Validity and reliability of the myTemp ingestible temperature capsule.

OBJECTIVES: An accurate and non-invasive measurement of core body temperature (Tc) is of great importance to quantify exercise-induced increases in Tc in athletes or to assess changes in Tc in patient populations. The use of ingestible gastrointestinal telemetric temperature capsules is widely accepted as a surrogate marker for Tc, but widespread implementation is lacking due to the high costs of these disposable capsules. A new and cheaper temperature capsule system (i.e. myTemp) was recently introduced. The aim of present study is to determine the validity and test-retest reliability of the myTemp system. DESIGN: Ex-vivo experimental study. METHODS: Fifteen ingestible temperature capsules (myTemp, Nijmegen, Netherlands) were tested in a highly temperature controlled water bath, in which the water temperature gradually increased from 34°C to 44°C. The study protocol was performed twice for each temperature capsule. RESULTS: Mean difference between myTemp temperature and water bath temperature was -0.001±0.005°C (Limit of Agreement (LOA): ±0.011°C) during Trial 1 (p=0.11) and -0.001±0.006°C (LOA: ±0.012°C) during Trial 2 (p=0.039). Furthermore, an Intraclass Correlation Coefficient (ICC) of 1.00 was found for both trials. A systematic difference between Trials 1 and 2 of 0.004±0.008°C (LOA: ±0.015°C) was found (p<0.001), whereas the ICC between both trials was 1.00 and the standard error of measurement was 0.005°C. CONCLUSIONS: Although we found a systematic bias for the sensitivity (-0.001°C) and reliability (0.004°C), these values can be considered insignificant from a physiological and clinical perspective. Thus, the myTemp ingestible temperature capsule is a valid technique to measure (water) temperature under controlled circumstances

Validity, Reliability, and Inertia of Four Different Temperature Capsule Systems.

PURPOSE: Telemetric temperature capsule systems are wireless, relatively non-invasive and easily applicable in field conditions, and have therefore great advantages for monitoring core body temperature. However, the accuracy and responsiveness of available capsule systems have not been compared previously. Therefore, the aim of this study was to examine the validity, reliability and inertia characteristics of four ingestible temperature capsule systems (i.e. CorTemp, e-Celsius, myTemp and VitalSense). METHODS: Ten temperature capsules were examined for each system in a temperature controlled water bath during three trials. The water bath temperature gradually increased from 33°C to 44°C during Trial 1 and 2 to assess the validity and reliability, and from 36°C to 42°C in Trial 3 to assess the inertia characteristics of the temperature capsules. RESULTS: A systematic difference between capsule and water bath temperature was found for CorTemp (0.077°C±0.040°C), e-Celsius (-0.081°C±0.055°C), myTemp (-0.003°C±0.006°C) and VitalSense (-0.017°C±0.023°C) (p0.05). Comparable inertia characteristics were found for CorTemp (25±4 sec), e-Celsius (21±13 sec) and myTemp (19±2 sec), while the VitalSense system responded more slowly (39±6 sec) to changes in water bath temperature (p<0.001). CONCLUSION: Although differences in temperature and inertia were observed between capsule systems, an excellent validity, test-retest reliability, and inertia was found for each system between 36°C and 44°C after removal of outliers

Exercise and Coronary Atherosclerosis: Observations, Explanations, Relevance, and Clinical Management.

Physical activity and exercise training are effective strategies for reducing the risk of cardiovascular events, but multiple studies have reported an increased prevalence of coronary atherosclerosis, usually measured as coronary artery calcification, among athletes who are middle-aged and older. Our review of the medical literature demonstrates that the prevalence of coronary artery calcification and atherosclerotic plaques, which are strong predictors for future cardiovascular morbidity and mortality, was higher in athletes compared with controls, and was higher in the most active athletes compared with less active athletes. However, analysis of plaque morphology revealed fewer mixed plaques and more often only calcified plaques among athletes, suggesting a more benign composition of atherosclerotic plaques. This review describes the effects of physical activity and exercise training on coronary atherosclerosis in athletes who are middle-aged and older and aims to contribute to the understanding of the potential adverse effects of the highest doses of exercise training on the coronary arteries. For this purpose, we will review the association between exercise and coronary atherosclerosis measured using computed tomography, discuss the potential underlying mechanisms for exercise-induced coronary atherosclerosis, determine the clinical relevance of coronary atherosclerosis in middle-aged athletes and describe strategies for the clinical management of athletes with coronary atherosclerosis to guide physicians in clinical decision making and treatment of athletes with elevated coronary artery calcification scores

First-Aid Treatment for Friction Blisters: "Walking Into the Right Direction?"

