Exercise Load Research Articles

An EDucation and eXercise intervention for gluteal tendinopathy in an Irish setting: a protocol for a feasibility randomised clinical trial (LEAP-Ireland RCT)

Background Gluteal tendinopathy (GT) is a degenerative tendon condition characterised by pain over the greater trochanter of the hip. A randomised controlled trial (RCT) in Australia found that 14 sessions of EDucation on load management plus eXercise (EDX) delivered over 8 weeks resulted in greater improvements in global rating of change and pain outcomes at 8 and 52 weeks, compared with corticosteroid injection or ‘wait and see’. Typically, 5-6 physiotherapy sessions are provided in public and private physiotherapy settings in Ireland, therefore, the aim of this study is to examine the feasibility of conducting an RCT to investigate effectiveness of 6 sessions of the EDX programme compared to usual care. Methods We will randomly allocate 64 participants with GT to physiotherapist-administered EDX or usual care. The EDX intervention (EDX-Ireland) will be delivered in 6 sessions over 8 weeks. To determine feasibility of an RCT, we will assess recruitment and retention and outcome measure completion. The health status outcomes to be assessed at baseline, 8 weeks and 3 months include: Global Rating of Change, pain severity, the Victorian Institute of Sport Assessment-Gluteal Questionnaire (VISA-G), the Patient-Specific Functional Scale, the Pain Catastrophizing Scale, Patient Health Questionnaire (PHQ), Pain Self-Efficacy Questionnaire, the EQ-5D-5L, the Central Sensitisation Inventory and hip abductor muscle strength. We will explore acceptability of the EDX-Ireland intervention from the perspective of patients and treatment providers, and the perspective of referrers to the trial. A Study Within A Trial will be also applied to compare recording of exercise adherence using app-based technology to paper-based diary. Discussion There is a need to establish effective treatments for GT that potentially can be implemented into existing health systems. The findings of this feasibility trial will inform development of a future definitive RCT. Registration The trial is registered prospectively on ClinicalTrials.gov (NCT05516563, 27/10/2022).

Remission of hypersensitivity by simple weight load stimuli in a complex regional pain syndrome mouse model.

Painful sensitivity of the hand or foot are the most common and debilitating symptoms of complex regional pain syndrome (CRPS). Physical therapy is standard treatment for CRPS, but evidence supporting its efficacy is minimal and it can be essentially impossible for CRPS patients to actively exercise the painful limb. Using the well-characterized distal tibial fracture CRPS mouse model, we compared the therapeutic effects of several weeks of daily hindlimb loading versus rotarod walking exercise. The effects of loading and exercise were evaluated by weekly testing of hind-paw withdrawal thresholds to von Frey fibers and radiant heat, as well as measurements of paw and ankle edema. At 6 weeks after fracture, the mice were killed and the ipsilateral femur, spinal cord and L4/5 dorsal root ganglia, and hind-paw skin collected for PCR assays and paw skin Immunohistochemistry evaluation. Hindlimb loading reduced hind-paw von Frey allodynia and heat hyperalgesia and edema within a week and these effects persisted for at least a week after discontinuing treatment. These therapeutic effects of loading exceeded the beneficial effects observed with rotarod walking exercise in fracture mice. Levels of nerve growth factor and transient receptor potential vanilloid 1 (TRPV1) immunostaining in the hind-paw skin were increased at 6 weeks after fracture, and both loading and exercise treatment reduced increases. Collectively, these results suggest that loading may be an effective and possibly curative treatment in CRPS patients with sensitivity in the affected limb.

Development of deep-learning models for real-time anaerobic threshold and peak VO2 prediction during cardiopulmonary exercise testing.

