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Foster J, Hodder SG, Lloyd AB, Havenith G. Individual Responses to Heat Stress: Implications for Hyperthermia and Physical Work Capacity. Front Physiol 2020; 11:541483. [PMID: 33013476 PMCID: PMC7516259 DOI: 10.3389/fphys.2020.541483] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Extreme heat events are increasing in frequency, severity, and duration. It is well known that heat stress can have a negative impact on occupational health and productivity, particularly during physical work. However, there are no up-to-date reviews on how vulnerability to heat changes as a function of individual characteristics in relation to the risk of hyperthermia and work capacity loss. The objective of this narrative review is to examine the role of individual characteristics on the human heat stress response, specifically in relation to hyperthermia risk and productivity loss in hot workplaces. Finally, we aim to generate practical guidance for industrial hygienists considering our findings. Factors included in the analysis were body mass, body surface area to mass ratio, body fat, aerobic fitness and training, heat adaptation, aging, sex, and chronic health conditions. Findings We found the relevance of any factor to be dynamic, based on the work-type (fixed pace or relative to fitness level), work intensity (low, moderate, or heavy work), climate type (humidity, clothing vapor resistance), and variable of interest (risk of hyperthermia or likelihood of productivity loss). Heat adaptation, high aerobic fitness, and having a large body mass are the most protective factors during heat exposure. Primary detrimental factors include low fitness, low body mass, and lack of heat adaptation. Aging beyond 50 years, being female, and diabetes are less impactful negative factors, since their independent effect is quite small in well matched participants. Skin surface area to mass ratio, body composition, hypertension, and cardiovascular disease are not strong independent predictors of the heat stress response. Conclusion Understanding how individual factors impact responses to heat stress is necessary for the prediction of heat wave impacts on occupational health and work capacity. The recommendations provided in this report could be utilized to help curtail hyperthermia risk and productivity losses induced by heat.
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Affiliation(s)
- Josh Foster
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
| | - Simon G Hodder
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
| | - Alex B Lloyd
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
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Mourot L, Fornasiero A, Rakobowchuk M, Skafidas S, Brighenti A, Stella F, Zignoli A, Savoldelli A, Pellegrini B, Danese E, Lippi G, Tarperi C, Schena F. Similar cardiovascular and autonomic responses in trained type 1 diabetes mellitus and healthy participants in response to half marathon. Diabetes Res Clin Pract 2020; 160:107995. [PMID: 31901470 DOI: 10.1016/j.diabres.2019.107995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/04/2019] [Accepted: 12/30/2019] [Indexed: 01/30/2023]
Abstract
AIMS This field experiment examined whether trained people with type 1 diabetes mellitus (T1D) have similar cardiovascular and baroreflex alterations after a 21-km running race when compared to healthy people. METHODS Nine T1D (39.0 ± 11.1 yr; 175.0 ± 10.2 cm; 70.8 ± 8.7 kg) were matched with 9 healthy participants (42.4 ± 5.8 yr; 175.7 ± 6.7 cm; 72.1 ± 8.5 kg) who ran an official half-marathon. Before and 1-hour after the race, cardiovascular variables, sympathetic activity (catecholamines), parasympathetic (heart rate variability analysis) modulation and cardiac baroreflex function (transfer function analysis) were assessed during supine rest and a squat stand test (forced blood pressure change). RESULTS Performance time and weight loss [104.0 ± 13.2 and 111.0 ± 18.7 min; -2.57 ± 1.05 kg (-1.88 ± 0.88%) and -2.29 ± 1.15 kg (-1.59 ± 0.59%)] for healthy and T1D participants, respectively) were similar. Before running, no significant differences in any cardiovascular or autonomic variables were noted between the groups. After 1 h of recovery, both groups exhibited post-exercise hypotension, accompanied by increased sympathetic activity, decreased parasympathetic modulation, and reduced cardiac baroreflex sensitivity. CONCLUSIONS Our results showed that the pattern of change in cardiovascular and autonomic nervous activity to strenuous exercise are well maintained in T1D participants with a training history of at least 5 years.
