This study describes the availability of physical activity information in the electronic health record, explores how electronic health record documentation correlates with accelerometer-derived physical activity data, and examines whether measured physical activity relates to venous thromboembolism (VTE) prophylaxis use. Prospective observational data comes from community-dwelling older adults admitted to general medicine (n = 65). Spearman correlations were used to examine association of accelerometer-based daily step count with documented walking distance and with duration of VTE prophylaxis. Only 52% of patients had documented walking in nursing and/or physical therapy/occupational therapy notes during the first three hospital days. Median daily steps recorded via accelerometer was 1,370 (interquartile range = 854, 2,387) and correlated poorly with walking distance recorded in physical therapy/occupational therapy notes (median 33 feet/day [interquartile range = 12, 100]; r = .24; p = .27). Activity measures were not associated with use or duration of VTE prophylaxis. VTE prophylaxis use does not appear to be directed by patient activity, for which there is limited documentation.
Juliessa M. Pavon, Richard J. Sloane, Carl F. Pieper, Cathleen S. Colón-Emeric, David Gallagher, Harvey J. Cohen, Katherine S. Hall, Miriam C. Morey, Midori McCarty, Thomas L. Ortel and Susan N. Hastings
Zhen Zeng, Christoph Centner, Albert Gollhofer and Daniel König
Purpose: Setting the optimal cuff pressure is a crucial part of prescribing blood-flow-restriction training. It is currently recommended to use percentages of each individual’s arterial occlusion pressure, which is most accurately determined by Doppler ultrasound (DU). However, the practicality of this gold-standard method in daily training routine is limited due to high costs. An alternative solution is pulse oximetry (PO). The main purpose of this study was to evaluate validity between PO and DU measurements and to investigate whether sex has a potential influence on these variables. Methods: A total of 94 subjects were enrolled in the study. Participants were positioned in a supine position, and a 12-cm-wide cuff was applied in a counterbalanced order at the most proximal portion of the right upper and lower limbs. The cuff pressure was successively increased until pulse was no longer detected by DU and PO. Results: There were no significant differences between the DU and PO methods when measuring arterial occlusion pressure at the upper limb (P = .308). However, both methods showed considerable disagreement for the lower limbs (P = .001), which was evident in both men (P = .028) and women (P = .008). No sex differences were detected. Conclusions: PO is reasonably accurate to determine arterial occlusion pressure of the upper limbs. For lower limbs, PO does not seem to be a valid instrument when assessing the optimal cuff pressure for blood-flow-restriction interventions compared with DU.
Kelly Cornett, Katherine Bray-Simons, Heather M. Devlin, Sunil Iyengar, Patricia Moore Shaffer and Janet E. Fulton
Artur Direito, Joseph J. Murphy, Matthew Mclaughlin, Jacqueline Mair, Kelly Mackenzie, Masamitsu Kamada, Rachel Sutherland, Shannon Montgomery, Trevor Shilton and on behalf of the ISPAH Early Career Network
Increasing population levels of physical activity (PA) can assist in achieving the United Nations sustainable development goals, benefiting multiple sectors and contributing to global prosperity. Practices and policies to increase PA levels exist at the subnational, national, and international levels. In 2018, the World Health Organization launched the first Global Action Plan on Physical Activity (GAPPA). The GAPPA provides guidance through a framework of effective and feasible policy actions for increasing PA, and requires engagement and advocacy from a wide spectrum of stakeholders for successful implementation of the proposed actions. Early career professionals, including researchers, practitioners, and policymakers, can play a major role with helping “all people being regularly active” by contributing to 4 overarching areas: (1) generation—of evidence, (2) dissemination—of key messages and evidence, (3) implementation—of the evidence-based actions proposed in the GAPPA, and (4) contributing to advocacy for robust national action plans on PA. The contribution of early career professionals can be achieved through 5 pathways: (1) research, (2) workplace/practice, (3) business, (4) policy, and (5) professional and public opinion. Recommendations of how early career professionals can contribute to the generation, dissemination, and implementation of the evidence and actions proposed by the GAPPA are provided.
