Nickos D. Geladas

Assessment of physical activity - a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation

Physical activity has a fundamental role in the prevention and treatment of chronic disease. The precise measurement of physical activity is key to many surveillance and epidemiological studies investigating trends and associations with disease. Public health initiatives aimed at increasing physical activity rely on the measurement of physical activity to monitor their effectiveness. Physical activity is multidimensional, and a complex behaviour to measure; its various domains are often misunderstood. Inappropriate or crude measures of physical activity have serious implications, and are likely to lead to misleading results and underestimate effect size. In this review, key definitions and theoretical aspects, which underpin the measurement of physical activity, are briefly discussed. Methodologies particularly suited for use in epidemiological research are reviewed, with particular reference to their validity, primary outcome measure and considerations when using each in the field. It is acknowledged that the choice of method may be a compromise between accuracy level and feasibility, but the ultimate choice of tool must suit the stated aim of the research. A framework is presented to guide researchers on the selection of the most suitable tool for use in a specific study.

Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR (Part II)

In a previous paper, as the first of a series of three on the importance of characteristics and modalities of physical activity (PA) and exercise in the management of cardiovascular health within the general population, we concluded that, in the population at large, PA and aerobic exercise capacity clearly are inversely associated with increased cardiovascular disease risk and all-cause and cardiovascular mortality and that a dose–response curve on cardiovascular outcome has been demonstrated in most studies. More and more evidence is accumulated that engaging in regular PA and exercise interventions are essential components for reducing the severity of cardiovascular risk factors, such as obesity and abdominal fat, high BP, metabolic risk factors, and systemic inflammation. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit for each separate risk factor. The present paper, therefore, will review and make recommendations for PA and exercise training in the management of cardiovascular health in individuals with cardiovascular risk factors. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and individual members of the public. Based on previous and the current literature overviews, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and regarding appropriate risk evaluation during exercise in individuals with cardiovascular risk factors.

Importance of characteristics and modalities of physical activity and exercise in defining the benefits to cardiovascular health within the general population: recommendations from the EACPR (Part I):

Over the last decades, more and more evidence is accumulated that physical activity (PA) and exercise interventions are essential components in primary and secondary prevention for cardiovascular disease. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit in achieving cardiovascular health. The present paper, as the first of a series of three, will make specific recommendations on the importance of these characteristics for cardiovascular health in the population at large. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and the individual member of the public. Based on previous and the current literature, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and exercise.

Plasticity in human motor cortex is in part genetically determined

Neuronal plasticity refers to the ability of the brain to change in response to different experiences. Plasticity varies between people, but it is not known how much of this variability is due to differences in their genes. In humans, plasticity can be probed by a protocol termed paired associative stimulation and the changes in the motor system that are brought about by such stimulation are thought to be due to strengthening synapses which connect different neurons. We examined pairs of sisters which were either genetically identical (monozygotic) or different (dizygotic). We found that the variability within the monozygotic sister pairs was less than the variability within the dizygotic sister pairs. That plasticity in human motor cortex is in a substantial part genetically determined may be relevant for motor learning and neurorehabilitation, such as after stroke.

Heritability in neuromuscular coordination: implications for motor control strategies.

PURPOSE The aim of this study was to assess the relative power of genetic and environmental contribution to the variation observed in neuromuscular coordination. METHODS Using the twin model and comparing intrapair differences between monozygotic (MZ) and dizygotic (DZ) twins, we derived heritability estimates (h2). Forty healthy male twins, 10 MZ and 10 DZ pairs, aged 21.5 +/- 2.4 and 21 +/- 2.1 yr, respectively, performed a series of elbow flexions in one degree of freedom with different velocities attempting to accurately reach a target. Neuromuscular coordination was evaluated for both accuracy and economy of movement and assessed by kinematics and EMG activity. RESULTS The heritability in movement accuracy as assessed by the displacement from the target at 70% maximal velocity was 0.87. The accuracy at 30% and 50% of maximal velocity showed that the intrapair variation of MZ twins did not differ significantly from that of DZ twins. High heritability indexes of 0.85 and 0.73 were found for neuromuscular coordination as expressed by movement economy, assessed by the relative EMG activity of biceps long head at 70% and 50% of maximal velocity; no genetic dependence was found for low velocities. CONCLUSION In this study, heredity accounted for most of the existing differences in neuromuscular coordination in fast movements. This implies that movement strategies, which are organized in the CNS and control fast movements, are also strongly genetically dependent.

