Principles and Practice of Structural Equation Modeling (2nd ed.)

The adoption and maintenance of physical activity are critical foci for blood glucose management and overall health in individuals with diabetes and prediabetes. Recommendations and precautions vary depending on individual characteristics and health status. In this Position Statement, we provide a clinically oriented review and evidence-based recommendations regarding physical activity and exercise in people with type 1 diabetes, type 2 diabetes, gestational diabetes mellitus, and prediabetes.

Physical activity includes all movement that increases energy use, whereas exercise is planned, structured physical activity. Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk factors, contributes to weight loss, and improves well-being (1,2). Regular exercise may prevent or delay type 2 diabetes development (3). Regular exercise also has considerable health benefits for people with type 1 diabetes (e.g., improved cardiovascular fitness, muscle strength, insulin sensitivity, etc.) (4). The challenges related to blood glucose management vary with diabetes type, activity type, and presence of diabetes-related complications (5,6). Physical activity and exercise recommendations, therefore, should be tailored to meet the specific needs of each individual.

Physical activity recommendations and precautions may vary by diabetes type. The primary types of diabetes are type 1 and type 2. Type 1 diabetes (5%–10% of cases) results from cellular-mediated autoimmune destruction of the pancreatic β-cells, producing insulin deficiency (7). Although it can occur at any age, β-cell destruction rates vary, typically occurring more rapidly in youth than in adults. Type 2 diabetes (90%–95% of cases) results from a progressive loss of insulin secretion, usually also with insulin resistance. Gestational diabetes mellitus occurs during pregnancy, with screening typically occurring at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. Prediabetes is diagnosed when blood glucose levels are above the normal range but not high enough to be classified as …

/pdf/physical-activity-exercise-and-diabetes-a-position-statement-4olttauib5.pdf

Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association

We investigated whether fatigue during prolonged exercise in uncompensable hot environments occurred at the same critical level of hyperthermia when the initial value and the rate of increase in bo...

Influence of body temperature on the development of fatigue during prolonged exercise in the heat

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Textbook Of Work Physiology Physiological Bases Of Exercise

Objective:
To present recommendations to optimize the fluid-replacement practices of athletes.


Background:
Dehydration can compromise athletic performance and increase the risk of exertional heat injury. Athletes do not voluntarily drink sufficient water to prevent dehydration during physical activity. Drinking behavior can be modified by education, increasing accessibility, and optimizing palatability. However, excessive overdrinking should be avoided because it can also compromise physical performance and health. We provide practical recommendations regarding fluid replacement for athletes.


Recommendations:
Educate athletes regarding the risks of dehydration and overhydration on health and physical performance. Work with individual athletes to develop fluid-replacement practices that optimize hydration status before, during, and after competition.

/pdf/national-athletic-trainers-association-position-statement-5e9yw20d4i.pdf

National athletic trainers' association position statement: fluid replacement for athletes.

Aim: To review current cycling-related sport-science literature to formulate guidelines to classify female subject groups and to compare this classification system for female subject groups with the classification system for male subject groups. Methods: A database of 82 papers that described female subject groups containing information on preexperimental maximal cycle-protocol designs, terminology, biometrical and physiological parameters, and cycling experience was analyzed. Subject groups were divided into performance levels (PLs), according to the nomenclature. Body mass, body-mass index, maximal oxygen consumption (VO2max), peak power output (PPO), and training status were compared between PLs and between female and male PLs. Results: Five female PLs were defined, representing untrained, active, trained, well-trained, and professional female subjects. VO2max and PPO significantly increased with PL, except for PL3 and PL4 (P < .01). For each PL, significant differences were observed in absolute and re...

Guidelines to classify subject groups in sport-science research.

The purpose of the present study was to determine the separate and combined effects of aerobic fitness, short-term heat acclimation, and hypohydration on tolerance during light exercise while wearing nuclear, biological, and chemical protective clothing in the heat (40 degrees C, 30% relative humidity). Men who were moderately fit [(MF); 55 ml . kg-1 . min-1 maximal O2 consumption; n = 8] were tested while they were euhydrated or hypohydrated by approximately 2.5% of body mass through exercise and fluid restriction the day preceding the trials. Tests were conducted before and after 2 wk of daily heat acclimation (1-h treadmill exercise at 40 degrees C, 30% relative humidity, while wearing the nuclear, biological, and chemical protective clothing). Heat acclimation increased sweat rate and decreased skin temperature and rectal temperature (Tre) in HF subjects but had no effect on tolerance time (TT). MF subjects increased sweat rate but did not alter heart rate, Tre, or TT. In both MF and HF groups, hypohydration significantly increased Tre and heart rate and decreased the respiratory exchange ratio and the TT regardless of acclimation state. Overall, the rate of rise of skin temperature was less, while DeltaTre, the rate of rise of Tre, and the TT were greater in HF than in MF subjects. It was concluded that exercise-heat tolerance in this uncompensable heat-stress environment is not influenced by short-term heat acclimation but is significantly improved by long-term aerobic fitness.

