Performing one or more verification VO2 workload(s) immediately after an incremental to maximal graded exercise test significantly increases the proportion of participants who meet the job-related aerobic fitness standard for structural firefighters.

PURPOSE: Graded exercise tests (GXTs) are commonly used to determine the maximal oxygen consumption (VO2max) of firefighter applicants. However, the criteria used to confirm VO2max are inconsistent and have a high inter-subject variability, which can compromise the reliability of the results. To address this, a verification phase (VP) after the GXT has been proposed as a "gold standard" protocol for measuring VO2max. METHODS: 4179 male and 283 female firefighter applicants completed a GXT and a VP to measure their VO2max. VO2peak values measured during the GXT were compared to the VO2 values measured during the VP. The proportion of participants who met the job-related aerobic fitness standard during the GXT was compared to that of those who met the required standard during the VP. RESULTS: For male and female participants that required the VP to attain their VO2max, the VO2peak values measured during the GXT (47.3 ± 6.0 and 41.6 ± 5.3 mL kg-1 min-1) were, respectively, 10.1% and 10.3% lower than the VO2 values measured during the VP (52.1 ± 6.7 and 45.9 ± 6.4 mL kg-1 min-1), p < 0.001. Furthermore, the proportion of male and female participants who met the job-related aerobic fitness standard significantly increased from the GXT to the VP by 11.6% and 29.9%, respectively, p < 0.001. CONCLUSION: These results strongly support the use of a VP to confirm VO2max, especially for females, older and overweight individuals. These findings are applicable to other physically demanding public safety occupations and when examining the efficacy of training interventions on VO2max.

A Comparison of On-Ice External Load Measures Between Subelite and Elite Female Ice Hockey Players.

ABSTRACT: Douglas, AS, Rotondi, MA, Baker, J, Jamnik, VK, and Macpherson, AK. A comparison of on-ice external load measures between subelite and elite female ice hockey players. J Strength Cond Res 36(7): 1978-1983, 2022-This study quantified and examined differences in measures of on-ice external load for subelite and elite female ice hockey players. External load variables were collected from subelite (N = 21) and elite (N = 24) athletes using Catapult S5 monitors during the preseason. A total of 574 data files were analyzed from training and competition during the training camp. Significant differences between groups were found across all variables. Differences in training between the 2 groups ranged from trivial (forwards PlayerLoad, p = 0.03, effect-size [ES] = 0.18) to large (forwards Explosive Efforts [EEs], p < 0.001, ES = 1.64; defense EEs, p < 0.001, ES = 1.40). Match comparisons yielded similar results, with differences ranging from small (defense Low Skating Load [SL], p = 0.05, ES = 0.49; Medium SL, p = 0.04, ES = 0.52) to very large (forwards PlayerLoad, p < 0.001. ES = 2.25; PlayerLoad·min-1, p < 0.001, ES = 2.66; EEs, p < 0.001, ES = 2.03; Medium SL, p < 0.001, ES = 2.31; SL·min-1, p < 0.001, ES = 2.67), respectively. The differences in external load measures of intensity demonstrate the need to alter training programs of subelite ice athletes to ensure they can meet the demands of elite ice hockey. As athletes advance along the development pathway, considerable focus of their off-ice training should be to improve qualities that enhance their ability to perform high-intensity on-ice movements.

