Heat stress increases carbohydrate oxidation rates and oxygen uptake during prolonged load carriage exercise.

Military missions are conducted in a multitude of environments including heat and may involve walking under load following severe exertion, the metabolic demands of which may have nutritional implications for fueling and recovery planning. Ten males equipped a military pack loaded to 30% of their body mass and walked in 20°C/40% relative humidity (RH) (TEMP) or 37°C/20% RH (HOT) either continuously (CW) for 90 min at the first ventilatory threshold or mixed walking (MW) with unloaded running intervals above the second ventilatory threshold between min 35 and 55 of the 90 min bout. Pulmonary gas, thermoregulatory, and cardiovascular variables were analyzed following running intervals. Final rectal temperature (MW: p < 0.001, g = 3.81, CW: p < 0.001, g = 4.04), oxygen uptake, cardiovascular strain, and energy expenditure were higher during HOT trials (p ≤ 0.05) regardless of exercise type. Both HOT trials elicited higher final carbohydrate oxidation (CHOox) than TEMP CW at min 90 (HOT MW: p < 0.001, g = 1.45, HOT CW: p = 0.009, g = 0.67) and HOT MW CHOox exceeded TEMP MW at min 80 and 90 (p = 0.049, g = 0.60 and p = 0.024, g = 0.73, respectively). There were no within-environment differences in substrate oxidation indicating that severe exertion work cycles did not produce a carryover effect during subsequent loaded walking. The rate of CHOox during 90 minutes of load carriage in the heat appears to be primarily affected by accumulated thermal load.

Resistance Training in the Heat: Mechanisms of Hypertrophy and Performance Enhancement.

ABSTRACT: Pryor, JL, Sweet, D, Rosbrook, P, Qiao, J, Hess, HW, and Looney, DP. Resistance training in the heat: Mechanisms of hypertrophy and performance enhancement. J Strength Cond Res 38(7): 1350-1357, 2024-The addition of heat stress to resistance exercise or heated resistance exercise (HRE) is growing in popularity as emerging evidence indicates altered neuromuscular function and an amplification of several mechanistic targets of protein synthesis. Studies demonstrating increased protein synthesis activity have shown temperature-dependent mammalian target of rapamycin phosphorylation, supplemental calcium release, augmented heat shock protein expression, and altered immune and hormone activity. These intriguing observations have largely stemmed from myotube, isolated muscle fiber, or rodent models using passive heating alone or in combination with immobilization or injury models. A growing number of translational studies in humans show comparable results employing local tissue or whole-body heat with and without resistance exercise. While few, these translational studies are immensely valuable as they are most applicable to sport and exercise. As such, this brief narrative review aims to discuss evidence primarily from human HRE studies detailing the neuromuscular, hormonal, and molecular responses to HRE and subsequent strength and hypertrophy adaptations. Much remains unknown in this exciting new area of inquiry from both a mechanistic and functional perspective warranting continued research.

Early trajectories of virological and immunological biomarkers and clinical outcomes in patients admitted to hospital for COVID-19: an international, prospective cohort study.