Exercise intolerance is a clinical feature of patients with heart failure (HF). Cardiopulmonary exercise testing (CPET) is the first-line examination for assessing exercise capacity in patients with HF. However, the need for extensive experience in assessing anaerobic threshold (AT) and the potential risk associated with the excessive exercise load when measuring peak oxygen uptake (peak VO2) limit the utility of CPET. This study aimed to use deep-learning approaches to identify AT in real time during testing (defined as real-time AT) and to predict peak VO2 at real-time AT. This study included the time-series data of CPET recorded at the Department of Cardiovascular Medicine, Kyushu University Hospital. Two deep neural network models were developed to: (i) estimate the AT probability using breath-by-breath data and (ii) predict peak VO2 using the data at the real-time AT. The eligible CPET contained 1472 records of 1053 participants aged 18-90 years and 20% were used for model evaluation. The developed model identified real-time AT with 0.82 for correlation coefficient (Corr) and 1.20 mL/kg/min for mean absolute error (MAE), and the corresponding AT time with 0.86 for Corr and 0.66 min for MAE. The peak VO2 prediction model achieved 0.87 for Corr and 2.25 mL/kg/min for MAE. Deep-learning models for real-time CPET analysis can accurately identify AT and predict peak VO2. The developed models can be a competent assistant system to assess a patient's condition in real time, expanding CPET utility.

Effects of cognitive load and different exercise intensities on perceived effort in sedentary university students: a follow up of the Cubo Fitness Test validation.

Work and intellectually fatiguing environments can significantly influence the health of individuals, which is strictly bound to motor efficiency. In particular, desk workers and university students may have a sedentary lifestyle and a condition of mental fatigue caused by daily routine, which could impair motor efficiency. The assessment is a starting point for enhancing awareness of the individual's psychophysical condition through the perception of one's body motor efficiency, motivating to move towards improvement. This way, a submaximal test based on perceived exertion was developed (Cubo Fitness Test, CFT) and validated in previous studies. Hence, two further studies were employed to enhance the consistency and accuracy of this instrument in different conditions. The first study investigated the internal responsiveness of CFT, evaluating if mental fatigue could affect motor efficiency. The second study investigated which perceived intensity (weak, moderate, strong, or absolute maximum) could be more reliable for applying the CFT (as previous research focused the investigation only on moderate intensity). In the first investigation, participants assessed two stimuli (mental fatigue induced with a Stroop color-word task and a neutral condition based on the vision of a documentary) lasting 60 min each. The quality of psychophysical recovery (total quality recovery) and the mood state (Italian Mood State questionnaire) were evaluated before the stimuli. After the fatiguing or the neutral task, the mood state was newly assessed, together with the evaluation of the workload's characteristics (Nasa TLX) and the CFT motor efficiency. In the second investigation, participants had to perform CFT twice for each at different intensities of Borg's Scale of perceived exertion. Researchers successfully requested to fill out the NASA TLX questionnaire regarding the perceived workload characteristics of CFT, and the reliability of each intensity was assessed. Results seem to enhance the consistency and the accuracy of the instrument. Indeed, findings evidenced that CFT is not influenced by mental fatigue conditions typical of the intellectual work of desk workers and university students for which this test was specifically conceived. Moreover, moderate and strong perceived intensity are the most adequate conditions to assess motor efficiency in these populations.

The association between cardiopulmonary exercise testing and postoperative outcomes in patients with lung cancer undergoing lung resection surgery: A systematic review and meta-analysis

Background Exercise capacity should be determined in all patients undergoing lung resection for lung cancer surgery and cardiopulmonary exercise testing (CPET) remains the gold standard. The purpose of this study was to investigate associations between preoperative CPET and postoperative outcomes in patients undergoing lung resection surgery for lung cancer through a review of the existing literature. Methods A search was conducted on PubMed, Scopus, Cochrane Library and CINAHL from inception until December 2022. Studies investigating associations between preoperative CPET and postoperative outcomes were included. Risk of bias was assessed using the QUIPS tool. A random effect model meta-analysis was performed. I2 > 40% indicated a high level of heterogeneity. Results Thirty-seven studies were included with 6450 patients. Twenty-eight studies had low risk of bias. V˙O2 peak is the oxygen consumption at peak exercise and serves as a marker of cardiopulmonary fitness. Higher estimates of V˙O2 peak, measured and as a percentagege of predicted, showed significant associations with a lower risk of mortality [MD: 3.66, 95% CI: 0.88; 6.43 and MD: 16.49, 95% CI: 6.92; 26.07] and fewer complications [MD: 2.06, 95% CI: 1.12; 3.00 and MD: 9.82, 95% CI: 5.88; 13.76]. Using a previously defined cutoff value of > 15mL/kg/min for V˙O2 peak, showed evidence of decreased odds of mortality [OR: 0.55, 95% CI: 0.28–0.81] and but not decreased odds of postoperative morbidity [OR: 0.82, 95% CI: 0.64–1.00]. There was no relationship between V˙E/V˙CO2 slope, which depicts ventilatory efficiency, with mortality [MD: -9.60, 95% CI: -27.74; 8.54] however, patients without postoperative complications had a lower preoperative V˙E/V˙CO2 [MD: -2.36, 95% CI: -3.01; -1.71]. Exercise load and anaerobic threshold did not correlate with morbidity or mortality. There was significant heterogeneity between studies. Conclusions Estimates of cardiopulmonary fitness as evidenced by higher V˙O2 peak, measured and as a percentage of predicted, were associated with decreased morbidity and mortality. A cutoff value of V˙O2 peak > 15mL/kg/min was consistent with improved survival but not with fewer complications. Ventilatory efficiency was associated with decreased postoperative morbidity but not with improved survival. The heterogeneity in literature could be remedied with large scale, prospective, blinded, standardised research to improve preoperative risk stratification in patients with lung cancer scheduled for lung resection surgery.

Where is Your Pain? Achilles Tendinopathy Pain Location on Loading Is Different to Palpation, Imaging and Recall Location.

OBJECTIVE: To describe and compare pain maps reported during Achilles tendon loading exercises with recall pain location, in people with pain on palpation in their Achilles tendon and tendon pathology on imaging. DESIGN: Cross-sectional analysis of baseline RCT. METHOD: Participants were recruited from a larger Achilles tendinopathy clinical trial. Inclusion criteria were at least 2-month self-reported history of Achilles tendinopathy, midtendon palpation pain, and pathology on ultrasound tissue characterization. Participants were asked to identify their Achilles tendon pain location on a pain map with 8 prespecified locations while at rest prior to loading (recall pain), and subsequently during tendon loading exercises (loading pain). Participants could select multiple locations or select "other" if the locations did not represent their pain. RESULTS: Ninety-three participants were included (93% of participants from a clinical trial). The locations of pain on loading were diverse; all 8 pain locations (and an "other" option) were represented within this sample. Twenty-five percent of participants did not report pain with loading (n = 23 of 93). Of the 70 participants with loading pain, recall pain location differed to loading pain location in 40% (n = 28 of 70) of the participants. CONCLUSION: Palpation pain location, recall pain location, or location of pathology on imaging were not valid proxies for load-related pain in the Achilles tendon. How different pain locations respond to treatment is unknown. Some pathologies (eg, plantaris) have clear pain locations (eg, medial tendon), and assessing pain location may assist differential diagnosis. J Orthop Sports Phys Ther 2024;54(1):1-9. Epub 7 December 2023. doi:10.2519/jospt.2023.12131.

Exercise intensity impacts the improvement of metabolic dysfunction-associated steatotic liver disease via variations of monoacylglycerol O-acyltransferase 1 expression

BackgroundThe involvement of monoacylglycerol O-acyltransferase 1 (MOGAT1) in the pathogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD) has been recognized. While exercise is recommended for the improvement of obesity and MASLD, the impact of exercise intensity remains unclear. This study aimed to examine the influence of exercise intensity on MOGAT1 expression in high-fat diet (HFD)-induced obese mice with MASLD. MethodMale C57BL/6 mice aged 6 weeks were subjected to either a regular or HFD with 60 % fat content for 8 weeks. The mice were categorized into 5 groups based on their diet and exercise intensity: normal diet group (ND), HFD group, low-intensity exercise with HFD group (HFD+LIE), moderate-intensity exercise with HFD group (HFD+MIE), and high-intensity exercise (HIE) with HFD group (HFD+HIE). The duration of running was adjusted to ensure uniform exercise load across groups (total distance = 900 m): HFD+LIE at 12 m/min for 75 min, HFD+MIE at 15 m/min for 60 min, and HFD+HIE at 18 m/min for 50 min. ResultsLipid droplet size and MASLD activity score were significantly lower in the HFD+HIE group compared to other exercise-intensity groups (p < 0.05). Among the 3 intensity exercise groups, the lowest MOGAT1 protein expression was found in the HFD+HIE group (p < 0.05). ConclusionThis study reveals that high-intensity exercise has the potential to mitigate MASLD development, partly attributed to the downregulation of MOGAT1 expression.

SMART System in the Assessment of Exercise Tolerance in Adults.

