Energy expenditure evaluation in humans and non-human primates by SenseWear Armband. Validation of energy expenditure evaluation by SenseWear Armband by direct comparison with indirect calorimetry

Insights into pathophysiology and therapeutic strategies for heat stroke: Lessons from a baboon model

Heat stroke is a perilous condition marked by severe hyperthermia and extensive multiorgan dysfunction, posing a considerable risk of mortality if not promptly identified and treated. Furthermore, the complex biological mechanisms underlying heat stroke-induced tissue and cell damage across organ systems remain incompletely understood. This knowledge gap has hindered the advancement of effective preventive and therapeutic strategies against this condition. In this narrative review, we synthesize key insights gained over a decade using a translational baboon model of heat stroke. By replicating heat stroke pathology in a non-human primate species that closely resembles humans, we have unveiled novel insights into the pathways of organ injury and cell death elicited by this condition. Here, we contextualize and integrate the lessons learned concerning heat stroke pathophysiology and recovery, areas that are inherently challenging to investigate directly in human subjects. We suggest novel research directions to advance the understanding of the complex mechanisms underlying cell death and organ injury. This may lead to precise therapeutic strategies that benefit individuals suffering from this debilitating condition.

Assessing adult physical activity and compliance with 2008 CDC guidelines using a Bayesian two-part measurement error model

While there is wide agreement that physical activity is an important component of a healthy lifestyle, it is unclear how many people adhere to public health recommendations on physical activity. The Physical Activity Guidelines (PAG), published by the CDC, provides guidelines to American adults, but it is difficult to assess compliance with these guidelines. The PAG further complicates adherence assessment by recommending activity to occur in at least 10 min bouts. To better understand the measurement capabilities of various instruments to quantify activity, and to propose an approach to evaluate activity relative to the PAG, researchers at Iowa State University administered the Physical Activity Measurement Survey (PAMS) to over 1000 participants in four different Iowa counties. In this paper, we develop a two-part Bayesian measurement error model and apply it to the PAMS data in order to assess compliance with the PAG in the Iowa adult population. The model accurately accounts for the 10 min bout requirement put forth in the PAG. The measurement error model corrects biased estimates and accounts for day-to-day variation in activity. The model is also applied to the nationally representative National Health and Nutrition Examination Survey.

Non-Right Handedness is Associated with More Time Awake After Sleep Onset and Higher Daytime Sleepiness Than Right Handedness: Objective (Actigraphic) and Subjective Data from a Large Community Sample

PURPOSE

Handedness has been linked to various physiological and pathological phenomena including memory function and psychiatric disorders. Also for sleep, several studies have reported associations. However, large-scale studies including a broad age span of participants and studies analyzing women and men separately are lacking.

METHODS

Therefore, objective sleep data were determined using at-home actigraphy from 1764 healthy participants (18 to 80 years, 908 women), averaging five consecutive nights. In addition, subjective sleep-related data were captured by self-report diaries, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Morningness-Eveningness-Questionnaire (MEQ). Handedness was determined with the Edinburgh Handedness Inventory (EHI) providing information on the direction (left vs right) and the degree of handedness (strong vs weak). To address the potential endocrine effects, premenopausal women (≤45 years) and postmenopausal women (≥55 years) were analyzed separately. This was also done for men.

RESULTS

The degree and direction of handedness were correlated with "wake after sleep onset" (WASO) in the total sample and all women (the more right-handed/lateralized the shorter WASO). In postmenopausal women, additionally, time in bed (TIB) and total sleep time (TST) were correlated. There were no other significant associations between an objective sleep variable and handedness. In both premenopausal women and >55-year-old men subjective quality of sleep (PSQI) was correlated with direction and degree of handedness (the more right-handed/lateralized the better). In the total sample and postmenopausal women, the degree and direction of handedness were negatively correlated with daytime sleepiness. The chronotype was not associated with handedness in any group.

CONCLUSION

While associations were not consistent in all groups, overall, right-handedness tended to be associated with better sleep and less daytime sleepiness. Handedness and sleep seemed to be differentially associated in women and men, being in line with endocrine interactions.

Relationship Between Sedentary Behavior and Physical Activity at Work and Cognition and Mood

BACKGROUND

Sedentary behavior is negatively associated with cognition and mood. Adults often engage in high levels of sedentary behavior at work through sitting, which may impact productivity. Consequently, replacing sitting with standing and physical activity (PA) is recommended. However, the associations between sitting, standing, and PA at work and cognition and mood are unknown; this study, therefore, aimed to explore these relationships.

METHODS

A total of 75 healthy full-time workers (33 male, mean [SD]; 33.6 [10.4] y, 38 [7] work hr/wk) wore sedentary behavior (activPAL) and PA (SenseWear Pro) monitors for 7 days and recorded their work hours. The day after this monitoring period, participants completed cognitive tests (executive function, attention, and working memory) and mood questionnaires (affect, alert, content, and calm). Multiple linear regression analyses examined the associations between cognition and mood and the time spent sitting, standing, and in each PA intensity during work hours, weekday leisure time, and weekends.

RESULTS

Workplace sitting, standing, or PA were not significantly associated with cognition or mood (P > .05). No significant associations were observed between these variables during weekday leisure time or weekends (P > .05).

CONCLUSIONS

In a cohort of healthy workers, workplace sitting, standing, and PA are not associated with cognition or mood. Further research in this population is needed, examining the influence of workplace behaviors on cognition and mood, because this will contribute to evidence-based workplace guidelines to increase productivity.

Physical activity in patients with Parkinson's disease: A holistic approach based on the ICF model

OBJECTIVES

The International Classification of Functioning, Disability and Health (ICF) is a framework providing information on disability and health. Physical activity's behavior is complex and affected by various factors. We aimed to examine the ICF domains in Parkinson's disease (PD) patients; to compare them in sedentary and non-sedentary PD patients and their association with activity level.

