Dr. Ronald Sigal is a Professor of Medicine, Cardiac Sciences, Kinesiology and Community Health Sciences Division of Endocrinology and Metabolism, University of Calgary. Dr. Sigal's current research focuses on clinical trials and cohort studies related to physical activity, obesity, diabetes and cardiovascular disease. He is the principal investigator of four randomized trials evaluating exercise interventions in people with or at risk of diabetes, funded by the Canadian Institutes of Health Research and/or the Canadian Diabetes Association. He was the principal author of the 2006 American Diabetes Association Statement on Physical Activity/Exercise and Diabetes, and headed the writing committee for physical activity guidelines for the Canadian Diabetes association 2003 and 2008 guidelines. Dr. Sigal is a Health Senior Scholar of the Alberta Heritage Foundation for Medical Research.
Most significant contributions pertinent to Dr. Kenny's research (Numbers of citations are on ISI Web of Science as of February 17, 2018):
COLLABORATIVE RESEARCH WITH DR. GLEN KENNY ON EXERCISE AND TEMPERATURE REGULATION IN OLDER PEOPLE AND PEOPLE WITH DIABETES Dr. Kenny and I have jointly authored >80 peer-reviewed publications, including those below. Our work was featured in our invited review “Body temperature regulation in diabetes” (Temperature, Jan 2016)
DIABETES AEROBIC AND RESISTANCE EXERCISE (DARE) TRIAL Sigal RJ, Kenny GP, et al. Effects of aerobic exercise, resistance exercise,or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007;147:357-369 This paper describes the main results of the CIHR-funded DARE trial, of which I was PI. It was the first trial to show aerobic and resistance training each improved glucose control (HbA1c) in type 2 diabetes (T2D), and combined aerobic+resistance exercise was superior to either type of exercise alone. Cited 507 times on ISI Web of Science as of February 17, 2018 (top 1% of 2007 publications). We published 13 other DARE trial papers.
EXERCISE AND TYPE 1 DIABETES (T1D): CHRONIC AND ACUTE EFFECTS OF AEROBIC AND RESISTANCE EXERCISE. We recently concluded the Type 1 Diabetes Aerobic and Resistance Exercise ( T1-DARE) trial in previously-sedentary T1D, and the CIHR-funded Resistance Exercise in Already-active Diabetic Individuals (READI) trial in habitually aerobically active T1D patients. In contrast to T2D, we found neither aerobic nor resistance exercise reduced HbA1c. In separate studies in T1D patients (YardleyJE et al, Diabetes Care 2012 and 2013), we found a 45-min session of resistance exercise caused much less acute drop in blood glucose and hypoglycemia than an aerobic session of the same length. When resistance exercise was performed before aerobic in the same session, there was far less hypoglycemia than if the order was reversed. These studies have key practical implications for active people with T1D.
EXERCISE AND DIABETES: SYSTEMATIC REVIEWS & POSITION STATEMENTS Boulé, NG, Haddad E, Kenny G, Wells GA, Sigal RJ. Effects of Exercise on HbA1c and Body Mass in Type 2 Diabetes Mellitus: A Systematic Review. JAMA 2001 Sep;286(10):1218-27. Cited 817 times. Boulé NG, Kenny G, Haddad E, Wells G, Sigal RJ. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia Aug2003 46:1071-1081. Cited 241 times. Sigal RJ, Kenny GP et al. ADA Statement: Physical Activity/Exercise and Type 2 Diabetes. Diabetes Care 2006 29:1433-38. Cited 454 times. Exercise trials in T2D published before these papers were small and inconclusive. Our meta-analyses showed exercise improved HbA1c, T2D patients in exercise trials improved aerobic capacity, strength and endurance similarly to non-T2D subjects, and greater intensity of aerobic exercise was associated with greater improvement in HbA1c. In part due to our findings, Clinical Practice Guidelines (CPGs) for exercise in diabetes were changed and levels of evidence upgraded. I was lead author of the 2004 Technical Review and 2006 Position Statement for the American Diabetes Association (ADA), and chapters on Physical Activity/Exercise in the 2003, 2008, 2013 Canadian Diabetes Association (CDA) CPGs. I chaired or co-chaired writing committees for the 2018 Diabetes Canada and 2016 ADA CPGs on exercise.
