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Measuring bioactive nitric oxide during exercise could help improve fitness, and this new device provides real-time data

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3 months ago

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Measuring bioactive nitric oxide during exercise could help improve fitness, and this new device provides real-time data

The heart is the master dispatcher for our lifeblood. It has the crucial burden of balancing physiological economics during rest, during a ride, and while recovering. If the heart can’t pump enough blood to equal demand for nutrients and oxygen, fatigue sets in, you bonk, and sometimes, you have to quit. Rest and replenishment are the only salvation. 

It is well understood that the body’s managerial mechanisms run much deeper, especially during exercise. Governing a cyclist’s overall ability to continue putting out power during any type of effort are the cellular and molecular constituents produced and delivered alongside every contraction of the restless courier in our chest. Oxygen, glucose, fatty acids, lactate, hemoglobin, bicarbonate, nitric oxide — all are important, each playing a role in how well we are able to respond to the stresses of exercise. They also dictate how well the body can adapt and repair between exercise sessions.

We make an intentional point to try and measure and understand the importance of biomarkers and vitals in athletic training and performance, with the current boom in wearable technologies making it possible to deliver insights never previously fathomed. Though no lack of data exists, is there a best measure to understanding an athlete’s exercise capacity and fitness?

Being able to measure blood flow has been a decades-long quest in sports medicine. Exercise physiologists often focus on the mitochondria, bioenergetics, and oxygen consumption (VO2) as a pathway to understanding someone’s performance capacity and upper limits. Coaches use biological outputs such as lactate and heart rate layered atop metrics like power to guide training strategy. The integration of all of these somatic informatics is rightfully based on what we know as best practice today.

But what are the true regulators and rate limiters of performance? We know that the ability to do work (ride a bike) is based on a few basic orderly factors:

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  1. Muscles need oxygen
  2. and fuel (glucose, fatty acids)
  3. to synthesize ATP
  4. which is used to output mechanical energy
  5. so that they can contract
  6. and work (exercise) can be done.

But a crucial step is missing: the regulation of delivering oxygen and fuel. The body was divinely designed to compensate and adapt to changing conditions, and at the level of muscle oxygenation and work output, here is how that concept is applied. At the onset of exercise, a shift in blood flow must occur to ensure oxygen and nutrients are delivered where they are needed most — your working skeletal muscles, the heart, and brain, primarily. The ability to measure and understand how this happens is crucial. As it turns out, one molecule is inadvertently responsible, and without it, everything else is impossible. 

Hello, SNO.

Performance regulation: There’s a new kid in town.

Nitric oxide (NO) has been hailed as one of the most important regulators of cardiovascular health, impacting blood pressure, inflammation, and overall vascular function. It is a potent vasodilator, responsible for directing and improving blood flow to areas of the body where blood flow is needed most. This happens during periods of oxygen demand and supply mismatch, like exercise, and it happens almost immediately. The supplement market is booming with products that help athletes improve NO production, such as L-arginine, to help maximize blood flow to muscles during a workout.

All of this stated, the classic understanding of how NO is produced and directs blood flow is beginning to change, which inevitably impacts how we think of performance regulation. Let’s break it down. We know that:

  1. Muscles need oxygen,
  2. and oxygen is carried by hemoglobin in red blood cells.
  3. Oxygen must be transferred from red blood cells to muscles 
  4. so work (exercise) can be done. 

Further:

  1. When exercise starts, 
  2. muscles begin consuming oxygen at a higher rate.
  3. A dip in available oxygen happens.
  4. Oxygen is increasingly offloaded from red blood cells to try and match the new demand. 

Remember: supply must match demand. 

Now what? An economic dance ensues between red blood cells (where oxygen is carried), and the oxygen tension in the muscle itself. A newer discovery has explained how this interplay impacts overall dispersion of blood during a workout so muscles can be adequately fueled and exercise can continue, and it is meticulously regulated.

