Category: Exercise

Can Running Beat Antidepressants as a Treatment for Depression?

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The first study to compare effects of antidepressants with running exercises for anxiety, depression and overall health shows that they have about the same benefits for mental health, with health benefits for those assigned to running.

Professor Brenda Penninx from Vrije University, Amsterdam, presented the work at the ECNP conference in Barcelona (after recent publication in the Journal of Affective Disorders). Prof Penninx said, “We wanted to compare how exercise or antidepressants affect your general health, not just your mental health.”  

The 16-week course of running over the same period scores higher in terms of physical health improvement, whereas antidepressants lead to a slightly worse physical condition, as has been suggested by previous studies.  However, the drop-out rate was much higher in the group which initially chose exercise.

The researchers studied 141 patients with depression and/or anxiety. They were offered a choice of treatment; SSRI antidepressants for 16 weeks, or group-based running therapy for 16 weeks. 45 chose antidepressants, with 96 participating in running. The members of the group which chose antidepressants were slightly more depressed than the members of the group which chose to take running.

Professor Penninx said, “This study gave anxious and depressed people a real-life choice, medication or exercise. Interestingly, the majority opted for exercise, which led to the numbers in the running group being larger than in the medication group.”

Treatment with antidepressants required patients to adhere to their prescribed medication intake but this generally does not directly impact on daily behaviours. In contrast, exercise directly addresses the sedentary lifestyle often found in patients with depressive and anxiety disorders by encouraging persons to go outside, set personal goals, improve their fitness and participate in a group activity.  

The antidepressant group took the SSRI Escitalopram for 16 weeks. The running group aimed for two to three closely supervised 45-minute group sessions per week (over 16 weeks). The adherence to the protocol was lower in the running group (52%) than in the antidepressant group (82%), despite the initial preference for running over antidepressants.

At the end of the trial, around 44% % in both groups showed an improvement in depression and anxiety, however the running group also showed improvements in weight, waist circumference, blood pressure, and heart function, whereas the antidepressant group showed a tendency towards a slight deterioration in these metabolic markers.

“Both interventions helped with the depression to around the same extent. Antidepressants generally had worse impact on body weight, heart rate variability and blood pressure, whereas running therapy led to improved effect on general fitness and heart rate for instance. We are currently looking in more detail for effects on biological aging and processes of inflammation’,” Prox Benninix said.

Physical activity is a good option, but antidepressants still have a role

Prof Benninx noted that it is not a case of one or the other when it comes to treating depression. “It is important to say that there is room for both therapies in care for depression. The study shows that lots of people like the idea of exercising, but it can be difficult to carry this through, even though the benefits are significant. We found that most people are compliant in taking antidepressants, whereas around half of the running group adhered to the two-times-a-week exercise therapy. Telling patients to go run is not enough. Changing physical activity behaviour will require adequate supervision and encouragement as we did by implementing exercise therapy in a mental health care institution.”

She added: “Antidepressants are generally safe and effective. They work for most people. We know that not treating depression at all leads to worse outcomes; so antidepressants are generally a good choice. Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them. Our results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good – and maybe even better – choice for some of our patients.  

“In addition, let’s also face potential side effects our treatments can have. Doctors should be aware of the dysregulation in nervous system activity that certain antidepressants can cause, especially in patients who already have heart problems. This also provides an argument to seriously consider tapering and discontinuing antidepressants when depressed or anxious episodes have remitted. In the end, patients are only truly helped when we are improving their mental health without unnecessarily worsening their physical health.”

Source: EurekAlert!

50 Steps a Day Cuts Heart Disease Risk by 20%

Credit: Pixabay CC0

Forget walking 10 000 steps a day – climbing up at least 50 steps a day could significantly reduce the risk of heart disease, according to a new study from Tulane University.

The study, published in Atherosclerosis, found that climbing more than five flights of stairs daily could reduce risk of cardiovascular disease by 20%.

Atherosclerotic cardiovascular disease (ASCVD) along with coronary artery disease and stroke are the leading causes of morbidity and mortality worldwide.

“Short bursts of high-intensity stair climbing are a time-efficient way to improve cardiorespiratory fitness and lipid profile, especially among those unable to achieve the current physical activity recommendations,” said co-corresponding author Dr Lu Qi, professor at Tulane University. “These findings highlight the potential advantages of stair climbing as a primary preventive measure for ASCVD in the general population.”