Dr. Andreas Flouris is an Assistant Professor in Human Physiology at the University of Thessaly Department of Exercise Science in Greece and an Adjunct Professor in Environmental Medicine with the School of Human Kinetics at the University of Ottawa, Canada. He is the Director of FAME Lab, a research facility investigating the (F)unctional (A)rchitecture of (M)ammals in their (E)nvironment, a Researcher in Environmental Physiology at the Centre for Research and Technology Hellas, as well as the Manager of Living Lab Thessaly, one of the founding members of the European Network of Living Labs. He is a Section Editor for the scientific journal Temperature, and an Associate Editor for the scientific journals BMC Pulmonary Medicine and BMC Research Notes. Dr. Flouris has published widely on the effects of different environmental factors on human health and performance and he has repeatedly obtained funding from National and European organisations to support his research. His work has been recognized through distinguished invitations from international organizations (United Nations, World Health Organization, European Commission, NASA, and others) and has been highlighted a number of times by the media. Since 2009 he is acting as a Consultant for different international organizations including the European Commission, NASA, and the European Space Agency.
Dr. Pierre Boulay is currently a full-time professor in the Faculté de l’acitivité physique et sportive at the Université de Sherbrooke.
Dr. Boulay and Dr. Kenny have maintained a long-standing research collaboration (2009-present), which has involved examining the heat stress response in workers and vulnerable population groups (CIHR funded project). Their collaborative efforts have resulted in the publication of 30 articles in highly ranked peer-reviewed journals. These key papers have advanced our understanding of the effect of aging and Type 2 diabetes on the body’s capacity to dissipate heat. They have showed that age-related reductions in whole-body heat loss occurs in adults as young as 40 years (PLoS One 2013,8(12): e83148), which is worsened in sedentary individuals (J Appl Physiol 2015,118(3):299-30), especially those with type 2 diabetes (Med Sci Sports Exerc 2013,45(10):1906-14). Dr. Boulay’s clinical experience over the last 20 years (which includes 20 000+ maximal exercise tests with ECG) in the field of cardiovascular disease (CVD), diabetes, hypertension and obesity has assisted Dr. Kenny with patient screening and assessments for participation in a wide range of research projects. In the future, Dr. Boulay will continue to play an important role in the research at the Human and Environmental Physiology Research Unit by providing regular on-site screening of potential participants and consulting with Dr. Kenny on the suitability of participants for various studies.
After a 10-year absence in academics, Dr. Boulay recently returned as a full-time professor (June 2013) at the University of Sherbrooke where he was recruited for his clinical expertise in exercise physiology. His work at the University of Sherbrooke involves implementing both a kinesiology clinic and a clinical research program related to the use of physical activity in the management of various health conditions in vulnerable populations. During his short tenure (~4 years) as a full-time professor at the University of Sherbrooke, Dr. Boulay has been actively involved in the supervision of 19 MSc trainees as well as 2 PhD trainees. His unique expertise in prescribing exercise to vulnerable populations in view of improving health has attracted many new students to the University of Sherbrooke.
One of Dr. Boulay’s most important research contributions stems from his work as a professor at the University of Moncton (1999-2004) wherein he was conducting work aimed at developing ‘best practices’ related to interventions in cardiac rehabilitation after a myocardial infarction which included an assessment of the related health care costs (Prev Med, 2004,38:586-93). His work lead to the establishment of important clinical predictors for hospital re-admission, healthcare consumption and CVD complications in cardiac patient following a cardiovascular event (Cor Health Care, 2001,5(3):133-40). Furthermore, Dr. Boulay’s work directed at evaluating the impact of beta-blockers on the accuracy of exercise prescription (target heart rate) and the resulting changes on resting metabolic rate and weight loss following an exercise training program (J Card Rehab 2005,25:354-60; Appl Phys Nutr Metab,2007,32(4):664-69; Ob Res,2008,16(9):2088-95) was supported by 2 research grants from the Medical Research Fund of New-Brunswick (2001-02; 2002-03).
