Assessing the impact of a comprehensive mental health program on frontline health service workers

Mental health issues are a growing concern in the workplace, linked to negative outcomes including reduced productivity, increased absenteeism, and increased turnover. Employer-sponsored mental health benefits that are accessible and proactive may help address these concerns. The aim of this retrospective cohort study was to evaluate the impact of a digital mental health benefit (Spring Health) on frontline healthcare service workers' clinical and workplace outcomes. The benefit was sponsored by a national health services company from 2021-2022 and included mental health screening, care navigation, psychotherapy and/or medication management. We hypothesized program use would be associated with improvements in depression and anxiety symptoms, and increased productivity and retention. Participants were employees enrolled in the benefit program, had at least moderate anxiety or depression, at least 1 treatment appointment, and at least 2 outcome assessments. Clinical improvement measures were PHQ-9 scale (range, 0-27) for depression and GAD-7 scale (range, 0-21) for anxiety; workplace measures were employee retention and the Sheehan Disability Scale (SDS) for functional impairment. A total of 686 participants were included. Participants using the mental health benefit had a 5.60 point (95% CI, 4.40-6.79, d = 1.28) reduction in depression and a 5.48 point (95% CI, 3.88-7.08, d = 1.64) reduction in anxiety across 6 months. 69.9% (95% CI, 61.8%-78.1%) of participants reliably improved (≥5 point change) and 84.1% (95% CI, 78.2%-90.1%) achieved reliable improvement or recovery (<10 points). Participants reported 0.70 (95% CI, 0.26-1.14) fewer workdays per week impacted by mental health issues, corresponding to $3,491 (95% CI, $1305-$5677) salary savings at approximately federal median wage ($50,000). Furthermore, employees using the benefit were retained at 1.58 (95% CI, 1.4-1.76) times the rate of those who did not. Overall, this evaluation suggests that accessible, proactive, and comprehensive mental health benefits for frontline health services workers can lead to positive clinical and workplace outcomes.

Cardiometabolic Risk Increased in Working-Aged Adults During the COVID-19 Pandemic

Background: Public health measures necessary to mitigate the spread of coronavirus disease 2019 (COVID-19) impacted lifestyles and health practices. This multiyear cohort analysis of U.S. working-aged adults aims to evaluate the impact of the COVID-19 pandemic on metabolic syndrome and explores contributing factors. Methods: This longitudinal study (n = 19,543) evaluated year-to-year changes in metabolic syndrome and cardiometabolic risk factors through employer-sponsored annual health assessment before and during the COVID-19 pandemic using logistic mixed-effects model. Results: From prepandemic to pandemic (2019 to 2020), prevalence of metabolic syndrome increased by 3.5% for men and 3.0% for women, across all ethnic groups. This change was mainly driven by increased fasting glucose (7.3%) and blood pressure (5.2%). The increased risk of metabolic syndrome was more likely to occur in individuals with an elevated body mass index (BMI) combined with insufficient sleep or physical activity. Conclusions: Cardiometabolic risk increased during the COVID-19 pandemic compared with before the pandemic in a working-aged adult population, more so for those with a high BMI, unhealthy sleep, and low physical activity practices. Given this observation, identification of risk and intervention (including lifestyle and medical) is increasingly necessary to reduce the cardiovascular and metabolic risk, and improve working-aged population health.

Prediction of Future Medical Costs by Modifiable Measures of Health

Introduction

Strategies to mitigate rising health-care costs are a priority for patients, employers, and health insurers. Yet gaps currently exist in whether health risk assessment can forecast medical claims costs. This study examined the ability of a health quotient (HQ) based on modifiable risk factors, age, sex, and chronic conditions to predict future medical claims spending.

Methods

The study included 18,695 employees and adult dependents who participated in health assessments and were enrolled in an employer-sponsored health plan. Linear mixed effect models stratified by chronic conditions and adjusted for age and sex were utilized to evaluate the relationship between the health quotient (score of 0-100) and future medical claims spending.

Results

Lower baseline health quotient was associated with higher medical claims cost over 2 years of follow up. For participants with chronic condition(s), costs were $3628 higher for those with a low health quotient (<73; N = 2673) compared to those with high health quotient (>85; N = 1045), after adjustment for age and sex (P value = 0.004). Each one-unit increase in health quotient was associated with a decrease of $154 (95% CI: 87.4, 220.3) in average yearly medical claims costs during follow up.

Discussion

This study used a large employee population with 2 years of follow-up data, which provides insights that are applicable to other large employers. Results of this analysis contribute to our ability to predict health-care costs using modifiable aspects of health, objective laboratory testing and chronic condition status.

Facilitating Mental Health Treatment Through Proactive Screening and Concierge Services in the Workplace

OBJECTIVE

The aim of this study is to determine if a proactive employer-sponsored mental health program closed gaps in detection and treatment of mental health conditions.

METHODS

Of n = 56,442 eligible, n = 8170 (14.5%) participated in the optional screening. Participants with mental health risk were offered care concierge services including support, care planning, and connection to care. Difference in behavioral health care utilization, diagnoses, and prescriptions were evaluated postintervention through claims analysis.

RESULTS

Compared with controls (n = 2433), those receiving concierge services (n = 369) were more likely to fill mental health prescriptions (adjusted hazards ratio [HR], 1.2; 1.0-1.5; P = 0.042), use professional mental health services (adjusted HR, 1.4; 1.1-1.8; P = 0.02), and use new mental health services (adjusted HR, 1.9; 1.2-2.8; P = 0.004) in the following 6 months.

CONCLUSIONS

This proactive mental health program with care concierge services identified risk, connected individuals to mental health care, and facilitated mental health treatment, among program participants.

Early Insights From a Pharmacogenomic-Enriched Comprehensive Medication Management Program Implementation in an Adult Employee Population

OBJECTIVES

The aims of the study are to assess adoption of a pharmacogenomic-enriched comprehensive medication management program in a self-insured employer setting and to better understand medication risks that affect employees.

METHODS

Employees were identified to be at high risk of medication mismanagement and were subsequently provided with a program and process to improve their health. DNA testing, a clinical decision support system, and pharmacists were used to identify medication safety and effectiveness issues and to recommend appropriate changes.

RESULTS

A total of 10.6% of the invited employees enrolled in the program. Actionable recommendations were suggested by pharmacists for 85.8% of employees who completed the program, averaging 5.2 recommendations per person.

CONCLUSIONS

Implementation of a PGx + CMM program in a self-insured employer setting is feasible, detects risks in prescription regimens, and offers opportunities to improve medication management and reduce the burden of healthcare expenses.

Role of Pharmacogenomics in Comprehensive Medication Management: Considerations for Employers

Rising prescription costs, poor medication adherence, and safety issues pose persistent challenges to employer-sponsored health care plans and their beneficiaries. Comprehensive medication management (CMM), a patient-centered approach to medication optimization, enriched by pharmacogenomics (PGx), has been shown to improve the efficacy and safety of pharmaceutical regimens. This has contributed to improved health care outcomes, reduced costs of treatments, better adherence, shorter durations of treatment, and fewer adverse effects from drug therapy. Despite compelling clinical and economic evidence to justify the application of CMM guided by PGx, implementation in clinical settings remains sparse; notable barriers include limited physician adoption and health insurance coverage. Ultimately, these challenges may be overcome through comprehensive programs that include clinical decision support systems and education through employer-sponsored population health management channels to the benefit of the employees, employers, health care providers, and health care systems. This article discusses benefits, considerations, and barriers of scalable PGx-enriched CMM programs in the context of self-insured employers.

