Measuring Hemoglobin – A New Way to Determine Athletic Performance

During exercise, your body’s vasculature is working extra hard to make sure that sufficient blood supply is delivered to your muscles. The main purpose of this is to transport oxygen from the lungs via red blood cells. Hemoglobin, a protein on red blood cells for binding oxygen, also contributes to the blood’s buffering capacity and ATP and NO release from red blood contributes to vasodilation and improved blood flow to working muscles. However, it has been found that trained athletes, specifically endurance athletes, have a decreased hematocrit, sometimes called “sports anemia.” Athletes actually tend to have an increased total mass of red blood cells and hemoglobin, but the decrease in hematocrit by training is due to an increased plasma volume. This means that the decreased hemoglobin concentration allows for less delivery of oxygen to cells.

Figure 1: Both of these graphs show that during single muscle exercise (Graph A) and whole body exercise (Graph D) there is a decrease in hemoglobin concentration.

Because of the effects that hemoglobin concentration has on athletic performance, there is a need for a faster, accurate method that athletes can use during training to evaluate their training program. Hemoglobin concentration does not only change due to elevation, but also due to exercise intensity as well. Typically, athletes only get their hemoglobin concentration tested four times a year, making this a huge need for endurance athletes to determine the efficacy of the their training programs. So the question is: how can we measure hemoglobin concentration? By looking at how we measure hemoglobin, we can look for new, portable and fast ways for athletes to measure their hemoglobin levels while training.

One way to measure hemoglobin is to take a blood sample from athletes and then to perform an absorbance test on the blood. This follows Beer’s Law. We will now explore how Beer’s Law works and how the concentration of hemoglobin is found for athletes. First, we need to make some assumptions and simplifications.

  • Assume that all the hemoglobin from the red blood cells in the sample will be be converted to cyanmethemoglobin.
  • Assume only interaction between radiation (light) and the absorber (sample) is absorption.
  • Assume these are at low concentrations ( < 0.01 M)
  • Assume that the nature of the absorber does not change with concentration

First, the blood is diluted in Drabkin’s Solution by 1:201, meaning if you have 20 microliters of blood you will need 4000 microliters of solution. Then the tube is covered and inverted several times and left to sit at room temperature. In the solution, these two reactions occur:

Then, the absorbance of cyanmethemoglobin is measured in a spectrophotometer at 540 nm. Beer’s Law, states:

where A is the absorbance, e is the molar absorbitivity (L/mol cm) which is specific for each compound, b is the path length of the sample (cm) and c is the concentration of the sample (mol/L). This equation tells us that there is a linear correlation between absorbance and concentration. If the solution is known, then we can create a linear graph like this:

Figure 2: This shows the Absorbance vs. Concentration graph from Beer’s Law and how to determine the concentration of an unknown.

Since we know that we are using cyanmethemoglobin (HiCN), then we can simplify Beer’s Law to calculate our hemoglobin concentration in our sample.  Since we are comparing the absorbance to a HiCN standard with a known concentration, we can calculate the concentration of HiCN in the blood sample by:

where, the test sample is the cyanmethemoglobin from the blood sample and the standard is a solution of standard cyanmethmeglobin. Following this equation, once the absorbance of the sample and standard are known, then the concentration of hemoglobin can be determined. Based on our assumptions, most of them will hold true in clinical practice – with blood samples we are dealing with low concentrations of hemoglobin.

            With Beer’s Law and the manipulation, we are able to determine the concentration of hemoglobin in a blood sample. Although this equation is effective in a laboratory, it takes time for an athlete to get a result. Perhaps improving technology, there could be a faster and portable device for athletes to use so that they can know their hemoglobin levels during their training sessions.

Recommended for Further Reading:

Red Blood Cells in Sports: Effects of Exercise and Training On Oxygen Supply by Red Blood Cells

Hemoglobin Concentration and Mass as Determinants of Exercise Performance and of Surgical Outcome

Oxygen Delivery by Blood Determines the Maximal VO2 and Work Rate During Whole Body Exercise In Humans: In Silico Studies

Questions for Readers:

How practical do you think it would be for athletes to measure their hemoglobin?

