Dynamic Medicine - Latest articles

Modeling transitions in body composition: the approach to steady state for anthropometric measures and physiological functions in the Minnesota human starvation study

James L Hargrove, Grete Heinz and Otto Heinz — 2008-10-07

Background: This study evaluated whether the changes in several anthropometric and functional measures during caloric restriction combined with walking and treadmill exercise would fit a simple model of approach to steady state (a plateau) that can be solved using spreadsheet software (Microsoft Excel(R)). We hypothesized that transitions in waist girth and several body compartments would fit a simple exponential model that approaches a stable steady-state. Methods: The model (an equation) was applied to outcomes reported in the Minnesota starvation experiment using Microsoft Excel's Solver(R) function to derive rate parameters (k) and projected steady state values. However, data for most end-points were available only at t = 0, 12 and 24 weeks of caloric restriction. Therefore, we derived 2 new equations that enable model solutions to be calculated from 3 equally spaced data points. Results: For the group of male subjects in the Minnesota study, body mass declined with a first order rate constant of about 0.079 wk-1. The fractional rate of loss of fat free mass, which includes components that remained almost constant during starvation, was 0.064 wk-1, compared to a rate of loss of fat mass of 0.103 wk-1. The rate of loss of abdominal fat, as exemplified by the change in the waist girth, was 0.213 wk-1. On average, 0.77 kg was lost per cm of waist girth. Other girths showed rates of loss between 0.085 and 0.131 wk-1. Resting energy expenditure (REE) declined at 0.131 wk-1. Changes in heart volume, hand strength, work capacity and N excretion showed rates of loss in the same range. The group of 32 subjects was close to steady state or had already reached steady state for the variables under consideration at the end of semi-starvation. Conclusions: When energy intake is changed to new, relatively constant levels, while physical activity is maintained, changes in several anthropometric and physiological measures can be modeled as an exponential approach to steady state using software that is widely available. The 3 point method for parameter estimation provides a criterion for testing whether change in a variable can be usefully modelled with exponential kinetics within the time range for which data are available.

The relationships among endurance performance measures as estimated from VO2PEAK, ventilatory threshold, and electromyographic fatigue threshold: a relationship design

2008-09-10

Background: The use of surface electromyography has been accepted as a valid, non-invasive measure of neuromuscular fatigue. In particular, the electromyographic fatigue threshold test (EMGFT) is a reliable submaximal tool to identify the onset of fatigue. This study examined the metabolic relationship between VO2PEAK, ventilatory threshold (VT), and the EMGFT, as well as compared the power output at VO2PEAK, VT, and EMGFT. Methods: Thirty-eight college-aged males (mean ± SD = 22.5 ± 3.5 yrs) performed an incremental test to exhaustion on an electronically-braked cycle ergometer for the determination of VO2PEAK and VT. Each subject also performed a discontinuous incremental cycle ergometer test to determine their EMGFT value, determined from bipolar surface electrodes placed on the longitudinal axis of the vastus lateralis of the right thigh. Subjects completed a total of four, 2-minute work bouts (ranging from 75–325 W). Adequate rest was given between bouts to allow for subjects' heart rate to drop within 10 beats of their resting heart rate. The EMG amplitude was averaged over 10-second intervals and plotted over the 2-minute work bout. The resulting slopes from each successive work bout were used to calculate EMGFT. Results: Power outputs and VO2 values from each subject's incremental test to exhaustion were regressed. The linear equations were used to compute the VO2 value that corresponded to each fatigue threshold. Two separate one-way repeated measure ANOVAs indicated significant differences (p < 0.05) among metabolic parameters and power outputs. However, the mean metabolic values for VT (1.90 ± 0.50 l·min-1) and EMGFTVO2(1.84 ± 0.53 l·min-1) were not significantly different (p > 0.05) and were highly correlated (r = 0.750). Furthermore, the mean workload at VT was 130.7 ± 37.8 W compared with 134.1 ± 43.5 W at EMGFT (p > 0.05) with a strong correlation between the two variables (r = 0.766). Conclusion: Metabolic measurements, as well as the power outputs at VT and EMGFT, were strongly correlated. The significant relationship between VT and EMGFT suggests that both procedures may reflect similar physiological factors associated with the onset of fatigue. As a result of these findings, the EMGFT test may provide an attractive alternative to estimating VT.