Cardiovascular drift and cerebral and muscle tissue oxygenation during prolonged cycling at different pedalling cadences.

We hypothesized that a faster cycling cadence could exaggerate cardiovascular drift and affect muscle and cerebral blood volume and oxygenation. Twelve healthy males (mean age, 23.4 ± 3.8 years) performed cycle ergometry for 90 min on 2 separate occasions, with pedalling frequencies of 40 and 80 r·min(-1), at individual workloads corresponding to 60% of their peak oxygen consumption. The main measured variables were heart rate, ventilation, cardiac output, electromyographic activity of the vastus lateralis, and regional muscle and cerebral blood volume and oxygenation. Cardiovascular drift developed at both cadences, but it was more pronounced at the faster than at the slower cadence, as indicated by the drop in cardiac output by 1.0 ± 0.2 L·min(-1), the decline in stroke volume by 9 ± 3 mL·beat(-1), and the increase in heart rate by 9 ± 1 beats·min(-1) at 80 r·min(-1). At the faster cadence, minute ventilation was higher by 5.0 ± 0.5 L·min(-1), and end-tidal CO(2) pressure was lower by 2.0 ± 0.1 torr. Although higher electromyographic activity in the vastus lateralis was recorded at 80 r·min(-1), muscle blood volume did not increase at this cadence, as it did at 40 r·min(-1). In addition, muscle oxygenation was no different between cadences. In contrast, cerebral regional blood volume and oxygenation at 80 r·min(-1) were not as high as at 40 r·min(-1) (p < 0.05). Faster cycling cadence exaggerates cardiovascular drift and seems to influence muscle and cerebral blood volume and cerebral oxygenation, without muscle oxygenation being radically affected.

Heritability of motor control and motor learning

The aim of this study was to elucidate the relative contribution of genes and environment on individual differences in motor control and acquisition of a force control task, in view of recent association studies showing that several candidate polymorphisms may have an effect on them. Forty‐four healthy female twins performed brisk isometric abductions with their right thumb. Force was recorded by a transducer and fed back to the subject on a computer screen. The task was to place the tracing of the peak force in a force window defined between 30% and 40% of the subjects maximum force, as determined beforehand. The initial level of proficiency was defined as the number of attempts reaching the force window criterion within the first 100 trials. The difference between the number of successful trials within the last and the first 100 trials was taken as a measure of motor learning. For motor control, defined by the initial level of proficiency, the intrapair differences in monozygotic (MZ) and dizygotic (DZ) twins were 6.8 ± 7.8 and 13.8 ± 8.4, and the intrapair correlations 0.77 and 0.39, respectively. Heritability was estimated at 0.68. Likewise for motor learning intrapair differences in the increment of the number of successful trials in MZ and DZ twins were 5.4 ± 5.2 and 12.8 ± 7, and the intrapair correlations 0.58 and 0.19. Heritability reached 0.70. The present findings suggest that heredity accounts for a major part of existing differences in motor control and motor learning, but uncertainty remains which gene polymorphisms may be responsible.

