Personal customizing exercise with a wearable measurement and control unit

BACKGROUND: Recently, wearable technology has been used in various health-related fields to develop advanced monitoring solutions. However, the monitoring function alone cannot meet all the requirements of customizing machine-based exercise on an individual basis by relying on biosignal-based controls. We propose a new wearable unit design equipped with measurement and control functions to support the customization process. METHODS: The wearable unit can measure the heart rate and electromyogram signals during exercise performance and output workload control commands to the exercise machines. The workload is continuously tracked with exercise programs set according to personally customized workload patterns and estimation results from the measured biosignals by a fuzzy control method. Exercise programs are adapted by relying on a computer workstation, which communicates with the wearable unit via wireless connections. A prototype of the wearable unit was tested together with an Internet-based cycle ergometer system to demonstrate that it is possible to customize exercise on an individual basis. RESULTS: We tested the wearable unit in nine people to assess its suitability to control cycle ergometer exercise. The results confirmed that the unit could successfully control the ergometer workload and continuously support gradual changes in physical activities. CONCLUSION: The design of wearable units equipped with measurement and control functions is an important step towards establishing a convenient and continuously supported wellness environment

The effects of exercise training interventions on the health profile of inactive premenopausal women

A physically inactive lifestyle is associated with increased morbidity of non-communicable diseases, with such diseases representing the leading cause of death worldwide. It is well documented that regular participation in physical activity is associated with an improvement in a number of established health markers. However, it has been reported that 34-39 % of UK women aged 25-54 y fail to meet the minimum physical activity recommendations and many conventional exercise training interventions and initiatives are failing to meaningfully increase physical activity levels and adherence in previously inactive premenopausal women. A common barrier preventing premenopausal women from initiating and maintaining increased habitual physical activity is a ‘lack of time’. Physical activity initiation and maintenance can also be affected by the exercise environment with some individuals preferring to exercise alone while others prefer to exercise within a supervised or group environment. Increasing evidence suggests that high-intensity interval training (HIIT) performed independently, under supervision or within a group environment can provide a time-efficient alternative for improving several health markers in different populations. However, limited research has examined the effects of HIIT on health markers in inactive women and the effects of different methods of HIIT on overall health status. Therefore, the purpose of this thesis was to identify how alternative and smaller volumes of higher-intensity exercise influence enjoyment, adherence rates and health markers in previously inactive premenopausal women following 12-16 wks of training. Chapter 4 examined the effects of 16 wks of short duration small-sided football training and whole-body vibration (WBV) training on body composition, aerobic fitness and muscle oxidative capacity of previously inactive premenopausal women. Results from this study demonstrated that short duration small-sided football elicited superior health benefits, which included a reduction in body fat percentage and submaximal exercise heart rate (HR) as well as a decrease in PCr depletion for a given work rate during one-legged knee-extension exercise, compared to WBV training. Chapter 5 demonstrated that 15 wks of high-intensity swim training was an effective and time-efficient alternative exercise modality for the improvement of insulin sensitivity, glucose control and plasma soluble intracellular and vascular cell adhesion molecules compared to prolonged continuous swim training for previously inactive premenopausal women. Chapter 6 revealed that 12 wks of self-paced high-intensity interval and prolonged continuous cycling training both increased cardiorespiratory fitness and cognitive function and reduced resting HR in previously inactive premenopausal women. On the other hand, reductions in resting blood pressure (BP), submaximal HR and body mass and increases in mental well-being were training-type-specific. Finally, Chapter 7 identified that a novel 12 wk home-based DVD-directed exercise programme for previously inactive premenopausal women, encompassing movements commonly found within football training, was beneficial for the improvement of high-density lipoprotein cholesterol concentration and mental well-being when carried out at a moderate- to high-intensity. The exercise training interventions were well tolerated and adhered to by participants and resulted in improvements to some established health markers. However, the improved health profile of premenopausal women after the various training interventions was not uniform, with several training specific adaptations being manifest. Collectively, the combined training studies (n=175 participants) provide some support for shorter-duration, higher-intensity physical exercise training, including football, swimming, cycling and home-based DVD-directed exercise training, but not whole-body vibration training, to improve key health markers in previously inactive premenopausal women. The findings presented in this thesis demonstrate that several HIIT exercise modalities appear to be effective and feasible alternatives to prolonged continuous exercise training for improving health markers in previously inactive premenopausal women.FIFA-Medical Assessments and Research Centre (F-Marc

