmark
- University of Cadiz Faculty of Education Sciences, Puerto Real, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, University of Cádiz Puerta del Mar University Hospital, Cádiz, Spain
| | - Knut Eirik Dalene
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Carlos Ayán
- Department of Special Didactics, University of Vigo Faculty of Education and Sports Sciences, Pontevedra, Spain
- Wellness and Movement Research Group (WellMove), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Jakob Tarp
- Department of Clinical Epidemiology, Aarhus University & University Hospital, Aarhus, Denmark
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Gault ML, Willems MET. Full Familiarisation Is Not Required for the Self-Paced 1 km Treadmill Walk to Predict Peak Oxygen Uptake in Phase IV Cardiac Patients. Clin Pract 2024; 14:327-336. [PMID: 38391411 PMCID: PMC10887902 DOI: 10.3390/clinpract14010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Exercise is a recommended part of phase IV cardiovascular rehabilitation (CR). The 1 km treadmill walk test (1-KTWT) is a submaximal continuous exercise test to predict cardiorespiratory fitness in patients with cardiovascular disease. We examined physiological, metabolic and subjective responses in patients with cardiovascular disease with self-selected, unchanging walking speed for two 1-KTWTs. Fifteen men (age: 65 ± 9 yr, height: 174 ± 5 cm, body mass: 86 ± 17 kg, BMI: 28.5 ± 5.5 kg·m-2, body fat%: 27.7 ± 7.5%, 10 on beta-blockers) were recruited from phase IV CR groups in the United Kingdom. Participants established a self-selected walking speed for the 1-KTWT and performed the 1-KTWT on separate days with recording of physiological responses to predict V˙O2peak with equations. For the two 1-KTWTs, no differences existed for walking speed, mean and maximal heart rates, oxygen uptake, predicted V˙O2peak (1st 1-KTWT (range: 41-78% V˙O2peak, 95%CI, 53-65; 2nd 1-KTWT range: 43-78% V˙O2peak, 95%CI, 52-65) and rating of perceived exertion. In phase IV cardiac patients, the 1-KTWT with self-selected, unchanging walking speed can be used for V˙O2peak prediction without the need for a full familiarisation. The self-selected constant walking speed for the first 1-KTWT can be used to support nonsupervised physical activity for phase IV CR patients.
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Affiliation(s)
- Mandy L Gault
- Institute of Applied Sciences, University of Chichester, Chichester PO19 6PE, UK
| | - Mark E T Willems
- Institute of Applied Sciences, University of Chichester, Chichester PO19 6PE, UK
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Zhang Q, Han H, Yang S, Liu W. Facilitators and barriers of initiation and maintenance of physical activity among people with coronary heart disease: a qualitative study. Disabil Rehabil 2024:1-10. [PMID: 38324455 DOI: 10.1080/09638288.2024.2309512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE We aimed to describe the facilitators and barriers of physical activity for patients with coronary heart disease. METHODS A qualitative descriptive study using semi-structured interviews was conducted with 15 participants with coronary heart disease. The interview guide was developed based on a multi-theory model. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. RESULTS Two main themes were identified: facilitators of initiation and maintenance of physical activity (behavioral motivation, perceived benefits, behavioral confidence, supportive physical environment, positive emotional experience, self-regulation, supportive social environment, illness perception, and excellent self-control), barriers of initiation and maintenance of physical activity (perceived barriers, restricted physical environment, psychological distress, insufficient social support, and poor self-control). CONCLUSIONS This study presents an in-depth theory-based exploration of facilitators and barriers to initiating and maintaining physical activity among people with coronary heart disease. Relevant factors should be taken into account to increase their effectiveness when designing the target interventions to encourage a physically active lifestyle in this population.
