Efficacy of a 6-week Novel Exergaming Intervention Guided by Heart Rate Zones on Aerobic Performance in Children with Fetal Alcohol Spectrum Disorder and Attention-deficit/Hyperactivity Disorder: A Feasibility Study.

The purpose of this study was to determine the feasibility of a novel exergaming intervention guided by heart rate zones for children and adolescents with fetal alcohol spectrum disorder (FASD) and attention-deficit/hyperactivity disorder (ADHD). Eight study participants (6 females, 2 males, mean age= 11.4±1.4 years old) participated twice weekly over six weeks to complete twelve multimodal exergaming sessions. Participants significantly improved 6MWT from baseline to week 6 (575.4±55.0 m to 732.8±58.9 m; P<0.01), which conferred a 31% improvement in estimated VO2max (31.5±5.5 ml/kg/min to 40.9±5.9 ml/kg/min), respectively. There was an upward trend of the mean percentage of time spent in the intermediate HR zones over the course of the 6-week intervention. These findings may provide value to the field as they support the clinical utility and promising effects of cardiovascular improvement in children who engage in a compelling exergaming intervention. In doing so, this establishes a preliminary understanding of how to augment routine physical exercise through exergaming using visually targeted heart rate zones.

Longitudinal Follow-Up of Participants With Tobacco Exposure and Preserved Spirometry.

Importance: People who smoked cigarettes may experience respiratory symptoms without spirometric airflow obstruction. These individuals are typically excluded from chronic obstructive pulmonary disease (COPD) trials and lack evidence-based therapies. Objective: To define the natural history of persons with tobacco exposure and preserved spirometry (TEPS) and symptoms (symptomatic TEPS). Design, Setting, and Participants: SPIROMICS II was an extension of SPIROMICS I, a multicenter study of persons aged 40 to 80 years who smoked cigarettes (>20 pack-years) with or without COPD and controls without tobacco exposure or airflow obstruction. Participants were enrolled in SPIROMICS I and II from November 10, 2010, through July 31, 2015, and followed up through July 31, 2021. Exposures: Participants in SPIROMICS I underwent spirometry, 6-minute walk distance testing, assessment of respiratory symptoms, and computed tomography of the chest at yearly visits for 3 to 4 years. Participants in SPIROMICS II had 1 additional in-person visit 5 to 7 years after enrollment in SPIROMICS I. Respiratory symptoms were assessed with the COPD Assessment Test (range, 0 to 40; higher scores indicate more severe symptoms). Participants with symptomatic TEPS had normal spirometry (postbronchodilator ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity >0.70) and COPD Assessment Test scores of 10 or greater. Participants with asymptomatic TEPS had normal spirometry and COPD Assessment Test scores of less than 10. Patient-reported respiratory symptoms and exacerbations were assessed every 4 months via phone calls. Main Outcomes and Measures: The primary outcome was assessment for accelerated decline in lung function (FEV1) in participants with symptomatic TEPS vs asymptomatic TEPS. Secondary outcomes included development of COPD defined by spirometry, respiratory symptoms, rates of respiratory exacerbations, and progression of computed tomographic-defined airway wall thickening or emphysema. Results: Of 1397 study participants, 226 had symptomatic TEPS (mean age, 60.1 [SD, 9.8] years; 134 were women [59%]) and 269 had asymptomatic TEPS (mean age, 63.1 [SD, 9.1] years; 134 were women [50%]). At a median follow-up of 5.76 years, the decline in FEV1 was -31.3 mL/y for participants with symptomatic TEPS vs -38.8 mL/y for those with asymptomatic TEPS (between-group difference, -7.5 mL/y [95% CI, -16.6 to 1.6 mL/y]). The cumulative incidence of COPD was 33.0% among participants with symptomatic TEPS vs 31.6% among those with asymptomatic TEPS (hazard ratio, 1.05 [95% CI, 0.76 to 1.46]). Participants with symptomatic TEPS had significantly more respiratory exacerbations than those with asymptomatic TEPS (0.23 vs 0.08 exacerbations per person-year, respectively; rate ratio, 2.38 [95% CI, 1.71 to 3.31], P < .001). Conclusions and Relevance: Participants with symptomatic TEPS did not have accelerated rates of decline in FEV1 or increased incidence of COPD vs those with asymptomatic TEPS, but participants with symptomatic TEPS did experience significantly more respiratory exacerbations over a median follow-up of 5.8 years.

