Standardized Exercise Protocol Research Articles

Acute Inflammatory Response to Eccentric Exercise in Young and Master Resistance-trained Athletes.

This study aimed to compare the acute inflammatory response following high-intensity eccentric exercise between resistance-trained young and master athletes with similar performance levels. Resistance-trained young (n=8; 22±2 years) and master (n=8; 52±4 years) male athletes of a similar performance level performed a standardized high-intensity eccentric squat exercise protocol (10 sets of half-squats at 70% of 1-repetition maximum). The serum concentration of 20 biomarkers related to tissue damage, inflammation, remodeling, and repair was measured at baseline, immediately after exercise, and over a 72 h recovery period. Both groups experienced similar muscle damage as evidenced by a comparable increase in creatine kinase activity 24 h after exercise (p<0.001). Interleukin-6 (p=0.009) and growth hormone (p<0.001) increased immediately post-exercise in both groups. Monocyte chemoattractant protein-1 increased immediately post-exercise only in young athletes (p=0.003) and then decreased 24 h later. There were no significant differences for the remaining variables, including cell markers related to neutrophil/macrophage activation or pro/anti-inflammatory cytokines. Resistance-trained young and master athletes, matched for performance level, showed an overall similar inflammatory response to eccentric exercise, possibly reflecting regulatory mechanisms or immunological adaptations to chronic stimulation in master athletes.

Skeletal muscle BMAL1 is necessary for transcriptional adaptation of local and peripheral tissues in response to endurance exercise training

ObjectiveIn this investigation, we addressed the contribution of the core circadian clock factor, BMAL1, in skeletal muscle to both acute transcriptional responses to exercise and transcriptional remodeling in response to exercise training. Additionally, we adopted a systems biology approach to investigate how loss of skeletal muscle BMAL1 altered peripheral tissue homeostasis as well as exercise training adaptations in iWAT, liver, heart, and lung of male mice. MethodsCombining inducible skeletal muscle specific BMAL1 knockout mice, physiological testing and standardized exercise protocols, we performed a multi-omic analysis (transcriptomics, chromatin accessibility and metabolomics) to explore loss of muscle BMAL1 on muscle and peripheral tissue responses to exercise. ResultsMuscle-specific BMAL1 knockout mice demonstrated a blunted transcriptional response to acute exercise, characterized by the lack of upregulation of well-established exercise responsive transcription factors including Nr4a3 and Ppargc1a. Six weeks of exercise training in muscle-specific BMAL1 knockout mice induced significantly greater and divergent transcriptomic and metabolomic changes in muscle. Surprisingly, liver, lung, inguinal white adipose and heart showed divergent exercise training transcriptomes with less than 5% of ‘exercise-training’ responsive genes shared for each tissue between genotypes. ConclusionsOur investigation has uncovered the critical role that BMAL1 plays in skeletal muscle as a key regulator of gene expression programs for both acute exercise and training adaptations. In addition, our work has uncovered the significant impact that altered exercise response in muscle and its likely impact on the system plays in the peripheral tissue adaptations to exercise training. Our work also demonstrates that if the muscle adaptations diverge to a more maladaptive state this is linked to increased gene expression signatures of inflammation across many tissues. Understanding the molecular targets and pathways contributing to health vs. maladaptive exercise adaptations will be critical for the next stage of therapeutic design for exercise mimetics.

Do tight nosebands have an effect on the upper airways of horses?

