Exercise Restriction Research Articles

A Case of Exertional Rhabdomyolysis in an 11-year-old Argentine Mare ‎

Exertional Rhabdomyolysis is an imbalance between the animal's diet and its workload, especially when on a high-grain diet. An 11-year-old Argentine mare weighing 360 Kg was presented with a complaint of pyrexia, anorexia, pointed stance and stiff gait, reluctance to move and trembling when compelled to walk. On physical examination, body condition score of 2.5/5, excessive sweating, stiff hind quarters, and reluctance to move were observed. On clinical examination, the animal showed tachypnea, congested ocular mucous membrane and a temperature of 38.9oC. Blood sample was taken for complete blood cell count and biochemical test. The result of haematological test was within normal range while the biochemical test revealed hypoglycemia, hypochloremia, hyponatremia and hypokalemia. The levels of calcium, creatine kinase and bicarbonate were higher than the normal range. A diagnosis of azoturia was made based on history, clinical signs and laboratory test. The movement of the horse was restricted and it was treated with 0.6 mg/kg meloxicam daily for 5 days, 0.2mg/kg dexamethasone daily for 2 days, 12 ml of VitESe daily for 3 days and 60ml of Promin® daily for 3 days. The horse was given gentle walking exercise and low carbohydrate diet during the treatment period and normal function of the horse gradually returned 4 weeks after presentation. It was concluded that exertional rhabdomyolysis can be managed by administration of analgesic and anti-inflammatory, restricted carbohydrate diet and limited exercise until muscle function returns to normal.

Development of capsaicin loaded nanoparticles based microneedle patch for transdermal drug delivery

Obesity and overweight lead to adverse metabolic effects on blood pressure, cholesterol, triglycerides and insulin resistance. To overcome this problem, the present study was carried out to develop capsaicin loaded nanoparticles based polymeric microneedle patches for transdermal delivery. The extracted capsaicin from Capsicum annuum L. was formulated as nanoparticles using clove oil, ethanol, PEG 400 and sodium caseinate. The nanoparticles were 106.8 nm in size with a zeta potential of −50.8 mV and polydispersity index (PDI) of 0.314, confirmed by DLS. The size and spherical morphology were confirmed further by SEM and TEM analysis. With an encapsulation efficiency of 95%, X-ray diffraction analysis of nanoparticles revealed 45% crystallinity and 54% amorphous properties. DSC profiles verified an endothermic peak with a melting point of 140.34 °C, and FTIR spectroscopy confirmed strong bonding between nanoparticles. The plasma bioavailability of capsaicin in nano-formulation was higher compared to native capsaicin in C57BL/6 mice. In vitro and ex vivo release kinetics of capsaicin from MNPs were maximum at 3 min. Thus, the transdermal delivery of capsaicin via microneedle patches will aid in converting WAT to BAT, specifically in those obese populations without the need for strenuous physical exercise and dietary restriction.

Analysis of body heat tolerance of workers in a simulated warm environment based on linear mixed model.

Workers' heat tolerance plays a crucial role in maintaining their health and performance in hot environments. This study aimed to empirically analyze the body heat tolerance of workers under a simulated warm environment. Twenty healthy male workers from the typical light metal industry (age: 23.15±2.45 years) were participated in the experimental study. Workers were exposed to two thermal environments (Ta = 22°C, RH = 35%, and Ta = 35°C, RH = 35%) in a simulated moderate workload in a climate-controlled room. The maximal aerobic capacity (VO2 max) and body fat mass of workers were determined. The heat tolerance indicators were determined based on heart rate (HR) and ear temperature (ET) before and after each experiment. A linear mixed model was employed to analyze body heat tolerance indicators using the SPSS statistical package. All physiological responses significantly increased in the warm air condition compared to the thermoneutral condition. The HR and ET increased by an average of 14 bpm and 0.75°C, respectively (p<0.05). The mixed model could accurately predict heat tolerance indicators (r = 0.95 and r = 0.97) so that the VO2 max and body fat mass were identified as the main individual influential factors. The VO2 max showed significant correlation with urinary specific gravity (r = -0.55, p<0.05), HR (r = -0.59, p<0.05), and ET (r = -0.57, p<0.05) in warm environment. The model confirmed that physical fitness is critical in increasing heat tolerance in warm environments. It can be a helpful screening tool for properly selecting workers in occupational medical examinations for working in warm air conditions. It is proposed that workers' regular exercise and lifestyle modifications can strengthen their heat tolerance.

