Maximal oxygen uptake is proportional to muscle fiber oxidative capacity, from chronic heart failure patients to professional cyclists

Histological changes in skeletal muscle induced by heart failure in human patients and animal models: A scoping review

OBJECTIVE

This scoping review aimed to characterize the histological changes in skeletal muscle after heart failure (HF) and to identify gaps in knowledge.

METHODS

On April 03, 2024, systematic searches were performed for papers in which histological analyses were conducted on skeletal muscle sampled from patients with HF or animal models of HF. Screening and data extraction were conducted by two independent authors.

RESULTS AND CONCLUSION

A total of 118 papers were selected, including 33 human and 85 animal studies. Despite some disagreements among studies, some trends were observed. These trends included a slow-to-fast transition, a decrease in muscle fiber size, capillary to muscle fiber ratio, and mitochondrial activity and content, and an increase in apoptosis. These changes may contribute to the fatigability and decrease in muscle strength observed after HF. Although there were some disagreements between the results of human and animal studies, the results were generally similar. Animal models of HF will therefore be useful in elucidating the histological changes in skeletal muscle that occur in human patients with HF. Because the muscles subjected to histological analysis were mostly thigh muscles in humans and mostly lower leg muscles in animals, it remains uncertain whether changes similar to those seen in lower limb (hindlimb) muscles after HF also occur in upper limb (forelimb) muscles. The results of this review will consolidate the current knowledge on HF-induced histological changes in skeletal muscle and consequently aid in the rehabilitation of patients with HF and future studies.

Mexidol, Cytoflavin, and succinic acid derivatives as antihypoxic, anti-ischemic metabolic modulators, and ergogenic aids in athletes and consideration of their potential as performance enhancing drugs

Emoxypine (ethylmethylhydroxypyridine) is a synthetic derivative of vitamin B6. Emoxypine succinate is a registered drug in Russia and Ukraine under various trade names including Mexidol, Mexicor, and Armadin Long. Mexidol demonstrates antihypoxic and anti-ischemic effects and also modulates metabolism. The use of Mexidol by Russian athletes has been confirmed in the past. Current use by athletes is unknown as this drug is not monitored or included in drug testing protocol. Metabotropic and antihypoxic effects of Mexidol were compared to the effects of meldonium or trimetazidine, both of which are included on the World Anti-Doping Agency (WADA) Prohibited List in category S4.4. Metabolic Modulators. The conjugation of emoxypine with succinate elevates the therapeutic effectiveness of the Mexidol formulation as succinic acid itself has important impacts to consider despite being a common food additive and drug excipient. Other succinic acid salts like ammonium succinate, found as dietary supplement, have been patented as performance enhancers. Available research on healthy subjects suggests that combinations of selected 3-substituted pyridine derivatives with succinate including Mexidol and a related drug Cytoflavin can enhance the performance of athletes. Cytoflavin is a multi-component formula containing meglumine sodium succinate, nicotinamide (vitamin B3), inosine (riboxin), and riboflavin. Other related succinate-based drugs include Remaxol, Reamberin, and Cogitum. Mexidol and Cytoflavin and related substances exhibit similar biological effects as drugs on the WADA Prohibited List, and if they are used for performance enhancement by athletes, they could be worthy of consideration as prohibited substances in sport.

The whole-body and skeletal muscle metabolic response to 14 days of highly controlled low energy availability in endurance-trained females

This study investigated the effects of 14 days low energy availability (LEA) versus optimal energy availability (OEA) in endurance-trained females on substrate utilization, insulin sensitivity, and skeletal muscle mitochondrial oxidative capacity; and the impact of metabolic changes on exercise performance. Twelve endurance-trained females (V̇O2max 55.2 ± 5.1 mL × min-1 × kg-1) completed two 14-day randomized, blinded, cross-over, controlled dietary interventions: (1) OEA (51.9 ± 2.0 kcal × kg fat-free mass (FFM)-1 × day-1) and (2) LEA (22.3 ± 1.5 kcal × kg FFM-1 × day-1), followed by 3 days OEA. Participants maintained their exercise training volume during both interventions (approx. 8 h × week-1 at 79% heart rate max). Skeletal muscle mitochondrial respiratory capacity, glycogen, and maximal activity of CS, HAD, and PFK were unaltered with LEA. 20-min time trial endurance performance was impaired by 7.8% (Δ -16.8 W, 95% CI: -23.3 to -10.4, p < .001) which persisted following 3 days refueling post-LEA (p < .001). Fat utilization was increased post-LEA as evidenced by: (1) 99.4% (p < .001) increase in resting plasma free fatty acids (FFA); (2) 270% (p = .007) larger reduction in FFA in response to acute exercise; and (3) 28.2% (p = .015) increase in resting fat oxidation which persisted during submaximal exercise (p < .001). These responses were reversed with 3 days refueling. Daily glucose control (via CGM), HOMA-IR, HOMA-β, were unaffected by LEA. Skeletal muscle O2 utilization and carbohydrate availability were not limiting factors for aerobic exercise capacity and performance; therefore, whether LEA per se affects aspects of training quality/recovery requires investigation.

Effects of Bifidobacterium-Fermented Milk on Obesity: Improved Lipid Metabolism through Suppression of Lipogenesis and Enhanced Muscle Metabolism

Obesity is a major global health concern. Studies suggest that the gut microflora may play a role in protecting against obesity. Probiotics, including lactic acid bacteria and Bifidobacterium, have garnered attention for their potential in obesity prevention. However, the effects of Bifidobacterium-fermented products on obesity have not been thoroughly elucidated. Bifidobacterium, which exists in the gut of animals, is known to enhance lipid metabolism. During fermentation, it produces acetic acid, which has been reported to improve glucose tolerance and insulin resistance, and exhibit anti-obesity and anti-diabetic effects. Functional foods have been very popular around the world, and fermented milk is a good candidate for enrichment with probiotics. In this study, we aim to evaluate the beneficial effects of milks fermented with Bifidobacterium strains on energy metabolism and obesity prevention. Three Bifidobacterium strains (Bif-15, Bif-30, and Bif-39), isolated from newborn human feces, were assessed for their acetic acid production and viability in milk. These strains were used to ferment milk. Otsuka-Long-Evans Tokushima Fatty (OLETF) rats administered Bif-15-fermented milk showed significantly lower weight gain compared to those in the water group. The phosphorylation of AMPK was increased and the expression of lipogenic genes was suppressed in the liver of rats given Bif-15-fermented milk. Additionally, gene expression related to respiratory metabolism was significantly increased in the soleus muscle of rats given Bif-15-fermented milk. These findings suggest that milk fermented with the Bifidobacterium strain Bif-15 can improve lipid metabolism and suppress obesity.

The Detrimental Effects of Bedrest: Premature Cardiovascular Aging and Dysfunction

Bedrest as an experimental paradigm or as an in-patient stay for medical reasons has negative consequences for cardiovascular health. The effects of severe inactivity parallel many of the changes experienced with natural aging but over a much shorter duration. Cardiac function is reduced, arteries stiffen, neural reflex responses are impaired, and metabolic and oxidative stress responses impose burden on the heart and vascular systems. The effect of these changes is revealed in studies of integrative function. Aerobic fitness progressively deteriorates with bedrest and tolerance of upright posture is rapidly impaired. In this review we consider the similarities of aging and bedrest-induced cardiovascular deconditioning. We concur with many recent clinical recommendations that early and regular mobility with upright posture will reduce likelihood of hospital-associated disability related to bedrest.

Determining V̇O2max in competitive swimmers: Comparing the validity and reliability of cycling, arm cranking, ergometer swimming, and tethered swimming

OBJECTIVES

This study aims to identify the optimal method for determining V̇O2max in competitive swimmers in terms of validity and test-retest reliability.

DESIGN

Controlled experiment.

METHODS

Twenty competitive swimmers performed four maximal incremental exercise tests: cycling, arm cranking, ergometer swimming, and tethered swimming. Gas analysis was conducted to estimate V̇O2max. Validity was assessed in terms of the amount of variance of the performance on a 1500-m time trial explained by the estimated V̇O2max . Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC).

RESULTS

V̇O2max obtained from tethered swimming, ergometer swimming, and cycling explained a similar amount of variance of the 1500-m performance (R2 = 0.64, 0.64 and 0.65, respectively). However, ergometer swimming yielded significantly lower V̇O2max estimates (40.54 ± 6.55 ml/kg/min) than tethered swimming (54.40 ± 6.21 ml/kg/min) and cycling (54.39 ± 5.63 ml/kg/min). Arm cranking resulted in both a lower explained variance (R2 = 0.41) and a significantly lower V̇O2max (43.14 ± 7.81 ml/kg/min). Tethered swimming showed good reliability (ICC = 0.81).