The public perception relating to the welfare of horses involved with equestrian sports is associated with training methods used and the presentation of horses at events. In this context, very tight nosebands, which are intended to prevent the horse from opening its mouth, also attract a lot of attention. Various studies have evaluated the impact of tight nosebands on stress parameters, whereas the effect of tight nosebands on upper airway function is unknown. Therefore, the aim of the study was to use overground endoscopy to evaluate changes in pharyngeal and laryngeal function when a tight noseband is fitted. Moreover, the ridden horse pain ethogram (RHpE) was applied to investigate signs of discomfort (Dyson et al., 2018). A randomized, blinded, and prospective study was performed. Sixteen warmblood horses consisting of twelve mares and four geldings with a mean age of 11.63 ± 3.53 years were ridden on 2 consecutive days with either loose or tight nosebands (two fingers or no space between bridge of the nose and noseband, respectively) and inserted endoscope in a random order. Videos were taken in a riding arena during a standardized exercise protocol involving beginner level tasks for 30 min in all gaits. For video analysis, freeze frames were prepared and analyzed at the beginning of the expiration phase. Pharyngeal diameter was measured using the pharynx-epiglottis ratio. Other findings (swallowing, pharyngeal collapse, soft palate movements, and secretion) were also evaluated. Moreover, the RHpE was applied. Descriptive statistics and generalized linear mixed effects models were used. Results with a p-value < 0.05 were considered statistically significant. While the pharynx-epiglottis ratio did not change significantly in horses ridden with loose versus tight nosebands, there was an increase in mean grade and total counts of parameters assessed in the pharyngeal region, for example, grade of secretion (1.5 [±SD 0.89] vs. 3.13 [±SD 0.96]; p = 0.0001), axial deviation of the aryepiglottic folds (0.29 [±SD 0.73] vs. 1.33 [±SD 1.44]; p = 0.01), and pharyngeal collapse (0.69 [±SD 0.87] vs. 1.88 [±SD 1.54]; p = 0.005) in horses ridden with tight nosebands. There was no RHpE score above 8 indicating musculoskeletal pain, but the RHpE scores were significantly higher in horses ridden with tight nosebands (p < 0.001). Video quality was limited when horses showed large amounts of secretion. Another limitation was the small number of horses. Results add to the evidence obtained in other studies that tight nosebands do not only cause adverse reactions based on the RHpE score such as head behind the vertical or intense staring but also contribute to changes in the pharyngeal region, such as increased secretion and collapse of pharyngeal structures. This may provide further support for future decisions regarding regulations on nosebands.

The analysis of the skeletal muscle metabolism is crucial for designing optimal exercise paradigms in type 2 diabetes mellitus

BackgroundType 2 diabetes mellitus (T2DM) is a chronic metabolic disease that commonly results from a high-calorie diet and sedentary lifestyle, leading to insulin resistance and glucose homeostasis perturbation. Physical activity is recommended as one first-line treatment in T2DM, but it leads to contrasted results. We hypothesized that, instead of applying standard exercise protocols, the prescription of personalized exercise programs specifically designed to reverse the potential metabolic alterations in skeletal muscle could result in better results.MethodsTo test this hypothesis, we drew the metabolic signature of the fast-twitch quadriceps muscle, based on a combined unbiased NMR spectroscopy and RT-qPCR study, in several T2DM mouse models of different genetic background (129S1/SvImJ, C57Bl/6J), sex and aetiology (high-fat diet (HFD) or HFD/Streptozotocin (STZ) induction or transgenic MKR (FVB-Tg Ckm-IGF1R*K1003R)1Dlr/J) mice. Three selected mouse models with unique muscular metabolic signatures were submitted to three different swimming-based programs, designed to address each metabolic specificity.ResultsWe found that depending on the genetic background, the sex, and the mode of T2DM induction, specific muscular adaptations occurred, including depressed glycolysis associated with elevated PDK4 expression, shift to β-oxidation, or deregulation of amino-acid homeostasis. Interestingly, dedicated swimming-based exercises designed to restore specific metabolic alterations in muscle were found optimal in improving systemic T2DM hallmarks, including a significant reduction in insulin resistance, the improvement of glucose homeostasis, and a delay in sensorimotor function alterations.ConclusionThe muscle metabolism constitutes an important clue for the design of precision exercises with potential clinical implications for T2DM patients.

Comparison of isokinetic exercise and standard exercise protocol in patients with spondyloarthropathies

Introduction: Spondyloarthropathy is a group of different chronic rheumatic diseases. There are a number of physiotherapy interventions that all aim to support the trunk flexors and extensors, relieve pain, and mobilize the joints. The aim of this study is to compare isokinetic exercises (IE) with a standard exercise protocol in patients with spondyloarthropathies. Methods: A total of 16 subjects participated in the study and were randomly divided into two groups: The group with the standard protocol (SP) and the other in the isokinetic protocol (IP). Both groups underwent the same follow-up testing: Muscle strength, pain, and functional status. Both groups underwent a total of 15 physiotherapy interventions over a 3-week period. Results: The mean age in the standard group was 36 ± 7.93 and in the isokinetic group 46.13 ± 13.88. In the isokinetic group, there was a difference in pain intensity between the second and third measurements (p = 0.016). There was an improvement in muscle strength in the isokinetic group (Cohen’s d = 0.33). At an angular velocity (AV) of 60°/s, this group is better than the delayed SP, while it is directly better at an AV of 90°/s (d = 0.30). The delayed measurement of the groups (IP) showed a lower functional deficit than the SP group (p = 0.012). Conclusion: Based on the results of this study and a search of the scientific literature, we can conclude that IE has been shown to be beneficial rather than harmful. Further longitudinal studies with a larger number of subjects are needed to investigate the effects of isokinetics on functional outcomes in rheumatology patients.