BACKGROUND: Serial measurement of virological and immunological biomarkers in patients admitted to hospital with COVID-19 can give valuable insight into the pathogenic roles of viral replication and immune dysregulation. We aimed to characterise biomarker trajectories and their associations with clinical outcomes. METHODS: In this international, prospective cohort study, patients admitted to hospital with COVID-19 and enrolled in the Therapeutics for Inpatients with COVID-19 platform trial within the Accelerating COVID-19 Therapeutic Interventions and Vaccines programme between Aug 5, 2020 and Sept 30, 2021 were included. Participants were included from 108 sites in Denmark, Greece, Poland, Singapore, Spain, Switzerland, Uganda, the UK, and the USA, and randomised to placebo or one of four neutralising monoclonal antibodies: bamlanivimab (Aug 5 to Oct 13, 2020), sotrovimab (Dec 16, 2020, to March 1, 2021), amubarvimab-romlusevimab (Dec 16, 2020, to March 1, 2021), and tixagevimab-cilgavimab (Feb 10 to Sept 30, 2021). This trial included an analysis of 2149 participants with plasma nucleocapsid antigen, anti-nucleocapsid antibody, C-reactive protein (CRP), IL-6, and D-dimer measured at baseline and day 1, day 3, and day 5 of enrolment. Day-90 follow-up status was available for 1790 participants. Biomarker trajectories were evaluated for associations with baseline characteristics, a 7-day pulmonary ordinal outcome, 90-day mortality, and 90-day rate of sustained recovery. FINDINGS: The study included 2149 participants. Participant median age was 57 years (IQR 46-68), 1246 (58·0%) of 2149 participants were male and 903 (42·0%) were female; 1792 (83·4%) had at least one comorbidity, and 1764 (82·1%) were unvaccinated. Mortality to day 90 was 172 (8·0%) of 2149 and 189 (8·8%) participants had sustained recovery. A pattern of less favourable trajectories of low anti-nucleocapsid antibody, high plasma nucleocapsid antigen, and high inflammatory markers over the first 5 days was observed for high-risk baseline clinical characteristics or factors related to SARS-CoV-2 infection. For example, participants with chronic kidney disease demonstrated plasma nucleocapsid antigen 424% higher (95% CI 319-559), CRP 174% higher (150-202), IL-6 173% higher (144-208), D-dimer 149% higher (134-165), and anti-nucleocapsid antibody 39% lower (60-18) to day 5 than those without chronic kidney disease. Participants in the highest quartile for plasma nucleocapsid antigen, CRP, and IL-6 at baseline and day 5 had worse clinical outcomes, including 90-day all-cause mortality (plasma nucleocapsid antigen hazard ratio (HR) 4·50 (95% CI 3·29-6·15), CRP HR 3·37 (2·30-4·94), and IL-6 HR 5·67 (4·12-7·80). This risk persisted for plasma nucleocapsid antigen and CRP after adjustment for baseline biomarker values and other baseline factors. INTERPRETATION: Patients admitted to hospital with less favourable 5-day biomarker trajectories had worse prognosis, suggesting that persistent viral burden might drive inflammation in the pathogenesis of COVID-19, identifying patients that might benefit from escalation of antiviral or anti-inflammatory treatment. FUNDING: US National Institutes of Health.

Defining Overweight and Obesity by Percent Body Fat instead of Body Mass Index.

OBJECTIVE: Thresholds for overweight and obesity are currently defined by body mass index (BMI), a poor surrogate marker of actual adiposity (percent body fat, %BF). Practical modern technologies provide estimates of %BF but medical providers need outcome-based %BF thresholds to guide patients. This analysis determines %BF thresholds based on key obesity-related comorbidities, exhibited as metabolic syndrome (MetSyn). These limits were compared to existing BMI thresholds of overweight and obesity. DESIGN: Correlational analysis of data from cross sectional sampling of 16,918 adults (8,734 men and 8,184 women) from the US population, accessed by the National Health and Nutrition Examination Survey (NHANES) public use datasets. RESULTS: Individuals measured by BMI as overweight (BMI>25 kg/m2) and with obesity (BMI>30 kg/m2) included 5% and 35% of individuals with MetSyn, respectively. For men, there were no cases of MetSyn below 18%BF, %BF equivalence to "overweight" (i.e., 5% of MetSyn individuals) occurred at 25%BF, and "obesity" (i.e., 35% of MetSyn individuals) corresponded to 30%BF. For women, there were no cases of MetSyn below 30%BF, "overweight" occurred at 36%BF, and "obesity" corresponded to 42%BF. Comparison of BMI to %BF illustrates the wide range of variability in BMI prediction of %BF, highlighting the potential importance of using more direct measures of adiposity to manage obesity-related disease. CONCLUSIONS: Practical methods of body composition estimation can now replace the indirect BMI assessment for obesity management, using threshold values provided from this study. Clinically relevant "overweight" can be defined as 25 and 36% BF for men and women, respectively, and "obesity" is defined as 30 and 42% BF for men and women.

Endocrine Responses to Heated Resistance Exercise in Men and Women.

