A Ketone Monoester with Carbohydrate Improves Cognitive Measures Postexercise, but Not Performance in Trained Females

PURPOSE

The acute ingestion of a ketone monoester with the coingestion of a carbohydrate (KME + CHO) compared with carbohydrate (CHO) was investigated on cycling performance and cognitive performance in trained females.

METHODS

Using a two condition, placebo-controlled, double-blinded and crossover design, 12 trained females (mean ± SD: age, 23 ± 3 yr; height, 1.64 ± 0.08 m; mass, 65.2 ± 12.7 kg) completed a baseline assessment of cognitive performance (psychomotor vigilance testing (PVT), task switching, and incongruent flanker), followed by 6 × 5-min intervals at 40%, 45%, 50%, 55%, 60%, and 65% of their maximal power output (W max ) and then a 10-km time trial, concluding with the same assessments of cognitive performance. Participants consumed either 375 mg·kg -1 body mass of KME with a 6% CHO solution (1 g·min -1 of exercise) or CHO alone, across three boluses (50:25:25).

RESULTS

Blood β-hydroxybutyrate concentrations averaged 1.80 ± 0.07 and 0.13 ± 0.01 mM during exercise in KME + CHO and CHO, respectively. Blood glucose decreased after drink 1 of KME + CHO (~15%; P = 0.01) but not CHO, and lactate concentrations were lower in KME + CHO at 50%, 55%, 60%, and 65% W max (all P < 0.05) compared with CHO. Despite these changes, no differences were found between conditions for time trial finishing times (KME + CHO, 29.7 ± 5.7 min; CHO, 29.6 ± 5.7 min; P = 0.92). However, only KME + CHO resulted in increases in psychomotor vigilance testing speed (~4%; P = 0.01) and faster reaction times (~14%; P < 0.01), speed (~15%; P < 0.01), and correct responses (~13%; P = 0.03) in the incongruent flanker during posttesting compared with CHO.

CONCLUSIONS

The acute ingestion of a KME + CHO elevated blood β-hydroxybutyrate and lowered glucose and lactate across multiple time points during exercise compared with CHO. Although these changes did not affect physical performance, several markers of cognitive performance were improved by the addition of a KME in trained females.

Exercise induces tissue-specific adaptations to enhance cardiometabolic health

The risk associated with multiple cancers, cardiovascular disease, diabetes, and all-cause mortality is decreased in individuals who meet the current recommendations for physical activity. Therefore, regular exercise remains a cornerstone in the prevention and treatment of non-communicable diseases. An acute bout of exercise results in the coordinated interaction between multiple tissues to meet the increased energy demand of exercise. Over time, the associated metabolic stress of each individual exercise bout provides the basis for long-term adaptations across tissues, including the cardiovascular system, skeletal muscle, adipose tissue, liver, pancreas, gut, and brain. Therefore, regular exercise is associated with a plethora of benefits throughout the whole body, including improved cardiorespiratory fitness, physical function, and glycemic control. Overall, we summarize the exercise-induced adaptations that occur within multiple tissues and how they converge to ultimately improve cardiometabolic health.

Acute Ingestion of a Ketone Monoester without Co-ingestion of Carbohydrate Improves Running Economy in Male Endurance Runners

PURPOSE

Acute ingestion of a ketone monoester, with and without co-ingestion of carbohydrate, was investigated for effects on running economy (RE), time to exhaustion (TTE), and other related indices of endurance running performance.

METHODS

Using a three condition, placebo-controlled, randomized crossover design, 11 male middle- and long-distance runners ran at five submaximal speeds (10-14 km·h -1 ) on a motorized treadmill for 8 min each, immediately followed by a ramp test to volitional exhaustion. Participants consumed either a 10% carbohydrate solution (CHO), a 10% carbohydrate solution with 750 mg·kg -1 body mass of an ( R )-3-hydroxybutyl ( R )-3-hydroxybutyrate ketone monoester (CHO + KE), or 750 mg·kg -1 body mass of the ketone monoester in flavored water (KE) before (two-thirds of the dose) and during (one-third of the dose) exercise.

RESULTS

β-hydroxybutyrate concentration averaged 1.8 ± 0.3 and 2.1 ± 0.3 mM during exercise in CHO + KE and KE, respectively. RE was lower at each submaximal running speed (effect size = 0.48-0.98) by an average of 4.1% in KE compared with CHO, but not between CHO + KE and CHO. TTE did not differ between CHO (369 ± 116 s), CHO + KE (342 ± 99 s), or KE (333 ± 106 s) ( P = 0.093).

CONCLUSIONS

Acute ingestion of a ketone monoester without carbohydrate, but not when coingested with carbohydrate, improved RE in middle- and long-distance runners at a range of submaximal running speeds and did not alter TTE in a short-duration ramp test to volitional exhaustion. Further investigation is required to examine if these differences translate into positive performance outcomes over longer durations of exercise.

The Effect of Hormonal Contraceptive Use on Skeletal Muscle Hypertrophy, Power and Strength Adaptations to Resistance Exercise Training: A Systematic Review and Multilevel Meta-analysis

BACKGROUND

Resistance exercise training is widely used by general and athletic populations to increase skeletal muscle hypertrophy, power and strength. Endogenous sex hormones influence various bodily functions, including possibly exercise performance, and may influence adaptive changes in response to exercise training. Hormonal contraceptive (HC) use modulates the profile of endogenous sex hormones, and therefore, there is increasing interest in the impact, if any, of HC use on adaptive responses to resistance exercise training.

OBJECTIVE

Our aim is to provide a quantitative synthesis of the effect of HC use on skeletal muscle hypertrophy, power and strength adaptations in response to resistance exercise training.

METHODS

A systematic review with meta-analysis was conducted on experimental studies which directly compared skeletal muscle hypertrophy, power and strength adaptations following resistance exercise training in hormonal contraceptive users and non-users conducted before July 2023. The search using the online databases PUBMED, SPORTDiscus, Web of Science, Embase and other supplementary search strategies yielded 4669 articles, with 8 articles (54 effects and 325 participants) meeting the inclusion criteria. The methodological quality of the included studies was assessed using the "Tool for the assessment of study quality and reporting in exercise".

RESULTS

All included studies investigated the influence of oral contraceptive pills (OCP), with no study including participants using other forms of HC. The articles were analysed using a meta-analytic multilevel maximum likelihood estimator model. The results indicate that OCP use does not have a significant effect on hypertrophy [0.01, 95% confidence interval (CI) [- 0.11, 0.13], t = 0.14, p = 0.90), power (- 0.04, 95% CI [- 0.93, 0.84], t =  - 0.29, p = 0.80) or strength (0.10, 95% CI [- 0.08, 0.28], t = 1.48, p = 0.20).

DISCUSSION

Based on the present analysis, there is no evidence-based rationale to advocate for or against the use of OCPs in females partaking in resistance exercise training to increase hypertrophy, power and/or strength. Rather, an individualised approach considering an individual's response to OCPs, their reasons for use and menstrual cycle history may be more appropriate.

REGISTRATION

The review protocol was registered on PROSPERO (ID number and hyperlink: CRD42022365677).

Functional assays reflective of cancer hallmarks in BT-549 cells are not impacted by media supplemented with exercise-trained plasma

NEW FINDINGS

What is the central question of this study? Little is known regarding the effects of media supplemented with resting plasma from exercise-trained individuals, despite the established bioactive effects of acutely exercised samples. Does media supplemented with resting plasma from endurance-trained, strength-trained or recreationally active controls impact hallmarks of cancer in BT-549 cells? What is the main finding and its importance? Supplementing media with plasma from these trained athletes did not impact proliferation, migration, invasion or anoikis resistance compared to plasma from recreationally-active controls. These findings suggest that 'anti-cancer' effects of exercise are not present in resting blood samples of exercise-trained individuals.

ABSTRACT

Media supplemented with sera from acutely exercised men has been shown to have 'anti-cancer' effects on prostate and breast cancer cell lines. This study investigated whether media supplemented with plasma samples taken at rest (≥30 h since the most recent exercise session) from men who were endurance-trained (END), strength-trained (STR) or recreationally active controls (CON) impacted the results of four assays that mimic hallmarks of cancer (proliferation, migration, extracellular matrix invasion and anoikis resistance) in the BT-549 breast cancer cell line. Compared to control conditions of either serum-free media or fetal bovine serum as appropriate, BT-549 cells cultured with plasma-supplemented media regardless of group resulted in greater cell proliferation (∼20-50%) and cell migration (∼15-20%), and lower extracellular matrix invasion (∼10-20%) and anoikis resistance (∼15-20%). Supplementing media with plasma from END or STR did not impact any outcomes of these assays compared to plasma from CON. Media supplemented with human plasma can impact functional assays reflective of cancer hallmarks in BT-549 cells, but effects of exercise on proliferation, migration, extracellular matrix invasion and anoikis resistance were not evident in resting blood samples of individuals with a prior history of exercise training.

The separation and identification of circulating small extracellular vesicles from endurance-trained, strength-trained and recreationally active men

Small extracellular vesicles (EV) are membrane-encapsulated particles that carry bioactive cargoes, are released by all cell types and are present in all human biofluids. Changes in EV profiles and abundance occur in response to acute exercise, but this study investigated whether individuals with divergent histories of exercise training (recreationally active controls - CON; endurance-trained - END; strength-trained - STR) presented with varied abundances of small EVs in resting samples and whether the abundance of small EVs differed within each group across two measurement days. Participants (n = 38, all male; CON n = 12, END n = 13, STR n = 13) arrived at the lab on two separate occasions in a rested, overnight fasted state, with standardisation of time of day of sampling, recent dietary intake, time since last meal and time since last exercise training session (∼40 h). Whole blood samples were collected and separated into plasma from which small EVs were separated using size exclusion chromatography and identified in accordance with the Minimal Information For Studies of Extracellular Vesicles (MISEV) guidelines. No differences in the abundance of small EVs were observed within or between groups across multiple methods of small EV identification (nanoparticle tracking analysis, flow cytometry, immunoblot of specific EV markers). Targeted metabolomics of the small EV preparations identified 96 metabolites that were associated with the structure and function of small EVs, with no statistically significant differences in concentrations observed across groups. The results of the current study suggest that the abundance and metabolomic profile of small EVs derived from men with divergent histories of exercise training are similar to those in resting blood samples. KEY POINTS: Extracellular vesicles (EV) are membrane-encapsulated particles that are present in circulation and carry bioactive materials as 'cargo'. The abundance and profile of small EVs are responsive to acute exercise, but little is known about the relationship between small EVs and exercise training. This study examined the abundance, and a targeted metabolomic profile, of small EVs separated from the blood of endurance athletes, strength athletes and recreationally active controls at rest (∼40 h after the most recent exercise session) on two separate but identical lab visits. No differences were observed in the abundance or metabolomic profile of small EV preparations between the groups or between the lab visits within each group. Further research should determine whether the bioactive cargoes (e.g. RNA, protein and additional metabolites) carried within EVs are altered in individuals with divergent histories of exercise training or in response to exercise training interventions.

Prevalence and determinants of sarcopenia in community-dwelling older adults in Ireland

BACKGROUND

Data on the prevalence of sarcopenia among older adults in Ireland are lacking.

AIMS

To assess the prevalence and determinants of sarcopenia among community-dwelling older adults in Ireland.

METHODS

This cross-sectional analysis involved n = 308 community-dwelling adults aged ≥ 65 y living in Ireland. Participants were recruited via recreational clubs and primary healthcare services. Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Skeletal muscle mass was estimated using bioelectrical impedance analysis, strength was measured via handgrip dynamometry, and physical performance was assessed using the Short Physical Performance Battery. Detailed information was collected on demographics, health, and lifestyle. Dietary macronutrient intake was measured via a single 24 h recall. Binary logistic regression was used to examine potential demographic, health, lifestyle, and dietary determinants of sarcopenia (where both probable and confirmed sarcopenia were combined).

RESULTS

The prevalence of EWGSOP2-defined probable sarcopenia was 20.8% and confirmed sarcopenia was 8.1% (5.8% had severe sarcopenia). Polypharmacy (OR 2.60, 95% confidence interval [CI] 1.3, 5.23), height (OR 0.95, 95% CI 0.91, 0.98), and Instrumental Activities Of Daily Living (IADL) score (OR 0.71, 95% CI 0.59, 0.86) were independently associated with sarcopenia (probable and confirmed combined). There were no independent associations between energy-adjusted macronutrient intakes, as determined by 24 h recall, and sarcopenia.

CONCLUSION

Sarcopenia prevalence within this sample of community-dwelling older adults in Ireland is broadly similar to other European cohorts. Polypharmacy, lower height, and lower IADL score were independently associated with EWGSOP2-defined sarcopenia.

The resting serum metabolome in response to short-term sprint interval training

PURPOSE

To investigate the response of a targeted fraction of (168 metabolites) of the resting serum metabolome to 9 sessions of sprint interval training (SIT).

METHODS

Thirty-four recreationally active males provided resting blood samples before (baseline) and 48-72 h after (post) a short-term (9 sessions) cycle ergometer-based SIT intervention. A targeted analysis of 168 metabolites was performed on serum using liquid chromatography mass spectrometry (LC-MS). 160 distinct metabolites were identified and combined with 4 calculated metabolite sums and 3 calculated metabolite ratios creating a panel of 167 individual factors. Data were analysed using principal component analysis and univariate testing of all factors classified into 5 metabolite subgroups.

RESULTS

SIT improved anaerobic capacity measured by average power output during a Wingate test (p < 0.01; mean difference = 38 W, 95% confidence interval [26, 51]) and aerobic capacity measured by average power output in a 20 min cycling test (p < 0.01; 17 W [12, 23]). Limited separation was discernible in the targeted serum metabolome between baseline and post-intervention when projected on the first and second principal component(s). However, univariate testing identified 11 fatty acids that had lower concentrations (false discovery rate < 0.05) in post-intervention samples.

CONCLUSIONS

These findings demonstrate that this short-term SIT intervention had limited effect on the serum metabolome at rest, but a subfraction of fatty acids are potentially sensitive to short-term exercise training.

Within-Subject Variability and the Influence of Exercise Training History on the Resting Plasma Metabolome in Men

This study investigated within-subject variability in the circulating metabolome under controlled conditions, and whether divergent exercise training backgrounds were associated with alterations in the circulating metabolome assessed in resting samples. Thirty-seven men comprising of endurance athletes (END; body mass, 71.0 ± 6.8 kg; fat-free mass index, 16.9 ± 1.1 kg/m2), strength athletes (STR; 94.5 ± 8.8 kg; 23.0 ± 1.8 kg/m2), and recreationally active controls (CON; 77.6 ± 7.7 kg; 18.1 ± 1.0 kg/m2) provided blood samples after an overnight fast on two separate occasions controlled for time of day of sampling, recent dietary intake, time since last meal, and time since last exercise training session. A targeted profile of metabolites, performed using liquid chromatography and mass spectrometry on plasma samples, identified 166 individual metabolites and metabolite features, which were analyzed with intraclass correlation coefficients, a multilevel principal component analysis, and univariate t tests adjusted for multiple comparisons. The median intraclass correlation coefficient was .49, with 46 metabolites displaying good reliability and 31 metabolites displaying excellent reliability. No difference in the abundance of any individual metabolite was identified within groups when compared between visits, but a combined total of 44 metabolites were significantly different (false discovery rate <0.05) between groups (END vs. CON, 42 metabolites; STR vs. CON, 10 metabolites; and END vs. STR, five metabolites). Under similar measurement conditions, the reliability of resting plasma metabolite concentrations varies largely at the level of individual metabolites with ∼48% of metabolites displaying good-to-excellent reliability. However, a history of exercise training was associated with alterations in the abundance of ∼28% of metabolites in the targeted profile employed in this study.

Physical Match Demands of International Women's Rugby Union: A Three-Year Longitudinal Analysis of a Team Competing in The Women's Six Nations Championship

There is a paucity of studies describing the physical match demands of elite international women's rugby union, which limits coaches' ability to effectively prepare players for the physical demands required to compete at the elite level. Global positioning system technologies were used to measure the physical match demands of 53 international female rugby union players during three consecutive Women's Six Nations Championships (2020-2022), resulting in 260 individual match performances. Mixed-linear modelling was used to investigate differences in physical match demands between positions. Significant effects (p < 0.05) of the position were observed for all variables, with the exception of relative distances (m.min^-1) at velocities of 1.01-3.00 m·s^-1 (p = 0.094) and 3.01-5.00 m·s^-1 (p = 0.216). This study provides valuable data on the physical match demands of elite international women's rugby union match play that may aid practitioners in the physical preparation of players to compete at this level. Training methodologies for elite-level female rugby union players should consider the unique demands across positional groups with specific considerations of high-velocity running and collision frequency.