Cardiac diastolic maladaptation is associated with the severity of exercise intolerance in sickle cell anemia patients

This pilot study focusing on Sickle Cell Anemia (SCA) patients offers a comprehensive and integrative evaluation of respiratory, cardiovascular, hemodynamic, and metabolic variables during exercise. Knowing that diastolic dysfunction is frequent in this population, we hypothesize that a lack of cardiac adaptation through exercise might lead to premature increase in blood lactate concentrations in SCA patients, a potential trigger for acute disease complication. SCA patients were prospectively included in PHYSIO-EXDRE study and underwent a comprehensive stress test with a standardized incremental exercise protocol up to 4 mmol L−1 blood lactate concentration (BL4). Gas exchange, capillary lactate concentration and echocardiography were performed at baseline, during stress test (at ∼ 2 mmol L−1) and BL4. The population was divided into two groups and compared according to the median value of percentage of theoretical peak oxygen uptake (%V˙O2peakth\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\dot{\ ext{V}}\ ext{O}}_{2peakth}$$\\end{document}) at BL4. Twenty-nine patients were included (42 ± 12 years old, 48% of women). Most patients reached BL4 at low-intensity exercise [median value of predicted power output (W) was 37%], which corresponds to daily life activities. The median value of %V˙O2peakth\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\dot{\ ext{V}}\ ext{O}}_{2peakth}$$\\end{document} at BL4 was 39%. Interestingly, diastolic maladaptation using echocardiography during stress test along with hemoglobin concentration were independently associated to early occurrence of BL4. As BL4 occurs for low-intensity exercises, SCA patients may be subject to acidosis-related complications even during their daily life activities. Beyond assessing physical capacities, our study underlines that diastolic maladaptation during exercise is associated with an early increase in blood lactate concentration.

Rehabilitation exercises for kidney transplant recipients in an organ transplant ward: a best practice implementation project.

Kidney transplantation is an effective treatment for end-stage kidney disease. Kidney transplant recipients (KTRs) are prone to experiencing reduced physical function, depression, fatigue, and lack of exercise motivation due to their sedentary lifestyle before surgery. Exercise is an effective intervention for KTRs, but it has not been properly implemented in many practice settings. This project aimed to promote evidence-based exercises as part of KTRs' rehabilitation to improve their health outcomes. This project was informed by the JBI Evidence Implementation Framework. The project was conducted in the organ transplant ward of a tertiary comprehensive hospital in Changsha, China. Based on a summary of best evidence, 12 audit criteria were developed for the baseline and follow-up audits involving 30 patients and 20 nursing staff. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tool were used to identify barriers and facilitators and develop targeted strategies to improve issues. Compared with the baseline audit, significant improvements were achieved in most of the criteria in the follow-up audit, with 9 of the 12 criteria reaching 100% compliance. Notably, the 6-minute walk distance test results were significantly higher, while the Self-Rating Depression Scale and Self-Rating Anxiety Scale scores were significantly lower ( p < 0.05). This project demonstrates that evidence-based practice can improve the clinical practice of rehabilitation exercises for KTRs. The GRiP strategies proved to be extremely useful, notably, the formulation of a standardized rehabilitation exercise protocol, training, and enhancement of the exercising environment. Head nurses' leadership and decision-making also played an important role in the success of this project. http://links.lww.com/IJEBH/A180.

Physiological Adaptations to Progressive Endurance Exercise Training in Adult and Aged Rats: Insights from the Molecular Transducers of Physical Activity Consortium (MoTrPAC).