CONCLUSIONS

Bicycle and tethered swimming tests demonstrated high validity with comparable V̇O2max estimates, explaining a large proportion of differences in endurance performance. Choosing between these two methods involves a trade-off between a higher practical applicability and reliability of the bicycle test and the more sport-specific nature of the tethered swimming test.

Skeletal muscle mitochondrial correlates of critical power and W' in healthy active individuals

The asymptote (critical power; CP) and curvature constant (W') of the hyperbolic power-duration relationship can predict performance within the severe-intensity exercise domain. However, the extent to which these parameters relate to skeletal muscle mitochondrial content and respiratory function is not known. Fifteen males (peak O2 uptake, 52.2 ± 8.7 mL kg-1 min-1; peak work rate, 366 ± 40 W; and gas exchange threshold, 162 ± 41 W) performed three to five constant-load tests to task failure for the determination of CP (246 ± 44 W) and W' (18.6 ± 4.1 kJ). Skeletal muscle biopsies were obtained from the vastus lateralis to determine citrate synthase (CS) activity, as a marker of mitochondrial content, and the ADP-stimulated respiration (P) and maximal electron transfer (E) through mitochondrial complexes (C) I-IV. The CP was positively correlated with CS activity (absolute CP, r = 0.881, P < 0.001; relative CP, r = 0.751, P = 0.001). The W' was not correlated with CS activity (P > 0.05). Relative CP was positively correlated with mass-corrected CI + IIE (r = 0.659, P = 0.038), with absolute CP being inversely correlated with CS activity-corrected CIVE (r = -0.701, P = 0.024). Relative W' was positively correlated with CS activity-corrected CI + IIP (r = 0.713, P = 0.021) and the phosphorylation control ratio (r = 0.661, P = 0.038). There were no further correlations between CP or W' and mitochondrial respiratory variables. These findings support the assertion that skeletal muscle mitochondrial oxidative capacity is positively associated with CP and that this relationship is strongly determined by mitochondrial content.

Distinct effects of type 2 diabetes and obesity on cardiopulmonary performance

AIM

Effort intolerance is frequent in patients with overweight/obesity and/or type 2 diabetes (T2D) free from cardiac and respiratory disease. We sought to quantify the independent effects of T2D and body mass index (BMI) on cardiopulmonary capacity and gain insights on the possible pathophysiology by case-control and regression analyses.

METHODS

Patients at high/moderate cardiovascular risk, with or without T2D, underwent spirometry and combined echocardiography-cardiopulmonary exercise test as part of their clinical workup. Subjects with evidence of cardiopulmonary disease were excluded. The effects of T2D and obesity were estimated by multivariable models accounting for known/potential confounders and the major pathophysiological determinants of oxygen uptake at peak exercise (VO2peak ) normalized for fat-free mass (FFM).

RESULTS

In total, 109 patients with T2D and 97 controls were included in the analysis. The two groups had similar demographic and anthropometric characteristics except for higher BMI in T2D (28.6 ± 4.6 vs. 26.3 ± 4.4 kg/m2 , p = .0003) but comparable FFM. Patients with T2D achieved lower VO2peak than controls (18.5 ± 4.4 vs. 21.7 ± 8.3 ml/min/kg, p = .0006). Subclinical cardiovascular dysfunctions were observed in T2D: concentric left ventricular remodelling, autonomic dysfunction, systolic dysfunction and reduced systolic reserve. After accounting for confounders and major determinants of VO2peakFFM , T2D still displayed reduced VO2peak by 1.0 (-1.7/-0.3) ml/min/kgFFM , p = .0089, while the effect of BMI [-0.2 (-0.3/0.1) ml/min/kgFFM , p = .06 per unit increase], was largely explained by a combination of chronotropic incompetence, reduced peripheral oxygen extraction, impaired systolic reserve and ventilatory (in)efficiency.

CONCLUSIONS

T2D is an independent negative determinant of VO2peak whose effect is additive to other pathophysiological determinants of oxygen uptake, including BMI.

Mitochondrial-targeted antioxidant ingestion acutely blunts VO2max in physically inactive females

PURPOSE

To determine the acute effects of a mitochondrial targeting antioxidant (MitoQ) on the metabolic response during exercise.

METHODS

Nine (n = 9) physically inactive females (age 47 ± 22 years) performed two trials (Placebo and MitoQ) in a double-blind randomized cross-over design. In both trials, participants performed an exercise protocol consisting of 3-min stages at submaximal workloads followed by a ramp protocol to volitional exhaustion. Participants received either Placebo or MitoQ (80 mg) 1 h prior to exercise. Indirect calorimetry and cardiovascular measurements were collected throughout the duration of the exercise bout.

RESULTS

Submaximal metabolic and cardiovascular variables were not different between trials (p > 0.05). VO2max was higher (p = 0.03) during Placebo (23.5 ± 5.7 mL kg min-1 ) compared to MitoQ (21.0 ± 6.6 mL kg min-1 ). Maximal ventilation was also higher (p = 0.02) in Placebo (82.4 ± 17.7 L/min) compared to MitoQ (75.0 ± 16.8 L/min). Maximal cardiovascular variables and blood lactate were not different between trials (p > 0.05).

CONCLUSION

An acute dose of MitoQ blunted VO2max , which was primarily mediated by impairment of ventilatory function. These data suggest that the acute accumulation of exercise-induced mitochondrial reactive oxygen species (mtROS) are necessary for maximal aerobic capacity. Further research is warranted on mtROS-antioxidant cell signaling cascades, and how they relate to mitochondrial function during exercise.

Muscle Oxidative Capacity in Vivo Is Associated With Physiological Parameters in Trained Rowers

Purpose: The muscle oxygen uptake (m V ˙ O 2 ) kinetics following exercise, measured by near-infrared spectroscopy, has been used as a functional evaluation of muscle oxidative metabolism. This study aimed to determine the m V ˙ O 2 off-kinetics and verify the relationship of the recovery rate of m V ˙ O 2 (k) with time-trial performance and different aerobic parameters in trained rowers. Methods: Eleven male rowers (age: 20 ± 3 years; V ˙ O 2 m a x : 4.28 ± 0.35 L·min-1) used a rowing ergometer to perform (I) an incremental test to determine the maximal oxygen uptake (V ˙ O 2 m a x ) and peak power output (Ppeak); (II) several visits to determine maximal lactate steady state (MLSS); and (III) a 2000-m rowing ergometer performance test. Also, one test to determine m V ˙ O 2 off-kinetics of the vastus lateralis muscle using a repeated arterial occlusions protocol. Results: The m V ˙ O 2 generated a good monoexponential fit (R2 = 0.960 ± 0.030; SEE = 0.041 ± 0.018%.s-1). The k of m V ˙ O 2 (2.06 ± 0.58 min-1) was associated with relative V ˙ O 2 m a x (r = 0.79), power output at MLSS (r = 0.76), and Ppeak (r = 0.83); however, it was not related with 2000-m rowing performance (r = -0.38 to 0.52; p > .152). Conclusion: These findings suggest that although not associated with rowing performance, the m V ˙ O 2 off-kinetics determined after a submaximal isometric knee extension may be a practical and less-exhaustive approach than invasive responses and incremental tests to assess the muscle oxidative metabolism during a training program.

Adverse cardiovascular and metabolic perturbations among older women: 'fat-craving' hearts

BACKGROUND

Despite known sex-based differences in cardiovascular aging, differences in aging biology are poorly understood. We hypothesize that circulating metabolites studied cross-sectionally with cardiac aging may be associated with cardiovascular changes that distinguish cardiac aging in women.

METHODS

A population-based cohort of community men and women without cardiovascular disease from Singapore underwent detailed clinical and echocardiography examinations. Cross-sectional associations between cardiac functional characteristics and metabolomics profiles were examined.

RESULTS

Five hundred sixty-seven adults (48.9% women) participated. Women were younger (72 ± 4.4 years vs 73 ± 4.3 years, p = 0.022), had lower diastolic blood pressures (71 ± 11.0 mmHg vs 76 ± 11.2 mmHg, p < 0.0001, and less likely to have diabetes mellitus (18.0% vs 27.6%, p = 0.013) and smoking (3.8% vs 34.5%, p < 0.001). Body mass indices were similar (24 ± 3.8 kg/m2 vs 24 ± 3.4 kg/m2, p = 0.29), but women had smaller waist circumferences (81 ± 10.1 cm vs 85 ± 9.2 cm, p < 0.001). Women had a significantly higher E/e' ratios (10.9 ± 3.4 vs 9.9 ± 3.3, p = 0.007) and mitral A peak (0.86 ± 0.2 m/s vs 0.79 ± 0.2 m/s, p < 0.001) than men. Among women, lower E/e' ratio was associated with higher levels of C16 (OR 1.019, 95%CI 1.002-1.036, p = 0.029), C16:1 (OR 1.06, 95%CI 1.006-1.118, p = 0.028), serine (OR 1.019, 95%CI 1.002-1.036, p = 0.025), and histidine (OR 1.045, 95%CI 1.013-1.078, p = 0.006). Lower mitral A peak was associated with higher levels of histidine (OR 1.039, 95%CI 1.009-1.070, p = 0.011), isoleucine (OR 1.013, 95%CI 1.004-1.021, p = 0.004), and C20 (OR 1.341, 95%CI 1.067-1.684, p = 0.012).