Dr. Andrew Seely is Associate Professor of Surgery within the Divisions of Thoracic Surgery and Critical Care Medicine at the University of Ottawa, Associate Scientist with the Ottawa Hospital Research Institute, Chair of Research for the Canadian Association of Thoracic Surgeons, Director of Research for the Ottawa Division of Thoracic Surgery, as well as Founder and Chief Science Officer of Therapeutic Monitoring Systems Inc. Education includes an undergraduate honors physics at Carleton University, followed by medical school, general surgery training, and a doctoral degree in basic science from McGill University, and thoracic surgery and critical care medicine training at the University of Ottawa. Scholarly interests include: theoretical research exploring the clinical insights of complex systems science (e.g. emergence, uncertainty and dissipation); physiologic understanding of complex biologic variability; applied research monitoring multiorgan variability during exercise, onset and resolution of infection, critical illness and weaning; and development and implementation of a systematic means to continuously monitor all adverse events after all surgery, and feedback that information to improve surgical care. Dr Seely has supervised several graduate students and built research teams, has published 60 peer-reviewed papers, presents annually at international meetings, was awarded a New Investigator Award by the Canadian Institutes of Health Research in 2005, and has been awarded over $5M in competitive grant funding.
The first domain of contribution relevant to Dr. Kenny's research is within the domain of theoretical research exploring clinical applications of complex systems science, which includes four key papers. To begin, I wrote “Multiple Organ Dysfunction Syndrome - exploring the paradigm of complex non-linear systems” (Critical Care Medicine 2000, cited 211 times as of 01/’14), which offered a novel review of the host response as a complex system. A subsequent paper entitled “Complex Systems and the Technology of Variability Analysis” (Critical Care 2004, cited by 215 as of 01/’14, and labeled “highly accessed”) presented a review and analysis of techniques to characterize variability. “Fractal variability: an emergent property of complex dissipative systems” was published in Chaos 2012, which introduces a novel explanation for the ubiquitous appearance of fractal structures in time and space. Last, “Embracing the certainty of uncertainty: Implications for health care and research”, published in Perspectives in Biology and Medicine, on how embracing and measuring uncertainty will improve care, management, communication and research practice. Second, applying these theoretical concepts at the bedside, I have pioneered clinical research, software development and commercialization of applied research in complexity, focusing on multiorgan variability monitoring. Research has demonstrated that altered patterns of heart rate variability (HRV) and respiratory rate variability (RRV) are associated with age and illness and that exercise training is capable of improving HRV. My research studies include the application of continuous variability monitoring in: 1) the early detection of infection (PLoSOne, 2009; PLoS One, 2012); 2) tracking severity of organ failure (J Crit Care); 3) prediction of extubation failure (Crit Care, 2014); and 4) as a measure of cardiopulmonary fitness and for tracking exercise-induced hyperthermia (Appl Physiol Nutr Metab, 2013; Eur J App Phys 2012, 2014). In 2007 I founded Therapeutic Monitoring Systems (TMS) Inc. with the aim of delivering variability-directed clinical decision support to improve patient care. Third, in conjunction with this theoretical and applied research, I have been an international leader, organizing and chairing international conferences related to the application of complex systems science and variability including: the Wakefield Roundtable Discussion on Complexity & Variability at the Bedside, Sep 2009; the Montebello Roundtable Discussion on Complexity & Variability at the Bedside, Sep 2010; and the International Conference on Complexity in Acute Illness in Ottawa Sept 2012, with 121 attendees, and 4 days of workshops and presentations. Fourth, along with my thoracic surgery colleagues in Ottawa, I have pioneered a system to continuously monitor both the incidence and severity of thoracic surgical complications. I presented our system, named the Ottawa Thoracic Morbidity & Mortality (TM&M) classification, at the Society of Thoracic Surgeons in January 2010; and several papers are published (including two in Annals of Thoracic Surgery, and one in Journal of Surgical Education). Last, as the Vice President of the Canadian Association of Thoracic Surgeons, I am working with colleagues across the country to standardize clinical data collection and build a national quality improvement database.
Dr. Naoto Fujii is currently an assistant professor at the University of Tsukuba in Japan. His research interest are determining the peripheral mechanisms governing heat loss responses as well as investigating the cardiovascular & respiratory control during exercise.
Dr. Janine Malcolm is an adult endocrinologist and clinical investigator with the Department of Medicine, University of Ottawa and the Ottawa Health Research Institute. She is the Program Director for the University of Ottawa Fellowship program in Endocrinology and Metabolism. She has extensive experience in the management of patients with type 1 and type 2 and an interest in health services delivery, diabetes in pregnancy, and exercise in diabetes. She has a Principal investigator for the GLUCOSE study, a trial investigating the effect of in-hospital glucose control in patients admitted with cardiovascular disease, for the Ottawa Model for Undiagnosed Diabetes Study (OMUD), a trial to screen for undiagnosed diabetes among hospitalized patients and link these patients to appropriate community care post discharge, and a study describing the prevalence of impaired glucose metabolism and obesity in offspring of gestational diabetes mothers. She has been an investigator in many other diabetes studies including HEARTY (Healthy Eating Aerobic and Resistance Training in Youth), READI (Resistance Exercise in Already-active Diabetic Individuals, TIDARE (Type 1 Diabetes Aerobic and Resistance Exercise trial), ACCORD (Action to Control Cardiovascular Disease in Diabetes) Trial, and the Tools for Transition program at the Ottawa Hospital, a multidisciplinary initiative studying the transition of patients with diabetes from speciality care back to the care of their primary care providers.