Using UK Biobank data collected from 450 000 adults, the study calculated participants’ susceptibility to cardiovascular disease based on family history, established risk factors and genetic risk factors and surveyed participants about their lifestyle habits and frequency of stair climbing. Median follow-up time was 12.5 years.

The study found that climbing more stairs daily especially reduced risk of cardiovascular disease in those who were less susceptible. However, Qi said the increased risk of heart disease in more susceptible people could be “effectively offset” by daily stair climbing.

Qi touted the public availability of stairs as a low-cost, accessible way to incorporate exercise into daily routines.

“This study provides novel evidence for the protective effects of stair climbing on the risk of ASCVD, particularly for individuals with multiple ASCVD risk factors,” Qi said.

Source: Tulane University

Yoga Therapy Improves Quality of Life and Cardiovascular Function

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Yoga therapy and lifestyle modifications have been shown to improve heart failure (HF) patients’ quality of life and enhance their cardiovascular function. A new study, presented at the American College of Cardiology Asia 2023 conference, examines the long-term outcomes of yoga therapy to determine the benefit of adding yoga therapy as a complementary treatment in the management of HF. After 12 months, participants with HF receiving yoga therapy continued to show improvement in left ventricular systolic function as well as quality of life.

The study included 75 heart failure patients (aged 30–70 years old) at a tertiary care centre in South India, who underwent coronary intervention, revascularisation or device therapy within in the previous six to 12 months. All of the patients included in the study were less than or equal to New York Heart Association (NYHA) Class III and had been on optimised medical therapy for at least 6 months to 12 months, and had a left ventricular ejection fraction (LVEF) of < 45%.

The interventional group included 35 participants (31 men and 4 women) and 40 (30 men and 10 women) were in the non-interventional (control) group. The interventional group received yoga therapy and guideline-directed medical therapy, while the control group only continued with standard guideline-directed medical therapy. Echocardiographic parameters were compared at various follow-ups to see the impact of yoga therapy on heart failure patients.

“Yoga is a combination of mind-body techniques, which is a set of physical exercises [asana] with breathing techniques [pranayama], relaxation and meditation that can be effectively used to stimulate physical and mental well-being,” said lead author Ajit Singh, PhD, research scientist for the Indian Council for Medical Research at Kasturba Medical College & Hospital, Manipal Academy of Heart Education in Manipal, India. “Our patients observed improvement in systolic blood pressure and heart rate compared to patients who were on medication without yoga.”

Participants in the yoga group were taken to the Department of Yoga at the hospital and an experienced yoga therapist taught selected yoga therapy like pranayama, meditation and relaxation techniques. Each session lasted around 60 minutes and participants were supervised for one week at the training centre before being asked to continue self-administered yoga at home. Those in the yoga group were advised to perform yoga at least five days a week for 12 months. At the training centre all the participants were taught together to perform the same steps, but individual support was available.

Researchers measured quality of life improvements using the World Health Organization Quality of Life questionnaire, which uses 26 questions to evaluate quality of life in four aspects: physical, psychological, social and environmental health. The participants completed the questionnaire at enrolment, as well as at 24 weeks and 48 weeks of follow-up. According to the researchers, the study showed participants in the yoga group had improvement in endurance, strength, balance, symptom stability and quality of life. They also observed that while patients improved physically and psychologically, there was no improvement in social and environmental health.

Echocardiographic parameters did not show any significant differences between the two groups at baseline. At both the six- and 12-month follow-up, improved biventricular systolic function was seen in the interventional (yoga) group compared to the control group. The interventional group also showed substantial improvement in functional outcomes as assessed by NHYA classification.

“This study proves that the addition of yoga therapy to standard medical management of heart failure leads to an improvement in left ventricular systolic function and quality of life in heart failure patients,” Singh said. “Hence, yoga therapy may improve physical well-being and left ventricular function among heart failure patients on guideline-directed optimal medical therapy.”

Source: American College of Cardiology

Even Moderate Physical Fitness Protects Against Atrial Fibrillation and Stroke

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A study in more than 15 000 people has found that even moderate physical fitness is linked with a lower likelihood of developing atrial fibrillation and stroke. Progressively higher levels of fitness also reduced the risk of cardiovascular events. The research is presented at ESC Congress 2023.