Sudden cardiac arrest in athletes and strategies to optimize preparedness.

Sudden cardiac arrest (SCA) is the leading cause of death in young athletes. Despite efforts to improve preparedness for cardiac emergencies, the incidence of out-of-hospital cardiac arrests in athletes remains high, and bystander awareness and readiness for SCA support are inadequate. Initiatives such as designing an emergency action plan (EAP) and mandating training in cardiopulmonary resuscitation (CPR) and automated external defibrillator use (AED) for team members and personnel can contribute to improved survival rates in SCA cases. This review provides an overview of SCA in athletes, focusing on identifying populations at the highest risk and evaluating the effectiveness of different screening practices in detecting conditions that may lead to SCA. We summarize current practices and recommendations for improving the response to SCA events, and we highlight the need for ongoing efforts to optimize preparedness through the implementation of EAPs and the training of individuals in CPR and AED use. Additionally, we propose a call to action to increase awareness and training in EAP development, CPR, and AED use for team members and personnel. To improve outcomes of SCA cases in athletes, it is crucial to enhance bystander awareness and preparedness for cardiac emergencies. Implementing EAPs and providing training in CPR and AED use for team members and personnel are essential steps toward improving survival rates in SCA cases.

Bronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD.

BACKGROUND: Bronchodilator responsiveness (BDR) in obstructive lung disease varies over time and may be associated with distinct clinical features. RESEARCH QUESTION: Is consistent BDR over time (always present) differentially associated with obstructive lung disease features relative to inconsistent (sometimes present) or never (never present) BDR in tobacco-exposed people with or without COPD? STUDY DESIGN AND METHODS: We retrospectively analyzed data from 2,269 tobacco-exposed participants in the Subpopulations and Intermediate Outcome Measures in COPD Study with or without COPD. We used various BDR definitions: change of ≥ 200 mL and ≥ 12% in FEV1 (FEV1-BDR), change in FVC (FVC-BDR), and change in in FEV1, FVC or both (ATS-BDR). Using generalized linear models adjusted for demographics, smoking history, FEV1 % predicted after bronchodilator administration, and number of visits that the participant completed, we assessed the association of BDR group: (1) consistent BDR, (2) inconsistent BDR, and (3) never BDR with asthma, CT scan features, blood eosinophil levels, and FEV1 decline in participants without COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 0) and the entire cohort (participants with or without COPD). RESULTS: Both consistent and inconsistent ATS-BDR were associated with asthma history and greater small airways disease (%parametric response mapping functional small airways disease) relative to never ATS-BDR in participants with GOLD stage 0 disease and the entire cohort. We observed similar findings using FEV1-BDR and FVC-BDR definitions. Eosinophils did not vary consistently among BDR groups. Consistent BDR was associated with FEV1 decline over time relative to never BDR in the entire cohort. In participants with GOLD stage 0 disease, both the inconsistent ATS-BDR group (OR, 3.20; 95% CI, 2.21-4.66; P < .001) and consistent ATS-BDR group (OR, 9.48; 95% CI, 3.77-29.12; P < .001) were associated with progression to COPD relative to the never ATS-BDR group. INTERPRETATION: Demonstration of BDR, even once, describes an obstructive lung disease phenotype with a history of asthma and greater small airways disease. Consistent demonstration of BDR indicated a high risk of lung function decline over time in the entire cohort and was associated with higher risk of progression to COPD in patients with GOLD stage 0 disease.

Effect of Real-Time Feedback on Power Output Using a Novel Smart-Resisted Sled Push.