Association between physical activity level and cardiovascular risk factors in adolescents living with type 1 diabetes mellitus: a cross-sectional study.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is associated with an increased risk for cardiovascular disease (CVD) related morbidity and premature mortality. Regular physical activity plays an important role in the primary and secondary prevention of CVD, improving overall health and wellbeing. Previous observational studies have examined the associations between self-reported physical activity and CVD risk factors in largely adult Caucasian populations. However, limited work has evaluated the relationship between objectively measured physical activity and CVD risk factors in other ethnicities, particularly Chinese youth living with T1DM. METHODS: This cross-sectional study assessed CVD risk factors, physical activity, and aerobic fitness (and their associations) in Chinese youth living with T1DM (n = 48) and peers (n = 19) without T1DM. Primary outcomes included blood pressure, lipid profiles, and physical activity (accelerometry). Statistical differences between groups were determined with chi-square, independent-samples t-tests, or analysis of covariance. The associations between aerobic fitness, daily physical activity variables, and CVD risk factors were assessed with univariate and multivariate linear regression analyses. RESULTS: Results were summarized using means and standard deviation (SD) for normally distributed variables and medians and 25-75th quartile for non-normally distributed variables. In comparison to peers without diabetes, youth living with T1DM showed higher levels of total cholesterol (3.14 ± 0.67 vs. 4.03 ± 0.81 mmol·L-1, p = 0.001), low-density lipoprotein cholesterol (1.74 ± 0.38 vs. 2.31 ± 0.72 mmol·L-1, p = 0.005), and triglycerides (0.60 ± 0.40 vs. 0.89 ± 0.31 mmol·L-1 p = 0.012), and lower maximal oxygen power (44.43 ± 8.29 vs. 35.48 ± 8.72 mL·kg-1·min-1, p = 0.003), total physical activity counts (451.01 ± 133.52 vs. 346.87 ± 101.97 counts·min-1, p = 0.004), metabolic equivalents (METs) (2.41 ± 0.60 vs. 2.09 ± 0.41 METs, p = 0.033), moderate-to-vigorous intensity physical activity [MVPA: 89.57 (61.00-124.14) vs (53.19 (35.68-63.16) min, p = 0.001], and the percentage of time spent in MVPA [11.91 (7.74-16.22) vs 8.56 (6.18-10.12) %, p = 0.038]. The level of high-density lipoprotein cholesterol was positively associated with METs (ß = 0.29, p = 0.030, model R2 = 0.168), and the level of triglycerides was negatively associated with physical activity counts (ß = - 0.001, p = 0.018, model R2 = 0.205) and METs (ß = - 0.359, p = 0.015, model R2 = 0.208), and positively associated with time spent in sedentary behaviour (ß = 0.002, p = 0.041, model R2 = 0.156) in persons living with T1DM. CONCLUSIONS: Chinese youth with T1DM, despite their young age and short duration of diabetes, present early signs of CVD risk, as well as low physical activity levels and cardiorespiratory fitness compared to apparently healthy peers without diabetes. Regular physical activity is associated with a beneficial cardiovascular profile in T1DM, including improvements in lipid profile. Thus, physical activity participation should be widely promoted in youth living with T1DM.

No differences in the body fat after violating core bioelectrical impedance measurement assumptions.

OBJECTIVE: It is unclear to what degree acutely violating bioelectrical impedance analysis (BIA) measurement assumptions will alter the predicted percent fat mass (%FM) and whether this differs by sex or body mass index (BMI). METHODS: %FM was assessed under control, dehydration, exercise, water, food intake and non-voided bladder conditions with three BIA devices (Tanita: BC-418, TBF-314, & Omron HBF-306CN) for men (n = 23, age: 24.0 ± 5.2 years old) and women (n = 17, age: 22.5 ± 3.4 years old) separately. RESULTS: For all BIA devices, there were no differences in the %FM values between the control and the other conditions in men or women (- 1.9 to 0.4%, p > 0.05). Across the three devices and five conditions, 97% of %FM tests returned values within 5% of control (2 tests), and 86% of tests were within 2% of control despite violating an assumption. The errors were greatest with dehydration and women were more likely to have a %FM difference greater than 2% than men with dehydration using the hand-to-foot device (Tanita TBF-314: 59% versus 9%). There were no differences in %FM between control and the conditions when examined by BMI (overweight/obesity: - 2.8 to 0.1% and normal weight: - 1.7 to 0.5%; BMI*trial, p = 0.99). CONCLUSION: %FM estimates were similar despite acutely violating the preliminary measurement BIA assumptions across a range of different BMIs. The minor variations in %FM are smaller than what would be expected with day-to-day variability or weight loss intervention but may be larger in women than men.

Cross-associations between physical activity and sedentary time on metabolic health: a comparative assessment using self-reported and objectively measured activity.

