Objective: The objectives were (1) to establish the strength of the association between incident cases of osteoarthritis (OA) and low back pain (LBP), and physical activity (PA) and to assess the likelihood of the associations being causal; and (2) to quantify the impact of PA on the burden of OA and LBP in Australia. Methods: We conducted a systematic literature review in EMBASE and PubMed databases from January 01, 2000, to April 28, 2020. We used the Bradford Hill viewpoints to assess causality. We used a proportional multistate life table model to estimate the impact of changes in the PA levels on OA and LBP burdens for the 2019 Australian population (aged ≥ 20 y) over their remaining lifetime. Results: We found that both OA and LBP are possibly causally related to physical inactivity. Assuming causality, our model projected that if the 2025 World Health Organization global target for PA was met, the burden in 25 years’ time could be reduced by 70,000 prevalent cases of OA and over 11,000 cases of LBP. Over the lifetime of the current adult population of Australia, the gains could add up to approximately 672,814 health-adjusted life years (HALYs) for OA (ie, 27 HALYs per 1000 persons) and 114,042 HALYs for LBP (ie, 5 HALYs per 1000 persons). The HALY gains would be 1.4 times bigger if the 2030 World Health Organization global target for PA was achieved and 11 times bigger if all Australians adhered to the Australian PA guidelines. Conclusion: This study provides empirical support for the adoption of PA in strategies for the prevention of OA and back pain.
Mary Njeri Wanjau, Holger Möller, Fiona Haigh, Andrew Milat, Rema Hayek, Peta Lucas, and J. Lennert Veerman
Jingzhi Yu, Kristopher Kapphahn, Hyatt Moore, Farish Haydel, Thomas Robinson, and Manisha Desai
Background: Clustering, a class of unsupervised machine learning methods, has been applied to physical activity data recorded by accelerometers to discover unique patterns of physical activity and health outcomes. The prediction strength metric provides a criterion to determine the optimal number of clusters for clustering methods. The aim of this study is to provide specific guidance for applying prediction strength to time series accelerometer data. Methods: For this purpose, we designed an extensive simulation study. We created a synthetic data set of accelerometer data using data from a childhood obesity management trial. We evaluated the role of a prespecified threshold of the prediction strength metric as a key input parameter. We compared the recommended threshold (between 0.8 and 0.9) with an approach we developed (Local Maxima). Results: The choice of threshold had a large impact on performance. When the noise level increased (greater overlap between true clusters), lower thresholds outperformed the recommended threshold, which tended to underestimate the true number of clusters. In addition, we found that sorting the data by magnitude of intensity in windows within the time series of interest prior to clustering alleviated sensitivity to threshold choice. Furthermore, for accelerometer data, we recommend that the Local Maxima approach be utilized together with a graphical evaluation of the prediction strength metric function over values of k. Finally, we strongly suggest sorting of the data prior to clustering if sorting retains meaning for the research question at hand. Conclusion: Our recommendations can help future researchers discover more robust patterns from accelerometer data.
Alannah K.A. McKay, Megan L.R. Ross, Nicolin Tee, Avish P. Sharma, Jill J. Leckey, and Louise M. Burke
Purpose: To examine the effects of a high-carbohydrate diet (HCHO), periodized-carbohydrate (CHO) diet (PCHO), and ketogenic low-CHO high-fat diet (LCHF) on training capacity. Methods: Elite male racewalkers completed 3 weeks of periodic training while adhering to their dietary intervention. Twenty-nine data sets were collected from 21 athletes. Each week, 6 mandatory training sessions were completed, with additional sessions performed at the athlete’s discretion. Mandatory sessions included an interval session (10 × 1-km efforts on a 6-min cycle), tempo session (14 km with a 450-m elevation gain), 2 long walks (25–40 km), and 2 easy walks (8–12 km) where “sleep-low” and “train-low” dietary strategies were employed for PCHO. Racewalking speed, heart rate, rating of perceived exhaustion, and blood metabolites were collected around key sessions. Results: LCHF covered less total distance than HCHO and PCHO (P < .001); however, no differences in training load between groups were evident (P = .285). During the interval sessions, walking speed was slower in LCHF (P = .001), equating to a 2.8% and 5.6% faster speed in HCHO and PCHO, respectively. LCHF was also 3.2% slower in completing the tempo session than HCHO and PCHO (P = .001). Heart rate was higher (P = .002) and lactate concentrations were lower (P < .001) in LCHF compared to other groups, despite slower walking speeds during the interval session. No between-groups differences in rating of perceived exhaustion were evident (P = .077). Conclusion: Athletes adhering to an LCHF diet showed impaired training capacity relative to their high-CHO-supported counterparts, completing lower training volumes at slower speeds, with higher heart rates.