Dietary Intakes and the Risk of Low Energy Availability in Male and Female Advanced and Elite Rock Climbers

ABSTRACT

Monedero, J, Duff, C, and Egan, B. Dietary intakes and the risk of low energy availability in male and female advanced and elite rock climbers. J Strength Cond Res 37(3): e8-e15, 2023-There is a culture among rock climbers of striving to maintain low body mass and percentage body fat to enhance performance. Diet practices based on this belief might lead to increased risk of low energy availability (LEA) or eating disorders (EDs). Twenty-five advanced or elite rock climbers (male, n = 14; female, n = 11) had body composition measured, completed 4-day food intake and physical activity diaries while wearing an accelerometer and heart rate monitor, and completed the Eating Attitudes Test (EAT)-26 and the Low Energy Availability in Females Questionnaire (LEAF-Q; n = 11 female subjects only). EAT-26 scores of 3.5 (1.8, 7.0) [median (IQR)] and 9.3 ± 6.4 (mean ± SD ) for male and female subjects, respectively, indicated low risk of ED in this cohort, but 4 female subjects were at high risk of LEA according to LEAF-Q scores. Suboptimal (<45 kcal·kg·FFM -1 ·d -1 ) and LEA (<30 kcal·kg·FFM -1 ·d -1 ) were evident in 88 and 28%, respectively, of climbers. However, only the female climbers had energy intakes (1775 ± 351 kcal·d -1 ) significantly lower than their calculated energy requirements (2056 ± 254 kcal·d -1 ; p = 0.006). In all subjects, carbohydrate intakes were lower (male subjects: 3.8 ± 1.2 g·kg -1 ·d -1 , p = 0.002; female subjects: 3.4 ± 0.7 g·kg -1 ·d -1 , p < 0.001), and fat intakes were higher (male subjects: 1.6 ± 0.5 g·kg -1 ·d -1 , p < 0.001; female subjects: 1.4 ± 0.4 g·kg -1 ·day -1 , p < 0.001) than current sports nutrition recommendations, and inadequate intakes of calcium, magnesium, and vitamin D were observed. Female subjects specifically had lower than recommended intakes of protein and iron. These results show that advanced and elite rock climbers have a high prevalence of LEA and have a risk of having nutritional deficiencies as result of their diet.

The Priming Effect of a Heavy or Very Heavy Resisted Sled Sprint-Based Conditioning Activity on Subsequent Unresisted Sprint Performance in Team Field Sport Athletes

ABSTRACT

Monahan, M and Egan, B. The priming effect of a heavy or very heavy resisted sled sprint-based conditioning activity on subsequent unresisted sprint performance in team field sport athletes. J Strength Cond Res 37(1): 91-97, 2023-The effect of resisted sled sprinting (RSS) on postactivation performance enhancement (PAPE) was investigated in team field sport athletes (n = 28; m and female, 15 and 13; age, 22.1 ± 2.5 years; height, 1.77 ± 0.11 m; body mass [BM], 75.1 ± 16.4 kg). After a standardized warm-up, unresisted sprint (URS) performance was measured over 10- and 20-m (PRE) followed by a conditioning activity (CA) consisting of 3 × 20 m RSS. Unresisted sprint performance was then measured again at 30 seconds and 4, 8, 12, 16, 20, and 24 minutes after CA. The effect of heavy (H-RSS) or very heavy (VH-RSS) sled loads were compared during 2 separate visits using a randomized crossover design. Heavy-resisted sled sprinting and VH-RSS loads corresponded to a velocity decrement (Vdec) of 17.3 ± 3.6%Vdec (20.0 ± 2.3%BM) and 52.9 ± 3.8%Vdec (64.3 ± 7.0%BM), respectively. Unresisted sprint performance after CA was slower than PRE over 10- and 20-m (both p < 0.001 for time). The decline in URS performance over 20-m was greater in VH-RSS (time × sled load interaction, p = 0.033). However, after extraction of the fastest sprint times after CA, the fastest sprint time for 10-m improved after H-RSS by 0.026 (0.001, 0.050) seconds (p = 0.040; d = 0.21) but not after VH-RSS (p = 0.054; d = 0.14). The fastest sprint times for 20-m were similar to PRE after H-RSS and VH-RSS. No sex-specific differences were observed. Given the high intersubject variability in the magnitude of improvement, and for the time point at which the fastest sprint occurred, there remains questionable practical value to an RSS-based CA as a means to induce a PAPE for URS performance.

Molecular Responses to Acute Exercise and Their Relevance for Adaptations in Skeletal Muscle to Exercise Training

Repeated, episodic bouts of skeletal muscle contraction undertaken frequently as structured exercise training is a potent stimulus for physiological adaptation in many organs. Specifically in skeletal muscle, remarkable plasticity is demonstrated by the remodeling of muscle structure and function in terms of muscular size, force, endurance, and contractile velocity as a result of the functional demands induced by various types of exercise training. This plasticity, and the mechanistic basis for adaptations to skeletal muscle in response to exercise training, is underpinned by activation and/or repression of molecular pathways and processes induced in response to each individual acute exercise session. These pathways include the transduction of signals arising from neuronal, mechanical, metabolic, and hormonal stimuli through complex signal transduction networks, which are linked to a myriad of effector proteins involved in the regulation of pre- and post-transcriptional processes, and protein translation and degradation processes. This review therefore describes acute exercise-induced signal transduction and the molecular responses to acute exercise in skeletal muscle including emerging concepts such as epigenetic pre- and post-transcriptional regulation, and the regulation of protein translation and degradation. A critical appraisal of methodological approaches and the current state of knowledge informs a series of recommendations offered as future directions in the field.

