Acute effects of leg heat therapy on walking performance and cardiovascular and inflammatory responses to exercise in patients with peripheral artery disease

Differential intestinal injury and unchanged systemic inflammatory responses to leg and whole-body passive hyperthermia in healthy humans

Hyperthermia can cause intestinal injury, facilitating endotoxin translocation and an inflammatory response that has been associated with heat illness. However, the potential occurrence of these responses has been incompletely reported during passive hyperthermia, and the independent effect of hyperthermia is equivocal. Furthermore, passive hyperthermia is a feature of heat therapy interventions, with mechanistic understanding developing. This experiment quantified the changes in intestinal fatty acid binding protein (iFABP), a marker of intestinal injury, and cytokine, chemokine and growth factor responses during three different prolonged passive hyperthermia protocols. Eight healthy males visited the laboratory on four counterbalanced occasions to undertake 2.5 h of rest (CON), one-leg heating (OLH), two-leg heating (TLH) and whole-body heating (WBH) via a garment circulating water at 50°C. Plasma concentrations of iFABP and 38 cytokines, chemokines and growth factors were quantified periodically, and core temperature (Tcore) was measured continuously. The Tcore increased from baseline in OLH, TLH and WBH (+0.4°C ± 0.2°C, +0.7°C ± 0.2°C and +2.3°C ± 0.4°C, respectively; P < 0.05) but remained unchanged in CON. iFABP increased from baseline in WBH only (∆587 ± 651 pg ml-1) and was different from CON and OLH in WBH after 2 h (P < 0.05). Increased iFABP (∆1085 ± 572 pg ml-1) was observed in 50% of participants at the end of WBH, with the other 50% demonstrating no change (∆89 ± 19 pg ml-1). All chemokines, cytokines and growth factors were unchanged in all protocols. These data indicate that passive whole-body hyperthermia, but not lower-limb hyperthermia, can cause intestinal injury in some individuals without a systemic inflammatory response.

Effects of thermal interventions on skeletal muscle adaptations and regeneration: perspectives on epigenetics: a narrative review

Recovery methods, such as thermal interventions, have been developed to promote optimal recovery and maximize long-term training adaptations. However, the beneficial effects of these recovery strategies remain a source of controversy. This narrative review aims to provide a detailed understanding of how cold and heat interventions impact long-term training adaptations. Emphasis is placed on skeletal muscle adaptations, particularly the involvement of signaling pathways regulating protein turnover, ribosome and mitochondrial biogenesis, as well as the critical role of satellite cells in promoting myofiber regeneration following atrophy. The current literature suggests that cold interventions can blunt molecular adaptations (e.g., protein synthesis and satellite cell activation) and oxi-inflammatory responses after resistance exercise, resulting in diminished exercise-induced hypertrophy and lower gains in isometric strength during training protocols. Conversely, heat interventions appear promising for mitigating skeletal muscle degradation during immobilization and atrophy. Indeed, heat treatments (e.g., passive interventions such as sauna-bathing or diathermy) can enhance protein turnover and improve the maintenance of muscle mass in atrophic conditions, although their effects on uninjured skeletal muscles in both humans and rodents remain controversial. Nonetheless, heat treatment may serve as an important tool for attenuating atrophy and preserving mitochondrial function in immobilized or injured athletes. Finally, the potential interplay between exercise, thermal interventions and epigenetics is discussed. Future studies must be encouraged to clarify how repeated thermal interventions (heat and cold) affect long-term exercise training adaptations and to determine the optimal modalities (i.e., method of application, temperature, duration, relative humidity, and timing).

Sympathetic Nerve Activity and Blood Pressure Response to Exercise in Peripheral Artery Disease: From Molecular Mechanisms, Human Studies, to Intervention Strategy Development

Sympathetic nerve activity (SNA) regulates the contraction of vascular smooth muscle and leads to a change in arterial blood pressure (BP). It was observed that SNA, vascular contractility, and BP are heightened in patients with peripheral artery disease (PAD) during exercise. The exercise pressor reflex (EPR), a neural mechanism responsible for BP response to activation of muscle afferent nerve, is a determinant of the exaggerated exercise-induced BP rise in PAD. Based on recent results obtained from a series of studies in PAD patients and a rat model of PAD, this review will shed light on SNA-driven BP response and the underlying mechanisms by which receptors and molecular mediators in muscle afferent nerves mediate the abnormalities in autonomic activities of PAD. Intervention strategies, particularly non-pharmacological strategies, improving the deleterious exercise-induced SNA and BP in PAD, and enhancing tolerance and performance during exercise will also be discussed.