During conditions where oxygen tension in muscles (and therefore red blood cells) decreases, a nitric oxide derivative called S-nitrosohemoglobin (SNO-Hb) is also produced and offloaded by hemoglobin alongside oxygen. SNO-Hb, part of a group of compounds called S-nitrosothiols, or SNOs, dilates the tiny blood vessels in the muscle tissue itself (capillaries, arterioles). Blood flow increases, and oxygen delivery can now meet the heightened demand. This goes for nutrient delivery too, like increased need for fatty acids and glucose.

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Why is measuring SNO helpful?

It could be hypothesized that many of the foundational benefits of exercise are due to these well-controlled increases in blood flow. There is a system-wide effect on the heart and brain, too. Further, there are adaptations to the cardiovascular system and blood profile in response to training. More exercise leads to more hemoglobin, a larger blood volume, and a greater and faster NO response. The latter specifically leads to a better blood flow response, and therefore improved oxygen and nutrient delivery. Theoretically, the same goes for bioactive NO derivative, SNO, at the tissue level. In this perspective, SNO is sitting in the driver’s seat and orchestrating it all.

Devices exist on the market today that measure oxygen saturation in muscles and other tissues (SmO2 or tissue oximeters), but that only paints a partial picture of the impact certain types and intensities of exercise have on an individual. Being able to measure someone’s SNO response to exercise would offer the first look into the gatekeeper of muscle oxygenation. Why do we care? All of this impacts the ability for mitochondria to output adenosine triphosphate (ATP). It is also an indicator of muscular damage during injury and nourishment during rehabilitation. These processes all require oxygen.

Measuring SNO is specific, and it may indicate the readiness and effectiveness of exercise on a personalized level. It can be associative to overall VO2, and oxygen consumption specific to the muscle (called mVO2) as well. It may be an indicator of power output and capacity, and could also correlate to lactate efflux. Further, and most importantly, it can stand alone as its own measurement. As with anything truly new and disruptive, a lot of research needs to be conducted, but there is evidence indicating the usefulness of SNO as a novel biomarker to gauge fitness and performance.

How can we measure SNO? NNOXX has a device

There is a device available today that non-invasively measures SNO, plus muscle oxygenation (SmO2) and muscle oxygen consumption (mVO2) from a company called NNOXX. (Full disclosure: I have consulted with NNOXX on clinical and regulatory affairs.)  It’s the only device of its kind, delivering continuously streaming data that can be accessed at any point during a ride or workout. NNOXX helps athletes understand the efficiency and effectiveness of an exercise by measuring these performance indicators directly in exercising muscle, in real time.

One differentiating thing about these biomarkers is that they are exercise “blind,” meaning you can ride or you can lift, and you will still produce SNO and use oxygen, just not in the same way (a topic for a different article). The $299 NNOXX device can be used to make individualized assessments during many types of exercise — biking, lifting, and running, as examples — and only needs to be placed on the exercising muscle during your workout. 

So how can riders use NNOXX to help improve their cycling performance?

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NNOXX provides a Performance Readiness Score

Muscle recovery can be impacted by insufficient calories, poor sleep, dehydration, overreaching, or even the onset of illness. NNOXX is differentiated because the biological assessments are measured and delivered in real-time based on rates of oxygenation and deoxygenation, plus the bioactive nitric oxide response while you’re exercising. All you have to do is a guided four-minute cycling protocol and the app will give you both a Muscle Readiness and Aerobic Readiness percentage tailored to your physiological status. You’ll be given a recommendation of how to proceed based on your score. You can also see a seven-day trend.

NNOXX can help you understand how well you performed compared to other rides or exercise sessions. 

The app provides individualized performance indicators, including a Power Index, Endurance Index, and Economy.  These indicators are based on your personal rates of muscle deoxygenation, reoxygenation and other factors, measured in real-time during your workout. After your workout is finished, you’ll receive your score for the day, your average range, and 60-day comparative trend. 

This feature is really useful if riders have regular routes or workouts, and they’re interested in seeing if they’re improving, especially when making changes to their routine (e.g. more sleep, additional interval sessions, changes in recovery or dietary habits, or longer rides). 