Health-oriented physical activity should meet two key criteria: safety and an optimal level of exercise. The system of monitoring and rationalization of training (SMART) was designed to meet them. SMART integrates a custom-configured inertial measurement unit (IMU) and a sensor with real-time heart rate measurement (HR) using a proprietary computer application. SMART was used to evaluate the safety and exercise load with 115 study participants: 51 women (44.35%) and 64 men (55.65%) aged 19 to 65 years. The exercise test was the 6MWT test. In 35% of the participants, the mean HR exceeded the recognized safe limit of HR 75% max. Ongoing monitoring of HR allows for optimal exercise and its safety. Step count data were collected from the SMART system. The average step length was calculated by dividing the distance by the number of steps. The aim of the present study was to assess the risk of excessive cardiovascular stress during the 6MWT test using the SMART system.

КЛИНИЧЕСКИЙ СЛУЧАЙ ДИАГНОСТИКИ КОАРКТАЦИИ АОРТЫ В ПОЖИЛОМ ВОЗРАСТЕ

Abstract. Introduction. Aortic coarctation is a congenital narrowing or complete rupture of aorta in the region of its arch, isthmus, lower thoracic part, or abdominal region. Predominantly (in over 90% of cases), the coarctation occurs in a “typical” place, i.e., around the aortic isthmus. This defect is often combined with other defects, such as bicuspid aortic valve, aortic stenosis, patent ductus arteriosus, and ventricular septal defect. Aim: To actualize knowledge about aortic coarctation and its potential clinical manifestations. Materials and Methods. Female patient N., 65 years old, was admitted in the Department of Cardiology of City Clinical Hospital 7, Kazan in an urgent manner, complaining of fatigue, chest burning that could not be reversed by taking nitroglycerin, mixed dyspnea at the minimum exercise load, heart activity disorders, and rapid uneven heartbeat for a long time. The patient was examined using general clinical, laboratory and instrumental methods. In writing this article, the authors used source medical records (history of the present disease). Results and Discussion. The defect manifested in the patient clinically at her age of 25 as her systemic hypertension was first detected, accompanied by headache, dizziness, seeing dark spots in her vision, and later rapid heartbeat and short of breath on exertion. According to literature, in about 10% of cases, early development of aortic atherosclerosis is observed especially at the site of narrowing, as well as atherosclerosis of the coronary arteries, which caused unstable angina pectoris and the development of atrial fibrillation in our patient. In view of clinical manifestations of acute coronary syndrome, the patient was prescribed coronary angiography, during which aortic coarctation was suspected. Echocardiography detected congenital heart disease that often accompanies aortic coarctation (up to 60% of cases according to official sources), namely bicuspid aortic valve, as well as atrial septal aneurysm, reduction of descending aorta, and moderate aortic stenosis with aortic insufficiency. Further, to verify the diagnosis, X-ray computed tomography of the aorta was performed, which is the gold standard in detecting aortic coarctation. This method allowed us to identify the extent of the lesion, the diameter of the narrowing of the aorta, pre- and post-stenotic areas, and the presence and condition of collaterals. Conclusions. These findings are necessary for practicing physicians when choosing a treatment strategy for patients with aortic coarctation.

The Basas Spanish Squat: Superimposition of Electrical Stimulation to Optimize Patellar Tendon Strain: A Case Series.

The Basas Spanish Squat with electrical stimulation (E-stim) has shown promising results as a potential key exercise in treatment of athletes with patellar tendinopathy. Gold standard exercise therapy for tendon injuries consists of tendon loading exercises, or exercises that appropriately applies high levels of mechanical strain to the tendon. The theoretical pathway in which the Basas Spanish Squat with E-stim improves tendinopathy has been speculated to be the additional strain applied through the patellar tendon during superimposition of E-stim. This theory, however, has yet to be confirmed. The purpose of this case series was to compare patellar tendon strain, during the Basas Spanish Squat with, and without E-stim, and open kinetic chain knee extension. Four healthy participants performed the three exercises while a physical therapist collected simultaneous unilateral ultrasound images from the patellar tendon. Strain was calculated as the change in patellar tendon length during contraction divided by the resting length. Amongst all participants, patellar tendon strain was smallest during the Basas Spanish Squat without E-stim, followed by the open kinetic chain knee extension at 60% maximum voluntary isometric contraction. The Basas Spanish Squat with E-stim yielded approximately double or more strain compared to the without E-stim condition and demonstrated higher level of strain compared to open kinetic chain knee extension in all participants. The findings reflect a clear trend of increased strain through the patellar tendon when E-stim was superimposed. The results support the theory that the Basas Spanish Squat with E-stim increases patellar tendon strain and could explain the reported clinical benefits in individuals with patellar tendinopathy. 4, Case series.