Atrial fibrillation is the most common heart rhythm disorder, and patients with the condition have a five-fold higher risk of stroke than their peers. This study examined whether fitness was related to the likelihood of developing atrial fibrillation.

The study included 15 450 individuals without atrial fibrillation who were referred for a treadmill test between 2003 and 2012. The average age was 55 years and 59% were men. Fitness was assessed using the Bruce protocol, where participants are asked to walk faster and at a steeper grade in successive three-minute stages. Fitness was calculated according to the rate of energy expenditure the participants achieved, which was expressed in metabolic equivalents (METs).

Participants were followed for new-onset atrial fibrillation, stroke, myocardial infarction and death. The researchers analysed the associations between fitness and atrial fibrillation, stroke and major adverse cardiovascular events (MACE; a composite of stroke, myocardial infarction and death) after adjusting for factors that could influence the relationships including age, sex, cholesterol level, kidney function, prior stroke, hypertension and medications.

During a median of 137 months, 515 participants (3.3%) developed atrial fibrillation. Each one MET increase on the treadmill test was associated with an 8% lower risk of atrial fibrillation, 12% lower risk of stroke and 14% lower risk of MACE.

Participants were divided into three fitness levels according to METs achieved during the treadmill test: low (less than 8.57 METs), medium (8.57 to 10.72) and high (more than 10.72). The probability of remaining free from atrial fibrillation over a five-year period was 97.1%, 98.4% and 98.4% in the low, medium and high fitness groups, respectively.

Study author Dr Shih-Hsien Sung of the National Yang Ming Chiao Tung University, Taipei, Taiwan said: “This was a large study with an objective measurement of fitness and more than 11 years of follow up. The findings indicate that keeping fit may help prevent atrial fibrillation and stroke.”

Source: European Society of Cardiology

Mediterranean Lifestyle Linked to Lower Risk of All-cause and Cancer Mortality

in Mayo Clinic Proceedings.

People who adhere to a Mediterranean lifestyle, which involves a plant-rich diet, adequate rest, physical activity and socialisation, have a lower risk of all-cause and cancer mortality, according to a new study in Mayo Clinic Proceedings. People who adhered to the lifestyle’s emphasis on rest, exercise, and socialising with friends had a lower risk of cardiovascular disease mortality.

While many studies have established the health benefits of a Mediterranean diet and lifestyle, there are few studies on the diet outside of its region of origin. “This study suggests that it’s possible for non-Mediterranean populations to adopt the Mediterranean diet using locally available products and to adopt the overall Mediterranean lifestyle within their own cultural contexts,” said lead author Mercedes Sotos Prieto, Ramon y Cajal research fellow at La Universidad Autónoma de Madrid and adjunct assistant professor of environmental health at Harvard Chan School. “We’re seeing the transferability of the lifestyle and its positive effects on health.”

Led by La Universidad Autónoma de Madrid and Harvard T.H. Chan School of Public Health, the study analysed the habits of 110,799 members of the UK Biobank cohort, a population-based study across England, Wales, and Scotland using the Mediterranean Lifestyle (MEDLIFE) index, which is derived from a lifestyle questionnaire and diet assessments. Participants, who were between the ages of 40 and 75, provided information about their lifestyle according to the three categories the index measures: “Mediterranean food consumption” (intake of foods part of the Mediterranean diet such as fruits and whole grains); “Mediterranean dietary habits” (adherence to habits and practices around meals, including limiting salt and drinking healthy beverages); and “physical activity, rest, and social habits and conviviality” (adherence to lifestyle habits including taking regular naps, exercising, and spending time with friends). Each item within the three categories was then scored, with higher total scores indicating higher adherence to the Mediterranean lifestyle.

The researchers followed up nine years later to examine participants’ health outcomes. Among the study population, 4247 died from all causes; 2401 from cancer; and 731 from cardiovascular disease. Analysing these results alongside MEDLIFE scores, the researchers observed an inverse association between adherence to the Mediterranean lifestyle and risk of mortality. Participants with higher MEDLIFE scores were found to have a 29% lower risk of all-cause mortality and a 28% lower risk of cancer mortality compared to those with lower MEDLIFE scores. Adherence to each MEDLIFE category independently was associated with lower all-cause and cancer mortality risk. The “physical activity, rest, and social habits and conviviality” category was most strongly associated with these lowered risks, and additionally was associated with a lower risk of cardiovascular disease mortality.

