Introduction to Myths & Methodologies series

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Myths and methodologies: Making sense of exercise mass and water balance

New Findings

• What is the topic of this review?

  There is a need to revisit the basic principles of exercise mass and water balance, the use of common equations and the practice of interpreting outcomes.

• What advances does it highlight?

  We propose use of the following equation as a way of simplifying exercise mass and water balance calculations in conditions where food is not consumed and waste is not excreted: ∆body mass − 0.20 g/kcal⁻¹ = ∆body water. The relative efficacy of exercise drinking behaviours can be judged using the following equation: percentage dehydration = [(∆body mass − 0.20 g kcal⁻¹)/starting body mass] × 100.

Changes in body mass occur because of flux in liquids, solids and gases. This knowledge is crucial for understanding metabolism, health and human water needs. In exercise science, corrections to observed changes in body mass to estimate water balance are inconsistently applied and often misinterpreted, particularly after prolonged exercise. Although acute body mass losses in response to exercise can represent a close surrogate for body water losses, the discordance between mass and water balance equivalence becomes increasingly inaccurate as more and more energy is expended. The purpose of this paper is briefly to clarify the roles that respiratory water loss, gas exchange and metabolic water production play in the correction of body mass changes for fluid balance determinations during prolonged exercise. Computations do not include waters of association with glycogen because any movement of water among body water compartments contributes nothing to water or mass flux from the body. Estimates of sweat loss from changes in body mass should adjust for non-sweat losses when possible. We propose use of the following equation as a way of simplifying the study of exercise mass and water balance: ∆body mass − 0.20 g kcal⁻¹ = ∆body water. This equation directly controls for the influence of energy expenditure on body mass balance and the approximate offsetting equivalence of respiratory water loss and metabolic water production on body water balance. The relative efficacy of exercise drinking behaviours can be judged using the following equation: percentage dehydration = [(∆body mass − 0.20 g kcal⁻¹)/starting body mass] × 100.

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Commentary on Myths and Methodologies: Making sense of exercise mass and water balance

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Auditory Dysfunction in Patients with Huntington’s Disease

Huntington's disease (HD) is an autosomal, dominant neurodegenerative disease, caused by the multiplication of a cytosine-adenine-guanine (CAG) trinucleotide (triplet). The main clinical features of HD are motor impairment, progressive cognitive deterioration and behavioral disorders (for detailed information see Bates et al., 2014).

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Physical Function after Total Knee Replacement: An observational study describing outcomes in a small group of women from China and the United States

Publication date: Available online 29 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Daniel K. White, Zhichang Li, Yuqing Zhang, Adam R. Marmon, Hiral Master, Joseph Zeni, Jingbo Niu, Long Jiang, Shu Zhang, Jianhao Lin
ObjectiveTo describe physical function before and six months after Total Knee Replacement (TKR) in a small sample of women from China and the United States (US).Participants60 women after TKR from China and the USDesign, Setting, Outcomes: Data was from an observational study of TKR outcomes in Newark, Delaware (US group) and a control group after TKR in Beijing (China group). Both groups followed the same Osteoarthritis Research Society International (OARSI) protocols for the six-minute walk and 30-second chair stand. We compared physical function prior to TKR and six months after using linear regression adjusted for covariates.ResultsAge and BMI were similar in the China group (n=30, 66 years and 27.0 kg/m²) as the US group (n=30, 65 years and 29.6 kg/m²). Before surgery, the China group walked 263 (95%CI [-309,-219]) less meters and had 10.2 (95%CI [-11.8, -8.5]) fewer chairs stands than the US group. At six months when compared to the US group, the China group walked 38 more meters, but this difference did not reach statistical significance (95%CI [-1.6, 77.4]), and had 3.1 (95%CI [-4.4, -1.7]) fewer chair stands. The China group had greater improvement in the six-minute walk compared with the US group, p< 0.001.ConclusionDespite having worse physical function prior to TKR, the China group had greater gains in walking endurance and similar gains in repeated chair stands compared with the US group after surgery.



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Work productivity loss after mild traumatic brain injury

Publication date: Available online 29 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Noah D. Silverberg, William J. Panenka, Grant L. Iverson
ObjectiveTo examine the completeness of return to work (RTW) and the degree of productivity loss in individuals who do achieve a complete RTW after mild traumatic brain injury (MTBI).DesignMulti-site prospective cohort.SettingOutpatient concussion clinics.ParticipantsSeventy-nine patients (M=41.5 years old, 55.7% female) who sustained an MTBI and were employed at the time of the injury. Participants were enrolled at their first clinic visit and assessed by telephone 6-8 months post-injury.InterventionNone.MeasuresStructured interview of RTW status, British Columbia Postconcussion Symptom Inventory (BC-PSI), Lam Employment Absence and Productivity Scale (LEAPS), MINI Neuropsychiatric Interview, brief pain questionnaire. Participants who endorsed symptoms from three or more categories with at least moderate severity on the BC-PSI were considered to meet International Classification of Diseases-10 criteria for postconcussional syndrome. RTW status was classified as complete if participants returned to their pre-injury job with the same hours and responsibilities or to a new job that was at least as demanding.ResultsOf the 46 (58.2%) patients who achieved a RTW, 33 (71.7%) had a complete RTW. Participants with complete RTW had high rates of postconcussional syndrome (44.5%) and comorbid depression (18.2%), anxiety disorder (24.2%), and bodily pain (30.3%). They also reported productivity loss on the LEAPS, such as "getting less work done" (60.6%) and "making more mistakes" (42.4%). In a regression model, productivity loss was predicted by the presence of postconcussional syndrome and a comorbid psychiatric condition, but not bodily pain.ConclusionEven in patients who RTW after MTBI, detailed assessment revealed underemployment and productivity loss associated with residual symptoms and psychiatric complications.



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Kinesiophobia and its Association with Health Related Quality of Life Across Injury Locations

Publication date: Available online 29 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Penny Goldberg, Giorgio Zeppieri, Joel Bialosky, Charlotte Bocchino, Jon van den Boogaard, Susan Tillman, Terese L. Chmielewski
ObjectiveTo compare baseline kinesiophobia levels and their association with health-related quality of life across injury locations.DesignRetrospective cross-sectional study.SettingSingle, large outpatient physical therapy clinic within an academic medical center.Participants1233 patients who underwent an initial evaluation for a diagnosis related to musculoskeletal pain and completed the TSK-11 and SF-8™ questionnaires within 7 days of their first visit were eligible for inclusion. 380 patients were excluded for missing data or because they were under 18 years of age.InterventionsNot applicable.Main Outcome MeasuresComparison of baseline kinesiophobia levels and their association with health-related quality of life across injury locations in an outpatient physical therapy setting.ResultsA total of 853 patients (range: 18-94 years, mean age = 43.55 years) were included. Separate ANOVA models compared TSK-11 scores based on involved body region and Pearson correlation coefficients were used to examine the association between TSK-11 scores the SF-8™ sub-scales at each body region. TSK-11 scores did not differ by body region (range = 23.9 to 26.1). Weak to moderate negative correlations existed between kinesiophobia and the SF-8™ subscales.ConclusionKinesiophobia levels appear elevated and negatively associated with health-related quality of life at initial physical therapy evaluation regardless of injury location. These findings suggest physical therapists in outpatient orthopaedic settings should implement routine kinesiophobia assessment and provide stratified care based on kinesiophobia levels across musculoskeletal conditions.



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