Cardio respiratory response: Validation of new modifications of Bruce protocol for exercise testing and training in elite Saudi triathlon and soccer players

Strength, power and aerobic capacity of transgender athletes: a cross-sectional study

OBJECTIVE

The primary objective of this cross-sectional study was to compare standard laboratory performance metrics of transgender athletes to cisgender athletes.

METHODS

19 cisgender men (CM) (mean±SD, age: 37±9 years), 12 transgender men (TM) (age: 34±7 years), 23 transgender women (TW) (age: 34±10 years) and 21 cisgender women (CW) (age: 30±9 years) underwent a series of standard laboratory performance tests, including body composition, lung function, cardiopulmonary exercise testing, strength and lower body power. Haemoglobin concentration in capillary blood and testosterone and oestradiol in serum were also measured.

RESULTS

In this cohort of athletes, TW had similar testosterone concentration (TW 0.7±0.5 nmol/L, CW 0.9±0.4 nmol/), higher oestrogen (TW 742.4±801.9 pmol/L, CW 336.0±266.3 pmol/L, p=0.045), higher absolute handgrip strength (TW 40.7±6.8 kg, CW 34.2±3.7 kg, p=0.01), lower forced expiratory volume in 1 s:forced vital capacity ratio (TW 0.83±0.07, CW 0.88±0.04, p=0.04), lower relative jump height (TW 0.7±0.2 cm/kg; CW 1.0±0.2 cm/kg, p<0.001) and lower relative V̇O2max (TW 45.1±13.3 mL/kg/min/, CW 54.1±6.0 mL/kg/min, p<0.001) compared with CW athletes. TM had similar testosterone concentration (TM 20.5±5.8 nmol/L, CM 24.8±12.3 nmol/L), lower absolute hand grip strength (TM 38.8±7.5 kg, CM 45.7±6.9 kg, p=0.03) and lower absolute V̇O2max (TM 3635±644 mL/min, CM 4467±641 mL/min p=0.002) than CM.

CONCLUSION

While longitudinal transitioning studies of transgender athletes are urgently needed, these results should caution against precautionary bans and sport eligibility exclusions that are not based on sport-specific (or sport-relevant) research.

Rating of Perceived Exertion Associated With Acute Symptoms in Athletes With Recent SARS-CoV-2 Infection: Athletes With Acute Respiratory InfEction (AWARE) VI Study

CONTEXT

SARS-CoV-2 infection can affect the exercise response in athletes. Factors associated with the exercise response have not been reported.

OBJECTIVE

To (1) describe heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) responses to exercise in athletes with a recent SARS-CoV-2 infection and (2) identify factors affecting exercise responses.

DESIGN

Cross-sectional, experimental study.

PATIENTS OR OTHER PARTICIPANTS

Male and female athletes (age = 24.2 ± 6.3 years) with a recent (<28 days) SARS-CoV-2 infection (n = 72).

SETTING

A COVID-19 Recovery Clinic for athletes.

MAIN OUTCOME MEASURE(S)

Heart rate, SBP, and RPE were measured during submaximal exercise (modified Bruce protocol) at 10 to 28 days after SARS-CoV-2 symptom onset. Selected factors (demographics, sport, comorbidities, preinfection training variables, and symptoms during the acute phase of the infection) affecting the exercise response were analyzed using random coefficient (linear mixed) models.

RESULTS

Heart rate, SBP, and RPE increased progressively from rest to stage 5 of the exercise test (P = .0001). At stage 5 (10.1 metabolic equivalents), a higher HR and a higher SBP during exercise were associated with younger age (P = .0007) and increased body mass index (BMI; P = .009), respectively. Higher RPE during exercise was significantly associated with a greater number of whole-body (P = .006) and total number (P = .004) of symptoms during the acute phase of infection.

CONCLUSIONS

A greater number of symptoms during the acute infection was associated with a higher RPE during exercise in athletes at 10 to 28 days after SARS-CoV-2 infection. We recommend measuring RPE during the first exercise challenge after infection, as this may indicate disease severity and be valuable for tracking progress, recovery, and return to sport.

Validation Study of Physical Activity and Sedentary Behavior in African-American Men and Women

BACKGROUND

Self-reported data of physical activity are practical and inexpensive ways to collect data, although, subject to significant measurement errors. Most physical activity questionnaires used in the USA have been predominately validated among non-Hispanic White American populations with limited attention paid to the validity of the measures among racial/ethnic minorities. Additionally, there are limited studies that have evaluated factors related to over- and under-reporting errors linked to self-reported physical activity data, particularly among African Americans. The primary objectives of this study were to validate self-reported levels of physical activity and sedentary behavior among African-American men and women against objective measurements and to identify the factors related to under- and over-reporting.