Physiological and Perceptual Responses to a Single Session of Resisted Sled Sprint Training at Light or Heavy Sled Loads

ABSTRACT

Monahan, M, Petrakos, G, and Egan, B. Physiological and perceptual responses to a single session of resisted sled sprint training at light or heavy sled loads. J Strength Cond Res 36(10): 2733-2740, 2022-The acute physiological and perceptual responses to a single session of resisted sled sprint (RSS) training are largely unexplored, nor have differences, if any, between male and female athletes been compared. Team field sport athletes (n = 27; male/female, 15/12; 21.1 ± 2.7 years) were assessed for Maximal Resisted Sled Load (MRSL) from which light (L-RSS, 30%MRSL) and heavy (H-RSS, 80%MRSL) sled loads were prescribed. On separate occasions in random order, 2 training sessions of 12 × 20 m RSS repetitions at either L- or H-RSS were performed, and assessments of physiological and perceptual responses were performed before (PRE), during, after (POST) and 24 hours after (+24 hours POST) each session. Compared to unresisted sprints, velocity decrements of 7.5 ± 2.2 and 22.7 ± 8.1% were produced by L-RSS and H-RSS, respectively. Heart rate, blood lactate, and ratings of perceived exertion were higher in H-RSS compared to L-RSS. Decrements in 20 m sprint and countermovement jump performance observed at POST had returned to PRE values at +24 hours POST. Except for a higher heart rate (∼7-12 b·min-1) in females during the respective sessions, responses to L- and H-RSS were generally similar between males and females. A single session of heavy RSS training is more demanding than light RSS training when matched for sprint number and distance, but measures of lower limb power and sprint performance return to pre-training levels within 24 hours regardless of sled load. Males and females respond similarly to a single session of RSS training when individualized, relative intensity sled loads are prescribed.

202 Frequency of inter-specialty consensus decisions and adherence to advice following a weekly neurovascular multidisciplinary meeting

Background/Aims

Data are limited on the frequency of ‘consensus’ between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses, and post-MDM ‘adherence’ to advice. This prospective audit/quality improve- ment project collated data at a Neurovascular/Stroke Centre.

Methods

Data from a weekly MDM were prospectively-recorded to document the proportion of extrac- ranial carotid/vertebral stenosis patients in whom ‘consensus management decisions’ were reached by Neurologists/Vascular Surgeons/Stroke Physicians-Geriatricians. Adherence to MDM advice was analysed in patients with asymptomatic, symptomatic and ‘indeterminate symptomatic status [ISS]’ stenoses, including intervals between symptom onset-MDM discussion +/- intervention.

Results

115 patients were discussed (September/2017-February/2020). Consensus regarding manage- ment was 96.5% (111/115) overall; 100% (29/29) with asymptomatic carotid stenosis [ACS], 96.5% (55/57) with symptomatic carotid stenosis [SCS], and 93.1% (27/29) with ISS. Overall adherence to MDM advice was 93% (107/115); 100% (29/29) with ACS, 89.5% (51/57) with SCS, 93.1% (27/29) with ISS. Median interval from index TIA/stroke to intervention was 12.5 days (IQR:9-18d), and MDM discussion-to-intervention was 5.5d (IQR:1-7d) in patients with 50-99% SCS.

Conclusions

High-frequency inter-specialty consensus regarding management/adherence to proposed treatment supports a collaborative, multidisciplinary model-of-care in patients with extracranial arterial stenosis. Service development should shorten intervals between symptoms-MDT discussion-intervention to optimise secondary prevention.

Effect of rapid weight loss incorporating hot salt water immersion on changes in body mass, blood markers, and indices of performance in male mixed martial arts athletes

Purpose

To investigate the effects of rapid weight loss (RWL), incorporating comparison of hot water immersion (HWI) in fresh or salt water, on changes in body mass, blood markers, and indices of performance in mixed martial arts athletes.

Methods

In a crossover design comparing fresh water (FWB) to salt water (SWB; 5.0%wt/vol Epsom salt) bathing, 13 males performed 20 min of HWI (~ 40.3 °C) followed by 40 min wrapped in a heated blanket, twice in sequence (2 h total). Before bathing, ~ 26 to ~ 28 h of fluid and dietary restriction was undertaken, and ~ 24 to ~ 26 h of a high carbohydrate diet and rehydration was undertaken as recovery.

Results

During the entire RWL process, participants lost ~ 5.3% body mass. Body mass lost during the 2 h hot bath protocol was 2.17 ± 0.81 kg (~ 2.7% body mass) and 2.24 ± 0.64 kg (~ 2.8% body mass) for FWB and SWB, respectively (P = 0.647 between trials). Blood urea nitrogen, creatinine, sodium, chloride, hemoglobin, and hematocrit were increased (all P < 0.05), and plasma volume was decreased (~ 14%; P < 0.01), but did not differ between FWB and SWB, and were similar to baseline values after recovery. No indices of performance (e.g., countermovement jump, isometric strength, and functional threshold power) were impacted when RWL was followed by the recovery process.

Conclusion

Under the conditions of this hot bath protocol, fluid loss was not augmented by the addition of ~ 5.0%wt/vol of Epsom salt during HWI, and RWL of ~ 5.3% body mass followed by > 24 h of recovery did not impact indices of performance.