ABSTRACT: Pryor, JL, Sweet, DK, Rosbrook, P, Qiao, J, Looney, DP, Mahmood, S, and Rideout, T. Endocrine responses to heated resistance exercise in men and women. J Strength Cond Res 38(7): 1248-1255, 2024-We examined the endocrine responses of 16 (female = 8) resistance trained volunteers to a single bout of whole-body high-volume load resistance exercise in hot (HOT; 40° C) and temperate (TEMP; 20° C) environmental conditions. Thermoregulatory and heart rate (HR) data were recorded, and venous blood was acquired before and after resistance exercise to assess serum anabolic and catabolic hormones. In men, testosterone increased after resistance exercise in HOT and TEMP ( p < 0.01), but postexercise testosterone was not different between condition ( p = 0.51). In women, human growth hormone was different between condition at pre-exercise ( p = 0.02) and postexercise ( p = 0.03). After controlling for pre-exercise values, the between-condition postexercise difference was abolished ( p = 0.16). There were no differences in insulin-like growth factor-1 for either sex ( p ≥ 0.06). In women, cortisol increased from pre-exercise to postexercise in HOT ( p = 0.04) but not TEMP ( p = 0.19), generating a between-condition difference at postexercise ( p < 0.01). In men, cortisol increased from pre-exercise to postexercise in HOT only ( p < 0.01). Rectal temperature increased to a greater extent in HOT compared with TEMP in both men ( p = 0.01) and women ( p = 0.02). Heart rate increased after exercise under both conditions in men and women ( p = 0.01), but only women experience greater postexercise HR in HOT vs. TEMP ( p = 0.04). The addition of heat stress to resistance exercise session did not overtly shift the endocrine response toward an anabolic or catabolic response. When acute program variables are prescribed to increase postresistance exercise anabolic hormones, adding heat stress is not synergistic but does increase physiologic strain (i.e., elevated HR and rectal temperature).

Metabolic Costs of Walking with Weighted Vests.

INTRODUCTION: The US Army Load Carriage Decision Aid (LCDA) metabolic model is used by militaries across the globe and is intended to predict physiological responses, specifically metabolic costs, in a wide range of dismounted warfighter operations. However, the LCDA has yet to be adapted for vest-borne load carriage, which is commonplace in tactical populations, and differs in energetic costs to backpacking and other forms of load carriage. PURPOSE: The purpose of this study is to develop and validate a metabolic model term that accurately estimates the effect of weighted vest loads on standing and walking metabolic rate for military mission-planning and general applications. METHODS: Twenty healthy, physically active military-age adults (4 women, 16 men; age, 26 ± 8 yr old; height, 1.74 ± 0.09 m; body mass, 81 ± 16 kg) walked for 6 to 21 min with four levels of weighted vest loading (0 to 66% body mass) at up to 11 treadmill speeds (0.45 to 1.97 m·s -1 ). Using indirect calorimetry measurements, we derived a new model term for estimating metabolic rate when carrying vest-borne loads. Model estimates were evaluated internally by k -fold cross-validation and externally against 12 reference datasets (264 total participants). We tested if the 90% confidence interval of the mean paired difference was within equivalence limits equal to 10% of the measured walking metabolic rate. Estimation accuracy, precision, and level of agreement were also evaluated by the bias, standard deviation of paired differences, and concordance correlation coefficient (CCC), respectively. RESULTS: Metabolic rate estimates using the new weighted vest term were statistically equivalent ( P < 0.01) to measured values in the current study (bias, -0.01 ± 0.54 W·kg -1 ; CCC, 0.973) as well as from the 12 reference datasets (bias, -0.16 ± 0.59 W·kg -1 ; CCC, 0.963). CONCLUSIONS: The updated LCDA metabolic model calculates accurate predictions of metabolic rate when carrying heavy backpack and vest-borne loads. Tactical populations and recreational athletes that train with weighted vests can confidently use the simplified LCDA metabolic calculator provided as Supplemental Digital Content to estimate metabolic rates for work/rest guidance, training periodization, and nutritional interventions.

Effect of Neutralizing Monoclonal Antibody Treatment on Early Trajectories of Virologic and Immunologic Biomarkers in Patients Hospitalized With COVID-19.

