Transcutaneous auricular Vagus Nerve Stimulation and Median Nerve Stimulation reduce acute stress in young healthy adults: a single-blind sham-controlled crossover study.

Stress is a major determinant of health and wellbeing. Conventional stress management approaches do not account for the daily-living acute changes in stress that affect quality of life. The combination of physiological monitoring and non-invasive Peripheral Nerve Stimulation (PNS) represents a promising technological approach to quantify stress-induced physiological manifestations and reduce stress during everyday life. This study aimed to evaluate the effectiveness of three well-established transcutaneous PNS modalities in reducing physiological manifestations of stress compared to a sham: auricular and cervical Vagus Nerve Stimulation (taVNS and tcVNS), and Median Nerve Stimulation (tMNS). Using a single-blind sham-controlled crossover study with four visits, we compared the stress mitigation effectiveness of taVNS, tcVNS, and tMNS, quantified through physiological markers derived from five physiological signals peripherally measured on 19 young healthy volunteers. Participants underwent three acute mental and physiological stressors while receiving stimulation. Blinding effectiveness was assessed via subjective survey. taVNS and tMNS relative to sham resulted in significant changes that suggest a reduction in sympathetic outflow following the acute stressors: Left Ventricular Ejection Time Index (LVETI) shortening (tMNS: p = 0.007, taVNS: p = 0.015) and Pre-Ejection Period (PEP)-to-LVET ratio (PEP/LVET) increase (tMNS: p = 0.044, taVNS: p = 0.029). tMNS relative to sham also reduced Pulse Pressure (PP; p = 0.032) and tonic EDA activity (tonicMean; p = 0.025). The nonsignificant blinding survey results suggest these effects were not influenced by placebo. taVNS and tMNS effectively reduced stress-induced sympathetic arousal in wearable-compatible physiological signals, motivating their future use in novel personalized stress therapies to improve quality of life.

The Beverage Hydration Index: Influence of Electrolytes, Carbohydrate and Protein.

The beverage hydration index (BHI) facilitates a comparison of relative hydration properties of beverages using water as the standard. The additive effects of electrolytes, carbohydrate, and protein on rehydration were assessed using BHI. Nineteen healthy young adults completed four test sessions in randomized order: deionized water (W), electrolytes only (E), carbohydrate-electrolytes (C + E), and 2 g/L dipeptide (alanyl-glutamine)-electrolytes (AG + E). One liter of beverage was consumed, after which urine and body mass were obtained every 60 min through 240 min. Compared to W, BHI was higher (p = 0.007) for C + E (1.15 ± 0.17) after 120 min and for AG + E (p = 0.021) at 240 min (1.15 ± 0.20). BHI did not differ (p > 0.05) among E, C + E, or AG + E; however, E contributed the greatest absolute net effect (>12%) on BHI relative to W. Net fluid balance was lower for W (p = 0.048) compared to C + E and AG + E after 120 min. AG + E and E elicited higher (p < 0.001) overall urine osmolality vs. W. W also elicited greater reports of stomach bloating (p = 0.02) compared to AG + E and C + E. The addition of electrolytes alone (in the range of sports drinks) did not consistently improve BHI versus water; however, the combination with carbohydrate or dipeptides increased fluid retention, although this occurred earlier for the sports drink than the dipeptide beverage. Electrolyte content appears to make the largest contribution in hydration properties of beverages for young adults when consumed at rest.

An Interpretable Experimental Data Augmentation Method to Improve Knee Health Classification Using Joint Acoustic Emissions.

The characteristics of joint acoustic emissions (JAEs) measured from the knee have been shown to contain information regarding underlying joint health. Researchers have developed methods to process JAE measurements and combined them with machine learning algorithms for knee injury diagnosis. While these methods are based on JAEs measured in controlled settings, we anticipate that JAE measurements could enable accessible and affordable diagnosis of acute knee injuries also in field-deployable settings. However, in such settings, the noise and interference would be greater than in sterile, laboratory environments, which could decrease the performance of existing knee health classification methods using JAEs. To address the need for an objective noise and interference detection method for JAE measurements as a step towards field-deployable settings, we propose a novel experimental data augmentation method to locate and then, remove the corrupted parts of JAEs measured in clinical settings. In the clinic, we recruited 30 participants, and collected data from both knees, totaling 60 knees (36 healthy and 24 injured knees) to be used subsequently for knee health classification. We also recruited 10 healthy participants to collect artifact and joint sounds (JS) click templates, which are audible, short duration and high amplitude JAEs from the knee. Spectral and temporal features were extracted, and clinical data was augmented in five-dimensional subspace by fusing the existing clinical dataset into experimentally collected templates. Then knee scores were calculated by training and testing a linear soft classifier utilizing leave-one-subject-out cross-validation (LOSO-CV). The area under the curve (AUC) was 0.76 for baseline performance without any window removal with a logistic regression classifier (sensitivity = 0.75, specificity = 0.78). We obtained an AUC of 0.86 with the proposed algorithm (sensitivity = 0.80, specificity = 0.89), and on average, 95% of all clinical data was used to achieve this performance. The proposed algorithm improved knee health classification performance by the added information through identification and collection of common artifact sources in JAE measurements. This method when combined with wearable systems could provide clinically relevant supplementary information for both underserved populations and individuals requiring point-of-injury diagnosis in field-deployable settings.