Physical fitness characteristics of an active firefighter population serving an urban area

Firefighters require a high level of physical fitness in order to meet the demands of their profession. While physical fitness testing is required to join the department, firefighters are not subject to further formal exercise testing throughout the duration of their careers. Active, career firefighters were tested on a variety of physical fitness measures related to body composition, strength, power, and endurance over three testing sessions. 49 firefighters (40.5 ± 8.3 yr, 89.5 ± 13.0 kg, 27.8 ± 3.6 kg/m2) were found to have a resting heart rate of 57.7 ± 8.2 bpm, blood pressure of 121.5 ± 11.9/71.5 ± 9.9 mmHg, and 24.2 ± 5.4 % body fat, culminating in 7.6 ± 6.8 points in the CPAFLA Healthy Body Composition Score. They performed 31.4 ± 11.6 pushups and scored 15.6 ± 1.6 on the 21-point Functional Movement Screen. A subset of participants also completed the Wingate Anaerobic Test, producing 10.6 ± 1.1 W/kg at peak revolutions and averaging 7.4 ± 1.0 W/kg of power with a fatigue index of 49.7 ± 8.7% over the test duration. Maximum strength, as measured by torque produced in a 60°/s isotonic, concentric contraction was 3.0 ± 0.7 Nm/kg for the quadriceps and 1.0 ± 0.1 Nm/kg for the bicep. Measures of core torso strength included the 60° abdominal endurance test (153.8 ± 94.2 s) and Biering-Sorensen test (113.4 ± 48.6 s) for back extensor endurance. Vertical jump was found to be 50.0 ± 9.6 cm. VO2 max was 42.2 ± 6.5 ml O2/kg/min while VO2 at the anaerobic threshold was 33.3 ± 8.2 ml O2/kg/min. Many of the measurements taken displayed large ranges and though many firefighters performed above-average, there were a number who did not. The contrast between the highest and lowest performers for many measures suggests that there may be a small, but significant, portion of the population that do not possess the requisite fitness to optimally perform their job responsibilities. This is cause for concern and may be mitigated by implementation of mandatory training and testing programs. Previous studies examining firefighter fitness have often used a young sample with little experience and fragmented testing while this report assessed greater numbers of senior firefighters and performed a more comprehensive range of testing. This is the first report of firefighter performance on Wingate tests, upper- and lower-body peak torque characteristics, and other performance and body composition characteristics. This data along with the other fitness measures assessed in this study will provide comprehensive baseline data to inform development of fitness training and maintenance protocols for active firefighters

Exercise training in patients awaiting liver transplantation and complex endovascular aortic aneurysm surgery

Introduction: Mounting evidence supports a relationship between physical fitness and perioperative outcomes. This thesis assesses the feasibility of a structured, preoperative exercise training programme in two high-risk surgical cohorts as two distinct studies: patients awaiting liver transplantation (LT) and fenestrated endovascular aortic aneurysm repair (FEVAR). Methods: Participants in the intervention arms for both studies performed thrice weekly directly supervised training sessions on a cycle ergometer for six weeks, individualised according to baseline fitness measured by cardiopulmonary exercise testing (CPET). Feasibility and acceptability outcomes were eligibility, recruitment, adverse events and adherence to exercise. The impact of training was assessed by repeat CPET after the intervention. In each study, changes in anaerobic threshold (AT) and peak oxygen-consumption (VO2peak) were compared to those among a group of control participants. The effect of exercise on cardiorespiratory fitness, health-related quality of life (HRQL) and exercise enjoyment was assessed along with the impact on postoperative outcomes. Results: Predefined feasibility and safety outcomes were met by both studies. A high participant drop-out rate in the LT study was noted (13 of 33 patients across both cohorts) attributed to transplantation, clinical deterioration and delisting. All 23 patients awaiting FEVAR (11 in the exercise and 12 in the control arm) completed the six week study period with a 97% compliance for exercise sessions in the intervention group. No difference in AT was observed between intervention and control cohorts in either study. In patients awaiting LT, an increase in VO2peak was demonstrated in the intervention group and a corresponding decrease in VO2peak in controls from baseline to week six. No change in HRQL scores were observed in either cohort, likewise no difference in postoperative intensive care lengths of stay were seen. Discussion: These two studies demonstrate feasibility for the exercise intervention and will form the basis for further evaluation of similar interventions in future studies