ACUTE EFFECT OF BLOOD FLOW RESTRICTED RESISTANCE EXERCISE ON IRISIN AND SEX HORMONES

Purpose: The relationship between exercise and irisin and sex hormone release is unclear and is of interest to current research. This study aimed to investigate the acute effect of blood flow restricted (BFR) resistance exercise on irisin and sex hormones.&#x0D; Material and Methods: The study included healthy males over 18 years of age. Participants' physical activity levels were determined using International Physical Activity Questionnaire (IPAQ). Participants underwent body composition analysis and isotonic muscle strength measurement and were randomly divided into 3 groups: low-intensity (20% of 1-RM) resistance exercise with BFR, high-intensity (70% of 1-RM) resistance exercise without BFR, and a control group. Blood samples were obtained 15 minutes post-exercise to assess acute irisin, testosterone, and estrogen responses.&#x0D; Results: The study included 17 healthy males. The average age was 26.1±2.9 years, mean physical activity was 1259.2±1003.1 MET/week, and mean 1-RM max (as measured with isotonic muscle strength test) was 41.1±7.5 kg. The descriptive characteristics of the three groups were statistically similar (p&gt;0.05). The acute post-intervention irisin and sex hormone levels were not statistically different between the groups (p&gt;0.05).&#x0D; Conclusion: Acute changes in irisin and sex hormone levels were not statistically different for low-intensity BFR and high-intensity non-BFR exercise.

Molecular mechanisms underlying the beneficial effects of exercise and dietary interventions in the prevention of cardiometabolic diseases.

Cardiometabolic diseases still represent a major cause of mortality worldwide. In addition to pharmacological approaches, lifestyle interventions can also be adopted for the prevention of these morbid conditions. Lifestyle changes include exercise and dietary restriction protocols, such as calorie restriction and intermittent fasting, which were shown to delay cardiovascular ageing and elicit health-promoting effects in preclinical models of cardiometabolic diseases. Beneficial effects are mediated by the restoration of multiple molecular mechanisms in heart and vessels that are compromised by metabolic stress. Exercise and dietary restriction rescue mitochondrial dysfunction, oxidative stress and inflammation. They also improve autophagy. The result of these effects is a marked improvement of vascular and heart function. In this review, we provide a comprehensive overview of the molecular mechanisms involved in the beneficial effects of exercise and dietary restriction in models of diabetes and obesity. We also discuss clinical studies and gap in animal-to-human translation.

The effect of 12 weeks of aerobic exercise and caloric restriction on Nrf2 protein expression in non-alcoholic fatty liver disease in rats

Background and aims: One of the most common causes of liver disease is non-alcoholic fatty liver disease (NAFLD), and its prevalence along with serious clinical problem is a growing. No studies have been conducted on the effect of calorie restriction (CR) and aerobic exercise (AE) on nuclear factor erythroid-related factor 2 (Nrf2) in rats with NAFLD. The present study aimed to assess the effects of 12 weeks of CR and AE on Nrf2 protein expression in rats with NAFLD. Methods: A total of 40 rats participated in this study, and 32 of them developed NAFLD by feeding fatty food (34% fat, 19% protein, and 47% carbohydrates) for eight weeks. Rats were classified into five groups: sham, control, CR, AE, and calorie restriction-aerobic exercise (CA). First, 60% of the daily diet was given to the CR and CA groups. AE was done for 12 weeks, five sessions per week on a treadmill for rats. Oil red, hematoxylin-eosin (H &amp; E) staining, and protein expression levels in the groups were evaluated. To analyze the data, one-way ANOVA was used at a significance level of P&lt;0.05. Results: The results showed a significant difference between the liver fat of the control group and other groups (RC: P=0.001, AE: P=0.001, RA: P=0.001). In healing liver damage, the control group was significantly different from the CA group (P=0.002). Regarding the Nrf2 protein expression, the CA group had significantly higher expression than the CR group (P=0.028), however there was no significant difference between the CA and AE groups (P=0.44). Conclusion: The findings revealed that AE through CR can cause recovery for NAFLD.