PATIENTS AND METHODS

Sixty PD patients (25 sedentary PD group, 35 non-sedentary PD group) were included in this retrospective study. Functional disability was evaluated using the Movement Disorder Society Unified Parkinson's Disease Rating Scale. The physical activity level was measured by the SenseWear Arm Band activity monitor. Patients' cognitive function, severity of depression and anxiety, the functional impact of fatigue, balance performance (NeuroCom Balance Master System), functional mobility (Timed Up and Go Test, TUG), walking capacity (Six-Minute Walk Test, 6MWT), fear of falling, health-related quality of life are also analyzed.

RESULTS

Sedentary PD patients had worse scores in NeuroCom Balance Master System parameters, TUG score, and 6MWT distance in activities domains of the ICF model as a guide than non-sedentary group (p < 0.05). No statistically significant differences were found in the body structures and function, participation, personal and environmental domains of the ICF model between sedentary and non-sedentary PD groups (p > 0.05). There was no correlation between steps taken per day and NeuroCom Balance Master System parameters, TUG score, and 6MWT distance in both groups (p > 0.05).

CONCLUSION

Patients with sedentary lifestyle had worse scores in postural control/balance, sit-to-stand and walking performance. However, deteriorated dynamic balance may not lead to sedentary lifestyle. Physiotherapy programs should be including the behavior change interventions and motivational strategies to promote activity level in PD.

Validity of Accelerometers for the Evaluation of Energy Expenditure in Obese and Overweight Individuals: A Systematic Review

OBJECTIVE

Even though the validity of accelerometers for the measurement of energy expenditure (EE) has been demonstrated for normal-weight individuals, the applicability of this instrument in obese individuals remains controversial. This review aims to summarize the level of agreement between accelerometers and the gold standards (indirect calorimetry and doubly labelled water) for the measurement of energy expenditure (EE) in obese or overweight individuals.

METHODS

The literature search was limited to comparison studies assessing agreement in EE determination between accelerometers and indirect calorimetry (IC) or doubly labelled water (DLW). We searched in PubMed and in Scopus until March 1, 2019. The analysis was restricted to obese or overweight adult individuals. The following descriptive information was extracted for each study: sample size, characteristics of participants (sex, age, BMI, fat mass percentage, any pathological conditions, modality of recruitment in the study, and exclusion criteria), accelerometer description (model, type and body position), and type of gold standard and validity protocol (duration, conditions, and requirements during and before the experiment). Three review authors independently screened the obtained results, and the quality of the selected articles was assessed by the QUADAS-2 tool.

RESULTS

We obtained seventeen eligible articles, thirteen of which showed concerns for the applicability section, due to the patient selection. Regarding the accelerometers, nine devices were validated in the included studies with the BodyMedia SenseWear® (SWA) being the most frequently validated. Although correlations between accelerometers and the gold standard were high in some studies, agreement between the two methods was low, as shown by the Bland-Altman plots.

CONCLUSIONS

Most accelerometer estimations of EE were inaccurate for obese/overweight subjects, and authors advise to improve the accuracy of algorithms for SWA software, or the predicted equations for estimating EE from other accelerometers.

Decline of physical activity in early adolescence: A 3-year cohort study

This study analyses the changes of moderate-to-vigorous physical activity (MVPA) in a cohort of boys and girls aged 11 (n = 50) and 14 (n = 50). Physical activity was assessed with Bodymedia SenseWear Pro Armband monitor for 6 days in October 2013 and October 2016, considering 90% of daily wear time (21h and 40min). The initial sample (n = 160) included the children who wore the monitors at age 11 but the final analyzed sample included only those children from the initial sample (n = 50), whose data fulfilled the inclusion criteria at age 11 and 14. Physical fitness and somatic characteristics of the final sample (n = 50) were compared to a representative sample of Slovenian schoolchildren at ages 11 (n = 385) and 14 (n = 236) to detect possible bias. Changes in MVPA were controlled for maturity using the timing of adolescent growth spurt as its indicator. The average MVPA decreased more than one quarter (34.96 min) from age 11 to age 14. Children were significantly more active at age 11 than at age 14 (p < 0.01, d = 0.39). The timing of puberty onset in girls was significantly earlier (12.01 ± 1.0 years) (p < 0.01) than in boys (13.2 ± 0.75 years) (p < 0.01, d = 1.35). There was a significant gender difference in moderate-to vigorous physical activity at age 14 (p < 0.05, η2 = 0.12) and between moderate-to vigorous physical activity at age 11 and 14 (η2 = 0.11). After controlling for the timing of adolescent growth spurt the girls at age 11 showed significantly higher level of physical activity than at age 14 (p < 0.01, η2 = 0.17). Early adolescence is crucial for the development of physical activity behaviours, which is especially pronounced in girls. The significant decline of MVPA between ages 11 and 14 in Slovenia are likely influenced by environmental changes since the timing of adolescent growth spurt did not prove as a factor underlying the decline of MVPA.

Is There an Association or Not?-Investigating the Association of Depressiveness, Physical Activity, Body Composition and Sleep With Mediators of Inflammation

BACKGROUND

Cytokines are mediators of inflammation that contribute to a low-grade inflammation in different disorders like major depression and obesity. It still remains unclear which psychological and medical factors interact with cytokine regulation. In the current investigation, the association between levels of pro-and anti-inflammatory cytokines and anthropometrics, mood state (depressiveness), physical activity and sleep were investigated in a sample of community-dwelled adults.

METHODS

Forty-nine subjects met the inclusion criteria for analyses and were assessed at two time-points (baseline (T1) and follow-up (T2), average T1-T2-interval = 215 days). Serum cytokine measures included the pro-inflammatory cytokines interleukin (IL)-2, IL-12, IFN-γ and TNF-α, the anti-inflammatory cytokines IL-4, IL-5, IL-10 and IL-13 and the granulocyte-macrophage colony-stimulating factor (GM-CSF); anthropometrics were assessed via physical examination, depressiveness was assessed via Beck Depression Inventory (BDI)2, parameters of physical activity (steps, METs) and sleep (night/total sleep duration) were measured via a 1-week actigraphy.