BACKGROUND: Neutralizing monoclonal antibodies (nmAbs) failed to show clear benefit for hospitalized patients with coronavirus disease 2019 (COVID-19). Dynamics of virologic and immunologic biomarkers remain poorly understood. METHODS: Participants enrolled in the Therapeutics for Inpatients with COVID-19 trials were randomized to nmAb versus placebo. Longitudinal differences between treatment and placebo groups in levels of plasma nucleocapsid antigen (N-Ag), anti-nucleocapsid antibody, C-reactive protein, interleukin-6, and D-dimer at enrollment, day 1, 3, and 5 were estimated using linear mixed models. A 7-point pulmonary ordinal scale assessed at day 5 was compared using proportional odds models. RESULTS: Analysis included 2149 participants enrolled between August 2020 and September 2021. Treatment resulted in 20% lower levels of plasma N-Ag compared with placebo (95% confidence interval, 12%-27%; P < .001), and a steeper rate of decline through the first 5 days (P < .001). The treatment difference did not vary between subgroups, and no difference was observed in trajectories of other biomarkers or the day 5 pulmonary ordinal scale. CONCLUSIONS: Our study suggests that nmAb has an antiviral effect assessed by plasma N-Ag among hospitalized patients with COVID-19, with no blunting of the endogenous anti-nucleocapsid antibody response. No effect on systemic inflammation or day 5 clinical status was observed. CLINICAL TRIALS REGISTRATION: NCT04501978.

The normal relationship between fat and lean mass for mature (21-30 year old) physically fit men and women.

OBJECTIVE: Determine if relative body fat (%BF) remains a biological norm in physically active, non-obese American men and women and determine reference values for other components of body composition. METHODS: Participants (n = 174 men, 70 women) were physically fit U.S. Marine 2nd Lieutenants, in their third decade of physical maturity (age 21-30). Body composition was assessed by dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA); and body images were obtained by 3D body scans. RESULTS: For men and women, respectively, %BF averaged 16.2 ± 4.1 (median 15.3), 24.3 ± 4.5 (median 23.8); fat-free mass (FFM): 67.7 ± 7.2, 49.4 ± 5.3 kg; FFM index: 21.5 ± 1.8, 18.3 ± 1.6 kg/m2 ; and body mass index (BMI): 25.5 ± 1.9, 24.1 ± 2.2 kg/m2 . Bone mineral content (BMC) was 5% of FFM; total body water (TBW) was 70%-72% of FFM. Physique remained similar between median and higher percentiles of %BF. Only small changes in key measures were noted across the six-month training program. CONCLUSIONS: Mean %BF of healthy active men and women in 2021 remains very similar to the 15% and 25% posited in 1980, suggesting that relative body fat has a normal fat-lean relationship in physically mature humans. These data may bring new attention to sex-appropriate %BF.

Estimating Metabolic Energy Expenditure During Level Running in Healthy, Military-Age Women and Men.

ABSTRACT: Looney, DP, Hoogkamer, W, Kram, R, Arellano, CJ, and Spiering, BA. Estimating metabolic energy expenditure during level running in healthy, military-age women and men. J Strength Cond Res 37(12): 2496-2503, 2023-Quantifying the rate of metabolic energy expenditure (M) of varied aerobic exercise modalities is important for optimizing fueling and performance and maintaining safety in military personnel operating in extreme conditions. However, although equations exist for estimating oxygen uptake during running, surprisingly, there are no general equations that estimate M. Our purpose was to generate a general equation for estimating M during level running in healthy, military-age (18-44 years) women and men. We compiled indirect calorimetry data collected during treadmill running from 3 types of sources: original individual subject data (n = 45), published individual subject data (30 studies; n = 421), and published group mean data (20 studies, n = 619). Linear and quadratic equations were fit on the aggregated data set using a mixed-effects modeling approach. A chi-squared (χ2) difference test was conducted to determine whether the more complex quadratic equation was justified (p < 0.05). Our primary indicator of model goodness-of-fit was the root-mean-square deviation (RMSD). We also examined whether individual characteristics (age, height, body mass, and maximal oxygen uptake [V̇O2max]) could minimize prediction errors. The compiled data set exhibited considerable variability in M (14.54 ± 3.52 W·kg-1), respiratory exchange ratios (0.89 ± 0.06), and running speeds (3.50 ± 0.86 m·s-1). The quadratic regression equation had reduced residual sum of squares compared with the linear fit (χ2, 3,484; p < 0.001), with higher combined accuracy and precision (RMSD, 1.31 vs. 1.33 W·kg-1). Age (p = 0.034), height (p = 0.026), and body mass (p = 0.019) were associated with the magnitude of under and overestimation, which was not the case for V̇O2max (p = 0.898). The newly derived running energy expenditure estimation (RE3) model accurately predicts level running M at speeds from 1.78 to 5.70 m·s-1 in healthy, military-age women and men. Users can rely on the following equations for improved predictions of running M as a function of running speed (S, m·s-1) in either watts (W·kg-1 = 4.43 + 1.51·S + 0.37·S2) or kilocalories per minute (kcal·kg-1·min-1 = 308.8 + 105.2·S + 25.58·S2).