Combining Exercise and Carbohydrate Restriction in Patients with Type 2 Diabetes Mellitus—A Critical Look at Possible Intervention Effects

Combining regular exercise and a healthy diet is recommended in international guidelines to fight type 2 diabetes mellitus (T2DM). Low- and very low-carbohydrate diets have attracted attention in the last years. This article takes a critical look at the possible effects when regular exercise and carbohydrate restriction are combined. An increased intervention effect on the oxidative capacity as well as glucose and lipid profiles can be assumed (at least for a short period of time). However, anabolic signaling pathways might be blunted during a very low-carbohydrate diet and increasing ketosis. Thus, muscle build-up can become difficult or impossible. Furthermore, maximal performance during high-intensity workouts may be attenuated due to a possible reduced anaerobic glycolysis and metabolic inflexibility in T2DM patients. However, more studies are needed to evaluate the effects of this combination in comparison to those of exercise and other types of diet.

Dietary- but not exercise-induced acute iso-energetic deficit result in short-term appetitive compensatory responses in adolescents with obesity

BackgroundProducing negative energy balance rests on the creation of energy deficits that have been shown, depending on their modality, to induce potential appetitive compensatory responses. The aim of this study was to compare energy intake (EI), appetite feelings, and the hedonic responses to equivalent acute energy deficits induced by exercise versus energy restriction in adolescents with obesity. MethodsIn a within-participants design, seventeen adolescents with obesity (12–16 years, Tanner stage 3–5, 9 males) randomly completed three conditions: i) control (CON); ii) deficit induced by diet only (Def-EI); and iii) deficit induced by exercise only (Def-EX). Lunch was calibrated to generate a 400-kcal deficit in Def-EI and remained similar in CON and Def-EX. A 400-kcal deficit was created through a cycling bout set at 65% VO2peak in Def-EX. Ad libitum EI, macronutrient intake and relative EI (REI) were assessed at dinner, subjective appetite sensations taken at regular intervals, and food reward measured before dinner. ResultsFood intake at dinner was greater in Def-EI (1112 ± 265 kcal) compared to CON (983 ± 277 kcal; p = 0.005) and Def-EX (1009 ± 281 kcal; p = 0.025). Absolute protein and lipid intake were significantly higher in Def-EI (52.4 ± 9.5 g and 36.8 ± 8.9 g respectively) compared with both CON (44.9 ± 12.6 g; p = 0.001 and 33.8 ± 10.1 g; p = 0.002 respectively) and Def-EX (47.3 ± 11.8 g, p = 0.018, 35.4 ± 10.1 g, p = 0.036 respectively). Area under the curve (AUC) for hunger, desire to eat and prospective food consumption were significantly higher in Def-EI compared with both CON (p = 0.0001) and Def-EX (p = 0.0001). AUC for fullness was significantly lower on Def-EI compared with CON and Def-EX (p = 0.0001). Implicit wanting for sweet food was significantly lower on Def-EX (p = 0.031), relative to CON. ConclusionAppetitive compensatory responses that are observed after iso-caloric energy restriction in adolescents with obesity are absent with acute exercise, which could contribute to optimize our impact on short-term energy balance.

The Role of Diet and Lifestyle in Women with Breast Cancer: A Review of the Literature