Workplace Outreach Program Improves Management of Chronic Kidney Disease

OBJECTIVE

Assess whether an employee outreach program improved management of chronic kidney disease (CKD).

METHODS

Participants with suspected CKD (eGFR <60 mL/min/1.73m 2 ) identified in employee health assessments in 2017 and 2018 were contacted by phone and offered physician consultation. Subsequent nephrologist visits at 11 months of follow up were compared between those who were (outreach group) and were not (control group) successfully contacted.

RESULTS

Most CKD risk factors at baseline were similar in outreach and control groups. At the end of the follow-up, outreach participants had more than 2-fold greater incidence of visiting a nephrologist compared with controls (HR = 2.3; 95% CI 1.2-4.2, P = 0.01), after adjusting for potential confounders. Conclusions: Employee outreach program increased utilization of nephrologist care.

Radiotherapy before or during androgen-deprivation therapy does not blunt the exercise-induced body composition protective effects in prostate cancer patients: A secondary analysis of two randomized controlled trials

BACKGROUND

Androgen deprivation therapy (ADT) contributes to lean mass loss and adiposity increases in prostate cancer patients. Radiotherapy during ADT might act synergistically and further worsen body composition. Previous investigations have shown that resistance training is an effective method of preserving body composition during ADT, however, most have not accounted for direct or indirect effects of other therapies, such as radiotherapy. Therefore, the purpose of this study was to examine training adaptations of the tissue composition in patients receiving radiation therapy (RT) prior or during ADT.

METHODS

Analyses were performed by combining data from two previous trials for a total of 131 prostate cancer patients who underwent a combination of resistance and aerobic exercise training (N = 70, age: 68.9 ± 6.6y, RT-before: 13%, RT-during: 14%) or usual care (N = 61, age: 67.5 ± 7.9y, RT-before: 16%, RT-during: 20%) for 3 months upon ADT onset. Whole-body lean mass (LM), fat percentage and appendicular LM were determined by dual energy x-ray absorptiometry, and lower-leg muscle area and density by peripheral computed tomography at baseline (onset of ADT) and at 3 months post-intervention. Covariates included RT prior and during the intervention, demographic characteristics, physical symptoms, and chronic conditions.

RESULTS

Radiotherapy before or during the intervention did not affect body composition. Only the usual care group experienced a significant decrease in whole-body LM (-994 ± 150 g, P < 0.001) and appendicular LM (-126 ± 19 g, P < 0.001), and an increase in whole-body fat percentage (1% ± 0.1%, P < 0.001). There was no change in lower-leg muscle area or density in either group.

CONCLUSION

We suggest that radiation prior to and during ADT does not interfere with the beneficial effects of exercise training on body composition in men with prostate cancer.

Workplace Mental Health: Application of a Population Health Approach of Proactive Screening to Identify Risk and Engage in Care

OBJECTIVE

To evaluate a proactive, voluntary screening program designed to identify employees with emerging mental health risk and engage them in care.

METHODS

Risk was proactively identified through online screening of 344 participants. At-risk participants were offered a mental health care concierge to provide support, develop a care plan, and connect to care.

RESULTS

Risk for common mental health conditions was identified in 244 (71%) participants, of whom 66 (27%) connected with a care concierge. Compared with participants who did not connect to a care concierge, those who did were more likely to report a financial crisis (68.2% vs 50.8%) and less likely to report verbal abuse (9.1% vs 19.6%) and difficulty meeting daily needs (12.1% vs 25.1%).

CONCLUSION

Implementation of this screening program identified employees at risk for mental health conditions and facilitated connection to care.

Return to Work: Managing Employee Population Health During the COVID-19 Pandemic

Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has abruptly transformed the outlook of employer health benefits plans for 2020 and 2021. Containing the spread of the virus and facilitating care of those infected have quickly emerged as immediate priorities. Employers have adjusted health benefits coverage to make COVID-19 testing and treatment accessible and remove barriers to care in order to facilitate the containment of the disease. Employers also are introducing strategies focused on testing, surveillance, workplace modifications, and hygiene to keep workforces healthy and workplaces safe. This paper is intended to provide evidence-based perspectives for self-insured employers for managing population health during the COVID-19 pandemic. Such considerations include (1) return to work practices focused on mitigating the spread of COVID-19 through safety practices, testing and surveillance; and (2) anticipating the impact of COVID-19 on health benefits and costs (including adaptations in delivery of care, social and behavioral health needs, and managing interrupted care for chronic conditions).

Model for Mitigation of Workplace Transmission of COVID-19 Through Population-Based Testing and Surveillance

The coronavirus disease-2019 (COVID-19) pandemic is having a widespread impact on societies across the globe. As part of the effort to control transmission in the United States, many businesses either closed or instituted nonpharmaceutical control measures and allowed only essential workers on-site. During summer and fall of 2020, employers began formulating "return to work" strategies designed to mitigate the risk of transmission among employees. On a population level, several countries implemented national testing and surveillance strategies that proved effective in mitigating citizen-to-citizen transmission and contributed to suppressing COVID-19. A crucial component of many such strategies is population-based testing to identify and engage individuals with asymptomatic or presymptomatic infection, which also is relevant to return-to-work strategies. The authors describe an approach that multisite employers might use to help mitigate transmission of COVID-19 in the workplace. This approach leverages a bioinformatics platform informed by real-time PCR test data at the county and subcounty (eg, Public Use Microdata Area) level, allowing for population-based testing to be selectively targeted for employees in geographies with elevated SARS-CoV-2 positivity. A "Command Center" application integrates data from multiple sources (eg, local infection trends, employee symptom diaries, Bluetooth thermometers) in real time, which can be used to inform decisions regarding surveillance and employee self-isolation or quarantine; a mobile phone-based application provides for rapid, secure communication with employees. This overview is based on peer-reviewed literature and the early experience of a large employer with implementing bioinformatics tools to mitigate the impact of the pandemic on the workplace.

1010 Individuals with Metabolic Syndrome and Unrecognized Sleep Apnea Can Be Identified by an Employer-Sponsored Healthcare Program and At-Home Sleep Study

Introduction

Obstructive sleep apnea (OSA) is common in individuals with metabolic syndrome (MetS) and increases risk of cardiovascular (CVD) events. Once recognized, therapeutic interventions can reduce OSA severity and associated CVD risk. Of the 25 million Americans with OSA, 80% are unaware of their disease. To facilitate and improve diagnosis of OSA, diagnostic devices for at-home OSA testing have been developed in clinical studies and approved by FDA. We evaluated an employer-sponsored healthcare outreach program and at-home OSA testing as a means of identifying individuals likely to have OSA and referring them into care.

