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Fuertes-Kenneally L, Blasco-Peris C, Casanova-Lizón A, Baladzhaeva S, Climent V, Sarabia JM, Manresa-Rocamora A. Effects of high-intensity interval training on vascular function in patients with cardiovascular disease: a systematic review and meta-analysis. Front Physiol 2023; 14:1196665. [PMID: 37576344 PMCID: PMC10413117 DOI: 10.3389/fphys.2023.1196665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Background: Exercise training improves endothelial function in patients with cardiovascular disease (CVD). However, the influence of training variables remains unclear. The aim of this study was to evaluate the effect of high-intensity interval training (HIIT), compared to moderate intensity training (MIT) and other exercise modalities (i.e., resistance and combined exercise), on endothelial function, assessed by arterial flow-mediated dilation (FMD) or endothelial progenitor cells (EPCs), in patients with CVD. Secondly, we investigated the influence of other training variables (i.e., HIIT protocol). Methods: The PICOS strategy was used to identify randomised and non-randomised studies comparing the effect of HIIT and other exercise modalities (e.g., MIT) on endothelial function in patients with CVD. Electronic searches were carried out in Pubmed, Embase, and Web of Science up to November 2022. The TESTEX scale was used to evaluate the methodological quality of the included studies. Random-effects models of between-group mean difference (MD) were estimated. A positive MD indicated an effect in favour of HIIT. Heterogeneity analyses were performed by the chi-square test and I 2 index. Subgroup analyses evaluated the influence of potential moderator variables. Results: Fourteen studies (13; 92.9% randomised) were included. Most of the studies trained 3 days a week for 12 weeks and performed long HIIT. No statistically significant differences were found between HIIT and MIT for improving brachial FMD in patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) (8 studies; MD+ = 0.91% [95% confidence interval (CI) = -0.06, 1.88]). However, subgroup analyses showed that long HIIT (i.e., > 1 min) is better than MIT for enhancing FMD (5 studies; MD+ = 1.46% [95% CI = 0.35, 2.57]), while no differences were found between short HIIT (i.e., ≤ 1 min) and MIT (3 studies; MD+ = -0.41% [95% CI = -1.64, 0.82]). Insufficient data prevented pooled analysis for EPCs, and individual studies failed to find statistically significant differences (p > .050) between HIIT and other exercise modalities in increasing EPCs. Discussion: Poor methodological quality could limit the precision of the current results and increase the inconsistency. Long HIIT is superior to MIT for improving FMD in patients with CAD or HFrEF. Future studies comparing HIIT to other exercise modalities, as well as the effect on EPCs and in HF with preserved ejection fraction are required. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier CRD42022358156.
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Affiliation(s)
- Laura Fuertes-Kenneally
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Dr. Balmis General University Hospital, Alicante, Spain
| | - Carles Blasco-Peris
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Physical Education and Sport, University of Valencia, Valencia, Spain
| | | | - Sabina Baladzhaeva
- Department of Sport Sciences, Miguel Hernández University of Elche, Elche, Spain
| | - Vicente Climent
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Dr. Balmis General University Hospital, Alicante, Spain
| | - José Manuel Sarabia
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Sport Sciences, Miguel Hernández University of Elche, Elche, Spain
| | - Agustín Manresa-Rocamora
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Sport Sciences, Miguel Hernández University of Elche, Elche, Spain
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Manresa-Rocamora A, Fuertes-Kenneally L, Blasco-Peris C, Sempere-Ruiz N, Sarabia JM, Climent-Paya V. Is the Verification Phase a Suitable Criterion for the Determination of Maximum Oxygen Uptake in Patients with Heart Failure and Reduced Ejection Fraction? A Validation Study. Int J Environ Res Public Health 2023; 20:2764. [PMID: 36833461 PMCID: PMC9956911 DOI: 10.3390/ijerph20042764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
The verification phase (VP) has been proposed as an alternative to the traditional criteria used for the determination of the maximum oxygen uptake (VO2 max) in several populations. Nonetheless, its validity in patients with heart failure with reduced ejection fraction (HFrEF) remains unclear. Therefore, the aim of this study was to analyse whether the VP is a safe and suitable method to determine the VO2 max in patients with HFrEF. Adult male and female patients with HFrEF performed a ramp-incremental phase (IP), followed by a submaximal constant VP (i.e., 95% of the maximal workload during the IP) on a cycle ergometer. A 5-min active recovery period (i.e., 10 W) was performed between the two exercise phases. Group (i.e., median values) and individual comparisons were performed. VO2 max was confirmed when there was a difference of ≤ 3% in peak oxygen uptake (VO2 peak) values between the two exercise phases. Twenty-one patients (13 males) were finally included. There were no adverse events during the VP. Group comparisons showed no differences in the absolute and relative VO2 peak values between both exercise phases (p = 0.557 and p = 0.400, respectively). The results did not change when only male or female patients were included. In contrast, individual comparisons showed that the VO2 max was confirmed in 11 patients (52.4%) and not confirmed in 10 (47.6%). The submaximal VP is a safe and suitable method for the determination of the VO2 max in patients with HFrEF. In addition, an individual approach should be used because group comparisons could mask individual differences.