Effects of running sprint interval training versus traditional endurance exercise on metabolic indices in sedentary, overweight and obese women

Evidence suggests that sprint interval training (SIT) is a time efficient alternative for improving aerobic fitness or insulin sensitivity due to its reduced training volume and is of increasing interest since most sedentary individuals indicate lack of time as their number one barrier to being physically active. However, most SIT research uses cycling exercise performed with healthy active males, and limited research examines its effects on women or individuals at higher risk for inactivity related diseases, as well as different modes of exercise. PURPOSE: To evaluate the effects of running SIT (R-SIT) versus moderate intensity endurance training (MIET) on aerobic capacity, resting HR, BP, body composition, blood lipids, and glucose in sedentary, overweight/obese women. METHODS: Twelve sedentary, overweight/obese women (30.7±7.4kg/m2, 33.6±5.8y, 27.9±6.5ml/kg/min) were randomly divided into two 12-week training protocols, each for 3 days per week. The R-SIT group (n=5) completed 4-10 bouts of 30s “all out” sprints on a motorized treadmill at a 3-5% incline with 4 min active recovery. The MIET group (n=7) completed 30-60 min of moderate intensity (45-55% HRR) walking on a treadmill at a 3-5% incline. RESULTS: VO2max significantly improved 19.7% with R-SIT (mean ± SD; 29.59±7.3 to 35.57±10.4 ml/kg/min) and 38.6% with MIET (26.74±35.29±6.6 ml/kg/min) pre to post (p0.05). CONCLUSION: Despite the reduced time commitment, R-SIT elicits similar improvements in aerobic fitness and was more effective at improving body composition than MIET in sedentary, overweight/obese women. Additionally, there is suggestive evidence that R-SIT may induce greater improvements in fat mass, triglycerides, and HbA1c measures. This study provides practical application for the implementation of R-SIT to reduce risk factors associated with cardiovascular disease in sedentary, overweight/obese population. More research is necessary to determine the extent of these reductions. x

An Occupation-Based Protocol for Treatment of Adults with Burn Injury

People are occupational beings. Occupations build the structure of a client’s day. Thus, occupations give life it’s meaning (Hocking, 2001). Occupational therapists have a holistic viewpoint of clients that focuses on improving their quality of life through meaningful occupations. There is a lack of literature supporting the use of occupationbased intervention with adults with burn injuries. Throughout the literature preparatory and purposeful interventions are prominent for burn rehabilitation. (Holavanahalli et al. 2011, Fung et al., 2010, Parry et al., 2012). According to Richard et al. (2008), current techniques to treat burn injuries have remained unchanged for centuries. They suggest that there needs to be a new approach to the treatment of burn injuries. Many occupational therapists find it difficult to provide occupation-based interventions when they need to meet the medical system needs as well (Rogers, 2007). For these many reasons, the authors have created an occupation-based protocol for the treatment of adults with burn injury. This protocol has been developed to guide occupational therapists through the burn rehabilitation process using occupation-based treatment. When using this protocol the occupational therapist should focus their treatment on the client population of adults with burn injuries. The layout of this protocol is based in accordance with the rehabilitative phase of treatment, specifically with inpatient rehabilitation. The Occupational Therapy Practice Framework (American Occupational therapy Association, 2008) is utilized to guide the process of service delivery. Occupational therapists are directed through the initial evaluation, intervention plan development, intervention implementation, and re-evaluation/outcomes. Based on the Occupational Adaptation Model (Schkade & Schultz, 1992; Schultz & Schkade, 1992; Schkade & McClung, 2001), this protocol will provide occupational therapists with inspiring ways to create a client-centered atmosphere and a refreshing alternative to the traditional burn rehabilitation process

