VO2max Research Articles

Implementation of nutrition care process in Indonesian athletes and its effect on nutritional status and aerobic capacity performance

Introduction: Despite the critical function of a nutritionist, only a few sports training centres for students in Indonesia have one. This study aimed to determine the effect of the nutrition care process (NCP) on athletes’ nutritional status and aerobic capacity performance. Methods: This cohort study was conducted in 2022 (May–August) in four training centres (TC) in Indonesia. Subjects were athletes who have been dwelling in TC for at least three months, excluding those absent for >14 days due to a competition or other commitments during the data collection period. NCP included the assistance of trained sports nutritionists. In total, 114 athletes participated in this study: 90 strength athletes and 24 endurance athletes. The participants were aged 14-19 years old with approximately (mean+SD) 6+2.5 years of experience in specific sports. Results: After three months of NCP, knowledge of nutrition (p=0.013), body fat composition (p<0.001), skinfold thickness scores (p<0.001), and performance (p<0.001) of athletes significantly improved. In spite of good intakes of protein and fat, none of the intakes showed significant changes (p>0.05). Furthermore, improved knowledge of sports nutrition and exercise science had a positive impact on dormitory meal choices. Conclusion: Overall, three months of NCP had a significant effect on athletes’ knowledge of nutrition, body fat composition, skinfold thickness, and also VO2Max.

Trends and Future Directions in the Sports Performance of Deaf and Hard-of-Hearing Athletes: A Systematic Review

The aim of this systematic review was twofold: to identify the main trends and issues that are being addressed by researchers in the context of physical fitness and sports performance in deaf and hard-of-hearing (D/HH) athletes and to indicate the needs and future directions that should be implemented in the training process of athletes with hearing impairments. The methodology of this systematic review was planned according to PRISMA guidelines. A search of electronic databases (PubMed, EBSCO, Scopus) was conducted to identify all studies on physical fitness, sports performance and participation, and D/HH athletes from 2003 to 2024. In total, 87 full-text articles were assessed to determine eligibility, while 34 studies met the inclusion criteria and were subjected to detailed analysis and assessment of their methodological quality. The presented systematic review indicates evidence that D/HH athletes are characterized by a similar or higher level in selected motor abilities compared to hearing athletes. Moreover, it seems that hearing impairment is not a barrier in the development of an athlete’s physical fitness, including aerobic capacity, muscular strength and power or speed of reaction. Furthermore, inclusion in sports participation and specific tools (i.e., communication aids) appear to be crucial factors for performance enhancement.

Effectiveness of maximum, explosive and combined strength training on endurance runners performance indicators: a systematic review and meta-analysis

Objective: This study aimed to analyze the effect of practicing maximum strength (MAX), explosive strength (EXP), or both combined (COMB) on seven runners’ performance indicators: vertical jump (VJ), one-repetition maximum squat (1RM), peak velocity/peak running speed (PV), lactate threshold (LT), middle-distance time trial (TT), maximum oxygen consumption (VO2max), and running economy (RE). Methods: A systematic review (Scopus, Web of Science, Sports Discuss, PubMed) with meta-analysis was conducted following PRISMA standards. Inclusion criteria (PICOS) were: Recreational or well-trained athletes aged 18-45 performing concurrent training for at least five weeks. The search terms used were related to different types of strength/endurance and participants’ age and sports modality. Twenty manuscripts were selected, and quality assessed with PEDro. Results: MAX training is more effective than EXP and COMB in improving VJ, 1RM, and PV, while COMB is more effective than MAX and EXP to enhance TT. MAX is more effective than EXP in improving LT. Concurrent workouts do not provide additional benefits to VO2max. It is unknown which strength modality (MAX, EXP, or COMB) is more effective in improving RE. Conclusion: Concurrent training is more effective than single-mode endurance training for enhancing specific performance variables in adult endurance runners. Middle- and long-distance runners may consider incorporating MAX training to target specific goals (i.e., improving VJ, 1RM, LT, PV) while utilizing COMB training to enhance TT. Certain variables may benefit from EXP. New randomized controlled trials are required to confirm these findings. Keywords: endurance, running, concurrent training, maximum strength, explosive strength

Informativeness of the LDF method in assessing physical performance

In healthy volunteers, physical performance was assessed according to PWC170 tests, maximum oxygen consumption and microcirculation status by laser Doppler flowmetry (LDF) using a computerized LAKK-02 analyzer. The performance indicators corresponded to the norms of the age group, while significant correlations were revealed with the indicators obtained during the LDF, which confirms the informativeness of the method.