CONCLUSION

Impairments in diastolic functions were more frequent among older women compared to men, despite lower prevalence of vascular risk factors and preserved cardiac structure. Cardiac aging in women correlated with metabolites involved in fatty acid oxidation and tricyclic acid cycle fuelling.

Selectively breeding for high voluntary physical activity in female mice does not bestow inherent characteristics that resemble eccentric remodeling of the heart, but the mini-muscle phenotype does

Physical activity engagement results in a variety of positive health outcomes, including a reduction in cardiovascular disease risk partially due to eccentric remodeling of the heart. The purpose of this investigation was to determine if four replicate lines of High Runner mice that have been selectively bred for voluntary exercise on wheels have a cardiac phenotype that resembles the outcome of eccentric remodeling. Adult females (average age 55 days) from the 4 High Runner and 4 non-selected control lines were anaesthetized via vaporized isoflurane, then echocardiographic images were collected and analyzed for structural and functional differences. High Runner mice in general had lower ejection fractions compared to control mice lines (2-tailed p ​= ​0.023 6) and tended to have thicker walls of the anterior portion of the left ventricle (p ​= ​0.065). However, a subset of the High Runner individuals, termed mini-muscle mice, had greater ejection fraction (p ​= ​0.000 6), fractional shortening percentage (p ​< ​0.000 1), and ventricular mass at dissection (p ​< ​0.002 7 with body mass as a covariate) compared to non-mini muscle mice. Mice from replicate lines bred for high voluntary exercise did not all have inherent positive cardiac functional or structural characteristics, although a genetically unique subset of mini-muscle individuals did have greater functional cardiac characteristics, which in conjunction with their previously described peripheral aerobic enhancements (e.g., increased capillarity) would partially account for their increased V ˙ O2max.

Effects of hyperbaric oxygen therapy on human psychomotor performance: A review

Psychomotor performance is the coordination of a sensory or ideational (cognitive) process and a motor activity. All sensorimotor processes involved in planning and execution of voluntary movements need oxygen supply and seem to be significantly disrupted in states of hypoxia. Hyperbaric oxygen therapy has become a widely used treatment in routine medicine and sport medicine due to its beneficial effects on different aspects of human physiology and performance. This paper presents state-of-the-art data on the effects of hyperbaric oxygen therapy on different aspects of human psychomotor function. The therapy's influence on musculoskeletal properties and motor abilities as well as the effects of hyperbaric oxygenation on cognitive, myocardial and pulmonary functions are presented. In this review the molecular and physiological processes related to human psychomotor performance in response to hyperbaric oxygen are discussed to contribute to this fast-growing field of research in integrative medicine. Please cite this article as: Olex-Zarychta D. Effects of hyperbaric oxygen therapy on human psychomotor performance: A review. J Integr Med. 2023; 21(5): 430-440.

Reduced glucose tolerance and insulin sensitivity after prolonged exercise in endurance athletes

AIM

The purpose of this study was to 1. investigate if glucose tolerance is affected after one acute bout of different types of exercise; 2. assess if potential differences between two exercise paradigms are related to changes in mitochondrial function; and 3. determine if endurance athletes differ from nonendurance-trained controls in their metabolic responses to the exercise paradigms.

METHODS

Nine endurance athletes (END) and eight healthy nonendurance-trained controls (CON) were studied. Oral glucose tolerance tests (OGTT) and mitochondrial function were assessed on three occasions: in the morning, 14 h after an overnight fast without prior exercise (RE), as well as after 3 h of prolonged continuous exercise at 65% of VO2 max (PE) or 5 × 4 min at ~95% of VO2 max (HIIT) on a cycle ergometer.

RESULTS

Glucose tolerance was markedly reduced in END after PE compared with RE. END also exhibited elevated fasting serum FFA and ketones levels, reduced insulin sensitivity and glucose oxidation, and increased fat oxidation during the OGTT. CON showed insignificant changes in glucose tolerance and the aforementioned measurements compared with RE. HIIT did not alter glucose tolerance in either group. Neither PE nor HIIT affected mitochondrial function in either group. END also exhibited increased activity of 3-hydroxyacyl-CoA dehydrogenase activity in muscle extracts vs. CON.

CONCLUSION

Prolonged exercise reduces glucose tolerance and increases insulin resistance in endurance athletes the following day. These findings are associated with an increased lipid load, a high capacity to oxidize lipids, and increased fat oxidation.

Operational Modal Analysis of Near-Infrared Spectroscopy Measure of 2-Month Exercise Intervention Effects in Sedentary Older Adults with Diabetes and Cognitive Impairment

The Global Burden of Disease Study (GBD 2019 Diseases and Injuries Collaborators) found that diabetes significantly increases the overall burden of disease, leading to a 24.4% increase in disability-adjusted life years. Persistently high glucose levels in diabetes can cause structural and functional changes in proteins throughout the body, and the accumulation of protein aggregates in the brain that can be associated with the progression of Alzheimer's Disease (AD). To address this burden in type 2 diabetes mellitus (T2DM), a combined aerobic and resistance exercise program was developed based on the recommendations of the American College of Sports Medicine. The prospectively registered clinical trials (NCT04626453, NCT04812288) involved two groups: an Intervention group of older sedentary adults with T2DM and a Control group of healthy older adults who could be either active or sedentary. The completion rate for the 2-month exercise program was high, with participants completing on an average of 89.14% of the exercise sessions. This indicated that the program was practical, feasible, and well tolerated, even during the COVID-19 pandemic. It was also safe, requiring minimal equipment and no supervision. Our paper presents portable near-infrared spectroscopy (NIRS) based measures that showed muscle oxygen saturation (SmO2), i.e., the balance between oxygen delivery and oxygen consumption in muscle, drop during bilateral heel rise task (BHR) and the 6 min walk task (6MWT) significantly (p < 0.05) changed at the post-intervention follow-up from the pre-intervention baseline in the T2DM Intervention group participants. Moreover, post-intervention changes from pre-intervention baseline for the prefrontal activation (both oxyhemoglobin and deoxyhemoglobin) showed statistically significant (p < 0.05, q < 0.05) effect at the right superior frontal gyrus, dorsolateral, during the Mini-Cog task. Here, operational modal analysis provided further insights into the 2-month exercise intervention effects on the very-low-frequency oscillations (<0.05 Hz) during the Mini-Cog task that improved post-intervention in the sedentary T2DM Intervention group from their pre-intervention baseline when compared to active healthy Control group. Then, the 6MWT distance significantly (p < 0.01) improved in the T2DM Intervention group at post-intervention follow-up from pre-intervention baseline that showed improved aerobic capacity and endurance. Our portable NIRS based measures have practical implications at the point of care for the therapists as they can monitor muscle and brain oxygenation changes during physical and cognitive tests to prescribe personalized physical exercise doses without triggering individual stress response, thereby, enhancing vascular health in T2DM.

Improvement of adiponectin in relation to physical performance and body composition in young obese males subjected to twenty-four weeks of training programs

Obesity and related metabolic diseases represent a worldwide health problem. The main factor predisposing to obesity is an unhealthy lifestyle including the lack of physical activity. A pivotal role in the etio-pathogenesis of obesity is carried out by adipose tissue, an endocrine organ secreting several adipokines involved in numerous metabolic and inflammatory processes. Among these, of particular importance is adiponectin, an adipokine involved in the regulation of insulin sensibility and in anti-inflammatory processes. The aim of the study was to determine the effects of 24 weeks of two different training programs polarized (POL) and threshold training (THR) on body composition, physical capacities and adiponectin expression. Thirteen male obese subjects (BMI: 32.0 ± 3.0 kg m-2) followed 24 weeks of two different training programs, POL and THR, consisting of walking or running (or a combination of the two methods) in their normal living conditions. Before (T0) and after the end of the program (T1), the assessment of body composition was assessed by bioelectrical impedance and the concentration of salivary and serum adiponectin was analyzed by enzyme-linked immunosorbent assay and western blotting. Although the results obtained did not show significant differences between the two training programs, body mass and body mass index decreased by a mean of -4.46 ± 2.90 kg and 1.43 ± 0.92 kg m^-2 (P < 0.05). Fat mass decreased by -4.47 ± 2.78 kg (P < 0.05). V'O₂max increased by a mean of 0.20 ± 0.26 L min^-1 (P < 0.05) Also, we observed an increase in saliva and in serum of adiponectin concentrations at T1 compared to T0 by 4.72 ± 3.52 μg mL^-1 and 5.22 ± 4.74 ng mL^-1 (P < 0.05) respectively. Finally, we found significant correlations between Δ serum adiponectin and Δ Hip (R = -0.686, P = 0.001) and between Δ salivary adiponectin and ΔWaist (R = -0.678, P = 0.011). Our results suggest that a 24 weeks training program, independently from intensity and volume, induces an amelioration of body composition and fitness performance. These improvements are associated with an increase in total and HMW adiponectin expression in both saliva and in serum.