While regular physical activity is a cornerstone of health, wellness, and vitality, the impact of endurance exercise training on molecular signaling within and across tissues remains to be delineated. The Molecular Transducers of Physical Activity Consortium (MoTrPAC) was established to characterize molecular networks underlying the adaptive response to exercise. Here, we describe the endurance exercise training studies undertaken by the Preclinical Animal Sites Studies component of MoTrPAC, in which we sought to develop and implement a standardized endurance exercise protocol in a large cohort of rats. To this end, Adult (6-mo) and Aged (18-mo) female (n=151) and male (n=143) Fischer 344 rats were subjected to progressive treadmill training (5 d/wk, ∼70%-75% VO2max) for 1, 2, 4, or 8 wk; sedentary rats were studied as the control group. A total of 18 solid tissues, as well as blood, plasma, and feces, were collected to establish a publicly accessible biorepository and for extensive omics-based analyses by MoTrPAC. Treadmill training was highly effective, with robust improvements in skeletal muscle citrate synthase activity in as little as 1-2 wk and improvements in maximum run speed and maximal oxygen uptake by 4-8 wk. For body mass and composition, notable age- and sex-dependent responses were observed. This work in mature, treadmill-trained rats represents the most comprehensive and publicly accessible tissue biorepository, to date, and provides an unprecedented resource for studying temporal-, sex-, and age-specific responses to endurance exercise training in a preclinical rat model.

Left ventricle function and post-transcriptional events with exercise training in pigs.

Standardized exercise protocols have been shown to improve overall cardiovascular fitness, but direct effects on left ventricular (LV) function, particularly diastolic function and relation to post-transcriptional molecular pathways (microRNAs (miRs)) are poorly understood. This project tested the central hypothesis that adaptive LV remodeling resulting from a large animal exercise training protocol, would be directly associated with specific miRs responsible for regulating pathways relevant to LV myocardial stiffness and geometry. Pigs (n = 9; 25 Kg) underwent a 4 week exercise training protocol (10 degrees elevation, 2.5 mph, 10 min, 5 days/week) whereby LV chamber stiffness (KC) and regional myocardial stiffness (rKm) were measured by Doppler/speckle tracking echocardiography. Age and weight matched non-exercise pigs (n = 6) served as controls. LV KC fell by approximately 50% and rKm by 30% following exercise (both p < 0.05). Using an 84 miR array, 34 (40%) miRs changed with exercise, whereby 8 of the changed miRs (miR-19a, miR-22, miR-30e, miR-99a, miR-142, miR-144, miR-199a, and miR-497) were correlated to the change in KC (r ≥ 0.5 p < 0.05) and mapped to matrix and calcium handling processes. Additionally, miR-22 and miR-30e decreased with exercise and mapped to a localized inflammatory process, the inflammasome (NLRP-3, whereby a 2-fold decrease in NLRP-3 mRNA occurred with exercise (p < 0.05). Chronic exercise reduced LV chamber and myocardial stiffness and was correlated to miRs that map to myocardial relaxation processes as well as local inflammatory pathways. These unique findings set the stage for utilization of myocardial miR profiling to identify underlying mechanisms by which exercise causes changes in LV myocardial structure and function.

Mobile Application Based Pelvic Floor Muscle Training for Treatment of Stress Urinary Incontinence: An Assessor-Blind, Randomized, Controlled Trial.

A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to increase treatment adherence. This study compared a reduction in SUI, exercise adherence, and quality of life in PFMT with animation vs. standard instruction. A prospective, single-blind, randomized control trial was collected. SUI patients were randomized into the application or control groups confirmed using a one-hour pad test. In the intervention group, the PFMT application was applied via mobile phone (PFMT with animations, recording system, and reminder system). The standard exercise protocol was similar in both groups. Additional follow-up was conducted at 4, 8, and 12 weeks. A total of 51 participants were randomized to the application (n = 26) and control groups (n = 25), respectively. At the 12-week follow-up, there was no significant difference between the two groups in terms of SUI cure rate, SUI severity by pad test, and daily SUI episodes from the bladder diary (p-value of 0.695, 0.472, and 0.338, respectively). The mean PFME adherence in the application group was higher than the control group at 8 weeks (66.3 ± 13.6 vs. 52.7 ± 16.6, p = 0.002) and 12 weeks (59.1 ± 13.9 vs. 37.8 ± 11.0, p = 0.001). The application group reported no difference from the conventional PFMT group in terms of improvements in SUI cure rate, symptom severity, and quality of life effects at 12-week follow-up. However, the improvement evaluated by the mean difference in SUI episodes and quality of life effects (ICIQ-UI SF) reported a better outcome in the mobile app group. The PFMT application has been proven to be an effective tool that improves PFMT adherence.

