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Angelidi AM, Stefanakis K, Chou SH, Valenzuela-Vallejo L, Dipla K, Boutari C, Ntoskas K, Tokmakidis P, Kokkinos A, Goulis DG, Papadaki HA, Mantzoros CS. Relative Energy Deficiency in Sport (REDs): Endocrine Manifestations, Pathophysiology and Treatments. Endocr Rev 2024; 45:676-708. [PMID: 38488566 DOI: 10.1210/endrev/bnae011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Indexed: 09/18/2024]
Abstract
Research on lean, energy-deficient athletic and military cohorts has broadened the concept of the Female Athlete Triad into the Relative Energy Deficiency in Sport (REDs) syndrome. REDs represents a spectrum of abnormalities induced by low energy availability (LEA), which serves as the underlying cause of all symptoms described within the REDs concept, affecting exercising populations of either biological sex. Both short- and long-term LEA, in conjunction with other moderating factors, may produce a multitude of maladaptive changes that impair various physiological systems and adversely affect health, well-being, and sport performance. Consequently, the comprehensive definition of REDs encompasses a broad spectrum of physiological sequelae and adverse clinical outcomes related to LEA, such as neuroendocrine, bone, immune, and hematological effects, ultimately resulting in compromised health and performance. In this review, we discuss the pathophysiology of REDs and associated disorders. We briefly examine current treatment recommendations for REDs, primarily focusing on nonpharmacological, behavioral, and lifestyle modifications that target its underlying cause-energy deficit. We also discuss treatment approaches aimed at managing symptoms, such as menstrual dysfunction and bone stress injuries, and explore potential novel treatments that target the underlying physiology, emphasizing the roles of leptin and the activin-follistatin-inhibin axis, the roles of which remain to be fully elucidated, in the pathophysiology and management of REDs. In the near future, novel therapies leveraging our emerging understanding of molecules and physiological axes underlying energy availability or lack thereof may restore LEA-related abnormalities, thus preventing and/or treating REDs-related health complications, such as stress fractures, and improving performance.
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Affiliation(s)
- Angeliki M Angelidi
- Department of Medicine, Boston VA Healthcare System, Boston, MA 02115, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Konstantinos Stefanakis
- Department of Medicine, Boston VA Healthcare System, Boston, MA 02115, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- First Propaedeutic Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
- Department of Internal Medicine, 251 Air Force General Hospital, Athens 11525, Greece
| | - Sharon H Chou
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, MA 02115, USA
| | - Laura Valenzuela-Vallejo
- Department of Medicine, Boston VA Healthcare System, Boston, MA 02115, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Konstantina Dipla
- Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres, Aristotle University of Thessaloniki, Serres 62100, Greece
| | - Chrysoula Boutari
- Second Propaedeutic Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Konstantinos Ntoskas
- Department of Internal Medicine, 251 Air Force General Hospital, Athens 11525, Greece
| | - Panagiotis Tokmakidis
- First Propaedeutic Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
- Department of Internal Medicine, 251 Air Force General Hospital, Athens 11525, Greece
| | - Alexander Kokkinos
- First Propaedeutic Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Helen A Papadaki
- Department of Hematology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion 71500, Greece
| | - Christos S Mantzoros
- Department of Medicine, Boston VA Healthcare System, Boston, MA 02115, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, MA 02115, USA
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Helge T, Windahl M, Björkman F. Observational study of the effects of maximal oxygen uptake on cognitive function and performance during prolonged military exercise. BMJ Mil Health 2024:e002757. [PMID: 39231542 DOI: 10.1136/military-2024-002757] [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: 04/16/2024] [Accepted: 08/20/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Military operations place high demands on many cognitive functions, and stressful events characterise the military work environment. The study aimed to examine the relationship between cardiorespiratory fitness, stress response, cognitive function and military performance during prolonged military exercise. METHODS 66 army cadets were included in the study. The subjects participated in a 4.5-day military winter training in northern Sweden. Maximal oxygen uptake (VO2max) was estimated from a cycle test. Cognitive tests (design fluency, DF test) and measurements of heart rate variability (HRV) were conducted before and after the exercise. Assessment of military performance as an individual soldier (P-ind) and performance as a team leader (P-lead) was carried out during the final day of the exercise. Pearson's coefficient of correlation (r) and Spearman's rho were used to evaluate correlations, and linear regressions were used to examine the relationships between VO2max, HRV, DF test scores and military performance. Simple mediation analyses were performed with DF test scores and military performance (P-ind, P-lead) as dependent variables, VO2max as a predictor and HRV as a mediator. RESULTS Post-exercise HRV was related to military performance (P-ind: r=0.40, p<0.01; P-lead: r=0.32, p<0.05). Absolute VO2max was positively correlated with P-ind (r=0.28, p<0.05), and the effect of VO2max on military performance was mediated by HRV. Post-test DF scores were negatively correlated with post-exercise HRV (total correct designs: r=-0.26, p<0.05; total incorrect designs: r=-0.27, p<0.05). CONCLUSIONS Results suggest that high absolute VO2max predicts military performance by reducing the stress response to prolonged military exercise. Aerobic capacity may provide a meaningful effect on the ability to preserve military performance. Future studies need to identify thresholds for this capacity. PRE-REGISTRATION The protocol was retrospectively registered at OSF (https://osf.io/), registration DOI 10.17605/OSF.IO/ND6XM.