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Affiliation(s)
- Agustín Manresa-Rocamora
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Laura Fuertes-Kenneally
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Cardiology Department, Dr. Balmis General University Hospital, 03010 Alicante, Spain
| | - Carles Blasco-Peris
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Department of Physical Education and Sport, University of Valencia, 46010 Valencia, Spain
| | - Noemí Sempere-Ruiz
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - José Manuel Sarabia
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Vicente Climent-Paya
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Cardiology Department, Dr. Balmis General University Hospital, 03010 Alicante, Spain
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Fuertes-Kenneally L, Manresa-Rocamora A, Blasco-Peris C, Ribeiro F, Sempere-Ruiz N, Sarabia JM, Climent-Paya V. Effects and Optimal Dose of Exercise on Endothelial Function in Patients with Heart Failure: A Systematic Review and Meta-Analysis. Sports Med Open 2023; 9:8. [PMID: 36739344 PMCID: PMC9899305 DOI: 10.1186/s40798-023-00553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation (CR) is considered an effective treatment for enhancing endothelial function in patients with heart failure (HF). However, recent studies have been published and the optimal "dose" of exercise required to increase the benefits of exercise-based CR programmes on endothelial function is still unknown. OBJECTIVES (a) To estimate the effect of exercise-based CR on endothelial function, assessed by flow-mediated dilation (FMD), in patients with HF; (b) to determine whether high-intensity interval training (HIIT) is better than moderate-intensity training (MIT) for improving FMD; and (c) to investigate the influence of exercise modality (i.e. resistance exercise vs. aerobic exercise and combined exercise vs. aerobic exercise) on the improvement of endothelial function. METHODS Electronic searches were carried out in PubMed, Embase, and Scopus up to February 2022. Random-effects models of between-group mean differences were estimated. Heterogeneity analyses were performed by means of the chi-square test and I2 index. Subgroup analyses and meta-regressions were used to test the influence of potential moderator variables on the effect of exercise. RESULTS We found a FMD increase of 3.09% (95% confidence interval [CI] = 2.01, 4.17) in favour of aerobic-based CR programmes compared with control groups in patients with HF and reduced ejection fraction (HFrEF). However, the results of included studies were inconsistent (p < .001; I2 = 95.2%). Higher FMD improvement was found in studies which were randomised, reported radial FMD, or performed higher number of training sessions a week. Moreover, HIIT enhanced FMD to a greater extent than MIT (2.35% [95% CI = 0.49, 4.22]) in patients with HFrEF. Insufficient data prevented pooled analyses for the effect of exercise in patients with HF and preserved ejection fraction and the influence of exercise modality on the improvement of endothelial function. CONCLUSION Aerobic-based CR is a non-pharmacological treatment for enhancing endothelial function in patients with HFrEF. However, higher training frequency and HIIT induce greater adaptation of endothelial function in these patients, which should betaken into consideration when designing exercise-based CR programmes. Trial registration The protocol was prospectively registered on the PROSPERO database (CRD42022304687).