Bioelectrical phase angle values in a clinical sample of ambulatory rehabilitation patients

2008-09-10

Background: Phase angle (PhA) is derived from the resistance and reactance measurements obtained from bioelectric impedance analysis (BIA) and is considered indicative of cellular health and membrane integrity. This study measured PhA values of rehabilitation patients and compared them to reference values, measures of functional ability and serum C-reactive protein (CRP) levels to explore their utility as a clinical tool to monitor disease progression and treatment efficacy. Methods: This cross-sectional observational study was conducted on 215 ambulatory rehabilitation patients aged 20 – 94 years. All participants had been hospitalised for a stroke, orthopaedic or other condition resulting in a functional limitation. PhA was derived from BIA analysis and functional ability characterised using the Functional Independence Measure (FIM), timed up and go (TUG) and maximal quadriceps strength (MQS). Serum levels of CRP were also collected. Results: Stroke patients had the highest PhA (5.3°) followed by elective orthopaedic surgery (5.0°) with the other group (4.3°) significantly lower than both previous categories (p < 0.001). Ambulatory rehabilitation patients' PhA values were dependent on age and sex (p < 0.001), lower than published age matched healthy reference values (p ≤ 0.05) and similar to other hospitalised or sick groups, but also higher than values reported in critically ill patients. Patients with CRP values less than 10 mg.L-1 had significantly (p = 0.005) higher mean PhA values. Furthermore, the highest functional status quartiles had significantly higher PhAs (p ≤ 0.04) for the FIM, MQS and TUG measures. Conclusion: The results suggest that the phase angles of rehabilitation patients are between those of healthy individuals and seriously ill patients, thereby supporting claims that PhA is indicative of general health status. Phase angles are a potentially useful indicator of functional status in patients commencing an ambulatory rehabilitation program with a normal hydration status.

Femoral artery remodeling after aerobic exercise training without weight loss in women

2008-09-08

Background: It is currently unclear whether reductions in adiposity mediate the improvements in vascular health that occur with aerobic exercise. The purpose of this longitudinal study of 13 healthy women (33 ± 4 years old) was to determine whether 14 weeks of aerobic exercise would alter functional measures of vascular health, namely resting aortic pulse wave velocity (aPWV, an index of arterial stiffness), femoral artery diameter (DFA), and femoral artery blood flow (BFFA) independent of changes in adiposity. Methods: Aerobic fitness was assessed as VO2peak normalized to fat-free mass, and adiposity (percent body fat) was determined by dual energy x-ray absorptiometry. Serum concentrations of proteins associated with risk for cardiovascular disease, including C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1), and leptin, were also measured. Subjects cycled for 50 minutes, 3 times per week. Results: Aerobic fitness normalized to fat-free mass increased 6% (P = 0.03) whereas adiposity did not change. Resting DFA increased 12% (P < 0.001) and resting shear rate decreased 28% (P = 0.007). Aortic PWV, and serum sICAM-1, CRP and leptin did not change with training. Conclusion: Significant reductions in adiposity were not necessary for aerobic exercise training to bring about improvements in aerobic fitness and arterial remodeling. Peripheral arterial remodeling occurred without changes in central arterial stiffness or markers of inflammation.

Biomechanical influence of TKA designs with varying radii on bilateral TKA patients during sit-to-stand

2008-08-13

Background: Compared to the design of a traditional multi-radius (MR) total knee arthroplasty (TKA), the single-radius (SR) implant investigated has a fixed flexion/extension center of rotation. The biomechanical effectiveness of an SR for functional daily activities, i.e., sit-to-stand, is not well understood. The purpose of the study was to compare the biomechanics underlying functional performance of the sit-to-stand (STS) movement between the limbs containing an MR and an SR TKA of bilateral TKA participants. Methods: Sagittal plane kinematics and kinetics, and EMG data for selected knee flexor and extensor muscles were analyzed for eight bilateral TKA patients, each with an SR and an MR TKA implant. Results: Compared to the MR limb, the SR limb demonstrated greater peak antero-posterior (AP) ground reaction force, higher AP ground reaction impulse, less vastus lateralis and semitendinosus EMG during the forward-thrust phase of the STS movement. No significant difference of knee extensor moment was found between the two knees. Conclusion: Some GRF and EMG differences were evident between the MR and SR limbs during STS movement. Compensatory adaptations may be used to perform the STS.