Nasopharyngeal SARS-CoV-2 viral load kinetics using digital PCR.

Background: The relationship between the viral kinetics of SARS-CoV-2 and clinical outcomes remains unclear. Methods: A convenience sample of 955 remnant nasopharyngeal swabs collected during routine care between 11/18/20 and 9/26/21 were analyzed using digital PCR and associated clinical data extracted from the medical record. 18 individuals had >1 sample within 30 days of onset of symptoms. Results: Paired samples were an average of 6 [range: 0-13] days apart. Four individuals sampled twice on the same day had a median 0.52 log10 viral load difference between samples. Of the remaining, 12 individuals had a decrease in viral load over time, with an average decay of -0.23 log10/day. Conclusions: Our study found a similar rate of viral decay to others, but did not find associations between viral kinetics and clinical outcomes. Larger studies would be useful to support the use of this measurement as a surrogate endpoint for therapeutic studies.

Using a Contemporary Portable Metabolic Gas Exchange System for Assessing Energy Expenditure: A Validity and Reliability Study.

There are several methods available to assess energy expenditure, all associated with inherent pros and cons that must be adequately considered for use in specific environments and populations. A requirement of all methods is that they must be valid and reliable in their capability to accurately measure oxygen consumption (VO2) and carbon dioxide production (VCO2). The purpose of this study was to evaluate the reliability and validity of the mobile CO2/O2 Breath and Respiration Analyzer (COBRA) relative to a criterion system (Parvomedics TrueOne 2400®, PARVO) with additional measurements to compare the COBRA to a portable system (Vyaire Medical, Oxycon Mobile®, OXY). Fourteen volunteers with a mean of 24 years old, body weight of 76 kg, and a VO2peak of 3.8 L∙min-1 performed four repeated trials of progressive exercises. Simultaneous steady-state measurements of VO2, VCO2, and minute ventilation (VE) by the COBRA/PARVO and OXY systems were conducted at rest, while walking (23-36% VO2peak), jogging (49-67% VO2peak), and running (60-76% VO2peak). Data collection was randomized by the order of system tested (COBRA/PARVO and OXY) and was standardized to maintain work intensity (rest to run) progression across study trials and days (two trials/day over two days). Systematic bias was examined to assess the accuracy of the COBRA to PARVO and OXY to PARVO across work intensities. Intra- and inter-unit variability were assessed with interclass correlation coefficients (ICC) and a 95% limit of agreement intervals. The COBRA and PARVO produced similar measures for VO2 (Bias ± SD, 0.01 ± 0.13 L·min-1; 95% LoA, (-0.24, 0.27 L·min-1); R2 = 0.982), VCO2 (0.06 ± 0.13 L·min-1; (-0.19, 0.31 L·min-1); R2 = 0.982), VE (2.07 ± 2.76 L·min-1; (-3.35, 7.49 L·min-1); R2 = 0.991) across work intensities. There was a linear bias across both the COBRA and OXY with increased work intensity. The coefficient of variation for the COBRA ranged from 7 to 9% across measures for VO2, VCO2, and VE. COBRA was reliable across measurements for VO2 (ICC = 0.825; 0.951), VCO2 (ICC = 0.785; 0.876), and VE (ICC = 0.857; 0.945) for intra-unit reliability, respectively. The COBRA is an accurate and reliable mobile system for measuring gas exchange at rest and across a range of work intensities.

Use case for predictive physiological models: tactical insights about frozen Russian soldiers in Ukraine.

Biomathematical models quantitatively describe human physiological responses to environmental and operational stressors and have been used for planning and real-time prevention of cold injury. These same models can be applied from a military tactical perspective to gain valuable insights into the health status of opponent soldiers. This paper describes a use case for predicting physiological status of Russian soldiers invading Ukraine using open-source information. In March 2022, media outlets reported Russian soldiers in a stalled convoy invading Ukraine were at serious risk of hypothermia and predicted these soldiers would be "freezing to death" within days because of declining temperatures (down to -20°C). Using existing Army models, clothing data and open-source intelligence, modelling and analyses were conducted within hours to quantitatively assess the conditions and provide science-based predictions. These predictions projected a significant increase in risks of frostbite for exposed skin and toes and feet, with a very low (negligible) risk of hypothermia. Several days later, media outlets confirmed these predictions, reporting a steep rise in evacuations for foot frostbite injuries in these Russian forces. This demonstrated what can be done today with the existing mathematical physiology and how models traditionally focused on health risk can be used for tactical intelligence.