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Affiliation(s)
- Laura Fuertes-Kenneally
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,Cardiology Department, Alicante General University Hospital (HGUA), 03010 Alicante, Spain
| | - Agustín Manresa-Rocamora
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Carles Blasco-Peris
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,grid.5338.d0000 0001 2173 938XDepartment of Physical Education and Sport, University of Valencia, 46010 Valencia, Spain
| | - Fernando Ribeiro
- grid.7311.40000000123236065Institute of Biomedicine‑iBiMED and School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Noemí Sempere-Ruiz
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - José Manuel Sarabia
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Vicente Climent-Paya
- grid.513062.30000 0004 8516 8274Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain ,Cardiology Department, Alicante General University Hospital (HGUA), 03010 Alicante, Spain
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Prat-Luri A, de Los Rios-Calonge J, Moreno-Navarro P, Manresa-Rocamora A, Vera-Garcia FJ, Barbado D. Effect of Trunk-Focused Exercises on Pain, Disability, Quality of Life, and Trunk Physical Fitness in Low Back Pain and How Potential Effect Modifiers Modulate Their Effects: A Systematic Review With Meta-analyses. J Orthop Sports Phys Ther 2023; 53:64-93. [PMID: 36645193 DOI: 10.2519/jospt.2023.11091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE: To analyze the effect of trunkfocused exercise programs (TEPs) and moderator factors on chronic nonspecific low back pain (LBP). DESIGN: Systematic review with meta-analyses. LITERATURE SEARCH: We searched the PubMed, Scopus, Embase, SPORTDiscus, and CENTRAL databases from their inception to June 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials comparing TEPs to control or general exercises. DATA SYNTHESIS: We used random-effects models to calculate the standardized mean difference (SMD) plus confidence interval (CI) and heterogeneity (I2) for pain, disability, quality of life, and trunk performance. The impact of moderator factors was analyzed through meta-regression. RESULTS: Forty randomized controlled trials (n = 2391) were included. TEPs showed positive effects for all outcomes versus control (SMD 0.90-2.46; 95% CI, -0.04 to 4.96; I2 61%-98%). There were small effects in favor of TEPs versus general exercises for pain (SMD = 0.20; 95% CI, 0.03-0.37; I2 = 13.4%) and disability (SMD = 0.20; 95% CI, 0.02-0.38; I2 = 0%). Trunk and/or hip range-of-motion improvements were associated with greater reductions in pain (P<.01; β = 0.56; 95% CI, 0.25-0.87) and disability (P<.01; β = 0.66; 95% CI, 0.27-1.05). Low body mass was associated with higher pain reduction (P = .03; β = -0.17; 95% CI, -0.32 to -0.02). CONCLUSIONS: Trunk-focused exercise programs had positive effects on pain, disability, quality of life, and trunk performance compared to control groups, and on pain and disability compared to general exercises. Increasing trunk and/or hip range of motion was associated with greater pain and disability reduction, and lower body mass with higher pain reduction. J Orthop Sports Phys Ther 2023;53(2):64-93. Epub: 16 January 2023. doi:10.2519/jospt.2023.11091.
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Casanova-Lizón A, Manresa-Rocamora A, Flatt AA, Sarabia JM, Moya-Ramón M. Does Exercise Training Improve Cardiac-Parasympathetic Nervous System Activity in Sedentary People? A Systematic Review with Meta-Analysis. Int J Environ Res Public Health 2022; 19:ijerph192113899. [PMID: 36360777 PMCID: PMC9656115 DOI: 10.3390/ijerph192113899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 05/13/2023]
Abstract
The aim of this study was to investigate the training-induced effect on cardiac parasympathetic nervous system (PNS) activity, assessed by resting heart rate variability (HRV) and post-exercise heart rate recovery (HRR), in sedentary healthy people. Electronic searches were carried out in PubMed, Embase, and Web of Science. Random-effects models of between-group standardised mean difference (SMD) were estimated. Heterogeneity analyses were performed by means of the chi-square test and I2 index. Subgroup analyses and meta-regressions were performed to investigate the influence of potential moderator variables on the training-induced effect. The results showed a small increase in RMSSD (SMD+ = 0.57 [95% confidence interval (CI) = 0.23, 0.91]) and high frequency (HF) (SMD+ = 0.21 [95% CI = 0.01, 0.42]) in favour of the intervention group. Heterogeneity tests reached statistical significance for RMSSD and HF (p ≤ 0.001), and the inconsistency was moderate (I2 = 68% and 60%, respectively). We found higher training-induced effects on HF in studies that performed a shorter intervention or lower number of exercise sessions (p ≤ 0.001). Data were insufficient to investigate the effect of exercise training on HRR. Exercise training increases cardiac PNS modulation in sedentary people, while its effect on PNS tone requires future study.
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Affiliation(s)
- Antonio Casanova-Lizón
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Alicante, Spain
| | - Agustín Manresa-Rocamora
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Alicante, Spain
- Department of Sport Sciences, Alicante Institute for Health and Biomedical Research (ISABIAL), Miguel Hernandez University, 03010 Alicante, Spain
| | - Andrew A. Flatt
- Department of Health Sciences and Kinesiology, Georgia Southern University—Armstrong Campus, Savannah, GA 31419, USA
| | - José Manuel Sarabia
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Alicante, Spain
- Department of Sport Sciences, Alicante Institute for Health and Biomedical Research (ISABIAL), Miguel Hernandez University, 03010 Alicante, Spain
| | - Manuel Moya-Ramón
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Alicante, Spain
- Department of Sport Sciences, Alicante Institute for Health and Biomedical Research (ISABIAL), Miguel Hernandez University, 03010 Alicante, Spain
- Correspondence: ; Tel.: +34-9666-52-046
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Manresa-Rocamora A, Sarabia JM, Guillen-Garcia S, Pérez-Berbel P, Miralles-Vicedo B, Roche E, Vicente-Salar N, Moya-Ramón M. Heart Rate Variability-Guided Training for Improving Mortality Predictors in Patients with Coronary Artery Disease. Int J Environ Res Public Health 2022; 19:10463. [PMID: 36078179 PMCID: PMC9518028 DOI: 10.3390/ijerph191710463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The objective of this research was to investigate whether heart rate variability (HRV)-guided training improves mortality predictors to a greater extent than predefined training in coronary artery disease patients. Twenty-one patients were randomly allocated to the HRV-guided training group (HRV-G) or the predefined training group (PRED-G). They measured their HRV at home daily and trained three times a week for six weeks. Resting heart rate, isolated vagal-related HRV indices (i.e., RMSSD, HF, and SD1), weekly averaged RMSSD, heart rate recovery, and maximum oxygen uptake were assessed before and after the training period. There was a statistically significant difference (p = 0.034) in the change in weekly averaged RMSSD in favor of the HRV-G, while no differences were found in the remaining analyzed variables (p > 0.050). Regardless of the training prescription method, exercise training decreased resting heart rate (p = 0.001; -4.10 [95% CI = -6.37--1.82] beats per minute (bpm)), and increased heart rate recovery at 2 min (p = 0.010; 4.33 [95% CI = 1.15-7.52] bpm) and maximum oxygen uptake (p < 0.001; 3.04 [95% CI = 1.70-4.37] mL·kg-1·min-1). HRV-guided training is superior to predefined training in improving vagal-related HRV when methodological factors are accounted for.