Heat acclimation, aerobic fitness, and hydration effects on tolerance during uncompensable heat stress

In many athletic and occupational settings, the wearing of protective clothing in warm or hot environments creates conditions of uncompensable heat stress where the body is unable to maintain a thermal steady state. Therefore, special precautions must be taken to minimise the threat of thermal injury. Assuming that manipulations known to reduce thermoregulatory strain during compensable heat stress would be equally effective in an uncompensable heat stress environment is not valid. In this review, we discuss the impact of hydration status, aerobic fitness, endurance training, heat acclimation, gender, menstrual cycle, oral contraceptive use, body composition and circadian rhythm on heat tolerance while wearing protective clothing in hot environments. The most effective countermeasure is ensuring that the individual is adequately hydrated both before and throughout the exercise or work session. In contrast, neither short term aerobic training or heat acclimation significantly improve exercise-heat tolerance during uncompensable heat stress. While short term aerobic training is relatively ineffective, long term improvements in physical fitness appear to provide some degree of protection. Individuals with higher proportions of body fat have a lower heat tolerance because of a reduced capacity to store heat. Women not using oral contraceptives are at a thermoregulatory disadvantage during the luteal phase of the menstrual cycle. The use of oral contraceptives eliminates any differences in heat tolerance throughout the menstrual cycle but tolerance is reduced during the quasi-follicular phase compared with non-users. Diurnal variations in resting core temperature do not appear to influence tolerance to uncompensable heat stress.

The thermophysiology of uncompensable heat stress. Physiological manipulations and individual characteristics.

It has been suggested that a critically high body core temperature may impair central neuromuscular activation and cause fatigue. We investigated the effects of passive hyperthermia on maximal isometric force production (MVC) and voluntary activation (VA) to determine the relative roles of skin (T
 sk) and body core temperature (T
 c) on these factors. Twenty-two males [VO2max=64.2 (8.9) ml kg−1 min−1, body fat=8.2 (3.9)%] were seated in a knee-extension myograph, then passively heated from 37.4 to 39.4°C rectal temperature (T
 re) and then cooled back to 37.4oC using a liquid conditioning garment. Voluntary strength and VA (interpolated twitch) were examined during an isometric 10-s MVC at 0.5°C intervals during both heating and cooling. Passive heating to a T
 c of 39.4oC reduced VA by 11 (11)% and MVC by 13 (18)% (P<0.05), but rapid skin cooling, with a concomitant reduction in cardiovascular strain [percentage heart rate reserve decreased from 64 (11)% to 29 (11)%] and psychophysical strain did not restore either of these measures to baseline. Only when cooling lowered T
 c back to normal did VA and MVC return to baseline (P<0.05). We conclude that an elevated T
 c reduces VA during isometric MVC, and neither T
 sk nor cardiovascular or psychophysical strain modulates this response. Results are given as mean (SD) unless otherwise stated.

Passive hyperthermia reduces voluntary activation and isometric force production

Exercise performance and capacity are impaired in hot, compared to temperate, conditions. Heat adaptation (HA) is one intervention commonly adopted to reduce this impairment because it may induce beneficial exercise performance and physiological and perceptual adaptations. A number of investigations have been conducted on HA but, due to large methodological differences, the effectiveness of different HA regimens remain unclear. (1) To quantify the effect of different HA regimens on exercise performance and the physiological and perceptual responses to subsequent heat exposure. (2) To offer practical HA recommendations and suggestions for future HA research based upon a systematic and quantitative synthesis of the literature. PubMed was searched for original research articles published up to, and including, 16 February 2016 using appropriate first- and second-order search terms. English-language, peer-reviewed, full-text original articles using human participants were reviewed using the four-stage process identified in the PRISMA statement. Data for the following variables were obtained from the manuscripts by at least two of the authors: participant sex, maximal oxygen consumption and age; HA duration, frequency, modality, temperature and humidity; exercise performance and capacity; core and skin temperature; heart rate, stroke volume, cardiac output, skin blood flow, sweat onset temperature, body mass loss, sweat rate, perception of thirst, volitional fluid consumption, plasma volume changes; sweat concentrations of sodium, chloride and potassium; aldosterone, arginine vasopressin, heat shock proteins (Hsp), ratings of perceived exertion (RPE) and thermal sensation. Data were divided into three groups based upon the frequency of the HA regimen. Performance and capacity data were also divided into groups based upon the type of HA used. Hedges’ g effect sizes and 95 % confidence intervals were calculated. Correlations were run where appropriate. Ninety-six articles were reviewed. The most common duration was 7–14 days and the most common method of HA was the controlled work-rate approach. HA had a moderately beneficial effect on exercise capacity and performance in the heat irrespective of regimen; however, longer regimens were more effective than shorter approaches. HA had a moderate-to-large beneficial effect on lowering core body temperature before and during exercise, maintaining cardiovascular stability, and improving heat-loss pathways. Data are limited but HA may reduce oxygen consumption during subsequent exercise, improve glycogen sparing, increase the power output at lactate threshold, reduce lactate concentrations during exercise, have a trivial effect on increasing extracellular concentrations of Hsp, and improve perceived ratings of exertion and thermal sensation. HA regimens lasting <14 days induce many beneficial physiological and perceptual adaptations to high ambient temperatures, and improve subsequent exercise performance and capacity in the heat; however, the extent of the adaptations is greatest when HA regimens lasting longer than 14 days are adopted. Large methodological differences in the HA literature mean that there is still uncertainty regarding the magnitude and time course of potential adaptation for a number of physiological and perceptual variables.

/pdf/the-effects-of-heat-adaptation-on-physiology-perception-and-6s6r6e3uk9.pdf

Stephen S. Cheung

Papers

Guidelines to classify subject groups in sport-science research.

Heat acclimation, aerobic fitness, and hydration effects on tolerance during uncompensable heat stress

The thermophysiology of uncompensable heat stress. Physiological manipulations and individual characteristics.

Passive hyperthermia reduces voluntary activation and isometric force production

The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis.