Indirect calorimetry is often done early in the morning in a fasting state. Reading either a magazine or an electronic device significantly increased REE. Listening to self-selected relaxing music increased REE by 27. Kcal / day.
Indirect calorimetry is often done early in the morning in a fasting state. Reading either a magazine or an electronic device significantly increased REE. Listening to self-selected relaxing music increased REE by 27. Kcal / day.
Indirect calorimetry is often done early in the morning in a fasting state. Reading either a magazine or an electronic device significantly increased REE. Listening to self-selected relaxing music increased REE by 27. Kcal / day.
Reading and Listening to Music Increase Resting Energy Expenditure during an Indirect Calorimetry Test Blaire Snell, MS, RDN; Susan Fullmer, PhD, RDN; Dennis L. Eggett, PhD ARTICLE INFORMATION Article history: Accepted 12 March 2014 Keywords: Resting energy expenditure (REE) Resting activities Music Reading Indirect calorimetry Copyright 2014 by the Academy of Nutrition and Dietetics. 2212-2672/$36.00 http://dx.doi.org/10.1016/j.jand.2014.03.013 ABSTRACT Indirect calorimetry is often done early in the morning in a fasting state, with the subject unshowered and abstained from caffeine or other stimulants. Subjects often fall asleep, resulting in measurement of a sleeping metabolic rate rather than a resting metabolic rate. The objective of this study was to determine whether listening to self- selected relaxing music or reading an electronic device or magazine affects resting energy expenditure (REE) during measurement in healthy adults. A randomized trial comparing three different conditions (ie, resting, reading, and listening to music) was performed. Sixty-ve subjects (36 female and 29 male) were used in nal data analysis. Inclusion criteria included healthy subjects between the ages of 18 and 50 years with a stable weight. Exclusion criteria included pregnant or lactating women or use of medications known to affect metabolism. Results showed that reading either a magazine or an electronic device signicantly increased REE by 102.7 kcal/day when compared with resting (P<0.0001); however, there was no difference in REE between the electronic device and magazine. Listening to self-selected relaxing music increased REE by 27.6 kcal/day compared with rest (P0.0072). Based on our results, we recommend subjects refrain from reading a magazine or electronic device during an indirect calorimetry test. Whether or not the smaller difference found while listening to music is practically signicant would be a decision for the indirect calorimetry test administrator. J Acad Nutr Diet. 2014;-:---. I NDIRECT CALORIMETRY (IC) IS THE MOST COMMON technique for measuring resting energy expenditure (REE) in both clinical and research settings. 1 IC analyzes pulmonary gases, namely oxygen consumption and car- bon dioxide expiration, to obtain a more accurate REE than can be predicted through equations. 1-4 The current protocol to conduct an IC test includes performing the test early in the morning after an overnight fast, being in a thermoneutral room with low lighting and minimal sounds or distractions, and the subject remaining awake but still. 1-4 Given these cir- cumstances, subjects often fall asleep. Sleeping metabolic rate has been shown to be at least 5% lower than REE; there- fore, one of the challenges in conducting an IC study is to keep the subject still, but awake. 5 Several studies have shown that REE can be affected by activities such as playing active video games, music, our physical environment, and laughter 5-20 ; however, the ma- jority of these studies were designed to explore how different activities might increase REE in otherwise sedentary activ- ities, they were not designed to standardize a measurement protocol. The purpose of this study was to determine whether sim- ple activities such as reading a magazine or electronic device or listening to relaxing music are acceptable activities that would help subjects stay awake and pass the time but would not signicantly increase REE during an IC test. Although some studies have evaluated the effects of music on stress or REE, few have been done to standardize a measurement protocol and, to the best of our knowledge, there have been no studies done testing the effect of reading on REE. METHODS Study Design A randomized trial was conducted with IC under three different conditions (ie, resting, reading, and listening to music). All three conditions were measured during one continuous IC test; subjects were randomly exposed to each condition. Music and reading material were self-selected. Description of Study Subjects A convenience sample of 68 male and female subjects was recruited from the faculty, staff, and the student body at Brigham Young University and the surrounding community. Recruitment efforts involved yers sent to all faculty and staff at Brigham Young University and displayed throughout campus, announcements made in specic classes, and by word of mouth. Inclusion criteria included healthy subjects between the ages of 18 and 50 years with a stable weight, dened as no weight loss or gain exceeding 2.3 kg (5 lb) in the past 6 months. Exclusion criteria included pregnant or lactating women and subjects taking medications known to 2014 by the Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 1 affect metabolism. The Brigham Young University Institu- tional Review Board approved the study protocol and all participants provided written informed consent. Procedures After recruitment, subjects were screened through e-mail to determine inclusion/exclusion criteria. If inclusion criteria were met, a short initial visit was scheduled at the subjects convenience. During this visit, height and weight were ob- tained, study procedures were explained, informed consent was read and signed, and music and reading preferences were determined. IC was performed within 1 week of the initial visit. Researchers performed the randomization to rest, music, or