1
|
Hancock R, Yavelberg L, Gledhill S, Birot O, Gledhill N, Jamnik V. Performing one or more verification VO 2 workload(s) immediately after an incremental to maximal graded exercise test significantly increases the proportion of participants who meet the job-related aerobic fitness standard for structural firefighters. Eur J Appl Physiol 2023; 123:1929-1937. [PMID: 37185933 DOI: 10.1007/s00421-023-05204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Graded exercise tests (GXTs) are commonly used to determine the maximal oxygen consumption (VO2max) of firefighter applicants. However, the criteria used to confirm VO2max are inconsistent and have a high inter-subject variability, which can compromise the reliability of the results. To address this, a verification phase (VP) after the GXT has been proposed as a "gold standard" protocol for measuring VO2max. METHODS 4179 male and 283 female firefighter applicants completed a GXT and a VP to measure their VO2max. VO2peak values measured during the GXT were compared to the VO2 values measured during the VP. The proportion of participants who met the job-related aerobic fitness standard during the GXT was compared to that of those who met the required standard during the VP. RESULTS For male and female participants that required the VP to attain their VO2max, the VO2peak values measured during the GXT (47.3 ± 6.0 and 41.6 ± 5.3 mL kg-1 min-1) were, respectively, 10.1% and 10.3% lower than the VO2 values measured during the VP (52.1 ± 6.7 and 45.9 ± 6.4 mL kg-1 min-1), p < 0.001. Furthermore, the proportion of male and female participants who met the job-related aerobic fitness standard significantly increased from the GXT to the VP by 11.6% and 29.9%, respectively, p < 0.001. CONCLUSION These results strongly support the use of a VP to confirm VO2max, especially for females, older and overweight individuals. These findings are applicable to other physically demanding public safety occupations and when examining the efficacy of training interventions on VO2max.
Collapse
Affiliation(s)
- Ryan Hancock
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - Loren Yavelberg
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Scott Gledhill
- Cardiovascular Surgery Division, St Michael's Hospital, Toronto, ON, Canada
| | - Olivier Birot
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Norman Gledhill
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Veronica Jamnik
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| |
Collapse
|
2
|
Riddell MC, Pooni R, Yavelberg L, Li Z, Kollman C, Brown RE, Li A, Aronson R. Reproducibility in the cardiometabolic responses to high-intensity interval exercise in adults with type 1 diabetes. Diabetes Res Clin Pract 2019; 148:137-143. [PMID: 30641168 DOI: 10.1016/j.diabres.2019.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/30/2018] [Accepted: 01/04/2019] [Indexed: 12/21/2022]
Abstract
AIMS Patients with type 1 diabetes (T1D) often report a rise in their blood glucose level following brief intense exercise. We sought to determine the reproducibility of the cardiometabolic responses to high-intensity interval training (HIIT). METHODS Sixteen adults with T1D, using an optimized multiple daily injection with basal insulin glargine 300 U/mL (Gla-300), performed four fasted HIIT sessions over a 4-6-week period. Exercise consisted of high-intensity interval cycling and multimodal training over 25 min. RESULTS Heart rate and rating of perceived exertion rose similarly in all sessions, as did lactate, catecholamine and growth hormone levels. Plasma glucose increased in response to HIIT in 62 of 64 visits (97%), with an overall increase of 3.7 ± 1.6 mmol/L (Mean ± SD) (P < 0.001). In within-patient comparisons, the change in plasma glucose among the four HIIT sessions was significantly correlated with a composite correlation of 0.58 ([r2 = 0.34]; 95% CI 0.35-0.80; P < 0.01). CONCLUSIONS Intersession observations of four separate HIIT sessions showed high intrasubject reproducibility in the cardiometabolic responses to exercise, including the rise in plasma glucose, when adults with T1D perform the activity in a fasted state.
Collapse
Affiliation(s)
- Michael C Riddell
- LMC Diabetes and Endocrinology, 1929 Bayview Ave., Toronto, Ontario, Canada; School of Kinesiology and Health Science, York University, 4700 Keele St., Toronto, Ontario, Canada.
| | - Rubin Pooni
- School of Kinesiology and Health Science, York University, 4700 Keele St., Toronto, Ontario, Canada.
| | - Loren Yavelberg
- School of Kinesiology and Health Science, York University, 4700 Keele St., Toronto, Ontario, Canada.
| | - Zoey Li
- JAEB Center for Health Research, 15310 Amberly Dr., Tampa, FL, USA.
| | - Craig Kollman
- JAEB Center for Health Research, 15310 Amberly Dr., Tampa, FL, USA.
| | - Ruth E Brown
- LMC Diabetes and Endocrinology, 1929 Bayview Ave., Toronto, Ontario, Canada.
| | - Aihua Li
- LMC Diabetes and Endocrinology, 1929 Bayview Ave., Toronto, Ontario, Canada.