Distant Operational Care Centre: Design Project Report

The goal of this project is to outline the design of the Distant Operational Care Centre (DOCC), a modular medical facility to maintain human health and performance in space, that is adaptable to a range of remote human habitats. The purpose of this project is to outline a design, not to go into a complete technical specification of a medical facility for space. This project involves a process to produce a concise set of requirements, addressing the fundamental problems and issues regarding all aspects of a space medical facility for the future. The ideas presented here are at a high level, based on existing, researched, and hypothetical technologies. Given the long development times for space exploration, the outlined concepts from this project embodies a collection of identified problems, and corresponding proposed solutions and ideas, ready to contribute to future space exploration efforts. In order to provide a solid extrapolation and speculation in the context of the future of space medicine, the extent of this project's vision is roughly within the next two decades. The Distant Operational Care Centre (DOCC) is a modular medical facility for space. That is, its function is to maintain human health and performance in space environments, through prevention, diagnosis, and treatment. Furthermore, the DOCC must be adaptable to meet the environmental requirements of different remote human habitats, and support a high quality of human performance. To meet a diverse range of remote human habitats, the DOCC concentrates on a core medical capability that can then be adapted. Adaptation would make use of the DOCC's functional modularity, providing the ability to replace, add, and modify core functions of the DOCC by updating hardware, operations, and procedures. Some of the challenges to be addressed by this project include what constitutes the core medical capability in terms of hardware, operations, and procedures, and how DOCC can be adapted to different remote habitats

Ready exerciser one: examining the efficacy of immersive technologies in the exercise domain

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonThe present programme of research sought to examine the effects of audio-visual stimuli during exercise, using immersive, commercially available technologies. Three original studies were conducted using a range of settings (i.e., real-world, laboratory), methodologies (i.e., qualitative and quantitative), exercise modalities (i.e., gym workouts, cycle ergometry) and consumer products (e.g., music-video channels, virtual reality head-mounted displays) in order to explore the main research question from various perspectives. A substantive theory was proposed in Study 1 that sought to explain and predict the social process of exercising in the presence of a music-video channel. The model provides support for a three-stage process that commences with the content of the music-video channel. The second stage depicts a series of moderators that revolve around the core category, appraisal of appropriateness. Lastly, a range of effects pertaining to exercisers and facility staff are predicted. Study 2 sought to examine the influence of a range of audio-visual stimuli on cycle ergometer exercise at the ventilatory threshold. The findings indicated that a 360-degree video with music condition elicited the most positive affective valence, greatest perceived activation, most dissociative thoughts, and highest ratings of perceived enjoyment. Study 3 sought to veer towards greater ecological validity with the inclusion of a commercially available virtual reality-enabled cycle ergometer. The findings demonstrated the efficacy of such technology, as conditions that entailed virtual reality elicited the most positive affective valence, highest perceived activation, largest number of dissociative thoughts, and greatest perceived enjoyment. Taken holistically, the present body of work demonstrates that audio-visual stimuli can serve as a catalyst for several affective, cognitive, and behavioural effects across various exercise modes and intensities. Researchers are beginning to recognise the importance of affective responses in shaping future exercise behaviours. The addition of audio-visual stimuli within the exercise environment represents a cost-effective and easily implementable intervention that might encourage individuals to partake in regular exercise

Stress-Buffering Effects of Physical Activity and Cardiorespiratory Fitness in Police Officers - A Real-Life Study