Purpose: Physical activity and sedentary time have distinct physiologic and metabolic effects, but little is known about their joint associations. Methods: The Canadian Health Measures Survey (n = 5950) was used to (i) examine the joint relationship between active/non-sedentary (referent group), active/sedentary, inactive/non-sedentary and inactive/sedentary phenotypes on obesity and metabolic health; and (ii) compare these relationships when using objective (accelerometer) total activity or subjective (self-report) leisure-time measures. Weighted associations for the metabolic syndrome (MetS), individual MetS components, 1+ disease (1 or more of diabetes, myocardial infarction, stroke, cardiovascular disease) and obesity were estimated using logistic regression. Results: After adjustments, the odds (OR, 95% CI) of 1+ disease (OR = 3.05, 1.47-6.34) and abdominal obesity (OR = 2.75, 1.16-6.55) were higher in the inactive/sedentary group versus the referent group (OR = 1.00) when measured objectively. Within self-report leisure-time groups, elevated odds were observed for the inactive/sedentary group for MetS, obesity, abdominal obesity and elevated triglycerides. Inactive/non-sedentary and active/sedentary groups were similarly protective when measured by accelerometer. Conclusion: Using accelerometer data, the inactive/sedentary group was at higher risk for 1+ disease and abdominal obesity only, whereas the active/sedentary and inactive/non-sedentary groups were not at higher risk for any health outcome.

Physical employment standard for Canadian wildland fire fighters; identifying and characterising critical initial attack response tasks.

Physical employment standards evaluate whether a worker possesses the physical abilities to safely and efficiently perform all critical on-the-job tasks. Initial Attack (IA) wildland fire fighters (WFF) must perform such critical tasks in all terrains. Following a physical demands analysis, IA WFF (n = 946 out of a possible 965) from all fire jurisdictions ranked the most demanding tasks and identified mountains, muskeg and rolling hills as the most challenging terrains. Experimental trials found the oxygen cost (mean ± SD V˙ O2 mL·kg-1·min-1) while performing the hose pack back carry to be 40 ± 7 in steep mountains, 34 ± 5 in muskeg and 34 ± 2 in rolling hills (n = 168). Back-carrying and hand-carrying a 28.5 kg pump, back-carrying a 25 kg hose pack and advancing charged hose were the most demanding tasks. Performing the same emergency IA WFF tasks was significantly more demanding in mountains (p ≤ 0.05), and these higher demands must be taken into account when developing a physical employment standard for Canadian wildland fire fighters. Practitioner Summary: Physical employment standards evaluate whether an applicant or incumbent possesses the physical and physiological abilities to safely and efficiently perform the critical on-the-job tasks. This paper details the process used to undertake a physical demands analysis and characterise tasks for the development of a  circuit test and fitness employment standard for IA WFF.

Physical employment standard for Canadian wildland firefighters: examining test-retest reliability and the impact of familiarisation and physical fitness training.

To assess the impact of repeat performances (familiarisation) plus exercise training on completion time for the Ontario Wildland Firefighter (WFF) Fitness Test circuit (WFX-FIT), normally active general population participants (n = 145) were familiarised to the protocol then randomised into (i) exercise training, (ii) circuit only weekly performances or (iii) controls. At Baseline, the WFX-FIT pass rate for all groups combined was 11% for females and 73% for males, indicating that the Ontario WFX-FIT standard had a possible adverse impact on females. Following test familiarisation, mean circuit completion times improved by 11.9% and 10.2% for females and males, respectively. There were significant improvements in completion time for females (19.8%) and males (16.9%) who trained, plus females (12.2%) and males (9.8%) who performed the circuit only, while control participants were unchanged. Post training, the pass rate of the training group was 80% for females and 100% for males. Practitioner Summary: This paper details the impact of familiarisation plus exercise training as accommodation to mitigate potential adverse impact on initial attack wildland firefighter test performance. The results underscore the importance of test familiarisation opportunities and physical fitness training programmes that are specific to the demands of the job.

Physical employment standard for Canadian wildland fire fighters; developing and validating the test protocol.

Developing the Canadian initial attack (IA) wildland fire fighter (WFF) physical employment standard (WFX-FIT) began in a previous investigation with a physical demands analysis in which hand and back carrying a 28.5 kg pump, back carrying a 25 kg hose pack and advancing charged hose were identified as the critical IA emergency tasks. In the present study, a circuit was created incorporating simulations of the critical tasks with faster completion times required for provinces with more arduous terrains. The oxygen cost (mean ± SD VO2 mL∙kg-1∙min-1) of performing IA WFF tasks sequentially on the job was 37 ± 6 compared to 37 ± 4 when performing the WFX-FIT, indicating strong construct validity. Content validation ratings comparing the likeness of on-the-job tasks to simulated tasks in the WFX-FIT provided strong agreement. These validations confirm that the physical demands involved in performing the WFX-FIT are the same as IA wildland fire fighting. Practitioner Summary: This paper details the process used to develop and validate the physical employment standard for jurisdictional employment and national exchange of IA WFF. The range of cut-scores reflects the differences in jurisdictional physical demands due to terrain difficulty, fire management policy on fire risk and forest value index.