Low myoglobin concentration in skeletal muscle of elite cyclists is associated with low mRNA expression levels

Myoglobin is essential for oxygen transport to the muscle fibers. However, measurements of myoglobin (Mb) protein concentrations within individual human muscle fibers are scarce. Recent observations have revealed surprisingly low Mb concentrations in elite cyclists, however it remains unclear whether this relates to Mb translation, transcription and/or myonuclear content. The aim was to compare Mb concentration, Mb messenger RNA (mRNA) expression levels and myonuclear content within muscle fibers of these elite cyclists with those of physically-active controls. Muscle biopsies were obtained from m. vastus lateralis in 29 cyclists and 20 physically-active subjects. Mb concentration was determined by peroxidase staining for both type I and type II fibers, Mb mRNA expression level was determined by quantitative PCR and myonuclear domain size (MDS) was obtained by immunofluorescence staining. Average Mb concentrations (mean ± SD: 0.38 ± 0.04 mM vs. 0.48 ± 0.19 mM; P = 0.014) and Mb mRNA expression levels (0.067 ± 0.019 vs. 0.088 ± 0.027; P = 0.002) were lower in cyclists compared to controls. In contrast, MDS and total RNA per mg muscle were not different between groups. Interestingly, in cyclists compared to controls, Mb concentration was only lower for type I fibers (P < 0.001), but not for type II fibers (P > 0.05). In conclusion, the lower Mb concentration in muscle fibers of elite cyclists is partly explained by lower Mb mRNA expression levels per myonucleus and not by a lower myonuclear content. It remains to be determined whether cyclists may benefit from strategies that upregulate Mb mRNA expression levels, particularly in type I fibers, to enhance their oxygen supply.

Taurine Stimulates AMP-Activated Protein Kinase and Modulates the Skeletal Muscle Functions in Rats via the Induction of Intracellular Calcium Influx

Taurine (2-aminoethanesulfonic acid) is a free amino acid abundantly found in mammalian tissues. Taurine plays a role in the maintenance of skeletal muscle functions and is associated with exercise capacity. However, the mechanism underlying taurine function in skeletal muscles has not yet been elucidated. In this study, to investigate the mechanism of taurine function in the skeletal muscles, the effects of short-term administration of a relatively low dose of taurine on the skeletal muscles of Sprague-Dawley rats and the underlying mechanism of taurine function in cultured L6 myotubes were investigated. The results obtained in this study in rats and L6 cells indicate that taurine modulates the skeletal muscle function by stimulating the expression of genes and proteins associated with mitochondrial and respiratory metabolism through the activation of AMP-activated protein kinase via the calcium signaling pathway.

Adaptations to 4 weeks of high-intensity interval training in healthy adults with different training backgrounds

PURPOSE

This study investigated the physical fitness and oxygen uptake kinetics ([Formula: see text]) along with the exercise-onset O₂ delivery (heart rate kinetics, τHR; changes in normalized deoxyhemoglobin/[Formula: see text] ratio, Δ[HHb]/[Formula: see text]) adaptations of individuals with different physical activity (PA) backgrounds responding to 4 weeks of high-intensity interval training (HIIT), and the possible effects of skeletal muscle mass (SMM) on training-induced adaptations.

METHODS

Twenty subjects (10 high-PA level, HIIT-H; 10 moderate-PA level, HIIT-M) engaged in 4 weeks of treadmill HIIT. Ramp-incremental (RI) test and step-transitions to moderate-intensity exercise were performed. Cardiorespiratory fitness, body composition, muscle oxygenation status, VO₂ and HR kinetics were assessed at baseline and post-training.

RESULTS

HIIT improved fitness status for HIIT-H ([Formula: see text], + 0.26 ± 0.07 L/min; SMM, + 0.66 ± 0.70 kg; body fat, - 1.52 ± 1.93 kg; [Formula: see text], - 7.11 ± 1.05 s, p < 0.05) and HIIT-M ([Formula: see text], 0.24 ± 0.07 L/min, SMM, + 0.58 ± 0.61 kg; body fat, - 1.64 ± 1.37 kg; [Formula: see text], - 5.48 ± 1.05 s, p < 0.05) except for visceral fat area (p = 0.293) without between-group differences (p > 0.05). Oxygenated and deoxygenated hemoglobin amplitude during the RI test increased for both groups (p < 0.05) except for total hemoglobin (p = 0.179). The Δ[HHb]/[Formula: see text] overshoot was attenuated for both groups (p < 0.05) but only eliminated in HIIT-H (1.05 ± 0.14 to 0.92 ± 0.11), and no change was observed in τHR (p = 0.144). Linear mixed-effect models presented positive effects of SMM on absolute [Formula: see text] (p < 0.001) and ΔHHb (p = 0.034).

CONCLUSION

Four weeks of HIIT promoted positive adaptations in physical fitness and [Formula: see text] kinetics, with the peripheral adaptations attributing to the observed improvements. The training effects are similar between groups suggesting that HIIT is effective for reaching higher physical fitness levels.

MicroRNAs as the Sentinels of Redox and Hypertrophic Signalling

Oxidative stress and inflammation are associated with skeletal muscle function decline with ageing or disease or inadequate exercise and/or poor diet. Paradoxically, reactive oxygen species and inflammatory cytokines are key for mounting the muscular and systemic adaptive responses to endurance and resistance exercise. Both ageing and lifestyle-related metabolic dysfunction are strongly linked to exercise redox and hypertrophic insensitivity. The adaptive inability and consequent exercise intolerance may discourage people from physical training resulting in a vicious cycle of under-exercising, energy surplus, chronic mitochondrial stress, accelerated functional decline and increased susceptibility to serious diseases. Skeletal muscles are malleable and dynamic organs, rewiring their metabolism depending on the metabolic or mechanical stress resulting in a specific phenotype. Endogenous RNA silencing molecules, microRNAs, are regulators of these metabolic/phenotypic shifts in skeletal muscles. Skeletal muscle microRNA profiles at baseline and in response to exercise have been observed to differ between adult and older people, as well as trained vs. sedentary individuals. Likewise, the circulating microRNA blueprint varies based on age and training status. Therefore, microRNAs emerge as key regulators of metabolic health/capacity and hormetic adaptability. In this narrative review, we summarise the literature exploring the links between microRNAs and skeletal muscle, as well as systemic adaptation to exercise. We expand a mathematical model of microRNA burst during adaptation to exercise through supporting data from the literature. We describe a potential link between the microRNA-dependent regulation of redox-signalling sensitivity and the ability to mount a hypertrophic response to exercise or nutritional cues. We propose a hypothetical model of endurance exercise-induced microRNA "memory cloud" responsible for establishing a landscape conducive to aerobic as well as anabolic adaptation. We suggest that regular aerobic exercise, complimented by a healthy diet, in addition to promoting mitochondrial health and hypertrophic/insulin sensitivity, may also suppress the glycolytic phenotype and mTOR signalling through miRNAs which in turn promote systemic metabolic health.

Effect of Long-Term Supplementation with Acetic Acid on the Skeletal Muscle of Aging Sprague Dawley Rats

Mitochondrial function in skeletal muscle, which plays an essential role in oxidative capacity and physical activity, declines with aging. Acetic acid activates AMP-activated protein kinase (AMPK), which plays a key role in the regulation of whole-body energy by phosphorylating key metabolic enzymes in both biosynthetic and oxidative pathways and stimulates gene expression associated with slow-twitch fibers and mitochondria in skeletal muscle cells. In this study, we investigate whether long-term supplementation with acetic acid improves age-related changes in the skeletal muscle of aging rats in association with the activation of AMPK. Male Sprague Dawley (SD) rats were administered acetic acid orally from 37 to 56 weeks of age. Long-term supplementation with acetic acid decreased the expression of atrophy-related genes, such as atrogin-1, muscle RING-finger protein-1 (MuRF1), and transforming growth factor beta (TGF-β), activated AMPK, and affected the proliferation of mitochondria and type I fiber-related molecules in muscles. The findings suggest that acetic acid exhibits an anti-aging function in the skeletal muscles of aging rats.