Association between SARS-CoV-2 Viral Load and Patient Symptoms and Clinical Outcomes Using Droplet Digital PCR.

The association between nasopharyngeal (NP) SARS-CoV-2 viral loads and clinical outcomes remains debated. Here, we examined the factors that might predict the NP viral load and the role of the viral load as a predictor of clinical outcomes. A convenience sample of 955 positive remnant NP swab eluent samples collected during routine care between 18 November 2020 and 26 September 2021 was cataloged and a chart review was performed. For non-duplicate samples with available demographic and clinical data (i.e., non-employees), an aliquot of eluent was sent for a droplet digital PCR quantification of the SARS-CoV-2 viral load. Univariate and multivariate analyses were performed to identify the clinical predictors of NP viral loads and the predictors of COVID-19-related clinical outcomes. Samples and data from 698 individuals were included in the final analysis. The sample cohort had a mean age of 50 years (range: 19-91); 86.6% were male and 76.3% were unvaccinated. The NP viral load was higher in people with respiratory symptoms (p = 0.0004) and fevers (p = 0.0006). In the predictive models for the clinical outcomes, the NP viral load approached a significance as a predictor for in-hospital mortality. In conclusion, the NP viral load did not appear to be a strong predictor of moderate-to-severe disease in the pre-Delta and Delta phases of the pandemic, but was predictive of symptomatic diseases and approached a significance for in-hospital mortality, providing support to the thesis that early viral control prevents the progression of disease.

With life there is motion. Activity biomarkers signal important health and performance outcomes.

Measures of human motion provide a rich source of health and physiological status information. This paper provides examples of motion-based biomarkers in the form of patterns of movement, quantified physical activity, and characteristic gaits that can now be assessed with practical measurement technologies and rapidly evolving physiological models and algorithms, with research advances fed by the increasing access to motion data and associated contextual information. Quantification of physical activity has progressed from step counts to good estimates of energy expenditure, useful to weight management and to activity-based health outcomes. Activity types and intensity durations are important to health outcomes and can be accurately classified even from carried smart phone data. Specific gaits may predict injury risk, including some re-trainable injurious running or modifiable load carriage gaits. Mood status is reflected in specific types of human movement, with slumped posture and shuffling gait signaling depression. Increased variability in body sway combined with contextual information may signify heat strain, physical fatigue associated with heavy load carriage, or specific neuropsychological conditions. Movement disorders might be identified earlier and chronic diseases such as Parkinson's can be better medically managed with automatically quantified information from wearable systems. Increased path tortuosity suggests head injury and dementia. Rapidly emerging wear-and-forget systems involving global positioning system and inertial navigation, triaxial accelerometry, smart shoes, and functional fiber-based clothing are making it easier to make important health and performance outcome associations, and further refine predictive models and algorithms that will improve quality of life, protect health, and enhance performance.

Peak performance and cardiometabolic responses of modern US army soldiers during heavy, fatiguing vest-borne load carriage.

INTRODUCTION: Physiological limits imposed by vest-borne loads must be defined for optimal performance monitoring of the modern dismounted warfighter. PURPOSE: To evaluate how weighted vests affect locomotion economy and relative cardiometabolic strain during military load carriage while identifying key physiological predictors of exhaustion limits. METHODS: Fifteen US Army soldiers (4 women, 11 men; age, 26 ± 8 years; height, 173 ± 10 cm; body mass (BM), 79 ± 16 kg) performed four incremental walking tests with different vest loads (0, 22, 44, or 66% BM). We examined the effects of vest-borne loading on peak walking speed, the physiological costs of transport, and relative work intensity. We then sought to determine which of the cardiometabolic indicators (oxygen uptake, heart rate, respiration rate) was most predictive of task failure. RESULTS: Peak walking speed significantly decreased with successively heavier vest loads (p < 0.01). Physiological costs per kilometer walked were significantly higher with added vest loads for each measure (p < 0.05). Relative oxygen uptake and heart rate were significantly higher during the loaded trials than the 0% BM trial (p < 0.01) yet not different from one another (p > 0.07). Conversely, respiration rate was significantly higher with the heavier load in every comparison (p < 0.01). Probability modeling revealed heart rate as the best predictor of task failure (marginal R2, 0.587, conditional R2, 0.791). CONCLUSION: Heavy vest-borne loads cause exceptional losses in performance capabilities and increased physiological strain during walking. Heart rate provides a useful non-invasive indicator of relative intensity and task failure during military load carriage.