The human immune system recognizes neopeptides derived from mitochondrial DNA deletions.

Mutations in mitochondrial (mt) DNA accumulate with age and can result in the generation of neopeptides. Immune surveillance of such neopeptides may allow suboptimal mitochondria to be eliminated, thereby avoiding mt-related diseases, but may also contribute to autoimmunity in susceptible individuals. To date, the direct recognition of neo-mtpeptides by the adaptive immune system has not been demonstrated. In this study we used bioinformatics approaches to predict MHC binding of neopeptides identified from known deletions in mtDNA. Six such peptides were confirmed experimentally to bind to HLA-A*02. Pre-existing human CD4(+) and CD8(+) T cells from healthy donors were shown to recognize and respond to these neopeptides. One remarkably promiscuous immunodominant peptide (P9) could be presented by diverse MHC molecules to CD4(+) and/or CD8(+) T cells from 75% of the healthy donors tested. The common soil microbe, Bacillus pumilus, encodes a 9-mer that differs by one amino acid from P9. Similarly, the ATP synthase F0 subunit 6 from normal human mitochondria encodes a 9-mer with a single amino acid difference from P9 with 89% homology to P9. T cells expanded from human PBMCs using the B. pumilus or self-mt peptide bound to P9/HLA-A2 tetramers, arguing for cross-reactivity between T cells with specificity for self and foreign homologs of the altered mt peptide. These findings provide proof of principal that the immune system can recognize peptides arising from spontaneous somatic mutations and that such responses might be primed by foreign peptides and/or be cross-reactive with self.

Integration of the functional movement screen into the National Hockey League Combine.

The sport of ice hockey requires coordination of complex skills involving musculoskeletal and physiological abilities while simultaneously exposing players to a high risk for injury. The Functional Movement Screen (FMS) was developed to assess fundamental movement patterns that underlie both sport performance and injury risk. The top 111 elite junior hockey players from around the world took part in the 2013 National Hockey League Entry Draft Combine (NHL Combine). The FMS was integrated into the comprehensive medical and physiological fitness evaluations at the request of strength and conditioning coaches with affiliations to NHL teams. The inclusion of the FMS aimed to help develop strategies that could maximize its utility among elite hockey players and to encourage or inform further research in this field. This study evaluated the outcomes of integrating the FMS into the NHL Combine and identified any links to other medical plus physical and physiological fitness assessment outcomes. These potential associations may provide valuable information to identify elements of future training programs that are individualized to athletes' specific needs. The results of the FMS (total score and number of asymmetries identified) were significantly correlated to various body composition measures, aerobic and anaerobic fitness, leg power, timing of recent workouts, and the presence of lingering injury at the time of the NHL Combine. Although statistically significant correlations were observed, the implications of the FMS assessment outcomes remain difficult to quantify until ongoing assessment of FMS patterns, tracking of injuries, and hockey performance are available.

Identifying persons at risk for developing type 2 diabetes in a concentrated population of high risk ethnicities in Canada using a risk assessment questionnaire and point-of-care capillary blood HbA1c measurement.

BACKGROUND: Amidst the growing health care burden created by diabetes, this study aimed to assess the utility of a prediabetes/type 2 diabetes risk questionnaire in high risk ethnic communities in Toronto Canada. METHODS: Participants (n = 691) provided questionnaire responses and capillary blood tests collected via fingerstick and results were analysed for HbA1c using the Bio-Rad in2it point-of-care device. The Bland-Altman method was used to compare point-of-care HbA1c analysis (Bio-Rad, boronate affinity chromatography) to that using high performance liquid chromatography. ANOVA and linear regression were performed to investigate the relationship between questionnaire and blood data. RESULTS: Mean (± SD) HbA1c was 5.99% ± 0.84 and the Bland-Altman analysis revealed no significant biases HbA1c (bias = 0.039, 95% limits of agreement = -1.14 to 1.22). ANOVA showed that with increasing risk classification based on questionnaire answers (with the exception of "moderate"-to-"high"), there was a significant increase in mean HbA1c (Welch Statistic 30.449, p < 0.001). Linear regression revealed that the number of high risk parents, age category, BMI, physical activity participation and previous diagnosis of high blood sugar were significant contributors (p < 0.05) to the variance in HbA1c. CONCLUSIONS: Though not a substitute for established diagnostic protocols, the use of a risk questionnaire can be an accurate, low cost, educational and time efficient method for assessment of type 2 diabetes risk. The early detection of prediabetes and type 2 diabetes is vital to increased awareness and opportunity for intervention with the goal of preventing or delaying the progression of type 2 diabetes and the known associated complications.

