Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

This is the final version. Available on open access from BMC via the DOI in this recordAvailability of data and materials: The datasets supporting the conclusions of this article are available on request.Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery. Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices. Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 males) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R = 0.57 (CI 0.29–0.76), R = 0.59 (CI 0.31–0.77) and R = 0.62 (CI 0.35–0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01–0.64), R = 0.39 (CI 0.04–0.66) and R = 0.42 (CI 0.07–0.68) respectively) and peak work (R = 0.56 (CI 0.27–0.75), R = 0.48 (CI 0.17–0.70) and R = 0.50 (CI 0.2–0.72) respectively). Receiver operator curve (ROC) analysis for direct and self-reported measures of 7-day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work. Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment. Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24 January 2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.Alan Turing InstituteMedical Research Council (MRC

PRESENT AND FUTURE PERVASIVE HEALTHCARE METHODOLOGIES: INTELLIGENT BODY DEVICES, PROCESSING AND MODELING TO SEARCH FOR NEW CARDIOVASCULAR AND PHYSIOLOGICAL BIOMARKERS

The motivation behind this work comes from the area of pervasive computing technologies for healthcare and wearable healthcare IT systems, an emerging field of research that brings in revolutionary paradigms for computing models in the 21st century. The aim of this thesis is focused on emerging personal health technologies and pattern recognition strategies for early diagnosis and personalized treatment and rehabilitation for individuals with cardiovascular and neurophysiological diseases. Attention was paid to the development of an intelligent system for the automatic classification of cardiac valve disease for screening purposes. Promising results were reported with the possibility to implement a new screening strategy for the diagnosis of cardiac valve disease in developing countries. A novel assistive architecture for the elderly able to non-invasively assess muscle fatigue by surface electromyography using wireless platform during exercise with an ergonomic platform was presented. Finally a wearable chest belt for ECG monitoring to investigate the psycho-physiological effects of the autonomic system and a wearable technology for monitoring of knee kinematics and recognition of ambulatory activities were characterized to evaluate the reliability for clinical purposes of collected data. The potential impact in the clinical arena of this research would be extremely important, since promising data show how such emerging personal technologies and methodologies are effective in several scenarios to early screening and discovery of novel diagnostic and prognostic biomarkers

Non-invasive wearable sensing systems for continuous health monitoring and long-term behavior modeling

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, February 2006.Includes bibliographical references (p. 212-228).Deploying new healthcare technologies for proactive health and elder care will become a major priority over the next decade, as medical care systems worldwide become strained by the aging populations. This thesis presents LiveNet, a distributed mobile system based on low-cost commodity hardware that can be deployed for a variety of healthcare applications. LiveNet embodies a flexible infrastructure platform intended for long-term ambulatory health monitoring with real-time data streaming and context classification capabilities. Using LiveNet, we are able to continuously monitor a wide range of physiological signals together with the user's activity and context, to develop a personalized, data-rich health profile of a user over time. Most clinical sensing technologies that exist have focused on accuracy and reliability, at the expense of cost-effectiveness, burden on the patient, and portability. Future proactive health technologies, on the other hand, must be affordable, unobtrusive, and non-invasive if the general population is going to adopt them.(cont.) In this thesis, we focus on the potential of using features derived from minimally invasive physiological and contextual sensors such as motion, speech, heart rate, skin conductance, and temperature/heat flux that can be used in combination with mobile technology to create powerful context-aware systems that are transparent to the user. In many cases, these non-invasive sensing technologies can completely replace more invasive diagnostic sensing for applications in long-term monitoring, behavior and physiology trending, and real-time proactive feedback and alert systems. Non-invasive sensing technologies are particularly important in ambulatory and continuous monitoring applications, where more cumbersome sensing equipment that is typically found in medical and clinical research settings is not usable. The research in this thesis demonstrates that it is possible to use simple non-invasive physiological and contextual sensing using the LiveNet system to accurately classify a variety of physiological conditions. We demonstrate that non-invasive sensing can be correlated to a variety of important physiological and behavioral phenomenon, and thus can serve as substitutes to more invasive and unwieldy forms of medical monitoring devices while still providing a high level of diagnostic power.(cont.) From this foundation, the LiveNet system is deployed in a number of studies to quantify physiological and contextual state. First, a number of classifiers for important health and general contextual cues such as activity state and stress level are developed from basic non-invasive physiological sensing. We then demonstrate that the LiveNet system can be used to develop systems that can classify clinically significant physiological and pathological conditions and that are robust in the presence of noise, motion artifacts, and other adverse conditions found in real-world situations. This is highlighted in a cold exposure and core body temperature study in collaboration with the U.S. Army Research Institute of Environmental Medicine. In this study, we show that it is possible to develop real-time implementations of these classifiers for proactive health monitors that can provide instantaneous feedback relevant in soldier monitoring applications. This thesis also demonstrates that the LiveNet platform can be used for long-term continuous monitoring applications to study physiological trends that vary slowly with time.(cont.) In a clinical study with the Psychiatry Department at the Massachusetts General Hospital, the LiveNet platform is used to continuously monitor clinically depressed patients during their stays on an in-patient ward for treatment. We show that we can accurately correlate physiology and behavior to depression state, as well as to track changes in depression state over time through the course of treatment. This study demonstrates how long-term physiology and behavioral changes can be captured to objectively measure medical treatment and medication efficacy. In another long-term monitoring study, the LiveNet platform is used to collect data on people's everyday behavior as they go through daily life. By collecting long-term behavioral data, we demonstrate the possibility of modeling and predicting high-level behavior using simple physiologic and contextual information derived solely from ambulatory mobile sensing technology.by Michael Sung.Ph.D