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Affiliation(s)
- Agustín Manresa-Rocamora
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
| | - José Manuel Sarabia
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
| | | | - Patricio Pérez-Berbel
- Department of Cardiology, Hospital Clínico Universitario San Juan, 03550 San Juan de Alicante, Spain
- Department of Cardiology, Hospital Universitario del Vinalopó, 03293 Elche, Spain
| | | | - Enrique Roche
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Department of Applied Biology-Nutrition, Institute of Bioengineering, Miguel Hernández University of Elche, 03202 Elche, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Néstor Vicente-Salar
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Department of Applied Biology-Nutrition, Institute of Bioengineering, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Manuel Moya-Ramón
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
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Blasco-Peris C, Fuertes-Kenneally L, Vetrovsky T, Sarabia-Marin JM, Climent-Paya V, Manresa-Rocamora A. Exergaming in cardiac rehabilitation: a systematic review and meta-analysis. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Valencia Region Innovation Agency (INNOAVI)
Background/Introduction
Cardiovascular disease (CVD) is the leading cause of death in Europe. The lack of physical activity is related to the onset of CVD. Despite the evidence of the effects of exercise-based cardiac rehabilitation (CR) on mortality risk in patients with CVD, the benefit of adding exergaming is unclear.
Purpose
The aim of this systematic review and meta-analysis was to (a) summarize the characteristics of previous studies regarding exercise-based CR programmes based on exergaming and (b) determine the effects of exergaming on functional capacity (i.e., distance covered in the 6-min walk test [6MWT]) and other outcomes (i.e., quality of life and motivation).
Methods
We carried out a systematic search in PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (without language restrictions) up to June 2021. Our search strategy included terms related to patients (e.g., chronic heart failure, cardiovascular disease, and coronary artery disease) and the interventions (e.g., exergaming and cardiac rehabilitation). We included controlled and uncontrolled studies and extracted data regarding the characteristics of the study, patients, and intervention. In regards to the quantitative analysis, we used the standardised mean difference (SMD) or mean difference (MD) to measure the effect size and random-effects models to perform a pooled analysis of outcomes reported in at least three studies.
Results
Eight studies fulfilled our inclusion criteria, of which seven were randomised controlled trials and all of them had an active control group. The studies included were published from 2006 to 2021. Three studies recruited patients with diverse diagnoses, four articles included patients diagnosed with coronary artery disease, and one study with heart failure. Five studies performed supervised training sessions. The type of VR varied between studies: four of them used Oculus glasses or 3D constructed reality in screens, three used a game console, and one combined several devices. The mean intervention length was 17 weeks and six studies performed less than four training sessions a week. There was a non-significant increase in the distance covered in the 6MWT in favour of the experimental groups compared to the control groups (MD = 13,89 m [95% confidence interval -18,01 to 45,79]). Moreover, there was no intervention effect on symptoms of depression (SMD = -0,21 [95% confidence interval = -0,56 – 0,13]).
Conclusion(s)
Exergaming is feasible in patients with cardiovascular disease. However, the effects of adding VR to improve functional capacity and symptoms of depression are questionable. Future research is needed to clarify the role of exergaming in CR.