reading at this initial visit. Randomization was achieved with three different colored marbles chosen from a concealed container. Music was chosen from a variety of Pandora stations played on a provided iPad 2 (Apple Inc). Subjects were given the choice to read on the provided iPad 2 or they could choose from a wide variety of print magazines; books were not allowed. Subjects also had the option of bringing in their own music, magazine, and/or electronic tablet. If subjects brought in their own device, they were instructed to have them fully charged. With the exception of turning pages, subjects were instructed to remain as still as possible during the reading portion of the test. These options were chosen because they reect realistic options that might be used in a practice or research setting. Anthropometrics Height was measured using a professional-grade stadiometer (model PE-WM-60-76-BRG2, Perspective Enterprises). Sub- jects were measured while standing, without shoes, and with weight evenly distributed. Height was measured to the nearest 0.5 inch. Weight was assessed with a Tanita 310 electronic scale. Subjects were weighed only once, before IC measurement, with light clothing and without shoes. Weight was recorded to the nearest 0.5 lb. IC Measurements The information obtained during the initial visit was used to have the music and reading preferences ready for each subject before having measurements taken. IC measurements were conducted as follows: tests were begun between 5:00 AM and 8:30 AM after an overnight fast, no shower the morning of the test, and subjects were asked to abstain from caffeine and exercise for at least 12 hours before the test. On the morning of the test, subjects parked close to the building. Upon arrival, subjects rested for 30 minutes in a supine po- sition. A light blanket was provided. All measurements were taken in a quiet, thermoneutral room with dimmed lights to avoid any environmental inuences on REE. AVMAX 29N indirect calorimeter (SensorMedics) was used to take all measurements. Calibrations on the mass ow sensor and gas analyzers were performed before each study. Gas analyzers were calibrated using the following known gases: 20% O 2 / 0.75% CO 2 and 26% O 2 /0% CO 2 . A clear canopy was placed over the subjects head to collect gas samples. Each condition was randomly assigned before the test and was measured for 25 minutes, for a total of 75 minutes; data collected in the rst 5 minutes of each segment were discarded. 21 Sol Tracks V8 headphones (Sol Republic) were provided for all subjects. Headphones were worn for the duration of all conditions to avoid unnecessary movement and to minimize noise. To control for volume, subjects were given a decibel scale with acceptable ranges highlighted. The maximum decibel was dened as normal conversation. Transitions from one condition to the next were done through written signs, communicating with the subject to start or pause music and/ or to stop or start reading. Data Analysis A power analysis based on a practical change in REE of 75 kcal determined a sample size of 50 subjects (a.2; b.05). The differences between treatments were determined with mixed-model repeated measures of analysis of variance using Statistical Analysis Software (version 9.3, 2012, SAS Institute, Inc). Results are reported as least squares meanstandard error. Demographic information was analyzed using Micro- soft Excel 2010. Results are reported means, standard de- viations, and ranges. RESULTS AND DISCUSSION A total of 65 subjects (36 female and 29 male) were included in the nal data analysis. Sixty-eight subjects were recruited matching the inclusion criteria and completed the initial visit; however, three subjects did not come in to have mea- surements taken due to scheduling conicts. Subject char- acteristics are described in Table 1. Reading either a magazine or an electronic device resulted in a signicant increase of 102.7 kcal/day or a 6.5% increase (Table 2) when compared with resting (P<0.0001). There was no difference in REE between reading a magazine or an electronic device (data not shown). Listening to self-selected relaxing music increased REE by 27.6 kcal/day or 1.8% compared with rest (P0.0072). The order in which subjects received the three tests (ie, rest, music, and reading) was considered in the rst statistical model (included order), but was not found to be signicantly related to the results, so it was excluded from the nal analyses. The primary ndings of this study suggest that both listening to self-selected relaxing music and reading either a magazine or an electronic device signicantly increase REE during an IC test. The magnitude of increase in REE (>100 Table 1. Characteristics of participants in a study comparing resting energy expenditure while at rest, listening to music, or reading a magazine or electronic tablet (n65) Characteristics Female, n (%) 36 (55.4) Age (y), meanSD a (range) 279 (18-50) Body weight (kg), meanSD (range) 7115 (46-120) Height (cm), meanSD (range) 1729 (150-193) Body mass index, meanSD (range) 244 (18-37) a SDstandard deviation. RESEARCH 2 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS -- 2014 Volume - Number - kcal) while reading a magazine or an iPad was surprising. Cooper and colleagues 11 tested several different activities on REE in adolescent girls. One activity was listening to a story being read out loud. They found no difference in REE when adolescent girls listened to a story (1,320 kcal/day) compared with rest (1,346 kcal/day) (P0.066). 11 The signicant in- crease we found while reading (102.7 kcal/day) in our study could be a result of physically holding an object, whether it be a magazine or electronic device, as opposed to just listening to a story being read. A likely explanation for an increased REE while reading is the energy required to hold the magazine or iPad. However, we are not aware of any other studies that have evaluated the effect of holding a magazine on REE. Studies have looked at the effects of music on stress and have shown that different genres of music can affect the stress response. For example, classical music generally has a relaxing effect on stress, while genres such as hip hop, techno music, and heavy metal are commonly associated with physiologic arousal. 