METHODS

This study was a 7-day, cross-sectional study conducted on African-American men and women (n = 56) who were between 21-70 years of age. Participants were required to attend two study visits for the collection of self-reported and objective measurements of physical activity and sedentary behavior (VO2max, DEXA scan, anthropometrics, ActivPal accelerometer, resting metabolic rate (RMR) and International Physical Activity Questionnaire (IPAQ) questionnaire.

RESULTS

Overall, energy expenditure measured by ActivPal was 24.1 MET/hr/week whereas self-reported (IPAQ) energy expenditure was 52.66 MET/hr/week. Self-reported sedentary time was 40.37 h/week, whereas sedentary time measured by ActivPal was 63.03 h/week. Obese participants tended to over-report their physical activity levels more so than non-obese participants (Obese, Activpal-23.89 MET/hr/week vs IPAQ-58.98 MET/hr/week; Non-obese, Activpal - 24.48 MET/hr/week vs IPAQ - 42.55 MET/hr/week). Both obese and non-obese participants underestimated their sedentary time (Obese, Activpal - 66.89 h/week vs IPAQ-43.92 h/week; Non-obese, Activpal -56.07 h/week vs IPAQ - 33.98 h/week).

CONCLUSIONS

The results of this study found that the ActivPal validated physical activity and sedentary behavior among African-Americans. Self-reported data were found to be highly variable, whereas the objective assessments of physical activity and sedentary behavior had limited variability. It was also found that obese individuals over-estimated their self-reported physical activity levels and under-estimated sedentary behavior in comparison to the ActivPal. These findings strongly support the need to measure physical activity and sedentary behaviors objectively, particularly among African-Americans.

Comparison of the Effects of Prebiotics and Synbiotics Supplementation on the Immune Function of Male University Football Players

This study was conducted to compare the effects of long-term prebiotic and synbiotic supplementations on the immunosuppression of male football players after daily high-intensity training and a one-time strenuous exercise. A total of 30 male university student-athletes were recruited and randomly assigned to the prebiotic (PG, n = 15) or synbiotic group (SG, n = 15), receiving a prebiotic or synbiotic once per day for six weeks. Physiological assessments were conducted by a maximal oxygen uptake (VO2max) test and an exhaustive constant load exercise (75% VO2max test). Inflammatory cytokine and secretory immunoglobulin A (SIgA) were measured. VO2max, maximal heart rate (HRmax), and lactic acid elimination rate (ER) were used to evaluate aerobic capacity. Upper respiratory tract infection (URTI) complaints were evaluated using a questionnaire. URTI incidence and duration were significantly lower in the SG group than that in the PG group (p < 0.05). At baseline, SIgA and interleukin-1β (IL-1β) levels in the SG group (p < 0.01) as well as IL-1β and IL-6 in the PG group (p < 0.05) were significantly increased, and IL-4 concentration was markedly reduced in the PG group (p < 0.01). The concentrations of IL-4, IL-10 and transforming growth factor-β1 (TGF-β1) were significantly reduced in the PG and SG group immediately after the constant load exercise. Significantly decreased HRmax and enhanced ER (increased by 193.78%) were detected in the SG group, not in the PG group, during the constant load experiment (p < 0.05) and the recovery period (p < 0.01), respectively. However, VO2max value was not changed. These data suggest that synbiotic supplementation for six weeks has a more positive effect than prebiotics on the immune function and athletic performance of male university football players.

Efficacy of Magnetic Therapy in Pain Reduction in Patients with Chronic Pelvic Pain: A Systematic Review

Chronic pelvic pain (CPP), also known as chronic pelvic pain syndrome (CPPS), is a common and painful condition. However, its treatment is still a challenge. The findings about the beneficial effects of electromagnetic therapy provide a new, potentially valid, therapeutic alternative for the management of patients with CPP. Objectives: to analyze the efficacy of magnetic field therapy in pain reduction in patients with CPP and for other variables, such as urinary symptoms and quality of life, as well as to review the evidence, in order to establish an action protocol. A qualitative systematic review was carried out, based on the PRISMA protocol and registered in PROSPERO (CRD42022285428). A search was performed in the PubMed, Medline, Scopus, Cochrane, PEDro, BVS, and WOS databases, including those articles in which the patients suffered from CPP; the study variable was pain, and the intervention was based on the application of magnetic fields. Results: Among the 81 articles found, five clinical trials were considered (with an average score of 7.2 in the PEDro scale), with a total of 278 participants, most of whom presented improvements in perceived pain (p ≤ 0.05), as well as in quality of life (p < 0.05) and urinary symptoms (p = 0.05), evaluated through the NIH-CPSI and VAS scales. The therapy was conducted as a monotherapy or in combination with a pharmacological treatment. There was no common protocol among the different articles. Conclusions: Intervention programs through electromagnetic therapy, on their own or with other therapies, can be effective in patients with CPP.