Increased Lean Body Mass After Bodyweight-Based High Intensity Interval Training in Overweight and Obese Men

Purpose: The effects of 8 weeks of bodyweight exercise-based, high-intensity interval training (BWHIIT) on body composition and blood-based markers of metabolic health were investigated in overweight and obese, sedentary young men. Methods: In a parallel group, PRE-POST design, n = 30 men (age, 25.7 ± 4.3 y; body mass index, 27.7 ± 2.1 kg m^-2; 26.1 ± 5.2% body fat) were randomized to BWHIIT (n = 20) or a control group (CON; n = 10). BWHIIT consisted of supervised, group-based training sessions (~30 minutes) performed 3 times weekly. Each session consisted of 6 high-intensity bodyweight-based exercises, with each exercise being performed for 4 minutes in the manner of 8 sets of 20 seconds of exercise, 10 seconds of rest. Prior to commencing training (PRE), and 36 h after the final training session (POST), an overnight fasted blood sample was drawn, and body composition was assessed by dual-energy X-ray absorptiometry. Eighteen participants completed the intervention (CON, n = 9; BWHIIT, n = 9). Results: Lean body mass (LBM) was increased at POST in BWHIIT compared to CON (P = .011, η²_p = .359), with the mean (95% confidence limits) increase in LBM from PRE to POST within BWHIIT being 1.23 (0.55, 1.92) kg. Body mass and fat mass were unchanged in both groups from PRE to POST. BWHIIT had no effect on serum concentrations of total cholesterol, HDL-C, LDL-C, triglycerides, NEFA, hsCRP, or glucose. Conclusion: Eight weeks of bodyweight exercise-based high intensity interval training by overweight and obese sedentary young men increased LBM by ~2%, but fat mass and blood-based markers of metabolic health were unchanged.

Interindividual variability in response to protein and fish oil supplementation in older adults: a randomized controlled trial

BACKGROUND

Precision nutrition is highly topical. However, no studies have explored the interindividual variability in response to nutrition interventions for sarcopenia. The purpose of this study was to determine the magnitude of interindividual variability in response to two nutrition supplementation interventions for sarcopenia and metabolic health, after accounting for sources of variability not attributable to supplementation.

METHODS

A 24 week, randomized, double-blind, placebo-controlled trial tested the impact of leucine-enriched protein (LEU-PRO), LEU-PRO plus long-chain n-3 PUFA (LEU-PRO+n-3) or control (CON) supplementation in older adults (n = 83, 71 ± 6 years) at risk of sarcopenia. To estimate the true interindividual variability in response to supplementation (free of the variability due to measurement error and within-subject variation), the standard deviation of individual responses (SD_R ) was computed and compared with the minimally clinically important difference (MCID) for appendicular lean mass (ALM), leg strength, timed up-and-go (TUG), and serum triacylglycerol (TG) concentration. Clinically meaningful interindividual variability in response to supplementation was deemed to be present when the SD_R positively exceeded the MCID. The probability that individual responses were clinically meaningful, and the phenotypic, dietary, and behavioural determinants of response to supplementation were examined.

RESULTS

The SD_R was below the MCID for ALM (LEU-PRO: -0.12 kg [90% CI: -0.38, 0.35], LEU-PRO+n-3: -0.32 kg [-0.45, 0.03], MCID: 0.21 kg), TUG (LEU-PRO: 0.58 s [0.18, 0.80], LEU-PRO+n-3: 0.73 s [0.41, 0.95], MCID: 0.9 s) and TG (LEU-PRO: -0.38 mmol/L [-0.80, 0.25], LEU-PRO+n-3: -0.44 mmol/L [-0.63, 0.06], MCID: 0.1 mmol/L), indicating no meaningful interindividual variability in response to either supplement. The SD_R exceeded the MCID (19 Nm) for strength in response to LEU-PRO (25 Nm [-29, 45]) and LEU-PRO+n-3 (23 Nm [-29, 43]) supplementation but the effect was uncertain, evidenced by wide confidence intervals. In the next stage of analysis, similar proportions of participant responses were identified as very likely, likely, possibly, unlikely, and very unlikely to represent clinically meaningful improvements across the LEU-PRO, LEU-PRO+n-3, and CON groups (P > 0.05). Baseline LC n-3 PUFA status, habitual protein intake, and numerous other phenotypic and behavioural factors were not determinants of response to LEU-PRO or LEU-PRO+n-3 supplementation.

CONCLUSIONS

Applying a novel, robust methodological approach to precision nutrition, we show that there was minimal interindividual variability in changes in ALM, muscle function, and TG in response to LEU-PRO and LEU-PRO+n-3 supplementation in older adults at risk of sarcopenia.

Prevalence of hormonal contraceptive use and reported side effects of the menstrual cycle and hormonal contraceptive use in powerlifting and rugby

OBJECTIVES

The prevalence of hormonal contraceptive (HC) use and the associated symptomology of use or nonuse are under-studied in athletic populations, and in particular, in strength and collision sports. This study aimed to investigate the prevalence of hormonal contraceptive use and reported side effects of the menstrual cycle and hormonal contraceptive use in powerlifters and rugby players.

METHODS

Competitive female powerlifters and rugby players (aged ≥18 y), representing a strength and a collision sport respectively, completed an anonymous online questionnaire for the purpose of assessing self-reported prevalence of HC use, and symptoms of the menstrual cycle and HC use. Athletes were categorized by sport (powerlifters, n = 149; rugby players, n = 135) in order to conduct a stratified analysis. For open-ended questions, a content analysis was conducted to categorize responses, and frequency analyses were performed.

RESULTS

Current HC use was reported by 51.1% of athletes, with similar prevalence for the two sports (powerlifting, 48.3% vs. rugby, 54.1%, P = 0.34). Side effects of the menstrual cycle were reported in 83.5% of non-HC users, with the most common being unspecified cramping (42.4%), headache/migraine (24.5%), and fatigue (24.5%). Side effects were reported in 40.0% of HC users, with the most common being mood changes (17.9%), stomach pain (8.3%) and headaches/migraines (6.9%).