The oxygen delivery response to acute hypoxia during incremental knee extension exercise differs in active and trained males

2008-08-12

Background: It is well known that hypoxic exercise in healthy individuals increases limb blood flow, leg oxygen extraction and limb vascular conductance during knee extension exercise. However, the effect of hypoxia on cardiac output, and total vascular conductance is less clear. Furthermore, the oxygen delivery response to hypoxic exercise in well trained individuals is not well known. Therefore our aim was to determine the cardiac output (Doppler echocardiography), vascular conductance, limb blood flow (Doppler echocardiography) and muscle oxygenation response during hypoxic knee extension in normally active and endurance-trained males. Methods: Ten normally active and nine endurance-trained males (VO2max = 46.1 and 65.5 mL/kg/min, respectively) performed 2 leg knee extension at 25, 50, 75 and 100% of their maximum intensity in both normoxic and hypoxic conditions (FIO2 = 15%; randomized order). Results were analyzed with a 2-way mixed model ANOVA (group × intensity). Results: The main finding was that in normally active individuals hypoxic sub-maximal exercise (25 – 75% of maximum intensity) brought about a 3 fold increase in limb blood flow but decreased stroke volume compared to normoxia. In the trained group there were no significant changes in stroke volume, cardiac output and limb blood flow at sub-maximal intensities (compared to normoxia). During maximal intensity hypoxic exercise limb blood flow increased approximately 300 mL/min compared to maximal intensity normoxic exercise. Conclusion: Cardiorespiratory fitness likely influences the oxygen delivery response to hypoxic exercise both at a systemic and limb level. The increase in limb blood flow during maximal exercise in hypoxia (both active and trained individuals) suggests a hypoxic stimulus that is not present in normoxic conditions.

Monitoring of pre-frontal oxygen status in helicopter pilots using near-infrared spectrophotometers

Azusa Kikukawa, Asao Kobayashi and Yoshinori Miyamoto — 2008-07-11

Background: There are few in-flight studies of cognition-related cerebral oxygen status in helicopter pilots. Methods: Four male helicopter pilots volunteered for nine sorties during visual flight in a BK117 and UH-60J. The pilots' pre-frontal oxy-hemoglobin (O2Hb) and deoxy-hemoglobin (HHb) concentration were continuously monitored from the right/left sections of the forehead using near-infrared spectrophotometers with a consideration of motion artifacts. Results: The concentration of O2Hb progressively increased (13.98 μmol•L-1 as a maximum increased concentration) in both the right/left sections of the forehead from the basal level during the heightened cognitive demand of helicopter flight. There was comparatively little change (4.32 μmol•L-1 as a maximum increased concentration) in HHb concentration during measurement of helicopter flight. HHb changes were apparently not affected by a heightened cognitive demand of helicopter pilots. Conclusion: These results demonstrate that near-infrared spectroscopy, especially O2Hb measurements, provides a sensitive method for the monitoring of cognitive demand (maneuvers) in helicopter pilots.

Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Gregory R Waryasz and Ann Y McDermott — 2008-06-26

Background: Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and return function to the individual. Applying preventive medicine strategies, the majority of cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic trainer testing the current researched potential risk factors during a Preparticipation Screening Evaluation (PPSE). We provide a detailed and comprehensive review of the soft tissue, arterial system, and innervation to the patellofemoral joint in order to supply the clinician with the knowledge required to assess the anatomy and make recommendations to patients identified as potentially at risk. The purpose of this article is to review knee anatomy and the literature regarding potential risk factors associated with patellofemoral pain syndrome and prehabilitation strategies. A comprehensive review of knee anatomy will present the relationships of arterial collateralization, innervations, and soft tissue alignment to the possible multifactoral mechanism involved in PFPS, while attempting to advocate future use of different treatments aimed at non-soft tissue causes of PFPS. Methods: A systematic database search of English language PubMed, SportDiscus, Ovid MEDLINE, Web of Science, LexisNexis, and EBM reviews, plus hand searching the reference lists of these retrieved articles was performed to determine possible risk factors for patellofemoral pain syndrome. Results: Positive potential risk factors identified included: weakness in functional testing; gastrocnemius, hamstring, quadriceps or iliotibial band tightness; generalized ligamentous laxity; deficient hamstring or quadriceps strength; hip musculature weakness; an excessive quadriceps (Q) angle; patellar compression or tilting; and an abnormal VMO/VL reflex timing. An evidence-based medicine model was utilized to report evaluation criteria to determine the at-risk individuals, then a defined prehabilitation program was proposed that begins with a dynamic warm-up followed by stretches, power and multi-joint exercises, and culminates with isolation exercises. The prehabilitation program is performed at lower intensity level ranges and can be conducted 3 days per week in conjunction with general strength training. Based on an objective one repetition maximum (1RM) test which determines the amount an individual can lift in good form through a full range of motion, prehabilitation exercises are performed at 50–60% intensity. Conclusion: To reduce the likelihood of developing PFPS, any individual, especially those with positive potential risk factors, can perform the proposed prehabilitation program.