The JUMPFOOD study: additional effect of hydrolyzed collagen and vitamin C to exercise treatment for patellar tendinopathy (jumper’s knee) in athletes—study protocol for a double-blind randomized controlled trial

BackgroundPatellar tendinopathy (PT) is a common problem in jumping athletes. Management can be challenging and treatment outcome is not always successful. In combination with tendon loading exercises, hydrolyzed collagen/vitamin C supplementation appears to have a promising effect on the recovery of tendinopathy. The aim of this study is to evaluate whether the use of oral supplementation of hydrolyzed collagen and vitamin C in combination with progressive tendon loading exercises (PTLE) is superior to PTLE and placebo on VISA-P score (which rates pain, function, sports participation) after 24 weeks for athletes with PT.MethodsThe JUMPFOOD study is a double-blinded, two-armed randomized controlled trial, in which the effectiveness of oral supplementation of hydrolyzed collagen/vitamin C combined with PTLE compared to PTLE with placebo on pain and recovery of function in athletes with PT will be investigated. Seventy-six athletes aged 16–40 years, with symptoms of PT for at least 12 weeks, who play sports at least once a week will be included. All participants will receive education, advice with regard to load management and a PTLE program according to the Dutch guidelines for anterior knee pain. In addition, the intervention group will receive daily 10 g hydrolyzed collagen and 40 mg vitamin C supplementation for 24 weeks whereas the control group receives 10 g maltodextrin placebo supplementation. Measurements will take place at baseline and at 12 and 24 weeks’ follow-up. Primary outcome is the VISA-P score, which evaluates pain, function, and sports participation. For secondary outcome measures, data with regard to pain during functional tests, flexibility measurements, blood withdrawals, imaging characteristics of the tendon, and health questionnaires will be collected. During the follow-up period, participants will register sports participation, amount of training and tendon load, pain during sports, co-medication, and side-effects in a digital weekly diary.DiscussionThe JUMPFOOD study is the first large RCT to study the effectiveness of hydrolyzed collagen/vitamin C supplementation in combination with the PTLE program in athletes with patellar tendinopathy. If supplementation of collagen/vitamin C appears to be effective, this treatment can be implemented in daily sports medicine practice to improve the treatment outcome of patients with PT.Trial registrationClinicalTrials.gov NCT05407194. Registered on 7 June 2022.

Exercise Immunology Applied to Pediatric Sport and the Importance of Monitoring Stages of Puberty and Biological Maturation

Context: Exercise immunology is aimed at understanding how exercise sessions can affect the immune system in athletic subjects of different age groups. The objective of the current study was to discuss in which stage of biological maturation (BM) young athletes may be more vulnerable in relation to the immune system, and whether there is a BM range in which it is safer to perform sports training with strenuous exercise loads. Evidence Acquisition: Evidence from scientific research from several scientific disciplines (eg, immunology, sport immunology, pediatrics, sports medicine, human development) was gathered to holistically examine the main particularities of exercise immunology as applied to pediatric sport. Study Design: Narrative review. Level of Evidence: Level 5. Results: In pediatric patients, lymphoid tissue expands during puberty and involutes after puberty until it returns to pre-expansion values. This suggests that there is a specific period in which the immune system may be stronger, which may provide opportunities for strenuous exercise in pediatric athletes. However, the chronological period when puberty occurs will be determined by BM, which is the rate at which the biological systems of the human body improves. This may affect the period of lymphoid tissue expansion and, consequently, the behavior of the immune system in pediatric subjects of the same age category. Conclusion: During puberty, there is a significant increase in the proinflammatory profile; to compensate for this, there is an expansion of lymphoid tissue that may favor the efficiency of the immune system. The period in which puberty is reached may vary according to the stages of BM. Therefore, in exercise immunology applied to pediatric sports, in addition to external and internal training loads, it is necessary to consider BM and puberty, which have been shown to be safer biomarkers than chronological age for determining immune system behavior in pediatric athletes. Strength-of-Recommendation Taxonomy (SORT): Evidence B level 3.