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Affiliation(s)
- C Blasco-Peris
- Institute for Health and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | - L Fuertes-Kenneally
- General University Hospital of Alicante, Cardiology Department and Institute for Health and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | - T Vetrovsky
- Charles University of Prague, Faculty of Physical Education and Sport, Prague, Czechia
| | - JM Sarabia-Marin
- University Miguel Hernandez, and Institute for Health and Biomedical Research of Alicante (ISABIAL), Elche, Spain
| | - V Climent-Paya
- General University Hospital of Alicante, Cardiology Department and Institute for Health and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | - A Manresa-Rocamora
- University Miguel Hernandez, and Institute for Health and Biomedical Research of Alicante (ISABIAL), Elche, Spain
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Manresa-Rocamora A, Ribeiro F, Casanova-Lizón A, Flatt AA, Sarabia JM, Moya-Ramón M. Cardiac Rehabilitation Improves Endothelial Function in Coronary Artery Disease Patients. Int J Sports Med 2022; 43:905-920. [PMID: 35468652 DOI: 10.1055/a-1717-1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Exercise-based cardiac rehabilitation may be an effective non-pharmacological intervention for improving endothelial function in coronary artery disease patients. Therefore, this systematic review with meta-analysis aimed to (a) estimate the training-induced effect on endothelial and vascular smooth muscle function, assessed by flow-mediated dilation and nitroglycerin-mediated dilation, respectively, in coronary artery disease patients; and to (b) study the influence of potential trial-level variables (i. e. study and intervention characteristics) on the training-induced effect on endothelial and vascular smooth muscle function. Electronic searches were performed in Pubmed, Scopus, and Embase up to February 2021. Random-effects models of standardised mean change were estimated. Heterogeneity analyses were performed by using the Chi 2 test and I 2 index. Our results showed that exercise-based cardiac rehabilitation significantly enhanced flow-mediated dilation (1.04 [95% confidence interval=0.76 to 1.31]) but did not significantly change nitroglycerin-mediated dilation (0.05 [95% confidence interval=-0.03 to 0.13]). Heterogeneity testing reached statistical significance (p<.001) with high inconsistency for flow-mediated dilation (I 2 =92%). Nevertheless, none of the analysed variables influenced the training-induced effect on flow-mediated dilation. Exercise-based cardiac rehabilitation seems to be an effective therapeutic strategy for improving endothelial-dependent dilation in coronary artery disease patients, which may aid in the prevention of cardiovascular events.
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Affiliation(s)
- Agustín Manresa-Rocamora
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain.,Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernandez University, 03550 Alicante, Spain
| | - Fernando Ribeiro
- School of Health Sciences and Institute of Biomedicine- iBiMED, Universidade de Aveiro, Aveiro, Portugal
| | - Antonio Casanova-Lizón
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Andrew A Flatt
- Health Sciences and Kinesiology, Georgia Southern University - Armstrong Campus, Savannah, United States
| | - José Manuel Sarabia
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain.,Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernandez University, 03550 Alicante, Spain
| | - Manuel Moya-Ramón
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain.,Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernandez University, 03550 Alicante, Spain
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Peña-González I, Sarabia JM, Manresa-Rocamora A, Moya-Ramón M. International football players with cerebral palsy maintained their physical fitness after a self-training program during the COVID-19 lockdown. PeerJ 2022; 10:e13059. [PMID: 35317073 PMCID: PMC8934527 DOI: 10.7717/peerj.13059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/13/2022] [Indexed: 01/11/2023] Open
Abstract
Background The COVID-19 global pandemic caused a complete stop in sport participation which meant a detraining period for athletes. High-level athletes had to train at home guided by their coaches and conditioning trainers in an effort to maintain their physical fitness. The aim of maintaining the training adaptations and physical fitness during the COVID-19 mandatory lockdown was especially important for CP athletes, in which the detraining period was expected to cause early declines in motor function, poor coordination and muscle weakness due to their disability. Methods The present study assessed the effect of a guided self-training program on international CP football players' physical fitness during the COVID-19 mandatory lockdown. Fifteen CP football players from the Spanish National Team participated in the study. An experimental design with a pre- (T1) and a post-intervention (T2) assessment was carried out, with a 12-week period of players' self-training (divided in two periods of 6 weeks) which combined strength and endurance training. Physical performance assessment consisted in the free countermovement jump (CMJ), 5, 10 and 20-m sprint, the modified agility T-test (MAT) and a dribbling test. The Kruskal-Wallis test was used for between-group comparisons, while the Student's paired t test or the Fisher Pitman permutation test, based on the normality of the data, were used for within-group comparisons. Results The results showed no differences between sport classes (FT1, FT2 and FT3) in physical fitness change after the training program (Chi2 = 0.16 to 1.73; p = 0.42 to 0.92). Within-group comparisons showed an increase of jump height in the CMJ (4.19 cm [2.46, 5.93]; p < 0.001) and a maintenance of the 5, 10 and 20-m sprint, MAT and dribbling ability (<0.01 to 0.09 s; p = 0.19 to 0.97). Discussion To the authors' knowledge, this is the first study that examined the physical fitness adaptations to a training program with CP football players. The results show that a 12-week guided self-training program without football-specific stimulus may be effective to maintain or even improve the specific physical performance of international CP football players during a non-competitive period (as the COVID-19 lockdown). This study reveals that CP football players are able to show adaptations to the strength and endurance training and this could be the basis for future research regarding training adaptations in CP football players.