Emily Bremer, Kelly P. Arbour-Nicitopoulos, Brianna Tsui, Kathleen A. Martin Ginis, Sarah A. Moore, Krista L. Best, and Christine Voss
Purpose: To examine the feasibility and utility of the Fitbit Charge HR to estimate physical activity among ambulatory children and youth with disabilities. Method: Participants (4–17 y old) with disabilities were recruited and asked to wear a Fitbit for 28 days. Feasibility was assessed as the number of participants who adhered to the 28-day protocol. Heat maps were generated to visually examine variability in step count by age, gender, and disability group. Between-group differences for wear time and step counts by age, gender, and disability type were assessed by independent sample t tests for gender and disability group, and a 1-way analysis of variance for age group. Results: Participants (N = 157; median age = 10 y; 71% boys; 71% nonphysical disabilities) averaged 21 valid days of wear time. Wear time was higher in girls than boys (mean difference = 18.0; 95% confidence interval [CI], 6.8 to 29.1), and in preadolescents (mean difference = 27.6; 95% CI, 15.5 to 39.7) and adolescents (mean difference = −21.2; 95% CI, −33.6 to −8.7) than children. More daily steps were taken by boys than girls (mean difference = −1040; 95% CI, −1465 to −615) and individuals with a nonphysical disability than a physical disability (mean difference = −1120; 95% CI, −1474 to −765). The heat maps showed peaks in physical activity on weekdays before school, at recess, lunchtime, and after school. Conclusion: The Fitbit is a feasible tool for monitoring physical activity among ambulatory children and youth with disabilities and may be useful for population-level surveillance and intervention.
Ricardo J.S. Costa, Kayla Henningsen, Stephanie K. Gaskell, Rebekah Alcock, Alice Mika, Christopher Rauch, Samuel N. Cheuvront, Phil Blazy, and Robert Kenefick
The study aimed to determine the effects of two differing amino acid beverage interventions on biomarkers of intestinal epithelial integrity and systemic inflammation in response to an exertional-heat stress challenge. One week after the initial assessment, participants (n = 20) were randomly allocated to complete two exertional-heat stress trials, with at least 1 week washout. Trials included a water control trial (CON), and one of two possible amino acid beverage intervention trials (VS001 or VS006). On VS001 (4.5 g/L) and VS006 (6.4 g/L), participants were asked to consume two 237-ml prefabricated doses daily for 7 days before the exertional-heat stress, and one 237-ml dose immediately before, and every 20 min during 2-hr running at 60% maximal oxygen uptake in 35 °C ambient conditions. A water volume equivalent was provided on CON. Whole blood samples were collected pre-, immediately post-, 1 and 2 hr postexercise, and analyzed for plasma concentrations of cortisol, intestinal fatty acid protein, soluble CD14, and immunoglobulin M (IgM) by ELISA, and systemic inflammatory cytokines by multiplex. Preexercise resting biomarker concentrations for all variables did not significantly differ between trials (p > .05). A lower response magnitude for intestinal fatty acid protein (mean [95% CI]: 249 [60, 437] pg/ml, 900 [464, 1,336] pg/ml), soluble CD14 (−93 [−458, 272] ng/ml, 12 [−174, 197] ng/ml), and IgM (−6.5 [−23.0, 9.9] MMU/ml, −10.4 [−16.2, 4.7] MMU/ml) were observed on VS001 and V006 compared with CON (p < .05), respectively. Systemic inflammatory response profile was lower on VS001, but not VS006, versus CON (p < .05). Total gastrointestinal symptoms did not significantly differ between trials. Amino acid beverages’ consumption (i.e., 4.5–6.4 g/L), twice daily for 7 days, immediately before, and during exertional-heat stress ameliorated intestinal epithelial integrity and systemic inflammatory perturbations associated with exercising in the heat, but without exacerbating gastrointestinal symptoms.