One in eight women worldwide will develop breast cancer in their lifetime. Obesity, physical activity, and dietary composition are known to influence the prognosis of breast cancer. There have been significant concerns regarding the toxicity of existing pharmaco- and chemotherapies, and additional complementary dietary and lifestyle interventions are suggested for breast cancer prevention. This review aims to highlight current information regarding the association between dietary patterns and lifestyle with BC, including risk and prognosis. In addition, this article discusses dietary intake, physical activity, and other habits as lifestyle modification strategy targets. The incidence of breast cancer is increasing at an alarming rate worldwide, making it the most prevalent malignancy in women. A significant relationship exists between obesity, physical inactivity, a sedentary lifestyle, dietary patterns, and breast cancer risk. Unhealthy lifestyle habits, such as smoking, alcohol consumption, and tobacco use, also contribute to this increased risk. Obese women who have a high risk of breast cancer had better metabolic and inflammatory profiles when they engaged in lifestyle activities and diet interventions that were tailored to their needs. Physical activity was linked with a reduction in cancer incidence and mortality risk. A decrease in an individual’s consumption of red meat, animal fat, and sugary foods, as well as their increased consumption of fiber, fruits, and vegetables, were associated with a reduced risk of breast cancer. Other modifiable risk factors, such as smoking cessation and the avoidance of alcohol and tobacco, contributed to breast cancer survival. A healthy lifestyle that includes exercise and dietary modifications may serve as adjuvants to expedite breast cancer prevention interventions and optimize the health of cancer survivors.

Metabolic Myopathies

Metabolic myopathies are disorders that affect skeletal muscle substrate oxidation. Although some drugs and hormones can affect metabolism in skeletal muscle, this review will focus on the genetic metabolic myopathies. Impairments in glycogenolysis/glycolysis (glycogen storage disease), fatty acid transport/oxidation (fatty acid oxidation defects), and mitochondrial metabolism (mitochondrial myopathies) represent most metabolic myopathies; however, they often overlap clinically with structural genetic myopathies, referred to as pseudometabolic myopathies. Although metabolic myopathies can present in the neonatal period with hypotonia, hypoglycemia, and encephalopathy, most cases present clinically in children or young adults with exercise intolerance, rhabdomyolysis, and weakness. In general, the glycogen storage diseases manifest during brief bouts of high-intensity exercise; in contrast, fatty acid oxidation defects and mitochondrial myopathies usually manifest during longer-duration endurance-type activities, often with fasting or other metabolic stressors (eg, surgery, fever). The neurologic examination is often normal between events (except in the pseudometabolic myopathies) and evaluation requires one or more of the following tests: exercise stress testing, blood (eg, creatine kinase, acylcarnitine profile, lactate, amino acids), urine (eg, organic acids, myoglobin), muscle biopsy (eg, histology, ultrastructure, enzyme testing), and targeted (specific gene) or untargeted (myopathy panels) genetic tests. Definitive identification of a specific metabolic myopathy often leads to specific interventions, including lifestyle, exercise, and nutritional modifications; cofactor treatments; accurate genetic counseling; avoidance of specific triggers; and rapid treatment of rhabdomyolysis.

Exercise Stress Electrocardiography Using the Two-Minute Jump Test in Children.

Although the treadmill and cycle ergometer are commonly used for exercise stress electrocardiography (ECG) testing, they are often difficult to perform with children. We herein evaluated the utility and safety of the 2-minute jump test (2MJT) as a simple, alternative exercise test. One hundred patients, including 60 male patients, with an average age at study commencement of 10.7±3.5years (mean±standard deviation) and with no exercise restriction who underwent a cardiac check-up between November 2020 and March 2022 at the study center were included. After recording their resting ECG, they jumped for 2minutes during ECG recording, and the change in heart rate (HR), ECG findings, and occurrence of adverse events were investigated. As a result, patients jumped 185±60 times in two minutes, and their HR increased from 76±13 beats/min at rest to 172±18 beats/min at peak during the test. Ninety (90%) patients attained the ideal target HR of > 150 beats/minute. During the recovery period after loading, five patients had abnormal ECG findings (ventricular extrasystoles, second-degree atrioventricular block, and atrial extrasystoles in two, two, and one patient, respectively) but completely resolved spontaneously within three minutes. Our findings suggested that the 2MJT is a useful and safe exercise test capable of inducing sufficient increase in HR in a short time in children.

Acute Effect of Resistance Training With Blood Flow Restriction on Perceptual Responses: A Systematic Review and Meta-Analysis.