A school-curriculum-based exercise intervention program for two years in pre-pubertal girls does not influence hip structure

2008-04-28

Background: It is known that physical activity during growth has a positive influence on bone mineral accrual, and is thus possibly one strategy to prevent osteoporosis. However, as bone geometry, independent of areal bone mineral density (aBMD), influences fracture risk, this study aimed to evaluate whether hip structure in pre-pubertal girls is also affected by a two-year exercise intervention program. Methods: Forty-two girls aged 7–9 years in a school-curriculum-based exercise intervention program comprising 40 minutes of general physical activity per school day (200 minutes per week) were compared with 43 age-matched girls who participated in the general Swedish physical education curriculum comprising a mean of 60 minutes per week. The hip was scanned by dual energy X-ray absorptiometry (DXA) and the hip structural analysis (HSA) software was applied to evaluate bone mineral content (BMC, g), areal bone mineral density (aBMD, g/cm2), periosteal diameter, cross-sectional area (CSA, cm2), section modulus (Z, cm3) and cross-sectional moment of inertia (CSMI, cm4) of the femoral neck (FN). Annual changes were compared. Subjective duration of physical activity was estimated by questionnaire and objective level of everyday physical activity at follow-up by means of accelerometers worn for four consecutive days. All children remained at Tanner stage 1 throughout the study. Group comparisons were made by independent student's t-test between means and analyses of covariance (ANCOVA). Results: At baseline, the two groups did not differ with regard to age, anthropometrics or bone parameters. No between-group differences were observed for annual changes in the FN variables measured. Conclusion: A two-year school-based moderately intense general exercise program for 7–9-year-old pre-pubertal girls does not influence structural changes in the FN.

Percent body fat estimations in college men using field and laboratory methods: A three-compartment model approach

2008-04-21

Background: Methods used to estimate percent body fat can be classified as a laboratory or field technique. However, the validity of these methods compared to multiple-compartment models has not been fully established. The purpose of this study was to determine the validity of field and laboratory methods for estimating percent fat (%fat) in healthy college-age men compared to the Siri three-compartment model (3C). Methods: Thirty-one Caucasian men (22.5 ± 2.7 yrs; 175.6 ± 6.3 cm; 76.4 ± 10.3 kg) had their %fat estimated by bioelectrical impedance analysis (BIA) using the BodyGram™ computer program (BIA-AK) and population-specific equation (BIA-Lohman), near-infrared interactance (NIR) (Futrex® 6100/XL), four circumference-based military equations [Marine Corps (MC), Navy and Air Force (NAF), Army (A), and Friedl], air-displacement plethysmography (BP), and hydrostatic weighing (HW). Results: All circumference-based military equations (MC = 4.7% fat, NAF = 5.2% fat, A = 4.7% fat, Friedl = 4.7% fat) along with NIR (NIR = 5.1% fat) produced an unacceptable total error (TE). Both laboratory methods produced acceptable TE values (HW = 2.5% fat; BP = 2.7% fat). The BIA-AK, and BIA-Lohman field methods produced acceptable TE values (2.1% fat). A significant difference was observed for the MC and NAF equations compared to both the 3C model and HW (p < 0.006). Conclusion: Results indicate that the BP and HW are valid laboratory methods when compared to the 3C model to estimate %fat in college-age Caucasian men. When the use of a laboratory method is not feasible, BIA-AK, and BIA-Lohman are acceptable field methods to estimate %fat in this population.