| | - Ronnie Aronson
- LMC Diabetes and Endocrinology, 1929 Bayview Ave., Toronto, Ontario, Canada.
| |
Collapse
|
3
|
Yavelberg L, Zaharieva D, Cinar A, Riddell MC, Jamnik V. A Pilot Study Validating Select Research-Grade and Consumer-Based Wearables Throughout a Range of Dynamic Exercise Intensities in Persons With and Without Type 1 Diabetes: A Novel Approach. J Diabetes Sci Technol 2018; 12:569-576. [PMID: 29320885 PMCID: PMC6154246 DOI: 10.1177/1932296817750401] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The increasing popularity of wearable technology necessitates the evaluation of their accuracy to differentiate physical activity (PA) intensities. These devices may play an integral role in customizing PA interventions for primary prevention and secondary management of chronic diseases. For example, in persons with type 1 diabetes (T1D), PA greatly affects glucose concentrations depending on the intensity, mode (ie, aerobic, anaerobic, mixed), and duration. This variability in glucose responses underscores the importance of implementing dependable wearable technology in emerging avenues such as artificial pancreas systems. METHODS Participants completed three 40-minute, dynamic non-steady-state exercise sessions, while outfitted with multiple research (Fitmate, Metria, Bioharness) and consumer (Garmin, Fitbit) grade wearables. The data were extracted according to the devices' maximum sensitivity (eg, breath by breath, beat to beat, or minute time stamps) and averaged into minute-by-minute data. The variables of interest, heart rate (HR), breathing frequency, and energy expenditure (EE), were compared to validated criterion measures. RESULTS Compared to deriving EE by laboratory indirect calorimetry standard, the Metria activity patch overestimates EE during light-to-moderate PA intensities (L-MI) and moderate-to-vigorous PA intensities (M-VI) (mean ± SD) (0.28 ± 1.62 kilocalories· minute-1, P < .001, 0.64 ± 1.65 kilocalories· minute-1, P < .001, respectively). The Metria underestimates EE during vigorous-to-maximal PA intensity (V-MI) (-1.78 ± 2.77 kilocalories · minute-1, P < .001). Similarly, compared to Polar HR monitor, the Bioharness underestimates HR at L-MI (-1 ± 8 bpm, P < .001) and M-VI (5 ± 11 bpm, P < .001), respectively. A significant difference in EE was observed for the Garmin device, compared to the Fitmate ( P < .001) during continuous L-MI activity. CONCLUSIONS Overall, our study demonstrates that current research-grade wearable technologies operate within a ~10% error for both HR and EE during a wide range of dynamic exercise intensities. This level of accuracy for emerging research-grade instruments is considered both clinically and practically acceptable for research-based or consumer use. In conclusion, research-grade wearable technology that uses EE kilocalories · minute-1 and HR reliably differentiates PA intensities.
Collapse
Affiliation(s)
- Loren Yavelberg
- Department of Kinesiology and Health
Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York
University, Toronto, ON, Canada
| | - Dessi Zaharieva
- Department of Kinesiology and Health
Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York
University, Toronto, ON, Canada
| | - Ali Cinar
- Department of Biomedical Engineering,
Illinois Institute of Technology, Chicago, IL, USA
| | - Michael C. Riddell
- Department of Kinesiology and Health
Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York
University, Toronto, ON, Canada
| | - Veronica Jamnik
- Department of Kinesiology and Health
Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York
University, Toronto, ON, Canada
- Veronica Jamnik, PhD, Department of
Kinesiology and Health Science, Faculty of Health, Physical Activity and Chronic
Disease Unit, York University, 4700 Keele St, Toronto, ON M3J 1P3, Canada.
| |
Collapse
|
4
|
Zaharieva D, Yavelberg L, Jamnik V, Cinar A, Turksoy K, Riddell MC. The Effects of Basal Insulin Suspension at the Start of Exercise on Blood Glucose Levels During Continuous Versus Circuit-Based Exercise in Individuals with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion. Diabetes Technol Ther 2017; 19:370-378. [PMID: 28613947 PMCID: PMC5510047 DOI: 10.1089/dia.2017.0010] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exercise causes glycemic disturbances in individuals with type 1 diabetes (T1D). Continuous moderate-intensity aerobic exercise (CON) generally lowers blood glucose (BG) levels and often leads to hypoglycemia. In comparison, circuit-based exercise (CIRC) may attenuate the drop in BG. The goal of this study is to contrast the effects of basal insulin suspension at the onset of two different forms of exercise (CON vs. CIRC). METHODS Twelve individuals (six men and six women) with T1D on insulin pump therapy were recruited for the study. All participants completed a maximal aerobic fitness test and two 40-min exercise sessions, consisting of either continuous treadmill walking or a circuit workout. Basal insulin infusion was stopped at the onset of exercise and resumed in recovery. After providing an initial reference value, volunteers were blinded to their [BG] and were asked to estimate their levels during exercise. RESULTS Oxygen consumption (47.5 ± 7.5 vs. 54.5 ± 13.5 mL·kg-1·min-1, P = 0.03) and heart rate (122 ± 20 vs. 144 ± 20 bpm, P = 0.003) were lower in CON vs. CIRC. Despite the lower workload, BG levels dropped more with CON vs. CIRC (delta BG = -3.8 ± 1.5 vs. -0.5 ± 3.0 mmol/L for CON vs. CIRC, respectively, P = 0.001). Participants were able to estimate their BG more accurately during CON (r = 0.83) vs. CIRC (r = 0.33) based on a regression analysis. CONCLUSION Despite a lower intensity of exercise, with full basal insulin suspension at the start of exercise, CON results in a larger drop in BG vs. CIRC. These findings have implications for single hormone-based artificial pancreas development for exercise. While this study does not negate the importance of frequent capillary BG monitoring during exercise, it does suggest that if persons are knowledgeable about their pre-exercise BG levels, they can accurately perceive the changes in BG during CON, but not during CIRC.