RESULTS

Correlation analyses showed low-to moderate significant relationships between the majority of cytokines and the BDI2 at T1, positive correlation with weight and BMI at T1 and T2, and negative correlations with the number of steps and METs at T2 and T2. Regression analyses for T1 revealed that the BDI2 score was the best positive predictor for the concentrations of all nine cytokines, followed by the number of steps and the nightsleep duration as negative predictors. At T2, the amount of steps was found to be negatively associated with IL-4, IL5, IL-10, GM-CSF, IFN-γ, and TNF-α, whereas the BMI could significantly predict IL-12 and IL-13. The BDI2-score was not significantly associated with any of the cytokines. No associations could be found between dynamics in cytokines from T1 and T2 and changes in any of the variables.

DISCUSSION

The present results indicate an influence of physical activity, subjective well-being and body composition on inflammatory mediators. Since there was no standardized intervention targeting the independent variables between T1 and T2, no assumptions on causality can be drawn from the association results.

The validity of two widely used commercial and research-grade activity monitors, during resting, household and activity behaviours

Wearable devices are increasingly prevalent in research environments for the estimation of energy expenditure (EE) and heart rate (HR). The aim of this study was to validate the HR and EE estimates of the Fitbit charge 2 (FC2), and the EE estimates of the Sensewear armband mini (SWA). We recruited 59 healthy adults to participate in walking, running, cycling, sedentary and household tasks. Estimates of HR from the FC2 were compared to a HR chest strap (Polar) and EE to a stationary metabolic cart (Vyntus CPX). The SWA overestimated overall EE by 0.03 kcal/min−1 and was statistically equivalent to the criterion measure, with a mean absolute percentage error (MAPE) of 29%. In contrast, the FC2 was not equivalent overall (MAPE = 44%). In household tasks, MAPE values of 93% and 83% were observed for the FC2 and SWA, respectively. The FC2 HR estimates were equivalent to the criterion measure overall. The SWA is more accurate than the commercial-grade FC2. Neither device is consistently accurate across the range of activities used in this study. The HR data obtained from the FC2 is more accurate than its EE estimates and future research may focus more on this variable.

Circadian skin temperature rhythms, circadian activity rhythms and sleep in individuals with self-reported depressive symptoms

BACKGROUND

Disturbed circadian rhythms have been associated with depression. New body-worn devices allow the objective recording of circadian parameters such as physical activity, skin temperature and sleep. The objective of this study was to investigate whether circadian skin temperature and circadian activity rhythms are altered in depressed individuals.

METHODS

Data on skin temperature, physical activity and sleep were available for 1610 subjects from a population-based cohort study. In a matching process two groups were formed for analysis: 121 participants with pronounced depression symptoms (CES-D Score > 21) and n = 121 matched non-depressed controls (CES-D Score < 15). Circadian rhythms were investigated by analyzing non-parametric rhythm indicators of 24-h skin temperature and physical activity data. Sleep timing, continuity and quantity were calculated from actigraphy.

RESULTS

No differences between the groups were found when all participants were considered. After excluding antidepressant medicated participants, the depression group was found to have a lower skin temperature amplitude t(208) = 2.45, p = .015 and a less stable skin temperature rhythm t(208) = 2.40, p = .017. The amplitude predicted the group status (beta = -5.529, p = .016). No effects were found for activity or sleep.

CONCLUSION

The results indicate that skin-temperature rhythms are blunted in unmedicated depressed individuals. This could be a promising non-invasive marker for further analysis.

Quantification of energy expenditure during daily living activities after stroke by multi-sensor

Objective: To explore the validity of energy expenditure estimates using the SenseWear Armband during a sequence of four daily living activities in patients post-stroke. Method: Patients with stroke who were able to walk during 6 min without human assistance were asked to wear the SenseWear Armband on the non-paretic arm while performing transfers, a manual task, walking, and walking up and down stairs. The energy expenditure estimated using the SenseWear Armband was compared to the energy expenditure calculated from oxygen consumption, measured by a portable indirect calorimeter (Metamax 3B). The mean of energy expenditure was pooled for each task. Accuracy was explored by mean bias (MB) of Bland-Altman analysis and root mean square error (RMSE), agreement by 95% of limits of agreement (95%LoA) and coefficient of correlation (r). Results: Thirty-eight participants (65.7 ± 13.5 years) were included. The SenseWear Armband globally underestimated energy expenditure, MB = 9.77 kcal for the whole sequence. RMSE were large, accounting for 15% to 41% of the measured energy expenditure. Agreement was low with r < 0.70 and 95%LoA from 42% to 93% of the measured energy expenditure. Conclusions: This study reported a global underestimation and a low level of agreement of the energy expenditure estimated by SenseWear Armband in four daily living activities in patients after stroke. Abbreviations: EE: Energy Expenditure; NIHSS: National Institute of Health Stroke Score.

Measuring the validity and reliability of the Apple Watch as a physical activity monitor

BACKGROUND

This study aimed to investigate the validity and reliability of the energy expenditure (EE) estimation of Apple Watch® among college students.

METHODS

Thirty college students completed two sets of three 10-minute treadmill walking and running trials while wearing three Apple watches and being connected to indirect calorimetry. The walking trials were at speeds of 54, 80, and 107 m·min-1 while the running trials were at 134, 161, 188 m·min-1. Energy expenditure comparisons were made using Two-way ANOVA with repeated measures. Reliability was analyzed by Intraclass Correlation.

RESULTS

There was no significant device x speed interactions (F (15, 696)=1.113, P=0.341) between the indirect calorimetry (criterion) and Apple Watch®. The lowest Inter-Class Correlation (ICC) scores were 0.49 (95%CI) at 54 while the highest were 0.72 (95%CI) at 107 and 134 m·min-1.

CONCLUSIONS

Apple Watch® demonstrated a low to moderate validity and reliability on measuring EE.

Physical activity in depressed and non-depressed patients with obesity

PURPOSE

Obesity and depression have both been shown to be associated with reduced physical activity (PA). However, most studies have not applied objective measures to determine PA in patients. Moreover, to our knowledge, no studies are available comparing depressed and non-depressed patients with regard to PA.

METHODS

We investigated PA in 47 patients with both obesity and depression, 70 non-depressed patients with obesity, and 71 non-depressed and non-obese healthy control participants using the SenseWear™ Armband (SWA) with walked steps per day and metabolic equivalents (MET) as parameters for PA.