Methods

Nine-hundred individuals with MetS, positive OSA Berlin questionnaire score and no prior diagnosis of OSA, as determined by annual workplace screening and health claims, were invited to participate in the sleep program. Those who agreed to participate (9.9%) received a diagnostic device for at-home OSA testing. Apnea-hypoapnea index (AHI) results recorded on returned diagnostic devices were evaluated by a sleep specialist. A telephone consultation with a program physician then provided each participant with an explanation of test results and referral into care. Based on AHI we identified individuals with moderate (AHI 16-30) to severe (AHI &gt;30) OSA and referred them to care.

Results

Of the 89 participating individuals, 21% had 3 MetS components, 53% had 4 components, and 20% had 5 components; 30% were diabetic; 83% had hypertension; and &gt;50% were obese. Moderate to severe OSA was diagnosed in 52 (58%) of participants. Of those, 50% had moderate OSA and 50%, had severe OSA. Among individuals with moderate to severe OSA, 29 (56%) had a physician consultation and were referred to treatment.

Conclusion

A personalized employer-sponsored healthcare outreach program identified individuals with unrecognized OSA and referred them into care.

Support

 

Monitoring Blood Biomarkers and Training Load Throughout a Collegiate Soccer Season

Huggins, RA, Fortunati, AR, Curtis, RM, Looney, DP, West, CA, Lee, EC, Fragala, MS, Hall, ML, and Casa, DJ. Monitoring blood biomarkers and training load throughout a collegiate soccer season. J Strength Cond Res 33(11): 3065-3077, 2019-This observational study aimed to characterize the responses of a comprehensive panel of biomarkers, observed ranges, training load (TL) metrics, and performance throughout the collegiate soccer season (August-November). Biomarkers (n = 92) were collected before the start of pre-season (PS), in-season weeks (W)1, W4, W8, and W12 in NCAA Division I male soccer players (n = 20, mean ± SD; age = 21 ± 1 years, height = 180 ± 6 cm, body mass = 78.19 ± 6.3 kg, body fat = 12.0 ± 2.6%, VO2max 51.5 ± 5.1 ml·kg·min). Fitness tests were measured at PS, and W12 and TL was monitored daily. Changes in biomarkers and performance were calculated via separate repeated-measures analysis of variance. Despite similar fitness (p > 0.05), endocrine, muscle, inflammatory, and immune markers changed over time (p < 0.05). Total and free testosterone was lower in W1 vs. PS, whereas free cortisol remained unchanged at PS, W1, and W4 (>0.94 mg·dL). Oxygen transport and iron metabolism markers remained unchanged except for HCT (W1 vs. PS) and total iron binding capacity (W8-W12 vs. W1). Hepatic markers albumin, globulin, albumin:globulin, and total protein levels were elevated (p < 0.05) at W12 vs. W1, whereas aspartate aminotransferase and alanine aminotransferase levels were elevated at W1-W12 and W8-W12 vs. PS, respectively. Vitamin E, zinc, selenium, and calcium levels were elevated (p < 0.05) at W12 vs. W1, whereas Vitamin D was decreased (p < 0.05). Fatty acids and cardiovascular markers (omega-3 index, cholesterol:high-density lipoprotein [HDL], docosahexenoic acid, low-density lipoprotein [LDL], direct LDL, non-HDL, ApoB) were reduced at W1 vs. PS (p ≤ 0.05). Immune, lipid, and muscle damage biomarkers were frequently outside clinical reference ranges. Routine biomarker monitoring revealed subclinical and clinical changes, suggesting soccer-specific reference ranges. Biomarker monitoring may augment positive adaptation and reduce injuries from stressors incurred during soccer.

Growth Hormone(s), Testosterone, Insulin-Like Growth Factors, and Cortisol: Roles and Integration for Cellular Development and Growth With Exercise

Hormones are largely responsible for the integrated communication of several physiological systems responsible for modulating cellular growth and development. Although the specific hormonal influence must be considered within the context of the entire endocrine system and its relationship with other physiological systems, three key hormones are considered the "anabolic giants" in cellular growth and repair: testosterone, the growth hormone superfamily, and the insulin-like growth factor (IGF) superfamily. In addition to these anabolic hormones, glucocorticoids, mainly cortisol must also be considered because of their profound opposing influence on human skeletal muscle anabolism in many instances. This review presents emerging research on: (1) Testosterone signaling pathways, responses, and adaptations to resistance training; (2) Growth hormone: presents new complexity with exercise stress; (3) Current perspectives on IGF-I and physiological adaptations and complexity these hormones as related to training; and (4) Glucocorticoid roles in integrated communication for anabolic/catabolic signaling. Specifically, the review describes (1) Testosterone as the primary anabolic hormone, with an anabolic influence largely dictated primarily by genomic and possible non-genomic signaling, satellite cell activation, interaction with other anabolic signaling pathways, upregulation or downregulation of the androgen receptor, and potential roles in co-activators and transcriptional activity; (2) Differential influences of growth hormones depending on the "type" of the hormone being assayed and the magnitude of the physiological stress; (3) The exquisite regulation of IGF-1 by a family of binding proteins (IGFBPs 1-6), which can either stimulate or inhibit biological action depending on binding; and (4) Circadian patterning and newly discovered variants of glucocorticoid isoforms largely dictating glucocorticoid sensitivity and catabolic, muscle sparing, or pathological influence. The downstream integrated anabolic and catabolic mechanisms of these hormones not only affect the ability of skeletal muscle to generate force; they also have implications for pharmaceutical treatments, aging, and prevalent chronic conditions such as metabolic syndrome, insulin resistance, and hypertension. Thus, advances in our understanding of hormones that impact anabolic: catabolic processes have relevance for athletes and the general population, alike.

Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association

Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.

Population health screenings for the prevention of chronic disease progression

OBJECTIVES

Early detection of disease enables prompt treatment that can prevent disease progression and costly health outcomes. We report incidence of previously unrecognized disease and investigate the expected effect of early detection and care on health outcomes.

STUDY DESIGN

Population health study based on laboratory evidence.

METHODS

Laboratory evidence of prediabetes, diabetes, chronic kidney disease, and colorectal cancer was evaluated in an employee and spouse population (65% women; mean [SD] age = 46 [12] years). Expected disease progression was assessed.

RESULTS

Annual screening found laboratory evidence for 1185 previously unrecognized cases of prediabetes, 287 cases of diabetes, 73 cases of chronic kidney disease, and 669 positive colorectal screens per 10,000 people.

CONCLUSIONS

Early identification and appropriate medical care may delay 34 cases of end-stage kidney disease and prevent diabetes-related complications, 210 cases of diabetes, and 3 cases of late-stage colorectal cancer over 5 years per 1000 cases identified.

Abstract 3315: Workplace program that offers annual fecal immunochemical testing improves adherence to colorectal cancer screening guidelines

Background: Although regular screening reduces the incidence and mortality of colorectal cancer, ~ 35% of eligible adults remain non-adherent to screening guidelines. We asked if a workplace screening program, using a non-invasive fecal immunochemical test (Insure FIT), would improve adherence to guidelines.