Assessment of oxygen kinetic parameters for closely related ammonia-oxidizing bacteria.

The reaction kinetics of lithotrophic ammonia-oxidizing bacteria (AOB) are strongly dependent on dissolved oxygen (DO) as their metabolism is an aerobic process. In this study, we estimate the kinetic parameters, including the oxygen affinity constant (Km[O2]) and the maximum oxygen consumption rate (Vmax[O2]), of different AOB species, by fitting the data to the Michaelis-Menten equation using nonlinear regression analysis. An example for three different species of Nitrosomonas bacteria (N. europaea, N. eutropha, and N. mobilis) in monoculture is given, finding a Km[O2] of 0.25±0.05mg l-1, 0.47±0.09mg l-1, and 0.28±0.08mg l-1, and a Vmax[O2] of 0.07±0.04 pg h-1cell-1, 0.25±0.06 pg h-1cell-1, and 0.02±0.001 pg h-1cell-1 for N. europaea, N. eutropha, and N. mobilis, respectively. This study shows that of the analyzed AOB, N. europaea has the highest affinity towards oxygen and N. eutropha the lowest affinity towards oxygen, indicating that the former can convert ammonia even under low DO conditions. These results improve the understanding of the ecophysiology of AOB in the environment. The accuracy of mathematically modelled ammonia oxidation can be improved, allowing the implementation of better management practices to restore the nitrogen cycle in natural and engineered water systems.

The complicated relationship between asthma and swimming

Introduction: Apart from pharmacological treatment, non-pharmacological strategies including physical activity play a significant role in the management of asthma. The aim of this paper is to examine various topics related to swimming and asthma. They include the detailed effect of swimming on asthma control,the potential role of swimming in early childhood asthma development, exercise induced asthma in swimmers as well as the relationship between asthma and cold water swimming. Review methods: This article is based on the literature found in the PubMed Database from the period of 1971-2024 with the use of keywords such as “asthma”, “swimming”, “cold water swimming”, “exercise induced asthma”, “childhood asthma” Description of the state of knowledge: Swimming is a safe form of physical activity for asthma patients.Swimming training enhances aerobic capacity, reduces exercise-induced bronchoconstriction and improves lung function in both pediatric and adult patients. However, there is a concern regarding indoor swimming pools that chlorine can potentially induce airway inflammation. There is research suggesting that early life swimming pool exposure may contribute to the asthma development in atopic children. There is some premise to the thought that cold water swimming may help alleviate asthma symptoms, but it also carries many risks.Swimming is a major cause of exercise induced asthma in professional athletes. Conclusions: Alongside appropriate pharmacological treatment, swimming is a valuable strategy in asthma management in both pediatric and adult asthma patients. The risks of chlorinating pools are still not known to outweigh the benefits of swimming for asthmatics. Further research should be carried out on safety of early swimming in atopic children. Cold water swimming should also be evaluated in terms of safety and potential benefits for asthma patients.

Physiological Responses of Wheelchair Basketball Athletes to a Combined Aerobic and Anaerobic Training Program