Caffeine Ingestion With or Without Low-Dose Carbohydrate Improves Exercise Tolerance in Sedentary Adults.

Caffeine (CAF) and carbohydrate (CHO) ingestion delay fatigue during prolonged exercise; however, this is primarily documented in endurance trained (ET) athletes. Our purpose was to determine if these ergogenic aids are also effective to improve exercise tolerance in age-matched sedentary (SED) adults. Using a double-blind crossover design, ET and SED (n = 12 each group) completed four exercise trials consisting of 30 min cycling at standardized matched work rates 10% below lactate threshold (MOD-EX) followed by a time to fatigue (TTF) ride at individually prescribed intensity of 5% above lactate threshold. After standardized breakfast, the following drink treatments were given before and throughout exercise: CAF (3 mg/kg of body mass, equivalent to 1.5 cups premium brewed coffee), low calorie CHO (LCHO) (0.4% solution, 2 g total CHO), CAF+LCHO, and artificially-sweetened placebo (PLA). SED and ET had similar perceived exertion (RPE) during MOD-EX and TTF (23.8 ± 3.1 and 24.1 ± 2.6 min in ET, SED, respectively). LCHO did not benefit exercise tolerance compared to PLA and was less effective (p < 0.05) compared to CAF+LCHO for all participants combined. Thus, the two CAF treatments were averaged, resulting in ~5% lower RPE (p < 0.05) and 21% longer TTF (26.3 ± 10.4 min) compared to the no-CAF (21.7 ± 9.9 min) treatments. Blood glucose and lactate were higher (p < 0.05) with CAF vs. no-CAF. SED and ET only differed in metabolic oxidation rates during exercise (higher overall fat oxidation with ET compared to SED). CAF reduces the perceived effort during exercise and increases the capacity for sedentary individuals, as well as trained athletes, to tolerate higher intensity exercise for greater duration; and, these benefits were not further enhanced by ingesting doses of low carbohydrate regularly during exercise.

Aging impairs regulation of ryanodine receptors from extensor digitorum longus but not soleus muscles.

INTRODUCTION: Because impaired excitation-contraction coupling and reduced sarcoplasmic reticulum (SR) Ca2+ release may contribute to the age-associated decline in skeletal muscle strength, we investigated the effect of aging on regulation of the skeletal muscle isoform of the ryanodine receptor (RyR1) by physiological channel ligands. METHODS: [3 H]Ryanodine binding to membranes from 8- and 26-month-old Fischer 344 extensor digitorum longus (EDL) and soleus muscles was used to investigate the effects of age on RyR1 modulation by Ca2+ and calmodulin (CaM). RESULTS: Aging reduced maximal Ca2+ -stimulated binding to EDL membranes. In 0.3 µM Ca2+ , age reduced binding and CaM increased binding to EDL membranes. In 300 µM Ca2+ , CaM reduced binding, but the age effect was not significant. Aging did not affect Ca2+ or CaM regulation of soleus RyR1. DISCUSSION: In aged fast-twitch muscle, impaired RyR1 Ca2+ regulation may contribute to lower SR Ca2+ release and reduced muscle function. Muscle Nerve 57: 1022-1025, 2018.

Limitations of body mass index for counseling individuals with unilateral lower extremity amputation.