Prior studies have demonstrated the beneficial effects of real-time data feedback (RTF) on athletic performance and motivation. Despite this evidence, the lack of practical means to implement RTF has hindered its widespread adoption. Recently, a smart-resisted sled push was developed to improve athletic power by utilizing electromagnetic motors as a resistance mechanism, coupled with an RTF display. Thirty healthy college-aged male football players were recruited in this randomized, crossover designed study to examine the efficacy of the RTF to improve power output. Participants were randomized into either group 1 (receiving RTF first then no RTF) or group 2 (receiving no RTF first then RTF) during six, 10-meter sled pushes with 3 min rest intervals. The first three pushes were set to an easier level (L1) and the last three were set to a resistance level twice that of the first three runs (L2). A one-month washout period was enforced. For trials 1-3 (L1) (p = 0.026, t = -2.34, ES = -0.428) and 4-6 (L2) (p = 0.035, t = -2.22, ES = -0.405), peak power output (the average peak power output over the course of trials 1-3 and 4-6) was greater in both groups when receiving RTF compared to no-RTF. These findings demonstrate the effectiveness of RTF in augmenting power output during performance training.

Reversible Airflow Obstruction Predicts Future Chronic Obstructive Pulmonary Disease Development in the SPIROMICS Cohort: An Observational Cohort Study.

Rationale: Chronic obstructive pulmonary disease (COPD) is defined by fixed spirometric ratio, FEV1/FVC < 0.70 after inhaled bronchodilators. However, the implications of variable obstruction (VO), in which the prebronchodilator FEV1/FVC ratio is less than 0.70 but increases to 0.70 or more after inhaled bronchodilators, have not been determined. Objectives: We explored differences in physiology, exacerbations, and health status in participants with VO compared with reference participants without obstruction. Methods: Data from the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) cohort were obtained. Participants with VO were compared with reference participants without obstruction. Measurements and Main Results: We assessed differences in baseline radiographic emphysema and small airway disease at study entry, baseline, and change in lung function by spirometry, functional capacity by 6-minute walk, health status using standard questionnaires, exacerbation rates, and progression to COPD between the two groups. All models were adjusted for participant characteristics, asthma history, and tobacco exposure. We assessed 175 participants with VO and 603 reference participants without obstruction. Participants with VO had 6.2 times the hazard of future development of COPD controlling for other factors (95% confidence interval, 4.6-8.3; P < 0.001). Compared with reference participants, the VO group had significantly lower baseline pre- and post-bronchodilator (BD) FEV1, and greater decline over time in post-BD FEV1, and pre- and post-BD FVC. There were no significant differences in exacerbations between groups. Conclusions: Significant risk for future COPD development exists for those with pre- but not post-BD airflow obstruction. These findings support consideration of expanding spirometric criteria defining COPD to include pre-BD obstruction. Clinical trial registered with www.clinicaltrials.gov (NCT01969344).

Use of a Wearable Biosensor to Study Heart Rate Variability in Chronic Obstructive Pulmonary Disease and Its Relationship to Disease Severity.

The purpose of this study was to explore the relationships between heart rate variability (HRV) and various phenotypic measures that relate to health and functional status in chronic obstructive pulmonary disease (COPD), and secondly, to demonstrate the feasibility of ascertaining HRV via a chest-worn wearable biosensor in COPD patients. HRV analysis was performed using SDNN (standard deviation of the mean of all normal R-R intervals), low frequency (LF), high frequency (HF), and LF/HF ratio. We evaluated the associations between HRV and COPD severity, class of bronchodilator therapy prescribed, and patient reported outcomes. Seventy-nine participants with COPD were enrolled. There were no differences in SDNN, HF, and LF/HF ratio according to COPD severity. The SDNN in participants treated with concurrent beta-agonists and muscarinic antagonists was lower than that in other participants after adjusting heart rate (beta coefficient -3.980, p = 0.019). The SDNN was positively correlated with Veterans Specific Activity Questionnaire (VSAQ) score (r = 0.308, p = 0.006) and handgrip strength (r = 0.285, p = 0.011), and negatively correlated with dyspnea by modified Medical Research Council (mMRC) questionnaire (r = -0.234, p = 0.039), health status by Saint George's Respiratory Questionnaire (SGRQ) (r = -0.298, p = 0.008), symptoms by COPD Assessment Test (CAT) (r = -0.280, p = 0.012), and BODE index (r = -0.269, p = 0.020). When measured by a chest-worn wearable device, reduced HRV was observed in COPD participants receiving inhaled beta-sympathomimetic agonist and muscarinic antagonists. HRV was also correlated with various health status and performance measures.