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Affiliation(s)
- Torbjörn Helge
- Department of Nutrition and Biomechanics, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
| | - M Windahl
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
- Department of Education, Land Warfare Centre, Swedish Armed Forces, Borensberg, Sweden
| | - F Björkman
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
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Cox C, Yates J, O’Brien F, Pajon L, Farrell A, Ward M, McCabe P, James A, McNamara-Catalano I. Wearable Technology: A Wellbeing Option for Serving Police Officers and Staff? A Comparison of Results of a Pilot Study with Firearms Officers and a Group of Mixed Officers and Staff. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:186. [PMID: 38397677 PMCID: PMC10888460 DOI: 10.3390/ijerph21020186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
The high-stress nature of policing contributes to deterioration of officer health and wellbeing as well as high levels of absenteeism and attrition. Wearable technology (WT) has been identified as a potential tool that can help in improving officer health and wellbeing. This pilot study aimed to give initial insight into acceptability and engagement with WT amongst officers. The study also aimed to uncover any notable areas for exploration in future research within the domain of officer health and wellbeing. Two groups were observed, firearms officers and a mixed group of officers. Participants wore the WT for an extended period, completed a variety of health and wellbeing questionnaires and discussed their experience in focus groups. Firearms officers and mixed group officers displayed similar sleep efficiency, but firearms officers have worse sleep consistency and sleep performance. Firearms officers appear to have higher HRV and a slightly lower resting heart rate. Both groups display reasonable acceptance of the use of WT, speaking favorably during the focus groups of how monitoring the data had improved their quality of life in terms of their understanding of sleep, wellbeing and how they had consequently completed lifestyle modification. WT offers some promise in managing officer health and wellbeing; studies with larger sample sizes are needed to confirm this.
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Affiliation(s)
- Carol Cox
- Liverpool Centre for Advanced Policing Studies, Liverpool John Moores University, Liverpool L3 5UX, UK; (J.Y.); (F.O.); (L.P.); (A.F.); (M.W.); (P.M.); (A.J.); (I.M.-C.)
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Tomes CD, Canetti EFD, Schram B, Orr R. Heart rate variability profile changes associated with specialist police selection activities: A case study. Work 2024; 77:1295-1303. [PMID: 38189726 DOI: 10.3233/wor-230297] [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: 01/09/2024] Open
Abstract
BACKGROUND Police Tactical Groups (PTGs) are specialist police units tasked with rigorous physical and psychosocial duties. Consequently, selection courses (SCs) for service in these units must also be rigorous. Given the intensity of SCs, holistic monitoring for potential overstress may be beneficial. Heart Rate Variability (HRV) is one holistic stress measure that can be obtained in austere environments. OBJECTIVE The purpose of this study was to profile HRV during a PTG SC. Six (n = 6) qualified male police officers attempted a 36-hour PTG selection course held at an Australian state facility. METHODS HRV was obtained from Equivitaltrademark EQ02 + LifeMonitor bioharnesses. The selection course consisted of physically demanding events with minimal sleep (approx. 45 mins). Only one candidate completed the full selection course; whose results are reported here. RESULTS A visual time-series of 384 consecutive 5 min HRV analyses was generated. Contextual analysis was applied to appreciate HRV changes between SC serials. HRV decline occurred during the planning of a navigation exercise and a pack march. Increases in HRV were observed throughout the pack march exercise and rest period. CONCLUSION This case study demonstrates the potential utility for selection personnel to obtain additional insight into candidate responses to various occupational challenges throughout an SC. Information provided by HRV monitoring may support leadership decisions when evaluating personnel holistically. For example, the ability to continue occupational task execution even while experiencing potential overstress (as measured by HRV) and after food and sleep deprivation is desirable. HRV may potentially inform stakeholders regarding overstress in PTG candidates.
