All-in-One, Wireless, Multi-Sensor Integrated Athlete Health Monitor for Real-Time Continuous Detection of Dehydration and Physiological Stress.

Athletes are at high risk of dehydration, fatigue, and cardiac disorders due to extreme performance in often harsh environments. Despite advancements in sports training protocols, there is an urgent need for a non-invasive system capable of comprehensive health monitoring. Although a few existing wearables measure athlete's performance, they are limited by a single function, rigidity, bulkiness, and required straps and adhesives. Here, an all-in-one, multi-sensor integrated wearable system utilizing a set of nanomembrane soft sensors and electronics, enabling wireless, real-time, continuous monitoring of saliva osmolality, skin temperature, and heart functions is introduced. This system, using a soft patch and a sensor-integrated mouthguard, provides comprehensive monitoring of an athlete's hydration and physiological stress levels. A validation study in detecting real-time physiological levels shows the device's performance in capturing moments (400-500 s) of synchronized acute elevation in dehydration (350%) and physiological strain (175%) during field training sessions. Demonstration with a few human subjects highlights the system's capability to detect early signs of health abnormality, thus improving the healthcare of sports athletes.

Guarana (Paullinia cupana) but Not Low-Dose Caffeine Improves Cycling Time-Trial Performance Versus Placebo.

Guarana (GUA) seed extract, containing caffeine (CAF) and additional bioactive compounds, may positively affect mental performance, but evidence regarding exercise is limited. This investigation assessed acute GUA ingestion compared with CAF on endurance performance. Eleven endurance-trained noncyclists and cyclists (V˙O2peak = 49.7 ± 5.9, 60.4 ± 4.6 ml·kg·min-1) completed a double-blind, crossover experiment after ingesting (a) 100 mg CAF, (b) 500 mg GUA (containing 130 mg CAF), or (c) placebo (P) prior to 60-min fixed cycling workload (FIX) + 15-min time trial. Oxygen uptake, heart rate, respiratory exchange ratio, blood glucose, and lactate were not different (p ≥ .052) during FIX. A significant interaction (p = .042) for perceived exertion was observed at 50-min FIX with lower rating (p = .023) for GUA versus CAF but not compared with P. Work accumulated over 15-min time trial was greater (p = .038) for GUA versus P due to higher early (1-11 min) work outputs. Work performance favored (effect size = 0.18; 95% confidence interval [0.003, 0.355], p = .046) GUA (241.4 ± 39.9 kJ) versus P (232.1 ± 46.6 kJ), but CAF (232.3 ± 43.9) was not different from GUA (effect size = 0.19; 95% confidence interval [-0.022, 0.410], p = .079) or P. Postexercise strength loss was not attenuated with GUA (-5.6 ± 8.5%) or CAF (-8.3 ± 9.4%) versus P (-10.3 ± 5.1%). Acute GUA ingestion improved work performance relative to P, but effects were trivial to small and unrelated to altered substrate oxidation or muscular strength. Ergogenicity may involve central mechanisms reducing perceived effort with GUA (containing 130 mg caffeine). Due to issues related to identical matching of dosage, whether GUA confers additional benefits beyond its CAF content cannot be determined at present.

Individual Variability Is More Important Than Analytical Methods When Calculating Relative Speed of Beverage Bioavailability.

Deuterium oxide (D2O) appearance in blood is a marker of fluid bioavailability. However, whether biomarker robustness (e.g., relative fluid delivery speed) is consistent across analytical methods (e.g., cavity ring-down spectroscopy) remains unclear. Fourteen men ingested fluid (6 ml/kg body mass) containing 0.15 g/kg D2O followed by 45 min blood sampling. Plasma (D2O) was detected (n = 8) by the following: isotope-ratio mass spectrometry after vapor equilibration (IRMS-equilibrated water) or distillation (IRMS-plasma) and cavity ring-down spectroscopy. Two models calculated D2O halftime to peak (t1/2max): sigmoid curve fit versus asymmetric triangle (TRI). Background (D2O) differed (p < .001, η2 = .98) among IRMS-equilibrated water, IRMS-plasma, and cavity ring-down spectroscopy (152.2 ± 0.8, 147.2 ± 1.5, and 137.7 ± 2.2 ppm), but did not influence (p > .05) D2O appearance (Δppm), time to peak, or t1/2max. Stratifying participants based on mean t1/2max (12 min) into "slow" versus "fast" subgroups resulted in a 5.8 min difference (p < .001, η2 = .73). Significant t1/2max model (p = .01, η2 = .44) and Model × Speed Subgroup interaction (p = .005, η2 = .50) effects were observed. Bias between TRI and sigmoid curve fit increased with t1/2max speed: no difference (p = .75) for fast (9.0 min vs. 9.2 min, respectively) but greater t1/2max (p = .001) with TRI for the slow subgroup (16.1 min vs. 13.7 min). Fluid bioavailability markers are less influenced by which laboratory method is used to measure D2O as compared with the individual variability effects that influence models for calculating t1/2max. Thus, TRI model may not be appropriate for individuals with slow fluid delivery speeds.

Carbohydrate Rinse Fails to Enhance Cycling Performance or Alter Metabolic and Autonomic Recovery in Recreational Cyclists.

The purpose of the study was to examine the effects of carbohydrate (CHO) mouth rinsing on autonomic and metabolic recovery as well as cycling performance. Ten male recreational cyclists (age = 30 ± 6 years, VO2peak = 54.5 ± 8.1 mL·kg-1·min-1) completed a randomized, double-blind, placebo-controlled, crossover designed study. A CHO or a placebo (PLA) rinse was administered every 12.5% of a work to completion trial (75%Wmax). Heart rate variability (lnRMSSD), the respiratory exchange ratio, and plasma epinephrine, norepinephrine, insulin, glucose, free fatty acids (FFA), and lactate were measured pre- and post-exercise. The CHO rinse did not improve time to completion of the test trial (CHO: 4108 ± 307 s, PLA: 4176 ± 374 s, p = 0.545). Further, the CHO rinse did not impact autonomic recovery, as measured by lnRMSSD (p = 0.787) and epinephrine (p = 0.132). Metabolic biomarkers were also unaffected by the CHO rinse, with no differences observed in responses of FFA (p = 0.064), lactate (p = 0.302), glucose (p = 0.113) or insulin (p = 0.408). Therefore, the CHO mouth rinse does not reduce the acute sympathetic response following strenuous exercise and does not result in improvements in cycling time to completion.

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.

Exercise-heat stress with and without water replacement alters brain structures and impairs visuomotor performance.

Effects of exercise-heat stress with and without water replacement on brain structure and visuomotor performance were examined. Thirteen healthy adults (23.6 ± 4.2 years) completed counterbalanced 150 min trials of exercise-heat stress (45°C, 15% RH) with water replacement (EHS) or without (~3% body mass loss; EHS-DEH) compared to seated rest (CON). Anatomical scans and fMRI Blood-Oxygen-Level-Dependent responses during a visuomotor pacing task were evaluated. Accuracy decreased (P < 0.05) despite water replacement during EHS (-8.2 ± 6.8% vs. CON) but further degraded with EHS-DEH (-8.3 ± 6.4% vs. EHS and -16.5 ± 10.2% vs. CON). Relative to CON, EHS elicited opposing volumetric changes (P < 0.05) in brain ventricles (-5.3 ± 1.7%) and periventricular structures (cerebellum: 1.5 ± 0.8%) compared to EHS-DEH (ventricles: 6.8 ± 3.4, cerebellum: -0.7 ± 0.7; thalamus: -2.7 ± 1.3%). Changes in plasma osmolality (EHS: -3.0 ± 2.1; EHS-DEH: 9.3 ± 2.1 mOsm/kg) were related (P < 0.05) to thalamus (r = -0.45) and cerebellum volume (r = -0.61) which, in turn, were related (P < 0.05) to lateral (r = -0.41) and fourth ventricle volume (r = -0.67) changes, respectively; but, there were no associations (P > 0.50) between structural changes and visuomotor accuracy. EHS-DEH increased neural activation (P < 0.05) within motor and visual areas versus EHS and CON. Brain structural changes are related to bidirectional plasma osmolality perturbations resulting from exercise-heat stress (with and without water replacement), but do not explain visuomotor impairments. Negative impacts of exercise-heat stress on visuomotor tasks are further exacerbated by dehydration.

Dehydration Impairs Cognitive Performance: A Meta-analysis.

Dehydration (DEH) is believed to impair cognitive performance but which domains are affected and at what magnitude of body mass loss (BML) remains unclear. PURPOSE: To conduct systematic literature review and meta-analysis to determine the effect size (ES) of DEH on cognitive performance and influence of experimental design factors (e.g., DEH > 2% BML). METHODS: Thirty-three studies were identified, providing 280 ES estimates from 413 subjects with DEH ranging from 1% to 6% BML. Outcome variables (accuracy, reaction time), cognitive domains, and methods to induce DEH varied. Effect sizes were calculated using standardized mean differences and multivariate meta-analysis. RESULTS: Impairment of cognitive performance (all domains/outcomes) with DEH was small but significant (ES = -0.21; 95% confidence interval [CI]: -0.31 to -0.11; P < 0.0001) with significant heterogeneity (Q(279) = 696.0, P < 0.0001; I = 37.6%). Tasks of executive function (ES = -0.24; 95% CI: -0.37 to -0.12), attention (ES = -0.52; 95% CI: -0.66 to -0.37), and motor coordination (ES = -0.40 to 95% CI: -0.63 to -0.17) were significantly impaired (P ≤ 0.01) after DEH, and attention/motor coordination was different (P < 0.001) from reaction time specific tasks (ES = -0.10; 95% CI: -0.23 to 0.02). Body mass loss was associated with the ES for cognitive impairment (P = 0.04); consequently, impairment was greater (P = 0.04) for studies reporting >2% BML (ES = -0.28; 95% CI: -0.41 to -0.16) compared with ≤2%; (ES = -0.14; 95% CI: -0.27 to 0.00). CONCLUSIONS: Despite variability among studies, DEH impairs cognitive performance, particularly for tasks involving attention, executive function, and motor coordination when water deficits exceed 2% BML.

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.

Is Physical Fitness Associated with Health in Overweight and Obese Youth? A Systematic Review.

A systematic review of literature was conducted to examine the association between changes in health-related fitness (e.g. aerobic capacity and muscular strength /endurance) and chronic disease risk factors in overweight and/or obese youth. Studies published from 2000-2010 were included if the physical activity intervention was a randomized controlled trial and reported changes in fitness and health outcomes by direction and significance (p< 0.05) of the effect. Aerobic capacity improved in 91% and muscular fitness improved in 82% of measures reported. Nearly all studies (32 of 33) reported improvement in at least one fitness test. Changes in outcomes related to adiposity, cardiovascular, musculoskeletal, metabolic, and mental/emotional health improved in 60%, 32%, 53%, 41%, and 33% of comparisons studied, respectively. In conclusion, overweight and obese youth can improve physical fitness across a variety of test measures. When fitness improves, beneficial health effects are observed in some, but not all chronic disease risk factors.

Quercetin and endurance exercise capacity: a systematic review and meta-analysis.