Several studies have compared perceptual responses between resistance exercise with blood flow restriction and traditional resistance exercise (non-BFR). However, the results were contradictory. To analyze the effect of RE+BFR versus non-BFR resistance exercise [low-load resistance exercise (LL-RE) or high-load resistance exercise (HL-RE)] on perceptual responses. CINAHL, Cochrane Library, PubMed®, Scopus, SPORTDiscus, and Web of Science were searched through August 28, 2021, and again on August 25, 2022. Studies comparing the effect of RE+BFR versus non-BFR resistance exercise on rate of perceived exertion (RPE) and muscle pain/discomfort were considered. Meta-analyses were conducted using the random effects model. Systematic review and meta-analysis. Level 2. All data were reviewed and extracted independently by 2 reviewers. Disagreements were resolved by a third reviewer. Thirty studies were included in this review. In a fixed repetition scheme, the RPE [standardized mean difference (SMD) = 1.04; P < 0.01] and discomfort (SMD = 1.10; P < 0.01) were higher in RE+BFR than in non-BFR LL-RE, but similar in sets to voluntary failure. There were no significant differences in RPE in the comparisons between RE+BFR and non-BFR HL-RE; after sensitivity analyses, it was found that the RPE was higher in non-BFR HL-RE in a fixed repetition scheme. In sets to voluntary failure, discomfort was higher in RE+BFR versus non-BFR HL-RE (SMD = 0.95; P < 0. 01); however, in a fixed scheme, the results were similar. In sets to voluntary failure, RPE is similar between RE+BFR and non-BFR exercise. In fixed repetition schemes, RE+BFR seems to promote higher RPE than non-BFR LL-RE and less than HL-RE. In sets to failure, discomfort appears to be similar between LL-RE with and without BFR; however, RE+BFR appears to promote greater discomfort than HL-RE. In fixed repetition schemes, the discomfort appears to be no different between RE+BFR and HL-RE, but is lower in non-BFR LL-RE.

Mental health and quality of life during weight loss in females with clinically severe obesity: a randomized clinical trial.

The purpose of this investigation was to explore the effects of dietary weight loss intervention, with and without the addition of exercise on health-related quality of life, depressive symptoms, and anxiety. As part of the EMPOWER study for women, sixty premenopausal women (BMI of 40.4 ± 6.7) were randomized to energy restriction only (ER) or to exercise plus energy restriction (EXER) for 12months. Health-related quality of life was assessed using the SF-36, depressive symptoms were assessed using the Beck Depression Inventory II (BDI), and anxiety symptoms using the Spielberger state and trait anxiety questionnaire. All measures were completed at baseline, 3, 6 and 12months. At 12months, there were significant (p < 0.05) group-by-time interactions favouring the EXER group for five of the eight domains and the mental component summary score. At 12months, a significant group-by-time interaction favouring the EXER group is reported for both state and trait anxiety (p = .005 and p = .001, respectively). At 12months, there was a significant group-by-time interaction for depressive symptoms favouring EXER (p < 0.05). Within-group changes for BDI scores were improved at all follow-up time points in the EXER group. Exercise training confers an additional benefit to energy restriction in the absence of additional weight loss at 12months for health-related quality of life, depressive symptoms, and state and trait anxiety scores when compared to energy restriction only. Exercise and an energy-restricted diet improve health-related quality of life and mental health. Exercise may protect mental health without further weight loss for women with severe obesity.