How do you think this would effect measuring for blood doping?

How can this apply to patients with anemia as well who wish to exercise?

 

How It Works: Bioelectric Impedance Analysis

How a Footwork Training System Can Improve Dance Training

Have you ever watched dancers on stage and think, how do they learn to do every moment at exactly the same time? The answer: lots and lots of practice. But, what if there was a way that would save them time and make sure they still perform in perfect unison? A system that a dance teacher could easily use in class? What if there was also a system that could help people track their own improvement at home?  Recently, there has been a huge need for home devices for personal training. However, at home training lacks in instructor feedback and also real-time evaluation and feedback. This led to the creation of the Footwork Training System and Method. I will explore this patent in how it works and the applications it is used for.

Patent Title: Footwork Training System and Method

Patent Number: US20080258921A1

Patent Filing Date: April 19, 2007

Patent Issue Date: October 23, 2008

How Long it Took to Issue: 1.5 years

Inventors: Helen Woo and Allan M.

Assignee: Nike, Inc.

U.S. Classification: A63B24/0006 – a computerized comparison for qualitative assessment of motion sequences or the course of movement

Claims: 50

            The system is comprised of several components: an article of clothing fit for the user’s body, a sensor attached to the article of clothing to detect the impact of the article of clothing against the surface, a processor connected to the sensor through a communication link, a target impact pattern accessible by the processor, and a display. The system is designed for a shoe. The processor and display are both a computer or portable electronic device. The purpose of this system is to provide an evaluation system for the user where while performing an activity, the sensor they are wearing can detect a performance impact pattern generated by the user. Then, the device can communicate the pattern to an evaluation system which will compare the performance impact pattern to the target impact pattern. The device can also store the information from the performance impact pattern.

Figure 1: The image on the left shows the shoe with sensors on it. The image on the right shows how when a person dances, the sensors in the shoe will collect the impact.

            The system works by determining a first performance metric based upon step, then the user can repeat the activity to generate a new performance pattern. Then, the system compares the new performance pattern to the target pattern to determine a new performance metric and finally, comparing the new performance pattern to the first performance metric to determine progress. The system will then display the performance pattern, new performance pattern, the target pattern, the first performance metric, and the new performance metric. The system can also be used for multiple users. This works by having a target impact pattern and then having each user wear the sensor. Then, the device compares the performance of the impact patter to the target impact pattern. Then the device will communicate the evaluation characteristics for the multiple users to a remote evaluation module via a communications network, which will compare the performances. The communication all occurs via the Internet and each user has access to a website that displays the results.

Figure 2: This chart depicts a simplified version of how the system works.

            In the references cited, there are various different patents that the device drew from including: music systems, shoe activated sound synthesized device, human movement measurement system, interactive surface and display system, sports electronic training system, and many others. The main difference with this device is that it incorporates different things from these patents to create a brand new device. It measures human movement patterns based on impact, which is different than some devices that record measurements visually. It also incorporates an interactive system and display which some devices have and others do not. It also is based on other shoe-like devices that have sensors or pads in them.

What I like about this device is that it can be used anywhere: it can be used at home, in class, in a gym, and a variety of other places. The creators list that this device is primarily used for dance, yoga posture, boxing moves, and martial arts movement. I primarily chose this patent because I thought how it was interesting how it is an evaluation tool for performance but can be used anywhere. I also liked how specifically the creators looked at how this device is used for dance. As a former dancer, I can clearly see the advantages of having a device like this. Not only can it be used to measure individual performance, it can also be used for multiple dancers which is definitely an advantage – it can help show if they are all performing in unison. When performing, all dancers want to be doing the same moves at the same time, and this device will help to evaluate that. I think that this device has so many applications and it can be further incorporated into not only a shoe, but a torso covering, leg covering, band, and jewelry. The possibilities seem endless for Footwork Training System and Method and it is really interesting to see where this goes in the future.

 

Help! I’ve Sprained My Ankle…Should I call the POLICE or use RICE?