20 Research has also suggested that per- sonal music preferences increase the ability of the music to diminish an individuals stress levels. 20 Labbe and colleagues 13 found that healthy volunteers who listened to self-selected or classical music after exposure to a stressor showed signicant decreases in self-rated anxiety, and those exposed to heavy metal or silence did not. 13 However, markers of physiological stress were not measured in the current study. Lubetzky and colleagues 15 used classical music (Mozart) in healthy preterm infants to see whether it would lower REE, allowing more rapid weight gain, and shorten hospital stay. REE decreased 13% when the infants were exposed to Mozart for 30 minutes compared with no music exposure. Based on the results of these studies and the known physiological ef- fects of relaxing music, it might have been expected to see a decrease in REE while subjects listened to self-selected relaxing music. However, we did see a modest but signi- cant increase in REE while listening to self-selected relaxing music. One explanation might be that the denition of relaxing can vary greatly from person to person. This vari- ability could have played a role in the increase we saw in REE during the music portion of the IC test. Subjects were allowed to choose their own relaxing music; however, researchers did preview all music selections to be sure they were appro- priate. On the other hand, the auditory stimulus of music might have raised REE. One study performed by Carlsson and colleagues 8 exam- ined the effects of calming music vs stressful music on REE. This study was designed to determine whether listening to stressful music could increase REE as a possible treat- ment for obesity. Results showed no signicant difference (P0.57) in REE when subjects listened to calm music (1,364 kcal/day) vs silence (1,366 kcal/day). There was also no signicant difference (P0.43) between silence (1,366 kcal/ day) and stressful music (1,371 kcal/day). 8 Although this study was similar to ours in protocol, subjects were only exposed to the music selections for 10 minutes each, as opposed to 25 minutes in our study. This short exposure might not have been long enough to see the full effects of the music on REE. Limitations A potential limitation of the current study is a lack of stan- dardization in the music and reading material provided for the tests. Subjects could choose any type of music they deemed relaxing, although the researchers did approve all music before it was used in the study. Any reading material was also acceptable, as long as it was a magazine or on an electronic device. However, this self-selection could also be considered a strength, as self-selection would be more applicable to practice settings. Additional research comparing the effects of the standardized quiet music would be appro- priate (ie, everyone listens to the same music). It is also possible that a smaller handheld device (ie, a smart phone) would be found to be acceptable during an IC study; however, it is highly likely that the activity being performed (answering texts or surng the web) might affect mood and, therefore, REE. CONCLUSIONS We found that reading and listening to relaxing music under a controlled environment have a signicant increase on REE during an IC test. Based on our results, we recommend sub- jects refrain from reading a magazine or electronic device during a test. Whether or not the smaller difference found Table 2. Least squares means of resting energy expediture, respiratory quotient, oxygen consumption, and carbon dioxide production for subjects during measurement of resting energy expediture during rest, while listening to self-selected relaxing music, and reading a magazine or electronic tablet Resting (n[65) Music (n[65) Reading (n[65) least squares meansstandard error! REE a (kcal/day) 1,577.240.03 x 1,606.340.03 y 1,680.440.03 z RQ b (VCO 2 c /VO 2 d ) 0.800.005 0.820.005 0.820.005 VO 2 (L/min) 0.2770.006 x 0.2310.006 xy 0.2400.006 z VCO 2 (L/min) 0.1820.005 x 0.1900.005 xy 0.2000.005 z a REEresting energy expediture. b RQrespiratory quotient. c VCO 2 carbon dioxide production. d VO 2 oxygen consumption. xyz Means not sharing the same superscript are signicantly different (P<0.001). RESEARCH -- 2014 Volume - Number - JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 3 while listening to music is practically signicant would be a decision for IC the test administrator. References 1. 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Individual thermogenic responses to mild cold and overfeeding are closely related. J Clin Endocrinol Metabol. 2007;92(11):4299-4305. 20. Yamasaki A, Booker A, Kapur V, et al. The impact of music on metabolism. Nutrition. 2012;28(11e12):1075-1080. 21. Frankeneld DC, Coleman A. Recovery to resting metabolic state after walking. J Am Diet Assoc. 2009;109(11):1914-1916. AUTHOR INFORMATION B. Snell is a dietitian, Anytime Fitness, Salem, UT, and a dietary consultant, Grover C. Dils Medical Center, Caliente, NV; at the time of the study, she was a graduate student, Nutrition Sciences, Brigham Young University, Provo, UT. S. Fullmer is a teaching professor, Department of Nutrition, Dietetics and Food Science, and D. L. Eggett is an associate professor, Department of Statistics, Brigham Young University, Provo, UT. Address correspondence to: Susan Fullmer, PhD, RDN, Department of Nutrition, Dietetics and Food Science, Brigham Young University, S227 ESC, Provo, UT 84602. E-mail: susan_fullmer@byu.edu STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conict of interest was reported by the authors. FUNDING/SUPPORT There is no funding to disclose. RESEARCH 4 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS -- 2014 Volume - Number -
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