Methods: An employer-sponsored program provided eligible employees (age 50-75 years) the opportunity to participate in colorectal cancer screening. InSure FIT collection kits were mailed annually to: (i) newly eligible employees, (ii) new hires, (iii) those who had participated the previous year and (iv) those who requested testing. Employees returned kits by mail for quantitative detection of human hemoglobin in fecal samples. Those with positive test results were contacted by phone and mail with a recommendation to contact their physician for follow up diagnostic testing. Using a limited data set of health plan claims, we identified those employees, with continuous medical coverage over the 5-year study period (2013-2017), who were adherent to current screening guidelines (colonoscopy any year or FIT every year). Colonoscopy procedures were identified in professional services and outpatient event files using current procedural terminology (CPT) codes.

Results: Approximately a third (32.7%; 1,858/5,686) of eligible employees participated in the program. Some 42.7% (794/1,858) of participants underwent colonoscopy over the 5-year study period. An additional 15.9% (296/1,858) were tested with InSure FIT all 5 years. In total 58.7% (1,090/1,858) of participants were adherent to guidelines (colonoscopy any year or annual FIT). In comparison, only 34.6% (1,323/3,828) of non-participants were adherent to guidelines.

ParticipantsNon-ParticipantsTotal1,8583,828Mean age, y (SD)55.9 (4.2)55.7 (4.3)Female, n (%)1,314 (70.7%)2,470 (64.5%)Adherent to screening guidelines, n (%)1,090 (58.7%)1,323 (34.6%)

Conclusion: Participants in an employer-sponsored FIT program had 24% higher adherence to guidelines for colorectal cancer screening compared to non-participants.

Citation Format: Carmen H. Tong, Anita Satish, Maren S. Fragala, Lance A. Bare, Charles E. Birse. Workplace program that offers annual fecal immunochemical testing improves adherence to colorectal cancer screening guidelines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3315.

Self-Insured Employer Health Benefits Strategy Established a Negative Cost Trend While Improving Performance

This case study describes the collaboration between a self-insured employee benefits team and a national health insurance provider to control costs while maintaining program quality and promoting population health. In 2015, Quest Diagnostics well exceeded the full-year expense target for their ∼60,000-life Group Health Insurance (GHI) program. Through proactive changes, physician executive leadership, health plan collaboration, disease-specific population health initiatives, and plan design, Quest GHI annual employer health care cost trend subsequently improved from a year-over-year trend of 5.7% for 2014 to 2015, to 4.6% for 2015 to 2016, to −1.0% for 2016 to 2017, and most recently, 0.3% for 2017 to 2018. The actuarial value of the GHI plan did not decline, and employee cost share also remained unchanged in 2017 and 2018 versus 2016 for the high-performance network option. There was a 3% premium increase for the Preferred Provider Organization option in 2018. A third-party analysis for full year 2017 showed Quest GHI to be 11% more efficient than the mean GHI for programs with a comparable benefit and employee contribution. Early results in 2018 show improvements in the health status of the health plan membership. This article describes an approach for self-insured employers to proactively collaborate with a health plan and pharmacy benefits manager to practice the Triple Aim of improving the patient health care experience and population health while reducing per capita health care spending.

Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes

Lee, EC, Fragala, MS, Kavouras, SA, Queen, RM, Pryor, JL, and Casa, DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes. J Strength Cond Res 31(10): 2920–2937, 2017—Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk.

Bioactive growth hormone in older men and women: It's relationship to immune markers and healthspan

OBJECTIVE

The consequences of age-related decline in the somatotropic axis of humans are complex and remain largely unresolved. We tested the hypothesis that hGH measurements of plasma by bioassay vs immunoassay from samples obtained from free-living, elderly individuals would reveal a dichotomy in GH activities that are correlated with the functional status of the donors, i.e. their healthspan.

DESIGN

Forty-one men and women of advanced age (men: N=16, age, 80.5±6.5years; height, 173.1±6.9cm; body mass, 81.8±13.0kg) and (women: N=25, age, 80.7±7.2years; height, 157.7±6.0cm; body mass, 68.8±17kg), were recruited for a cross-sectional study. Participants filled out PROMIS (Patient-Reported Outcomes Measurement Information System, U. S. Department of Health and Human Services) scales, undertook physical performance tests and had fasted blood samples obtained at rest for measurement of hormonal and immunology biomarkers.

RESULTS

When measured by the well-established rat tibial line GH bioassay, one half of the plasma samples (n=20) contained bioassayable GH (bGH), but the other half (n=21) failed to mount increases in tibial plate width above saline injected controls. This difference did not correlate with the age, sex or physical functionality of the plasma donor. It also did not correlate with hGH concentrations measured by immunoassay. In those cases in which bGH was detected, various hierarchical regression models predicted that GHRH, c-peptide, VEGF, NPY, IL-4 and T-regulatory lymphocytes were associated with the difference and predicted bGH.

CONCLUSION

Results from this study suggest that the actions of bGH at the cellular level may be modified by other factors and that this may explain the lack of correlations observed in this study.

The effects of different exercise training modalities on plasma proenkephalin Peptide F in women

Due to the important interactions of proenkephalin fragments (e.g., proenkephalin [107-140] Peptide F) to enhance activation of immune cells and potentially combat pain associated with exercise-induced muscle tissue damage, we examined the differential plasma responses of Peptide F to different exercise training programs. Participants were tested pre-training (T1), and after 8 weeks (T2) of training. Fifty-nine healthy women were matched and then randomly assigned to one of four groups: heavy resistance strength training (STR, n=18), high intensity endurance training (END, n=14), combined strength and endurance training (CMB, n=17), or control (CON, n=10). Blood was collected using a cannula inserted into a superficial vein in the antecubital fossa with samples collected at rest and immediately after an acute bout of 6 X 10 RM in a squat resistance exercise before training and after training. Prior to any training, no significant differences were observed for any of the groups before or after acute exercise. With training, significant (P≤0.95) elevations were observed with acute exercise in each of the exercise training groups and this effect was significantly greater in the CMB group. These data indicate that in untrained women exercise training will not change resting of plasma Peptide F concentrations unless both forms of exercise are performed but will result in significant increases in the immediate post-exercise responses. Such findings appear to indicate adrenal medullary adaptations opioid production significantly altered with exercise training.

The Need for Standardized Assessment of Muscle Quality in Skeletal Muscle Function Deficit and Other Aging-Related Muscle Dysfunctions: A Symposium Report

A growing body of scientific literature suggests that not only changes in skeletal muscle mass, but also other factors underpinning muscle quality, play a role in the decline in skeletal muscle function and impaired mobility associated with aging. A symposium on muscle quality and the need for standardized assessment was held on April 28, 2016 at the International Conference on Frailty and Sarcopenia Research in Philadelphia, Pennsylvania. The purpose of this symposium was to provide a venue for basic science and clinical researchers and expert clinicians to discuss muscle quality in the context of skeletal muscle function deficit and other aging-related muscle dysfunctions. The present article provides an expanded introduction concerning the emerging definitions of muscle quality and a potential framework for scientific inquiry within the field. Changes in muscle tissue composition, based on excessive levels of inter- and intra-muscular adipose tissue and intramyocellular lipids, have been found to adversely impact metabolism and peak force generation. However, methods to easily and rapidly assess muscle tissue composition in multiple clinical settings and with minimal patient burden are needed. Diagnostic ultrasound and other assessment methods continue to be developed for characterizing muscle pathology, and enhanced sonography using sensors to provide user feedback and improve reliability is currently the subject of ongoing investigation and development. In addition, measures of relative muscle force such as specific force or grip strength adjusted for body size have been proposed as methods to assess changes in muscle quality. Furthermore, performance-based assessments of muscle power via timed tests of function and body size estimates, are associated with lower extremity muscle strength may be responsive to age-related changes in muscle quality. Future aims include reaching consensus on the definition and standardized assessments of muscle quality, and providing recommendations to address critical clinical and technology research gaps within the field.