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Affiliation(s)
| | - Hongya Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shupeng Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weiwei Liu
- School of Nursing, Capital Medical University, Beijing, China
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Bunæs-Næss H, Kvæl LAH, Nilsson BB, Heywood S, Heiberg KE. Aquatic high-intensity interval training (HIIT) may be similarly effective to land-based HIIT in improving exercise capacity in people with chronic conditions: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2023; 9:e001639. [PMID: 38022764 PMCID: PMC10649609 DOI: 10.1136/bmjsem-2023-001639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/19/2023] Open
Abstract
Objective To investigate the effect of aquatic high-intensity interval training (AHIIT) on exercise capacity in people with chronic conditions. Design Systematic review and meta-analysis. Participants Adults (age ≥18 years) with any chronic conditions (long duration, continuing health problems). Data sources The databases Medline, EMBASE, CINAHL, SPORTSDiscus, PEDro and The Cochrane Library were searched from inception to 11 August 2023. Eligibility criteria Randomised or non-randomised controlled trials of adults reporting one or more chronic conditions were included, comparing the effect of AHIIT with a non-exercising control group, land-based high-intensity interval training (LBHIIT) or aquatic moderate-intensity continuous training (AMICT). Results Eighteen trials with 868 participants with chronic musculoskeletal, respiratory, cardiovascular, metabolic or neurological conditions were included. Adherence to AHIIT was high, ranging from 84% to 100%. There was moderate certainty in evidence according to the Grading of Recommendations Assessment, Development and Evaluation system for a moderate beneficial effect on exercise capacity standardised mean differences (SMD) 0.78 (95% CI 0.48 to 1.08), p<0.00001) of AHIIT compared with a non-exercising control group. There was moderate certainty in evidence for no difference of effects on exercise capacity (SMD 0.28 (95% CI -0.04 to 0.60), p=0.08) of AHIIT compared with LBHIIT. There was moderate certainty in evidence for small effect on exercise capacity (SMD 0.45 (95% CI 0.10 to 0.80), p=0.01) of AHIIT compared with AMICT. Conclusion There are beneficial effects of AHIIT on exercise capacity in people with a range of chronic conditions. AHIIT has similar effects on exercise capacity as LBHIIT and may represent an alternative for people unable to perform LBHIIT. PROSPERO registration number CRD42022289001.
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Affiliation(s)
- Heidi Bunæs-Næss
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Linda Aimée Hartford Kvæl
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
- Centre for Welfare and Labour Research, Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| | - Birgitta Blakstad Nilsson
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
- Division of Medicine, Department of Clinical Services, Oslo University Hospital, Oslo, Norway
| | - Sophie Heywood
- Department of Physiotherapy, St Vincent's Hospital, St Vincent's Health Australia Ltd Fitzroy, Fitzroy, Victoria, Australia
- Department of Physiotherapy, University of Melbourne VCCC, Parkville, Victoria, Australia
| | - Kristi Elisabeth Heiberg
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
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Cundrič L, Bosnić Z, Kaminsky LA, Myers J, Peterman JE, Markovic V, Arena R, Popović D. A Machine Learning Approach to Developing an Accurate Prediction of Maximal Heart Rate During Exercise Testing in Apparently Healthy Adults. J Cardiopulm Rehabil Prev 2023; 43:377-383. [PMID: 36880964 DOI: 10.1097/hcr.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
PURPOSE Maximal heart rate (HR max ) continues to be an important measure of adequate effort during an exercise test. The aim of this study was to improve the accuracy of HR max prediction using a machine learning (ML) approach. METHODS We used a sample from the Fitness Registry of the Importance of Exercise National Database, which included 17 325 apparently healthy individuals (81% males) who performed a maximal cardiopulmonary exercise test. Two standard formulas for HR max prediction were tested: Formula1 = 220 - age (yr), root-mean-squared error (RMSE) 21.9, relative root-mean-squared error (RRMSE) 1.1; and Formula2 = 209.3 - 0.72 × age (yr), RMSE 22.7 and RRMSE 1.1. For ML model prediction, we used age, weight, height, resting HR, and systolic and diastolic blood pressure. The following ML algorithms to predict HR max were applied: lasso regression (LR), neural networks (NN), support vector machine (SVM) and random forests (RF). An evaluation was performed using cross-validation and by computing the RMSE and RRMSE, Pearson correlation, and Bland-Altman plots. The best predictive model was explained with Shapley Additive Explanations (SHAP). RESULTS The HR max for the cohort was 162 ± 20 bpm. All ML models improved HR max prediction and reduced RMSE and RRMSE compared with Formula1 (LR: 20.2%, NN: 20.4%, SVM: 22.2%, and RF: 24.7%). The predictions of all algorithms significantly correlated with HR max ( r = 0.49, 0.51, 0.54, 0.57, respectively; P < .001). Bland-Altman analysis demonstrated lower bias and 95% CI for all ML models in comparison with standard equations. The SHAP explanation showed a high impact of all selected variables. CONCLUSIONS Machine learning, particularly the RF model, improved prediction of HR max using readily available measures. This approach should be considered for clinical application to refine HR max prediction.