Among the multifarious adapted sports, wheelchair basketball stands out as a highly recommended group activity among individuals with paraplegia, including those with Spinal Cord Injury (SCI). Athletes facing this particular impairment exhibit distinct alterations in their metabolic, cardiorespiratory, neuromuscular, and thermoregulatory systems, ultimately leading to a diminished physiological respiratory capacity in comparison to able-bodied individuals or those with other forms of impairments. The primary objective of the present research endeavor is therefore to explore the impact of a comprehensive exercise regime, encompassing both aerobic and anaerobic components, upon the enhancement of the aerobic capacity of wheelchair basketball athletes. A total of 32 wheelchair basketball players, ranging in age from 34 to 42, were enlisted in the study, with half allocated to an experimental group engaging in combined aerobic and anaerobic training [EG, n = 16], while the remaining participants were assigned to a control group undertaking solely aerobic exercise training [CG, n = 16]. The 12-minute wheelchair propulsion distance was utilized to evaluate the V̇O2peak in individuals with paraplegia, both before and after the intervention. The findings revealed a significant Time x Group interaction for the 12-minute wheelchair propulsion distance variable, highlighting a notable enhancement in the treatment group (p < 0.001). In contrast, no substantial changes were detected in the control group. Thus, the outcomes suggest that the integration of aerobic and anaerobic exercise yields a highly positive impact on the aerobic performance of wheelchair basketball players. Key words: physiology; exercise; sport; spinal cord injuries; cardiorespiratory fitness.

Time-course for onset and decay of physiological adaptations in endurance trained athletes undertaking prolonged heat acclimation training

ABSTRACT Short-term heat acclimation (HA) appears adequate for maximizing sudomotor adaptations and enhancing thermal resilience in trained athletes. However, for enhanced erythropoiesis and transfer effects to exercise capacity in cooler environments, prolonged HA appears necessary. To establish the time-course for physiological adaptations and performance effects, 20 male elite cyclists were divided into an intervention group (HEAT; n = 10) completing 5 weeks of HA (six one-hour HA-training sessions per week) and control (n = 10) tested pre and post in hot (40°C) and cool conditions (20°C). HEAT completed tests at 40°C every week during HA with measures of sweat rate and [Na+] and a decay test 2 weeks after termination of HA. HEAT improved time for exhaustion by 15 min (p < 0.001) in the 40°C test, increased sweat rate by 0.44 L/hour (p < 0.001), and lowered sweat sodium concentration [Na+] by 14.1 mmol/L (p = 0.006) from pre- to post-HA, with performance returning to pre-HA levels in the 2-week decay test. Total hemoglobin mass (tHbmass) was increased by 30 grams (+3%, p = 0.048) after 3 weeks and 40 grams (+4%, p = 0.038) after 5 weeks in HEAT but returned to pre-HA levels at the 2-week decay test. HEAT improved incremental peak power output (+12 W, p = 0.001) without significant changes in maximal oxygen uptake (p = 0.094). In conclusion, improvements in heat exercise tolerance and sudomotor adaptations materialized during the first ~3 weeks and the entire 5 weeks of HA augmented both cool exercise capacity and tHbmass. However, the 2-week post-HA evaluation demonstrated a rapid decay of physiological adaptations and exercise capacity in the heat.

Effects of Exhaustive Exercise on Adiponectin and High-Molecular-Weight Oligomer Levels in Male Amateur Athletes.

Physical activity promotes metabolic health and prevents lifestyle-related diseases. Adiponectin is specifically produced by adipose tissue and comes in three forms, differing in terms of weight: trimers (LMW), hexamers (MMW), and high-molecular-weight (HMW) oligomers. The oligomers are associated with the beneficial effects of adiponectin. In this study, we aimed to investigate the impact of a single bout of exhaustive exercise on adiponectin expression in 25 male amateur athletes, divided into two groups, one comprising young adults (YAs) (n = 15), and the other comprising middle-aged adults (MAs) (n = 10). Body fat was estimated through skinfold thickness. Adiponectin levels were assessed at baseline and at 15 min and 24 h post-exercise, while HMW oligomer levels were evaluated at baseline and at 24 h post-exercise. We observed a significant increase in total adiponectin at both 15 min and 24 h after exercise, with there being a more evident effect among the YA subjects. HMW oligomers also increased significantly after exercise both in the total sample and among the YA subjects, but this was not the case in the MA subjects. The increase in adiponectin levels was significantly associated with Powerpeak. Furthermore, a significant inverse correlation was found between basal adiponectin and VO2peak and Powerpeak. In conclusion, a single bout of exhaustive exercise can rapidly and significantly enhance the basal circulating adiponectin concentration, which seems to be negatively associated with maximal aerobic capacity.

Abstract We147: The Utility of Cardiopulmonary Exercise Testing (CPET) Amongst Male and Female athletes to Differentiate Between Physiological Left Ventricular Enlargement and Mildly Depressed Resting Systolic Function and Athletic Individuals with Dilated Cardiomyopathy.