Forced Expiratory Flow at 25%-75% Links COPD Physiology to Emphysema and Disease Severity in the SPIROMICS Cohort.

BACKGROUND: Forced expiratory volume in 1 second (FEV1) is central to the diagnosis of chronic obstructive pulmonary disease (COPD) but is imprecise in classifying disease burden. We examined the potential of the maximal mid-expiratory flow rate (forced expiratory flow rate between 25% and 75% [FEF25%-75%]) as an additional tool for characterizing pathophysiology in COPD. OBJECTIVE: To determine whether FEF25%-75% helps predict clinical and radiographic abnormalities in COPD. STUDY DESIGN AND METHODS: The SubPopulations and InteRediate Outcome Measures In COPD Study (SPIROMICS) enrolled a prospective cohort of 2978 nonsmokers and ever-smokers, with and without COPD, to identify phenotypes and intermediate markers of disease progression. We used baseline data from 2771 ever-smokers from the SPIROMICS cohort to identify associations between percent predicted FEF25%-75% (%predFEF25%-75%) and both clinical markers and computed tomography (CT) findings of smoking-related lung disease. RESULTS: Lower %predFEF25-75% was associated with more severe disease, manifested radiographically by increased functional small airways disease, emphysema (most notably with homogeneous distribution), CT-measured residual volume, total lung capacity (TLC), and airway wall thickness, and clinically by increased symptoms, decreased 6-minute walk distance, and increased bronchodilator responsiveness (BDR). A lower %predFEF25-75% remained significantly associated with increased emphysema, functional small airways disease, TLC, and BDR after adjustment for FEV1 or forced vital capacity (FVC). INTERPRETATION: The %predFEF25-75% provides additional information about disease manifestation beyond FEV1. These associations may reflect loss of elastic recoil and air trapping from emphysema and intrinsic small airways disease. Thus, %predFEF25-75% helps link the anatomic pathology and deranged physiology of COPD.

Craving among individuals with stimulant use disorder in residential social model-based treatment - Can exercise help?

BACKGROUND: In a randomized controlled 8-week trial, we examined the efficacy of aerobic and resistance exercise in reducing craving for methamphetamine (MA) among individuals with MA-use disorder during residential treatment. METHODS: Individuals with MA use disorder (138) who were newly enrolled in residential treatment volunteered for random assignment to either an 8-week exercise intervention (EX) or health education control (HE), with both conditions meeting 3 times weekly; 3 dropped out of the trial, bringing the analysis sample to 135. The majority of participants were male (80%), and 48% were Latino/Hispanic. The mean age of the sample was 31.7 (SD = 6.9) years. Using multivariate mixed models, differences between conditions were examined in: (1) craving for MA, measured by self-reported ratings on a Visual Analog Scale over the 8-week trial and, (2) MA use, measured by self-report and urine drug screens at baseline and 30 and 60 days after discharge from the 8-week study. RESULTS: Results revealed significantly lower craving scores among the participants in the EX group than those in the HE group over the 8-week trial (median daily craving score for EX = 13.5, for HE = 21.8; p = .009). In addition, participants with less craving during treatment had significantly lower rates of MA use after discharge than participants with high craving measured at 30-days (p = .004) and 60-days post-discharge (p < .001). CONCLUSIONS: Results support the utility of incorporating a structured exercise program for individuals with MA-use disorder to reduce craving and improve MA-use outcomes.