Further, users can potentially infer if a specific type of riding is best for them. For example, if the data shows you’re more efficient at climbing than previously thought, it may be something worth capitalizing on or integrating more often into your routine. The opposite can be a takeaway, too. If the app indicates you perform better doing power activities than long rides, you can use this to create a goal around improving your endurance.

What if I am new to mountain biking or cross-training and to improve my performance without hiring a coach or personal trainer? 

The NNOXX app provides an AI-guided coach to customize your ride or other workout to be the most effective and efficient. The output is based on the effects of your real-time SNO production. As data is aggregated, workouts can be compared and personalized to your individual physical performance to help maximize gains.

For a new-to-market device and a new biomarker, the metrics provided by the device do seem to be physiologically reliable and accurate. Because the data is provided continuously with relatively no lag, the information can easily be compared to other performance indicators. Users can see how their body is compensating for increases in cadence or terrain grade, as examples.

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NNOXX recently released a feature that allows users to import their Strava and Peloton data into the High Performance Platform on their website. Comparisons between SNO and SmO2 can be made alongside work, power, heart rate, and others on a single platform. 

Again, the SNO biomarker and associated performance indicators are new. Like most things in science and medicine, it takes time to build up a bank of clinical evidence that is trustworthy, and the data on SNO as a performance biometric promises to evolve as discoveries are made and information is added. The digital technology boom is allowing researchers and developers to change the landscape at an unmatched speed, and NNOXX is a great example of what I believe is a positive outcome of the race.

Sources

Premont, R. T., Reynolds, J. D., Zhang, R., & Stamler, J. S. (2020). Role of nitric oxide carried by hemoglobin in cardiovascular physiology: developments on a three-gas respiratory cycle. Circulation research, 126(1), 129-158.

Reynolds, J. D., Posina, K., Zhu, L., Jenkins, T., Matto, F., Hausladen, A., … & Stamler, J. S. (2023). Control of tissue oxygenation by S-nitrosohemoglobin in human subjects. Proceedings of the National Academy of Sciences, 120(9), e2220769120.

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Fitness

Do you need a wearable health & fitness tracker?

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6 hours ago

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November 14, 2024

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Do you need a wearable health & fitness tracker?

Getting on track

Overwhelming evidence indicates three lifestyle choices can help humans optimize wellness: increasing physical activity behaviors, decreasing sedentary behaviors, and consuming a well-balanced diet.

As director of the University Weight Control Center for more than 12 years, I supported the use of “structured lifestyle interventions” to increase participation in physical activities. This included group or individual counseling, introduction of behavior change and self-monitoring techniques, written information, and phone/online counseling.

Our program proved effective for changing behaviors, as long as people were enrolled. When the 12-week program concluded, nearly half of the participants did not maintain their newly learned exercise/nutrition behaviors during a one-year follow-up. Those participants reported it was too difficult to “do it on their own.” They needed continuous interaction, support, reminders, hints, and to-do lists. On a positive note, 50% of the participants (approximately) reported “success” at maintaining their new behaviors at the same one-year follow-up.

What are you wearing?

Most modern wearables can track vital signs, such as resting and activity pulse rate, and make comparisons with individuals of one’s same gender and age, reflecting changes (improvements) over time. (Image: iStock.)

Consumer-based health/fitness wearables can help one feel they are not doing this “on their own.” Wearables can monitor physical activity and specific health metrics and, when combined with a smartphone or computer, assist with a range of other motivational and health-monitoring tools. It’s just like the activities we performed in the clinic but with less expense. These tools include continuous heart monitoring with the diagnostic ability to detect rate and function abnormalities, blood oxygen saturation (PO2), sleep tracking, body temperature, blood pressure, and even blood glucose levels. These emerging technologies can provide ongoing support and motivation and interface with designated medical professionals.

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The health & fitness wearable marketplace will be worth an estimated $63.48 billion by 2027! Wow! Rising health awareness is a vital factor in increasing this market growth.

What can fitness/health wearables measure?