Background: Athletes frequently reveal a dilated left ventricle (LV),some also demonstrate a co-existent mildly depressed LV ejection fraction, raising the possibility of mild dilated cardiomyopathy (DCM). The maximal oxygen consumption(VO2max) is a valuable tool for assessing fitness, largely determined by cardiac output. References ranges derived from the general population, may have limitations when assessing athletes with primary myocardial disease. This study investigated the role of VO2max and VO2max predicted (V02pred) to differentiate between physiological LV dilatation and athletic individuals with DCM in male and female athletes. Methods: 147 male and 35 female athletes with dilated LV(mean age 35.4years, 34.5 years respectively) underwent a 25watt cycle ergometer continuous ramp protocol. 75% males and 67% females participated in endurance sports, remaining participating in mixed sports. 52 had mild DCM, 62 defined as healthy control athletes(dilated LV) and 68 were Grey zone (dilated LV and mildly depressed LVEF) Results: DCM males (N=39) revealed a lower mean VO2max than male control (N=46), 34.9ml/kg/min and 48ml/kg/min respectively (p value &lt;0.001). DCM females(N=13) showed lower VO2max of 29.9ml/min/kg than female control (N=16) who revealed similar values to male controls (48 ml/kg/min)(p value &lt;0.001). 62 male Grey zones and 6 female Grey zone revealed lower VO2max than controls 43.1ml/min/kg and 34.1ml/min/kg respectively. DCM females had lower VO2pred than control females 119% and 161% respectively but significantly higher than their male counterparts, means of 106% and 123% respectively (p value &lt;0.001). Male and female grey zones had lower mean VO2pred than controls, 121% and 106% respectively. Higher VO2max of ≥38ml/kg/min and VO2pred of ≥120% gave a sensitivity, specificity of 84.7% and 77%respectively to differentiate healthy athletes and athletic DCMs in males and females. Only41.1% Grey zone athletes were able to achieve above these thresholds. Conclusion: Female athletes with dilated LV may reveal supranormal VO2max which can equal their male counterparts. Furthermore, athletic females with physiological or pathological LV dilatation can reveal higher VO2pred than male athletes. Most athletic DCM individuals show lower CPET parameters than controls athletes but can still achieve greater than normal measurements seen in healthy general population. VO2 may have a role in assisting in differentiating healthy athletes from athletic DCM.

Safety and Effectiveness of Selexipag in Pediatric Pulmonary Hypertension: A Retrospective Multicenter Cohort Study

ObjectiveTo describe the safety and effectiveness of treating pediatric patients who have pulmonary arterial hypertension (PAH) with selexipag in a real-world, multi-center cohort, given that data supporting its use in pediatric PAH are sparse. Study designWe report a multi-center, retrospective, cohort study of children with PAH treated with selexipag. Demographic and clinical variables were extracted from the medical records. Clinical parameters were analyzed at 3 timepoints: pre-selexipag, 3-12 months post-selexipag, and >12 months follow-up. ResultsEighty-seven patients were included, 32 received selexipag as add-on to background therapy, and 55 transitioned from another prostanoid. Median starting and final doses were 4.7 and 28.5 μg/kg/dose BID, respectively. Add-on patients demonstrated improved indexed pulmonary to systemic vascular resistance ratio after selexipag initiation (PVRi/SVRi, 0.62v0.53, p=0.034) with a lower average mean pulmonary artery pressure (MPAP, 46v39 mmHg, p=NS), and oxygen consumption (VO2 max 27.8v30.9 mL/kg/min, p=NS). Transition patients demonstrated stable MPAP (47v45 mmHg, p=NS) and a lower mean PVRi (10.9v8.2 Wood units*m2, p=NS) but late functional worsening in some with VO2 max decreased at follow-up (26.0v19.5 ml/kg/min). Side effects were noted in 40% of the cohort but prompted discontinuation in only 2%. ConclusionsIn a large, multi-center cohort, the oral prostacyclin agonist selexipag demonstrates favorable tolerability and effectiveness. Add-on patients demonstrated early hemodynamic improvement. Transition patients demonstrated early stability with risk of late functional worsening, highlighting the importance of ongoing monitoring.