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Affiliation(s)
- Colin D Tomes
- Faculty of Health Science and Medicine, Bond University, Robina, QLD, Australia
- Tactical Research Unit, Bond University, Robina, QLD, Australia
| | - Elisa F D Canetti
- Faculty of Health Science and Medicine, Bond University, Robina, QLD, Australia
- Tactical Research Unit, Bond University, Robina, QLD, Australia
| | - Ben Schram
- Faculty of Health Science and Medicine, Bond University, Robina, QLD, Australia
- Tactical Research Unit, Bond University, Robina, QLD, Australia
| | - Robin Orr
- Faculty of Health Science and Medicine, Bond University, Robina, QLD, Australia
- Tactical Research Unit, Bond University, Robina, QLD, Australia
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Tramel W, Schram B, Canetti E, Orr R. An Examination of Subjective and Objective Measures of Stress in Tactical Populations: A Scoping Review. Healthcare (Basel) 2023; 11:2515. [PMID: 37761712 PMCID: PMC10530665 DOI: 10.3390/healthcare11182515] [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: 08/02/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Persons working in tactical occupations are often exposed to high-stress situations. If this stress is to be measured, an understanding of the stress outcomes used in these occupations is needed. The aim of this review was to capture and critically appraise research investigating subjective and objective outcome measures of physiological stress in tactical occupations. Several literature databases (PubMed, EMBASE, EBsco) were searched using key search words and terms. Studies meeting inclusion criteria were critically evaluated and scored by two authors using the Joanne Briggs Institute (JBI) critical appraisal tool. Of 17,171 articles, 42 studies were retained. The Cohen's Kappa agreement between authors was 0.829 with a mean JBI Score of included studies of 8.1/9 ± 0.37 points. Multiple subjective and objective measures were assessed during a variety of high-stress tasks and environments across different occupations, including police officers, emergency service personnel, firefighters, and soldiers in the military. Common objective outcomes measures were heart rate, cortisol, and body temperature, and subjective measures were ratings of perceived exertion, and the Self Trait Anxiety Inventory. Often used in combination (i.e., subjective and objective), these outcome measures can be used to monitor stressors faced by tactical personnel undergoing on-the-job training.
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Affiliation(s)
- Whitney Tramel
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia; (B.S.); (E.C.); (R.O.)
| | - Ben Schram
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia; (B.S.); (E.C.); (R.O.)
- Tactical Research Unit, Bond University, Robina, QLD 4226, Australia
| | - Elisa Canetti
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia; (B.S.); (E.C.); (R.O.)
- Tactical Research Unit, Bond University, Robina, QLD 4226, Australia
| | - Robin Orr
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia; (B.S.); (E.C.); (R.O.)
- Tactical Research Unit, Bond University, Robina, QLD 4226, Australia
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Ras J, Smith DL, Kengne AP, Soteriades ES, Leach L. Physical fitness, cardiovascular and musculoskeletal health, and occupational performance in firefighters. Front Public Health 2023; 11:1241250. [PMID: 37693709 PMCID: PMC10485367 DOI: 10.3389/fpubh.2023.1241250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction To perform their work efficiently and safely, firefighters should maintain all aspects of physical fitness. Cardiac-related incidents are the leading cause of duty-related deaths in firefighters, and many firefighters have poor musculoskeletal health (MSH) that hinder their occupational performance (OP). Establishing the relationship between physical fitness, cardiovascular health (CVH), MSH and OP may add new insight on the most significant factors influencing OP in firefighters, specifically in the City of Cape Town Fire and Rescue Service (CoCTFS), which had not been studied before. Therefore, the purpose of this study was to investigate whether physical fitness, CVH and MSH were associated with OP in firefighters, in the COCTFRS. Methods This cross-sectional study included 283 full-time firefighters aged 20-65 years from Cape Town, South Africa. A researcher-generated questionnaire was used to collect data on sociodemographic characteristics, lifestyle factors and MSH. Physical measures were used to collect information on physical fitness, CVH, and OP [using a physical ability test (PAT)]. Linear and binary logistic regressions, adjusted for age, sex, height and weekly metabolic equivalent minutes (WMETM), multivariate analysis of covariance (MANCOVA), adjusted for age, sex, height and body mass index (BMI) and backward stepwise regressions were used to investigate the associations between the various constructs. Results From multivariable analyses, age, lean body mass, body fat percentage (BF%), estimated absolute oxygen consumption (abV̇O2max), grip strength, leg strength, push-ups, sit-ups, WMETM and heart rate variability were associated with PAT completion times (all p < 0.01). The MANCOVA showed a significant difference between performance categories of the PAT based on physical fitness and CVH (both p < 0.001). WMETM, BF%, abV̇O2max, grip strength, leg strength and sit-ups explained the highest proportion (50.5%) of the variation in PAT completion times. Conclusion Younger, non-obese, fitter and stronger firefighters, with a better CVH status, performed significantly better and were most likely to pass the PAT in firefighters, in Cape Town, South Africa. Firefighters should maintain high levels of physical fitness and a good level of CVH to ensure a satisfactory level of OP.
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Affiliation(s)
- Jaron Ras
- Department of Sport, Recreation and Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Denise L. Smith
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Andre P. Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Elpidoforos S. Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, Nicosia, Cyprus
- Environmental and Occupational Medicine and Epidemiology (EOME), Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lloyd Leach
- Department of Sport, Recreation and Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Ras J, Soteriades ES, Smith DL, Kengne AP, Leach L. Association between Cardiovascular and Musculoskeletal Health in Firefighters. J Occup Environ Med 2023; 65:e496-e505. [PMID: 37130821 PMCID: PMC10332654 DOI: 10.1097/jom.0000000000002872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The aim of the study is to determine the association between cardiovascular health (CVH) and musculoskeletal health in firefighters. METHODS This cross-sectional study involved 309 full-time firefighters aged 20 to 65 years. Cardiovascular health encompassed cardiovascular disease risk factors, risk scores, CVH metrics, and heart rate variability. Musculoskeletal health was assessed using two validated questionnaires. RESULTS Increasing age ( P = 0.004), body mass index ( P < 0.001), body fat percentage ( P < 0.001), diastolic blood pressure ( P = 0.003), total cholesterol ( P = 0.006), and Framingham risk score ( P = 0.011) increased the risk of reporting musculoskeletal injuries (MSIs). Obesity ( P = 0.018), hypertension ( P = 0.034), and dyslipidemia ( P = 0.005) increased the risk of reporting MSIs. Musculoskeletal discomfort was associated with total cholesterol ( P = 0.0.34) and low-density lipoprotein ( P = 0.014). CONCLUSIONS Adverse cardiovascular disease risk profile was associated with MSIs and musculoskeletal discomfort in firefighters. Firefighters should maintain an ideal CVH profile, especially as they age.
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Bustos D, Cardoso R, Carvalho DD, Guedes J, Vaz M, Torres Costa J, Santos Baptista J, Fernandes RJ. Exploring the Applicability of Physiological Monitoring to Manage Physical Fatigue in Firefighters. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115127. [PMID: 37299854 DOI: 10.3390/s23115127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Physical fatigue reduces productivity and quality of work while increasing the risk of injuries and accidents among safety-sensitive professionals. To prevent its adverse effects, researchers are developing automated assessment methods that, despite being highly accurate, require a comprehensive understanding of underlying mechanisms and variables' contributions to determine their real-life applicability. This work aims to evaluate the performance variations of a previously developed four-level physical fatigue model when alternating its inputs to have a comprehensive view of the impact of each physiological variable on the model's functioning. Data from heart rate, breathing rate, core temperature and personal characteristics from 24 firefighters during an incremental running protocol were used to develop the physical fatigue model based on an XGBoosted tree classifier. The model was trained 11 times with different input combinations resulting from alternating four groups of features. Performance measures from each case showed that heart rate is the most relevant signal for estimating physical fatigue. Breathing rate and core temperature enhanced the model when combined with heart rate but showed poor performance individually. Overall, this study highlights the advantage of using more than one physiological measure for improving physical fatigue modelling. The findings can contribute to variables and sensor selection in occupational applications and as the foundation for further field research.