Effects of Hyperbaric Oxygen Therapy on Mitochondrial Respiration and Physical Performance in Middle-Aged Athletes: A Blinded, Randomized Controlled Trial

Introduction

Hyperbaric oxygen therapy (HBOT) has been used to increase endurance performance but has yet to be evaluated in placebo-controlled clinical trials. The current study aimed to evaluate the effect of an intermittent HBOT protocol on maximal physical performance and mitochondrial function in middle-aged master athletes.

Methods

A double-blind, randomized, placebo-controlled study on 37 healthy middle-aged (40–50) master athletes was performed between 2018 and 2020. The subjects were exposed to 40 repeated sessions of either HBOT [two absolute atmospheres (ATA), breathing 100% oxygen for 1 h] or SHAM (1.02ATA, breathing air for 1 h).

Results

Out of 37 athletes, 16 HBOT and 15 SHAM allocated athletes were included in the final analysis. Following HBOT, there was a significant increase in the maximal oxygen consumption (VO2Max) (p = 0.010, effect size(es) = 0.989) and in the oxygen consumption measured at the anaerobic threshold (VO2AT)(es = 0.837) compared to the SHAM group. Following HBOT, there were significant increases in both maximal oxygen phosphorylation capacity (es = 1.085, p = 0.04), maximal uncoupled capacity (es = 0.956, p = 0.02) and mitochondrial mass marker MTG (p = 0.0002) compared to the SHAM sessions.

Conclusion

HBOT enhances physical performance in healthy middle-age master athletes, including VO2max, power and VO2AT. The mechanisms may be related to significant improvements in mitochondrial respiration and increased mitochondrial mass.

Trial Registration ClinicalTrials.gov Identifier: https://clinicaltrials.gov/ct2/show/NCT03524989 (May 15, 2018).

HIIT'ing or MISS'ing the Optimal Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of High- Versus Moderate-Intensity Exercise Prescription

Introduction: Polycystic Ovary syndrome (PCOS) is a metabolic disorder associated with increased cardiovascular disease risk. Exercise is an effective treatment strategy to manage symptoms and reduce long-term health risk. High-intensity interval training (HIIT) has been suggested as a more efficient exercise mode in PCOS; however, it is not clear whether HIIT is superior to moderate intensity steady state exercise (MISS).

Methods: We synthesized available data through a systematic review and meta-analysis to compare the effectiveness of isolated HIIT and MISS exercise interventions. Our primary outcome measures were cardiorespiratory fitness and insulin resistance, measured using V˙O_2max and HOMA-IR respectively.

Results: A total of 16 studies were included. Moderate-quality evidence from 16 studies identified significant improvements in V˙O_2max following MISS (Δ = 1.081 ml/kg/min, p < 0.001, n = 194), but not HIIT (Δ = 0.641 ml/kg/min, p = 0.128, n = 28). Neither HIIT nor MISS improved HOMA-IR [(Δ = −0.257, p = 0.374, n = 60) and (Δ = −0.341, p = 0.078, n = 159), respectively].

Discussion: A significant improvement in V˙O_2max was evident following MISS, but not HIIT exercise in women with PCOS. This contrasts with previous literature in healthy and clinical cohorts that report superior benefits of HIIT. Therefore, based on available moderate-quality evidence, HIIT exercise does not provide superior outcomes in V˙O_2max compared with MISS, although larger high-quality interventions are needed to fully address this. Additional dietary/pharmacological interventions may be required in conjunction with exercise to improve insulin sensitivity.

W' Recovery Kinetics after Exhaustion: A Two-Phase Exponential Process Influenced by Aerobic Fitness

PURPOSE

The aims of this study were 1) to model the temporal profile of W' recovery after exhaustion, 2) to estimate the contribution of changing V˙O2 kinetics to this recovery, and 3) to examine associations with aerobic fitness and muscle fiber type (MFT) distribution.

METHODS

Twenty-one men (age = 25 ± 2 yr, V˙O2peak = 54.4 ± 5.3 mL·min-1·kg-1) performed several constant load tests to determine critical power and W' followed by eight trials to quantify W' recovery. Each test consisted of two identical exhaustive work bouts (WB1 and WB2), separated by a variable recovery interval of 30, 60, 120, 180, 240, 300, 600, or 900 s. Gas exchange was measured and muscle biopsies were collected to determine MFT distribution. W' recovery was quantified as observed W' recovery (W'OBS), model-predicted W' recovery (W'BAL), and W' recovery corrected for changing V˙O2 kinetics (W'ADJ). W'OBS and W'ADJ were modeled using mono- and biexponential fitting. Root-mean-square error (RMSE) and Akaike information criterion (∆AICC) were used to evaluate the models' accuracy.

RESULTS

The W'BAL model (τ = 524 ± 41 s) was associated with an RMSE of 18.6% in fitting W'OBS and underestimated W' recovery for all durations below 5 min (P < 0.002). Monoexponential modeling of W'OBS resulted in τ = 104 s with RMSE = 6.4%. Biexponential modeling of W'OBS resulted in τ1 = 11 s and τ2 = 256 s with RMSE = 1.7%. W'ADJ was 11% ± 1.5% lower than W'OBS (P < 0.001). ∆AICC scores favored the biexponential model for W'OBS, but not for W'ADJ. V˙O2peak (P = 0.009) but not MFT distribution (P = 0.303) was associated with W'OBS.

CONCLUSION

We showed that W' recovery from exhaustion follows a two-phase exponential time course that is dependent on aerobic fitness. The appearance of a fast initial recovery phase was attributed to an enhanced aerobic energy provision resulting from changes in V˙O2 kinetics.

Under the Hood: Skeletal Muscle Determinants of Endurance Performance

In the past decades, researchers have extensively studied (elite) athletes' physiological responses to understand how to maximize their endurance performance. In endurance sports, whole-body measurements such as the maximal oxygen consumption, lactate threshold, and efficiency/economy play a key role in performance. Although these determinants are known to interact, it has also been demonstrated that athletes rarely excel in all three. The leading question is how athletes reach exceptional values in one or all of these determinants to optimize their endurance performance, and how such performance can be explained by (combinations of) underlying physiological determinants. In this review, we advance on Joyner and Coyle's conceptual framework of endurance performance, by integrating a meta-analysis of the interrelationships, and corresponding effect sizes between endurance performance and its key physiological determinants at the macroscopic (whole-body) and the microscopic level (muscle tissue, i.e., muscle fiber oxidative capacity, oxygen supply, muscle fiber size, and fiber type). Moreover, we discuss how these physiological determinants can be improved by training and what potential physiological challenges endurance athletes may face when trying to maximize their performance. This review highlights that integrative assessment of skeletal muscle determinants points toward efficient type-I fibers with a high mitochondrial oxidative capacity and strongly encourages well-adjusted capillarization and myoglobin concentrations to accommodate the required oxygen flux during endurance performance, especially in large muscle fibers. Optimisation of endurance performance requires careful design of training interventions that fine tune modulation of exercise intensity, frequency and duration, and particularly periodisation with respect to the skeletal muscle determinants.

Preserved skeletal muscle oxidative capacity in older adults despite decreased cardiorespiratory fitness with ageing

KEY POINTS

Healthy older adults exhibit lower cardiorespiratory fitness ( V ̇ O 2 peak ) than young in the absence of any age-related difference in skeletal muscle mitochondrial capacity, suggesting central haemodynamics plays a larger role in age-related declines in V ̇ O 2 peak . Total physical activity did not differ by age, but moderate-to-vigorous physical activity was lower in older compared to young adults. Moderate-to-vigorous physical activity is associated with V ̇ O 2 peak and muscle oxidative capacity, but physical inactivity cannot entirely explain the age-related reduction in V ̇ O 2 peak .

ABSTRACT

Declining fitness ( V ̇ O 2 peak ) is a hallmark of ageing and believed to arise from decreased oxygen delivery and reduced muscle oxidative capacity. Physical activity is a modifiable lifestyle factor that is critical when evaluating the effects of age on parameters of fitness and energy metabolism. The objective was to evaluate the effects of age and sex on V ̇ O 2 peak , muscle mitochondrial physiology, and physical activity in young and older adults. An additional objective was to assess the contribution of skeletal muscle oxidative capacity to age-related reductions in V ̇ O 2 peak and determine if age-related variation in V ̇ O 2 peak and muscle oxidative capacity could be explained on the basis of physical activity levels. In 23 young and 52 older men and women measurements were made of V ̇ O 2 peak , mitochondrial physiology in permeabilized muscle fibres, and free-living physical activity by accelerometry. Regression analyses were used to evaluate associations between age and V ̇ O 2 peak , mitochondrial function, and physical activity. Significant age-related reductions were observed for V ̇ O 2 peak (P < 0.001), but not muscle mitochondrial capacity. Total daily step counts did not decrease with age, but older adults showed lower moderate-to-vigorous physical activity, which was associated with V ̇ O 2 peak (R²  = 0.323, P < 0.001) and muscle oxidative capacity (R²  = 0.086, P = 0.011). After adjusting for sex and physical activity, age was negatively associated with V ̇ O 2 peak but not muscle oxidative capacity. Healthy older adults exhibit lower V ̇ O 2 peak but preserved mitochondrial capacity compared to young. Physical activity, particularly moderate-to-vigorous, is a key factor in observed age-related changes in fitness and muscle oxidative capacity, but cannot entirely explain the age-related reduction in V ̇ O 2 peak .