In vivo imaging of patients with chronic pruritus of unknown origin reveals partial sweat duct obstruction with partial itch resolution upon retinoid treatment.

Chronic pruritus of unknown origin (CPUO) is poorly understood and lacks effective treatment options. We aimed to elucidate abnormalities in the sweat apparatus of patients with CPUO, and to assess efficacy and safety of treatment with systemic retinoids. An initial case-control study included 20 affected patients and five healthy controls, for whom heat and sweating were induced, either through a standardized exercise protocol or ingestion of hot water. In vivo high-definition optical coherence tomography, whole-body starch-iodine testing, and skin biopsy for immunofluorescence staining were done to evaluate for sweat duct obstruction. A subsequent retrospective cohort analysis included 56 patients with CPUO, seen at an Itch subspecialty clinic of a single tertiary referral centre, who failed conventional treatments and were treated with isotretinoin and/or acitretin from May 2014 to November 2020. Treatment response to retinoids was defined as a sustained reduction in itch score of ≥2/10. Safety was assessed by proportion stopping treatment due to side effects. In vivo imaging in 19 (95%) patients revealed features of partial keratinaceous sweat duct obstruction with statistically significant luminal dilatation compared to controls. Immunofluorescence studies of three patients' paired lesional/non-lesional biopsies revealed dermcidin accumulation within sweat glands coupled with dermcidin leakage in itchy skin. Fifty-six patients (mean [SD] age 55.2 [17.5] years, 69.6% male) were treated with systemic retinoids. Mean (SD) duration of itch was 116.3 (140.4) months and mean (SD) itch score was 8.2 (1.8). Forty-one (73.2%) initially received isotretinoin, and 15 (26.8%) acitretin. At three months, mean itch score reduced by 2.38 (95% CI -3.2 to -1.6, p < 0.0001). Thirty-eight (67.9%) had a sustained response. Eight (14.81%) achieved an itch score of 0 or 1, with four stopping treatment for a mean (SD) of 318.5 (291.2) days without relapse. Eight (14.3%) stopped or switched retinoid due to adverse effects, with similar incidences between both retinoids, the commonest being dryness. Based on novel findings from physiological imaging studies identifying partial keratinaceous sweat duct obstruction in CPUO, we instituted systemic retinoid treatment to address the underlying pathology. In patients who failed conventional therapies, the treatment appears effective and safe.

The efficacy in shoulder range of motion of a snapping manual maneuver added to a standardized exercise protocol in axillary web syndrome: a randomized controlled trial

Purpose Axillary Web Syndrome (AWS) is a common sequela after surgical axillary lymph node dissection (ALND) often manifesting with reduced range of motion (ROM) of the limb, which requires rehabilitation. Notwithstanding, a standardized rehabilitation protocol is currently lacking in clinical practice. Our primary objective was therefore to evaluate the effectiveness of the use of a snapping manual maneuver (SMM, used in our clinical practice) to increase ROM during abduction (ABD) when compared with a standardized stretching exercise (SSE) protocol. A three-year follow-up of the enrolled patients was also carried out to determine the incidence of Breast Cancer-Related Lymphedema (BCRL). Materials and methods Between July 2013 and January 2019, we conducted a single-blinded randomized clinical trial. A total of 60 patients, who underwent ALND in our hospital, came to our clinic under medical advice or on voluntary access and reported AWS symptoms. The patients were randomly assigned into two equally divided groups. The treatment of group one consists in the execution of a supervised SSEs protocol, while group two additionally received a manual snapping maneuver. Patients of both groups received two treatment sessions within two weeks. At the end of the session, they were asked to continue the exercises autonomously on a daily basis, three times per day, for one month. Results There were no statically significant differences in ROM at our one-month follow-up and the incidence of BCRL was equally distributed after three years. Conclusions The use of the manual snapping maneuver in addition to stretching once per week for two weeks does not appear to improve the outcome of the patients in comparison with stretching alone and does not appear to be related to lymphedema in our 3 years follow-up.