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Affiliation(s)
- Denisse Bustos
- Associated Laboratory for Energy, Transports and Aeronautics-LAETA (PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Ricardo Cardoso
- Centre of Research, Education, Innovation and Intervention in Sport-CIFI2D, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Porto Biomechanics Laboratory, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Diogo D Carvalho
- Centre of Research, Education, Innovation and Intervention in Sport-CIFI2D, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Porto Biomechanics Laboratory, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Joana Guedes
- Associated Laboratory for Energy, Transports and Aeronautics-LAETA (PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Mário Vaz
- Associated Laboratory for Energy, Transports and Aeronautics-LAETA (PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Porto Biomechanics Laboratory, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - José Torres Costa
- Associated Laboratory for Energy, Transports and Aeronautics-LAETA (PROA), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - João Santos Baptista
- Associated Laboratory for Energy, Transports and Aeronautics-LAETA (PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Porto Biomechanics Laboratory, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Ricardo J Fernandes
- Centre of Research, Education, Innovation and Intervention in Sport-CIFI2D, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
- Porto Biomechanics Laboratory, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
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Ras J, Smith DL, Soteriades ES, Kengne AP, Leach L. Association between Physical Fitness and Cardiovascular Health in Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5930. [PMID: 37297534 PMCID: PMC10252711 DOI: 10.3390/ijerph20115930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Firefighters perform strenuous work in dangerous and unpredictable environments requiring optimal physical conditioning. The aim of this study was to investigate the association between physical fitness and cardiovascular health (CVH) in firefighters. This cross-sectional study systematically recruited 309 full-time male and female firefighters between the ages of 20 to 65 years in Cape Town, South Africa. Physical fitness was assessed using absolute (abV̇O2max) and relative oxygen consumption (relVO2max), grip and leg strength, push-ups and sit-ups, sit-and-reach for flexibility and lean body mass (LBM). CVH encompassed age, smoking, blood pressure (BP), blood glucose, lipid profile, body mass index, body fat percentage (BF%), and waist circumference. Linear regressions and logistic regressions were applied. Multivariable analysis indicated that relVO2max was associated with systolic BP (p < 0.001), diastolic BP (p < 0.001), non-fasting blood glucose (p < 0.001), and total cholesterol (p = 0.037). Poor CVH index was negatively associated with relV̇O2max (p < 0.001), leg strength (p = 0.019), and push-ups (p = 0.012). Furthermore, age was inversely associated with V̇O2max (p < 0.001), push-up and sit-up capacity (p < 0.001), and sit-and-reach (p < 0.001). BF% was negatively associated with abV̇O2max (p < 0.001), grip and leg strength (p < 0.001), push-ups (p = 0.008), sit-ups (p < 0.001), and LBM (p < 0.001). Cardiorespiratory fitness, muscular strength, and muscular endurance were significantly associated with a better overall CVH profile.
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Affiliation(s)
- Jaron Ras
- Department of Sport, Recreation and Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa;
| | - Denise L. Smith
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY 12866, USA;
| | - Elpidoforos S. Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, Nicosia 2220, Cyprus;
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA 02115, USA
| | - Andre P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa;
| | - Lloyd Leach
- Department of Sport, Recreation and Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa;
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Wang YF, Zhang Y, Lin Y, Luo Y. Comment on "Relationship between the number of comorbidities, quality of life, and cardiac autonomic modulation in patients with coronary disease: a cross-sectional study". REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:7. [PMID: 36629656 PMCID: PMC9937596 DOI: 10.1590/1806-9282.20221136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/09/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Yi-Feng Wang
- Taizhou Municipal Hospital, Department of Endocrine – Taizhou, China
| | - Yangfen Zhang
- Taizhou University, School of Medicine – Taizhou, China
| | - Yi Lin
- Taizhou University, School of Medicine – Taizhou, China
| | - Yi Luo
- Taizhou Municipal Hospital, Department of Endocrine – Taizhou, China.,Corresponding author:
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Does Wearable-Measured Heart Rate Variability During Sleep Predict Perceived Morning Mental and Physical Fitness? Appl Psychophysiol Biofeedback 2023; 48:247-257. [PMID: 36622531 DOI: 10.1007/s10484-022-09578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 01/10/2023]
Abstract
The emergence of wearable sensor technology may provide opportunities for automated measurement of psychophysiological markers of mental and physical fitness, which can be used for personalized feedback. This study explores to what extent within-subject changes in resting heart rate variability (HRV) during sleep predict the perceived mental and physical fitness of military personnel on the subsequent morning. Participants wore a Garmin wrist-worn wearable and filled in a short morning questionnaire on their perceived mental and physical fitness during a period of up to 46 days. A custom-built smartphone app was used to directly retrieve heart rate and accelerometer data from the wearable, on which open-source algorithms for sleep detection and artefact filtering were applied. A sample of 571 complete observations in 63 participants were analyzed using linear mixed models. Resting HRV during sleep was a small predictor of perceived physical fitness (marginal R2 = .031), but not of mental fitness. The items on perceived mental and physical fitness were strongly correlated (r = .77). Based on the current findings, resting HRV during sleep appears to be more related to the physical component of perceived fitness than its mental component. Recommendations for future studies include improvements in the measurement of sleep and resting HRV, as well as further investigation of the potential impact of resting HRV as a buffer on stress-related outcomes.