For anyone who’s had a sprain, you’ve probably heard of RICE, or Rest, Ice, Compression, and Elevation, to take care of your injury. Sprains are extremely common; each year, approximately 1 million people are treated with ankle sprains with costs at about $40 million per year.  A sprain is a stretching or tearing of ligaments, which are fibrous tissue that connect two bones together. Common symptoms include pain, swelling, bruising, and limited mobility in the affected area.  Most doctors and physical therapists recommend RICE for treatment and can be treated at home. RICE is an acronym used for patients to remember when they have sprains for treatments. They first must REST the injured area and ICE the area as soon as possible. Then they must COMPRESS the area with an elastic wrap or bandage and finally ELEVATE the injured area to avoid swelling.

Although RICE has been recommended for treatment for a long time, doctors are beginning to question RICE and are beginning to recommend POLICE for treatment. POLICE stands for protection, optimal loading, ice, compression, and elevation. Optimal loading means creating a balance and incremental rehabilitation program where early activity leads to early recovery.  It also has been shown that long periods of rest are harmful and produce adverse changes to tissue biomechanics and morphology. Progressive mechanical loading is more likely to restore strength and to get patients to recover faster.  The addition of optimal loading raises new questions on whether this is beneficial or detrimental to the healing process of sprains. The challenge also is defining optimal loading for each individual case for dosage, nature, and timing. Let’s take a look at the evidence to see if optimal loading leads to a better recovery than RICE.

A study by Green, et al. showed looked at passive joint mobilization, a technique commonly used by physical therapists for patients with an acute ankle inversion sprain. Their study included forty-one subjects with acute ankle sprains and they were randomly assigned to two groups: the control group who received RICE and an experimental group that received anteroposterior mobilization along with RICE. At the end of two weeks with treatments every second day, the experimental group required fewer treatment sessions to achieve pain-free dorsiflextion, greater improvement in range of movement, and had a greater increased stride speed.  However, a limitation with this study is that the participants followed the RICE protocol at home so the question arises: did the participants actually RICE for as long as they said they did?

Bleakley et al. in another study had two groups with acute ankle sprains, one group had standard treatment (ice and compression) and another group had cryokinetic treatment (ice, compression and exercise consisting of muscle strengthening, neuromuscular training, and sports specific functional exercises five times a week). Function was assessed using the Lower Extremity Functional scale, pain, swelling, and activity levels. Following weeks 1 and 2, the exercise group had a better Lower Extremity Function score and had a higher activity level. The exercise group was also more active as well. They concluded that the aim of initiating early exercise during the acute phase of ankle sprains was to have early reactivation of ankle muscles and movement patterns. For this study as well, the participants wrote in a treatment journal of what they did every day.  Again, the question arises, did the participants actually do what they wrote?

Karlsson et al. also completed a study where one group received functional treatment of compression, elevation, early full weight0bearing, and proprioceptive range of motion training. Another group received conventional treatment with compression, protection, and crutches. They also concluded that return to sports activity was higher in the functional treatment group.  All three of these studies discuss only certain exercises that they had their participants take, there was not a universal exercise to help with ankle sprains.  I think it is interesting that despite having different exercises, they all arrived at the same conclusion.   I believe that a study comparing different exercises compared to healing would be interesting to observe.

Overall, all these studies show that some sort of early mobilization helps patients with acute ankle sprains recover faster and have less pain. Despite all the research conducted about early movement, research also lacks on whether ice, compression, and elevation are significant for recovery from sprains as well. With the new burst of research on optimal loading, I am led to believe that optimal loading may be best for a full recovery. However, I also believe that ankle sprains need to be treated differently for each case. For example, an athlete who exercises regularly and uses their ankle more, may be able to have more optimal loading compared to someone who does not exercise regularly. I also believe that more research needs to be conducted to determine which exercises are best for ankle sprains and what these exercises do internally do the muscles. Hopefully, new research will help to show what should be done to heal ankle sprains.

Recommended for Further Reading:

What is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?

Early functional treatment for acute ligament injuries of the ankle joint

National Athletic Trainers’ Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

Temporal extracellular matrix adaptations in ligament during wound healing and hindlimb unloading 

Effectiveness of exercise therapy and manual mobilisation in acute ankle sprain and functional instability: A systematic review 

Should POLICE Replace RICE as the Ankle Therapy of Choice?