Abstract We052: Angiotensin-converting enzyme (ACE): A new role to regulate β-oxidation in monocytic cells

The metabolic failure of macrophages to adequately process lipid, and the deleterious effects of ingested lipid on macrophage behavior, is central to the etiology of atherosclerosis. As angiotensin-converting enzyme (ACE) has major effects on myeloid cell metabolism, we examined the role of macrophage ACE in a mouse model of atherosclerosis. Animals with increased macrophage ACE expression (ACE 10/10 mice) have a marked reduction in atherosclerosis vs. WT mice. Macrophages from both the aorta and peritoneum of ACE 10/10 express increased PPARα and higher levels of effector molecules downstream of PPARα. These macrophages have increased basal and maximal oxygen consumption compared to WT macrophages. When exposed to lipid in vitro, ACE 10/10 macrophages ingest more fatty acid than WT and have increased efferocytosis. ACE 10/10 macrophages metabolize via β oxidation far more fatty acid than WT cells as determined using 13C isotope tracing. In part by increasing PPARα, ACE boosts myeloid metabolic function under pathophysiologic lipid stress, addressing a key myeloid failure in atherosclerosis.

Acute Effects of Wearing a Cooling Vest after High-Intensity Running and at Rest on Energy Intake and Appetite in Young Men.

Body cooling during and after exercise stimulates energy intake (EI). Cooling vests can also reasonably decrease body temperature under various sport occasions. This study examined the acute effects of wearing a cooling vest on EI and appetite after exercise and rest. Fifteen healthy young men underwent four trials randomly in a thermoneutral room (~24 °C, ~40% humidity). In two exercise trials, participants performed a 60-minute run at 75% of maximum oxygen uptake and wore a cooling vest (ExC) or thermoneutral vest (ExN) from 1030-1130 h. In two resting trials, participants rested for 60 minutes and wore a cooling vest (RC) or a thermoneutral vest (RN) from 1030-1130 h. From 1130 h, participants consumed a buffet meal until satiety. EI was calculated from the buffet meal. Skin and rectal temperatures were assessed between 0930 h and 1130 h. EI was significantly higher in the ExC trial (1740 ± 642 kcal) than in the ExN trial (1584 ± 604 kcal) and higher in the RC trial (1879 ± 806 kcal) than in the RN trial (1726 ± 806 kcal). Hot foods consumption was significantly higher in the ExC trial than in the ExN trial and higher in the RC trial than in the RN trial. Subjective hunger was significantly higher in the ExC trial than in the ExN trial. Lower rectal temperatures were associated with higher relative EI (β = -8.871, P < 0.001).Conclusions: Wearing a cooling vest increased EI after exercise or rest and increased subjective appetite only after exercise. Increased EI may result from a preference for hot foods altered by a cooling vest.

Acute effects of static stretching exercise-induced decrease in arterial stiffness on maximal aerobic capacity.

We recently have reported that individual day-to-day arterial stiffness variations are associated with maximal aerobic capacity. However, the evidence of this phenomenon was not provided sufficiently. The present study aimed to examine whether a decrease in arterial stiffness through static stretching exercise could enhance maximal aerobic capacity. Twelve healthy young men (age 22±2 years, mean and standard deviation) participated in this study and underwent two separate sessions in a randomized controlled crossover design: a single session of a whole-body static stretching exercise protocol that involved the trunk, upper limb, and lower limb (stretch condition), and sedentary control where they rested in the exercise room. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of systemic arterial stiffness before, immediately after and at 30 min after both conditions. Maximal oxygen uptake (V̇O<inf>2</inf>max) was assessed using a graded power test on an electronically braked cycle ergometer after these measurements. As we expected, there was a significant decrease in the baPWV at 30 min after the stretch trial compared to baseline values (P=0.01). The baPWV in the stretch condition was lower than that of the control condition, while V̇O<inf>2</inf>max in the stretch condition was higher than that of the control condition (P=0.03). Based on these findings, it can be inferred that an acute reduction in arterial stiffness may contribute to change in maximal aerobic capacity.