Source: Harvard T.H. Chan School of Public Health

Optimum Heart Rate for Fat Burning can Vary Widely among Individuals

The study uncovered individual variations in fat burning during exercise. Graphs of two people’s fat burning curves highlight differences in fat burning rates at varying exercise intensities and demonstrate that fatMAX falls outside the predicted ‘fat burning zone’. Credit: Hannah Kittrell, Mount Sinai Physiolab and AIMS Lab at Icahn Mount Sinai

The ‘fat burning zone’ on commercial exercise machines often does not line up the best heart rate for burning fat as it differs for each individual, Icahn School of Medicine at Mount Sinai researchers report.

Instead, the researchers said, clinical exercise testing (a diagnostic procedure to measure a person’s physiological response to exercise) may be a more useful tool to help individuals achieve intended fat loss goals. The study, which used a machine learning-based modelling approach, was published online in Nutrition, Metabolism and Cardiovascular Disease.

“People with a goal of weight or fat loss may be interested in exercising at the intensity which allows for the maximal rate of fat burning. Most commercial exercise machines offer a ‘fat-burning zone’ option, depending upon age, sex, and heart rate,” says lead author Hannah Kittrell, MS, RD, CDN, a PhD candidate at Icahn Mount Sinai. “However, the typically recommended fat-burning zone has not been validated, thus individuals may be exercising at intensities that are not aligned with their personalised weight loss goals.”

The term FATmax is sometimes used to represent the exercise intensity and associated heart rate at which the body reaches its highest fat-burning rate during aerobic exercise. At this point, fat is a significant fuel source and therefore this intensity may be of interest to those seeking to optimize fat loss during workouts.

As part of the study, the researchers compared heart rate at FATmax, as measured during a clinical exercise test, to predicted heart rate at percentages of maximal effort within the typically recommended ‘fat-burning zone’. In a sample of 26 individuals, the researchers found that there was poor agreement between measured and predicted heart rate, with a mean difference of 23 beats per minute between the two measures. This suggests that general recommendations for a ‘fat-burning zone’ may not provide accurate guidance.

Next, the researchers plan to study whether individuals who receive a more personalised exercise prescription demonstrate more weight and fat loss, as well as improvement of metabolic health markers that identify health risks like type 2 diabetes, obesity, and heart disease.

“We hope that this work will inspire more individuals and trainers to utilise clinical exercise testing to prescribe personalised exercise routines tailored to fat loss. It also emphasises the role that data-driven approaches can have toward precision exercise,” says senior author Girish Nadkarni, MD, MPH, Professor of Medicine at Icahn Mount Sinai.

Source: The Mount Sinai Hospital / Mount Sinai School of Medicine

Health Benefits Appear Even with Fewer Steps per Day

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Contrary to previous belief, fewer numbers of daily steps are necessary for health benefits to appear, according to the largest analysis to investigate this. The study, published in the European Journal of Preventive Cardiology, found that walking at least 3967 steps a day started to reduce the risk of dying from any cause, and 2337 steps a day reduced the risk of dying from cardiovascular disease.

The new analysis included 226 889 people from 17 different studies around the world. It showed that the risk of dying from any cause or from cardiovascular disease decreases significantly with every 500 to 1000 extra steps you walk. An increase of 1000 steps a day was associated with a 15% reduction in the risk of dying from any cause, and an increase of 500 steps a day was associated with a 7% reduction in dying from cardiovascular disease.

The researchers, led by Maciej Banach, Professor of Cardiology at the Medical University of Lodz, Poland, and Adjunct Professor at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, found that even if people walked as many as 20 000 steps a day, the health benefits continued to increase, with no upper limit found yet.

“Our study confirms that the more you walk, the better,” says Prof Banach. “We found that this applied to both men and women, irrespective of age, and irrespective of whether you live in a temperate, sub-tropical or sub-polar region of the world, or a region with a mixture of climates. In addition, our analysis indicates that as little as 4000 steps a day are needed to significantly reduce deaths from any cause, and even fewer to reduce deaths from cardiovascular disease.”