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Ask TF, Knox BJ, Lugo RG, Helgetun I, Sütterlin S. Neurophysiological and emotional influences on team communication and metacognitive cyber situational awareness during a cyber engineering exercise. Front Hum Neurosci 2023; 16:1092056. [PMID: 36684840 PMCID: PMC9850429 DOI: 10.3389/fnhum.2022.1092056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Cyber operations unfold at superhuman speeds where cyber defense decisions are based on human-to-human communication aiming to achieve a shared cyber situational awareness. The recently proposed Orient, Locate, Bridge (OLB) model suggests a three-phase metacognitive approach for successful communication of cyber situational awareness for good cyber defense decision-making. Successful OLB execution implies applying cognitive control to coordinate self-referential and externally directed cognitive processes. In the brain, this is dependent on the frontoparietal control network and its connectivity to the default mode network. Emotional reactions may increase default mode network activity and reduce attention allocation to analytical processes resulting in sub-optimal decision-making. Vagal tone is an indicator of activity in the dorsolateral prefrontal node of the frontoparietal control network and is associated with functional connectivity between the frontoparietal control network and the default mode network. Aim: The aim of the present study was to assess whether indicators of neural activity relevant to the processes outlined by the OLB model were related to outcomes hypothesized by the model. Methods: Cyber cadets (N = 36) enrolled in a 3-day cyber engineering exercise organized by the Norwegian Defense Cyber Academy participated in the study. Differences in prospective metacognitive judgments of cyber situational awareness, communication demands, and mood were compared between cyber cadets with high and low vagal tone. Vagal tone was measured at rest prior to the exercise. Affective states, communication demands, cyber situational awareness, and metacognitive accuracy were measured on each day of the exercise. Results: We found that cyber cadets with higher vagal tone had better metacognitive judgments of cyber situational awareness, imposed fewer communication demands on their teams, and had more neutral moods compared to cyber cadets with lower vagal tone. Conclusion: These findings provide neuroergonomic support for the OLB model and suggest that it may be useful in education and training. Future studies should assess the effect of OLB-ing as an intervention on communication and performance.
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Affiliation(s)
- Torvald F. Ask
- Department of Information Security and Communication Technology, Norwegian University of Science and Technology, Gjøvik, Norway
- Faculty for Health, Welfare and Organization, Østfold University College, Halden, Norway
| | - Benjamin J. Knox
- Department of Information Security and Communication Technology, Norwegian University of Science and Technology, Gjøvik, Norway
- Faculty for Health, Welfare and Organization, Østfold University College, Halden, Norway
- Norwegian Armed Forces Cyber Defense, Lillehammer, Norway
| | - Ricardo G. Lugo
- Department of Information Security and Communication Technology, Norwegian University of Science and Technology, Gjøvik, Norway
- Faculty for Health, Welfare and Organization, Østfold University College, Halden, Norway
| | - Ivar Helgetun
- Norwegian Defense University College, Cyber Academy, Lillehammer, Norway
| | - Stefan Sütterlin
- Faculty for Health, Welfare and Organization, Østfold University College, Halden, Norway
- Faculty of Computer Science, Albstadt-Sigmaringen University, Sigmaringen, Germany
- Centre for Digital Forensics and Cyber Security, Tallinn University of Technology, Tallinn, Estonia
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13
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Dysautonomia in Children with Post-Acute Sequelae of Coronavirus 2019 Disease and/or Vaccination. Vaccines (Basel) 2022; 10:vaccines10101686. [PMID: 36298551 PMCID: PMC9607162 DOI: 10.3390/vaccines10101686] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
Long-term health problems such as fatigue, palpitations, syncope, and dizziness are well-known in patients after COVID-19 (post-acute sequelae of coronavirus (PASC)). More recently, comparable problems have been noticed after the SARS-CoV-2 vaccination (post-VAC). The pathophysiology of these problems is not well-understood. Methods: In 38 children and young adults, we tested if these health problems were related to dysautonomia in an active standing test (Group 1: 19 patients after COVID-19; Group 2: 12 patients with a breakthrough infection despite a vaccination; and Group 3: 7 patients after a vaccination without COVID-19). The data were compared with a control group of 47 healthy age-matched patients, as recently published. Results: All patients had a normal left ventricular function as measured by echocardiography. Significantly elevated diastolic blood pressure in all patient groups indicated a regulatory cardiovascular problem. Compared with the healthy control group, the patient groups showed significantly elevated heart rates whilst lying and standing, with significantly higher heart rate increases. The stress index was significantly enhanced in all patient groups whilst lying and standing. Significantly decreased pNN20 values, mostly whilst standing, indicated a lower vagus activity in all patient groups. The respiratory rates were significantly elevated in Groups 1 and 2. Conclusion: The uniform increase in the heart rates and stress indices, together with low pNN20 values, indicated dysautonomia in children with health problems after COVID-19 disease and/or vaccination. A total of 8 patients fulfilled the criteria of postural orthostatic tachycardia syndrome and 9 patients of an inappropriate sinus tachycardia, who were successfully treated with omega-3 fatty acid supplementation and pharmacotherapy.