RESULTS

Depressed as well as non-depressed patients with obesity showed a significantly reduced PA as reflected by walked steps as well as reduced METs. Healthy controls walked a mean of 11,586 ± 3731 (SD) steps per day, whereas non-depressed patients with obesity accumulated 7283 ± 3547 and patients with both obesity and depression recorded only 6177 ± 3291 steps per day. However, the difference between depressed and non-depressed patients with obesity did not reach statistical significance either in terms of walked steps or with regard to METs.

CONCLUSIONS

Obesity seems to be associated with a substantial reduction of PA and energy expenditure, whereas the effect of an additional depressive disorder was comparably small. Even though depression did not have any statistically significant effect on steps and METs per day in this study with obese patients, it could be clinically relevant for an individual patient.

Routine resting energy expenditure measurement increases effectiveness of dietary intervention in obesity

AIMS

Primary outcome of this observational study was to compare weight changes in two groups of overweight and obese individuals: subjects who had a diet prescribed on the base of resting energy expenditure (REE) measured by indirect calorimetry and subjects whose REE was estimated by a predictive equation. In addition, we analyzed differences in weight and metabolic parameter variation in subjects with and without an adequate to predicted REE.

METHODS

We retrospectively analyzed data of 355 overweight and obese patients: 215 on a diet based on REE measured by indirect calorimetry and 140 following a diet based on REE estimated by the Harris-Benedict equation. Anthropometric and metabolic parameters were evaluated for 18 months from baseline. Propensity score adjustment was used to adjust for known differences between the groups being compared.

RESULTS

A significant greater decrease in body weight was observed in the group that underwent indirect calorimetry compared to the group that did not undergo it (p < 0.001). No significant differences were observed between patients with not adequate to predicted REE compared to patients with adequate to predicted REE.

CONCLUSIONS

A weight reduction program based on REE measurement appears more effective than a dietary program based on predictive formulas. This study suggests the routine use of indirect calorimetry in all weight reduction procedures.

Use and Importance of Nonhuman Primates in Metabolic Disease Research: Current State of the Field

Obesity and its multiple metabolic sequelae, including type 2 diabetes, cardiovascular disease, and fatty liver disease, are becoming increasingly widespread in both the developed and developing world. There is an urgent need to identify new approaches for the prevention and treatment of these costly and prevalent metabolic conditions. Accomplishing this will require the use of appropriate animal models for preclinical and translational investigations in metabolic disease research. Although studies in rodent models are often useful for target/pathway identification and testing hypotheses, there are important differences in metabolic physiology between rodents and primates, and experimental findings in rodent models have often failed to be successfully translated into new, clinically useful therapeutic modalities in humans. Nonhuman primates represent a valuable and physiologically relevant model that serve as a critical translational bridge between basic studies performed in rodent models and clinical studies in humans. The purpose of this review is to evaluate the evidence, including a number of specific examples, in support of the use of nonhuman primate models in metabolic disease research, as well as some of the disadvantages and limitations involved in the use of nonhuman primates. The evidence taken as a whole indicates that nonhuman primates are and will remain an indispensable resource for evaluating the efficacy and safety of novel therapeutic strategies targeting clinically important metabolic diseases, including dyslipidemia and atherosclerosis, type 2 diabetes, hepatic steatosis, steatohepatitis, and hepatic fibrosis, and potentially the cognitive decline and dementia associated with metabolic dysfunction, prior to taking these therapies into clinical trials in humans.

Monitoring Energy Expenditure Using a Multi-Sensor Device-Applications and Limitations of the SenseWear Armband in Athletic Populations

In order to monitor their energy requirements, athletes may desire to assess energy expenditure (EE) during training and competition. Recent technological advances and increased customer interest have created a market for wearable devices that measure physiological variables and bodily movement over prolonged time periods and convert this information into EE data. This mini-review provides an overview of the applicability of the SenseWear armband (SWA), which combines accelerometry with measurements of heat production and skin conductivity, to measure total daily energy expenditure (TDEE) and its components such as exercise energy expenditure (ExEE) in athletic populations. While the SWA has been shown to provide valid estimates of EE in the general population, validation studies in athletic populations indicate a tendency toward underestimation of ExEE particularly during high-intensity exercise (>10 METs) with an increasing underestimation as exercise intensity increases. Although limited information is available on the accuracy of the SWA during resistance exercise, high-intensity interval exercise, or mixed exercise forms, there seems to be a similar trend of underestimating high levels of ExEE. The SWA, however, is capable of detecting movement patterns and metabolic measurements even at high exercise intensities, suggesting that underestimation may result from limitations in the proprietary algorithms. In addition, the SWA has been used in the assessment of sleep quantity and quality as well as non-exercise activity thermogenesis. Overall, the SWA provides viable information and remains to be used in various clinical and athletic settings, despite the termination of its commercial sale.

Explaining sex differences in lifespan in terms of optimal energy allocation in the baboon

We provide a quantitative test of the hypothesis that sex role specialization may account for sex differences in lifespan in baboons if such specialization causes the dependency of fitness upon longevity, and consequently the optimal resolution to an energetic trade-off between somatic maintenance and other physiological functions, to differ between males and females. We present a model in which females provide all offspring care and males compete for access to reproductive females and in which the partitioning of available energy between the competing fitness-enhancing functions of growth, maintenance, and reproduction is modeled as a dynamic behavioral game, with the optimal decision for each individual depending upon his/her state and the behavior of other members of the population. Our model replicates the sexual dimorphism in body size and sex differences in longevity and reproductive scheduling seen in natural populations of baboons. We show that this outcome is generally robust to perturbations in model parameters, an important finding given that the same behavior is seen across multiple populations and species in the wild. This supports the idea that sex differences in longevity result from differences in the value of somatic maintenance relative to other fitness-enhancing functions in keeping with the disposable soma theory.