Short-Term Unilateral Resistance Training Results in Cross Education of Strength Without Changes in Muscle Size, Activation, or Endocrine Response

Short-term unilateral resistance training results in cross education of strength without changes in muscle size, activation, or endocrine response. J Strength Cond Res 30(5): 1213-1223, 2016-The purpose of this study was to assess the cross education of strength and changes in the underlying mechanisms (muscle size, activation, and hormonal response) after a 4-week unilateral resistance training (URT) program. A group of 9 untrained men completed a 4-week URT program on the dominant leg (DOM), whereas cross education was measured in the nondominant leg (NON); and were compared with a control group (n = 8, CON). Unilateral isometric force (PKF), leg press (LP) and leg extension (LE) strength, muscle size (by ultrasonography) and activation (by electromyography) of the rectus femoris and vastus lateralis, and the hormonal response (testosterone, growth hormone, insulin, and insulin-like growth factor-1) were tested pretraining and posttraining. Group × time interactions were present for PKF, LP, LE, and muscle size in DOM and for LP in NON. In all interactions, the URT group improved significantly better than CON. There was a significant acute hormonal response to URT, but no chronic adaptation after the 4-week training program. Four weeks of URT resulted in an increase in strength and size of the trained musculature, and cross education of strength in the untrained musculature, which may occur without detectable changes in muscle size, activation, or the acute hormonal response.

A Microbiopsy Method for Immunohistological and Morphological Analysis: A Pilot Study

INTRODUCTION

The fine aspiration microbiopsy is a relatively new biopsy technique, which allows muscle physiologists to sample skeletal muscle less invasively. However, the small sample size obtained is often deemed insufficient for certain analyses. The aim of the current study was to develop procedures for muscle fiber morphology and immunohistological analysis from a microbiopsy technique.

METHODS

Microbiopsies of the vastus lateralis were taken with a 14-gauge microbiopsy needle from four healthy men on two separate occasions. The tissue was oriented in a cryomold, embedded in Tissue-Tek® then frozen in liquid nitrogen cooled isopentane. The muscle sections were stained with hematoxylin and eosin, laminin, MHCI, MHCIIa, and Pax7 for fiber number, mean fiber area, muscle fiber typing, and satellite cell observation.

RESULTS

The mean ± SD (range) microbiopsy sample weight was 18.3 ± 2.9 mg (14-22 mg). The mean fiber number within the microbiopsy specimens was 150.4 ± 120.6 (64-366). All viable fibers were measured in each sample, and the mean fiber area was 4385.1 ± 1265.8 μm2 (977.0-10,132.93 μm2). There was no significant time difference (P = 0.69) in mean fiber area.

DISCUSSION

Results suggest the potential use of a "minimally invasive" muscle biopsy technique for immunohistological and morphological analysis. This could provide clinicians and investigators additional data in future research. Further investigations are needed to determine the usefulness and potential limiting factors of this technique.

Evaluation of critical rest interval determined from repeated sprint ability testing

BACKGROUND

To test if the critical power (CP) concept can be utilized to determine the critical rest interval (CRI) using repeated sprint ability (RSA) testing with varying work-to-rest ratios.

METHODS

Twelve recreationally trained men (mean±SD; age 24.1±3.6 years) completed a graded exercise test and three RSA protocols with 6-second maximal sprints and varying rest intervals (12-36 s) on a cycle ergometer to determine CRI. Intermittent critical power (ICP) was calculated through the linear total work (TW) and time-to-exhaustion (TTE) relationship, whereas CRI was estimated using average work per sprint and ICP. Validation trials above and below CRI were conducted to evaluate physiological response. Repeated measures analysis of variance were used to analyze variables from RSA trials and changes in blood lactate, oxygen uptake (V̇O2), heart rate (HR), peak power, and TW throughout the validation trials.

RESULTS

Blood lactate, average V̇O2, V̇O2peak, and heart rate were significantly greater below CRI (8.94±4.89 mmol/L, 2.05±0.36 L/min, 2.84±0.48 L/min, and 151.14±18.46 bpm, respectively) when compared to above CRI (6.56±3.45 mmol/L, 1.78±0.26 L/min, 2.61±0.43 L/min, and 138.14±17.51 bpm). Significant interactions were found between above and below CRI for minimal V̇O2 response and maximal HR response, which were consistent with the heavy and severe exercise intensity domains.

CONCLUSIONS

The use of the work-time relationship determined from RSA testing with varying rest intervals can be used to determine CRI and may distinguish between physiological responses related to exercise intensity domains.

Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo

P1 Impact of antioxidant-enriched nutrient bar supplementation on the serum antioxidant markers and physical fitness components of track and field athletes

Lalitha Ramaswamy, Supriya Velraja

P2 The effects of phosphatidic acid supplementation on fitness levels in resistance trained women

Guillermo Escalante, Phil Harvey, Michelle Alencar, Bryan Haddock

P3 The effects of phosphatidic acid supplementation on cardiovascular risk factors in resistance trained men

Phil Harvey, Guillermo Escalante, Michelle Alencar, Bryan Haddock

P4 The efficacy of sodium bicarbonate supplementation on physical capacity and selected biochemical markers in elite wrestlers

Krzysztof Durkalec-Michalski, Jan Jeszka, Bogna Zawieja, Tomasz Podgórski

P5 Effects of different nutritional strategies in hydration and physical performance in healthy well-trained males

Ana Paula Trussardi Fayh, Alexandre Hideki Okano, Amanda Maria de Jesus Ferreira

P6 Reduction of plasma creatine concentrations as an indicator of improved bioavailability

Ralf Jäger, Martin Purpura, Roger C Harris

P7 Effect of three different breakfast meals on energy intake and nutritional status in college-age women

Molly M. Krause, Kiley A. Lavanger, Nina O. Allen, Allison E. Lieb, Katie A. Mullen, Joan M. Eckerson

P8 Accuracy of the ASA24® Dietary Recall system for assessing actual dietary intake in normal weight college-age women.