T cell memory to evolutionarily conserved and shared hemagglutinin epitopes of H1N1 viruses: a pilot scale study.

BACKGROUND: The 2009 pandemic influenza was milder than expected. Based on the apparent lack of pre-existing cross-protective antibodies to the A (H1N1)pdm09 strain, it was hypothesized that pre-existing CD4+ T cellular immunity provided the crucial immunity that led to an attenuation of disease severity. We carried out a pilot scale study by conducting in silico and in vitro T cellular assays in healthy population, to evaluate the pre-existing immunity to A (H1N1)pdm09 strain. METHODS: Large-scale epitope prediction analysis was done by examining the NCBI available (H1N1) HA proteins. NetMHCIIpan, an eptiope prediction tool was used to identify the putative and shared CD4+ T cell epitopes between seasonal H1N1 and A (H1N1)pdm09 strains. To identify the immunogenicity of these putative epitopes, human IFN-γ-ELISPOT assays were conducted using the peripheral blood mononuclear cells from fourteen healthy human donors. All donors were screened for the HLA-DRB1 alleles. RESULTS: Epitope-specific CD4+ T cellular memory responses (IFN-γ) were generated to highly conserved HA epitopes from majority of the donors (93%). Higher magnitude of the CD4+ T cell responses was observed in the older adults. The study identified two HA2 immunodominant CD4+ T cell epitopes, of which one was found to be novel. CONCLUSIONS: The current study provides a compelling evidence of HA epitope specific CD4+ T cellular memory towards A (H1N1)pdm09 strain. These well-characterized epitopes could recruit alternative immunological pathways to overcome the challenge of annual seasonal flu vaccine escape.

Effect of tai chi on musculoskeletal health-related fitness and self-reported physical health changes in low income, multiple ethnicity mid to older adults.

BACKGROUND: Tai Chi (TC) has proven to be effective at improving musculoskeletal fitness by increasing upper and lower body strength, low back flexibility and overall physical health. The objectives of this study were to examine changes in musculoskeletal health-related fitness and self-reported physical health after a 16 week TC program in a low income multiple ethnicity mid to older adult population. METHODS: Two hundred and nine ethnically diverse mid to older community dwelling Canadian adults residing in low income neighbourhoods were enrolled in a 16 week Yang style TC program. Body Mass Index and select musculoskeletal fitness measures including upper and lower body strength, low back flexibility and self-reported physical health measured by SF 36 were collected pre and post the TC program. Determinants of health such as age, sex, marital status, education, income, ethnicity of origin, multi-morbidity conditions, weekly physical activity, previous TC experience as well as program adherence were examined as possible musculoskeletal health-related fitness change predictors. RESULTS: Using paired sample t-tests significant improvements were found in both upper and lower body strength, low back flexibility, and the SF 36 physical health scores (p < 0.05). Based on multiple linear regression analyses, no common health determinants explained a significant portion of the variation in percent changes of the musculoskeletal fitness and SF 36 measures. CONCLUSIONS: These results reveal that TC has the potential of having a beneficial influence on musculoskeletal health-related fitness and self-reported physical health in a mid to older low socioeconomic, ethnically diverse sample.

Catalog of Canadian fitness screening protocols for public safety occupations that qualify as a bona fide occupational requirement.