Rehabilitation after Distal Radius Fractures: Opportunities for Improvement.

Background Exercises are frequently prescribed to regain function; yet there is no consensus on a standardized protocol, and adherence is low. Smart technology innovations, such as mobile applications, may be useful to provide home-based patient support in rehabilitation after distal radius fractures. Purposes Our purpose was to establish the potential of digital innovations for support and monitoring of patients and treatment adherence in rehabilitation programs, and additionally, to compare the current practice among physiotherapists to the various wrist exercise regimens and their effectiveness as described in the literature. Methods Standard practice, including the use of support tools for treatment adherence, was evaluated using a nationwide survey. Then, scientific databases were searched using "distal radius fracture" and "physiotherapy" or "exercise therapy," and related search terms, up until 23 March 2023. Results of the survey and literature review were compared. Results The survey was completed by 92 therapists. Nonstandardized support tools were used by 81.6% of respondents; 53.2% used some form of technology, including taking photos on the patients' smartphone for home reference. In the literature review, 23 studies were included, of which five described an exercise protocol. Treatment adherence was not reported in any of the included studies. Two studies described the use of smart technology or support tools. Conclusions There is no consensus on a standardized exercise protocol for rehabilitation after distal radius fractures, neither from a systematic literature search nor from a nationwide survey. Smart technology may facilitate monitoring of patients and exercise adherence, hereby supporting self-efficacy and improving adherence and outcomes.

584-P: Similar Variability in Pre- and Post-exercise Glucose Levels between Morning-Fasted and Afternoon-Fed Resistance Exercise in Adults with Type 1 Diabetes

Background: Exercise increases longevity and decreases the incidence/progression of diabetes-related complications for those with type 1 diabetes (T1D), but it complicates blood glucose management. Understanding variability in blood glucose response to exercise may help guide choices of exercise strategies for people with T1D. Our primary objective was to compare the variability in capillary glucose (CG) response to morning, fasted resistance exercise (AMre), to afternoon post-prandial exercise (PMre). We hypothesized that CG responses would be less variable during morning fasted RE. Methods: Seven participants [4F/3M; mean (SD): age = 29.1 (11.3) yrs; diabetes duration = 19.4 (6.7) yrs; HbA1c = 7.5 (0.7)%] completed a standardized resistance exercise protocol (3 sets of 8 repetitions of seven exercises involving all major muscle groups with 90 seconds between sets) three times in the morning (~7am) while in a fasted state and three times in the afternoon (~5pm) in a fed state. Sessions were performed in a random order with at least 48 hrs between sessions. Participants aimed for close consistency in the timing of the sessions, any associated meals (PMre only) and related insulin adjustments. To determine the intra-individual variability in CG response during AMre and PMre, as well as subsequent 30-minute recovery periods, we performed paired t-tests of the within-participant SD of the change in CG. Results: From the beginning to the end of RE, mean within-participant SD of CG change was 1.2 (0.5) and 1.9 (1.2) mmol/L during AMre and PMre respectively (p=0.08), and 1.2 (0.4) and 1.2 (1.2) mmol/L during subsequent 30-minute recovery periods (p=0.98). Conclusion: For adults with T1D the variability in CG response may be similar between AMre and PMre. More data are needed to clarify these effects. Disclosure R.Mcclure: None. C.J.Nitz: None. J.E.Yardley: Speaker's Bureau; Dexcom, Inc., Abbott. Funding LifeScan

Evaluation of jacketed telemetry in rats for cardiorespiratory phenotyping at exercise