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Affiliation(s)
- Larsen Cundrič
- University of Ljubljana, Faculty of Computer and Information Science, Ljubljana, Slovenia (Mr Cundrič and Dr Bosnić); Fisher Institute of Health and Well-Being and Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Kaminsky and Peterman); VA Palo Alto Health Care System and Stanford University, Palo Alto, California (Dr Myers); Departments of Information Systems, Faculty of Organizational Sciences (Dr Markovic) and Physiology, Faculty of Pharmacy (Dr Popović), University of Belgrade, Belgrade, Serbia; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago (Dr Arena); Division of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia (Dr Popović); and Department for Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota (Dr Popović)
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Pugh CJA, Williams A. Editorial: Prime time to recommend sex-specific cardiorespiratory fitness threshold values for pre-operative risk stratification. Eur J Clin Invest 2023:e14030. [PMID: 37211589 DOI: 10.1111/eci.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Affiliation(s)
| | - Abbie Williams
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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Franklin B, H. Eijsvogels T. A narrative review on exercise and cardiovascular disease: Physical activity thresholds for optimizing health outcomes. HEART AND MIND 2023. [DOI: 10.4103/hm.hm_1_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Gaesser GA, Poole DC, Angadi SS. Quantifying the benefits of inefficient walking: Monty Python inspired laboratory based experimental study. BMJ 2022; 379:e072833. [PMID: 36543338 PMCID: PMC9768815 DOI: 10.1136/bmj-2022-072833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the rate of energy expenditure of low efficiency walking with high efficiency walking. DESIGN Laboratory based experimental study. SETTING United States. PARTICIPANTS 13 healthy adults (six women, seven men) with no known gait disorder, mean (±standard deviation) age 34.2±16.1 years, height 174.2±12.6 cm, weight 78.2±22.5 kg, and body mass index 25.6±6.0. INTERVENTION Participants performed three, five minute walking trials around an indoor 30 m course. The first trial consisted of walking at a freely chosen walking speed in the participant's usual style. The next two trials consisted of low efficiency walks in which participants were asked to duplicate the walks of Mr Teabag and Mr Putey (acted by John Cleese and Michael Palin, respectively) in the legendary Monty Python Ministry of Silly Walks (MoSW) skit that first aired in 1970. Distance covered during the five minute walks was used to calculate average speed. Ventilation and gas exchange were collected throughout to determine oxygen uptake (V̇O2; mL O2/kg/min) and energy expenditure (EE; kcal/kg/min; 1 kcal=4.18 kJ), reported as mean±standard deviation. MAIN OUTCOME MEASURES V̇O2 and EE. RESULTS V̇O2 and EE were about 2.5 times higher (P<0.001) during the Teabag walk compared with participants' usual walk (27.9±4.8 v 11.3±1.9 mL O2/kg/min; 0.14±0.03 v 0.06±0.01 kcal/kg/min), but were not different during the Putey walk (12.3±1.8 mL/kg/min; 0.06±0.01 kcal/kg/min). Each minute of Teabag walking increased EE over participants' usual walking by an average of 8.0 kcal (range 5.5-12.0) in men and by 5.2 kcal (range 3.9-6.2) in women, and qualified as vigorous intensity physical activity (>6 resting metabolic equivalents). CONCLUSIONS For adults with no known gait disorder who average approximately 5000 steps/day, exchanging about 22%-34% of their daily steps with higher energy, low efficiency walking in Teabag style-requiring around 12-19 min-could increase daily EE by 100 kcal. Adults could achieve 75 minutes of vigorous intensity physical activity per week by walking inefficiently for about 11 min/day. Had an initiative to promote inefficient movement been adopted in the early 1970s, we might now be living among a healthier society. Efforts to promote higher energy-and perhaps more joyful-walking should ensure inclusivity and inefficiency for all.
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Affiliation(s)
- Glenn A Gaesser
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - David C Poole
- Departments of Kinesiology and Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Siddhartha S Angadi
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
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