Kiley A. Lavanger, Molly M. Krause, Nina O. Allen, Allison E. Lieb, Katie A. Mullen, Joan M. Eckerson

P9 β-aminoisobutyric acid does not regulate exercise induced UCP-3 expression in skeletal muscle

Elisa Morales, Jeffrey Forsse, Thomas Andre, Sarah McKinley, Paul Hwang, Grant Tinsley, Mike Spillane, Peter Grandjean, Darryn Willoughby

P10 The ability of collegiate football athletes to adhere to sport-specific nutritional recommendations

A. Jagim, G. Wright, J. Kisiolek, M. Meinking, J. Ochsenwald, M. Andre, M.T. Jones, J. M. Oliver

P11 A single session of low-volume high intensity interval exercise improves appetite regulation in overweight men

Victor Araújo Ferreira, Daniel Costa de Souza, Victor Oliveira Albuquerque dos Santos, Rodrigo Alberto Vieira Browne, Eduardo Caldas Costa, Ana Paula Trussardi Fayh

P12 Acute effects of oral peppermint oil ingestion on exercise performance in moderately-active college students

Suresh T. Mathews, Haley D. Bishop, Clara R. Bowen, Yishan Liang, Emily A. West, Rebecca R. Rogers, Mallory R. Marshall, John K. Petrella

P13 Associations in body fat and liver triglyceride content with serum health markers in sedentary and exercised rats fed a ketogenic diet, Western diet or standard chow over a 6-week period

A. Maleah Holland, Wesley C. Kephart, Petey W. Mumford, C. Brooks Mobley, Ryan P. Lowery, Jacob M. Wilson, Michael D. Roberts

P14 Physiological changes following competition in male and female physique athletes: A pilot study

Eric T. Trexler, Katie R. Hirsch, Bill I. Campbell, Meredith G. Mock, Abbie E. Smith-Ryan

P15 Relationship between cognition and hydration status in college students at a large Southwestern university

Kate Zemek, Carol Johnston

P16 Whey protein-derived exosomes increase protein synthesis in C2C12 myotubes

C. Brooks Mobley, Petey W. Mumford, David D. Pascoe, Christopher M. Lockwood, Michael E. Miller, Michael D. Roberts

P17 The effect of three different energy drinks on 1.5-mile running performance, oxygen consumption, and perceived exertion

Gabriel J. Sanders, Willard Peveler, Brooke Warning, Corey A. Peacock

P18 The Ketogenic diet improves rotarod performance in young and older rats

Wesley C. Kephart, Petey W. Mumford, Ryan P. Lowery, Michael D. Roberts, Jacob M. Wilson

P19 Absorption of bonded arginine silicate compared to individual arginine and silicon components

David Sandler, Sara Perez Ojalvo, James Komorowski

P20 Effects of a high (2.4 g/kg) vs. low/moderate (1.2 g/kg) protein intake on body composition in aspiring female physique athletes engaging in an 8-week resistance training program

Bill I. Campbell, Danielle Aguilar, Andres Vargas, Laurin Conlin, Amey Sanders, Paola Fink-Irizarry, Layne Norton, Ross Perry, Ryley McCallum, Matthew R. Wynn, Jack Lenton

P21 Effects of a high (2.4 g/kg) vs. low/moderate (1.2 g/kg) protein intake on maximal strength in aspiring female physique athletes engaging in an 8-week resistance training program

Bill I. Campbell, Chris Gai, Seth Donelson, Shiva Best, Daniel Bove, Kaylee Couvillion, Jeff Dolan, Dante Xing, Kyshia Chernesky, Michael Pawela, Andres D. Toledo, Rachel Jimenez

P22 Monitoring of female collegiate athletes over a competitive season reveals changes in nutritional biomarkers

M. Rabideau, A. Walker, J. Pellegrino, M. Hofacker, B. McFadden, S. Conway, C. Ordway, D. Sanders, R. Monaco, M. S. Fragala, S. M. Arent

P23 Comparison of prediction equations to indirect calorimetry in men and women athletes

Jason D. Stone, Andreas Kreutzer, Jonathan M. Oliver, Jacob Kisiolek, Andrew R. Jagim

P24 Regional variations in sweat-based electrolyte loss and changes in plasma electrolyte content in Division I female athletes over the course of a competitive season

M. Hofacker, A. Walker, J. Pellegrino, M. Rabideau, B. McFadden, S. Conway, D. Sanders, C. Ordway, R. Monaco, M. S. Fragala, S. M. Arent

P25 In-season changes in plasma amino acid levels in Division I NCAA female athletes

Ozlem Tok, Joseph K. Pellegrino, Alan J. Walker, David J. Sanders, Bridget A. McFadden, Meaghan M. Rabideau, Sean P. Conway, Chris E. Ordway, Marissa Bello, Morgan L. Hofacker, Nick S. Mackowski, Anthony J. Poyssick, Eddie Capone, Robert M. Monaco, Maren S. Fragala, Shawn M. Arent

P26 Effects of a ketogenic diet with exercise on serum markers of bone metabolism, IGF-1 and femoral bone mass in rats

Petey W. Mumford, A. Maleah Holland, Wesley C. Kephart, Ryan P. Lowery, C. Brooks Mobley, Romil K. Patel, Annie Newton, Darren T. Beck, Michael D. Roberts, Jacob M. Wilson, Kaelin C. Young

P27 Casein supplementation in trained men and women: morning versus evening

Tobin Silver, Anya Ellerbroek, Richard Buehn, Leo Vargas, Armando Tamayo, Corey Peacock, Jose Antonio

P28 A high protein diet has no harmful effects: a one-year crossover study in resistance-trained males

Anya Ellerbroek, Tobin Silver, Richard Buehn, Leo Vargas, Armando Tamayo, Corey Peacock, Jose Antonio

P29 SUP (Stand-up Paddling) athletes: nutritional intake and body composition

Adam Pollock, Anya Ellerbroek, Tobin Silver, Corey Peacock, Jose Antonio

P30 The effects of 8 weeks of colostrum and bio-active peptide supplementation on body composition in recreational male weight lifters

A. Kreutzer, P. Zavala, S. Fleming, M. Jones, J. M. Oliver, A. Jagim

P31 Effects of a Popular Women’s Thermogenic Supplement During an Energy-Restricted High Protein Diet on Changes in Body Composition and Clinical Safety Markers

Cody T. Haun, Petey W. Mumford, Parker N. Hyde, Ciaran M. Fairman, Wesley C. Kephart, Darren T. Beck, Jordan R. Moon, Michael D. Roberts, Kristina L. Kendall, Kaelin C. Young

P32 Three days of caffeine consumption following caffeine withdrawal yields small strength increase in knee flexors

Geoffrey M Hudson, Tara Hannings, Kyle Sprow, Loretta DiPietro

P33 Comparison of cellular nitric oxide production from various sports nutrition ingredients

Doug Kalman, Sara Perez Ojalvo, James Komorowski

P34 The effects of 8 weeks of bio-active peptide supplementation on training adaptations in recreational male weight lifters

P. Zavala, S. Fleming, M. Jones, J. Oliver, A. Jagim

P35 Effects of MusclePharm Assault Black^TM on lower extremity spinal excitability and postactivation potentiation: A pilot study

Brian Wallace, Haley Bergstrom, Kelly Wallace

P36 Effects of four weeks of Ketogenic Diet alone and combined with High intensity Interval Training or Continuous-Moderate intensity on body composition, lipid profile and physical performance on healthy males

Matias Monsalves-Alvarez, Sebastian Oyharçabal, Victoria Espinoza

P37 Effect of branched-chain amino acid supplementation on creatine kinase, muscular performance, and perceived muscle soreness following acute eccentric exercise

Trisha A. VanDusseldorp, Kurt A. Escobar, Kelly E. Johnson, Nathan Cole, Terence Moriarty, Matthew Stratton, Marvin R. Endito, Christine M. Mermier, Chad M. Kerksick

P38 Effects of endurance training on markers of ribosome biogenesis in rodents fed a high fat diet

Matthew A. Romero, C. Brooks Mobley, Melissa Linden, Grace Margaret-Eleanor Meers, R. Scott Rector, Michael D. Roberts

P39 The effects of acute citrulline-malate on lower-body isokinetic performance in recreationally active individuals

Joshua L Gills, Hocheng Lu, Kimberly Parker, Chris Dobbins, Joshua N Guillory, Braden Romer, David Szymanski, Jordan Glenn

P40 The effect pre-ingested L-isoleucine and L-leucine on blood glucose responses and glycemic hormones in healthy inactive adults: Preliminary data.

