National Academies Press: OpenBook

Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance (2004)

Chapter: Appendix A: Examples of Physiological and Cognitive Markers of Performance

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Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

A
Examples of Physiological and Cognitive Markers of Performance

Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

TABLE A-1 Examples of Metabolic Markers

Tissue, Organ, Function

Intermediate Marker

Source

Body temperature

Cold strain index

Esophageal telemetry device

Galvanic skin response

Heart rate

Heat flux

Oral temperature

Reaction time

Skin temperature

Physiological strain index

 

Hydration

Aldosterone

Arginine

Blood pressure

Heart rate

Hydration status from bioelectrical impedance

Sodium

Total body water

Vasopressin

Blood

Saliva

Urine

Physical activity/energy expenditure

Accelerometers

Activity logs

Activity monitors (integrated, i.e., body movement, heart rate, and core temperature)

Dietary questionnaires

Doubly labeled water

Foot-ground contact/body weight

Glucose

Heart rate monitors

Insulin

Insulin-like growth factor-1

Lactate

Blood

NOTE: Metabolic monitoring biomarkers can be categorized according to outcome function or intermediate measure that can be quantified to reflect the outcome function. This table summarizes outcome functions of various organs/systems/physiological/ psychological states and some intermediate biomarkers that might be used to predict or quantify these outcome functions and optimal performance. In general, it was felt that no single intermediate biomarker accurately predicts outcome function. Accurate measures of outcome function are often invasive and not applicable to field situations. More emphasis should be placed on developing noninvasive measures that accurately predict peak performance or catastrophic failure of a given organ/system or physiological/psychological state.

Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

Performance, Outcome

Measure

Heat stress

Hypo- and hyperthermia

Core temperature

Cognitive performance

De- and overhydration

Fatigue

Heat exhaustion

Heat tolerance

Muscular endurance

Body-weight change

Eye pressure

Plasma volume, osmolarity

Saliva flow

Skin turgor

Urine color

Urine specific gravity, osmolarity

Urine volume

Cognition

Hypo- and hyperglycemia

Heat cramps

Heat exhaustion

Sunstroke

Body weight

Calorimetry (direct and indirect)

Lean body mass

Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

TABLE A-2 Examples of Brain Function Markers

Tissue, Organ, Function

Intermediate Marker

Source

Cognitive

Blood flow

Electrocardiogram

Functional magnetic resonance imaging

Imaging

Magneto-electroencephalography

Metabolism

Positron emission tomography

Spectroscopy

 

Mood

Odor profiles

 

Sleep

Ambulatory sleep monitor

Electrocardiogram pattern

 

Stress response

Autonomic nervous system

Cortisol

Dehydroepiandrosterone

Growth hormones

Heart rate variability

Impedance

Insulin-like growth factor-1

Neuropeptide Y

Neurotransmitters

Norepinephrine

Other hormones

Prolactin

Stress hormones

Testosterone

Blood

Salivaa

Urineb

NOTE: Metabolic monitoring biomarkers can be categorized according to outcome function or intermediate measure that can be quantified to reflect the outcome function. This table summarizes outcome functions of various organs/systems/ physiological/psychological states and some intermediate biomarkers that might be used to predict or quantify these outcome functions and optimal performance. In general, it was felt that no single intermediate biomarker accurately predicts outcome function. Accurate measures of outcome function are often invasive and not applicable to field situations. More emphasis should be placed on developing noninvasive measures that accurately predict peak performance or catastrophic failure of a given organ/system or physiological/psychological state.

Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

Performance, Outcome

Measure

Focused attention

Memory

Problem solving

Ratings of perceived exertion

Self-assessment scales

Appropriate relative to situation

Fear

Modified STROOP

Profile mood

Self-assessment scales

Visual analog

Reaction time

Sleepiness/alertness

Task performance

Self-assessment scales

Appropriate activation relative to situation

Self-assessment scales

a Salivary cortisol is an accurate measure of single plasma-free cortisol at the time point collected.

b Urinary cortisol measured in 24-hour urine reflects average cortisol secretion over 24 hours.

Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

TABLE A-3 Examples of Bone Markers

Tissue, Organ, Function

Intermediate Marker

Source

Bone

Collagen breakdown products

Carboxy-terminal telepeptide

Deoxypridinoline

Hydroproline

N-telepeptide

Pyridinoline

Plasma

Urine

 

Cytokines

Interleukin-1 and -6

Tumor necrosis factor

Transforming growth factor

 

 

Endocrine markers

Calcitonin

Growth hormone

Insulin-like growth factor-1

Osteocalcin

Parathyroid hormone

Thyroid hormones

 

 

Enzymes

Alkaline phosphatase

Bone-specific alkaline

Phosphatase

 

 

Resorption markers

24-hour urinary calcium

Calcium balance

Phosphatase

Tartrate-resistant acid

 

NOTE: Metabolic monitoring biomarkers can be categorized according to outcome function or intermediate measure that can be quantified to reflect the outcome function. This table summarizes outcome functions of various organs/systems/physiological/ psychological states and some intermediate biomarkers that might be used to predict or quantify these outcome functions and optimal performance. In general, it was felt that no single intermediate biomarker accurately predicts outcome function. Accurate measures of outcome function are often invasive and not applicable to field situations. More emphasis should be placed on developing noninvasive measures that accurately predict peak performance or catastrophic failure of a given organ/system or physiological/psychological state.

Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

Performance, Outcome

Measure

Bone fracture, including stress fracture

Edema

Inflammation/damage

Pain

Weakness

Bone mineral density:

Dual-energy X-ray absorptiometry

Ultrasound

Quantitative computed topography

Histology

Mono accumulation

Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

TABLE A-4 Examples of Cardiac, Muscle, and Pulmonary Markers

Tissue, Organ, Function

Intermediate Marker

Source

Cardiac

Heart rate

Heart rate variability

Impedance

 

Muscle

Amino acids (glutamine, histidine, 3-methyl-histidine)

 

 

Enzymes/molecules

Carbonic anhydrase

Isoenzymes of creatine kinase

Myoglobin

Myosin heavy chains

Phosphocreatine levels

Ubiquitin

Muscle

 

Immune

Circulatory polymorphonuclear leukocytes

Insulin-like growth factor-1

Interleukin-1, -6

Tumor necrosis factor

Blood

Salivaa

Urineb

 

Metabolism/catabolism/anabolism

Lactate

Glycogen

Blood ammonia

Blood

Urine

 

Protein turnover

Blood

Urine

 

Structure/metabolism

3-methyl-/histidine excretion

Glycogen

Trace metals

Muscle

Pulmonary

Expired air

Oxygen and carbon dioxide saturation

NOTE: Metabolic monitoring biomarkers can be categorized according to outcome function or intermediate measure that can be quantified to reflect the outcome function. This table summarizes outcome functions of various organs/systems/ physiological/psychological states and some intermediate biomarkers that might be used to predict or quantify these outcome functions and optimal performance. In general, it was felt that no single intermediate biomarker accurately predicts outcome function. Accurate measures of outcome function are often invasive and not applicable to field situations. More emphasis should be placed on developing noninvasive developing noninvasive measures that accurately predict peak performance or catastrophic failure of a given organ/system or physiological/psychological state.

Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

Performance, Outcome

Measure

Cardiac output

Relative sympathetic and parasympathetic control

Dynamometers

Ergometers

Strain gauges

Ratings of perceived exertion

Decreased endurance

Decreased performance

Decreased strength

Fatigue

Delayed onset muscle soreness

Increased muscle atrophy

Pulse oximeter

Capnograph

 

a Salivary cytokine concentrations vary according to salivary gland source from which saliva is collected and presence and degree of periodontal disease.

b 24-hour urine for Interleukin-6 and soluble receptors for tumor necrosis factor normalized to creatine are currently used and are sensitive measures of cytokine production.

Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×

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Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
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Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
Page 210
Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
Page 211
Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
Page 212
Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
Page 213
Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
Page 214
Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
Page 215
Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
Page 216
Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
Page 217
Suggested Citation:"Appendix A: Examples of Physiological and Cognitive Markers of Performance." Institute of Medicine. 2004. Monitoring Metabolic Status: Predicting Decrements in Physiological and Cognitive Performance. Washington, DC: The National Academies Press. doi: 10.17226/10981.
×
Page 218
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The U.S. military’s concerns about the individual combat service member’s ability to avoid performance degradation, in conjunction with the need to maintain both mental and physical capabilities in highly stressful situations, have led to and interest in developing methods by which commanders can monitor the status of the combat service members in the field. This report examines appropriate biological markers, monitoring technologies currently available and in need of development, and appropriate algorithms to interpret the data obtained in order to provide information for command decisions relative to the physiological “readiness” of each combat service member. More specifically, this report also provides responses to questions posed by the military relative to monitoring the metabolic regulation during prolonged, exhaustive efforts, where nutrition/hydration and repair mechanisms may be mismatched to intakes and rest, or where specific metabolic derangements are present.

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