BACKGROUND: Body composition is important for health screening, but appropriate methods for unilateral lower extremity amputees have not been validated. OBJECTIVES: To compare body mass index adjusted using Amputee Coalition equations (body mass index-Amputee Coalition) to dual-energy X-ray absorptiometry in unilateral lower limb amputees. STUDY DESIGN: Cross-sectional, experimental. METHODS: Thirty-eight men and women with lower limb amputations (transfemoral, transtibial, hip disarticulation, Symes) participated. Body mass index (mass/height2) was compared to body mass index corrected for limb loss (body mass index-Amputee Coalition). Accuracy of classification and extrapolation of percent body fat with body mass index was compared to dual-energy X-ray absorptiometry. RESULTS: Body mass index-Amputee Coalition increased body mass index (by ~ 1.1 kg/m2) but underestimated and mis-classified 60% of obese and overestimated 100% of lean individuals according to dual-energy X-ray absorptiometry. Estimated mean percent body fat (95% confidence interval) from body mass index-Amputee Coalition (28.3% (24.9%, 31.7%)) was similar to dual-energy X-ray absorptiometry percent body fat (29.5% (25.2%, 33.7%)) but both were significantly higher ( p < 0.05) than percent body fat estimated from uncorrected body mass index (23.6% (20.4%, 26.8%)). However, total errors for body mass index and body mass index-Amputee Coalition converted to percent body fat were unacceptably large (standard error of the estimate = 6.8%, 6.2% body fat) and the discrepancy between both methods and dual-energy X-ray absorptiometry was inversely related ( r = -0.59 and r = -0.66, p < 0.05) to the individual's level of body fatness. CONCLUSIONS: Body mass index (despite correction) underestimates health risk for obese patients and overestimates lean, muscular individuals with lower limb amputation. Clinical relevance Clinical recommendations for an ideal body mass based on body mass index-Amputee Coalition should not be relied upon in lower extremity amputees. This is of particular concern for obese lower extremity amputees whose health risk might be significantly underestimated based on body mass index despite a "correction" formula for limb loss.

Carbohydrate ingestion but not mouth rinse maintains sustained attention when fasted.

UNLABELLED: Carbohydrate (CHO) receptors in the mouth signal brain areas involved in cognitive tasks relying upon motivation and task persistence; however, the minimal CHO dose that improves mental activity is unclear. PURPOSE: To determine if CHO (via ingestion or oral rinse) influences sustained attention without eliciting glycemic responses when in a fasted state. METHODS: Study A: Six healthy adults completed five treatment trials, ingesting 0-6% CHO solutions to evaluate glycemic response. Peak blood glucose for 6% and 1.5% CHO was greater (p<0.05) than 0% and 0.4% CHO; thus, the low 0.4% CHO was evaluated further. Study B: Following an overnight fast, ten healthy adults completed three trials in a crossover design: 1) 400 ml 0.4% CHO ingested serially via 25 ml boluses, 2) 375 ml 0% CHO control (CON) ingested followed by one 25 ml 6% CHO isocaloric (1.5 g CHO) mouth rinse, and 3) CON ingest followed by CON rinse. Following treatments, a 20 min Continuous Performance Task (CPT) was performed to assess accuracy and precision. RESULTS: Accuracy and precision were not different during the first 5 min of CPT. However, accuracy was maintained with CHO ingest (p=1.0) but decreased over 20 min (p<0.05) with both CHO and CON rinse treatments. Precision tended to decline over 20 min CPT with CON (p=0.06) and CHO rinse (p=0.05) but were maintained with CHO ingest (p=1.0). No differences in glycemic responses were observed between treatments. CONCLUSIONS: Compared to mouth rinsing CON or CHO (1.5 g in 6% CHO), ingestion of an isocaloric low-CHO drink maintained sustained attention over a mentally fatiguing task and appears effective after fasting without eliciting a glycemic response.

Mitral valve annular downsizing forces: implications for annuloplasty device development.

OBJECTIVE: Mitral valve repair with annulus downsizing is a popular surgical procedure for functional mitral regurgitation. We investigated the effects of externally applied downsizing on the observed in-plane forces and valvular dimensions. METHODS: Five animals were included in an acute porcine study. Three traction sutures were anchored at the right fibrous trigone (T) and suspended across the annulus for externalization at the P1, P2, and P3 annular segments. The annulus was downsized with the sutures in controlled increments while measuring the tension force in the sutures. Downsizing percentages ranged from a 2% to 32% reduction of the T-P distances. Sonomicrometry was used to measure the resulting valvular dimensions. RESULTS: No difference in force was found between the P1, P2, and P3 segments across all levels of downsizing. The peak forces at 32% downsizing were 1.2 ± 0.9 N, 1.5 ± 1.0 N, and 0.8 ± 0.2 N for the T-P1, T-P2, and T-P3 segments, respectively. The maximum total suture forces in the mitral plane during downsizing increased from 0.12 ± 0.03 N to 3.5 ± 1.3 N (P < .005). Sonomicrometry showed a decrease in the systolic thickening of the posterior myocardial wall at the annular level with annular downsizing (0%-32%) from 5 ± 3 mm to 1 ± 1 mm (P < .05). CONCLUSIONS: Segmental mitral valve annulus downsizing increased in-plane traction suture forces and has a significant influence on the in-plane biomechanics. These results have implications for device design in terms of mechanical strength requirements and can be used to supplement boundary conditions for computational left heart models.