The Efficacy of an Immersive Virtual Reality Exergame Incorporating an Adaptive Cable Resistance System on Fitness and Cardiometabolic Measures: A 12-Week Randomized Controlled Trial.

Exergaming, combining elements of video game into the realm of exercise, has recently incorporated immersive virtual reality (IVR) with resistance training. Thirty-two participants (14 females, mean age = 24.3) were randomized to IVR or self-directed control group (SELF) and worked out thrice weekly for 12 weeks (for 36 sessions). The IVR group spent 14 fewer minutes per session (p < 0.001) while reporting the sessions "enjoyable'. Compared to SELF, the IVR group had significantly greater improvement in changes from baseline to post-training in upper-and-lower muscular strength (1-RM) and muscular endurance (85% 1-RM) (14.3 kg vs. 10.0 kg for 1-RM upper, 28.6 kg vs. 22.5 kg for 1-RM lower, 2.6 reps vs. 1.9 reps for 85% 1-RM of upper, 2.7 vs. 2.0 reps for 85% 1-RM of lower, all p < 0.001), peak leg power (1424 vs. 865 W, p < 0.001), body fat% (−3.7% vs. −1.9%, p < 0.001), heart rate variability (4.3 vs. 1.8 ms, p < 0.001), rVO2max (3.28 vs. 0.89 mL/min/kg, p < 0.001) with decreased systolic BP (−0.4 vs. −2.3 mmHg, p < 0.001), and level of perceived exertion during workouts (RPE 14 vs. 16, p < 0.001). With its high-paced and action-filled gaming coupled with superior fitness and cardiometabolic outcomes, this IVR exergaming platform should be considered as another exercise modality for performance and health-related training.

Muscle Activity During Immersive Virtual Reality Exergaming Incorporating an Adaptive Cable Resistance System.

The purpose of this exploratory study was to characterize muscle activation via surface electromyography (sEMG), user-perceived exertion, and enjoyment during a 30-minute session of immersive virtual reality (IVR) cable resistance exergaming. Ten healthy, college-aged males completed a signature 30-minute exergaming session using an IVR adaptive cable resistance system that incorporated six traditional compound exercises. Muscle activation (sEMG) was captured during the session with a wearable sEMG system. Rated of Perceived Exertion (RPE) and Physical Activity Enjoyment Scale (PACES) were recorded following the session. Pectoralis major showed the highest activation during chest press, deltoids showed the highest activation on overhead press, latissimus dorsi showed the highest activation during lat pulldown and row exercises, hamstrings were the most activated muscles during Romanian deadlift, and glutes showed the highest activity during squats. RPE and PACES mean scores were 14 (1) and 4.27 (0.38), respectively. IVR exergaming with resistance cable training provides an enjoyable experience and distracts practitioners from exertion while exercising at a high intensity. Results from this study suggest similar muscle activation responses compared to traditional resistance exercises as demonstrated with prior evidence. This novel form of exercise might have important repercussions for improving health outcomes among those who find it challenging to adhere to and enjoy exercise routines, as well as with little knowledge on how to progress in their resistance training. Further investigations are needed to explore long-term adaptations and to assess if IVR exergaming has additional benefits compared to traditional resistance training.

Lifestyle Modification Using a Wearable Biometric Ring and Guided Feedback Improve Sleep and Exercise Behaviors: A 12-Month Randomized, Placebo-Controlled Study.