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Affiliation(s)
- Iván Peña-González
- Department of Sport Sciences, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain
| | - José Manuel Sarabia
- Department of Sport Sciences, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain,Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain
| | - Agustín Manresa-Rocamora
- Department of Sport Sciences, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain,Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain
| | - Manuel Moya-Ramón
- Department of Sport Sciences, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain,Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain
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10
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Holgado D, Manresa-Rocamora A, Zamboni L, Lugoboni F, Peiró AM, Zandonai T. The effect of benzodiazepines on exercise in healthy adult participants: A systematic review. J Addict Dis 2021; 40:336-344. [PMID: 34751107 DOI: 10.1080/10550887.2021.1990640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The use of benzodiazepines among athletes is a new and growing phenomenon according to the recent case reports published. Therefore, there is an urgent need to identify if there is rationale for the use of benzodiazepines and its effects on exercise. This review aims to provide an overview of the effects of benzodiazepine in exercise among healthy adult participants and if they might have an additional ergogenic or ergolytic effect. Electronic searches were conducted in Pubmed, Scopus and Web of Science databases up to December 2020. Search terms covered all active substance names of benzodiazepine class and search terms about sport, exercise performance and athletes. We used the Physiotherapy Evidence Database (PEDro) to assess the methodological quality of the studies included in the qualitative synthesis. The methods and planned analyses of this systematic review were pre-registered at Open Science Framework (OSF: https://osf.io/uq6j8). A total of thirty-one full articles were assessed for eligibility and ten of them were included in the qualitative analysis. We found 7 studies which investigated benzodiazepine effects after an acute dose administered, whereas only 3 studies studied long-term effects after several doses used. According to our findings it does not seem that benzodiazepines might have an ergogenic or ergolytic effect on exercise performance. The small number of articles included (n = 10) with a relatively low sample of participants (N = 16, range = 6-58) does invite us to take our results with caution. This review evidences valuable insights into the use of benzodiazepines from a physical performance point of view. Our findings highlight the unclear effects benzodiazepines might have on exercise performance and its possible mechanisms of actions. Hence, the need to conduct new studies to understand its possible effects becomes essential to protect the health of athletes of all levels.
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Affiliation(s)
- Darías Holgado
- Mind, Brain and Behavior Research Centre (CIMCYC), Department of Experimental Psychology, University of Granada, Granada, Spain
| | - Agustín Manresa-Rocamora
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, Elche, Spain.,Institute of Health and Biomedical Research of Alicante (ISABIAL Foundation), Alicante, Spain
| | - Lorenzo Zamboni
- Department of Internal Medicine, Unit of Addiction Medicine, Integrated University, Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Fabio Lugoboni
- Department of Internal Medicine, Unit of Addiction Medicine, Integrated University, Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy
| | - Ana María Peiró
- Institute of Health and Biomedical Research of Alicante (ISABIAL Foundation), Neuropharmacology on Pain and Functional Diversity (NED), Alicante, Spain.,Pain Unit, Department of Health of Alicante-General Hospital, Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante-General Hospital, Alicante, Spain.,Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Sant Joan, Alicante, Spain
| | - Thomas Zandonai
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, Elche, Spain.,Institute of Health and Biomedical Research of Alicante (ISABIAL Foundation), Neuropharmacology on Pain and Functional Diversity (NED), Alicante, Spain.,Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Sant Joan, Alicante, Spain
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11
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Manresa-Rocamora A, Sarabia JM, Javaloyes A, Flatt AA, Moya-Ramón M. Heart Rate Variability-Guided Training for Enhancing Cardiac-Vagal Modulation, Aerobic Fitness, and Endurance Performance: A Methodological Systematic Review with Meta-Analysis. Int J Environ Res Public Health 2021; 18:10299. [PMID: 34639599 PMCID: PMC8507742 DOI: 10.3390/ijerph181910299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE This systematic review with meta-analysis was conducted to establish whether heart rate variability (HRV)-guided training enhances cardiac-vagal modulation, aerobic fitness, or endurance performance to a greater extent than predefined training while accounting for methodological factors. METHODS We searched Web of Science Core Collection, Pubmed, and Embase databases up to October 2020. A random-effects model of standardized mean difference (SMD) was estimated for each outcome measure. Chi-square and the I2 index were used to evaluate the degree of homogeneity. RESULTS Accounting for methodological factors, HRV-guided training was superior for enhancing vagal-related HRV indices (SMD+ = 0.50 (95% confidence interval (CI) = 0.09, 0.91)), but not resting HR (SMD+ = 0.04 (95% CI = -0.34, 0.43)). Consistently small but non-significant (p > 0.05) SMDs in favor of HRV-guided training were observed for enhancing maximal aerobic capacity (SMD+ = 0.20 (95% CI = -0.07, 0.47)), aerobic capacity at second ventilatory threshold (SMD+ = 0.26 (95% CI = -0.05, 0.57)), and endurance performance (SMD+ = 0.20 (95% CI = -0.09, 0.48)), versus predefined training. No heterogeneity was found for any of the analyzed aerobic fitness and endurance performance outcomes. CONCLUSION Best methodological practices pertaining to HRV index selection, recording position, and approaches for establishing baseline reference values and daily changes (i.e., fixed or rolling HRV averages) require further study. HRV-guided training may be more effective than predefined training for maintaining and improving vagal-mediated HRV, with less likelihood of negative responses. However, if HRV-guided training is superior to predefined training for producing group-level improvements in fitness and performance, current data suggest it is only by a small margin.