MUSCLE OXYGENATION OF THE QUADRICEPS AND GASTROCNEMIUS DURING MAXIMAL AEROBIC EFFORT

ABSTRACT Introduction: Near infrared spectroscopy (NIRS) is a non-invasive technique that is used in the assessment of tissue oxygenation and the monitoring of physical activity. Objective: To determine the influence of sexual, anthropometric and ergospirometric factors on muscle oxygenation of the quadriceps and gastrocnemius, obtained by NIRS during a stress test. Methods: Twenty healthy subjects participated in this study (10 women). Two Humon Hex® devices were placed on the dominant side of the quadriceps and gastrocnemius muscles to measure muscle oxygen saturation (SmO2). The stress test was performed on a treadmill with electrocardiographic control and measurement of oxygen consumption. SmO2 was obtained at rest and after maximum effort during the stress test. In addition, the height, weight, skinfold and waist contour were measured. Bioimpedance was used to obtain the percentages of fat mass and muscle mass, which were used to calculate the relative fat mass (RFM). Results: The SmO2 of both muscles at rest is higher in males than in females. At maximum effort, the SmO2 of the quadriceps is similar in both groups. The SmO2 of both muscles is positively related to height, body mass, percentage of mass muscle and waist contour, and negatively with percentage of mass fat, RFM and skinfold thickness. The negative correlation between fat percentage and oxygen saturation is more evident in females. It was observed that the variables that quantify maximum effort are not related to the SmO2 values, except for the correlation between HR max and SmO2 of the gastrocnemius muscle in males. Conclusion: The SmO2 of recreational athletes is influenced by the location of the device and the fat mass of the subjects. The biggest differences between the sexes are in the gastrocnemius muscle. Level of Evidence II; Diagnostic Studies - Investigating a Diagnostic Test .

Both Traditional and Stair Climbing-based HIIT Cardiac Rehabilitation Induce Beneficial Muscle Adaptations

PURPOSE

There is a lack of knowledge as to how different exercise-based cardiac rehabilitation programming affects skeletal muscle adaptations in coronary artery disease (CAD) patients. We first characterized the skeletal muscle from adults with CAD compared with a group of age- and sex-matched healthy adults. We then determined the effects of a traditional moderate-intensity continuous exercise program (TRAD) or a stair climbing-based high-intensity interval training program (STAIR) on skeletal muscle metabolism in CAD.

METHODS

Sixteen adults (n = 16, 61 ± 7 yr), who had undergone recent treatment for CAD, were randomized to perform (3 d·wk-1) either TRAD (n = 7, 30 min at 60%-80% of peak heart rate) or STAIR (n = 9, 3 × 6 flights) for 12 wk. Muscle biopsies were collected at baseline in both CAD and healthy controls (n = 9), and at 4 and 12 wk after exercise training in CAD patients undertaking TRAD or STAIR.

RESULTS

We found that CAD had a lower capillary-to-fiber ratio (C/Fi, 35% ± 25%, P = 0.06) and capillary-to-fiber perimeter exchange (CFPE) index (23% ± 29%, P = 0.034) in Type II fibers compared with healthy controls. However, 12 wk of cardiac rehabilitation with either TRAD or STAIR increased C/Fi (Type II, 23% ± 14%, P < 0.001) and CFPE (Type I, 10% ± 23%, P < 0.01; Type II, 18% ± 22%, P = 0.002).

CONCLUSION

Cardiac rehabilitation via TRAD or STAIR exercise training improved the compromised skeletal muscle microvascular phenotype observed in CAD patients.

Excessive exercise training causes mitochondrial functional impairment and decreases glucose tolerance in healthy volunteers

Exercise training positively affects metabolic health through increased mitochondrial oxidative capacity and improved glucose regulation and is the first line of treatment in several metabolic diseases. However, the upper limit of the amount of exercise associated with beneficial therapeutic effects has not been clearly identified. Here, we used a training model with a progressively increasing exercise load during an intervention over 4 weeks. We closely followed changes in glucose tolerance, mitochondrial function and dynamics, physical exercise capacity, and whole-body metabolism. Following the week with the highest exercise load, we found a striking reduction in intrinsic mitochondrial function that coincided with a disturbance in glucose tolerance and insulin secretion. We also assessed continuous blood glucose profiles in world-class endurance athletes and found that they had impaired glucose control compared with a matched control group.

Mitochondrial impairments in aetiopathology of multifactorial diseases: common origin but individual outcomes in context of 3P medicine

Mitochondrial injury plays a key role in the aetiopathology of multifactorial diseases exhibiting a "vicious circle" characteristic for pathomechanisms of the mitochondrial and multi-organ damage frequently developed in a reciprocal manner. Although the origin of the damage is common (uncontrolled ROS release, diminished energy production and extensive oxidative stress to life-important biomolecules such as mtDNA and chrDNA), individual outcomes differ significantly representing a spectrum of associated pathologies including but not restricted to neurodegeneration, cardiovascular diseases and cancers. Contextually, the role of predictive, preventive and personalised (PPPM/3P) medicine is to introduce predictive analytical approaches which allow for distinguishing between individual outcomes under circumstance of mitochondrial impairments followed by cost-effective targeted prevention and personalisation of medical services. Current article considers innovative concepts and analytical instruments to advance management of mitochondriopathies and associated pathologies.

Can Proprioceptive Training Enhance Fatigability and Decrease Progression Rate of Sarcopenia in Seniors? A Novel Approach

Sarcopenia is a common condition in older adults, which causes the frequent occurrence of muscle fatigue. Muscle fatigue commonly develops among seniors. Muscle fatigue is a type of physical fatigue that occurs due to either motor or sensory dysfunctions. Current interventions developed to decrease the occurrence of muscle fatigue, which include either increasing rest periods or subdividing large tasks into small ones. The effectiveness of these interventions is highly contradicted. Recently, researchers discovered that mechanoreceptors are the main receptors of muscle fatigue, however, no clinical study investigated the effect of performing proprioceptive training to enhance the mechanoreceptors and decrease the occurrence of muscle fatigue. Performing proprioceptive training could improve muscle fatigue by improving its sensory part. The function of mechanoreceptors might consequently enhance fatigue and decrease the progression rate of sarcopenia. Thus, this review was conducted to suggest a novel approach of treatment to enhance fatigue and decrease Sarcopenia in seniors. This might be accomplished through increasing the firing rate of α- motor neurons, increasing the amount of Ca2+ ions in the neuromuscular junction, slowing the progression rate of Sarcopenia, and correcting movement deviations, which commonly occur with muscle fatigue in seniors. In conclusion, proprioceptive training could play an effective role in decreasing the progression rate of sarcopenia and enhancing the fatigability among seniors.

Plasma Lactate as a Marker for Metabolic Health

Blood lactate concentrations traditionally have been used as an index of exercise intensity or clinical hyperlactatemia. However, more recent data suggest that fasting plasma lactate can also be indicative of the risk for subsequent metabolic disease. The hypothesis presented is that fasting blood lactate accumulation reflects impaired mitochondrial substrate use, which in turn influences metabolic disease risk.

Articles with impact: insights into 10 years of research with machine learning

Worldwide scientific output is growing faster and faster. Academics should not only publish much and fast, but also publish research with impact. The aim of this study is to use machine learning to investigate characteristics of articles that were published in the Journal of Applied Physiology between 2009 and 2018, and characterize high-impact articles. Article impact was assessed for 4,531 publications by three common impact metrics: the Altmetric Attention Scores, downloads, and citations. Additionally, a broad collection of (more than 200) characteristics was collected from the article's title, abstract, authors, keywords, publication, and article engagement. We constructed random forest (RF) regression models to predict article impact and articles with the highest impact (top-25% and top-10% for each impact metric), which were compared with a naive baseline method. RF models outperformed the baseline models when predicting the impact of unseen articles (P < 0.001 for each impact metric). Also, RF models predicted top-25% and top-10% high-impact articles with a high accuracy. Moreover, RF models revealed important article characteristics. Higher impact was observed for articles about exercise, training, performance and V̇o_2max, reviews, human studies, articles from large collaborations, longer articles with many references and high engagement by scientists, practitioners and public or via news outlets and videos. Lower impact was shown for articles about respiratory physiology or sleep apnea, editorials, animal studies, and titles with a question mark or a reference to places or individuals. In summary, research impact can be predicted and better understood using a combination of article characteristics and machine learning.NEW & NOTEWORTHY Common measures of article impact are the Altmetric Attention Scores, number of downloads, and number of citations. To our knowledge, this is the first study that applies machine learning on a comprehensive collection of article characteristics to predict article attention scores, downloads, and citations. Using 10 years of research articles, we obtained accurate predictions of high-impact articles and discovered important article characteristics related to article impact.