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Affiliation(s)
- Laurent Mourot
- EA3920 Prognostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, Exercise Performance Health Innovation (EPHI) Platform, University of Bourgogne Franche-Comté, Besançon, France; National Research Tomsk Polytechnic University, Tomsk, Russia.
| | - Alessandro Fornasiero
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mark Rakobowchuk
- Department of Biological Sciences, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Spyros Skafidas
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alfredo Brighenti
- EA3920 Prognostic Factors and Regulatory Factors of Cardiac and Vascular Pathologies, Exercise Performance Health Innovation (EPHI) Platform, University of Bourgogne Franche-Comté, Besançon, France; CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Stella
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Zignoli
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Aldo Savoldelli
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Barbara Pellegrini
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Danese
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Cantor Tarperi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Francisco MA, Minson CT. Cutaneous active vasodilation as a heat loss thermoeffector. HANDBOOK OF CLINICAL NEUROLOGY 2019; 156:193-209. [PMID: 30454590 DOI: 10.1016/b978-0-444-63912-7.00012-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Human skin is the interface between the human body and the environment. As such, human temperature regulation relies largely on cutaneous vasomotor and sudomotor adjustments to appropriately thermoregulate. In particular, changes in skin blood flow can increase or decrease the convective heat transfer from internal tissues to the periphery where it can increase or prevent heat loss to the environment. Thermoregulatory control of the cutaneous vasculature is largely due to cutaneous sympathetic nerves. Sympathetic adrenergic nerves mediate vasoconstriction of the skin, similar to other vascular beds, whereas active vasodilator nerves in nonglabrous skin respond to changes in internal and peripheral temperatures and can profoundly increase skin blood flow. Activation of these vasodilator nerves is known as cutaneous active vasodilation and has been the subject of much recent research. This research has uncovered a highly complex system that involves the activation of multiple receptors and vasodilator pathways in a synergistic and sometimes redundant manner. This complexity and redundancy has left our understanding of cutaneous active vasodilation incomplete; however, the employment of new techniques and use of new pharmacologic agents have introduced many new insights into cutaneous active vasodilation.
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Affiliation(s)
- Michael A Francisco
- Department of Human Physiology, University of Oregon, Eugene, OR, United States
| | - Christopher T Minson
- Department of Human Physiology, University of Oregon, Eugene, OR, United States.
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Buoite Stella A, Yardley J, Francescato MP, Morrison SA. Fluid Intake Habits in Type 1 Diabetes Individuals during Typical Training Bouts. ANNALS OF NUTRITION AND METABOLISM 2018; 73:10-18. [PMID: 29843124 DOI: 10.1159/000489823] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS Hyperglycemia may influence the hydration status in diabetic individuals. During exercise, type 1 diabetes mellitus (T1DM) individuals may be challenged by a higher risk of dehydration due to a combination of fluid losses from sweat and increased urine output via glycosuria. So far, no study has characterised spontaneous fluid intake in T1DM individuals during active trainings. METHODS A validated questionnaire was used to assess T1DM participants' diabetes therapy, sports characteristics and fluid intake during training; results were then compared to an age- and sport-matched sample of non-diabetic individuals. RESULTS Ninety individuals completed the survey (n = 45 T1DM individuals, n = 45 matched controls). A proportion of T1DM -individuals reported blood glucose levels greater than 10.0 mmol at both the start (28.9%) and end (24.4%) of the exercise. The mean self-reported fluid intake was greater in T1DM (0.60 ± 0.47 L·h-1) compared to that of the control (0.37 ± 0.28 L·h-1, p < 0.05). In spite of drinking fluid volumes in line with international guidelines, 84.4% of those with T1DM reported that they were still feeling thirsty at the end of their training session. CONCLUSIONS T1DM individuals self-report spontaneously consuming fluid adequate volumes suggested by sport nutrition guidelines for non-diabetic athletes. Discrepancies in the T1DM subjectively reported feelings of thirst suggest that more education on hydration during exercise is needed for this population to adequately compensate for elevated blood glucose levels. It remains to be established whether fluid volumes suggested for healthy athletes are adequate for maintaining euhydration in T1DM patients due to their altered diuresis.