CONCLUSION

A large proportion of HC users and nonusers in this study experience negative side effects of HC use and the menstrual cycle, respectively. The symptoms experienced by both groups are wide-ranging, with a high degree of variation between individuals. The negative side-effects experienced by HC users and nonusers may have an influence on athletic performance, and this requires future investigation.

Exercise Training and Circulating Small Extracellular Vesicles: Appraisal of Methodological Approaches and Current Knowledge

In response to acute exercise, an array of metabolites, nucleic acids, and proteins are enriched in circulation. Collectively termed "exercise factors," these molecules represent a topical area of research given their speculated contribution to both acute exercise metabolism and adaptation to exercise training. In addition to acute changes induced by exercise, the resting profile of circulating exercise factors may be altered by exercise training. Many exercise factors are speculated to be transported in circulation as the cargo of extracellular vesicles (EVs), and in particular, a sub-category termed "small EVs." This review describes an overview of exercise factors, small EVs and the effects of exercise, but is specifically focused on a critical appraisal of methodological approaches and current knowledge in the context of changes in the resting profile small EVs induced by exercise training, and the potential bioactivities of preparations of these "exercise-trained" small EVs. Research to date can only be considered preliminary, with interpretation of many studies hindered by limited evidence for the rigorous identification of small EVs, and the conflation of acute and chronic responses to exercise due to sample timing in proximity to exercise. Further research that places a greater emphasis on the rigorous identification of small EVs, and interrogation of potential bioactivity is required to establish more detailed descriptions of the response of small EVs to exercise training, and consequent effects on exercise adaptation.

The Between-Competition Running Demands of Elite Hurling Match-Play

The current study aimed to investigate the differences in running demands between the National Hurling League (NHL) and the Championship, and within playing positions. GPS (10 Hz, STATSports Apex GNSS) were used to analyse the running demands during 34 games (2017–2020 seasons) of the Championship and the NHL. The running demands (total-, relative-, high-speed- [>17 km·h⁻¹] and sprint [≥22 km·h⁻¹] distance, number and length of sprints, and peak speed) were compared between competitions. Greater total- [ES = 0.32], relative- [ES = 0.26], and sprint-distance [ES = 0.41], and number of sprints [ES = 1.29] were completed in the Championship. The high-speed distance was similar between competitions. Half-backs and half-forwards covered greater total- (ES = 0.91 and 0.21, respectively), relative- (ES = 1.14 and 0.68, respectively), high-speed- (ES = 0.69 and 0.44, respectively), and sprint-distance (ES = 0.50 and 1.26, respectively), number of sprints (ES = 2.66 and 1.73, respectively), and peak speed (ES = 1.09 and 1.32, respectively) in the Championship. There was no difference (p < 0.05) in the sprint distance covered between positions in the Championship. The results showed that the Championship is more physically demanding. The findings present key implications for the transition between competitions.

Does supplementation with leucine-enriched protein alone and in combination with fish-oil-derived n-3 PUFA affect muscle mass, strength, physical performance, and muscle protein synthesis in well-nourished older adults? A randomized, double-blind, placebo-controlled trial

BACKGROUND

Leucine-enriched protein (LEU-PRO) and long-chain (LC) n-3 (ω-3) PUFAs have each been proposed to improve muscle mass and function in older adults, whereas their combination may be more effective than either alone.

OBJECTIVE

The impact of LEU-PRO supplementation alone and combined with LC n-3 PUFAs on appendicular lean mass, strength, physical performance and myofibrillar protein synthesis (MyoPS) was investigated in older adults at risk of sarcopenia.

METHODS

This 24-wk, 3-arm parallel, randomized, double-blind, placebo-controlled trial was conducted in 107 men and women aged ≥65 y with low muscle mass and/or strength. Twice daily, participants consumed a supplement containing either LEU-PRO (3 g leucine, 10 g protein; n = 38), LEU-PRO plus LC n-3 PUFAs (0.8 g EPA, 1.1 g DHA; LEU-PRO+n-3; n = 38), or an isoenergetic control (CON; n = 31). Appendicular lean mass, handgrip strength, leg strength, physical performance, and circulating metabolic and renal function markers were measured pre-, mid-, and postintervention. Integrated rates of MyoPS were assessed in a subcohort (n = 28).

RESULTS

Neither LEU-PRO nor LEU-PRO+n-3 supplementation affected appendicular lean mass, handgrip strength, knee extension strength, physical performance or MyoPS. However, isometric knee flexion peak torque (treatment effect: -7.1 Nm; 95% CI: -12.5, -1.8 Nm; P < 0.01) was lower postsupplementation in LEU-PRO+n-3 compared with CON. Serum triacylglycerol and total adiponectin concentrations were lower, and HOMA-IR was higher, in LEU-PRO+n-3 compared with CON postsupplementation (all P < 0.05). Estimated glomerular filtration rate was higher and cystatin c was lower in LEU-PRO and LEU-PRO+n-3 postsupplementation compared with CON (all P < 0.05).

CONCLUSIONS

Contrary to our hypothesis, we did not observe a beneficial effect of LEU-PRO supplementation alone or combined with LC n-3 PUFA supplementation on appendicular lean mass, strength, physical performance or MyoPS in older adults at risk of sarcopenia. This trial was registered at clinicaltrials.gov as NCT03429491.