COLLABORATIVE RESEARCH WITH DR. KENNY ON EXERCISE AND THERMOREGULATION IN OLDER PEOPLE AND PEOPLE WITH DIABETES I am co-author of 4 published papers with Dr. Glen Kenny examining the heat stress response in older adults and individuals with type 2 diabetes These include: 1) Stapleton et al. At what level of heat load are age-related impairments in the ability to dissipate heat evident in females? PLoS One. 2015 Mar 19;10(3):e0119079., 2) Stapleton JM et al, Aging impairs heat loss, but when does it matter? J Appl Physiol. 2015 1;118(3):299-309. 3) Carrillo AE et al, Heart rate variability during high heat stress: a comparison between young and older adults with and without type 2 diabetes. Am J Physiol Regul Integr Comp Physiol. 2016 Oct 1;311(4):R669-R675 and 4) Kenny GP et al. Hyperthermia and cardiovascular strain during an extreme heat exposure in young versus older adults. Temperature (Austin). 2016 Aug 31;4(1):79-88. In addition, Dr. Kenny and I (as well as Dr. R. Sigal, Project PI) have established a collaborative program involving clinical trials examining the benefits of exercise in the management of diabetes and adolescent obesity which to date has resulted in the publication of 6 papers in high ranked journals (e.g., JAMA Pediatr, Diabetes Care, Int J Obesity).
RESISTANCE EXERCISE IN ALREADY ACTIVE DIABETIC INDIVIDUAL (READI TRIAL), TYPE 1 DIABETES AEROBIC AND RESISTANCE EXERCISE TRIAL (T1-DARE). We completed the Type 1 Diabetes Aerobic and Resistance Exercise Trial in previously sedentary type 1 diabetes patients and the CIHR-funded Resistance Exercise in Already Active Diabetic Individuals (READI) trial in habitually exercising individuals with type 1 diabetes. In contrast to findings with patients with type 2 diabetes, neither aerobic or resistance exercise reduced HbA1c. As Co-investigator and Site Principal Investigator for Ottawa for these studies, I have been intimately involved with the running of these studies and have subsequently developed experience and expertise in conducting exercise studies for patients with diabetes. In separate studies of type 1 diabetes patients (T1DARE), we found that aerobic exercise performed after resistance exercise caused less hypoglycemia than exercise performed in the reverse order which has important practical implications for active people with T1D (Yardley JE et al, Diabetes Care 2012,Yardley et al, Diabetes Care 2013).
HEALTHY EATING AEROBIC AND RESISTANCE TRAINING IN YOUTH (HEARTY) HEARTY is a randomized controlled trial in which we found that resistance, aerobic, and combined resistance and aerobic exercise significantly reduced body fat and waist circumference in obese youth (Sigal et al, Effects of aerobic training, resistance training or both on percentage body fat and cardiometabolic markers in obese adolescents: the healthy eating and aerobic and resistance training in youth randomized clinical trial. JAMA Pediatric. 2014; 168(11):1006-13, Goldfield et al. Video game playing is independently associated with blood pressure and lipids in overweight and obese adolescents. PLoS ONE 2011; 6(11):e26643, Alberga et al. Does exercise training affect resting metabolic rate in adolescents with obesity? Appl Physiol Nutr Metab 2017; 42(1):15-22). As site principal investigator for Ottawa for this trial, I have gained extensive expertise in conducting exercise studies in obese individuals.
Dr. Lucie Brosseau is a rehabilitation epidemiologist. She holds a Bachelor of Physiotherapy, a Master of Clinical Science, a Master of Kinanthropology (neurokinetics) and a Doctorate in Public Health (Epidemiology). She is currently a full professor at the School of Rehabilitation Sciences at the University of Ottawa. She holds a University Research Chair in Evidence based Practice in Rehabilitation. She is also a member of the musculoskeletal group at Collaboration Cochrane. She co-developed the Ottawa Panel guidelines methodology.