OBJECTIVE: Blisters are common foot injuries during and after prolonged walking. However, the best treatment remains unclear. The aim of the study was to compare the effect of 2 different friction blister treatment regimens, wide area fixation dressing versus adhesive tape. DESIGN: A prospective observational cohort study. SETTING: The 2015 Nijmegen Four Days Marches in the Netherlands. PARTICIPANTS: A total of 2907 participants (45 ± 16 years, 52% men) were included and received 4131 blister treatments. INTERVENTIONS: Blisters were treated with either a wide area fixation dressing or adhesive tape. MAIN OUTCOME MEASURES: Time of treatment application was our primary outcome. In addition, effectiveness and satisfaction were evaluated in a subgroup (n = 254). During a 1-month follow-up period, blister healing, infection and the need for additional medical treatment were assessed in the subgroup. RESULTS: Time of treatment application was lower (41.5 minutes; SD = 21.6 minutes) in the wide area fixation dressing group compared with the adhesive tape group (43.4 minutes; SD = 25.5 minutes; P = 0.02). Furthermore, the wide area fixation dressing group demonstrated a significantly higher drop-out rate (11.7% vs 4.0%, P = 0.048), delayed blister healing (51.9% vs 35.3%, P = 0.02), and a trend toward lower satisfaction (P = 0.054) when compared with the adhesive tape group. CONCLUSIONS: Wide area fixation dressing decreased time of treatment application by 2 minutes (4.5%) when compared with adhesive tape. However, because of lower effectiveness and a trend toward lower satisfaction, we do not recommend the use of wide area fixation dressing over adhesive tape in routine first-aid treatment for friction blisters

Protein Intake and Distribution in Relation to Physical Functioning and Quality of Life in Community-Dwelling Elderly People: Acknowledging the Role of Physical Activity.

Increasing total protein intake and a spread protein intake distribution are potential strategies to attenuate sarcopenia related loss of physical function and quality of life. The aim of this cross-sectional study was to investigate whether protein intake and protein intake distribution are associated with muscle strength, physical function and quality of life in community-dwelling elderly people with a wide range of physical activity. Dietary and physical activity data were obtained from two studies (N = 140, age 81 ± 6, 64% male), with the following outcome measures: physical functioning (Short Physical Performance Battery (SPPB), comprising balance, gait speed and chair rise tests), handgrip strength and quality of life (EQ-5D-5L). Protein intake distribution was calculated for each participant as a coefficient of variance (CV = SD of grams of protein intake per main meal divided by the average total amount of proteins (grams) of the main meals). Based on the CV, participants were divided into tertiles and classified as spread, intermediate or pulse. The average total protein intake was 1.08 ± 0.29 g/kg/day. Total protein intake was not associated with outcome measures using multivariate regression analyses. Individuals with a spread protein diet during the main meals (CV < 0.43) had higher gait speed compared to those with an intermediate diet (CV 0.43⁻0.62) (β = -0.42, p = 0.035), whereas a spread and pulse protein diet were not associated with SPPB total score, chair rise, grip strength and Quality-Adjusted Life Year (QALY). The interaction of higher physical activity and higher total protein intake was significantly associated with higher quality of life (β = 0.71, p = 0.049). While this interaction was not associated with SPPB or grip strength, the association with quality of life emphasizes the need for a higher total protein intake together with an active lifestyle in the elderly

Association of Resistance Exercise, Independent of and Combined With Aerobic Exercise, With the Incidence of Metabolic Syndrome.

OBJECTIVE: To determine the association of resistance exercise, independent of and combined with aerobic exercise, with the risk of development of metabolic syndrome (MetS). PATIENTS AND METHODS: The study cohort included adults (mean ± SD age, 46±9.5 years) who received comprehensive medical examinations at the Cooper Clinic in Dallas, Texas, between January 1, 1987, and December, 31, 2006. Exercise was assessed by self-reported frequency and minutes per week of resistance and aerobic exercise and meeting the US Physical Activity Guidelines (resistance exercise ≥2 d/wk; aerobic exercise ≥500 metabolic equivalent min/wk) at baseline. The incidence of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III criteria. We used Cox regression to generate hazard ratios (HRs) and 95% CIs. RESULTS: Among 7418 participants, 1147 (15%) had development of MetS during a median follow-up of 4 years (maximum, 19 years; minimum, 0.1 year). Meeting the resistance exercise guidelines was associated with a 17% lower risk of MetS (HR, 0.83; 95% CI, 0.73-0.96; P=.009) after adjusting for potential confounders and aerobic exercise. Further, less than 1 hour of weekly resistance exercise was associated with 29% lower risk of development of MetS (HR, 0.71; 95% CI, 0.56-0.89; P=.003) compared with no resistance exercise. However, larger amounts of resistance exercise did not provide further benefits. Individuals meeting both recommended resistance and aerobic exercise guidelines had a 25% lower risk of development of MetS (HR, 0.75; 95% CI, 0.63-0.89; P<.001) compared with meeting neither guideline. CONCLUSION: Participating in resistance exercise, even less than 1 hour per week, was associated with a lower risk of development of MetS, independent of aerobic exercise. Health professionals should recommend that patients perform resistance exercise along with aerobic exercise to reduce MetS

Endurance exercise-induced changes in BNP concentrations in cardiovascular patients versus healthy controls.