Brianna J. Stubbs, Pete J. Cox, Tom Kirk, Rhys D. Evans and Kieran Clarke
Exogenous ketone drinks may improve athletic performance and recovery, but information on their gastrointestinal tolerability is limited. Studies to date have used a simplistic reporting methodology that inadequately represents symptom type, frequency, and severity. Herein, gastrointestinal symptoms were recorded during three studies of exogenous ketone monoester (KME) and salt (KS) drinks. Study 1 compared low- and high-dose KME and KS drinks consumed at rest. Study 2 compared KME with isocaloric carbohydrate (CHO) consumed at rest either when fasted or after a standard meal. Study 3 compared KME+CHO with isocaloric CHO consumed before and during 3.25 hr of bicycle exercise. Participants reported symptom type and rated severity between 0 and 8 using a Likert scale at regular intervals. The number of visits with no symptoms reported after ketone drinks was n = 32/60 in Study 1, n = 9/32 in Study 2, and n = 20/42 in Study 3. Following KME and KS drinks, symptoms were acute but mild and were fully resolved by the end of the study. High-dose KS drinks caused greater total-visit symptom load than low-dose KS drinks (13.8 ± 4.3 vs. 2.0 ± 1.0; p < .05) and significantly greater time-point symptom load than KME drinks 1–2 hr postdrink. At rest, KME drinks caused greater total-visit symptom load than CHO drinks (5.0 ± 1.6 vs. 0.6 ± 0.4; p < .05). However, during exercise, there was no significant difference in total-visit symptom load between KME+CHO (4.2 ± 1.0) and CHO (7.2 ± 1.9) drinks. In summary, exogenous ketone drinks cause mild gastrointestinal symptoms that depend on time, the type and amount of compound consumed, and exercise.
Stephen S. Cheung
Nicolas Hobson, Sherry L. Dupuis, Lora M. Giangregorio and Laura E. Middleton
Persons with mild cognitive impairment (MCI) and early dementia are often physically inactive, despite associated benefits. This study explored the barriers, facilitators, and preferences for exercise among persons living with MCI/early dementia. The authors conducted 2 focus groups among persons living with MCI/early dementia (n = 4, 6 participants) and 2 focus groups among care partners (n = 3, 4 participants). The transcripts were analyzed using thematic analysis, guided by the social-ecological model. Three themes emerged, reinforcing motivation to exercise, managing changes to cognitive and physical health, and variable perceptions of dementia, each with influences from individual, care partner, and community levels. Low intrinsic motivation, poor physical/cognitive health, and stigma restricted the exercise among persons living with MCI/early dementia. The care partners motivated their partners and provided company and transportation to exercise. People with MCI/early dementia also indicated poor access to exercise providers and exercise opportunities that met their needs and preferences was a barrier to exercise participation. Knowledge translation research should develop exercise interventions at the individual, social, and community levels.
Øyvind Skattebo, Thomas Losnegard and Hans Kristian Stadheim
Purpose: Long-distance cross-country skiers specialize to compete in races >50 km predominantly using double poling (DP). This emphasizes the need for highly developed upper-body endurance capacities and an efficient DP technique. The aim of this study was to investigate potential effects of specialization by comparing physiological capacities and kinematics in DP between long-distance skiers and skiers competing using both techniques (skating/classic) in several competition formats (“all-round skiers”). Methods: Seven male long-distance (32  y, 183  cm, 76  kg) and 6 all-round (25  y, 181  cm, 75  kg) skiers at high international levels conducted submaximal workloads and an incremental test to exhaustion for determination of peak oxygen uptake (VO2peak) and time to exhaustion (TTE) in DP and running. Results: In DP and running maximal tests, TTE showed no difference between groups. However, long-distance skiers had 5–6% lower VO2peak in running (81  vs 85  mL·kg−1·min−1; P = .07) and DP (73  vs 78  mL·kg−1·min−1; P < .01) than all-round skiers. In DP, long-distance skiers displayed lower submaximal O2 cost than all-round skiers (3.8 ± 3.6%; P < .05) without any major differences in cycle times or cyclic patterns of joint angles and center of mass. Lactate concentration over a wide range of speeds (45–85% of VO2peak) did not differ between groups, even though each workload corresponded to a slightly higher percentage of VO2peak for long-distance skiers (effect size: 0.30–0.68). Conclusions: The long-distance skiers displayed lower VO2peak but compensated with lower O2 cost to perform equally with the all-round skiers on a short TTE test in DP. Furthermore, similar submaximal lactate concentration and reduced O2 cost could be beneficial in sustaining high skiing speeds in long-duration competitions.
Mhairi K. MacLean and Daniel P. Ferris
The authors tested 4 young healthy subjects walking with a powered knee exoskeleton to determine if it could reduce the metabolic cost of locomotion. Subjects walked with a backpack loaded and unloaded, on a treadmill with inclinations of 0° and 15°, and outdoors with varied natural terrain. Participants walked at a self-selected speed (average 1.0 m/s) for all conditions, except incline treadmill walking (average 0.5 m/s). The authors hypothesized that the knee exoskeleton would reduce the metabolic cost of walking uphill and with a load compared with walking without the exoskeleton. The knee exoskeleton reduced metabolic cost by 4.2% in the 15° incline with the backpack load. All other conditions had an increase in metabolic cost when using the knee exoskeleton compared with not using the exoskeleton. There was more variation in metabolic cost over the outdoor walking course with the knee exoskeleton than without it. Our findings indicate that powered assistance at the knee is more likely to decrease the metabolic cost of walking in uphill conditions and during loaded walking rather than in level conditions without a backpack load. Differences in positive mechanical work demand at the knee for varying conditions may explain the differences in metabolic benefit from the exoskeleton.