Phosphate Loading Does not Improve 30-km Cycling Time-Trial Performance in Trained Cyclists.

Phosphate is integral to numerous metabolic processes, several of which strongly predict exercise performance (i.e., cardiac function, oxygen transport, and oxidative metabolism). Evidence regarding phosphate loading is limited and equivocal, at least partly because studies have examined sodium phosphate supplements of varied molar mass (e.g., mono/di/tribasic, dodecahydrate), thus delivering highly variable absolute quantities of phosphate. Within a randomized cross-over design and in a single-blind manner, 16 well-trained cyclists (age 38 ± 16 years, mass 74.3 ± 10.8 kg, training 340 ± 171 min/week; mean ± SD) ingested either 3.5 g/day of dibasic sodium phosphate (Na2HPO4: 24.7 mmol/day phosphate; 49.4 mmol/day sodium) or a sodium chloride placebo (NaCl: 49.4 mmol/day sodium and chloride) for 4 days prior to each of two 30-km time trials, separated by a washout interval of 14 days. There was no evidence of any ergogenic benefit associated with phosphate loading. Time to complete the 30-km time trial did not differ following ingestion of sodium phosphate and sodium chloride (3,059 ± 531 s vs. 2,995 ± 467 s). Accordingly, neither absolute mean power output (221 ± 48 W vs. 226 ± 48 W) nor relative mean power output (3.02 ± 0.78 W/kg vs. 3.08 ± 0.71 W/kg) differed meaningfully between the respective intervention and placebo conditions. Measures of cardiovascular strain and ratings of perceived exertion were very closely matched between treatments (i.e., average heart rate 161 ± 11 beats per minute vs. 159 ± 12 beats per minute; Δ2 beats per minute; and ratings of perceived exertion 18 [14-20] units vs. 17 [14-20] units). In conclusion, supplementing with relatively high absolute doses of phosphate (i.e., >10 mmol daily for 4 days) exerted no ergogenic effects on trained cyclists completing 30-km time trials.

Ketone Monoester Ingestion Alters Metabolism and Simulated Rugby Performance in Professional Players.

Ketone ingestion can alter metabolism but effects on exercise performance are unclear, particularly with regard to the impact on intermittent-intensity exercise and team-sport performance. Nine professional male rugby union players each completed two trials in a double-blind, randomized, crossover design. Participants ingested either 90 ± 9 g carbohydrate (CHO; 9% solution) or an energy matched solution containing 20 ± 2 g CHO (3% solution) and 590 mg/kg body mass ß-hydroxybutyrate monoester (CHO + BHB-ME) before and during a simulated rugby union-specific match-play protocol, including repeated high-intensity, sprint and power-based performance tests. Mean time to complete the sustained high-intensity performance tests was reduced by 0.33 ± 0.41 s (2.1%) with CHO + BHB-ME (15.53 ± 0.52 s) compared with CHO (15.86 ± 0.80 s) placebo (p = .04). Mean time to complete the sprint and power-based performance tests were not different between trials. CHO + BHB-ME resulted in blood BHB concentrations that remained >2 mmol/L during exercise (p < .001). Serum lactate and glycerol concentrations were lower after CHO + BHB-ME than CHO (p < .05). Coingestion of a BHB-ME with CHO can alter fuel metabolism (attenuate circulating lactate and glycerol concentrations) and may improve high-intensity running performance during a simulated rugby match-play protocol, without improving shorter duration sprint and power-based efforts.

Effect of novel technology-enabled multidimensional physical activity feedback in primary care patients at risk of chronic disease - the MIPACT study: a randomised controlled trial.