Are dynamic measurements of central venous pressure in Fontan circulation during exercise or volume loading superior to resting measurements?

The main objective measure to assess the health of the Fontan circulation is the pressure measurement of the superior vena cava or pulmonary arteries. We reviewed the literature for benefits of measuring resting pressure in the Fontan circuit and explored whether dynamic measurement by volume loading or exercise has the potential to refine this diagnostic tool. PubMed was searched for articles showing a relationship between resting post-operative central venous pressure or pulmonary artery pressure and Fontan failure. Relationships between post-operative central venous pressure or pulmonary artery pressure and volume loading changes, such as during exercise or volume loading during cardiac catheterization, were also queried. A total of 44 articles mentioned relationships between resting central venous pressure or pulmonary artery pressure and Fontan failure. Only 26 included an analysis between the variables and only seven of those articles found pressure to be predictive of Fontan failure. Ten articles examined the relationship between exercise or volume loading and outcomes and demonstrated a large individual variation of pressures under these dynamic conditions. Based on current literature, there is not a lot of strong evidence to show that elevated resting central venous pressure or pulmonary artery pressure is predictive of Fontan failure. Some individuals experience dramatic increases in central venous pressure or pulmonary artery pressure under increased loading conditions with exercise or bolus fluid infusion, while others experience increases closer to that of a healthy control population. Further studies are needed to examine whether more dynamic and continuous monitoring of systemic venous pressures might better predict outcomes in patients with Fontan circulation.

Neuromuscular and perceptual-cognitive response to 4v4 small-sided game in youth soccer players.

The physical and psychological load of small-sided games (SSGs) can affect players' neuromuscular and cognitive functions. Yet, little is known about the acute performance changes after such a specific exercise in young soccer players and their association with exercise load applied. This study investigates i) the neuromuscular and perceptual-cognitive response to the SSG exercise load, and ii) the relationship between pre- and post-SSG changes in variables of performance and the respective exercise load in youth soccer players. Sixteen participants (13.6 ± 0.5years) underwent a 30-min SSG 4v4 + GK protocol. Prior to and after the SSG they performed countermovement jump (CMJ), planned and reactive Y-shaped agility tests (PA, RA), and go/no-go task (GNG). Their subjective perception of fatigue was evaluated by visual analog scale. Fatigue induced by SSG (perception of fatigue increased by 41.56%, p = .001, g = 4.15) increased PA time (4.04%, p = .002, g = .97), RA time (6.45%, p = .003, g = 1.16), and number of errors in the response inhibition task (87.1%, p = .023, rc = .57), whilst decreased CMJ height (-6.65%, p = .014, g = .56). These performance deteriorations were not significantly associated with neither internal nor external load variables. However, a less pronounced drop in performance was related to external load variables, i.e., ∆CMJ height and ∆RA time correlated with very high-speed running (rs = .66, p = .006; rs = -.50, p = .022; respectively) and maximal speed (r = .54, p = .032; r = -.52, p = .037; respectively), whilst ∆PA time was associated with high-intensity accelerations (rs = -.76, p = .002). These findings indicate that fatigue induced by SSG affects both planned and reactive agility, decision-making in response inhibition task, and explosive strength in youth soccer players regardless of significant contribution of any robust internal or external load variables. Nonetheless, high-intensity actions within SSG partially compensate for the decrements in their agility performance and explosive strength. The load variables encountered during SSG do not fully reflect youth players' neuromuscular and perceptual-cognitive responses to sport-specific exercise.

Atrial fibrosis and local right atrial inflammation are characteristic of strenuous, but not moderate exercise, and underlie increased AF inducibility in heavily trained rats