Purpose: Wearable biometric monitoring devices (WBMD) show promise as a cutting edge means to improve health and prevent disease through increasing accountability. By regularly providing real-time quantitative data regarding activity, sleep quality, and recovery, users may become more aware of the impact that their lifestyle has on their health. The purpose of this study was to examine the efficacy of a biometric tracking ring on improving sleep quality and increasing physical fitness over a one-year period. Methods: Fifty-six participants received a biometric tracking ring and were placed in one of two groups. One group received a 3-month interactive behavioral modification intervention (INT) that was delivered virtually via a smartphone app with guided text message feedback (GTF). The other received a 3-month non-directive wellness education control (CON). After three months, the INT group was divided into a long-term feedback group (LT-GTF) that continued to receive GTF for another nine months or short-term feedback group (ST-GTF) that stopped receiving GTF. Weight, body composition, and VO2max were assessed at baseline, 3months, and 12months for all participants and additionally at 6 and 9months for the ST-GTF and LT-GTF groups. To establish baseline measurements, sleep and physical activity data were collected daily over a 30-day period. Daily measurements were also conducted throughout the 12-month duration of the study. Results: Over the first 3months, the INT group had significant (p<0.001) improvements in sleep onset latency, daily step count, % time jogging, VO2max, body fat percentage, and heart rate variability (rMSSD HRV) compared to the CON group. Over the next 9months, the LT-GTF group continued to improve significantly (p<0.001) in sleep onset latency, daily step count, % time jogging, VO2max, and rMSSD HRV. The ST-GTF group neither improved nor regressed over the latter 9months except for a small increase in sleep latency. Conclusion: Using a WBMD concomitantly with personalized education, encouragement, and feedback, elicits greater change than using a WBMD alone. Additionally, the improvements achieved from a short duration of personalized coaching are largely maintained with the continued use of a WBMD.

Physiological and Metabolic Requirements, and User-Perceived Exertion of Immersive Virtual Reality Exergaming Incorporating an Adaptive Cable Resistance System: An Exploratory Study.

Objective: To measure metabolic and physiological demand, subjective fatigue, and enjoyment during a signature 30-minute immersive virtual reality (IVR) adaptive cable resistance exergaming session. Methods: Fourteen healthy college-aged individuals (seven females) were initially acquainted with the IVR equipment and gameplay dynamics. Participants then underwent a 30-minute IVR exergaming session performing six different cable resistance exercises. A portable metabolic gas exchange analyzer concurrently assessed energy expenditure (EE) through indirect calorimetry while a chest-worn monitor captured heart rate (HR). Participants subsequently completed questionnaires, including the Borg scale for rating of perceived exertion (RPE), Physical Activity Enjoyment Scale (PACES), and Simulator Sickness Questionnaire (SSQ). Results: The mean EE, mean metabolic equivalent, and average total calories expended during the 30-minute session were 14.7 (standard deviation [SD] 2.8) kcal/minute, 12.9 (SD 0.5), and 440 (SD 84) kcals respectively. The mean HR was 176 (SD 3.1) beats per minute (bpm) with a mean max HR of 188 SD (SD 2.9) bpm. The combined training volume among all participants was 16,102 kg (SD 4137). Participants classified the IVR training session to be "somewhat hard-to-hard" with a RPE score of 14 (SD 1) while indicating the session to be "enjoyable" with a PACES score of 4.31 (SD 0.36). The participants did not report any cybersickness symptoms, demonstrating an average total SSQ score of 24.04 (SD 24.13). Conclusions: IVR exergaming incorporating cable resistance training elicits high EE and physiological demand with high enjoyment scores while attenuating perceived fatigue. The potential for IVR to elicit these acute training effects over long-term training periods warrants further investigation into its contribution to fitness and health.

Ratio of FEV1/Slow Vital Capacity of < 0.7 Is Associated With Clinical, Functional, and Radiologic Features of Obstructive Lung Disease in Smokers With Preserved Lung Function.