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Affiliation(s)
- Alex Buoite Stella
- Department of Medicine, University of Udine, Udine, Italy.,Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Jane Yardley
- Department of Social Sciences, Augustana Campus, University of Alberta, Edmonton, Alberta, Canada
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Flouris AD, McGinn R, Poirier MP, Louie JC, Ioannou LG, Tsoutsoubi L, Sigal RJ, Boulay P, Hardcastle SG, Kenny GP. Screening criteria for increased susceptibility to heat stress during work or leisure in hot environments in healthy individuals aged 31-70 years. Temperature (Austin) 2017; 5:86-99. [PMID: 29687046 PMCID: PMC5902215 DOI: 10.1080/23328940.2017.1381800] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/15/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022] Open
Abstract
Population aging and global warming generate important public health risks, as older adults have increased susceptibility to heat stress (SHS). We defined and validated sex-specific screening criteria for SHS during work and leisure activities in hot environments in individuals aged 31-70 years using age, anthropometry, and cardiorespiratory fitness. A total of 123 males and 44 females [44 ± 14 years; 22.9 ± 7.4% body fat; 40.3 ± 8.6 peak oxygen uptake (mlO2/kg/min)] participated, separated into the Analysis (n = 111) and Validation (n = 56) groups. Within these groups, participants were categorized into YOUNG (19-30 years; n = 47) and OLDER (31-70 years; n = 120). All participants performed exercise in the heat inside a direct calorimeter. Screening criteria for OLDER participants were defined from the Analysis group and were cross-validated in the Validation group. Results showed that 30% of OLDER individuals in the Analysis group were screened as SHS positive. A total of 274 statistically valid (p < 0.05) criteria were identified suggesting that OLDER participants were at risk for SHS when demonstrating two or more of the following (males/females): age ≥ 53.0/55.8 years; body mass index ≥29.5/25.7 kg/m2; body fat percentage ≥ 28.8/34.9; body surface area ≤2.0/1.7 m2; peak oxygen uptake ≤48.3/41.4 mlO2/kg fat free mass/min. In the Validation group, McNemar χ2 comparisons confirmed acceptable validity for the developed criteria. We conclude that the developed criteria can effectively screen individuals 31-70 years who are at risk for SHS during work and leisure activities in hot environments and can provide simple and effective means to mitigate the public health risks caused by heat exposure.
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Affiliation(s)
- Andreas D. Flouris
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Greece
- Human and Environmental Physiological Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Ryan McGinn
- Human and Environmental Physiological Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Martin P. Poirier
- Human and Environmental Physiological Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Jeffrey C. Louie
- Human and Environmental Physiological Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Leonidas G. Ioannou
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Greece
| | - Lydia Tsoutsoubi
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Greece
| | - Ronald J. Sigal
- Human and Environmental Physiological Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Departments of Medicine, Cardiac Sciences, and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Pierre Boulay
- Faculty of Physical Activity Sciences, Department of Human Kinetics, University of Sherbrooke, Sherbrooke, Canada
| | | | - Glen P. Kenny
- Human and Environmental Physiological Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Kenny GP, McGinn R. Restoration of thermoregulation after exercise. J Appl Physiol (1985) 2016; 122:933-944. [PMID: 27881668 DOI: 10.1152/japplphysiol.00517.2016] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/26/2016] [Accepted: 11/16/2016] [Indexed: 11/22/2022] Open
Abstract
Performing exercise, especially in hot conditions, can heat the body, causing significant increases in internal body temperature. To offset this increase, powerful and highly developed autonomic thermoregulatory responses (i.e., skin blood flow and sweating) are activated to enhance whole body heat loss; a response mediated by temperature-sensitive receptors in both the skin and the internal core regions of the body. Independent of thermal control of heat loss, nonthermal factors can have profound consequences on the body's ability to dissipate heat during exercise. These include the activation of the body's sensory receptors (i.e., baroreceptors, metaboreceptors, mechanoreceptors, etc.) as well as phenotypic factors such as age, sex, acclimation, fitness, and chronic diseases (e.g., diabetes). The influence of these factors extends into recovery such that marked impairments in thermoregulatory function occur, leading to prolonged and sustained elevations in body core temperature. Irrespective of the level of hyperthermia, there is a time-dependent suppression of the body's physiological ability to dissipate heat. This delay in the restoration of postexercise thermoregulation has been associated with disturbances in cardiovascular function which manifest most commonly as postexercise hypotension. This review examines the current knowledge regarding the restoration of thermoregulation postexercise. In addition, the factors that are thought to accelerate or delay the return of body core temperature to resting levels are highlighted with a particular emphasis on strategies to manage heat stress in athletic and/or occupational settings.