The purpose of this paper was to provide succinct descriptions of prominent job-specific physical fitness protocols (JSPFPs) that were constructed to satisfy the legal obligations to qualify as a bona fide occupational requirement for physically demanding public safety occupations. The intent of a JSPFP is to determine whether an applicant or incumbent possesses the necessary physical capabilities to safely and efficiently perform the critical on-the-job tasks encountered in a physically demanding occupation. The JSPFP information summarized in this report is accessible in full detail in the public domain. Therefore, prospective JSPFP participants and fitness professionals who require the information to train participants can fully inform themselves about the specific protocol requirements and associated fitness training implications.

Relationship of Fitness Combine Results and National Hockey League Performance: A 25-Year Analysis.

PURPOSE: Along with past performance, professional teams consider physical fitness and physiological potential in determining the value of prospective draft picks. The National Hockey League (NHL) Combine fitness results have been examined for their ability to predict draft order, but not bona fide hockey performance. Therefore, we sought to identify the relationships of combine fitness test results to short- and long-term NHL performance. METHODS: During NHL Combine fitness testing (1994-2007), a standardized battery of tests was conducted. Player performance (1995-2020) was quantified using career cumulative points, time on ice, transitional period to playing in the NHL, and NHL career length. Forward and defensive positions were considered separately. Goalies were not considered. Stepwise linear regression analysis was used to identify fitness variables that predict NHL success. RESULTS: Overall models ranged in their predictive ability from 2% to 16%. The transitional period was predicted by peak leg power and aerobic capacity (V˙O2max; forwards, R2 = .03, and defense, R2 = .06, both P < .01). Points and time on ice within seasons 1 to 3 were predicted by peak leg power and V˙O2max for forwards and defense (R2 = .02-.09, P < .01). Among players accumulating 10 NHL seasons, cumulative points were inversely related to upper-body push-strength-related variables in forwards (R2 = .11) and defense (R2 = .16; both P < .01). CONCLUSIONS: The NHL Combine fitness testing offers meaningful data that can inform the likelihood of future success. Peak leg power and V˙O2max predict league entry and early career success. Counterintuitively, upper-body strength is inversely related to long-term performance, which may offer insight into recruitment strategies, player development, or differential team roles.

Associations between Sleep Characteristics and Cardiovascular Risk Factors in Adolescents Living with Type 1 Diabetes.

Adolescents living with type 1 diabetes (T1D) have an increased risk of developing cardiovascular disease. Sleep patterns have physiological and behavioral impacts on diabetes outcomes. This study aimed to investigate the associations between sleep patterns and CVD risk factors in adolescents living with T1D and their peers living without T1D. This cross-sectional study assessed CVD risk factors and sleep characteristics (and their associations) in adolescents, aged 12-18 years, living with T1D (n = 48) and their peers (n = 19) without T1D. Outcomes included blood pressure, lipid profiles, and sleep characteristics (accelerometry). Statistical differences between groups were determined with chi-square or independent samples t-tests. The associations between sleep characteristics and CVD risk factors were assessed with multivariate linear regression analyses. We found no significant differences between the two groups in terms of sleep duration, efficiency, sleep onset and offset, and frequency of awakenings, and there were associations between sleep efficiency and LDL-C (ß = -0.045, p = 0.018, model R2 = 0.230) and triglycerides (ß = -0.027, p = 0.012, model R2 = 0.222) after adjusting confounders (diabetes status, sex, age, pubertal stage) in all participants. In conclusion, adolescents with T1D and without T1D sleep less than the recommended eight hours per night. The associations between sleep efficiency and LDL-C and triglycerides are independent of sleep duration, regardless of sex, age, and pubertal stage.

Primary care provider perceptions of intake transition records and shared care with outpatient cardiac rehabilitation programs.

BACKGROUND: While it is recommended that records are kept between primary care providers (PCPs) and specialists during patient transitions from hospital to community care, this communication is not currently standardized. We aimed to assess the transmission of cardiac rehabilitation (CR) program intake transition records to PCPs and to explore PCPs' needs in communication with CR programs and for intake transition record content. METHOD: 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews. RESULTS: Sixty-eight (47.6%) PCPs received a CR intake transition record. Fifty-eight (87.9%) PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%). On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61), with 48 (76.2%) reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64), exercise test results (4.61 ± 0.52), and the proposed patient care plan (4.59 ± 0.71). CONCLUSIONS: Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.

Self-directed exercise improves perceived measures of health in adults with partly controlled asthma.