BACKGROUND: Mild expiratory flow limitation may not be recognized using traditional spirometric criteria based on the ratio of FEV1/FVC. RESEARCH QUESTION: Does slow vital capacity (SVC) instead of FVC increase the sensitivity of spirometry to identify patients with early or mild obstructive lung disease? STUDY DESIGN AND METHODS: We included 854 current and former smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study cohort with a postbronchodilator FEV1/FVC ≥ 0.7 and FEV1 % predicted of ≥ 80% at enrollment. We compared baseline characteristics, chest CT scan features, exacerbations, and progression to COPD (postbronchodilator FEV1/FVC, < 0.7) during the follow-up period between 734 participants with postbronchodilator FEV1/SVC of ≥ 0.7 and 120 with postbronchodilator FEV1/SVC < 0.7 at the enrollment. We performed multivariate linear and logistic regression models and negative binomial and interval-censored proportion hazards regression models adjusted for demographics and smoking exposure to examine the association of FEV1/SVC < 0.7 with those characteristics and outcomes. RESULTS: Participants with FEV1/SVC < 0.7 were older and had lower FEV1 and more emphysema than those with FEV1/SVC ≥ 0.7. In adjusted analysis, individuals with postbronchodilator FEV1/SVC < 0.7 showed a greater percentage of emphysema by 0.45% (95% CI, 0.09%-0.82%), percentage of gas trapping by 2.52% (95% CI, 0.59%-4.44%), and percentage of functional small airways disease based on parametric response mapping by 2.78% (95% CI, 0.72%-4.83%) at baseline than those with FEV1/SVC ≥ 0.7. During a median follow-up time of 1,500 days, an FEV1/SVC < 0.7 was not associated with total exacerbations (incident rate ratio [IRR], 1.61; 95% CI, 0.97-2.64), but was associated with severe exacerbations (IRR, 2.60; 95% CI, 1.04-4.89). An FEV1/SVC < 0.7 was associated with progression to COPD during a 3-year follow-up even after adjustment for demographics and smoking exposure (hazard ratio, 3.93; 95% CI, 2.71-5.72). We found similar results when we examined the association of prebronchodilator FEV1/SVC < 0.7 or FEV1/SVC less than the lower limit of normal with chest CT scan features and progression to COPD. INTERPRETATION: Low FEV1 to SVC in current and former smokers with normal spirometry results can identify individuals with CT scan features of COPD who are at risk for severe exacerbations and is associated with progression to COPD in the future. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01969344T4; URL: www.clinicaltrials.gov.

COVID-19 Lockdowns: Exacerbating the Silent Pandemic.

The global medical community has exalted the vaccine as the champion solution to end the violent toll inflicted by COVID-19. While the role of vaccines cannot be undervalued in wide-scale intervention, presenting them as the sole solution exonerates individuals of the importance of taking ownership over their lifestyle choices. This editorial focuses on the importance of physical activity as a crucial component of COVID-19 prevention programs and a long-term investment against chronic diseases.

A Multidomain Approach to Assessing the Convergent and Concurrent Validity of a Mobile Application When Compared to Conventional Methods of Determining Body Composition.

Determining body composition via mobile application may circumvent limitations of conventional methods. However, the accuracy of many technologies remains unknown. This investigation assessed the convergent and concurrent validity of a mobile application (LS) that employs 2-dimensional digital photography (LS2D) and 3-dimensional photonic scanning (LS3D). Measures of body composition including circumferences, waist-to-hip ratio (WHR), and body fat percentage (BF%) were obtained from 240 healthy adults using LS and a diverse set of conventional methods-Gulick tape, bioelectrical impedance analysis (BIA), and skinfolds. Convergent validity was consistently high-indicating these methods vary proportionally and can thus reliably detect changes despite individual measurement differences. The span of the Limits of Agreement (LoA) using LS were comparable to the LoA between conventional methods. LS3D exhibited high agreement relative to Gulick tape in the measurement of WHR, despite poor agreement with individual waist and hip circumferences. In BF%, LS2D exhibited high agreement with BIA and skinfold methods, whereas LS3D demonstrated low agreement. Interestingly, the low inferred bias between LS3D and DXA using existing data suggests that LS3D may have high agreement with dual-energy x-ray absorptiometry. Overall, the suitability of LS2D and LS3D to replace conventional methods must be based on an individual user's criteria.

Not All HIFT Classes Are Created Equal: Evaluating Energy Expenditure and Relative Intensity of a High-Intensity Functional Training Regimen.