Novel approaches to metabolic assessment and structured exercise to promote recovery in ICU survivors

PURPOSE OF REVIEW

Survivorship or addressing impaired quality of life (QoL) in ICU survivors has been named 'the defining challenge of critical care' for this century to address this challenge; in addition to optimal nutrition, we must learn to employ targeted metabolic/muscle assessment techniques and utilize structured, progressive ICU rehabilitative strategies.

RECENT FINDINGS

Objective measurement tools such as ccardiopulmonary exercise testing (CPET) and muscle-specific ultrasound show great promise to assess/treat post-ICU physical dysfunction. CPET is showing that systemic mitochondrial dysfunction may underlie development and persistence of poor post-ICU functional recovery. Finally, recent data indicate that we are poor at delivering effective, early ICU rehabilitation and that there is limited benefit of currently employed later ICU rehabilitation on ICU-acquired weakness and QoL outcomes.

SUMMARY

The combination of nutrition with effective, early rehabilitation is highly likely to be essential to optimize muscle mass/strength and physical function in ICU survivors. Currently, technologies such as muscle-specific ultrasound and CPET testing show great promise to guide ICU muscle/functional recovery. Further, we must evolve improved ICU-rehabilitation strategies, as current methods are not consistently improving outcomes. In conclusion, we must continue to look to other areas of medicine and to athletes if we hope to ultimately improve 'ICU Survivorship'.

Lifelong Endurance Exercise as a Countermeasure Against Age-Related V ˙ O 2 max Decline: Physiological Overview and Insights from Masters Athletes

Maximum oxygen consumption (V ˙ O 2 max ) is not only an indicator of endurance performance, but also a strong predictor of cardiovascular disease and mortality. This physiological parameter is known to decrease with aging. In turn, physical exercise might attenuate the rate of aging-related decline inV ˙ O 2 max , which in light of the global population aging is of major clinical relevance, especially at advanced ages. In this narrative review, we summarize the evidence available from masters athletes about the role of lifelong endurance exercise on aging-relatedV ˙ O 2 max decline, with examples of the highestV ˙ O 2 max values reported in the scientific literature for athletes across different ages (e.g., 35 ml·kg-1·min-1 in a centenarian cyclist). These data suggest that a linear decrease inV ˙ O 2 max might be possible if physical exercise loads are kept consistently high through the entire life span, withV ˙ O 2 max values remaining higher than those of the general population across all ages. We also summarize the main physiological changes that occur with inactive aging at different system levels-pulmonary and cardiovascular function, blood O2 carrying capacity, skeletal muscle capillary density and oxidative capacity-and negatively influenceV ˙ O 2 max , and review how lifelong exercise can attenuate or even prevent most-but apparently not all (e.g., maximum heart rate decline)-of them. In summary, although aging seems to be invariably associated with a progressive decline inV ˙ O 2 max , maintaining high levels of physical exercise along the life span slows the multi-systemic deterioration that is commonly observed in inactive individuals, thereby attenuating age-relatedV ˙ O 2 max decline.

An Equivocal Final Link - Quantitative Determination of the Thermodynamic Efficiency of ATP Hydrolysis - Sullies the Chain of Electric, Ionic, Mechanical and Metabolic Steps Underlying Cardiac Contraction

Each beat of the heart completes the final step in a sequence of events commencing with electrical excitation-triggered release of Ca2+ from the sarcoplasmic reticulum which, in turn, triggers ATP-hydrolysis-dependent mechanical contraction. Given that Thermodynamics is inherently detail-independent, the heart can be thus be viewed as a mechanical pump - the generator of pressure that drives blood through the systemic and pulmonary circulations. The beat-to-beat pressure-volume work (W) of the heart is relatively straightforward to measure experimentally. Given an ability to measure, simultaneously, the accompanying heat production or oxygen consumption, it is trivial to calculate the mechanical efficiency: ε = W/ΔH where ΔH is the change of enthalpy: (W + Q), Q representing the accompanying production of heat. But it is much less straightforward to measure the thermodynamic efficiency: η = W/ΔG ATP , where ΔG ATP signifies the Gibbs Free Energy of ATP hydrolysis. The difficulty arises because of uncertain quantification of the substrate-dependent yield of ATP - conveniently expressed as the P/O2 ratio. P/O2 ratios, originally ("classically") inferred from thermal studies, have been considerably reduced over the past several decades by re-analysis of the stoichiometric coefficients separating sequential steps in the electron transport system - in particular, dropping the requirement that the coefficients have integer values. Since the early classical values are incompatible with the more recent estimates, we aim to probe this discrepancy with a view to its reconciliation. Our probe consists of a simple, thermodynamically constrained, algebraic model of cardiac mechano-energetics. Our analysis fails to reconcile recent and classical estimates of PO2 ratios; hence, we are left with a conundrum.

Improvements in Skeletal Muscle Can Be Detected Using Broadband NIRS in First-Time Marathon Runners

Skeletal muscle metabolic function is known to respond positively to endurance exercise interventions, such as marathon training. Studies investigating skeletal muscle have typically used muscle biopsy samples or magnetic resonance spectroscopy (MRS) to interrogate metabolic function. We aimed to non-invasively detect exercise-training-induced improvements in muscle function using broadband near-infrared spectroscopy (NIRS). We used NIRS to determine concentration changes in oxygenated haemoglobin (HbO2) and the oxidation state of cytochrome-c-oxidase (oxCCO) in gastrocnemius during arterial occlusion in 14 volunteers. We also used a cardio-pulmonary exercise test (CPET) to assess peak total body oxygen uptake (peakVO2; a measure of fitness). Measurements were made at baseline (BL) which was prior to a period of at least 16 weeks of training for the 2017 London Marathon, and then within 3 weeks after completion of the marathon, follow-up (FU). We observed an increase in locally measured muscle oxygen consumption and rate of oxCCO concentration change, but not in cardio-respiratory fitness measured as whole-body peak oxygen consumption (peakVO2).

Complex I is bypassed during high intensity exercise

Human muscles are tailored towards ATP synthesis. When exercising at high work rates muscles convert glucose to lactate, which is less nutrient efficient than respiration. There is hence a trade-off between endurance and power. Metabolic models have been developed to study how limited catalytic capacity of enzymes affects ATP synthesis. Here we integrate an enzyme-constrained metabolic model with proteomics data from muscle fibers. We find that ATP synthesis is constrained by several enzymes. A metabolic bypass of mitochondrial complex I is found to increase the ATP synthesis rate per gram of protein compared to full respiration. To test if this metabolic mode occurs in vivo, we conduct a high resolved incremental exercise tests for five subjects. Their gas exchange at different work rates is accurately reproduced by a whole-body metabolic model incorporating complex I bypass. The study therefore shows how proteome allocation influences metabolism during high intensity exercise.

Anthropometric Clusters of Competitive Cyclists and Their Sprint and Endurance Performance

Do athletes specialize toward sports disciplines that are well aligned with their anthropometry? Novel machine-learning algorithms now enable scientists to cluster athletes based on their individual anthropometry while integrating multiple anthropometric dimensions, which may provide new perspectives on anthropometry-dependent sports specialization. We aimed to identify clusters of competitive cyclists based on their individual anthropometry using multiple anthropometric measures, and to evaluate whether athletes with a similar anthropometry also competed in the same cycling discipline. Additionally, we assessed differences in sprint and endurance performance between the anthropometric clusters. Twenty-four nationally and internationally competitive male cyclists were included from sprint, pursuit, and road disciplines. Anthropometry was measured and k-means clustering was performed to divide cyclists into three anthropometric subgroups. Sprint performance (Wingate 1-s peak power, squat-jump mean power) and endurance performance (mean power during a 15 km time trial, V˙O_2peak) were obtained. K-means clustering assigned sprinters to a mesomorphic cluster (endo-, meso-, and ectomorphy were 2.8, 5.0, and 2.4; n = 6). Pursuit and road cyclists were distributed over a short meso-ectomorphic cluster (1.6, 3.8, and 3.9; n = 9) and tall meso-ectomorphic cluster (1.5, 3.6, and 4.0; n = 9), the former consisting of significantly lighter, shorter, and smaller cyclists (p < 0.05). The mesomorphic cluster demonstrated higher sprint performance (p < 0.05), whereas the meso-ectomorphic clusters established higher endurance performance (p < 0.001). Overall, endurance performance was associated with lean ectomorph cyclists with small girths and small frontal area (p < 0.05), and sprint performance related to cyclists with larger skinfolds, larger girths, and low frontal area per body mass (p < 0.05). Clustering optimization revealed a mesomorphic cluster of sprinters with high sprint performance and short and tall meso-ectomorphic clusters of pursuit and road cyclists with high endurance performance. Anthropometry-dependent specialization was partially confirmed, as the clustering algorithm distinguished short and tall endurance-type cyclists (matching the anthropometry of all-terrain and flat-terrain road cyclists) rather than pursuit and road cyclists. Machine-learning algorithms therefore provide new insights in how athletes match their sports discipline with their individual anthropometry.