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Affiliation(s)
- Agustín Manresa-Rocamora
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.M.-R.); (J.M.S.); (A.J.)
- Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernandez University, 03550 Alicante, Spain
| | - José Manuel Sarabia
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.M.-R.); (J.M.S.); (A.J.)
- Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernandez University, 03550 Alicante, Spain
| | - Alejandro Javaloyes
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.M.-R.); (J.M.S.); (A.J.)
| | - Andrew A. Flatt
- Department of Health Sciences and Kinesiology, Georgia Southern University (Armstrong Campus), Savannah, GA 31419, USA;
| | - Manuel Moya-Ramón
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, 03202 Elche, Spain; (A.M.-R.); (J.M.S.); (A.J.)
- Institute for Health and Biomedical Research (ISABIAL Foundation), Miguel Hernandez University, 03550 Alicante, Spain
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12
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Javaloyes A, Mateo-March M, Manresa-Rocamora A, Sanz-Quinto S, Moya-Ramón M. The Use of a Smartphone Application in Monitoring HRV during an Altitude Training Camp in Professional Female Cyclists: A Preliminary Study. Sensors (Basel) 2021; 21:s21165497. [PMID: 34450939 PMCID: PMC8401324 DOI: 10.3390/s21165497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022]
Abstract
Altitude training is a common strategy to improve performance in endurance athletes. In this context, the monitoring of training and the athletes’ response is essential to ensure positive adaptations. Heart rate variability (HRV) has been proposed as a tool to evaluate stress and the response to training. In this regard, many smartphone applications have emerged allowing a wide access to recording HRV easily. The purpose of this study was to describe the changes of HRV using a validated smartphone application before (Pre-TC), during (TC), and after (Post-TC) an altitude training camp in female professional cyclists. Training load (TL) and vagal markers of heart rate variability (LnRMSSD, LnRMSSDcv) of seven professional female cyclists before, during, and after and altitude training camp were monitored. Training volume (SMD = 0.80), LnRMSSD (SMD = 1.06), and LnRMSSDcv (SMD = −0.98) showed moderate changes from Pre-TC to TC. Training volume (SMD = 0.74), TL (SMD = 0.75), LnRMSSD (SMD = −1.11) and LnRMSSDcv (SMD = 0.83) showed moderate changes from TC to Post-TC. Individual analysis showed that heart rate variability responded differently among subjects. The use of a smartphone application to measure HRV is a useful tool to evaluate the individual response to training in female cyclists.
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Affiliation(s)
- Alejandro Javaloyes
- Sports Research Centre, Department of Sports Science, Universidad Miguel Hernández de Elche, 03202 Elche, Spain; (A.J.); (A.M.-R.); (S.S.-Q.)
| | | | - Agustín Manresa-Rocamora
- Sports Research Centre, Department of Sports Science, Universidad Miguel Hernández de Elche, 03202 Elche, Spain; (A.J.); (A.M.-R.); (S.S.-Q.)
| | - Santiago Sanz-Quinto
- Sports Research Centre, Department of Sports Science, Universidad Miguel Hernández de Elche, 03202 Elche, Spain; (A.J.); (A.M.-R.); (S.S.-Q.)
| | - Manuel Moya-Ramón
- Sports Research Centre, Department of Sports Science, Universidad Miguel Hernández de Elche, 03202 Elche, Spain; (A.J.); (A.M.-R.); (S.S.-Q.)