Her main research interests are evidence-based practice and knowledge translation. In this area, Dr. Brosseau has conducted many meta-analyses on the effectiveness of rehabilitation care. She has also participated in developing and implementing clinical guidelines in the musculoskeletal and neurological fields.
Her current research work covers the dissemination and implementation of these various guidelines amongst patients and rehabilitation specialists in their daily practice. She is also interested in conducting clinical trials on the effectiveness of rehabilitation interventions.
Dr. Kenny and I have collaborated on various research projects resulting in a total of 19 co-authored publications. My expertise in evidence-based practice (EBP) and knowledge translation (KT) will ensure that key project outcomes are achieved.
COLLABORATIVE RESEARCH WITH DR. KENNY ON EXERCISE PHYSIOLOGY IN OLDER INDIVIDUALS WITH MILD TO MODERATE KNEE OSTEOARTHRITIS Larose J, King J, Brosseau L, Wells GA, Reid R, Maetzel A, Tugwell P, Huijbregts M, McCullough C, Loew L, Kenny GP. The effects of aerobic walking on measures of cardiorespiratory fitness in older adults with osteoarthritis of the knee (OA). Applied Physiology, Nutrition, and Metabolism 38: 886-891, 2013.
DEVELOPMENT OF CLINICAL RECOMMENDATIONS USING A RIGOROUS QUANTITATIVE METHODOLY: THE OTTAWA PANEL CLINICAL PRACTICE GUIDELINES (CPGS) ON VARIOUS CHRONIC CONDITIONS/ Research Chair in EBP & KT Ottawa Panel CPGs have produced 20 scientific publications for recommendations on effective rehabilitation interventions, such as exercise for chronic disease management (i. e. rheumatoid arthritis (RA), osteoarthritis (OA), juvenile idiopathic arthritis (JIA)). Further, all of our CPGs are published in high impact journals in our field. Dr. Kenny and I have jointly co-authored on more than 9 Ottawa Panel publications including an editorial. These publications helped develop: 1) other rehabilitation CPGs 2) an effective self-management educational program called People Getting a Grip on Arthritis (PGrip) for individuals with OA, RA and JIA, 3) RCTs on promising health interventions, and 4) KT RCTs to implement the evidence from the published Ottawa Panel CPGs. Ottawa Panel CPGs also contributes to policy development in health for CIHR Summit Task Force and other conferences. Currently, we have ongoing KT RCTs to implement the PGrip program in both patients and health professionals. Online PGrip will lead to national and international projects involving multi-stakeholders and multi-research users (e.g. The Arthritis Society, CIHR Summit Task Force, health professionals, future health professionals, researchers, and patients).
IMPLEMENTING OTTAWA PANEL CPGs ON VARIOUS CHRONIC CONDITIONS (2006-PRESENT) Dr. Kenny and I have jointly co-authored 3 publications on a KT RCT implementing general evidence-based clinical recommendations for an effective walking program in older individuals with mild-to-moderate knee OA. In addition, Dr. Kenny and I (the principal applicant) have successful obtained a CIHR research grant ($708,000) for this KT RCT and produced 2 articles. All of our KT RCTs for walking serve to identify innovative KT strategies that individuals with OA can integrate in their daily lives based on evidence proving effectiveness and long term health benefits.
TEACHING A UNIVERSITY OF OTTAWA KT COURSE TITLED: KNOWLEDGE TRANSFER AND EXCHANGE (REA-7103) I have developed a KT course for the U of O PhD program in Rehabilitation Sciences based on the Knowledge-to-Action Framework. My expertise on this subject will guide the first stage of knowledge dissemination for this proposed project. My knowledge in this field is recognized by the my University Research Chair (2004 to present) and various invites I have received from national and international conferences to present my work on implementing evidence-based recommendations to patients, health professionals, health organizations and policy-makers.
Dr. Joo-Young Lee is an associate professor of Seoul National University in Korea (2012 - present) and a director of COMFORT Laboratory.
Her research topics are thermoregulation in extreme environments and clothing. In particular, she has been doing research to improve the safety and health of workers who wear personal protective clothing as a P.I.
Dr. Lee has published a total of 96 peer reviewed papers in domestic and international journals, along with 216 conference presentations and 11 patents.
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