Colleen X. Muñoz and Michael F. Bergeron
First morning urine (FMU) assessment would be a practical and convenient solution for clinically acceptable detection of underhydration prior to competition/training, and for the general public. Thus, we thus sought to determine the diagnostic accuracy of FMU as a valid indicator of recent (previous 24 hr, 5 days average) hydration practices. For 5 consecutive days and one final morning, 67 healthy women (n = 38) and men (n = 29; age: 20  years, body mass index: 25.9 [5.5]) completed 24-hr diet logs for total water intake (from beverages and foods, absolute and relative to body mass), 24-hr urine and FMU collection (last morning only) for osmolality (Osm), specific gravity (SG), and color (Col), and morning blood sampling for plasma osmolality and copeptin. Correlations determined significance and relationship strength among FMU and all other variables. Area under the receiver operating characteristic curves, sensitivity, specificity, and positive likelihood ratios were employed using previously reported values to indicate underhydration (total water intake < 30 ml/kg, osmolality > 500, and >800 mOsm/kg, specific gravity > 1.017, and copeptin > 6.93 pmol/L). FMU_Osm and FMU_SG were significantly correlated (p < .05) to all variables except the previous 5-day plasma osmolality. FMU_Col was only significantly correlated with other color time intervals and total water intake per gram. FMU_Osm held greatest utility (area under the receiver operating characteristic curve, sensitivity, and specificity >80%) overall, with the best outcome being FMU_Osm indicating a previous 24-hr osmolality threshold of 500 mOsm/kg (FMU_Osm criterion >710 mOsm/kg and positive likelihood ratio = 5.9). With less effort and cost restriction, FMU is a viable metric to assess underhydration.
Sarah R. Jackman, Gareth A. Wallis, Jinglei Yu, Andrew Philp, Keith Baar, Kevin D. Tipton, and Oliver C. Witard
Branched-chain amino acids (BCAA) and carbohydrate (CHO) are commonly recommended postexercise supplements. However, no study has examined the interaction of CHO and BCAA ingestion on myofibrillar protein synthesis (MyoPS) rates following exercise. We aimed to determine the response of MyoPS to the co-ingestion of BCAA and CHO following an acute bout of resistance exercise. Ten resistance-trained young men completed two trials in counterbalanced order, ingesting isocaloric drinks containing either 30.6-g CHO plus 5.6-g BCAA (B + C) or 34.7-g CHO alone following a bout of unilateral, leg resistance exercise. MyoPS was measured postexercise with a primed, constant infusion of L-[ring13C6] phenylalanine and collection of muscle biopsies pre- and 4 hr postdrink ingestion. Blood samples were collected at time points before and after drink ingestion. Serum insulin concentrations increased to a similar extent in both trials (p > .05), peaking at 30 min postdrink ingestion. Plasma leucine (514 ± 34 nmol/L), isoleucine (282 ± 23 nmol/L), and valine (687 ± 33 nmol/L) concentrations peaked at 0.5 hr postdrink in B + C and remained elevated for 3 hr during exercise recovery. MyoPS was ∼15% greater (95% confidence interval [−0.002, 0.028], p = .039, Cohen’s d = 0.63) in B + C (0.128%/hr ± 0.011%/hr) than CHO alone (0.115%/hr ± 0.011%/hr) over the 4 hr postexercise period. Co-ingestion of BCAA and CHO augments the acute response of MyoPS to resistance exercise in trained young males.
Marie-Reine El-Hage, Alexandra Wendling, Mindy F. Levin, and Anatol G. Feldman
The referent control theory (RCT) for action and perception is an advanced formulation of the equilibrium-point hypothesis. The RCT suggests that rather than directly specifying the desired motor outcome, the nervous system controls action and perception indirectly by setting the values of parameters of physical and physiological laws. This is done independently of values of kinematic and kinetic variables including electromyographic patterns describing the motor outcome. One such parameter—the threshold muscle length, λ, at which motoneurons of a given muscle begin to be recruited, has been identified experimentally. In RCT, a similar parameter, the referent arm position, R, has been defined for multiple arm muscles as the threshold arm position at which arm muscles can be quiescent but activated depending on the deflection of the actual arm position, Q, from R. Changes in R result in reciprocal changes in the activity of opposing muscle groups. We advanced the explanatory power of RCT by combining the usual biomechanical descriptions of motor actions with the identification of the timing of R underlying arm movements made with reversals in three directions and to three different extents. We found that in all movements, periods of minimization of the activity of multiple muscles could be identified at ∼61%–86% of the reaching extent in each direction. These electromyographic minimization periods reflect the spatial coordinates at which the R and Q overlap during the production of movements with reversals. The findings support the concept of the production of arm movement by shifting R.