Contractile mitral annular forces are reduced with ischemic mitral regurgitation.

OBJECTIVE: Forces acting on mitral annular devices in the setting of ischemic mitral regurgitation are currently unknown. The aim of this study was to quantify the cyclic forces that result from mitral annular contraction in a chronic ischemic mitral regurgitation ovine model and compare them with forces measured previously in healthy animals. METHODS: A novel force transducer was implanted in the mitral annulus of 6 ovine subjects 8 weeks after an inferior left ventricle infarction that produced progressive, severe chronic ischemic mitral regurgitation. Septal-lateral and transverse forces were measured continuously for cardiac cycles reaching a peak left ventricular pressure of 90, 125, 150, 175, and 200 mm Hg. Cyclic forces and their rate of change during isovolumetric contraction were quantified and compared with those measured in healthy animals. RESULTS: Animals with chronic ischemic mitral regurgitation exhibited a mean mitral regurgitation grade of 2.3 ± 0.5. Ischemic mitral regurgitation was observed to decrease significantly septal-lateral forces at each level of left ventricular pressure (P < .01). Transverse forces were consistently lower in the ischemic mitral regurgitation group despite not reaching statistical significance. The rate of change of these forces during isovolumetric contraction was found to increase significantly with peak left ventricular pressure (P < .005), but did not differ significantly between animal groups. CONCLUSIONS: Mitral annular forces were measured for the first time in a chronic ischemic mitral regurgitation animal model. Our findings demonstrated an inferior left ventricular infarct to decrease significantly cyclic septal-lateral forces while modestly lowering those in the transverse. The measurement of these forces and their variation with left ventricular pressure contributes significantly to the development of mitral annular ischemic mitral regurgitation devices.

Acute carbohydrate ingestion affects lactate response in highly trained swimmers.

PURPOSE: Effects of acute carbohydrate ingestion on blood lactate (BLa) response to graded exercise was examined in highly trained male and female swimmers. METHODS: Twenty-three swimmers performed the United States Swimming Lactate Protocol, a graded interval test (5x200 on 5 min), following ingestion of carbohydrate sports drink (CHO) and placebo (PLA). RESULTS: There was no difference in heart rate (P=.55), swim velocity (P=.95), or ratings of perceived exertion (P=.58) between beverages. There was a significant main effect for gender (P=.002) on BLa during all swim stages and recovery. In females, BLa was 27% to 50% higher for CHO during the first (P=.009) and second (P=.04) swim stages. Predicted BLa at selected swim velocity was higher (P=.048) for CHO versus PLA in females at 1.27 mxs(-1) and higher (P<.02) for men at 1.4 mxs(-1). Mean (+/-SD) BLa was significantly (P=.004) greater for CHO (2.7+/-1.2) compared with PLA (2.0+/-1.1 mmolxL(-1)) during the second test stage and when normalized relative to velocity (P=.004). Peak BLa after the final swim (9.6+/-3.1 vs. 9.0+/-3.2 mmolxL(-1), P=.36) was not different between CHO and PLA. CONCLUSIONS: Acute CHO ingestion alters the BLa: swim velocity relationship during moderate intensity swims of an incremental swim test, particularly for females. Therefore, pretest beverage ingestion should be standardized during the administration of BLa testing to prevent potential erroneous interpretations regarding athlete's training status.

Metabolic and thermoregulatory responses to a simulated American football practice in the heat.