The challenge of cardiorespiratory function through physical exercise is highly relevant to reveal pathological phenotypes, both in humans and animals, but available monitoring tools (implanted telemetry, metabolic chamber) remain challenging to use in the context of exercise. Recently, jacketed telemetry systems for small laboratory animals have been developed, allowing non-invasive physiological monitoring in various conditions. The aim of this work was to evaluate the feasibility, using this new technology, to monitor cardiorespiratory function during treadmill exercise in rats. The effects of a moderate-intensity treadmill exercise protocol were monitored using a non-invasive telemetric jacket on a group of untrained male wistar rats (N = 9, 9–10 weeks). This incremental protocol consisted in increase the speed level of 5 cm/sec every 2 minutes (Speed: from 10 to 35 cm/sec max). Heart rate (HR), respiratory rate (RespR) and activity level (AL) were monitored with a small electronic Bluetooth device (15 g) and analyzed during a control state (Baseline), the last 30 seconds of each speed level and at post-exercise recovery. The animals were equipped with the device and placed back in their home cage. After 25 minutes of stabilization, HR was 392 ± 36 bpm, RespR was 173 ± 53 brpm, and AL was 15 ± 12 mg. All animals successfully ran on the treadmill with the jacket to the maximum speed of 35 cm/sec. Exercise induced a significant physiological increase in HR (+26%, 104 ± 21 bpm, P < 0.01) and RespR (+73%, 126 ± 22 brpm, P < 0.01). In conclusion, this novel telemetry jacket can be used to monitor cardiorespiratory parameters adaptation during a standard forced exercise protocol. Jacketed telemetry provides a completely non-invasive way to study the phenotypes of animals avoiding any additional risk on fragile pathological models and meeting the regulatory 3Rs requirements. As illustrated phenotype characterization can be enriched with a monitoring of the animal in various situations (treadmill, home cage, but also metabolic or hypoxia cage, etc.…).

Low-load exercise program and platelet-rich plasma for intrasubstance tear in lateral elbow tendinopathy: protocol for a double-blinded randomized clinical trial

Background: Lateral elbow tendinopathy (LET) is one of the most common musculoskeletal conditions. Treatment includes a series of therapeutic alternatives. However, the resolution takes nearly 24 months. Platelet-rich plasma (PRP) is an effective option, especially when the tendon presents an intrasubstance tear (IST). It is unknown what type of rehabilitation plan is more effective after this treatment. Aim: To perform a study protocol of a double-blinded, randomized clinical trial to determine the efficacy of a specific low-load exercise program in patients with LET and IST treatment with PRP under US-guided Methods: A single-center, parallel-controlled, randomized, double-blinded, phase III trial was pro-posed. Patients over 18 years-old diagnosed with LET and IST treated with US-guided PRP will be selected. Two arms of treatment will be allocated with a ratio a 1:1 ratio (low-load exercise protocol vs. conventional exercise program). The principal outcome will be the reduction of the tendon tear size. Secondary outcomes will include Patient-Rated Tennis Elbow Evaluation score, visual analogue scale, and handgrip at baseline, 3, 6, and 12 months of follow-up. Statistical tests will be 2-sided t-test with an alpha level (significance level) of 0.05. Discussion: The intervention aims to significantly reduce tendon tear size and improve pain and functionality in patients with LET and IST treated with US-guided PRP. We proposed one of the first studies in the literature that considered a detailed standardized exercise protocol applied to these patients. The result could be used to speed up treatment save time and money, help evaluate guidelines, and improve patients' and athletes' quality of life.

Incremental Increases in Non-Exercise Estimated Fitness Reduce Subsequent Depressive Symptoms

The purpose of this observational retrospective cohort study was to examine the association between non-exercise estimated Cardiorespiratory Fitness (eCRF) and incident depressive symptoms. A total of 14,431 participants from the Aerobics Center Longitudinal Study cohort between February 5, 1979 and December 31, 1998, were followed for incident depressive symptoms through December 31, 1999. Depressive symptoms were determined by the CES-D 10 item questionnaire. eCRF in MET was determined from a non-exercise algorithm developed by Jackson and further grouped into sex-specific tertiles. Multivariable logistic regression was used to estimate odds ratios and 95% confidence intervals. 11.7% of men and 14.8% of women developed depressive symptoms after a mean of 12 follow- up years. In the overall sample, the odds ratio of depressive symptoms was 0.84 (95% CI 0.74-0.95) times lower in the middle eCRF tertile than in the lower tertile and was 0.74 (95% CI 0.66-0.85) times lower in the highest tertile. Each 1-MET increase in fitness reduced the odds ratio for depressive symptoms by 0.91 times (95% CI 0.89-0.93). The pattern of the association between eCRF and incident depressive symptoms was consistent between men and women, however, the magnitude of the risk reduction was smaller in women than in men. eCRF is a useful predictor of depressive symptoms. The non-traditional way of estimating CRF might provide more clinical utility compared to CRF measured using standard exercise protocols.