Abstract Introduction The U-shaped relationship between exercise load and atrial fibrillation (AF) risk, where moderate exercise is protective but strenuous training increases the risk of AF, is currently well accepted (1, 2). Clinical and experimental data suggest that atrial fibrosis and parasympathetic tone (PT) enhancement may underlie the excess risk of AF in endurance athletes (3). Delving into the atrial differences between moderate exercise and strenuous training may be important to understand the pathophysiology of exercise-induced AF. Purpose To compare the atrial structural, electrophysiological and molecular remodelling occurring after long-term moderate and strenuous exercise. Methods Male Wistar rats were randomly assigned to sedentary (SED), moderate (MOD, 35 cm/s, 45 minutes) or high intensity exercise (INT, 60 cm/s, 60 minutes) for 16 weeks. An electrocardiogram (ECG) and electrophysiological study (EPS) were performed before sacrifice. Left (LA) and right (RA) atrial samples were collected for fibrosis assessment and a mRNA array. Results After the exercise protocol, weight of SED rats was higher (486±77 g) compared with both the MOD (377±28 g) and INT groups (385±43 g). In the ECG (Figure 1), INT rats presented a prolonged P-wave compared with SED and MOD. Both trained groups presented with significant bradycardia compared with SED, along with enhanced PT (heart rate variability: low to high frequency ratio). The remaining ECG parameters were similar between groups. Consistent with an enhanced PT, the Wenckebach cycle length was similarly prolonged in both trained groups in the EPS. Conversely, the sinus node recovery time was prolonged in INT rats compared with SED and MOD. AF inducibility increased from SED to MOD to INT. Myocardial fibrosis was measured in atrial samples stained with Sirius red. In both the RA and LA, fibrosis was significantly higher in the INT group (6,3±0.8 %) compared with the SED (4,4±0.2 %) and MOD (4,3±0.5 %) groups. An mRNA array showed large differences between atria. 384 and 419 genes were deregulated between INT and MOD (nominal p&amp;lt;0.05) in the RA and LA, respectively. Only 19 genes were consistent between both atria. In pathway analyses, the inflammatory response pathway was enriched (upregulation) in the RA, but not in the LA, of INT rats compared with MOD (Figure 2). Conclusions In healthy rats, strenuous training promoted a differential, pathological remodelling involving atrial fibrosis and sinus node dysfunction, compared with moderate exercise. Local inflammation may play a role in strenuous exercise-induced fibrosis in the RA. PT enhancement was similar in both groups.Figure 1.Figure 2.

Body composition assessment in a large cohort of Olympic athletes with different training loads: possible reference values for fat mass and fat-free mass domains.

To assess body composition by means of BOD POD in the large cohort of Italian Olympic athletes of many sport disciplines (studied at the same time), and to provide possible reference values for body composition in elite athletes. 1556 elite athletes, who took part in the selection procedure for the 2016 Rio Olympic Games for the National Italian Olympic Committee (CONI), were retrospectively studied. Body composition was determined using air plethysmography-based BOD POD. We observed that Fat Mass (FM) and Fat-free Mass (FFM) should be considered as two mutually independent domains in elite athletes. By performing Principal Component Analysis, we defined two independent main domains (respectively, representing FM and FFM), which presented different trends according to gender and static or dynamic exercise load. Lastly, we reported possible reference values for FM index and FFM index, respectively, representing the largest contributors to FM domain and FFM domain, and calculated as FM or FFM (kg)/height (m2). Our findings might provide a basis to optimize the practical approach to body composition in athletes, highlighting the importance of considering indicators of fat mass and lean mass "simultaneously" and not specularly, according to different sport disciplines as well. Moreover, these data might contribute to standardize reference values for body composition in elite athletes, with a view to potentially helping to monitor and guide training regimens, prevent related detrimental practices and plan cardiometabolic prevention and rehabilitation programs.

Rehabilitation Therapy for Acute Brain Disease

Early mobilization and rehabilitation therapy are becoming more critical in acute stroke, traumatic brain injury, and neurological disorder. Better functional prognosis for patients are obtained by performing comprehensive early mobilization and rehabilitation by a multidisciplinary team, generally within 48 hours after the onset. Early and frequent mobilization and rehabilitation therapy are recommended unless systemic management is paramount, such as hemodynamic instability, increased intracranial pressure, or active bleeding. Future considerations to be verified include implementation of rehabilitation in the very early phase(e.g., within 24 hours after the onset), selection of patients(e.g., when to start rehabilitation for each disease type), amount of exercise load in the intensive care unit(ICU), and content of training at the early stage. In addition, there are still few established methods for evaluating motor activity that can be performed in bed. It is also necessary to consider the nature of the rehabilitation team and leadership that were poorly addressed.

Conservative Approach to Treating American Football Players With Medial Collateral Ligament Grade 2 Sprain During the Season.