BACKGROUND: Supervised exercise leads to significant improvements in asthma control and quality-of-life in adults with partly controlled asthma; however, the role of unsupervised exercise is unknown. METHODS: The purpose of this study was to determine the impact of self-directed exercise on subjective and objective indices of asthma-related health. Participants (n = 24) were assigned to an exercise group or a control group for a 12-week period. Those in the exercise group were provided with exercise programs by a qualified exercise professional. These programs were updated through electronic mail every 3 weeks to ensure progression. Controls maintained their current lifestyle habits for the intervention period. Assessments of aerobic fitness, lung function, and subjective and objective asthma measures were conducted at baseline and after completion of the 12-week intervention period for both groups. Analysis of covariance was used to detect differences between groups from baseline to week 12. Qualitative analyses were used to assess responses to open-ended questions. RESULTS: Adherence to the program was poor. Perceived asthma control and self-reported frequency and severity of asthma improved significantly in the exercise group at week 12 compared with that in the control group. Objective measures of asthma such as asthma control, quality-of-life, and lung function, as well as peak and submaximal aerobic fitness did not change relative to controls. Responses to open-ended questions revealed improvements in three areas: asthma management, perceived fitness, and well-being. CONCLUSION: Adults with partly controlled asthma are able to improve perceived control and subjective measures of asthma-related health with 12 weeks of self-directed exercise; however, supervision may be required to make significant improvements to measured asthma control, quality of life, and aerobic fitness. Future research should focus on the means to improve adherence of self-directed exercise programs in this population.

A cross-sectional examination of the physical fitness and selected health attributes of recreational all-terrain vehicle riders and off-road motorcyclists.

The aims of this study were: (1) to characterize selected fitness and health attributes of two types of habitual recreational off-road vehicle riders - off-road motorcyclists and all-terrain vehicle riders; (2) to explore differences among riders in terms of vehicle type, age, and gender; and (3) to compare the fitness and health of riders to population norms and clinical health standards. Canadian off-road riders (n = 141) of both sexes aged 16 years and over were recruited through local and national off-road riding organizations. Anthropometry, fitness, and health measures of off-road motorcycle and all-terrain vehicle riders were compared with population norms, health standards, and physical activity guidelines. Off-road motorcycle riders had above average aerobic fitness (79th percentile), while all-terrain vehicle riders were lower than average (40th percentile). All riders had a healthy blood lipid profile and a low incidence of the metabolic syndrome (12.9%) compared with members of the general population. Off-road motorcycle riders had healthier body composition and fitness than all-terrain vehicle riders; however, the body composition of off-road motorcycle riders was no healthier than that of the general population and all-terrain vehicle riders were worse than the general population. Off-road motorcycle riders had healthier anthropometry and fitness than all-terrain vehicle riders and thus fewer health risk factors for future disease, demonstrating that the physiological profiles of off-road riders are dependent on vehicle type.

The role of physical activity in type 2 diabetes prevention: physiological and practical perspectives.

Lifestyle changes that include a nutritionally balanced diet and increased physical activity (PA) are effective intervention options for persons with prediabetes who want to prevent progression to type 2 diabetes mellitus. Although nutritional counseling is standard practice for patients in a clinical setting, an individualized PA prescription, including recommendations on the type, frequency, duration, and intensity, is much less likely to occur. This is surprising because lifestyle modifications including a PA program are at least as effective in diabetes prevention as any single pharmacological agent. The success of regular PA in improving glycemic control in persons with either prediabetes or type 2 diabetes likely results from adaptations that occur in several organs and tissues, including adipose, skeletal muscle, liver, and pancreas. Increased insulin sensitivity is an important link between increased PA, body composition, and metabolic health, and it is at this link where increases in PA and energy expenditure exert much of their effect on preventing metabolic disorders and improving symptoms of existing disease. In addition to improving insulin sensitivity, regular PA has several cardioprotective effects, especially for persons with metabolic dysfunction, and has been shown to elicit minimal adverse events in these populations. Effective PA prescription is contingent on an understanding of the underlying physiological adaptations and the differing responses to diverse modes and intensities of PA. This article highlights recent findings on the beneficial role of regular PA for improving and/or maintaining insulin sensitivity in persons with prediabetes. We also provide an evidence-informed prescription for the type, intensity, and duration of both resistance and aerobic PA in persons with prediabetes.