Step counter/exercise trackers
Most wearable health/fitness devices include some sort of step counter that records how many steps and distances are covered for a given period. Prudent recommendations include a minimum of 7,000-10,000 steps daily to decrease sedentary risk syndrome (cardiovascular disease development). Most current wearable health/fitness devices also monitor acceleration, frequency, duration, intensity, and movement patterns. Some devices allow users to add running, cardio, dancing, cycling, and more. Summary information and recommendations data are available on request.

Vital sign monitor
Most modern wearables can track vital signs, such as resting and activity pulse rate, and make comparisons with individuals of one’s same gender and age, reflecting changes (improvements) over time. Some devices offer selected body temperature readings, perspiration tracking, blood-oxygen saturation, and menstrual cycle data. By combining physical and workout data, the user can get a better picture of their overall health. Moreover, these data also can be stored and forwarded to an individual’s physician.

Woman dressed for exercise wears a tracker on wrist and bicep, surrounded by graphics representing healthcare technology.

There are roughly 32,000 gyms in the U.S. with about 64 million people who regularly exercise in them. Of these, about 55% use a smartwatch to track their exercise duration, heart rate, steps, distance, and more. (Image: iStock.)

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Sleep recorder
Keeping track of how much and how restful one sleeps is an important metric that offers important insight into health. Some trackers can discern and distinguish between sleep cycles, including REM sleep. Sleep quantity and quality represent an important indicator of health and wellness. In a previous column, I discussed different aspects of sleep and health.

Calorie tracking
Most health & fitness wearables can track the number of calories expended during rest and physical activity; some allow the user to track calories consumed by entering the foods consumed.

Sync with other devices
All health & fitness wearables can work with applications installed on a phone, tablet, or computer. Users can store data and compare progress with others (or just oneself) day-by-day or week-by-week. Some wearable devices are compatible with other tools, such as smart scales and clocks, or even specific exercise equipment. In some instances, one can instantaneously transfer data to a physician for review and evaluation. A growing number of devices can produce a medical-quality ECG (electrocardiogram) that offers a cursory evaluation of some heart anomalies and conditions like atrial fibrillation (AF), bradycardia, or tachycardia. These conditions may warrant further evaluation by a physician.

Expectations

Before you go out and buy a fitness/health tracker, make sure it’s worth it to you. Here are some of the pros and cons to consider.

Woman wearing fitness tracker touches the tracker on her wrist while reviewing data and graphs on an iPad.

Emerging technologies can provide ongoing support and motivation and interface with designated medical professionals. (Image credit: iStock.)

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Pros
For many, tracking different fitness/health metrics can provide a better understanding of how you’re doing, not how you think you’re doing. This is important. Properly used, wearable data can provide the first indicator that something has gone haywire healthwise, and offers the opportunity to be proactive, not blindsided by an unwanted diagnosis.

Also, trackers can be very motivating, particularly to those who like numbers, notifications, digital rewards, comparisons, and reminders. When it’s cold outside, going for a winter walk may be a non-starter for many, but a simple reminder from a tracker may motivate one to produce enough steps to reach the day’s goal. The trackers feed into our competitive nature, pushing us toward the finish line, even when difficult.

Cons
Not all fitness trackers are created equal. They have varying degrees of accuracy. Research indicates most trackers are reasonably accurate, but ‘reasonably’ isn’t perfect, which always leaves room for error. How much error depends on which device you choose. Inaccuracies can range from +/- 3% up to 20%. And another consideration is repeatability: Can the monitor accurately produce the same result on the same person on repeat use within a few minutes?

Any new gadget is fun for a while, and wearable trackers are no different. After some time, many individuals find themselves bored and over-stimulated with data, not to mention the need to constantly input and update data. The process can become anxiety-provoking, particularly for those who become obsessed with amassing the most data possible.

Another negative aspect is cost. There’s a tracker for every budget and style; you can spend $50, $1,000, or more. As with any technology, the more you spend, the more you get.

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Let’s talk about accuracy

Scientists have done numerous validation studies on most mainstream health & fitness trackers. The results indicate that accuracy is variable, depending on the technology used and what the tracker is trying to measure.