Background: In modern society, psychosocial stress is a major health threat, related to cardiovascular disease and impaired mental well-being. The workplace constitutes a main source of stress in western countries. The related physiological and mental health impairments are manifold and welldocumented, and the associated costs for individuals and society are considerable. Promising evidence suggests physical activity (PA) and cardiorespiratory fitness (CRF) may be public health resources that buffer the negative effects of stress on health. However, evidence from laboratory studies is conflicting to some extent, and research to elaborate previous findings in externally valid conditions is required. To date, research has primarly been based on retrospective self-reports, and studies in realistic circumstances are scarce. This project was designed to examine the stress-buffering effects of PA and CRF on physiological and psychological health in realistic circumstances with a comprehensive methodology. A central goal of the current study was to investigate underlying mechanisms in line with the cross-stressor adaptation hypothesis (CSA) on psychophysiological stress responses. Dynamic psychophysiological processes were captured using newest methodological developments of Ecological Momentary Assessment (EMA) and Ambulatory Assessment (AA), as well as sophisticated statistical models. Research objectives: In a one-year prospective study with a sample of 201 police officers, exposure to chronic and acute work stress was examined, along with cardiometabolic and mental health parameters. PA was assessed over seven consecutive days via accelerometry, substantiated by a recently developed and validated questionnaire (Simple Physical Activity Questionnaire; SIMPAQ). CRF was objectively measured with the submaximal Åstrand cycling test. Chronic work stress was observed based on the job-demand and control (JDC) model, as well as the effort-reward imbalance (ERI) model. Acute work stress was measured using smartphone-based EMA of current stress experiences, whereas physiological responses were captured using AA of heart rate variability (HRV). Cardiovascular risk factors (waist circumference, blood pressure, blood sugar, blood lipids) were assessed in a laboratory setting and psychological health outcomes (Burnout, sleep health, psychological distress) via online-questionnaire. The first hypothesis posited moderating effects of PA and CRF on the association between chronic work stress, cardiometabolic health, and mental health. Higher levels of PA and CRF were suggested to be related to improved cardiometabolic and mental health, with stronger effects when levels of chronic work stress were higher. Hypothesis testing was performed using cross-sectional and prospective regression analyses. The second research question focussed on the CSA hypothesis. Lower physiological stress reactivity and increased physiological stress recovery were expected for individuals with higher levels of PA (results not VIII shown), as well as CRF. Physiological stress reactivity was defined as changes in HRV which were matched to the individuals’ specific stress experiences. Physiological recovery was investigated by measuring HRV during the following night. Hypothesis testing was performed using multilevel models and regression analysis. Results: The validation studies supported the suitability of the applied questionnaires for the assessment of PA and burnout. The main finding was that no stress-buffering effects of PA appeared in the data. Furthermore, CRF partially occurred as a stress-buffer on the cross-sectional association between ERI scores and cardiovascular risk factors, whereas no stress-buffering effects occurred on metabolic syndrome and mental health. The second major finding was that PA did not appear to influence physiological stress reactivity or recovery. However, CRF partially buffered physiological stress reactivity, whereas no effect occurred on physiological stress recovery. CRF was related to a more favorable stress reactivity regarding feelings of stress, whereas no effects occurred for feelings of anger, positive or negative affect. Aside from these main findings, PA was significantly and negatively correlated with metabolic syndrome scores after one year. CRF was a reliable significant predictor for lowered cardiovascular risk factors, including metabolic syndrome after one year. Additionally, CRF showed significant associations with more favorable day and night HRV levels. The present findings must be cautiously interpreted because of non-probability sampling. Furthermore, an inconsistent relationship between work stress and physiological outcomes might have lowered the detectable effects. This could be due to the high activity and fitness levels in the present sample, which may have entailed a ceiling effect. Conclusion: This is one of the first real-life studies examining the stress-buffering effects of PA and CRF in realistic circumstances and with such comprehensive methodology. In summary, CRF appeared as an important health resource with the potential to buffer some of the associations between stress and health risk factors. Therefore, the consistent and routine measurement of CRF should be addressed in occupational health programs for police officers, and constant efforts to encourage individuals to improve and preserve CRF levels should be made. PA has to be measured more precisely to elaborate acute and regular differences and interactions with fitness, and differences in leisure time and work-related PA, especially in a physically demanding work environment. Research with longer follow-up periods including continuous/multiple measurements is warranted to elaborate important health related effects and mechanisms more precisely