BACKGROUND: Technological progress has enabled the provision of personalised feedback across multiple dimensions of physical activity that are important for health. Whether this multidimensional approach supports physical activity behaviour change has not yet been examined. Our objective was to examine the effectiveness of a novel digital system and app that provided multidimensional physical activity feedback combined with health trainer support in primary care patients identified as at risk of chronic disease. METHODS: MIPACT was a parallel-group, randomised controlled trial that recruited patients at medium (≥10 and < 20%) or high (≥20%) risk of cardiovascular disease and/or type II diabetes from six primary care practices in the United Kingdom. Intervention group participants (n = 120) received personal multidimensional physical activity feedback using a customised digital system and web-app for 3 months plus five health trainer-led sessions. All participants received standardised information regarding physical activity. Control group participants (n = 84) received no further intervention. The primary outcome was device-based assessment of physical activity at 12 months. RESULTS: Mean intervention effects were: moderate-vigorous physical activity: -1.1 (95% CI, - 17.9 to 15.7) min/day; moderate-vigorous physical activity in ≥10-min bouts: 0.2 (- 14.2 to 14.6) min/day; Physical Activity Level (PAL): 0.00 (- 0.036 to 0.054); vigorous physical activity: 1.8 (- 0.8 to 4.2) min/day; and sedentary time: 10 (- 19.3 to 39.3) min/day. For all of these outcomes, the results showed that the groups were practically equivalent and statistically ruled out meaningful positive or negative effects (>minimum clinically important difference, MCID). However, there was profound physical activity multidimensionality, and only a small proportion (5%) of patients had consistently low physical activity across all dimensions. CONCLUSION: In patients at risk of cardiovascular disease and/or type II diabetes, MIPACT did not increase mean physical activity. Using a sophisticated multidimensional digital approach revealed enormous heterogeneity in baseline physical activity in primary care patients, and practitioners may need to screen for low physical activity across dimensions rather than rely on disease-risk algorithms that are heavily influenced by age. TRIAL REGISTRATION: This trial is registered with the ISRCTN registry ( ISRCTN18008011 ; registration date 31 July 2013).

Feedback from physical activity monitors is not compatible with current recommendations: A recalibration study.

Wearable devices to self-monitor physical activity have become popular with individuals and healthcare practitioners as a route to the prevention of chronic disease. It is not currently possible to reconcile feedback from these devices with activity recommendations because the guidelines refer to the amount of activity required on top of normal lifestyle activities (e.g., 150 minutes of moderate-to-vigorous intensity activity per week over-and-above normal moderate-to-vigorous lifestyle activities). The aim of this study was to recalibrate the feedback from self-monitoring. We pooled data from four studies conducted between 2006 and 2014 in patients and volunteers from the community that included both sophisticated measures of physical activity and 10-year risk for cardiovascular disease and type 2 diabetes (n=305). We determined the amount of moderate-to-vigorous intensity activity that corresponded to FAO/WHO/UNU guidance for a required PAL of 1.75 (Total Energy Expenditure/Basal Metabolic Rate). Our results show that, at the UK median PAL, total moderate-to-vigorous intensity physical activity will be around 735 minutes per week (~11% of waking time). We estimate that a 4% increase in moderate-to-vigorous intensity activity will achieve standardised guidance from FAO/WHO/UNU and will require ~1000 minutes of moderate-to-vigorous intensity activity per week. This study demonstrates that feedback from sophisticated wearable devices is incompatible with current physical activity recommendations. Without adjustment, people will erroneously form the view that they are exceeding recommendations by several fold. A more appropriate target from self-monitoring that accounts for normal moderate-to-vigorous lifestyle activities is ~1000 minutes per week, which represents ~15% of waking time.

Measurement of steroid hormones in saliva: Effects of sample storage condition.