Daniel E. Newmire, Eric Rivas, Sarah E. Deemer, Robert Wildman, Victor Ben-Ezra

P41 Does protein and source impact substrate oxidation and energy expenditure during and after moderate intensity treadmill exercise?

C Kerksick, B Gieske, R Stecker, C Smith, K Witherbee

P42 Effects of a pre-workout supplement on peak power and power maintenance during lower and upper body testing

Michael T. Lane, M. Travis Byrd, Zachary Bell, Emily Frith, Lauren M.C. Lane

P43 Effects of a pre-workout supplement on peak power production during lower and upper body testing in college-age females

Michael T. Lane, M. Travis Byrd, Zachary Bell, Emily Frith, Lauren M.C. Lane

P44 A comparison of whey versus casein protein supplementation on resting metabolic rate and body composition: a pilot study

Corey A. Peacock, Tobin A. Silver, Megan Colas, Mauricio Mena, Winter Rodriguez, Gabriel J. Sanders, Jose Antonio

P45 A novel mixed-tocotrienol intervention enhances recovery after eccentric exercise: preliminary findings

Andrea Vansickle, Brittany DiFiore, Stephanie Stepp, Grant Slack, Bridget Smith, Kayla Ruffner, Ronald Mendel, Lonnie Lowery

P46 The effects of post-exercise ingestion of a high molecular weight glucose on cycle performance in female cyclists

Katie R. Hirsch, Meredith G. Mock, Malia M.N. Blue, Eric T. Trexler, Erica J. Roelofs, Abbie E. Smith-Ryan

P47 Inclusive vs. exclusive dieting and the effects on body composition in resistance trained individuals

Laurin Conlin, Danielle Aguilar, Bill I. Campbell, Layne Norton, Katie Coles, Eric T. Trexler, Nic Martinez

P48 A whey protein hydrolysate may positively augment resting metabolism compared to intact whey protein

Jordan M. Joy, Roxanne M. Vogel, Thomas H. Hoover, K. Shane Broughton

P49 Seven days of high and low dose creatine nitrate supplementation I: hepatorenal, glucose and muscle enzyme function

R Dalton, R Sowinski, T Grubic, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider

P50 Seven days of high and low dose creatine nitrate supplementation II: performance

T Grubic, R Dalton, R Sowinski, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider

P51 Seven days of high and low dose creatine nitrate supplementation III: hemodynamics

R Sowinski, R Dalton, T Grubic, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider

P52 The efficacy of a β-hydroxy-β-methylbutyrate supplementation on physical capacity, body composition and biochemical markers in highly-trained combat sports athletes

Krzysztof Durkalec-Michalski, Jan Jeszka, Tomasz Podgórski

P53 Does protein and source impact substrate oxidation and energy expenditure during and after moderate intensity treadmill exercise?

C Kerksick, B Gieske, R Stecker, C Smith, K Witherbee

P54 Effects of 30 days of Cleanse™ supplementation on measure of body composition, waist circumference, and markers of gastrointestinal distress in females

Stacie Urbina, Emily Santos, Katelyn Villa, Alyssa Olivencia, Haley Bennett, Marissa Lara, Cliffa Foster, Colin Wilborn, Lem Taylor

P55 The effects of moderate- versus high-load training on body composition, muscle growth, and performance in college aged females

Jason M Cholewa, Amy Hewins, Samantha Gallo, Ashley Micensky, Christian De Angelis, Christopher Carney, Bill Campbell, Laurin Conlin, Layne Norton, Fabricio Rossi

P56 Effect of a multi-ingredient preworkout supplement on cognitive function and perceptions of readiness to perform

MS Koozehchian, PB Collins, R Sowinski, T Grubic, R Dalton, A O’Connor, SY Shin, Y Peter Jung, BK Sanchez, A Coletta, M Cho, A Reyes, C Rasmussen, CP Earnest, PS Murano, M Greenwood, RB Kreider

Comparison of Handgrip and Leg Extension Strength in Predicting Slow Gait Speed in Older Adults

OBJECTIVES

To compare the relative predictive power of handgrip and leg extension strength in predicting slow walking.

DESIGN

Report of correlative analysis from two epidemiological cohort studies.

SETTING

Foundation of the National Institutes of Health Sarcopenia Project.

PARTICIPANTS

Men and women aged 67 to 93 (N=6,766).

MEASUREMENTS

Leg strength, handgrip strength, and gait speed were measured. Strength cutpoints associated with slow gait speed were developed using classification and regression tree analyses and compared using ordinary least squares regression models.

RESULTS

The cutpoints of lower extremity strength associated with slow gait speed were 154.6 N-m in men and 89.9 N-m in women for isometric leg extension strength and 94.5 N-m in men and 62.3 N-m in women for isokinetic leg extension strength. Weakness defined according to handgrip strength (odds ratios (OR)=1.99 to 4.33, c-statistics=0.53 to 0.67) or leg strength (ORs=2.52 to 5.77; c-statistics=0.61 to 0.66) was strongly related to odds of slow gait speed. Lower extremity strength contributed 1% to 16% of the variance and handgrip strength contributed 3% to 17% of the variance in the prediction of gait speed depending on sex and mode of strength assessment.

CONCLUSION

Muscle weakness of the leg extensors and forearm flexors is related to slow gait speed. Leg extension strength is only a slightly better predictor of slow gait speed. Thus, handgrip and leg extension strength appear to be suitable for screening for muscle weakness in older adults.

Leukocyte IGF-1 receptor expression during muscle recovery

INTRODUCTION

The insulin-like growth factor 1 (IGF-1) system plays a central role in anabolic cellular processes. Recently, a regulatory role of IGF-1 in the immune response for muscle repair has been suggested, but how it modulates the inflammatory process is largely unknown. We evaluated changes in leukocyte expression of IGF-1 receptors (IGF-1R) during recovery from resistance exercise to determine whether changes in the potential for IGF-1 interactions with leukocytes may mediate the role of IGF-1 in muscle repair.