BACKGROUND: Healthy athletes demonstrated increased B-type natriuretic peptide (BNP) concentrations following exercise, but it is unknown whether these responses are exaggerated in individuals with cardiovascular risk factors (CVRF) or disease (CVD). We compared exercise-induced increases in BNP between healthy controls (CON) and individuals with CVRF or CVD. Furthermore, we aimed to identify predictors for BNP responses. METHODS: Serum BNP concentrations were measured in 191 participants (60±12yrs) of the Nijmegen Marches before (baseline) and immediately after 4 consecutive days of walking exercise (30-50km/day). CVRF (n=54) was defined as hypertension, hypercholesterolemia, obesity or smoking and CVD (n=55) was defined as a history of myocardial infarction, heart failure, atrial fibrillation or angina pectoris. RESULTS: Individuals walked 487±79min/day at 65±10% of their maximum heart rate. Baseline BNP concentrations were higher for CVD (median: 28.1pg/ml; interquartile range: 13-50, p0.05). Predictors for post-exercise BNP (R(2)=0.77) were baseline BNP, beta-blocker use and age. CONCLUSION: Prolonged moderate-intensity walking exercise increases BNP concentrations in CVD participants, but not in CVRF and CON. BNP increases were small, and did not accumulate across consecutive days of exercise. These findings suggest that prolonged walking exercise for multiple consecutive days is feasible with minimal effect on myocardial stretch, even for participants with CVD

Impact of Hypertension on the Dose-Response Association Between Physical Activity and Stroke: A Cohort Study

BACKGROUND: Regular physical activity is associated with a reduced stroke risk. However, this relationship might be attenuated in the presence of hypertension and antihypertensive medication use. We examined the dose-response relationship between physical activity and stroke in normotensive and hypertensive individuals. METHODS: A Dutch population-based cohort including 139 930 individuals (41% men; mean age, 44±13) was performed (median follow-up, 6.75 years). Participants were stratified at baseline as hypertensive (44%) or normotensive (56%) and categorized into quartiles of the lowest (Q1) to the highest (Q4) moderate-to-vigorous, self-reported physical activity. The primary outcome was incident stroke (fatal and nonfatal). Cox regression estimated hazard ratios and 95% CIs. The main analyses were stratified on baseline blood pressure and adjusted for confounders. Hypertensives were stratified into medicated (21%) or non-medicated (79%). RESULTS: Compared with Q1, adjusted hazard ratios were 0.87 (0.69–1.10; P=0.23), 0.75 (0.59–0.95; P=0.02), and 0.94 (0.74–1.20; P=0.64) for Q2 to Q4, respectively in the total population. Hazard ratios for normotensives were 0.79 (0.50–1.25; P=0.32), 0.75 (0.48–1.18; P=0.22), 0.97 (0.62–1.51; P=0.90) for Q2 to Q4, respectively. In hypertensives, hazard ratios were 0.89 (0.68–1.17; P=0.41), 0.74 (0.56–0.98; P=0.03), 0.92 (0.69–1.23; P=0.56) for Q2 to Q4, respectively. There was no significant interaction between hypertension status for the relation between physical activity and stroke risk. The stratified analysis revealed a smaller benefit of moderate-to-vigorous physical activity in medicated hypertensives compared with nonmedicated hypertensives, but no significant interaction effect was found. CONCLUSIONS: Regular moderate-to-vigorous physical activity is beneficial for stroke risk reduction (Q3 compared with Q1), which is not affected by hypertension. Antihypertensive medication may be associated with a smaller benefit of moderate-to-vigorous physical activity on the risk of stroke, but further research is warranted

The impact of feedback during formative testing on study behaviour and performance of (bio)medical students: a randomised controlled study.

BACKGROUND: A potential concern of formative testing using web-based applications ("apps") is provision of limited feedback. Adopting a randomised controlled trial in 463 first year (bio) medical students, we explored if providing immediate, detailed feedback during "app"-based formative testing can further improve study behaviour and study performance of (bio)medical students. METHODS: Students had access to a formative testing "app", which involved 7 formative test modules throughout the 4-week course. In a randomised order, subjects received the "app" with (n = 231, intervention) or without (n = 232, control) detailed feedback during the formative test modules. RESULTS: No differences in app-use was found between groups (P = 0.15), whereas the intervention group more frequently reviewed information compared to controls (P = 0.007). Exam scores differed between non-/moderate-/intensive- users of the "app" (P  0.05). CONCLUSIONS: Providing detailed feedback did not further enhance the effect of a web-based application of formative testing on study behaviour or study performance in (bio)medical students, possibly because of a ceiling-effect