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Cardiovascular Disease Risk Factors, Musculoskeletal Health, Physical Fitness, and Occupational Performance in Firefighters: A Narrative Review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:7346408. [PMID: 36193397 PMCID: PMC9526561 DOI: 10.1155/2022/7346408] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022]
Abstract
Introduction Firefighting is a strenuous occupation that requires firefighters to be in peak physical condition. However, many firefighters have risk factors for cardiovascular disease, impaired musculoskeletal health, and are not physically fit for duty, which all negatively impact their occupational performance. Therefore, the aim of this review is to determine the relationship between cardiovascular disease risk factors, musculoskeletal health, physical fitness, and occupational performance in firefighters. Methods The electronic databases PubMed, SCOPUS, and Web of Science were searched online via the library portal of the University of the Western Cape. Publications and grey literature between the years 2000 to present were used. In total, 2607 articles were identified; after the removal of duplicates 1188 articles were then screened, and were excluded for not meeting initial screening criteria. The remaining 209 full-text articles were screened based on the inclusion and exclusion criteria, where 163 articles were excluded. Only studies that were quantitative were included. This left 46 articles that were then finally included in the current narrative review. Results The current literature indicated that significant relationships existed between cardiovascular risk factors, musculoskeletal health, physical fitness, and occupational performance. The results indicated firefighters who were aged, obese, physically inactive, cigarette smokers, and unfit were at the highest risk for cardiovascular and musculoskeletal health complications, and unsatisfactory occupational performance. Musculoskeletal health complications significantly affected occupational performance and work ability and were related to physical fitness of firefighters. Most cardiovascular risk factors were related to physical fitness, and all physical fitness parameters were related to occupational performance in firefighters. Conclusion The overwhelming evidence in the current review established that physical fitness is related to occupational performance. However, the relationship between cardiovascular risk factors and musculoskeletal health in relation to occupational performance is less clear and still understudied. Significant gaps remain in the literature.
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15
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Effects of Acute Stress on Psychophysiology in Armed Tactical Occupations: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031802. [PMID: 35162825 PMCID: PMC8834678 DOI: 10.3390/ijerph19031802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 01/23/2023]
Abstract
The ability to perform under extreme pressure is one of the most sought-after qualities in both sports and tactical (military, law enforcement, fire, and rescue, etc.) occupations. While tactical performance relies on both physical and mental capabilities to achieve a desired outcome, it is often hampered by the stressful environments in which these personnel work. The acute stress experienced by tactical personnel can interfere with occupational performance, impacting both physical execution of tasks and decision-making. This narrative review discusses the implications of acute stress on the psychophysiology and physical performance of personnel serving in armed tactical occupations.