Estimating activity of Japanese macaques (Macaca fuscata) using accelerometers

Accelerometers have been used to study both terrestrial and aquatic wildlife, mainly for mammal and bird species. In terrestrial mammals, there is a bias toward ungulates and carnivores, with fewer studies on nonhuman primates. In this study, we tested the use of accelerometers for studying the activity of Japanese macaques (Macaca fuscata). We modeled the activity of a male and a female subject by matching continuous focal observations from video recordings to sensor parameters derived from collar-mounted accelerometers. Models achieved classification performance (AUC) of greater than 90% for both subjects, with similar results when subjects were cross-validated. Accelerometer-based estimates of activity had comparable accuracies to estimates from instantaneous sampling at 1 min and 5 min intervals. We further demonstrated the use of model estimates for analyzing circadian rhythm and night time activity of M. fuscata. Our results add support to the feasibility of using accelerometers for studying activity of nonhuman primates. We discussed the limitations, benefits and potential applications of remote-sensing technology like accelerometers for advancing primalotogical studies.

Metabolic effects of resistance or high-intensity interval training among glycemic control-nonresponsive children with insulin resistance

BACKGROUND

Little evidence exists on which variables of body composition or muscular strength mediates more glucose control improvements taking into account inter-individual metabolic variability to different modes of exercise training.

OBJECTIVE

We examined 'mediators' to the effects of 6-weeks of resistance training (RT) or high-intensity interval training (HIT) on glucose control parameters in physically inactive schoolchildren with insulin resistance (IR). Second, we also determined both training-induce changes and the prevalence of responders (R) and non-responders (NR) to decrease the IR level.

METHODS

Fifty-six physically inactive children diagnosed with IR followed a RT or supervised HIT program for 6 weeks. Participants were classified based on ΔHOMA-IR into glycemic control R (decrease in homeostasis model assessment-IR (HOMA-IR) <3.0 after intervention) and NRs (no changes or values HOMA-IR⩾3.0 after intervention). The primary outcome was HOMA-IR associated with their mediators; second, the training-induced changes to glucose control parameters; and third the report of R and NR to improve body composition, cardiovascular, metabolic and performance variables.

RESULTS

Mediation analysis revealed that improvements (decreases) in abdominal fat by the waist circumference can explain more the effects (decreases) of HOMA-IR in physically inactive schoolchildren under RT or HIT regimes. The same analysis showed that increased one-maximum repetition leg-extension was correlated with the change in HOMA-IR (β=-0.058; P=0.049). Furthermore, a change in the waist circumference fully mediated the dose-response relationship between changes in the leg-extension strength and HOMA-IR (β'=-0.004; P=0.178). RT or HIT were associated with significant improvements in body composition, muscular strength, blood pressure and cardiometabolic parameters irrespective of improvement in glycemic control response. Both glucose control RT-R and HIT-R (respectively), had significant improvements in mean HOMA-IR, mean muscular strength leg-extension and mean measures of adiposity.

CONCLUSIONS

The improvements in the lower body strength and the decreases in waist circumference can explain more the effects of the improvements in glucose control of IR schoolchildren in R group after 6 weeks of RT or HIT, showing both regimes similar effects on body composition or muscular strength independent of interindividual metabolic response variability.

Validity of the ActiGraph GT3X+ and BodyMedia SenseWear Armband to estimate energy expenditure during physical activity and sport

OBJECTIVES

The purpose of this study was to assess the validity of the ActiGraph GT3X+ (GT3X+) and the BodyMedia SenseWear Armband (SWA) to estimate energy expenditure (EE) during physical activity and field sport movements.

DESIGN

Criterion validity.

METHODS

Twenty-six active adults completed a single 90min session involving alternating intervals of exercise (5min) and recovery (10min). Exercise involved walking (4km/h), jogging (8km/h), running (12km/h) or a sport-simulated circuit (three intervals). Participants wore two triaxial accelerometers (GT3X+ and SWA) and a portable gas analyser (MetaMax 3B), used as the criterion measure.

RESULTS

Total EE was significantly underestimated (p<0.01) by the GT3X+ (mean bias±SD: -374.5±132.84kJ; % difference=-29.3%) and SWA (-244.3±148.0kJ; -18.2%). Overestimations were made by both accelerometers during the walk (GT3X+: 27.4±30.8kJ; SWA: 32.1±15.4kJ) and jog (38.0±30.0kJ; 34.5±31.6kJ). Underestimations were evident during the run (-41.2±25.1kJ; -43.8±33.5kJ) and circuit (C1: GTX+: -127.2±41.6kJ; SWA: -86.1±40.2kJ). Error of estimation increased in magnitude as the intensity of exercise increased (GT3X+: 40.8-143.0kJ; SWA: 35.5-102.0kJ).

CONCLUSIONS

The ActiGraph GT3X+ and BodyMedia SWA do not provide valid EE estimates across a range of exercise modalities and intensities when compared to a criterion measure. Poor accuracy and large precision errors, particularly during high intensity and intermittent movement patterns, suggest these devices have limitations and should be used cautiously in the field.

Exergaming can be an innovative way of enjoyable high-intensity interval training

OBJECTIVES

Exergames can replace sedentary time spent on computer gaming with physical activity. Previous research has found exergaming to elicit light-to-moderate exercise intensity. Our primary aim was to examine the exercise intensity of a newly developed biking exergame.

METHODS

Eight males (23.9±0.6 years) played the exergame (PLAY) and walked (WALK) on three separate occasions, with the condition counterbalanced and in random sequence within each day. They were asked to PLAY and WALK for a minimum of 15 min and then continue for as long as they wanted. We measured heart rate (HR), activity duration, caloric expenditure and subject-rated exertion and enjoyment (based on 0-10 Visual Analogue Scale, VAS). We used an average of each outcome variable across the 3 days in the analysis.

RESULTS

The average intensity during PLAY (73%±10% of HR_max) was significantly higher than that during WALK (57%±7% of HR_max, p=0.01). Participants spent 12.5±5.3 min at 80%-89% of HR_max and 5.5±4.6 min at ≥90% of HR_max during PLAY, whereas intensity during WALK was ≤72% of HR_max. The duration of PLAY was 44.3±0.7 min and of WALK 17.0±0.7 min (p=0.01). The relative energy expenditure during PLAY was 7.6±0.7 kcal/min and during WALK 6.2±0.3 kcal/min (p<0.01). The enjoyment of PLAY (VAS 8.7±0.1) was higher than that of WALK (VAS 3.9±1.8, p=0.01).