Heavy-intensity priming exercise extends the V̇o2max plateau and increases peak-power output during ramp-incremental exercise.

This study investigated whether a heavy-intensity priming exercise precisely prescribed within the heavy-intensity domain would lead to a greater peak-power output (POpeak) and a longer maximal oxygen uptake (V̇o2max) plateau. Twelve recreationally active adults participated in this study. Two visits were required: 1) a step-ramp-step test [ramp-incremental (RI) control], and 2) an RI test preceded by a priming exercise within the heavy-intensity domain (RI primed). A piecewise equation was used to quantify the V̇o2 plateau duration (V̇o2plateau-time). The mean response time (MRT) was computed during the RI control condition. The delta (Δ) V̇o2 slope (S; mL·min-1·W-1) and V̇o2-Y intercept (Y; mL·min-1) within the moderate-intensity domain between conditions (RI primed minus RI control) were also assessed using a novel graphical analysis. V̇o2plateau-time (P = 0.001; d = 1.27) and POpeak (P = 0.003; d = 1.08) were all greater in the RI primed. MRT (P < 0.001; d = 2.45) was shorter in the RI primed compared with the RI control. A larger ΔV̇o2plateau-time was correlated with a larger ΔMRT between conditions (r = -0.79; P = 0.002). This study demonstrated that heavy-intensity priming exercise lengthened the V̇o2plateau-time and increased POpeak. The overall faster RI-V̇o2 responses seem to be responsible for the longer V̇o2plateau-time. Specifically, a shorter MRT, but not changes in RI-V̇o2-slopes, was associated with a longer V̇o2plateau-time following priming exercise.NEW & NOTEWORTHY It remains unclear whether priming exercise extends the maximal oxygen uptake (V̇o2max) plateau and increases peak-power output (POpeak) during ramp-incremental (RI) tests. This study demonstrates that a priming exercise, precisely prescribed within the heavy-intensity domain, extends the plateau at V̇o2max and leads to a greater POpeak. Specifically, the extended V̇o2max plateau was associated with accelerated RI-V̇o2 responses.

Combined intermittent hypoxic exposure at rest and continuous hypoxic training can maintain elevated hemoglobin mass after a hypoxic camp.

Athletes use hypoxic living and training to increase hemoglobin mass (Hbmass), but Hbmass declines rapidly upon return to sea level. We investigated whether intermittent hypoxic exposure (IHE) + continuous hypoxic training (CHT) after return to sea level maintained elevated Hbmass, and if changes in Hbmass were transferred to changes in maximal oxygen uptake (V̇o2max) and exercise performance. Hbmass was measured in 58 endurance athletes before (PRE), after (POST1), and 30 days after (POST2) a 27 ± 4-day training camp in hypoxia (n = 44, HYP) or at sea level (n = 14, SL). After returning to sea level, 22 athletes included IHE (2 h rest) + CHT (1 h training) in their training every third day for 1 mo (HYPIHE + CHT), whereas the other 22 HYP athletes were not exposed to IHE or CHT (HYPSL). Hbmass increased from PRE to POST1 in both HYPIHE + CHT (4.4 ± 0.7%, means ± SE) and HYPSL (4.1 ± 0.6%) (both P < 0.001). Compared with PRE, Hbmass at POST2 remained 4.2 ± 0.8% higher in HYPIHE + CHT (P < 0.001) and 1.9 ± 0.5% higher in HYPSL (P = 0.023), indicating a significant difference between the groups (P = 0.002). In SL, no significant changes were observed in Hbmass with mean alterations between -0.5% and 0.4%. V̇o2max and time to exhaustion during an incremental treadmill test (n = 35) were elevated from PRE to POST2 only in HYPIHE + CHT (5.8 ± 1.2% and 5.4 ± 1.4%, respectively, both P < 0.001). IHE + CHT possesses the potential to mitigate the typical decline in Hbmass commonly observed during the initial weeks after return to sea level.NEW & NOTEWORTHY Sets of 2-h intermittent hypoxic exposure + 1-h continuous hypoxic training, every third day, possess the potential to mitigate the typical decline in Hbmass that is commonly observed during the initial weeks after return to sea level from an altitude camp. Inclusion of IHE + CHT in the training regimen was also accompanied by improvements in V̇o2max and exercise performance in most but not all Tier 3-Tier 5 level endurance athletes during the training season.