Energy cost is a major factor influencing the tolerable thermal load, particularly during exercise in the heat. However, no data exist on the metabolic cost of football practice, although a value of 35% of maximal aerobic capacity (VO(2)max) has been estimated. The energy cost and thermoregulatory response of offensive linemen (OL) was measured wearing different American football ensembles during a simulated half of football practice in the heat. Five collegiate offensive linemen (133 kg, 20% fat, 42 ml x kg(-1) x min(-1) maximal oxygen uptake) completed each of four 60-minute test sessions in an environmental chamber (28 degrees C, 55% relative humidity [RH]) wearing shorts (S), helmet (H), helmet and shoulder pads (HS), and full gear (FUL). Core temperature in the digestive tract (TGI) was obtained using an ingestible sensor. During simulated football drills (e.g., repetitions of drive blocking), exercise intensity ranged from 30 to 81% VO(2)max but averaged 55%VO(2)max (6.7 METS) overall. Blood lactate remained >5 mmol x L(-1), and heart rate (HR) averaged 79%HRmax. Equipment had a significant effect on %VO(2)max but only during recovery between drills with HS (61.4 +/- 3.7%) compared with H (53.3 +/- 6.9%) and S (40.1 +/- 8.5%). The TGI was higher (p < 0.05) with HS compared with H at several time-points after 30 minutes. Football practice for OL elicits a significantly higher overall metabolic cost (>6 METS, >50%VO(2)max) than assumed in previous studies. The addition of shoulder pads increases core temperature and energy cost, especially during recovery between active drills in unacclimatized linemen.

Should carbohydrate concentration of a sports drink be less than 8% during exercise in the heat?

Our purpose was to determine if sports drinks with 6 and 8% CHO differentially affect physiological responses or run performance in the heat. Ten men ran 32 km while ingesting: placebo (P), 6% carbohydrate-electrolyte (CE6), and 8% carbohydrate-electrolyte (CE8). At 15 km, a 250 mL drink labeled with deuterium oxide (D2O) was ingested. Blood glucose and respiratory exchange ratio were significantly higher (P < 0.05) for CE6 and CE8 compared to P. Rectal temperature (T(re)) at 32 km was higher for CE8 (40.1 +/- 0.2 degrees C) compared to P (39.5 +/- 0.2 degrees C) but similar to CE6 (39.8 +/- 0.2 degrees C). D2O accumulation was not different among drink trials. Run performance was 8% faster for CE8 (1062 +/- 31 s) compared to P (1154 +/- 56 s) and similar to CE6 (1078 +/- 33 s). Confirming the ACSM Position Stand, 8% CE are acceptable during exercise in the heat and attenuate the decline in performance.

Effect of race and musculoskeletal development on the accuracy of air plethysmography.

PURPOSE: The purpose of this study was to determine the effect of race and musculoskeletal development on the accuracy of estimates of body fatness (%fat) via air displacement plethysmography (AP). METHODS: Estimates of %fat were made via AP, hydrostatic weighing (HW), dual-energy x-ray absorptiometry (DXA), and the criterion, a four-component model (4C) in 64 black (B) and white (W) men, who were either resistance trained (RT) or served as controls (C). RESULTS: Based on a three-way ANOVA, there were no statistically significant three-way or race x musculoskeletal development interactions. There was no main effect of race on the validity of estimating %fat by AP; the mean bias between %FatAP and %Fat4C was similar for B (3.6% body fat) and W (3.7%). In addition, the density of the fat-free mass (Dffm) for B (1.098 +/- 0.002 g x mL) was not different than 1.10 g x mL. There was a significant effect of musculoskeletal development on the validity of the estimation of %fat from AP; the mean difference in %fat between %FatAP and %Fat4C was less in RT (1.5% body fat) than in C (5.3%), but a large SEE of 5.5% was observed for RT. A significant (P < 0.05) correlation was found between the mean bias between methods and body volume (-0.44) and mesomorphy (-0.55). CONCLUSIONS: Race does not affect the accuracy of estimating %fat by AP. Race-specific equations estimating %fat via densitometry (e.g., AP, HW) such as the Schutte are not justified, because Dffm is not greater than 1.10 g x mL. Estimation of %fat via AP is more accurate in larger individuals with high musculoskeletal development as a group, but individual results are highly variable.

Physical activity patterns in recent college alumni.

Within this sample of recent college alumni, a high proportion indicated that they enjoy exercise (66.1%) and felt confident in setting their own fitness programs (79.4%). Yet, only 34.3% reported engaging in recommended levels of moderate or vigorous PA. In contrast to previous reports, rates of participation in vigorous, moderate, and strengthening-type PA did not differ between men and women. Alumni who reported that they engaged in adequate levels of moderate or vigorous PA had gained significantly less weight in the years following graduation than those who reported being insufficiently active (3.0 kg vs. 6.1 kg). Last, we noted a strong positive association between PA patterns as college seniors and current PA behavior as recent alumni.