Any fitness tracker needs to accurately assess your activity level to be able to calculate it. A recent research review of the latest health & fitness trackers found that wrist- or arm-worn trackers for measuring energy expenditure varied in accuracy, depending on the task being performed. When the body’s movement was the only parameter being measured, they were less accurate than when the tracker also included a heart-rate monitor or body-heat sensor. In another study measuring aerobic workouts, caloric expenditure tended to be overestimated when working at a slower pace and underestimated when working at a faster pace.

Yet, in another study that compared 11 different trackers, researchers found that accuracy varied between them when counting steps. They tended to be better at correctly counting steps during brisk walking than day-to-day activities and intermittent walking when arm movements were frequently miscounted as steps.

Earlier-generation fitness trackers came with a chest band to measure heart rate by tracking the body’s electrical signals. These devices are very accurate. In contrast, modern fitness trackers worn on the wrist that measure heart rate using photoplethysmography (PPG) are less accurate, by varying degrees, depending on the tracker. These trackers contain LEDs (light-emitting diodes) that send light waves into your skin, and a photodetector captures the light that bounces off the wrist, which is then turned into information that the device’s inbuilt algorithms can analyze to determine heart rate. While these trackers have been shown to be accurate enough for measuring the heart rate of an average person, they are not suitable for research purposes and tend to produce erroneous, extreme readings, which might misinterpret the real-time exercise intensity.

Conclusions

Overall, the research on fitness & health trackers indicates that most people who use them tend to become more active, increase their step counts, and expend more energy at moderate and vigorous levels. They also found that trackers helped maintain good habits in the long term and could be helpful to medical professionals monitoring the health of their patients.
 
 
References

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  • ACSM. Wearable technology named top fitness trend for 2024.
  • Ash, G.I., et al. “Establishing a global standard for wearable devices in sport and exercise medicine: Perspectives from academic and industry stakeholders.” Sports Medicine. 2021;51(11):2237–50.
  • Chevance, G., et al. “Accuracy and precision of energy expenditure, heart rate, and steps measured by combined-sensing Fitbits against reference measures: Systematic review and meta-analysis.” JMIR mHealth and uHealth. 2022;10(4): e35626.
  • Fuller, D., et al. “Reliability and validity of commercially available wearable devices for measuring steps, energy expenditure, and heart rate: Systematic review. JMIR mHealth uHealth. 2020;8(9): e18694.
  • Gualtieri, L., et al. “Can a free wearable activity tracker change behavior? The impact of trackers on adults in a physician-led wellness group.” JMIR Research Protocols. 2016;5(4): e237.
  • Hickey, A.M., Freedson, P.S. “Utility of consumer physical activity trackers as an intervention tool in cardiovascular disease prevention and treatment.” Progress in Cardiovascular Diseases. 2016;58(6):613–9.
  • Hsueh-Wen, C., et al. “Accuracy of optical heart rate sensing technology in wearable fitness trackers for young and older adults: Validation and comparison study.” JMIR mHealth uHealth 2020;8(4):e14707.
  • Huhn, S., et al. “The impact of wearable technologies in health research: Scoping review.” JMIR mHealth uHealth. 2022;10(1): e34384.
  • Keogh, A., et al. “Breaking down the digital fortress: The unseen challenges in healthcare technology — Lessons learned from 10 years of research.” Sensors. 2024;24(12):3780.
  • Lupton, D. “The quantified self: A sociology of self-tracking.” Sociology of Health and Illness. 2016;39:1557–71.
  • Molina-Garcia, P., et al. “Validity of estimating the maximal oxygen consumption by consumer wearables: A systematic review with meta-analysis and expert statement of the INTERLIVE network.” Sports Medicine. 2022;52(7):1577–97.
  • Perez, M.V., et al. “Large-scale assessment of a smartwatch to identify atrial fibrillation.” New England Journal of Medicine. 2019;381(20):1909–17.
  • Piwek, L., et al. “The rise of consumer health wearables: Promises and barriers.” PLOS Medicine. 2016;13(2): e1001953.
  • Shilaih, M., et al. “Modern fertility awareness methods: Wrist wearables capture the changes in temperature associated with the menstrual cycle.” Biosci Reports. 2018;38(6): BSR20171279.
  • Spaccarotella, C., et al. “Assessment of non-invasive measurements of oxygen saturation and heart rate with an Apple Smartwatch: C0mparison with a standard pulse oximeter.” Journal of Clinical Medicine. 2022;11(6):1467.
  • Swee Sun Tang, M., et al. “Effectiveness of wearable trackers on physical activity in healthy adults: Systematic review and meta-analysis of randomized controlled trials.” JMIR mHealth uHealth 2020;8(7);e15576.