Can a 6-Month Exercise Training Program Improve Musculoskeletal Health in Individuals with Systemic Lupus Erythematosus post Glucocorticoid Pulsetherapy? Protocol for a Randomized Controlled Trial

ABSTRACT Background Systemic lupus erythematosus is an autoimmune condition characterized by immune dysregulation, exacerbated systemic inflammation, and tissue damage. Glucocorticoid (GC) pulse therapy is a pharmacological strategy used to manage high activity phases. Although clinically effective, it can lead to adverse effects, including compromised musculoskeletal health. Adjuvant therapies that allow maintenance of the clinical benefits of pulse therapy, while preventing or attenuating these adverse effects, are warranted. Exercise training has the potential to counteract these adverse effects, but the efficacy and viability of this approach has yet to be explored. Hence, this randomized, controlled, parallel-group trial aims to investigate the effects of a home-based, supervised, 6-month exercise training program on a battery of musculoskeletal health parameters in women with systemic lupus erythematosus who recently underwent GC pulse therapy. Methods After baseline assessments, participants will be randomized to either the control or exercise group. Participants in both groups will receive usual care, while those randomized to the exercise group will also undergo a multimodal training program. Outcomes will be examined at baseline and after 3 and 6 months. Primary outcomes include bone mineral density by dual-energy x-ray absorptiometry, bone microarchitecture by high-resolution peripheral quantitative computed tomography, and circulating levels of bone turnover markers (β-CTX and PINP). Secondary outcomes include body composition, muscle strength and function, and aerobic capacity as well as feasibility and acceptability metrics. Conclusion The information gained from this investigation has the potential to inform care and management strategies for this and similarly affected patient groups.

Longitudinal decline in peak V̇o2 with aging in a healthy population is associated with a reduction in peripheral oxygen utilization but not in cardiac output.

Aging is associated with a significant decline in aerobic capacity assessed by maximal exercise oxygen consumption (V̇o2max). The relative contributions of the specific V̇o2 components driving this decline, namely cardiac output (CO) and arteriovenous oxygen difference (A - V)O2, remain unclear. We examined this issue by analyzing data from 99 community-dwelling participants (baseline age: 21-96 yr old; average follow-up: 12.6 yr old) from the Baltimore Longitudinal Study of Aging, free of clinical cardiovascular disease. V̇o2peak, a surrogate of V̇o2max, was used to assess aerobic capacity during upright cycle ergometry. Peak exercise left ventricular volumes, heart rate, and CO were estimated using repeated gated cardiac blood pool scans. The Fick equation was used to calculate (A - V)O2diff,peak from COpeak and V̇o2peak. In unadjusted models, V̇o2peak, (A - V)O2diff,peak, and COpeak declined longitudinally over time at steady rates with advancing age. In multiple linear regression models adjusting for baseline values and peak workload, however, steeper declines in V̇o2peak and (A - V)O2diff,peak were observed with advanced entry age but not in COpeak. The association between the declines in V̇o2peak and (A - V)O2diff,peak was stronger among those ≥50 yr old compared with their younger counterparts, but the difference between the two age groups did not reach statistical significance. These findings suggest that age-associated impairment of peripheral oxygen utilization during maximal exercise poses a stronger limitation on peak V̇o2 than that of CO. Future studies examining interventions targeting the structure and function of peripheral muscles and their vasculature to mitigate age-associated declines in (A - V)O2diff are warranted.NEW & NOTEWORTHY The age-associated decline in aerobic exercise performance over an average of 13 yr in community-dwelling healthy individuals is more closely associated with decreased peripheral oxygen utilization rather than decreased cardiac output. This association was more evident in older than younger individuals. These findings suggest that future studies with larger samples examine whether these associations vary across the age range and whether the decline in cardiac output plays a greater role earlier in life. In addition, studies focused on determinants of peripheral oxygen uptake by exercising muscle may guide the selection of preventive strategies designed to maintain physical fitness with advancing age.