Measurement of steroid hormones in saliva is increasingly common in elite sport settings. However, this environment may enforce handling and storage practices that introduce error in measurement of hormone concentrations. We assessed the influence of storage temperature and duration on reproducibility of salivary steroid levels. Nine healthy adults provided morning and afternoon saliva samples on two separate occasions. Each sample was divided into identical saliva aliquots which were stored long-term (i.e. 28 and 84 days) at - 80°C or - 20°C (testing day 1), and short-term (i.e. 1, 3, 7 and 14 days) at 4°C or 20°C (testing day 2). Samples were analyzed for cortisol, testosterone and estradiol using ELISA. In non-freezer conditions, there was a decrease from baseline to 7 days in testosterone (- 26 ± 15%) and estradiol (- 58 ± 17%) but not cortisol concentrations (p < 0.001). This decrease was larger in samples stored at room temperature than in the refrigerator (p ≤ 0.01). There were small but significant changes in measured concentrations of all hormones after 28 and/or 84 days of storage in freezer conditions (p ≤ 0.01), but these were generally within 12% of baseline concentrations, and may be partly explained by inter-assay variability. Whole saliva samples to be analyzed for cortisol, testosterone and estradiol should be frozen at - 20°C or below within 24 h of collection, and analyzed within 28 days. Storage of samples for measurement of testosterone and estradiol at temperatures above - 20°C can introduce large error variance to measured concentrations.

Impact of a carbohydrate-electrolyte drink on ingestive behaviour, affect and self-selected intensity during recreational exercise after 24-h fluid restriction.

This study examined the effects of a carbohydrate-electrolyte drink on voluntary fluid intake, affect and self-selected intensity during recreational exercise after fluid restriction. In a randomised counterbalanced design, ten physically active adults were dehydrated via a 24-h period of fluid restriction before completing two 20-min bouts of cardiovascular exercise, 20-min of resistance exercise and 20 min on a cycle ergometer at a self-selected intensity with ad libitum access to water (W) or a carbohydrate-electrolyte solution (CES). Fluid restriction induced hypohydration of ∼1.2% initial body mass. Fluid intake during exercise was greater with CES (2105 ± 363 vs. 1470 ± 429 mL; P<0.01) and resulted in more adequate hydration (-0.03 ± 0.65 vs. -1.26 ± 0.80%; P<0.01). Plasma glucose concentrations (4.48 ± 0.40 vs. 4.28 ± 0.32 mmol L(-1); P<0.01) and pleasure ratings (2.63 ± 1.17 vs. 1.81 ± 1.37; P<0.01) were greater with CES than W. Mean power output during exercise performed at a self-selected intensity was 5.6% greater with CES (171 ± 63 vs. 162 ± 60 W; P<0.05). In physically active adults performing a 'real-life' recreational exercise simulation, CES resulted in more adequate hydration and an enhanced affective experience that corresponded with an increase in self-selected exercise intensity.

Voluntary drinking behaviour, fluid balance and psychological affect when ingesting water or a carbohydrate-electrolyte solution during exercise.

This study investigated the effects of drink composition on voluntary intake, hydration status, selected physiological responses and affective states during simulated gymnasium-based exercise. In a randomised counterbalanced design, 12 physically active adults performed three 20-min intervals of cardiovascular exercise at 75% heart rate maximum, one 20-min period of resistance exercise and 20 min of recovery with ad libitum access to water (W), a carbohydrate-electrolyte solution (CES) or with no access to fluids (NF). Fluid intake was greater with CES than W (1706±157 vs. 1171±152 mL; P<0.01) and more adequate hydration was achieved in CES trials (NF vs. W vs. CES: -1668±73 vs. -700±99 vs. -273±78 g; P<0.01). Plasma glucose concentrations were highest with CES (CES vs. NF vs. W: 4.26±0.12 vs. 4.06±0.08 vs. 3.97±0.10 mmol/L; P<0.05). Pleasure ratings were better maintained with ad libitum intake of CES (CES vs. NF vs. W: 2.72±0.23 vs. 1.09±0.20 vs. 1.74±0.33; P<0.01). Under conditions of voluntary drinking, CES resulted in more adequate hydration and a better maintenance of affective states than W or NF during gymnasium-based exercise.

Initial hydration status, fluid balance, and psychological affect during recreational exercise in adults.

There is little information on the impact of hydration status on the psychological response to exercise despite potential implications for adherence to an exercise programme and for overall health and fitness. We investigated initial hydration status, fluid balance, and psychological responses associated with a typical recreational exercise session in healthy adults. Fifty-two participants performed a freely chosen gymnasium-based exercise session at a fitness centre, with ad libitum access to fluids. Urine samples were collected on arrival for analysis of osmolality. Sweat loss was estimated from the change in body mass after correction for fluid intake and urinary losses. Subjective psychological ratings were recorded before and after exercise. Pre-exercise urine osmolality was above 900 mOsmol · kg(-1) (used as a threshold for hypohydration) in 37% of participants. Fluid intake during exercise was 390 ± 298 mL, while estimated sweat loss was 794 ± 391 mL. The percentage change from pre-exercise body mass was -0.62 ± 0.20%. Physically active adults who arrived to take part in exercise hypohydrated reported more negative changes in psychological affect in response to their subsequent freely chosen recreational exercise session than those classified as euhydrated prior to exercise (-0.2 ± 0.7 vs. 0.8 ± 0.7; P < 0.005).

The impact of multidimensional physical activity feedback on healthcare practitioners and patients.

BACKGROUND: Promotion of physical activity in primary care has had limited success. Wearable technology presents an opportunity to support healthcare practitioners (HCPs) in providing personalised feedback to their patients. AIM: To explore the differing thoughts and feelings of both HCPs and at-risk patients provided with personalised multidimensional physical activity feedback. DESIGN & SETTING: Qualitative study with HCPs (n = 15) and patients at risk of cardiovascular disease or type 2 diabetes (n = 29), recruited from primary care. METHOD: HCPs and patients wore a physical activity monitor for 7 days and were subsequently shown their personalised multidimensional feedback, including sedentary time, calorie burn, short (1-minute) or long (>10-minute) bouts of moderate-to-vigorous activity during semi-structured interviews. Transcripts were analysed thematically with comparisons made between individuals of high (n = 21) and low (n = 23) physical activity levels as to their cognitive-affective responses to their data. RESULTS: Personalised feedback elicited positive emotional responses for highly active participants and negative emotional responses for those with low activity. However, individuals with low activity demonstrated largely positive coping mechanisms. Some low active participants were in denial over feedback, but the majority valued it as an opportunity to think of ways to improve physical activity (cognitive reappraisal) and started forming action plans (problem-focused coping). Around half of all participants also sought to validate their feedback against peers. CONCLUSION: Personalised, visual feedback elicits immediate emotional and coping responses in participants of high and low physical activity levels. Further studies should explore whether multidimensional feedback could help practitioners explore diverse ways for lifestyle change with patients.

Assessment of laboratory and daily energy expenditure estimates from consumer multi-sensor physical activity monitors.

Wearable physical activity monitors are growing in popularity and provide the opportunity for large numbers of the public to self-monitor physical activity behaviours. The latest generation of these devices feature multiple sensors, ostensibly similar or even superior to advanced research instruments. However, little is known about the accuracy of their energy expenditure estimates. Here, we assessed their performance against criterion measurements in both controlled laboratory conditions (simulated activities of daily living and structured exercise) and over a 24 hour period in free-living conditions. Thirty men (n = 15) and women (n = 15) wore three multi-sensor consumer monitors (Microsoft Band, Apple Watch and Fitbit Charge HR), an accelerometry-only device as a comparison (Jawbone UP24) and validated research-grade multi-sensor devices (BodyMedia Core and individually calibrated Actiheart™). During discrete laboratory activities when compared against indirect calorimetry, the Apple Watch performed similarly to criterion measures. The Fitbit Charge HR was less consistent at measurement of discrete activities, but produced similar free-living estimates to the Apple Watch. Both these devices underestimated free-living energy expenditure (-394 kcal/d and -405 kcal/d, respectively; P<0.01). The multi-sensor Microsoft Band and accelerometry-only Jawbone UP24 devices underestimated most laboratory activities and substantially underestimated free-living expenditure (-1128 kcal/d and -998 kcal/d, respectively; P<0.01). None of the consumer devices were deemed equivalent to the reference method for daily energy expenditure. For all devices, there was a tendency for negative bias with greater daily energy expenditure. No consumer monitors performed as well as the research-grade devices although in some (but not all) cases, estimates were close to criterion measurements. Thus, whilst industry-led innovation has improved the accuracy of consumer monitors, these devices are not yet equivalent to the best research-grade devices or indeed equivalent to each other. We propose independent quality standards and/or accuracy ratings for consumer devices are required.