According to World Health Organization data, insufficient physical activity is the fourth most frequent cause of death in the world, with 3.2 million deaths a year related to physical inactivity. The COVID-19 pandemic also resulted in a reduction in physical activity, and activity levels have not recovered two years on from it.

Dr Ibadete Bytyçi from the University Clinical Centre of Kosovo, Pristina, Kosovo, senior author of the paper, says: “Until now, it’s not been clear what is the optimal number of steps, both in terms of the cut-off points over which we can start to see health benefits, and the upper limit, if any, and the role this plays in people’s health. However, I should emphasise that there were limited data available on step counts up to 20 000 a day, and so these results need to be confirmed in larger groups of people.”

This meta-analysis is the first not only to assess the effect of walking up to 20 000 steps a day, but also to look at whether there are any differences depending on age, sex or where in the world people live.

The studies analysed by the researchers followed up participants for a median (average) of seven years. The mean (average) age was 64, and 49% of participants were female.

In people aged 60 years or older, the size of the reduction in risk of death was smaller than that seen in people aged younger than 60 years. In the older adults, there was a 42% reduction in risk seen in those who walked 6000–10 000 steps a day, while there was a 49% reduction in risk in younger adults who walked 7000–13 000 steps a day.

Prof Banach says: “In a world where we have more and more advanced drugs to target specific conditions such as cardiovascular disease, I believe we should always emphasise that lifestyle changes, including diet and exercise, which was a main hero of our analysis, might be at least as, or even more effective in reducing cardiovascular risk and prolonging lives. We still need good studies to investigate whether these benefits may exist for intensive types of exertion, such as marathon running and iron man challenges, and in different populations of different ages, and with different associated health problems. However, it seems that, as with pharmacological treatments, we should always think about personalising lifestyle changes.”

Strengths of the meta-analysis include its size and that it was not restricted to looking at studies limited to a maximum of 16 000 steps a day. Limitations include the observational nature of the study. The impact of step counts was not tested on people with different diseases; all the participants were generally healthy when they entered the studies analysed. The researchers were not able to account for differences in race and socioeconomic status, and the methods for counting steps were not identical in all the studies included in this meta-analysis.

Source: European Society of Cardiology

Review Identifies Most Effective Forms of Exercise to Reduce Blood Pressure

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A meta-analysis published in the British Journal of Sports Medicine has shown that isometric exercises, which involve contracting muscles to hold the body in position without moving such as in wall squats, are best for reducing resting blood pressure. The researchers reviewed 270 randomised clinical trials with a total of 15 827 participants.

All of the studies included measured blood pressure after two weeks or more of exercise intervention, and included non-intervention control groups. It was found that isometric exercises reduced systolic and diastolic blood pressure by 8.24 and 4.00mmHg respectively. The next most effective forms of training in reducing blood pressure were combined training, followed by dynamic resistance training, aerobic exercise, and high-intensity interval training (HIIT).

The researchers noted that current guidelines are based on older research and as such don’t include data from new forms of exercise such as HIIT. These guidelines tend to emphasise aerobic training such as running for controlling blood pressure. In addition to helping clinicians optimise individualised exercise recommendations, the new findings suggest that it might be time to update exercise guidelines for preventing and treating high blood pressure.

Source: JAMA Network

Could an Alzheimer’s Treatment be Lurking in a Bodybuilder’s Supplement?

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A safe treatment against Alzheimer’s progression may be hidden in a common bodybuilding supplement. Researchers recently discovered that a muscle-building supplement called beta-hydroxy beta-methylbutyrate (HMB), may help protect memory, reduce plaques and ultimately help prevent the progression of Alzheimer’s disease. The researchers published their results in the journal Cell Reports.

HMB is a safe over-the-counter supplement, which bodybuilders regularly use to enhance exercise-related muscle strength and growth.

“This may be one of the safest and the easiest approaches to halt disease progression and protect memory in Alzheimer’s disease patients,” said Kalipada Pahan, PhD, at RUSH Medical College.

Studies in mouse models of Alzheimer’s have shown that HMB successfully reduces plaques and increases factors for neuronal growth to protect learning and memory, according to neurological researchers at RUSH.