Effects of home-based leg heat therapy on walking performance in patients with symptomatic peripheral artery disease: a pilot randomized trial

Few noninvasive therapies currently exist to improve functional capacity in people with lower extremity peripheral artery disease (PAD). The goal of the present study was to test the hypothesis that unsupervised, home-based leg heat therapy (HT) using water-circulating trousers perfused with warm water would improve walking performance in patients with PAD. Patients with symptomatic PAD were randomized into either leg HT (n = 18) or a sham treatment (n = 16). Patients were provided with water-circulating trousers and a portable pump and were asked to apply the therapy daily (7 days/wk, 90 min/session) for 8 wk. The primary study outcome was the change from baseline in 6-min walk distance at 8-wk follow-up. Secondary outcomes included the claudication onset-time, peak walking time, peak pulmonary oxygen consumption and peak blood pressure during a graded treadmill test, resting blood pressure, the ankle-brachial index, postocclusive reactive hyperemia in the calf, cutaneous microvascular reactivity, and perceived quality of life. Of the 34 participants randomized, 29 completed the 8-wk follow-up. The change in 6-min walk distance at the 8-wk follow-up was significantly higher (P = 0.029) in the group exposed to HT than in the sham-treated group (Sham: median: -0.9; 25%, 75% percentiles: -5.8, 14.3; HT: median: 21.3; 25%, 75% percentiles: 10.1, 42.4, P = 0.029). There were no significant differences in secondary outcomes between the HT and sham group at 8-wk follow-up. The results of this pilot study indicate that unsupervised, home-based leg HT is safe, well-tolerated, and elicits a clinically meaningful improvement in walking tolerance in patients with symptomatic PAD.NEW & NOTEWORTHY This is the first sham-controlled trial to examine the effects of home-based leg heat therapy (HT) on walking performance in patients with peripheral artery disease (PAD). We demonstrate that unsupervised HT using water-circulating trousers is safe, well-tolerated, and elicits meaningful changes in walking ability in patients with symptomatic PAD. This home-based treatment option is practical, painless, and may be a feasible adjunctive therapy to counteract the decline in lower extremity physical function in patients with PAD.

Complex Network Model Reveals the Impact of Inspiratory Muscle Pre-Activation on Interactions among Physiological Responses and Muscle Oxygenation during Running and Passive Recovery

Simple Summary

Different warm-ups can be used to improve physical and sports performance. Among these strategies, we can include the pre-activation of the inspiratory muscles. Our study aimed to investigate this pre-activation model in high-intensity running performance and recovery using an integrative computational analysis called a complex network. The participants in this study underwent four sessions. The first and second sessions were performed to explain the procedures, characterize them and determine the individualized pre-activation intensity (40% of the maximum inspiratory pressure). Subsequently, on different days, the subjects were submitted to high-intensity tethered runs on a non-motorized treadmill with monitoring of the physiological responses during and after this effort. To understand the impacts of the pre-activation of inspiratory muscles on the organism, we studied the centrality metrics obtained by complex networks, which help in the interpretation of data in a more integrated way. Our results revealed that the graphs generated by this analysis were altered when inspiratory muscle pre-activation was applied, emphasizing muscle oxygenation responses in the leg and arm. Blood lactate also played an important role, especially after our inspiratory muscle strategy. Our findings confirm that the pre-activation of inspiratory muscles promotes modulations in the organism, better integrating physiological responses, which could increase performance and improve recovery.

Abstract

Although several studies have focused on the adaptations provided by inspiratory muscle (IM) training on physical demands, the warm-up or pre-activation (PA) of these muscles alone appears to generate positive effects on physiological responses and performance. This study aimed to understand the effects of inspiratory muscle pre-activation (IM_PA) on high-intensity running and passive recovery, as applied to active subjects. In an original and innovative investigation of the impacts of IM_PA on high-intensity running, we proposed the identification of the interactions among physical characteristics, physiological responses and muscle oxygenation in more and less active muscle to a running exercise using a complex network model. For this, fifteen male subjects were submitted to all-out 30 s tethered running efforts preceded or not preceded by IM_PA, composed of 2 × 15 repetitions (1 min interval between them) at 40% of the maximum individual inspiratory pressure using a respiratory exercise device. During running and recovery, we monitored the physiological responses (heart rate, blood lactate, oxygen saturation) and muscle oxygenation (in vastus lateralis and biceps brachii) by wearable near-infrared spectroscopy (NIRS). Thus, we investigated four scenarios: two in the tethered running exercise (with or without IM_PA) and two built into the recovery process (after the all-out 30 s), under the same conditions. Undirected weighted graphs were constructed, and four centrality metrics were analyzed (Degree, Betweenness, Eigenvector, and Pagerank). The IM_PA (40% of the maximum inspiratory pressure) was effective in increasing the peak and mean relative running power, and the analysis of the complex networks advanced the interpretation of the effects of physiological adjustments related to the IM_PA on exercise and recovery. Centrality metrics highlighted the nodes related to muscle oxygenation responses (in more and less active muscles) as significant to all scenarios, and systemic physiological responses mediated this impact, especially after IM_PA application. Our results suggest that this respiratory strategy enhances exercise, recovery and the multidimensional approach to understanding the effects of physiological adjustments on these conditions.