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Affiliation(s)
- Glen P Kenny
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Ryan McGinn
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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7
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Fujii N, Dervis S, Sigal RJ, Kenny GP. Type 1 diabetes modulates cyclooxygenase- and nitric oxide-dependent mechanisms governing sweating but not cutaneous vasodilation during exercise in the heat. Am J Physiol Regul Integr Comp Physiol 2016; 311:R1076-R1084. [PMID: 27733388 DOI: 10.1152/ajpregu.00376.2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/30/2016] [Accepted: 10/11/2016] [Indexed: 01/09/2023]
Abstract
Both cyclooxygenase (COX) and nitric oxide synthase (NOS) contribute to sweating, whereas NOS alone contributes to cutaneous vasodilation during exercise in the heat. Here, we evaluated if Type 1 diabetes mellitus (T1DM) modulates these responses. Adults with (n = 11, 25 ± 5 yr) and without (n = 12, 24 ± 4 yr) T1DM performed two bouts of 30-min cycling at a fixed rate of heat production of 400 W in the heat (35°C); each followed by a 20- and 40-min recovery period, respectively. Sweat rate and cutaneous vascular conductance (CVC) were measured at four intradermal microdialysis sites treated with either 1) lactated Ringer (vehicle control site), 2) 10 mM ketorolac (nonselective COX inhibitor), 3) 10 mM NG-nitro-l-arginine methyl ester (nonselective NOS inhibitor), or 4) a combination of both inhibitors. In nondiabetic adults, separate and combined inhibition of COX and NOS reduced exercise sweat rate (P ≤ 0.05), and the magnitude of reductions were similar across sites. In individuals with T1DM, inhibition of COX resulted in an increase in sweat rate of 0.10 ± 0.09 and 0.09 ± 0.08 mg ·: min-1 ·: cm-2 for the first and second exercise bouts, respectively, relative to vehicle control site (P ≤ 0.05), whereas NOS inhibition had no effect on sweating. In both groups, NOS inhibition reduced CVC during exercise (P ≤ 0.05), although the magnitude of reduction did not differ between the nondiabetic and T1DM groups (exercise 1: -28 ± 10 vs. -23 ± 8% max, P = 0.51; exercise 2: -31 ± 12 vs. -24 ± 10% max, P = 0.38). We show that in individuals with T1DM performing moderate intensity exercise in the heat, NOS-dependent sweating but not cutaneous vasodilation is attenuated, whereas COX inhibition increases sweating.
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Affiliation(s)
- Naoto Fujii
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sheila Dervis
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Ronald J Sigal
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Departments of Medicine, Cardiac Sciences and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, Alberta Canada; and.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada; .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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8
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Wong BJ, Hollowed CG. Current concepts of active vasodilation in human skin. Temperature (Austin) 2016; 4:41-59. [PMID: 28349094 PMCID: PMC5356216 DOI: 10.1080/23328940.2016.1200203] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 10/30/2022] Open
Abstract
In humans, an increase in internal core temperature elicits large increases in skin blood flow and sweating. The increase in skin blood flow serves to transfer heat via convection from the body core to the skin surface while sweating results in evaporative cooling of the skin. Cutaneous vasodilation and sudomotor activity are controlled by a sympathetic cholinergic active vasodilator system that is hypothesized to operate through a co-transmission mechanism. To date, mechanisms of cutaneous active vasodilation remain equivocal despite many years of research by several productive laboratory groups. The purpose of this review is to highlight recent advancements in the field of cutaneous active vasodilation framed in the context of some of the historical findings that laid the groundwork for our current understanding of cutaneous active vasodilation.
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Affiliation(s)
- Brett J. Wong
- Department of Kinesiology & Health, Georgia State University, Atlanta, GA, USA
| | - Casey G. Hollowed
- Department of Kinesiology & Health, Georgia State University, Atlanta, GA, USA
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Kenny GP, Sigal RJ, McGinn R. Body temperature regulation in diabetes. Temperature (Austin) 2016; 3:119-45. [PMID: 27227101 PMCID: PMC4861190 DOI: 10.1080/23328940.2015.1131506] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 01/06/2023] Open
Abstract
The effects of type 1 and type 2 diabetes on the body's physiological response to thermal stress is a relatively new topic in research. Diabetes tends to place individuals at greater risk for heat-related illness during heat waves and physical activity due to an impaired capacity to dissipate heat. Specifically, individuals with diabetes have been reported to have lower skin blood flow and sweating responses during heat exposure and this can have important consequences on cardiovascular regulation and glycemic control. Those who are particularly vulnerable include individuals with poor glycemic control and who are affected by diabetes-related complications. On the other hand, good glycemic control and maintenance of aerobic fitness can often delay the diabetes-related complications and possibly the impairments in heat loss. Despite this, it is alarming to note the lack of information regarding diabetes and heat stress given the vulnerability of this population. In contrast, few studies have examined the effects of cold exposure on individuals with diabetes with the exception of its therapeutic potential, particularly for type 2 diabetes. This review summarizes the current state of knowledge regarding the impact of diabetes on heat and cold exposure with respect to the core temperature regulation, cardiovascular adjustments and glycemic control while also considering the beneficial effects of maintaining aerobic fitness.
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Affiliation(s)
- Glen P Kenny
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ronald J Sigal
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Departments of Medicine, Cardiac Sciences, and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Ryan McGinn
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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McGinn R, Kenny GP. Autonomic dysfunction associated with Type 1 diabetes: a role for fitness? Clin Auton Res 2014; 24:249-51. [PMID: 25398261 DOI: 10.1007/s10286-014-0262-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Ryan McGinn
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
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