Forearm–finger skin temperature gradient as an index of cutaneous perfusion during steady-state exercise

The purpose of this study was to examine whether the forearm–finger skin temperature gradient (Tforearm–finger), an index of vasomotor tone during resting conditions, can also be used during steady‐state exercise. Twelve healthy men performed three cycling trials at an intensity of ~60% of their maximal oxygen uptake for 75 min separated by at least 48 h. During exercise, forearm skin blood flow (BFF) was measured with a laser‐Doppler flowmeter, and finger skin blood flow (PPG) was recorded from the left index fingertip using a pulse plethysmogram. Tforearm–finger of the left arm was calculated from the values derived by two thermistors placed on the radial side of the forearm and on the tip of the middle finger. During exercise, PPG and BFF increased (P<0·001), and Tforearm–finger decreased (P<0·001) from their resting values, indicating a peripheral vasodilatation. There was a significant correlation between Tforearm–finger and both PPG (r = −0·68; P<0·001) and BFF (r = −0·50; P<0·001). It is concluded that Tforearm–finger is a valid qualitative index of cutaneous vasomotor tone during steady‐state exercise.

Oxygen saturation in the triceps brachii muscle during an arm Wingate test: the role of training and power output.

The purpose of this study was to investigate the role of training and power output on muscle oxygen desaturation during and resaturation after an arm Wingate test (WAnT). Two groups of subjects were studied; the first group consisted of nine athletes participating in upper arm anaerobic sports and the second group of 11 university students. As a consequence, the group of athletes (HP) produced higher peak and mean power output (p < 0.01) than the group of university students (LP). Muscle oxygenation status was evaluated by using near infrared spectroscopy at the triceps brachii. The HP group exhibited 17.6 ± 8.0% less muscle oxygen desaturation than the LP group (p < 0.05) but similar muscle total hemoglobin during exercise and faster (p < 0.05) muscle oxygen resaturation during recovery (τ = 12.4 ± 5.2 sec in HP vs. τ = 24.2 ± 11.0 sec in LP). These results indicate that the HP group exhibits less muscle desaturation during an arm WAnT and has a faster resaturation rate, probably attributed to differences in muscle mass, muscle fiber recruitment capability, and ATP production through anaerobic pathways.

Prescribed Drinking Leads to Better Cycling Performance than Ad Libitum Drinking

Drinking ad libitum during exercise often leads to dehydration ranging from −1% to −3% of body weight. Purpose This article aimed to study the effect of a prescribed hydration protocol matching fluid losses on a simulated 30-km criterium-like cycling performance in the heat (31.6°C ± 0.5°C). Methods Ten elite heat-acclimatized male endurance cyclists (30 ± 5 yr, 76.5 ± 7.2 kg, 1.81 ± 0.07 m, V˙O2peak = 61.3 ± 5.2 mL·min−1·kg−1, body fat = 10.5% ± 3.3%, Powermax = 392 ± 33 W) performed three sets of criterium-like cycling, which consisted of a 5-km cycling at 50% power max followed by a 5-km cycling all out at 3% grade (total 30 km). Participants rode the course on two separate occasions and in a counterbalanced order, during either ad libitum drinking (AD; drink water as much as they wished) or prescribed drinking (PD; drink water every 1 km to much fluid losses). To design the fluid intake during PD, participants performed a familiarization trial to calculate fluid losses. Results After the exercise protocol, the cyclist dehydrated by −0.5% ± 0.3% and −1.8% ± 0.7% of their body weight for the PD and AD trial, respectively. The mean cycling speed for the third bout of the 5-km hill cycling was greater in the PD trial (30.2 ± 2.4 km·h−1) compared with the AD trial (28.8 ± 2.6 km·h−1) by 5.1% ± 4.8% (P < 0.05). Gastrointestinal, mean skin, and mean body temperatures immediately after the last hill climbing were greater in the AD compared with the PD trial (P < 0.05). Overall, sweat sensitivity during the three climbing bouts was lower in the AD (15.6 ± 5.7 g·W−1·m−2) compared with the PD trial (22.8 ± 3.4 g·W−1·m−2, P < 0.05). Conclusion The data suggested that PD to match fluid losses during exercise in the heat provided a performance advantage because of lower thermoregulatory strain and greater sweating responses.