Verification Phase Confirms V̇O 2max in a Hot Environment in Sedentary Untrained Males.

PURPOSE: This study aimed to assess the V̇O 2 uptake obtained during a GXT and subsequent verification phase in untrained participants in a hot environment. METHODS: Twelve sedentary males completed a GXT followed by a biphasic supramaximal-load verification phase in a hot environment (39°C, 32% relative humidity). Rest between tests occurred in a temperate chamber and lasted until gastrointestinal temperature returned to baseline. RESULTS: Mean verification phase V̇O 2max (37.8 ± 4.3 mL·kg -1 ·min -1 ) was lower than GXT (39.8 ± 4.1 mL·kg -1 ·min -1 ; P = 0.03) and not statistically equivalent. Using an individualized analysis approach, only 17% (2/12) of participants achieved a V̇O 2 plateau during the GXT. Verification phase confirmed GXT V̇O 2max in 100% of participants, whereas the traditional and the new age-dependent secondary V̇O 2max criteria indicated GXT V̇O 2max achievement at much lower rates (8/12 [67%] vs 7/12 [58%], respectively). Correlational indices between GXT and verification phase V̇O 2max were strong (intraclass correlation coefficient = 0.95, r = 0.86), and Bland-Altman analysis revealed a low mean bias of -2.1 ± 1.9 mL·kg -1 ·min -1 and 95% limits of agreement (-5.8 to 1.7 mL·kg -1 ·min -1 ). CONCLUSIONS: Very few untrained males achieved a V̇O 2 plateau during GXT in the heat. When conducting GXT in a hot condition, the verification phase remains a valuable addition to confirm V̇O 2max in untrained males.

Diver Underwater Cycling Endurance After Short-Term Warm and Hot Water Acclimation.

INTRODUCTION: It is unclear whether immersion heat acclimation benefits exercise in warm water conditions. This study examined the effects of heat acclimation strategies on heart rate (HR), core temperature, and time to exhaustion (TTE) during cycling exercise in varying warm water conditions. METHODS: Twenty male divers completed this study at the Navy Experimental Diving Unit. Subjects were randomly assigned to one of two 9-day heat acclimation groups. The first group (WARM; n = 10) cycled for 2 hours at 50 W in 34.4 °C water, while the second group (HOT; n = 10) cycled for 1 hour against minimal resistance in 36.7 °C water. Following acclimation, TTE was tested by underwater cycling (30 W) in 35.8 °C, 37.2 °C, and 38.6 °C water. RESULTS: Throughout acclimation, the rate of core temperature rise in the first 30 minutes of exercise increased (P = .02), but the maximum core temperature reached was not different for either group. Time to exhaustion (TTE) was reduced, and the rate of core temperature rise during performance testing increased (both P < .001) with increasing water temperature but was not different between groups. Core temperature and HR increased throughout performance testing in each water condition and were lower in the HOT compared to the WARM acclimation group (all P < .05) with the exception of core temperature in the 37.2 °C condition. CONCLUSIONS: Underwater exercise performance did not differ between the two acclimation strategies. This study suggests that passive acclimation to a higher water temperature may improve thermoregulatory and cardiovascular responses to exercise in warm water. Hot water immersion adaptations are dependent on exercise intensity and water temperature.

Body surface area equations for physically active men and women.