“Understanding how the disease works is important to developing effective drugs to protect the brain and stop the progression of Alzheimer’s disease,” Pahan said.

Previous studies indicate that a family of proteins known as neurotrophic factors are drastically decreased in the brains of people with Alzheimer’s disease and have been found to help in survival and function of neurons, which are cells that receive and send messages from the body to the brain and vice versa.

“Our study found that after oral consumption, HMB enters into the brain to increase these beneficial proteins, restore neuronal connections and improve memory and learning in mice with Alzheimer’s-like pathology, such as plaques and tangles,” Pahan said.

The study findings indicate that HMB stimulates the nuclear hormone receptor PPARα within the brain that regulates the transport of fatty acids, which is key to the success of HMB as a neuroprotective supplement.

“If mouse results with HMB are replicated in Alzheimer’s disease patients, it would open up a promising avenue of treatment of this devastating neurodegenerative disease,” Pahan said.

Source: Rush University Medical Center

A Sensor Printed onto Clothing that Monitors Sweat Electrolytes

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Researchers from Japan have developed a novel wearable chemical sensor capable of measuring the concentration of chloride ions in sweat. The technology, described in the journal ACS Sensors, uses a ‘heat-transfer printing’ technique, the proposed sensor can be applied to the outer surface of common textiles to prevent skin irritation and allergies, and could also be useful in the early detection of heat stroke and dehydration.

Advances in miniaturisation have led to science-fiction like technologies such as wearable sensors which are usually placed directly on the skin. They can monitor important bodily parameters, including heart rate, blood pressure, and muscle activity and are often incorporated into devices such as smart watches.

Some wearable sensors can also detect chemicals in bodily fluids. For instance, sweat biosensors can measure the concentration of ions in sweat, providing information on their levels in blood. However, designing such chemical sensors is more complex than physical sensors. Direct contact between a wearable chemical sensor and skin can cause irritation and allergies. In contrast, if the sensor is fabricated directly on a wearable textile, its accuracy decreases due to surface irregularities.

In a recent study, a research team, led by Associate Professor Isao Shitanda of the Tokyo University of Science (TUS) in Japan, has developed an innovative sweat biosensor that addresses the aforementioned problems. Their technique involves ‘heat-transfer printing’ to fix a thin, flexible chloride ion sensor onto a textile substrate.

“The proposed sensor can be transferred to fibre substrates, and thus can be incorporated into textiles such as T-shirts, wristbands, and insoles,” explains Dr Shitanda. “Further, health indicators such as chloride ion concentration in sweat can be measured by simply wearing them.”

The heat-transfer printing approach offers several advantages. For one thing, the sensor is transferred outside of the piece of clothing, which prevents skin irritation. In addition, the wicking effect of the textile helps spread the sweat evenly between the electrodes of the sensor, creating a stable electrical contact. Moreover, printing the sensor on a flat surface and then transferring it prevents the formation of blurred edges that commonly occur when printing directly onto a textile.

The researchers carefully selected non-allergenic materials and electrochemical mechanisms of the sensor. After developing the sensor, they conducted various experiments using artificial sweat to verify its accuracy in measuring chloride ion concentration. The change in the electromotive force of the sensor was −59.5 mTV/log CCl−. Additionally, it displayed a Nernst response and a linear relationship with the concentration range of chloride ions in human sweat. Moreover, no other ions or substances typically present in sweat were found to interfere with the measurements.

Lastly, the team tested the sensor on a volunteer who exercised on a static bicycle for 30 minutes, by measuring their perspiration rate, chloride ion levels in blood, and saliva osmolality every five minutes to compare with the data previously gathered by the sensor. The proposed wearable sensor could reliably measure the concentration of chloride ions in sweat.

The sensor can also transmit data wirelessly, making real-time health monitoring easier. “Since chloride is the most abundant electrolyte in human sweat, measuring its concentration provides an excellent indicator of the body’s electrolyte balance and a useful tool for the diagnosis and prevention of heat stroke,” remarks Dr Shitanda.

This research thus demonstrates the potential of using wearable ion sensors for the real-time monitoring of sweat biomarkers, facilitating personalised healthcare development and athlete training management.

Source: Tokyo University of Science