The medial collateral ligament is the most commonly injured ligament in the knee. The high-speed pivoting and agility movements that are common in the sport of American Football put participants at an increased risk for a valgus force stress from contact or noncontact injuries. Positional release therapy (PRT) also considered strain/counterstrain focuses on releasing the tension in a tissue through unloading the involved body part. Two male student-athletes participating in football with a mean age of 20.5years were diagnosed by a physician with medial collateral ligament grade 2 sprain. Both patients sustained their injuries in a regular season game with a contact valgus force from an opposing player. After the initial 72hours of compression, elevation, and cryotherapy, the patients were both treated with PRT followed by progressive loading exercises. Following 4 treatment sessions of PRT over the next 6days, the patients started with quadriceps engagement exercises, single-leg squats to 60° knee flexion, side steps, triceps dips, slow controlled lunges, and toe walk. The patients progressed to full body weight squats, single-leg landing, step-up tri-extension, and sidekicks with a leg on table. Then, the patients completed function movements and sports-specific exercises. In this case series, 2 patients competing in intercollege American Football were treated with PRT and progressive loading exercises to facilitate return to unrestricted activities and improve outcome measures. Commonly, a grade 2 medial collateral ligament sprain is conservatively treated with return to sport taking 20days on average. In this type 2 case series, the clinician found success utilizing PRT early in the recovery process, which in these 2 cases lead to restoration of function, outcome measure improvement, and an expedited return to sport. The expedited return to sport occurred at an average of 18days for these patients.

Muscle Mass and Muscle Strength Following 6 Weeks of Blood Flow Restriction Combined with Low-Intensity Strength Training in Overweight Adolescents

Background and Study purpose. Blood flow restriction training is a new training technique that involves low-intensity exercise and can generate physiological changes equivalent to high-intensity exercise. The aim of this study is to assess the impact of blood flow restriction in conjunction with low-intensity resistance exercise on muscle mass and muscle strength among overweight adolescents, in comparison to conventional resistance exercise. Materials and methods. The study involved two randomized groups: an experimental group, which performed 40% of one repetition maximum (1RM) resistance exercise combined with 60% of arterial occlusion pressure (AOP), and a traditional resistance exercise group, which performed 70% of 1RM resistance exercise. All participants underwent pre-test and post-test evaluations for body composition, 1RM, and muscle circumference. The training program lasted for six weeks and consisted of upper and lower body training, including exercises such as leg press, leg curl, arm curl, and arm extension. Results. The group that underwent low-load blood flow restriction (LLBFR) training showed a notable increase in muscle mass (p&lt;0.049) as well as arm and leg circumference (p&lt;0.047 and p&lt;0.046, respectively) compared to before the training program, similar to the results of high-intensity resistance exercise. Conclusions. Combining blood flow restriction with low-intensity resistance training is a potentially effective approach to increase muscle size and strength, especially in overweight adolescents. Moreover, this type of training can decrease the amount of exercise load, making it a feasible option for individuals who may not tolerate high loads due to certain medical conditions or other limitations.

Rapid recovery in a patient with severe COVID-19 after a low-load, high-frequency rehabilitation program using an ergometer in the supine position.

Background Rehabilitation therapy for patients with severe coronavirus disease 2019 (COVID-19) is crucial; however, studies regarding rehabilitation strategies for intensive care unit (ICU) patients with COVID-19 are limited. We report a case of severe COVID-19 in an ICU patient whose physical function and basic movement ability rapidly improved after the initiation of active aerobic exercise in the supine position.Case A 70-year-old man with hypertension and obesity was admitted to the ICU and managed with a ventilator because of severe COVID-19. Physical therapy started on postadmission day 34. Problems encountered during physical therapy included low saturation of percutaneous oxygen (SpO2; <90%), dyspnea with a light exercise load, advancing muscle weakness, and endurance decline. The rehabilitation program included getting out of bed and resistance training of the upper and lower limbs twice daily while maintaining SpO2 at ≥90%. After ventilator weaning, we initiated aerobic training using a supine ergometer with varying load volume. On discharge from the ICU on postadmission day 45, the patient' s physical function (handgrip strength, Medical Research Council score, and Borg scale) and basic movement ability (Functional Status Score for ICU) rapidly improved.Conclusion Rehabilitation therapy involving aerobic cycling training based on a quantitative load setting may be effective in treating COVID-19.