Collapse
Affiliation(s)
- Dessi Zaharieva
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
| | - Loren Yavelberg
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
| | - Veronica Jamnik
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
| | - Ali Cinar
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
- Chemical and Biological Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Kamuran Turksoy
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Michael C. Riddell
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
- LMC Diabetes & Endocrinology, Toronto, Canada
| |
Collapse
|
5
|
Turksoy K, Paulino TML, Zaharieva DP, Yavelberg L, Jamnik V, Riddell MC, Cinar A. Classification of Physical Activity: Information to Artificial Pancreas Control Systems in Real Time. J Diabetes Sci Technol 2015; 9:1200-7. [PMID: 26443291 PMCID: PMC4667299 DOI: 10.1177/1932296815609369] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physical activity has a wide range of effects on glucose concentrations in type 1 diabetes (T1D) depending on the type (ie, aerobic, anaerobic, mixed) and duration of activity performed. This variability in glucose responses to physical activity makes the development of artificial pancreas (AP) systems challenging. Automatic detection of exercise type and intensity, and its classification as aerobic or anaerobic would provide valuable information to AP control algorithms. This can be achieved by using a multivariable AP approach where biometric variables are measured and reported to the AP at high frequency. We developed a classification system that identifies, in real time, the exercise intensity and its reliance on aerobic or anaerobic metabolism and tested this approach using clinical data collected from 5 persons with T1D and 3 individuals without T1D in a controlled laboratory setting using a variety of common types of physical activity. The classifier had an average sensitivity of 98.7% for physiological data collected over a range of exercise modalities and intensities in these subjects. The classifier will be added as a new module to the integrated multivariable adaptive AP system to enable the detection of aerobic and anaerobic exercise for enhancing the accuracy of insulin infusion strategies during and after exercise.
Collapse
Affiliation(s)
- Kamuran Turksoy
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | | | - Dessi P Zaharieva
- School of Kinesiology and Health Science & Muscle Health Research Center, York University, Toronto, Ontario, Canada
| | - Loren Yavelberg
- School of Kinesiology and Health Science & Muscle Health Research Center, York University, Toronto, Ontario, Canada
| | - Veronica Jamnik
- School of Kinesiology and Health Science & Muscle Health Research Center, York University, Toronto, Ontario, Canada
| | - Michael C Riddell
- School of Kinesiology and Health Science & Muscle Health Research Center, York University, Toronto, Ontario, Canada
| | - Ali Cinar
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA Department of Chemical and Biological Engineering, Illinois Institute of Technology, Chicago, IL, USA
| |
Collapse
|
6
|
Abstract
Regular physical activity (PA) promotes numerous health benefits for people living with type 1 diabetes (T1D). However, PA also complicates blood glucose control. Factors affecting blood glucose fluctuations during PA include activity type, intensity and duration as well as the amount of insulin and food in the body at the time of the activity. To maintain equilibrium with blood glucose concentrations during PA, the rate of glucose appearance (Ra) to disappearance (Rd) in the bloodstream must be balanced. In nondiabetics, there is a rise in glucagon and a reduction in insulin release at the onset of mild to moderate aerobic PA. During intense aerobic -anaerobic work, insulin release first decreases and then rises rapidly in early recovery to offset a more dramatic increase in counterregulatory hormones and metabolites. An "exercise smart" artificial pancreas (AP) must be capable of sensing glucose and perhaps other physiological responses to various types and intensities of PA. The emergence of this new technology may benefit active persons with T1D who are prone to hypo and hyperglycemia.
Collapse
Affiliation(s)
- Michael C Riddell
- School of Kinesiology and Health Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Dessi P Zaharieva
- School of Kinesiology and Health Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Loren Yavelberg
- School of Kinesiology and Health Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Ali Cinar
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA Department of Chemical and Biological Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Veronica K Jamnik
- School of Kinesiology and Health Science, Faculty of Health, Physical Activity and Chronic Disease Unit, York University, Toronto, Ontario, Canada
| |
Collapse
|