Geoffrey A.

Exercise blood pressure (BP) metrics have been promoted as a means of identifying latent or mild hypertension in athletes. We evaluated the diagnostic accuracy of four exercise BP metrics to diagnose hypertension, defined by 24-h ambulatory BP monitoring (ABPM) as mean ≥130/80 mmHg, daytime ≥135/85 mmHg and/or nighttime ≥120/70 mmHg. Fifty-four endurance-trained athletes (48 [IQR 24–58] years, 67% male) underwent exercise testing with serial BP measurements and 24-h ABPM. Exaggerated exercise BP (EEBP) was defined as exceeding a threshold for any of the four metrics: 1) maximal systolic BP (SBPmax) using published cut-offs; SBPmax ≥ 220 mmHg and ≥200 mmHg in males and females, respectively, 2) SBP/Workload-slope, 3) SBPmax/Workload-ratio, 4) SBP at 2 Watts/kg. Receiver operating characteristic (ROC) curve analysis and Youden’s Index determined optimal cut-offs and diagnostic performance. Twelve of 54 (22%) athletes met criteria for hypertension. SBPmax was reasonably sensitive for identifying hypertension (83% identified) but demonstrated poor specificity (62% of non-hypertensives misclassified), with an area under the ROC-curve (AUC) of 0.63. An EEBP cut-off of SBP > 176 mmHg at 2 Watts/kg had the best diagnostic performance with 100% sensitivity, moderate specificity of 62%, and AUC of 0.79. Other metrics, incorporating exercise BP and workload, SBPmax/Workload-ratio and SBP/Workload-slope, had moderate diagnostic utility (AUC = 0.71 and 0.67, respectively). In endurance athletes, exercise BP metrics demonstrated modest and variable diagnostic accuracy for identifying hypertension on 24-h ABPM. Assessment of SBP at a relative submaximal workload provided acceptable diagnostic accuracy while reducing overdiagnosis associated with published SBPmax thresholds.

Objectives:To determine symptoms, signs, and etiology of brain attacks in children presenting to the emergency department (ED) as a first step for developing a pediatric brain attack pathway.Methods:Prospective observational study of children aged 1 month ...

Purpose Fast rate of torque development (RTD) is crucial for all movements, from balance to athletics. Aging and fatigue decrease RTD, increasing fall and injury risk. Thus, finding accessible methods to increase RTD is necessary. Given the neuromechanical coupling that exists between foot-sole skin and lower-limb motor neurons, cutaneous stimulation may impact RTD. This work investigated whether foot-sole cutaneous stimulation could mitigate the fatigue-induced declines in plantarflexion RTD. Methods Adult males (n = 11, age = 28(7)) participated in three data collection sessions. Voluntary isometric plantarflexion RTD was measured during explosive plantarflexion contractions in a dynamometer. RTD was assessed at rest and post-fatigue, under three conditions: cutaneous electrical stimulation at the heel, metatarsal, or no stimulation. Fatigue was induced with a sustained maximal plantarflexion until torque dropped below 30% of maximum voluntary torque. RTD was calculated in cumulative 25ms epochs from contraction onset to 100ms. Post-fatigue, percent of rested RTD was compared between conditions. Results Post-fatigue RTD decreased across all conditions (p < 0.001) (mean = 31(12%)). No effect of stimulation was found for the change in RTD post-fatigue. (p = 0.174). However, when removing polarity of response by comparing absolute changes in RTD post-fatigue, a main effect of stimulation was found (p = 0.002) (mean difference from control: 14.6% with heel stimulation, and 17.5% with metatarsal stimulation). Conclusions Although no clear location-dependent increase or decrease emerged, cutaneous stimulation did change fatigued RTD compared to control. Future work should focus on understanding the directional variability of responses across participants to isolate improved RTD as a mechanism to enhance performance and restore mobility.