UNLABELLED: Quercetin is a dietary flavonoid purported to improve human endurance exercise capacity. However, published findings are mixed. PURPOSE: The study's purpose was to perform a systematic review of the literature and meta-analysis to examine whether quercetin ingestion increases endurance exercise capacity. METHODS: A search of the literature was conducted using the key words quercetin, performance, exercise, endurance, and aerobic capacity. Eleven studies were identified as meeting the inclusion criteria providing data on 254 human subjects. Across all studies, subject presupplementation VO(2max) ranged from 41 to 64 mL·kg(-1)·min(-1) (median = 46), and median treatment duration was 11 d with a median dosage of 1000 mg·d(-1). Effect sizes (ES) were calculated as the standardized mean difference, and meta-analyses were completed using a random-effects model. RESULTS: The ES calculated for all studies combining VO(2max) and endurance performance measures indicates a significant effect favoring quercetin over placebo (ES = 0.15, P = 0.021, 95% confidence interval = 0.02-0.27), but the magnitude of effect is considered between trivial and small, equating to a ∼2% [corrected] improvement of quercetin over placebo. Using a subgroup meta-analysis comparing quercetin's effect on endurance exercise performance versus VO(2max), no significant difference was found (P = 0.69). Meta-regression of study ES relative to subjects' fitness level or plasma quercetin concentration achieved by supplementation was also not significant. CONCLUSIONS: On average, quercetin provides a statistically significant benefit in human endurance exercise capacity (VO(2max) and endurance exercise performance), but the effect is between trivial and small. Experimental factors that explain the between-study variation remain to be elucidated.

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.

Effect of caffeine ingestion on muscular strength and endurance: a meta-analysis.

PURPOSE: Our objective was to perform a systematic review and meta-analysis of the research literature assessing the effect of caffeine ingestion on maximal voluntary contraction (MVC) strength and muscular endurance. METHODS: Thirty-four relevant studies between 1939 and 2008 were included in the meta-analyses of caffeine's effects on MVC strength (n = 27 studies) and muscular endurance (n = 23 studies). Effect sizes (ES) were calculated as the standardized mean difference and meta-analyses were completed using a random-effects model. RESULTS: Overall, caffeine ingestion was found to result in a small beneficial effect on MVC strength (overall ES = 0.19, P = 0.0003). However, caffeine appears to improve MVC strength primarily in the knee extensors (i.e., by approximately 7%, ES = 0.37) and not in other muscle groups such as the forearm or the knee flexors. In an attempt to offer a physiological mechanism behind caffeine's ability to improve MVC strength, a meta-analysis was run on ES from nine studies that measured percent muscle activation during MVC in trials comparing caffeine versus placebo; the overall ES (0.67) was highly significant (P = 0.00008) and of moderate to large size, thus implicating an effect of caffeine on the CNS. Caffeine ingestion was also found to exert a small beneficial effect on muscular endurance (overall ES = 0.28, P = 0.00005). However, it appears caffeine improves muscular endurance only when it is assessed using open (i.e., by approximately 18%, ES = 0.37) and not fixed end point tests. CONCLUSIONS: Overall, caffeine ingestion improves MVC strength and muscular endurance. The effect on strength appears exclusively in the knee extensors, and the effect on muscular endurance appears only detectable with open end point tests.

Recovery nutrition: timing and composition after endurance exercise.

Consumption of macronutrients, particularly carbohydrate (CHO) and possibly a small amount of protein, in the early recovery phase after endurance exercise can enhance muscle glycogen resynthesis rates. A target of at least 1.2 g x kg body weight(-1) x h(-1) CHO (over several hours) is suggested. This rate of CHO intake could be sustained with liquid, gel, or solid food rich in CHO for maximizing muscle glycogen. Whether the coingestion of protein with CHO compared with isocaloric CHO results in meaningful differences in glycogen replenishment that translate into subsequent performance enhancement is equivocal. Advantages of added protein with CHO in reducing true muscle damage from endurance exercise remain to be verified. There are, however, no apparent contraindications for using milk or specialty CHO/protein/amino acid products either. Future investigations that examine signaling mechanisms within muscle should be conducted in parallel with translational evidence in humans.

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.