CONCLUSIONS

Exergaming can be an innovative way of enjoyable high-intensity training.

The association of change in physical activity and body weight in the regulation of total energy expenditure

BACKGROUND/OBJECTIVES

The limited success in addressing the current obesity epidemic reflects the insufficient understanding of the regulation of energy balance. The present study examines the longitudinal association of body weight with physical activity (PA), total daily energy expenditure (TDEE) and total daily energy intake (TDEI).

SUBJECTS/METHODS

A total of 195 adults (52% male) between 21 and 35 years of age with no intention for weight loss were followed over a 2-year period. Body weight, fat mass and fat-free mass were measured every 3 months. Participants were stratified into three groups based on change in body weight using a 5% cutpoint. TDEE and time spent in different PA intensities were determined via a multisensor device at each measurement time. TDEI was calculated based on change in body composition and TDEE.

RESULTS

At 2-year follow-up, 57% of the participants maintained weight, 14% lost weight and 29% gained weight. Average weight change was -6.9±3.4 and 7.1±3.6 kg in the weight-loss and weight-gain groups, respectively. Average TDEE and TDEI did not change significantly in any weight change group (P>0.16). Moderate-to-vigorous PA, however, increased significantly in the weight-loss group (35±49 min/day; P<0.01) and decreased in the weight-gain group (-35±46 min/day; P<0.01).

CONCLUSIONS

Results of this observational study indicate an inverse association between body weight and PA to maintain a stable TDEE and allow for a stable TDEI over time. Sufficient PA levels, therefore, are an important contributor to weight loss maintenance.

Nutritional status and physical inactivity in moderated asthmatics: A pilot study

Preservation of nutritional status and of fat-free mass (FFM) and/or preventing of fat mass (FM) accumulation have a positive impact on well-being and prognosis in asthma patients. Physical inactivity is identified by World Health Organization as the fourth leading risk factor for global mortality. Physical activity (PA) may contribute to limit FM accumulation, but little information is available on the interactions between habitual PA and body composition and their association with disease severity in asthma severity.Associations between habitual PA, FM, FFM, and pulmonary function were investigated in 42 subjects (24 patients with mild-moderate asthma and 18 matched control subjects). Sensewear Armband was used to measure PA and metabolic equivalent of tasks (METs) continuously over 4 days, while body composition was measured by bioelectrical impedance analysis. Respiratory functions were also assessed in all study participants.FM and FFM were comparable in mild-moderate asthmatics and controls, but PA was lower in asthmatics and it was negatively correlated with FM and positively with the FFM marker body cell mass in all study subjects (P < 0.05). Among asthmatics, treated moderate asthmatics (ICS, n = 12) had higher FM and lower PA, METs, steps number/die, and forced expiratory volume in the 1st second (FEV1)/forced vital capacity (FVC) than in untreated intermittent asthmatics (UA, n = 12).This pilot study assesses that in mild-moderate asthma patients, lower PA is associated with higher FM and higher disease severity. The current results support enhancement of habitual PA as a potential tool to limit FM accumulation and potentially contribute to preserve pulmonary function in moderate asthma, considering the physical inactivity a strong risk factor for asthma worsening.

Genome-wide association analysis of actigraphic sleep phenotypes in the LIFE Adult Study

The genetic basis of sleep is still poorly understood. Despite the moderate to high heritability of sleep-related phenotypes, known genetic variants explain only a small proportion of the phenotypical variance. However, most previous studies were based solely upon self-report measures. The present study aimed to conduct the first genome-wide association (GWA) of actigraphic sleep phenotypes. The analyses included 956 middle- to older-aged subjects (40-79 years) from the LIFE Adult Study. The SenseWear Pro 3 Armband was used to collect 11 actigraphic parameters of night- and daytime sleep and three parameters of rest (lying down). The parameters comprised measures of sleep timing, quantity and quality. A total of 7 141 204 single nucleotide polymorphisms (SNPs) were analysed after imputation and quality control. We identified several variants below the significance threshold of P ≤ 5× 10^-8 (not corrected for analysis of multiple traits). The most significant was a hit near UFL1 associated with sleep efficiency on weekdays (P = 1.39 × 10^-8 ). Further SNPs were close to significance, including an association between sleep latency and a variant in CSNK2A1 (P = 8.20 × 10^-8 ), a gene known to be involved in the regulation of circadian rhythm. In summary, our GWAS identified novel candidate genes with biological plausibility being promising candidates for replication and further follow-up studies.

Change in energy expenditure and physical activity in response to aerobic and resistance exercise programs

Exercise is considered an important component of a healthy lifestyle but there remains controversy on effects of exercise on non-exercise physical activity (PA). The present study examined the prospective association of aerobic and resistance exercise with total daily energy expenditure and PA in previously sedentary, young men. Nine men (27.0 ± 3.3 years) completed two 16-week exercise programs (3 exercise sessions per week) of aerobic and resistance exercise separated by a minimum of 6 weeks in random order. Energy expenditure and PA were measured with the SenseWear Mini Armband prior to each intervention as well as during week 1, week 8 and week 16 of the aerobic and resistance exercise program. Body composition was measured via dual x-ray absorptiometry. Body composition did not change in response to either exercise intervention. Total daily energy expenditure on exercise days increased by 443 ± 126 kcal/d and 239 ± 152 kcal/d for aerobic and resistance exercise, respectively (p < 0.01). Non-exercise moderate-to-vigorous PA, however, decreased on aerobic exercise days (−148 ± 161 kcal/d; p = 0.03). There was no change in total daily energy expenditure and PA on non-exercise days with aerobic exercise while resistance exercise was associated with an increase in moderate-to-vigorous PA during non-exercise days (216 ± 178 kcal/d, p = 0.01). Results of the present study suggest a compensatory reduction in PA in response to aerobic exercise. Resistance exercise, on the other hand, appears to facilitate non-exercise PA, particularly on non-exercise days, which may lead to more sustainable adaptations in response to an exercise program.