"Question Your Categories": the Misunderstood Complexity of Middle-Distance Running Profiles With Implications for Research Methods and Application

Middle-distance running provides unique complexity where very different physiological and structural/mechanical profiles may achieve similar elite performances. Training and improving the key determinants of performance and applying interventions to athletes within the middle-distance event group are probably much more divergent than many practitioners and researchers appreciate. The addition of maximal sprint speed and other anaerobic and biomechanical based parameters, alongside more commonly captured aerobic characteristics, shows promise to enhance our understanding and analysis within the complexities of middle-distance sport science. For coaches, athlete diversity presents daily training programming challenges in order to best individualize a given stimulus according to the athletes profile and avoid “non-responder” outcomes. It is from this decision making part of the coaching process, that we target this mini-review. First we ask researchers to “question their categories” concerning middle-distance event groupings. Historically broad classifications have been used [from 800 m (~1.5 min) all the way to 5,000 m (~13–15 min)]. Here within we show compelling rationale from physiological and event demand perspectives for narrowing middle-distance to 800 and 1,500 m alone (1.5–5 min duration), considering the diversity of bioenergetics and mechanical constraints within these events. Additionally, we provide elite athlete data showing the large diversity of 800 and 1,500 m athlete profiles, a critical element that is often overlooked in middle-distance research design. Finally, we offer practical recommendations on how researchers, practitioners, and coaches can advance training study designs, scientific interventions, and analysis on middle-distance athletes/participants to provide information for individualized decision making trackside and more favorable and informative study outcomes.

Enhanced Echo Intensity of Skeletal Muscle Is Associated With Exercise Intolerance in Patients With Heart Failure

BACKGROUND

Skeletal muscle is quantitatively and qualitatively impaired in patients with heart failure (HF), which is closely linked to lowered exercise capacity. Ultrasonography (US) for skeletal muscle has emerged as a useful, noninvasive tool to evaluate muscle quality and quantity. Here we investigated whether muscle quality based on US-derived echo intensity (EI) is associated with exercise capacity in patients with HF.

METHODS AND RESULTS

Fifty-eight patients with HF (61 ± 12 years) and 28 control subjects (58 ± 14 years) were studied. The quadriceps femoris echo intensity (QEI) was significantly higher and the quadriceps femoris muscle thickness (QMT) was significantly lower in the patients with HF than the controls (88.3 ± 13.4 vs 81.1 ± 7.5, P= .010; 5.21 ± 1.10 vs 6.54 ±1.34 cm, P< .001, respectively). By univariate analysis, QEI was significantly correlated with age, peak oxygen uptake (VO₂), and New York Heart Association class in the HF group. A multivariable analysis revealed that the QEI was independently associated with peak VO₂ after adjustment for age, gender, body mass index, and QMT: β-coefficient = -11.80, 95%CI (-20.73, -2.86), P= .011.

CONCLUSION

Enhanced EI in skeletal muscle was independently associated with lowered exercise capacity in HF. The measurement of EI is low-cost, easily accessible, and suitable for assessment of HF-related alterations in skeletal muscle quality.

Physiological comparison of hemorrhagic shock and V˙ O2max: A conceptual framework for defining the limitation of oxygen delivery

IMPACT STATEMENT

Disturbance of normal homeostasis occurs when oxygen delivery and energy stores to the body's tissues fail to meet the energy requirement of cells. The work submitted in this review is important because it advances the understanding of inadequate oxygen delivery as it relates to early diagnosis and treatment of circulatory shock and its relationship to disturbance of normal functioning of cellular metabolism in life-threatening conditions of hemorrhage. We explored data from the clinical and exercise literature to construct for the first time a conceptual framework for defining the limitation of inadequate delivery of oxygen by comparing the physiology of hemorrhagic shock caused by severe blood loss to maximal oxygen uptake induced by intense physical exercise. We also provide a translational framework in which understanding the fundamental relationship between the body's reserve to compensate for conditions of inadequate oxygen delivery as a limiting factor to V ˙ O2max helps to re-evaluate paradigms of triage for improved monitoring of accurate resuscitation in patients suffering from hemorrhagic shock.

High-Intensity Exercise and Mitochondrial Biogenesis: Current Controversies and Future Research Directions

It is well established that different types of exercise can provide a powerful stimulus for mitochondrial biogenesis. However, there are conflicting findings in the literature, and a consensus has not been reached regarding the efficacy of high-intensity exercise to promote mitochondrial biogenesis in humans. The purpose of this review is to examine current controversies in the field and to highlight some important methodological issues that need to be addressed to resolve existing conflicts.

Fndc5 loss-of-function attenuates exercise-induced browning of white adipose tissue in mice

Fibronectin type III domain containing 5 (Fndc5) is a transmembrane protein highly expressed in the skeletal muscle. It was reported that exercise promotes the shedding of the extracellular domain of Fndc5, generating a circulating peptide (irisin) that cross-talks to adipose tissues to convert lipid-storing white adipocytes to energy-catabolizing beige adipocytes. However, the requirement of Fndc5 in mediating the beneficial effect of exercise remains to be determined. Here, we created a mouse model of Fndc5 mutation through transcription activator-like effector nuclease-mediated DNA targeting. The Fndc5 mutant mice have normal skeletal muscle development, growth, regeneration, as well as glucose and lipid metabolism at resting state, even when fed a high-fat diet. In response to running exercise, however, the Fndc5 mutant mice exhibit reduced glucose tolerance and insulin sensitivity and have lower maximal oxygen consumption compared with the exercised wild-type mice. Mechanistically, Fndc5 mutation attenuates exercise-induced browning of white adipose tissue that is crucial for the metabolic benefits of physical activities. These data provide genetic evidence that Fndc5 is dispensable for muscle development and basal metabolism but essential for exercise-induced browning of white adipose tissues in mice.-Xiong, Y., Wu, Z., Zhang, B., Wang, C., Mao, F., Liu, X., Hu, K., Sun, X., Jin, W., Kuang, S. Fndc5 loss-of-function attenuates exercise-induced browning of white adipose tissue in mice.

Cross-Adaptation: Heat and Cold Adaptation to Improve Physiological and Cellular Responses to Hypoxia

To prepare for extremes of heat, cold or low partial pressures of oxygen (O₂), humans can undertake a period of acclimation or acclimatization to induce environment-specific adaptations, e.g. heat acclimation (HA), cold acclimation (CA), or altitude training. While these strategies are effective, they are not always feasible due to logistical impracticalities. Cross-adaptation is a term used to describe the phenomenon whereby alternative environmental interventions, e.g. HA or CA, may be a beneficial alternative to altitude interventions, providing physiological stress and inducing adaptations observable at altitude. HA can attenuate physiological strain at rest and during moderate-intensity exercise at altitude via adaptations allied to improved O₂ delivery to metabolically active tissue, likely following increases in plasma volume and reductions in body temperature. CA appears to improve physiological responses to altitude by attenuating the autonomic response to altitude. While no cross-acclimation-derived exercise performance/capacity data have been measured following CA, post-HA improvements in performance underpinned by aerobic metabolism, and therefore dependent on O₂ delivery at altitude, are likely. At a cellular level, heat shock protein responses to altitude are attenuated by prior HA, suggesting that an attenuation of the cellular stress response and therefore a reduced disruption to homeostasis at altitude has occurred. This process is known as cross-tolerance. The effects of CA on markers of cross-tolerance is an area requiring further investigation. Because much of the evidence relating to cross-adaptation to altitude has examined the benefits at moderate to high altitudes, future research examining responses at lower altitudes should be conducted, given that these environments are more frequently visited by athletes and workers. Mechanistic work to identify the specific physiological and cellular pathways responsible for cross-adaptation between heat and altitude, and between cold and altitude, is warranted, as is exploration of benefits across different populations and physical activity profiles.