Epidemiology of Injury in English Women's Super league Football: A Cohort Study

INTRODUCTION: The epidemiology of injury in male professional football has been well documented (Ekstrand, Hägglund, & Waldén, 2011) and used as a basis to understand injury trends for a number of years. The prevalence and incidence of injuries occurring in womens super league football is unknown. The aim of this study is to estimate the prevalence and incidence of injury in an English Super League Women’s Football squad. METHODS: Following ethical approval from Leeds Beckett University, players (n = 25) signed to a Women’s Super League Football club provided written informed consent to complete a self-administered injury survey. Measures of exposure, injury and performance over a 12-month period was gathered. Participants were classified as injured if they reported a football injury that required medical attention or withdrawal from participation for one day or more. Injuries were categorised as either traumatic or overuse and whether the injury was a new injury and/or re-injury of the same anatomical site RESULTS: 43 injuries, including re-injury were reported by the 25 participants providing a clinical incidence of 1.72 injuries per player. Total incidence of injury was 10.8/1000 h (95% CI: 7.5 to 14.03). Participants were at higher risk of injury during a match compared with training (32.4 (95% CI: 15.6 to 48.4) vs 8.0 (95% CI: 5.0 to 10.85)/1000 hours, p 28 days) of which there were three non-contact anterior cruciate ligament (ACL) injuries. The epidemiological incidence proportion was 0.80 (95% CI: 0.64 to 0.95) and the average probability that any player on this team will sustain at least one injury was 80.0% (95% CI: 64.3% to 95.6%) CONCLUSION: This is the first report capturing exposure and injury incidence by anatomical site from a cohort of English players and is comparable to that found in Europe (6.3/1000 h (95% CI 5.4 to 7.36) Larruskain et al 2017). The number of ACL injuries highlights a potential injury burden for a squad of this size. Multi-site prospective investigations into the incidence and prevalence of injury in women’s football are require

Cardiac Arrhythmias

The most intimate mechanisms of cardiac arrhythmias are still quite unknown to scientists. Genetic studies on ionic alterations, the electrocardiographic features of cardiac rhythm and an arsenal of diagnostic tests have done more in the last five years than in all the history of cardiology. Similarly, therapy to prevent or cure such diseases is growing rapidly day by day. In this book the reader will be able to see with brighter light some of these intimate mechanisms of production, as well as cutting-edge therapies to date. Genetic studies, electrophysiological and electrocardiographyc features, ion channel alterations, heart diseases still unknown , and even the relationship between the psychic sphere and the heart have been exposed in this book. It deserves to be read

Chronotropic Competence Indices Extracted from Wearable Sensors for Cardiovascular Diseases Management

Chronotropic incompetence (CI) has been proven to be an important factor in the diagnosis and management of cardiovascular diseases. In this paper, we extend the existing CI parameters and propose chronotropic competence indices (CCI) to describe the exercise response of the cardiopulmonary system. A cardiac chronotropic competence Test (3CT), dedicated to CCI measurement using a wearable device, is also presented. Preliminary clinical trials are presented for the validation of 3CT measurement accuracy, and to show the potential of CCI in the prevention and rehabilitation of cardiovascular diseases

A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer

The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in women’s professional football. Therefore, the extent of injury burden in women’s professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations

Training for Optimal Sports Performance and Health

In this book, the emphasis is on various training interventions. Types of exercises that can help improve performance in athletes and health in people facing poor movement diseases.Also, we have presented a variety of strength training interventions in the form of various types of research. On the other hand, we continue to monitor internal and external loads related to non-contact injuries and performance analysis