Exercise as medicine-the use of group medical visits to promote physical activity and treat chronic moderate depression: a preliminary 14-week pre-post study

Objective

The evidence that regular physical activity can treat depressive disorders is increasingly robust. However, motivating patients with depression to engage in physical activity can be challenging. Interdisciplinary group medical visits (GMVs) with an integrated physical activity component may be a novel means to support patients in becoming more active.

Methods

We conducted a ‘pre–post’ pilot study within a primary care setting. Participants were adults (≥18 years) with a chronic major depressive disorder or a bipolar 2 disorder (depression; chronic). A psychiatrist and exercise therapist co-led a series of 14 weekly 2 h GMVs. Each group visit combined specific medical advice, physical activity, patient discussions and a targeted educational component. Participants also attended 11 weekly hatha yoga classes. Primary outcome was ‘steps’ as measured by accelerometer (SenseWear) as well as depression (Patient Health Questionnaire, PHQ-9) and anxiety (Generalised Anxiety Disorder, GAD-7) ratings.

Results

14 of 15 participants (93.3%) completed the 14-week programme. After 3 months postintervention, median depression scales (PHQ-9) decreased 38% from 16 to 10 (p<0.01; IQR pre/post 8/12); and median anxiety scales (GAD-7) decreased 50% from 13 to 6.5 (p<0.05; IQR 8.5/9). Median daily ‘steps’ increased 71% from 3366 to 5746 (IQR 2610/6237), though this was not significant (p>0.10).

Conclusions

While other studies have examined the efficacy of GMVs in addressing chronic illnesses and the promotion of lifestyle changes, none to our knowledge have embedded physical activity within the actual patient visits. Interdisciplinary GMVs (eg, psychiatrist/exercise professional) may be a means to decrease depression and anxiety ratings within clinical care while improving physical activity.

Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

BACKGROUND

The association between malnutrition and worse outcomes as pressure ulcers and mortality is well established in a variety of setting. Currently none investigation was conducted in patients with long-term consequences of the acquired brain injury in which recovery from brain injury could be influenced by secondary complications. The aim of this study was to investigate the association between various nutritional status parameters (in particular albumin) and pressure ulcers formation and short-term mortality in minimal conscious state patients.

METHODS

In this prospective, observational study of 5-months duration, a 30 patients sample admitted to a Neurological Institute was considered. All patients underwent a complete medical examination. Anthropometric parameters like mid-arm circumference and mid-arm muscle circumference and nutritional parameters as serum albumin and blood hemoglobin concentration were assessed.

RESULTS

At univariate and logistic regression analysis, mid-arm circumference (p = 0.04; beta = -0.89), mid-arm muscle circumference (p = 0.050; beta = -1.29), hemoglobin (p = 0.04, beta -1.1) and albumin (p = 0.04, beta -7.91) were inversely associated with pressure ulcers. The area under the ROC curve for albumin to predict sores was 0.76 (p = 0.02) and mortality was 0.83 (p = 0.03). Patient with lower albumin had significantly higher short-term mortality than those with higher serum albumin (p = 0.03; χ(2) test = 6.47).

CONCLUSION

Albumin, haemoglobin and mid-arm circumference are inversely associated with pressure ulcers. Albumin is a prognostic index in MCS patients. Since albumin and haemoglobin could be affected by a variety of factors, this association suggests to optimize nutrition and investigate on other mechanism leading to mortality and pressure ulcers.

Inflammatory cytokines in general and central obesity and modulating effects of physical activity

Context

Chronic systemic inflammation in obesity originates from local immune responses in visceral adipose tissue. However, assessment of a broad range of inflammation-mediating cytokines and their relationship to physical activity and adipometrics has scarcely been reported to date.

Objective

To characterize the profile of a broad range of pro- and anti-inflammatory cytokines and the impact of physical activity and energy expenditure in individuals with general obesity, central obesity, and non-obese subjects.

Design, Setting, and Participants

A cross-sectional study comprising 117 obese patients (body mass index (BMI) ≥ 30) and 83 non-obese community-based volunteers.

Main Outcomes Measures

Serum levels of interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12, IL-13, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN)-γ and tumor necrosis factor (TNF)-α were measured. Physical activity and energy expenditure (MET) were assessed with actigraphy. Adipometrics comprised BMI, weight, abdominal-, waist- and hip-circumference, waist to hip ratio (WHR), and waist-to-height-ratio (WHtR).

Results

General obesity was associated with significantly elevated levels of IL-5, IL-10, IL-12, IL-13, IFN-γ and TNF-α, central obesity with significantly elevated IL-5, IL-10, IL-12, IL-13 and IFN-γ-levels. In participants with general obesity, levels of IL-4, IL-10 and IL-13 were significantly elevated in participants with low physical activity, even when controlled for BMI which was negatively associated with physical acitivity. Cytokines significantly correlated with adipometrics, particularly in obese participants.

Conclusions

Results confirm up-regulation of certain pro- and anti-inflammatory cytokines in obesity. In obese subjects, physical activity may lower levels and thus reduce pro-inflammatory effects of cytokines that may link obesity, insulin resistance and diabetes.

Physical activity and energy expenditure during depressive episodes of major depression

BACKGROUND

Recent data suggest a substantial association between physical activity and depressive symptoms, but there is a lack of research evaluating the physical activity levels in patients suffering from unipolar depression across different stages of disease in an objective way. The aim of the present pilot study was to objectively examine physical activity levels of this patient group compared to healthy controls.

METHODS

Physical activity performance of 19 patients with major depressive episode and 19 healthy controls was assessed at three different time points using a multisensory armband device (SenseWear® Pro3 Armband) and was reported as total energy expenditure (TEE), active energy expenditure (EE), metabolic equivalents (METs), physical activity (PA) and time of lying down (LD), in each case over 24h.

RESULTS

Over all measurements, depressive patients presented a significantly lower mean TEE and EE over 24h. Moreover, the patient group showed significantly shorter duration of PA and lower average MET over 24h. When depressive symptoms abated, physical activity parameters significantly increased in the patient group. Correlation analyses demonstrated a significant relation between depressive status/anhedonia and parameters of physical activity, especially in healthy subjects.

LIMITATIONS

Results represented valid data for inpatients only.