Impedance change during intentional weight loss in Thai obese patients

<h2>Summary</h2><h3>Background & aims</h3> Longitudinal measurements of raw bioelectrical impedance analysis (BIA) parameters suggested a worsening of the nutritional status in obese patients during weight loss after bariatric surgery. The effects of weight reduction through dietary intervention on raw BIA parameters is rarely described. <h3>Methods</h3> A retrospective observational study was conducted on obese patients who were in a weight-loss program. Dietary counseling, exercise, and lifestyle modification were suggested as the main approach to lose weight. Then longitudinal follow-up visits were scheduled every 1–3 months for up to 2 years. On each visit, body weight, waist, and hip circumferences were recorded along with BIA measurements. Repeated measures correlation (r_rm) was used to assess the relationship between BIA-derived impedance and body weight. <h3>Results</h3> A total of 116 obese patients were recruited. Participants had lost their weight from 113.47 ± 26.73 kg at the first visit to 103.69 ± 23.97 kg at the last visit (<i>P</i> < 0.001). A significant decrease of percentage of body fat was observed by −3.30 ± 4.33% from baseline. Total body water and fat-free mass were also significantly decreased. There was an increase in impedance from 483.55 ± 78.38 ohm at baseline to 496.11 ± 82.30 ohm at the last visit (<i>P</i> < 0.001). The r_rm between impedance and body weight was −0.31 (95% CI −0.37 to −0.25, <i>P</i> < 0.001). <h3>Conclusions</h3> Impedance had a significant negative correlation on body weight in obese patients during intentional weight loss, which might be due to decreased total body water and fat-free mass. Further study is required to explore the clinical meaning of these changes.

P128 Effect of acute exercise on stress and working memory following sleep restriction

Abstract Introduction Cognitive impairment poses a serious risk to worker safety. We investigated the interacting effects of acute exercise and sleep restriction (SR) on stress and working memory (WM). Methods Our randomized crossover design had 14 adults (10 M, 23 ± 3 years) complete two sessions under different sleep conditions (normal sleep (NS)=8h; restricted sleep (RS)=4h). Sleep duration was verified by validated wrist-worn actigraphy (Fitbit tracker). Salivary cortisol levels (stress indicator) and WM (via n-back task performance) were measured before and after high-intensity exercise on a cycle ergometer. Data was collected at the same time of day for each participant and a washout interval of at least 72-hours separated experimental conditions. Results A two-factor repeated measure ANOVA revealed sleep condition to have a significant effect on cortisol levels (F(1,13)=7.78, p&amp;lt;0.05) and n-back reaction time (RT) (F(1,13) = 10.54, p&amp;lt;0.01), but not response accuracy. Post-hoc dependent t-tests showed that RS lead to slower RTs compared to the NS condition (t(27)=3.32, p&amp;lt;0.01), as well as higher cortisol levels both before (t(13)=2.22, p&amp;lt;0.05) and after (t(13)=2.64, p&amp;lt;0.05) exercise. Acute exercise did not affect cortisol levels, but did appear to have a facilitative effect on response accuracy (t(27)=2.13, p&amp;lt;0.05), as well as RT in both sleep conditions ( ES t(13)=2.32, p&amp;lt;0.05. RS t(13)=2.2, p&amp;lt;0.05). Discussion These findings suggest that RS may lead to increased stress and impaired cognitive function, while acute exercise may serve as an effective tool for counteracting the negative cognitive effects induced by SR.

Abstract 10977: Shared Decision-Making in Athletes Diagnosed With a Cardiovascular Condition: A Scoping Review

Introduction: Exercise restriction following the identification of a cardiovascular condition can profoundly impact the identity, career, and well-being of athletes. Shared decision-making (SDM) is emerging as the standard of care to guide recommendations for athletes at risk of cardiovascular events. This scoping review summarizes existing approaches, barriers, and facilitators to SDM in sports cardiology. Methods: A literature search of the MEDLINE, Embase, Cochrane Library, PubMed, CINAHL, SPORTDiscus, and PsycInfo databases was conducted in January 2022. Abstract screening and full-text review were completed in duplicate by independent reviewers. The PCC (Participants, Concepts, Context) framework was used to assess study eligibility. Included articles discussed the use of SDM (C/C) following the diagnosis of a cardiovascular condition in an athlete (P). Results: A total of 6,049 records were screened, of which 38 were included in this review. Article classifications included theoretical papers (31), such as editorials and guidelines, and research studies (7). Main findings of the research studies are shown in Table 1. All selected articles defined SDM as an open dialogue between the athlete, healthcare team, and other stakeholders (e.g., parents, coaches). The benefits and risks of management strategies, treatment options, and return-to-play were the focus of this dialogue. Common themes among SDM approaches emerged, such as emphasizing patient values, considering non-physical factors (e.g., emotional, psychological, financial), and informed consent. Barriers to SDM included pressure from institutions and liability of healthcare providers in the case of adverse events. Conclusions: SDM is the recommended paradigm for providing care to athletes diagnosed with cardiovascular conditions. Further education for healthcare providers regarding the SDM approach, as well as future research assessing SDM in a clinical setting, is needed.