Effects of Training on Cardiorespiratory Fitness in Triathletes: A Systematic Review and Meta-Analysis

Triathlon is an aerobic sport, which is commonly measured by maximal aerobic consumption (VO₂max). Objective: to analyze the changes produced in cardiorespiratory and physiological measurements during practice, which determine triathletes’ performance level. A systematic review and a meta-analysis based on PRISMA protocol and registered in PROSPERO (CRD42020189076) was conducted. The research was performed using PubMed, SPORTDiscus, Embase, Dialnet, Web of Science (WOS) and MEDLINE databases during February and March 2020. Studies that measured cardiorespiratory variables in triathletes published in the last 10 years were included. Results: 713 articles were identified, with 25 studies selected for the systematic review and five articles for the meta-analysis. These articles concluded that the main cardiorespiratory variables that determine triathletes’ performance were modified depending on the triathlon segment performed and the athletes’ sex and age. The meta-analysis showed no conclusive results related to the effects of changes in VO₂max in triathletes’ performance [SMD = −0.21; 95%CI: (−0.84 to 0.43)]. Conclusions: cardiorespiratory fitness, in terms of VO₂max and ventilatory thresholds, is the strongest predictor of performance in triathlon. This response may be affected depending on the triathlon segment performed and the athlete’s age or sex, leading to both physiological and biomechanical alterations that affect competition performance.

Distance and Intensity Profiles in Division I Women's Soccer Matches across a Competitive Season

Women’s participation in soccer has increased rapidly. The purpose of this study was to evaluate the physiological demands imposed on women’s NCAA Division I soccer players across a season according to speed, total distance traveled, and numbers of sprints measured via GPS (Polar Team Pro^®). Eighteen athletes (19.2 ± 1.1 years, 50.5 ± 6.5 mL/kg/min and 23.4 ± 3.6% fat) participated in this study. The analysis was obtained through 13 official matches. Speed zones were defined as Zone 1 (1.0 to 5.99 km·h⁻¹), Zone 2 (6.0 to 10.99 km·h⁻¹), Zone 3 (11.0 to 15.49 km·h⁻¹), Zone 4 (15.5 to 19.9 km·h⁻¹) and Zone 5 (sprint > 20 km·h⁻¹), with Zones 4–5 considered as high intensity running. Individual differences in playing time and total distance were highly variable due to substitutions. Average distance traveled per game in quartiles was 3.9 km, 5.6 km and 7.4 km in the 25th, 50th, and 75th quartiles, respectively. Relative to playing time, players travelled an average of 113.64 ± 17.12 m/min (range: 93.7 to 143.5 m/min) and ran one sprint every 4.12 ± 2.06 min. When distance was summated and analyzed for the entire team, significant difference between halves was found for speed Zones 2, 3 and 4, with greater values found in the first half. Total distance, high intensity running and sprint distance were significantly less than previously recorded in professional players. These findings suggest that coaches should consider the unique physiological demands and recovery opportunities present in NCAA play when constructing practices and conditioning programs.

Relationship between anthropometric characteristics and aerobic fitness among Malaysian men and women

This cross-sectional study evaluated the relationships between anthropometric and aerobic fitness (rate of perceived exertion [RPE] and predicted maximal oxygen uptake [VO_2max]) among 228 participants (age: 23.78±4.42 years). RPE and predicted VO_2max were determined during the cycle ergometer exercise test. Data were also obtained for height, weight, body mass index (BMI), hip and waist (WC) circumferences. Data analysis revealed VO_2max is correlated with WC (r=−0.571), weight (r=−0.521), waist-to-height ratio (WHtR) (r=−0.516), waist-to-hip ratio (WHR) (r=−0.487), and BMI (r=−0.47) in men, while, in women with WC (r=−0.581), weight (r=−0.571), WHtR (r=−0.545), BMI (r=−0.545), WHR (r=−0.473), and height (r=−0.287) (all P<0.05). Regression analysis showed WC was a significant predictor for VO_2max in men and women (r₂=32.6% vs. 33.7%). The receiver operating characteristic curve of WC showed 0.786 and 0.831 for men and women, respectively. WC or abdominal obesity is the strongest predictor for VO_2max, which is an indicator of aerobic fitness in Malaysian adults.