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16
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Applicability of Physiological Monitoring Systems within Occupational Groups: A Systematic Review. SENSORS 2021; 21:s21217249. [PMID: 34770556 PMCID: PMC8587311 DOI: 10.3390/s21217249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022]
Abstract
The emergence of physiological monitoring technologies has produced exceptional opportunities for real-time collection and analysis of workers' physiological information. To benefit from these safety and health prognostic opportunities, research efforts have explored the applicability of these devices to control workers' wellbeing levels during occupational activities. A systematic review is proposed to summarise up-to-date progress in applying physiological monitoring systems for occupational groups. Adhering with the PRISMA Statement, five databases were searched from 2014 to 2021, and 12 keywords were combined, concluding with the selection of 38 articles. Sources of risk of bias were assessed regarding randomisation procedures, selective outcome reporting and generalisability of results. Assessment procedures involving non-invasive methods applied with health and safety-related goals were filtered. Working-age participants from homogeneous occupational groups were selected, with these groups primarily including firefighters and construction workers. Research objectives were mainly directed to assess heat stress and physiological workload demands. Heart rate related variables, thermal responses and motion tracking through accelerometry were the most common approaches. Overall, wearable sensors proved to be valid tools for assessing physiological status in working environments. Future research should focus on conducting sensor fusion assessments, engaging wearables in real-time evaluation methods and giving continuous feedback to workers and practitioners.
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17
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Summers SJ, Keegan RJ, Flood A, Martin K, McKune A, Rattray B. The Acute Readiness Monitoring Scale: Assessing Predictive and Concurrent Validation. Front Psychol 2021; 12:738519. [PMID: 34630249 PMCID: PMC8498198 DOI: 10.3389/fpsyg.2021.738519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
To complement and enhance readiness-monitoring capability, the Acute Readiness Monitoring Scale (ARMS) was developed: a widely applicable, simple psychometric measure of perceived readiness. While this tool may have widespread utility in sport and military settings, it remains unknown if the ARMS demonstrates predictive and concurrent validity. Here, we investigated whether the ARMS is: (1) responsive to an acute manipulation of readiness using sleep deprivation, (2) relates to biological markers of readiness [cortisol/heart-rate variability (HRV)], and (3) predicts performance on a cognitive task. Thirty young adults (aged 23 ± 4 years; 18 females) participated. All participants engaged in a 24-h sleep deprivation protocol. Participants completed the ARMS, biological measures of readiness (salivary cortisol, HRV), and cognitive performance measures (psychomotor vigilance task) before, immediately after, 24-, and 48-h post-sleep deprivation. All six of the ARMS subscales changed in response to sleep deprivation: scores on each subscale worsened (indicating reductions in perceived readiness) immediately after sleep deprivation, returning to baseline 24/48 h post. Lower perceived readiness was associated with reduced awakening responses in cortisol and predicted worse cognitive performance (slower reaction time). No relationship was observed between the ARMS and HRV, nor between any biological markers of readiness (cortisol/HRV) and cognitive performance. These data suggest that the ARMS may hold practical utility in detecting, or screening for, the wide range of deleterious effects caused by sleep deprivation; may constitute a quick, cheap, and easily interpreted alternative to biological measures of readiness; and may be used to monitor or mitigate potential underperformance on tasks requiring attention and vigilance.
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Affiliation(s)
- Simon J Summers
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Penrith, NSW, Australia.,Research School of Biology, Australian National University, Canberra, ACT, Australia
| | - Richard J Keegan
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Andrew Flood
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia.,Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Kristy Martin
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Andrew McKune
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia.,School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Ben Rattray
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
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18
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Stephenson MD, Thompson AG, Merrigan JJ, Stone JD, Hagen JA. Applying Heart Rate Variability to Monitor Health and Performance in Tactical Personnel: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8143. [PMID: 34360435 PMCID: PMC8346173 DOI: 10.3390/ijerph18158143] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022]
Abstract
Human performance optimization of tactical personnel requires accurate, meticulous, and effective monitoring of biological adaptations and systemic recovery. Due to an increased understanding of its importance and the commercial availability of assessment tools, the use of heart rate variability (HRV) to address this need is becoming more common in the tactical community. Measuring HRV is a non-invasive, practical method for objectively assessing a performer's readiness, workload, and recovery status; when combined with additional data sources and practitioner input, it provides an affordable and scalable solution for gaining actionable information to support the facilitation and maintenance of operational performance. This narrative review discusses the non-clinical use of HRV for assessing, monitoring, and interpreting autonomic nervous system resource availability, modulation, effectiveness, and efficiency in tactical populations. Broadly, HRV metrics represent a complex series of interactions resulting from internal and external stimuli; therefore, a general overview of HRV applications in tactical personnel is discussed, including the influence of occupational specific demands, interactions between cognitive and physical domains, and recommendations on implementing HRV for training and recovery insights into critical health and performance outcomes.
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Affiliation(s)
- Mark D. Stephenson
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26505, USA; (A.G.T.); (J.J.M.); (J.D.S.); (J.A.H.)
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