Abstract 13039: A Rare Case of Anomalous Aortic Origin of Right Coronary Artery From Left Coronary Cusp Presenting With Recurrent Atypical Chest Pain

Background: The incidence of anomalous aortic origin of the right coronary artery (AAORCA) is between 0.026% and 0.25%. There is limited data regarding medical versus surgical management. We present a case of AAORCA which did not “qualify” for surgical intervention but remained symptomatic on medical management. Presentation: A 58-year-old female with paroxysmal atrial fibrillation presented for the eighth time in the past two years with recurrent atypical chest pain and lightheadedness. Vital signs and cardiac biomarkers were normal. Work-up: EKG showed normal sinus rhythm. TTE revealed EF 68%. Myocardial perfusion imaging was normal but exercise stress test showed ventricular ectopy, ventricular bigeminy, short bursts of ventricular tachycardia (VT) at peak exercise, and a 7-beat run of VT. A 30-day event monitor revealed a 17-beat run of VT at a rate of 173 bpm (Figure A). Management: Cardiac catheterization showed the dominant right coronary artery (RCA) arising from the left coronary cusp with a shared ostium to the left coronary system (Figure B-D). A coronary CT scan confirmed dominant RCA arising from left coronary cusp (Figure E) with an interarterial course (Figure F) and slit-like appearance of the proximal RCA, with a likely intramural course (Figure G).She was managed conservatively with restriction of vigorous exercise, up-titration of beta-blockers, addition of anti-anginal agents and implantation of loop recorder. Conclusion: The most updated consensus statement for AAORCA recommends surgical intervention for those with signs or symptoms of myocardial ischemia (true angina, findings on provocative testing, aborted sudden cardiac arrest or non-vagally-mediated arrhythmia).Although our patient did not “qualify” for surgical intervention, she continued to experience refractory symptoms. Hence, it is of utmost importance to consider surgical intervention in patients who have failed medical management, for improved quality of life.

Abstract 11974: A Randomized, Controlled Trial of Resistance Training Added to Caloric Restriction Plus Aerobic Exercise Training in Obese Heart Failure With Preserved Ejection Fraction

Background: We previously showed that the combination of caloric restriction (CR) and aerobic exercise training (AT) produce robust improvements in exercise capacity and quality of life (QOL) in patients with obese Heart Failure with Preserved Ejection Fraction (HFpEF). However, ~ 35% of weight lost during CR+AT was from skeletal muscle (SM) mass, which may have adverse long-term consequences. Hypothesis: The addition of resistance training (RT) to CR+AT would reduce SM loss and further improve exercise capacity and QOL. Methods: Randomized, controlled, single blind trial of 20 weeks of RT+CR+AT vs. CR+AT in 88 patients with HFpEF and body mass index (BMI) ≥28 kg/m 2 . Measurements were: peak exercise O 2 consumption (VO 2 ); body composition by MRI and dual X-ray absorptiometry; leg muscle strength; leg muscle quality (leg strength ÷ leg SM area); Kansas City Cardiomyopathy Questionnaire (KCCQ) total score. Results: 77 participants completed the trial: age 68±5 years; 85% women; BMI 39.6±5.8 kg/m 2 . Both RT+CR+AT and CR+AT had substantial weight loss, mean (95% CI): -8.1 (-9.3, -6.8) vs. -9.2 (-10.5, -7.9) kg with no significant intergroup difference (p=0.21). Both RT+CR+AT and CR+AT had substantial loss of total body fat [-6.5 (-7.2, -5.8) vs. -7.4 (-8.1, -6.7) kg] and SM [-2.1 (-2.7,- 1.5) vs. -2.1 (-2.7, -1.4) kg], with no intergroup differences (p=0.20 and 0.23, respectively). Despite similar relative loss of SM (26% vs. 23% of total weight lost), RT+CR+AT vs. CR+AT alone produced significantly greater increases in leg muscle strength [4.9 (0.7, 9.0) vs. -1.1 (-5.5, 3.2) Nm, p=0.05] and leg muscle quality [0.07 (0.03, 0.11) vs. 0.02 (-0.02, 0.06) Nm/cm 2 , p=0.04]. Both RT+CR+AT and CR+AT produced large, significant improvements in peak VO 2 [108 (958, 157) vs. 80 (30, 130) ml/min; p=0.001 and 0.002, respectively], and in KCCQ score [17 (12, 22) vs. 23 (17, 28); p=0.001 for both], with no significant intergroup differences (p=0.21 and p=0.07, respectively). There were no study related serious adverse events. Conclusion: In older obese HFpEF patients, CR+AT produces large, significant improvements in exercise capacity and QOL. Addition of RT to CR+AT increased leg strength and leg muscle quality without attenuating SM loss or further increasing peak VO 2 or KCCQ score.