The impact of exercise training on muscle sympathetic nerve activity: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to examine the effects of exercise training on muscle sympathetic nerve activity (MSNA) in humans. Studies included exercise interventions [randomized controlled trials (RCTs), nonrandomized controlled trials (non-RCTs), or pre-to-post intervention] that reported on adults (≥18 yr) where MSNA was directly assessed using microneurography, and relevant outcomes were assessed [MSNA (total activity, burst frequency, burst incidence, amplitude), heart rate, blood pressure (systolic blood pressure, diastolic blood pressure, or mean blood pressure), and aerobic capacity (maximal or peak oxygen consumption)]. Forty intervention studies (n = 1,253 individuals) were included. RCTs of exercise compared with no exercise illustrated that those randomized to the exercise intervention had a significant reduction in MSNA burst frequency and incidence compared with controls. This reduction in burst frequency was not different between individuals with cardiovascular disease compared with those without. However, the reduction in burst incidence was greater in those with cardiovascular disease [9 RCTs studies, n = 234, mean difference (MD) -21.08 bursts/100 hbs; 95% confidence interval (CI) -16.51, -25.66; I2 = 63%] compared with those without (6 RCTs, n = 192, MD -10.92 bursts/100 hbs; 95% CI -4.12, -17.73; I2 = 76%). Meta-regression analyses demonstrated a dose-response relationship where individuals with higher burst frequency and incidence preintervention had a greater reduction in values post-intervention. These findings suggest that exercise training reduces muscle sympathetic nerve activity, which may be valuable for improving cardiovascular health.NEW & NOTEWORTHY This systematic review and meta-analysis suggests exercise training reduces muscle sympathetic nerve activity (MSNA), which may be valuable for improving cardiovascular health. The reduction in burst incidence was greater among individuals with cardiovascular disease when compared with those without; exercise training may be particularly beneficial for individuals with cardiovascular disease. Meta-regression analyses demonstrated a dose-response relationship, where individuals with higher sympathetic activity preintervention had greater reductions in sympathetic activity post-intervention.

The combined effect of cardiorespiratory and muscular fitness on the incidence of metabolic syndrome before midlife.

Cardiorespiratory fitness (CRF) could reduce the risk of metabolic syndrome (MetS) while the association between muscular endurance capacity (MEC) and incident MetS has rarely been investigated in young adults. A total of 2890 military men and women, aged 18-39years, free of baseline MetS in Taiwan, were followed for incident MetS from baseline (2014) until the end of 2020. All subjects received annual health examinations for assessment of MetS. Physical fitness was assessed by CRF (estimated maximal oxygen uptake, VO2 max [mL/kg/min], in a 3000-m run) and MEC (numbers of 2-min push-ups). MetS was defined according to the International Diabetes Federation (IDF) criteria. Multiple Cox regression analysis was conducted with adjustments for baseline age, sex, substance use status and physical activity to determine the associations of CRF and MEC with incidences of new-onset MetS and related features, for example, central obesity, hypertension, dyslipidaemia and prediabetes or diabetes. To examine the combined effects of CRF and MEC status on incidence of MetS, high and low levels of CRF and MEC were separately defined by over and under the sex-specific median in each exercise test. During a median follow-up of 5.8years, there were 673 (23.3%) new-onset MetS. Higher CRF was associated with a lower incidence of MetS (hazard ratio [HR] and 95% confidence interval: 0.905 [0.877-0.933]), and its components separately, except hypertension. No association was observed between MEC and incident MetS, and its components separately, except hypertension. When evaluating the combined effects of MEC and CRF status on the incidence of MetS, it was observed that compared with the low CRF/low MEC, the high CRF/high MEC (HR: 0.553 [0.439-0.697]) and the high CRF/low MEC (HR: 0.730 [0.580-0.918]) had a lower incidence of new-onset MetS (P value for the intergroup difference=0.04). There was no significant result for the low CRF/high MEC. This study highlights that although the protective effects of MEC to reduce the incidence of MetS and most of its related features were mainly driven by CRF in young adults, there was an addictive effect of greater MEC on CRF to prevent the development of new-onset MetS before midlife.