The demand for efficient and effective exercises has grown in concert with increased attention to fitness as a determinant of overall health. While past studies have examined the benefits traditional conditioning exercises, there have been few investigations of high intensity functional training (HIFT). The aim of this study was to measure the energy expenditure and relative intensity from participation in a signature, 35-minute group-based HIFT regimen. During the HIFT session, 13 volunteers (aged 23-59 years, 6 females) donned a portable breath-by-breath gas analyzer and a heart rate monitor. Mean caloric expenditure (528 ± 62 kcal), maximum heart rate (172 ± 8 bpm), and metabolic equivalents (12.2 ± 1.4 kcal/kg/h) were characterized as a vigorous-intensity activity according to the Compendium of Physical Activities guidelines. Moreover, implementing this high energy expenditure session twice weekly may comport with Physical Activity Guidelines for Americans weekly physical activity recommendations. HIFT training may provide time-efficient exercise for those seeking exercise-related health benefits.

Remote Patient Monitoring for the Detection of COPD Exacerbations.

Background: COPD exacerbations occur more frequently with disease progression and are associated with worse prognosis and higher healthcare expenditure. Purpose: To utilize a networked system, optimized with statistical process control (SPC), for remote patient monitoring (RPM) and to identify potential predictors of COPD exacerbations. Methods: Seventeen subjects, mean (SD) age of 69.7 (7.2) years, with moderate to severe COPD received RPM. Over 2618 patient-days (7.17 patient-years) of monitoring, we obtained daily symptom scores, treatment adherence, self-reported activity levels, daily spirometry (SVC, FEV1, FVC, PEF), inspiratory capacity (IC), and oxygenation (SpO2). These data were used to identify predictors of exacerbations defined using Anthonisen and other criteria. Results: After implementation of SPC, concordance analysis showed substantial agreement between FVC (decrease below the 7-day rolling average minus 1.645 SD) and self-reported healthcare utilization events (κ=0.747, P<0.001) as well as between increased use of inhaled short-acting bronchodilators and exacerbations defined by two Anthonisen criteria (κ=0.611, P<0.001) or modified Anthonisen criteria (κ=0.622, P<0.001). There was a moderate agreement between FEV1 (decrease >1.645 SD below the 7-day rolling average) and self-reported healthcare utilization events (κ=0.475, P<0.001) and between SpO2 less than 90% and exacerbations defined by two Anthonisen criteria (κ=0.474, P<0.001) or modified Anthonisen criteria (κ=0.564, P<0.001). Conclusion: Exacerbations were best predicted by FVC and FEV1 below the one-sided 95% confidence interval derived from SPC but also by increased use of inhaled short-acting bronchodilators and fall in oxygen saturation. An RPM program that captures these parameters may be used to guide appropriate interventions aimed at reducing healthcare utilization in COPD patients.

Donning a Novel Lower-Limb Restrictive Compression Garment During Training Augments Muscle Power and Strength.

The popularity of graduated compression garments (GCG) in sport and exercise is largely driven by the abundance of anecdotal claims suggesting their efficacy. A new line of compression apparel, restrictive compression garments (RCG), integrate novel resistance technology into lower-limb compression garments designed to provide variable resistance to movement. This study aimed to investigate the effect of donning an RCG during a 4-week training program on selected performance variables. Twelve college-aged males were recruited for four weeks of lower-body strength-power resistance training. Participants were randomized 1:1 and blinded to (i) an intervention group (RCG; n = 6) that donned a lower-body RCG during training or (ii) a control group (SHAM; n = 6) that donned a sham during identical training. Both groups demonstrated significant increases in 1-repetition maximum (1-RM) on a seated leg press after 4 weeks (both p < 0.001), with RCG showing a significantly greater increase compared SHAM (p = 0.005, g = 3.35). Similarly, RCG demonstrated significantly greater increases in jump height, peak power, and average power compared to SHAM (p = 0.032, g = 3.44; p < 0.001, g = 4.40; p < 0.001, g = 4.50, respectively). Donning a RCG while engaging in lower-body strength-power training may augment increases 1-RM on a seated leg press, jump height, peak and average power, compared with same exercise training without an RCG.