Gauging the Positive Predictive Value of Exercise Tolerance Test Using Angiographic Evaluation: A Cross-Sectional Analysis From a Developing Country

Background

Exercise tolerance test (ETT) and angiographic evaluation are important tools to evaluate patients presenting with ischemic cardiac pathologies. Angiographic evaluation is regarded as the gold standard diagnostic modality to diagnose coronary artery disease (CAD). Our study aims to evaluate the positive predictive value (PPV) of ETT to diagnose CAD using coronary angiography.

Methods

We conducted a cross-sectional study that analyzed 94 patients with a positive ETT test after the application of strict inclusion and exclusion criteria. All 94 patients were referred for angiography after a positive ETT test. Data collection was performed using a structured proforma, and analysis was carried out on Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY). PPV for various demographic characteristics was calculated.

Results

Out of 94 patients, 76 were males and 18 were females with a mean age of 52.28 ± 7.55 years. A total of 35.1% of the patients had type-2 diabetes, and 31.9% were hypertensive. On coronary angiography, only 25 patients had normal findings, and 69 patients had a significant occlusion in at least one of the major coronary arteries. The overall PPV of the ETT against angiographic evaluation was 73.40%. The PPV for females, hypertensives, non-smokers, and non-diabetics was lower than the PPV of males, smokers, non-hypertensives, and diabetics.

Conclusion

Angiographic evaluation of patients with positive ETT findings has a high likelihood of false positivity especially among females, non-smokers, hypertensives, and non-diabetics. The results of ETT must be interpreted with caution in these subsets of the population. Invasive radiological modalities can be used for diagnosis; however, such modalities do not elucidate the functioning of myocardium under stress.

Reliability of the Polar Vantage M Sports Watch when Measuring Heart Rate at Different Treadmill Exercise Intensities

Background: Usage of wrist-worn activity monitors has rapidly increased in recent years, and these devices are being used by both fitness enthusiasts and in clinical populations. We, therefore, assessed the test–retest reliability of the Polar Vantage M (PVM) watch when measuring heart rate (HR) during various treadmill exercise intensities. Methods: HR was measured every 30 s (simultaneous electrocardiography (ECG) and PVM). Test–retest reliability was determined using an intraclass correlation coefficient (ICC) with 95% confidence intervals (CIs). Standard error of measurement (SEM) and smallest real difference (SRD) were used to determine measurement variability. Results: A total of 29 participants completed the trials. ICC values for PVM during stages 1, 2 and 5 demonstrated good to excellent test–retest reliability (0.78, 0.78 and 0.92; 95% CI (0.54–0.90, 0.54–0.9, 0.79–0.97)). For PVM during stages 0 (rest), 3 and 4, the ICC values indicated poor to good reliability (0.42, 0.68 and 0.58; 95% CI (−0.27–0.73, 0.32–0.85, 0.14–0.80)). Conclusion: This study identified that the test–retest reliability of the PVM was comparable at low and high exercise intensities; however, it revealed a poor to good test–retest reliability at moderate intensities. The PVM should not be used in a clinical setting where monitoring of an accurate HR is crucial to the patients’ safety.

Effect of Meridian Acupressure on Aerobic Performance of Healthy Young Population: A Randomized Controlled Study

OBJECTIVES

An enhancement of aerobic capacity has always been in the scope of various exercise programs. Apart from traditional, like endurance training, methods to improve aerobic performance, there is growing interest to alternative bodywork techniques, like massage, yoga, and acupuncture. This study aimed to investigate the acupressure effect on maximal aerobic capacity (VO₂max) in healthy young adult males.

DESIGN

Forty young healthy participants were randomly divided into intervention (n = 20) and control (n = 20) groups. The inferred VO₂max level in groups was assessed by the 6-min Harvard step test twice: at baseline and after acupressure session.

INTERVENTION

Three-minute finger-tip point massage of Neiguan, Juque, and Xinshu acupoints covered by 1 cm² sticky capsaicin-dressed heat plasters was applied in the intervention group, whereas in the control group, placebo acupressure was utilized.

RESULTS

The inferred VO₂max in the intervention group increased from baseline 2.38 ± 0.48 L/min to 2.57 ± 0.6 L/min (p < 0.003), whereas inferred VO₂max of the control group remained unchanged (2.46 ± 0.5 L/min at baseline and 2.47 ± 0.4 L/min after placebo acupressure, p > 0.9).

CONCLUSIONS

The results of the study demonstrated that finger-tip acupressure increases aerobic performance of young healthy males on more than 10%. Acupressure probably decreased anxiety level, which allowed better utilization of available energy sources.