Female athlete triad affects rat intestinal morphology and sucrase-isomaltase expression.

Female athletes follow a strict diet and perform rigorous exercise to boost their performance, which induces health issues called the female athlete triad (FAT), defined as the combination of disordered eating, amenorrhoea and low bone mineral density. It is known to have a significant effect on bones. However, its effects on the small intestine, which is responsible for nutrient uptake into the body, remain unclear. In this study, we created an animal model of FAT to examine its effects on digestive and absorptive molecules in the small intestine. Thirty 5-week-old female Sprague-Dawley (sd) rats with an initial body weight of about 147 g were divided into control (Con, n = 7), exercise (Ex, n = 7), food restriction (FR, n = 8) and exercise plus food restriction (FAT, n = 8) groups. The rats were subjected to 4 weeks of wheel running (Ex, FAT) and 50-40 % food restriction (FR, FAT) to examine the effects on bone and typical digestive enzymes and transporters in the jejunum. Two-way ANOVA and the Kruskal-Wallis test were used for statistical analysis of normal and non-normal data, respectively. Four weeks of exercise and food restriction decreased bone weight (vs. other group P < 0·01) and bone breaking power (vs. other group P < 0·01). Villus height decreased in the jejunum (vs. other group P < 0·01), but the expression of typical macronutrients digestive enzyme and absorptive molecules remained unchanged. In contrast, sucrase-isomaltase gene (v. Ex P = 0·02) and protein expression were increased (vs. other group P < 0·05). The study findings show that FAT affects sucrase-isomaltase without histone methylation changes.

Effects of Blood Flow Restricted Exercise on Electromechanical Delay and Time to Peak Force after Task Failure: A Randomized Crossover Trial

Introduction: Electromechanical delay (ED) and time to peak force (TPF) could be used to investigate the central or peripheral sources of performance decline in fatiguing tasks. Exercise with partial blood flow restriction (BFR) has been shown to induce fatigue, but the repercussions of exercise with partial BFR on ED and TPF are unclear. The present study aimed to compare the ED and TPF after an intermittent isometric task until failure with BFR and free blood flow (FBF). Methods: In this crossover randomized clinical trial, 15 healthy and physically active men volunteered in this study. Volunteers performed two intermittent isometric handgrip exercise (IIHE) to failure (72 h apart), combined with either BFR or FBF. Maximum voluntary isometric force (MVIF) concomitant with the electromyographic activity of the wrist and finger flexor muscles were assessed before (PRE) and one minute after (POST) the task failure. Within (PRE vs. POST) and between comparisons (eFBF vs. eBFR) of peak force, time to peak force, rate of force development (RFDpeak) and ED were carried out. Results: No significant between-intervention differences were identified pre- or post-exercise. Peak force and RFDpeak reduced significantly after both blood flow conditions (p &lt; 0.05), but without between-condition difference. TPF was statistically higher after exercise only in the FBF intervention (p &lt; 0.05). None of the interventions induced a significant change in the ED after IIHE. Conclusion: ED and TPF were similar after BFR and FBF, indicating both conditions induce similar acute performance impairments after IIHE, which seems not to be caused by local (i.e., muscular) factors, but probably by central (i.e., neural) factors.