Relationship of Blood Lactate and Sweat Lactate on Exercise Intensity

Typical procedures for measuring blood lactate involve either finger stick blood samples or venous blood draws. The literature is equivocal regarding whether sweat lactate values change with exercise intensity. Recently, wearable technology devices have been developed to measure sweat lactate. Purpose: To examine the relationship between sweat lactate and blood lactate values during incremental exercise. Methods: This study consisted of 12 (8 male, 4 female) healthy recreationally active individuals (VO2peak 35.5 ± 7.6 ml/kg/min) between the ages of 18 and 25 (22 ± 2 yrs) who volunteered for the study. Participants performed an exercise test on a cycle ergometer to volitional fatigue to determine blood lactate, lactate threshold, VO2peak, and peak heart rate (HR). Blood lactate was collected via finger stick at each 3-min stage of exercise. Participants performed a subsequent exercise session at 40, 60, and 80% heart rate reserve (HRR). During the 20-min stages of this test, blood and sweat lactate were collected during each intensity level. Sweat lactate was collected in a sweat “pouch” at each state of exercise. Sweat lactate samples were analyzed via the lactate oxidase method on a Chemwell 2910 chemistry analyzer. Blood lactate samples were analyzed using a Lactate Plus analyzer. Whole body sweat rate was calculated from pre- and post-exercise body weight at each intensity, factoring in water consumed and urine voided. Results: Sweat rate increased with increasing intensity (40%: 9.66 ± 7.58; 60%: 18.10 ± 12.51; 80% 24.32 ± 15.44 ml/min). Sweat lactate significantly differed between 60 and 80% intensities (15.66 ± 5.73, 12.52 ± 4.44 mmol/L, respectively), P = 0.03. Blood lactate levels at 40, 60, and 80% intensities were 2.67 ± 1.15, 3.60 ± 1.90, and 4.83 ± 1.52, respectively (P \u3c 0.001). CONCLUSION: These findings agree with Buono, Lee, & Miller, 2010 who found sweat lactate decreases as sweat rate increases. It is likely that sweat lactate decreases with increasing exercise intensity due to dilution as sweat rate increases. From this data, it appears that sweat lactate does not demonstrate a relationship with blood lactate that warrants replacing blood lactate in exercise testing with sweat lactate. This may be due to the lactate in sweat originating from eccrine glands and thus is not reflective of muscle metabolism

ARIA 2016 : Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.Peer reviewe

Adherence to treatment in allergic rhinitis using mobile technology. The MASK Study

Background: Mobile technology may help to better understand the adherence to treatment. MASK-rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient-centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries. Objectives: To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App. Methods: An observational cross-sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach. Results: A total of 12 143 users were registered. A total of 6 949 users reported at least one VAS data recording. Among them, 1 887 users reported ≥7 VAS data. About 1 195 subjects were included in the analysis of adherence. One hundred and thirty-six (11.28%) users were adherent (MPR ≥70% and PDC ≤1.25), 51 (4.23%) were partly adherent (MPR ≥70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non-adherent to medications (MPR <70%). Of those, the largest group was non-adherent to medications and the time interval was increased in 442 (36.68%) users. Conclusion and clinical relevance: Adherence to treatment is low. The relative efficacy of continuous vs on-demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication-taking behaviour in a real-world setting

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)