- Correspondence: ; Tel.: +34-9656-62-523
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13
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Manresa-Rocamora A, Flatt AA, Casanova-Lizón A, Ballester-Ferrer JA, Sarabia JM, Vera-Garcia FJ, Moya-Ramón M. Heart rate-based indices to detect parasympathetic hyperactivity in functionally overreached athletes. A meta-analysis. Scand J Med Sci Sports 2021; 31:1164-1182. [PMID: 33533045 DOI: 10.1111/sms.13932] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Abstract
Investigations into the sensitivity of heart rate-(HR) derived indices for tracking parasympathetic nervous system (PNS) changes in functionally overreached (F-OR) endurance-trained athletes have produced equivocal findings. Lack of clarity may be a result of methodological inconsistencies. Therefore, the aims of this systematic review and meta-analysis were (a) to determine the sensitivity of resting and post-exercise vagal-related HR variability (HRV) and HR recovery (HRR) indices to detect PNS modulation in F-OR and non-overreached (non-OR) athletes, and (b) to investigate the influence of methodological factors on the sensitivity of HR-based indices to detect PNS hyperactivity in F-OR athletes. We searched CENTRAL, Scopus, PubMed, Embase, and Web of Science up to May 2020 for the following terms: male and female endurance-trained athletes, controlled and uncontrolled studies that carried out an overload training period, and PNS modulation measured in resting and post-exercise, pre- and post-overload training period. A random-effects model of standardized mean difference (SMD) was estimated for each outcome measure based on the training-induced fatigue status (F-OR vs non-OR athletes), and the influence of methodological issues to detect PNS hyperactivity in F-OR was assessed by subgroup analyses. Pooled analysis showed that resting vagal-related HRV indices did not detect PNS hyperactivity in F-OR athletes (SMD+ = -0.01; 95% confidence interval [CI] = -0.51, 0.50), and no statistical difference (P = .600) was found with non-OR athletes (SMD+ = 0.15; 95% CI = -0.14, 0.45). However, subgroup analysis based on HRV parameter showed a moderate statistical increase in weekly averaged HRV in F-OR athletes (SMD+ = 0.81; 95% CI = 0.35, 1.26), while isolated HRV values did not reach statistical significance (SMD+ = -0.45; 95% CI = -0.96, 0.06). We observed a moderate and statistically significant increase in HRR indices among F-OR athletes (SMD+ = 0.65; 95% CI = 0.44, 0.87), no changes for non-OR athletes (SMD+ = 0.10; 95% CI = -0.15, 0.34), and statistically significant differences between F-OR and non-OR athletes (P < .001). Insufficient data prevented meta-analysis for post-exercise vagal-related HRV indices. Our findings show that when methodological factors are considered, HR-based indices are sensitive to increased PNS modulation in F-OR.
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Affiliation(s)
- Agustín Manresa-Rocamora
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Andrew A Flatt
- Department of Health Sciences and Kinesiology, Georgia Southern University, Georgia, USA
| | - Antonio Casanova-Lizón
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Juan A Ballester-Ferrer
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - José M Sarabia
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain.,Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Miguel Hernandez University, Alicante, Spain
| | - Francisco J Vera-Garcia
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Manuel Moya-Ramón
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain.,Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Miguel Hernandez University, Alicante, Spain
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14
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Zandonai T, Manresa-Rocamora A, Monese L, Moya-Ramón M, Schena F, Chiamulera C. A descriptive study of exercise dependence: a short report among Italian and Japanese runners. J Addict Dis 2020; 39:133-137. [PMID: 33028178 DOI: 10.1080/10550887.2020.1829450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Exercise dependence is a phenomenon characterized by behavioral, physiological and psychological symptoms similarly to substance use disorders. Although exercise addiction is not classified as a mental health disorder. A descriptive study of exercise dependence in two different countries, Italy and for the first time Japan was performed.Methods: We interviewed 229 Italian and 198 Japanese runners by using the exercise dependence scale-21 (EDS-R), a questionnaire to assess exercise dependence.Results: In Italy, 86.9% of subjects were nondependent symptomatic, 4.4% wxercise-dependent, and 8.7% were nondependent asymptomatic. In Japan, participants were classified as nondependent symptomatic (49%) and nondependent asymptomatic (51%), but none considered as at-risk. Significant differences were found in all the seven EDS-R categories between the two cohorts.Conclusions: Exercise dependence is a complex with many contributing factors such as neuroadaptation to protracted exposure to exercise, runner's features and contextual factors. The role of social and cultural factors of exercise dependence would need further investigations.
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Affiliation(s)
- Thomas Zandonai
- Department of Pharmacology, Pediatrics and Organic Chemistry, Miguel Hernández University, Elche, Spain.,Department of Sport Sciences, Sport Research Centre, Miguel Hernández University, Elche, Spain
| | | | - Luca Monese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Manuel Moya-Ramón
- Department of Sport Sciences, Sport Research Centre, Miguel Hernández University, Elche, Spain.,Institute of Health and Biomedical Research of Alicante (ISABIAL Foundation), Alicante, Spain
| | - Federico Schena
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cristiano Chiamulera
- Neuropsychopharmacology Lab, Department of Diagnostics and Public Health, Pharmacology Section, University of Verona, Verona, Italy
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