Exercise testing in top athletes

Exercise testing is an essential part of the annual sports medical check-up for competitive athletes. The aim of the examination is to assess the current health status and to perform medical clearance for competitive sports. In addition, assessment of intraindividual changes over time, interindividual comparisons, and determination of training recommendations are of interest. For the assessment of cardiopulmonary fitness, abicycle or treadmill ergometry with ECG recordings is usually conducted. The exercise test is performed according to standardized exercise protocols until maximum individual exhaustion. In competitive sports, understanding of the muscular metabolic situation during exercise is crucial for assessing current exercise capacity and for managing workouts. Therefore, exercise tests are often performed as lactate performance testing or cardiopulmonary exercise test. Lactate performance testing is one of the most frequently used methods regarding exercise testing in competitive sports and is afixed component in most of the annual medical check-ups, which are performed in the sports medicine examination centers of the German Olympic Sports Confederation (DOSB). It enables the analysis of aerobic and anaerobic metabolism during exercise, which allows identification of individual endurance training intensities based on the underlying metabolism. Cardiopulmonary exercise testing is also suitable to determine the maximum oxygen uptake and to better understand medical issues related to exercise capacity.

Validation of Wearable Device Consisting of a Smart Shirt with Built-In Bioelectrodes and a Wireless Transmitter for Heart Rate Monitoring in Light to Moderate Physical Work

Real-time monitoring of heart rate is useful for monitoring workers. Wearable heart rate monitors worn on the upper body are less susceptible to artefacts caused by arm and wrist movements than popular wristband-type sensors using the photoplethysmography method. Therefore, they are considered suitable for stable and accurate measurement for various movements. In this study, we conducted an experiment to verify the accuracy of our developed and commercially available wearable heart rate monitor consisting of a smart shirt with bioelectrodes and a transmitter, assuming a real-world work environment with physical loads. An exercise protocol was designed to light to moderate intensity according to international standards because no standard exercise protocol for the validation simulating these works has been reported. This protocol includes worker-specific movements such as applying external vibration and lifting and lowering loads. In the experiment, we simultaneously measured the instantaneous heart rate with the above wearable device and a Holter monitor as a reference to evaluate mean absolute percentage error (MAPE). The MAPE was 0.92% or less for all exercise protocols conducted. This value indicates that the accuracy of the wearable device is high enough for use in real-world cases of physical load in light to moderate intensity tasks such as those in our experimental protocol. In addition, the experimental protocol and measurement data devised in this study can be used as a benchmark for other wearable heart rate monitors for use for similar purposes.

VP.89 Skeletal muscle after a single bout of eccentric exercise in myotonic dystrophy type 1: a complete proteomic analysis

Myotonic dystrophy type 1 (DM1) is a multisystemic progressive genetic disease that causes muscle weakness and wasting. Strength training has been shown to be safe and can induce maximal strength gains. However, the underlying molecular mechanisms of these maximal strength gains remain unclear. The aim of this study is to determine how a single bout of eccentric exercise modulates protein expression in DM1 individuals compared to controls. Eight men with DM1 and five healthy controls completed the study. On day zero, a biopsy of the vastus lateralis was taken. On day eight, participants completed a standardized eccentric knee extension exercise protocol of the biopsied leg on an isokinetic device. 24 hours later, on day nine, a second biopsy was taken in the same muscle. Proteomics were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS): all samples were pooled to create an ion library which was used to assess muscle protein expression in individual samples. A total of 894 proteins were identified. Protein expression and its modulation by exercise were heterogenous in DM1 individuals. The expression of 111 proteins was significantly modulated by exercise for the control subjects while 50 were significantly modulated in DM1 subjects. Of these proteins, 9 had increased their expression in both groups. This includes 4 structural proteins (FLNC, NEXN, XIRP1 and NRAP), 2 translation factors (EF2 and IF5), a ubiquitin and skeletal muscle differentiation modulator (KLHL40), a chaperone protein (HS90B) and a neutrophil serine protease inhibitor (ILEU). In both groups, a mitochondrial protein (NDUB8) had decreased its expression. Further analyses are being conducted to assess how DM1 individuals responded differently to exercise compared to healthy controls. In conclusion, despite the genetic default, DM1 muscle has some similar responses to exercise compared to healthy controls although it remains heterogenous among DM1 individuals.