The understanding and interpretation of innovative technology-enabled multidimensional physical activity feedback in patients at risk of future chronic disease.

BACKGROUND: Innovative physical activity monitoring technology can be used to depict rich visual feedback that encompasses the various aspects of physical activity known to be important for health. However, it is unknown whether patients who are at risk of chronic disease would understand such sophisticated personalised feedback or whether they would find it useful and motivating. The purpose of the present study was to determine whether technology-enabled multidimensional physical activity graphics and visualisations are comprehensible and usable for patients at risk of chronic disease. METHOD: We developed several iterations of graphics depicting minute-by-minute activity patterns and integrated physical activity health targets. Subsequently, patients at moderate/high risk of chronic disease (n=29) and healthcare practitioners (n=15) from South West England underwent full 7-days activity monitoring followed by individual semi-structured interviews in which they were asked to comment on their own personalised visual feedback Framework analysis was used to gauge their interpretation and of personalised feedback, graphics and visualisations. RESULTS: We identified two main components focussing on (a) the interpretation of feedback designs and data and (b) the impact of personalised visual physical activity feedback on facilitation of health behaviour change. Participants demonstrated a clear ability to understand the sophisticated personal information plus an enhanced physical activity knowledge. They reported that receiving multidimensional feedback was motivating and could be usefully applied to facilitate their efforts in becoming more physically active. CONCLUSION: Multidimensional physical activity feedback can be made comprehensible, informative and motivational by using appropriate graphics and visualisations. There is an opportunity to exploit the full potential created by technological innovation and provide sophisticated personalised physical activity feedback as an adjunct to support behaviour change.

Multidimensional individualised Physical ACTivity (Mi-PACT)--a technology-enabled intervention to promote physical activity in primary care: study protocol for a randomised controlled trial.

BACKGROUND: Low physical activity is a major public health problem. New cost-effective approaches that stimulate meaningful long-term changes in physical activity are required, especially within primary care settings. It is becoming clear that there are various dimensions to physical activity with independent health benefits. Advances in technology mean that it is now possible to generate multidimensional physical activity 'profiles' that provide a more complete representation of physical activity and offer a variety of options that can be tailored to the individual. Mi-PACT is a randomised controlled trial designed to examine whether personalised multidimensional physical activity feedback and self-monitoring alongside trainer-supportive sessions increases physical activity and improves health outcomes in at-risk men and women. METHODS/DESIGN: We aim to recruit 216 patients from within primary care aged 40 to 70 years and at medium or high risk of cardiovascular disease and/or type II diabetes mellitus. Adopting an unequal allocation ratio (intervention: control) of 2:1, participants will be randomised to one of two groups, usual care or the intervention. The control group will receive usual care from their general practitioner (GP) and standardised messages about physical activity for health. The intervention group will receive physical activity monitors and access to a web-based platform for a 3-month period to enable self-monitoring and the provision of personalised feedback regarding the multidimensional nature of physical activity. In addition, this technology-enabled feedback will be discussed with participants on 5 occasions during supportive one-to-one coaching sessions across the 3-month intervention. The primary outcome measure is physical activity, which will be directly assessed using activity monitors for a 7-day period at baseline, post intervention and at 12 months. Secondary measures (at these time-points) include weight loss, fat mass, and markers of metabolic control, motivation and well-being. DISCUSSION: Results from this study will provide insight into the effects of integrated physical activity profiling and self-monitoring combined with in-person support on physical activity and health outcomes in patients at risk of future chronic disease. TRIAL REGISTRATION: ISRCTN18008011 Trial registration date: 31 July 2013.