METHODS

Twenty resistance-trained men (18-35 yr) performed resistance exercise followed by cold water immersion (CWI) or control treatment (CON) on three consecutive days. Blood was sampled at baseline (PRE), immediately (IP), 30 min (30P), 24 h (24H), and 48 h after (48H) exercise. Circulating IGF-1 was assayed, and IGF-1 receptor expression (CD221) on gated circulating leukocytes (monocytes, granulocytes, and lymphocytes) was measured by flow cytometry. Time and treatment effects were analyzed with ANCOVA.

RESULTS

Circulating IGF-1 significantly increased from PRE to IP as a result of resistance exercise, but no differences between CON and CWI were observed. Mean fluorescence intensity of CD221 on monocytes and granulocytes and percent of CD221+ granulocytes significantly increased at 30P (P < 0.000) and returned to preexercise levels by 24H. No treatment effects on monocytes or granulocytes were observed. On lymphocytes, mean fluorescence intensity of CD221+ significantly increased from PRE to 30P in CWI.

CONCLUSIONS

Changes in IGF-1 and its receptor on monocytes and granulocytes seem to be part of the mechanism that facilitates recovery from resistance exercise during earlier stages of muscle recovery. In addition, CWI seems to alter IGF-mediated responses on slower-acting lymphocytes, suggesting that its effects may be seen in later stages of muscle repair.

Developmental differences between boys and girls result in sex-specific physical fitness changes from fourth to fifth grade

To better understand how developmental differences impact performance on a broad selection of common physical fitness measures, we examined changes in boys and girls from fourth to fifth grade. Subjects included 273 boys (age, 9.5 ± 0.6 years; height, 139.86 ± 7.52 cm; mass, 38.00 ± 9.55 kg) and 295 girls (age, 9.6 ± 0.5 years; height, 139.30 ± 7.19 cm; weight, 37.44 ± 9.35 kg). We compared anthropometrics, cardiorespiratory and local muscular endurance, flexibility, power, and strength. A mixed-method analysis of variance was used to compare boys and girls at the 2 time points. Pearson correlation coefficients were used to examine relationships between anthropometric and fitness measurements. Significance was set at p ≤ 0.05. Weight increased significantly (>10%) in both sexes, and girls became significantly taller than boys after growing 4.9% by fifth grade (vs. 3.5%). Both groups improved cardiorespiratory endurance and power, although boys performed better than girls at both time points. Boys were stronger in fourth grade, but girls improved more, leading to similar fifth-grade values. Girls were more flexible in fourth grade, but their significant decreases (∼32.4%) coupled with large improvements in boys (∼105%) resulted in similar fifth-grade scores. Body mass index (BMI) was positively correlated with run time regardless of grade or sex. Power was negatively correlated with BMI and run time in fourth grade. In conclusion, sex-specific differences in physical fitness are apparent before pubescence. Furthermore, this selection of measures reveals sexually dimorphic changes, which likely reflect the onset of puberty in girls. Coaches and teachers should account these developmental differences and their effects on anthropometrics and fitness in boys and girls.

Moderate Altitude Affects High Intensity Running Performance in a Collegiate Women's Soccer Game

The effect of altitude on soccer game activity profiles was retrospectively examined in six NCAA Division I female soccer players. Comparisons were made between two matches played at sea level (SL) and one match played at a moderate altitude (1839 m). A 10-Hz global positioning system device was used to measure distance and velocity. The rate of total distance capacity (TDC) and high intensity running (HIR) as well as percent of time at HIR were evaluated. Significant differences were seen in the distance rate (120.55 ± 8.26 m·min−1 versus 105.77 ± 10.19 m·min−1) and the HIR rate (27.65 ± 9.25 m·min−1 versus 25.07 ± 7.66 m·min−1) between SL and altitude, respectively. The percent of time at HIR was not significantly different (p = 0.064), yet tended to be greater at SL (10.4 ± 3.3%) than at altitude (9.1 ± 2.2%). Results indicate that teams residing at SL and competing at a moderate altitude may have a reduced ability in distance covered and a high intensity run rate.

Evaluation of Electromyographic Frequency Domain Changes during a Three-Minute Maximal Effort Cycling Test

To evaluate the time course of EMG frequency changes during a three-minute maximal effort cycling test (3MT) session and to examine which parameter between mean (MNF) and median (MDF) frequency is more suitable for evaluation of changes in neuromuscular function throughout a 3MT. Eighteen recreationally-active men volunteered to participate in this study. Maximum voluntary contraction (MVC) was measured using a dynamometer to determine maximal EMG frequency of the vastus lateralis (VL) of the kicking leg during isometric knee extension. A maximal oxygen consumption test (VO2peak) on a cycle ergometer was performed to establish the appropriate load profile for the 3MT which was completed after a period of at least 48 hours. MNF, MDF and power output (PO) values were measured at 10-second epochs throughout the duration of the 3MT. Repeated measures analysis of variance was used to compare the changes in EMG frequency, relative to maximal values from the MVC, and change in PO during the testing procedure. MNF, Root Mean Square (RMS), and PO significantly decreased during the 3MT, while MDF did not change significantly. Statistically, EMG frequency and PO decreased at first and remained constant in response to the 3MT, which may be reflective of differing patterns of muscle fiber type fatigue throughout the testing session. Due to decreased variability, changes in neuromuscular function during this protocol may be better evaluated using MNF than MDF. Key pointsEMG frequency decreased initially and remained constant in response to all-out cycling test.The change in EMG frequency and power output were similar during all-out cycling test.MNF may be better than MDF for neuromuscular function evaluation during all-out cycling test due to decreased variability.

Effects of time-release caffeine containing supplement on metabolic rate, glycerol concentration and performance

This study compared caffeine pharmacokinetics, glycerol concentrations, metabolic rate, and performance measures following ingestion of a time-release caffeine containing supplement (TR-CAF) versus a regular caffeine capsule (CAF) and a placebo (PL). Following a double-blind, placebo-controlled, randomized, cross-over design, ten males (25.9 ± 3.2 y) who regularly consume caffeine ingested capsules containing either TR-CAF, CAF, or PL. Blood draws and performance measures occurred at every hour over an 8-hour period. Plasma caffeine concentrations were significantly greater (p < 0.05) in CAF compared to TR-CAF during hours 2-5 and significantly greater (p = 0.042) in TR-CAF compared to CAF at hour 8. There were no significant differences between trials in glycerol concentrations (p = 0.86) or metabolic measures (p = 0.17-0.91). Physical reaction time was significantly improved for CAF at hour 5 (p=0.01) compared to PL. Average upper body reaction time was significantly improved for CAF and TR-CAF during hours 1-4 (p = 0.04 and p = 0.01, respectively) and over the 8-hour period (p = 0.04 and p = 0.001, respectively) compared to PL. Average upper body reaction time was also significantly improved for TR-CAF compared to PL during hours 5-8 (p = 0.004). TR-CAF and CAF showed distinct pharmacokinetics yielding modest effects on reaction time, yet did not alter glycerol concentration, metabolic measures, or other performance measures. Key pointsTime-release caffeine and regular caffeine showed distinct pharmacokinetics over an 8-hour period following ingestion.Time-release caffeine and regular caffeine yielded modest effects on reaction time over an 8-hour period following ingestion.Time-release caffeine and regular caffeine did not alter glycerol concentration, metabolic measures, or other performance measures over an 8-hour period following ingestion.