CONCLUSION

Acute unipolar depression was associated with a significantly lower level of physical activity and showed a significant increase in parallel to clinical improvement. Electronic monitoring of physical activity may be an additional tool for evaluating and controlling therapeutic effects.

Chronic continuous exenatide infusion does not cause pancreatic inflammation and ductal hyperplasia in non-human primates

In this study, we aimed to evaluate the effects of exenatide (EXE) treatment on exocrine pancreas of nonhuman primates. To this end, 52 baboons (Papio hamadryas) underwent partial pancreatectomy, followed by continuous infusion of EXE or saline (SAL) for 14 weeks. Histological analysis, immunohistochemistry, Computer Assisted Stereology Toolbox morphometry, and immunofluorescence staining were performed at baseline and after treatment. The EXE treatment did not induce pancreatitis, parenchymal or periductal inflammatory cell accumulation, ductal hyperplasia, or dysplastic lesions/pancreatic intraepithelial neoplasia. At study end, Ki-67-positive (proliferating) acinar cell number did not change, compared with baseline, in either group. Ki-67-positive ductal cells increased after EXE treatment (P = 0.04). However, the change in Ki-67-positive ductal cell number did not differ significantly between the EXE and SAL groups (P = 0.13). M-30-positive (apoptotic) acinar and ductal cell number did not change after SAL or EXE treatment. No changes in ductal density and volume were observed after EXE or SAL. Interestingly, by triple-immunofluorescence staining, we detected c-kit (a marker of cell transdifferentiation) positive ductal cells co-expressing insulin in ducts only in the EXE group at study end, suggesting that EXE may promote the differentiation of ductal cells toward a β-cell phenotype. In conclusion, 14 weeks of EXE treatment did not exert any negative effect on exocrine pancreas, by inducing either pancreatic inflammation or hyperplasia/dysplasia in nonhuman primates.

Validation and reliability of two activity monitors for energy expenditure assessment

OBJECTIVES

This study explores the reliability and validity of the SenseWear Armband (SWA) and Actical (ACT) for free-living total energy expenditure, and energy expenditure during rest and light-to-moderate exercises (walking, ergocycling).

DESIGN

Participants wore the 2 devices during 7 days (free-living) and then participated to 3 days of testing in our laboratory.

METHODS

SWA and ACT estimates of total energy expenditure was compared to the doubly labeled water technique (7 days), and energy expenditure during rest (60min), treadmill (45min; intensities ∼22% to ∼41% VO2peak) and ergocycling (45min; ∼50% VO2peak) were compared to indirect calorimetry over the following 3 days. Paired T-tests and intra-class correlation coefficient (ICC) with 95% confidence interval (CI95) were computed.

RESULTS

Twenty adults were recruited (BMI 23.1±2.3kg/m(2)). Compared to doubly labelled water, SWA overestimated energy expenditure by 94kcal/d (±319; P=0.2) and ACT underestimated by -244kcal/d (±258; P=0.001). Energy expenditure during rest (SWA 210±116, ACT 124±133kcal/d; p<0.05) and treadmill (according on intensity: SWA 54±46 to 67±38, ACT 68±25 to 84±40kcal; p<0.05) were overestimated and underestimated during ergocycling (SWA -93±65, ACT -269±111kcal; p<0.05) compared to indirect calorimetry. High ICC were observed at rest (SWA 0.994 CI95 0.987-0.997; ACT 0.998 CI95 0.996-0.999) and during ergocycling (SWA 0.941 CI95 0.873-0.975; ACT 0.854 CI95 0.687-0.939).

CONCLUSION

Acceptable estimation of total energy expenditure was observed with the SWA. Both devices were reliable but not accurate for energy expenditure's estimations during rest and for specific exercises.

The association between different types of exercise and energy expenditure in young nonoverweight and overweight adults

With decades of trends for decreasing activity during work and travel, exercise becomes an important contributor to total physical activity (PA) and energy expenditure. The purpose of this study was to examine the contribution of different types of exercise to the variability in energy expenditure and time spent at different PA intensities in young adults. Four hundred and seventeen adults (49.9% male; 46.2 overweight/obese) between 21 and 36 years of age provided valid objective PA and energy expenditure data, assessed via the SenseWear Armband (BodyMedia Inc.). Frequency and duration of participation in various exercise types was self-reported. Weight status was based on body mass index (BMI) (kg/m(2)) with body weight and height being measured according to standard procedures. Eighty-four percent of the participants reported regular exercise engagement with no difference in participation rate by sex or BMI category. Exercise time along with sex and ethnicity explained roughly 60% of the variability in total daily energy expenditure (TDEE) while the association between exercise and time spent in moderate to vigorous PA or being sedentary was low or nonsignificant. Engagement in endurance exercise and sports contributed predominantly to the variability in energy expenditure and PA in nonoverweight participants. In overweight/obese participants engagement in resistance exercise and swimming contributed significantly to variability in TDEE. Current exercise recommendations focus primarily on aerobic exercise, but results of the present study suggest that nonweight-bearing exercises, such as resistance exercise and swimming, contribute significantly to the variability in TDEE in overweight/obese adults, which would make these types of activities viable options for exercise interventions.

Assessment of physical activity and energy expenditure: an overview of objective measures

The ability to assess energy expenditure (EE) and estimate physical activity (PA) in free-living individuals is extremely important in the global context of non-communicable diseases including malnutrition, overnutrition (obesity), and diabetes. It is also important to appreciate that PA and EE are different constructs with PA defined as any bodily movement that results in EE and accordingly, energy is expended as a result of PA. However, total energy expenditure, best assessed using the criterion doubly labeled water (DLW) technique, includes components in addition to physical activity energy expenditure, namely resting energy expenditure and the thermic effect of food. Given the large number of assessment techniques currently used to estimate PA in humans, it is imperative to understand the relative merits of each. The goal of this review is to provide information on the utility and limitations of a range of objective measures of PA and their relationship with EE. The measures discussed include those based on EE or oxygen uptake including DLW, activity energy expenditure, physical activity level, and metabolic equivalent; those based on heart rate monitoring and motion sensors; and because of their widespread use, selected subjective measures.