Lead image: iStock.)

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Fitness

To avoid premature death, fitness is more important than losing weight, new research finds – WTOP News

Published

13 hours ago

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November 14, 2024

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To avoid premature death, fitness is more important than losing weight, new research finds – WTOP News

As more and more Americans are becoming obese, some are turning to weight-loss drugs to help them shed a few pounds. But new research shows there’s another factor that may be more important to consider for your overall health: exercise.

Overall fitness is more important than a person’s weight in avoiding a premature death, a new analysis published in the British Journal of Sports Medicine found.

Cardiorespiratory fitness, the analysis found, is a better predictor of cardiovascular disease and mortality than body mass index (BMI).

The new research reviewed 20 studies with almost 400,000 adults from different parts of the world. Researchers found that someone who is “normal weight” and unfit has a risk of death that’s twice as much as someone who is normal weight and fit.

If someone is obese and fit, the risk of death is about half that of someone who is normal weight but unfit.

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The review defined fitness using a stress test and defined weight and obesity by using body mass index. The majority of studies classified people as fit if they get out of the bottom-20th percentile of fitness.

“People view exercise only as a means to losing calories, and we really ought to get away from that,” said Siddhartha Angadi, associate professor of exercise physiology at the University of Virginia School of Education and Human Development.

“You ought to exercise to improve your heart health, to improve your muscular health, to basically maintain your pulmonary function and so on. That is what is going to give you the most ‘bang for your buck’ from a health and disease perspective in the long term,” he added.

Generally, Angadi said, the findings suggest it’s more important to be physically fit than it is to be a lower weight.

Focusing on weight rather than overall fitness presents a set of challenges, Angadi said, because people who are overweight or clinically obese often get tasked with losing weight. Many do in the short term, but most people regain all of it in five to 10 years.

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“So what do you do to improve health in that situation? The nice thing is that exercise is pretty accessible,” Angadi said. “When you’re talking about getting out of the bottom 20th percentile, when you’re talking about just getting a little more fit, it is reasonably achievable.”

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Fitness

Exercise Your Demons is a mixed reality fitness game from hell

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21 hours ago

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November 14, 2024

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Exercise Your Demons is a mixed reality fitness game from hell

Image: Vyersoft

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Exercise your Demons is a new spin on fitness games where you get in shape by fighting demons from hell right in your room.

After you carelessly sign a contract with the Demonomicon, a portal to hell opens in your world and countless demons pour out. The only way to repel these uninvited guests is to fight them off with brute force.

Under the tutelage of demonic instructors Ash and Zephyr, you will learn the proper moves such as ducking, dodging and smashing in the “Infernal Gym” and at locations such as Poison Blossom Park and the Ultimate Demon Derby.

Coming in December for Meta Quest

Studio Vyersoft promises a story campaign where you unlock new levels and cosmetic items using Impcoins and Soulbars, and thanks to an online leaderboard you can compete with others and see your physical progress in the game.

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Exercise Your Demons will be released on December 12 in the Horizon Store. Meta Quest 3S, 3, 2 and Pro are supported. The price will be $20. The mixed reality game supports a range of languages.

Buy Quest 3S & Accessories

Note: Links to online stores in articles can be so-called affiliate links. If you buy through this link, MIXED receives a commission from the provider. For you the price does not change.

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