OBJECTIVES: To improve predictive formulae for estimating body surface area (BSA) in healthy men and women using a modern three-dimensional scanner technology. METHODS: Body surface areas were obtained from a convenience sample of 1267 US Marines (464 women and 803 men) using a whole body surface scanner (Size Stream SS20). The reliability of SS20 measures of total and regional BSA within participants was compared across triplicate scans. We then derived a series of formulae to estimate SS20-measured BSA using various combinations of sex, height, and mass. We also assessed relationships between percent body fat measured by dual-energy x-ray absorptiometry and sex-specific formulae errors in Marines. RESULTS: Body surface areas recorded by the SS20 were highly reliable whether measured for the total body or by region (ICC ≥ .962). Formulae estimates of BSA from sex, height, and mass were precise (root-mean-square deviation, 0.031 m2 ). Errors from the Marine Corps formulae were positively associated with percent body fat for men (p = .001) but not women (p = .843). CONCLUSIONS: Clinicians, military leaders, and researchers can use the newly developed BSA formulae for precise estimates in healthy physically active men and women. Users should be aware that height- and mass-based BSA estimates are less accurate for individuals with extremely low or high percent body fat.

Physical performance and body composition reference values for modern US Marine Corps women.

Women's roles in the US military have progressively changed over the past several decades. Previously women were barred from combat roles. Recent change in policy allow women into combat roles in the Marine Corps, and this has led to women being trained for combat specialties. Objectives: This observational cross-sectional study describes body composition and performance values for modern Marine Corps women. Methods: Volunteers were 736 Marine women who were assessed for body composition and physical performance; (age 29.5±7.3 (18-56) years; height 163.6±6.8 (131.0-186.1) cm; body mass 68.3±9.2 (42.0-105.3) kg; years in the military 8.9±6.8 (0.5-37) years-in-service). Body composition measures were obtained using dual-energy X-ray absorptiometry and single-frequency bioelectrical impedance analyses. Performance measures were obtained from official physical and combat fitness test scores (PFT; CFT) as well as from data on measured countermovement jumps (CMJ) on a calibrated force platform. Results: Mean body composition metrics for Marine women were: 47.5±5.7 fat free mass (FFM) (kg), 30.1%±6.4% body fat (%BF), 2.6±0.3 bone mineral content (kg), and 25.5±2.8 body mass index (kg/m2); performance metrics included 43.4±3.2 maximal oxygen uptake (VO2max; mL.kg.min), 22.4±7.1 CMJ height (cm) and 2575±565.2 CMJ peak power (W). Data showed strong correlations (r) (≥0.70) between PFT and VO2max scores (0.75), and moderate correlations (≥0.50) between CFT and VO2max scores (0.57), CFT and PFT scores (0.60), FFM and CMJ peak power (W) (0.68), and %BF to VO2max (-0.52), PFT (-0.54), CMJ-Ht (-0.52) and CMJ relative power (W/kg) (-0.54). Conclusion: Modern Marine women are both lean and physically high performing. Body composition is a poor predictor of general physical performance.

Do the National Institute for Occupational Safety and Health recommendations for working in the heat prevent excessive hyperthermia and body mass loss in unacclimatized males?

The National Institute for Occupational Safety and Health recommendations for work in the heat suggest workers consume 237 mL of water every 15-20 min and allow for continuous work at heavy intensities in hot environments up to 34 °C and 30% relative humidity. The goal was to determine whether the National Institute for Occupational Safety and Health recommendations prevented core temperature from exceeding 38.0 °C and greater than 2% body mass loss during heavy-intensity work in the heat. Eight males consumed 237 mL of water every 20 min during 2 hr of continuous heavy-intensity walking (6.4 kph, 1% grade) in a 34 °C/30% relative humidity environment, in accordance with the National Institute for Occupational Safety and Health recommendations. Projected core temperature and percent body mass loss were calculated for 4 and 8 hr of continuous work. Core temperature rose from baseline (36.8 ± 0.3 °C) to completion of 2 hr of work (38.1 ± 0.6 °C, p < 0.01), with two participants reaching the 38.0 °C threshold. Projected core temperatures remained elevated from baseline (p < 0.01), did not change from 2 to 4 hr (38.1 ± 0.7 °C, p > 0.99) and 4 to 8 hr (38.1 ± 0.8 °C, p > 0.99), respectively, and one participant exceeded 38.0 °C at 4 to 8 hr. There was no change in body mass loss over time (p > 0.99). During 2 hr of continuous heavy-intensity work in the heat, 75% of participants did not reach 38 °C core temperature and 88% did not reach 2% body mass loss when working to National Institute for Occupational Safety and Health recommendations.