Increased Leg Strength After Concurrent Aerobic and Resistance Exercise Training in Older Adults Is Augmented by a Whole Food-Based High Protein Diet Intervention

Most studies in older adults have utilized powdered protein supplements or oral nutrition solutions as a source of additional dietary protein, but whole foods may provide a greater anabolic stimulus than protein isolated from food matrices. Therefore, the present study investigated a concurrent aerobic and resistance exercise training program in older adults, in the absence or presence of a high protein whole food-based dietary intervention, for effects on strength, physical function, and body composition. Community-dwelling older adults (n = 56; M/F, 28/28; age, 69.3 ± 4.0 years; BMI, 26.6 ± 3.7 kg m⁻²) participated in a 12-week intervention after randomization to either nutrition only (NUTR; n = 16), exercise only (EX, n = 19), or nutrition plus exercise (NUTR + EX, n = 21) groups. NUTR and NUTR + EX followed a dietary intervention targeting an increase in protein-rich meals at breakfast, lunch, and dinner. Exercise training in EX and NUTR + EX consisted of 24 min sessions of concurrent aerobic and resistance exercise performed three times per week. Daily protein intake increased in NUTR and NUTR + EX, but not EX. The increase in 1RM leg press strength was greater (Interaction effect, P = 0.012) in NUTR + EX [29.6 (18.1, 41.0) kg] than increases observed in NUTR [11.1 (−1.3, 23.6) kg] and EX [12.3 (0.9, 23.8) kg]. The increase in 1RM chest press strength was greater (interaction effect, P = 0.031) in NUTR + EX [6.3 (4.0, 8.6) kg] than the increase observed in NUTR [2.9 (0.3, 5.5) kg], but not EX [6.3 (3.9, 8.7) kg]. Hand-grip strength and sit-to-stand performance were each improved in all three groups, with no differences observed between groups (interaction effect, P = 0.382 and P = 0.671, respectively). An increase in percentage body fat was observed in NUTR, but not in EX or NUTR + EX (interaction effect, P = 0.018). No between-group differences were observed for change in lean body mass (interaction effect, P = 0.402). Concurrent aerobic and resistance exercise training improves strength and physical function in older adults, but combining this training with an increase in daily protein intake through whole foods may be advantageous to increase lower limb strength.

Effects of a Long Chain n-3 Polyunsaturated Fatty Acid-rich Multi-ingredient Nutrition Supplement on Body Composition and Physical Function in Older Adults with Low Skeletal Muscle Mass

Six months of supplementation with a multi-ingredient nutrition supplement was investigated in older adults with low skeletal muscle mass given the recently purported benefits of such approaches. Community-dwelling older adults (age, 74.9 ± 3.6 y; M/F, 18/19) participated in a double-blind, placebo-controlled, randomized trial involving daily consumption of either fruit juice placebo (PLA) or supplement (SUPP) in the form of a 200-mL carton of a juice-based emulsion of long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) (3000 mg as 1500 mg docosahexaenoic acid and 1500 mg eicosapentaenoic acid), whey protein isolate (8 g), vitamin D3 (400 IU), and resveratrol (150 mg). Body composition, physical function, and circulating markers of metabolic health were assessed at baseline (PRE), and after 3 (MID) and 6 (POST) months of supplementation. Lean body mass (LBM) was unchanged in either group, but fat mass increased in SUPP by 1.41 (0.75, 2.07) kg at POST (+6.4%; p < .001; d = 0.20). Hand-grip strength was maintained in SUPP, but declined in PLA by 2.50 (0.81, 4.19) kg at POST (-6.8%; p = .002; d = 0.38). Short physical performance battery score was unchanged in PLA, but increased in SUPP by 1.13 (0.41, 1.84) above PRE at POST (p = .001; d = 0.47). Circulating markers of metabolic health were unchanged in response to the intervention in either PLA or SUPP. Long-term supplementation with an LC n-3 PUFA-rich multi-ingredient nutrition supplement demonstrates potential efficacy for improving physical function in older adults in the absence of exercise training and independent of a change in LBM.

Effects of 8 wk of 16:8 Time-restricted Eating in Male Middle- and Long-Distance Runners

PURPOSE

Eight weeks of time-restricted eating (TRE) in concert with habitual exercise training was investigated for effects on body composition, energy and macronutrient intakes, indices of endurance running performance, and markers of metabolic health in endurance athletes.

METHODS

Male middle- and long-distance runners (n = 23) were randomly assigned to TRE (n = 12) or habitual dietary intake (CON; n = 11). TRE required participants to consume all of their dietary intake within an 8-h eating window (so-called 16:8 TRE), but dietary patterns, food choices, and energy intake were ad libitum during this window. Participants continued their habitual training during the intervention period. Participants completed an incremental exercise test before (PRE) and after (POST) the 8-wk intervention for the assessment of blood lactate concentrations, running economy, and maximal oxygen uptake. Fasted blood samples were analyzed for glucose, insulin, and triglyceride concentrations. Dietary intake was assessed at PRE, MID (week 4), and POST using a 4-d semiweighed food diary.

RESULTS

Seventeen participants (TRE, n = 10; CON, n = 7) completed the intervention. Training load did not differ between groups for the duration of the intervention period. TRE resulted in a reduction in body mass (mean difference of -1.92 kg, 95% confidence interval = -3.52 to -0.32, P = 0.022). Self-reported daily energy intake was lower in TRE at MID and POST (group-time interaction, P = 0.049). No effect of TRE was observed for oxygen consumption, respiratory exchange ratio, running economy, blood lactate concentrations, or heart rate during exercise, nor were there any effects on glucose, insulin, or triglyceride concentrations observed.

CONCLUSION

Eight weeks of 16:8 TRE in middle- and long-distance runners resulted in a decrease in body mass commensurate with a reduction in daily energy intake, but it did not alter indices of endurance running performance or metabolic health.

A Fish-Derived Protein Hydrolysate Induces Postprandial Aminoacidaemia and Skeletal Muscle Anabolism in an In Vitro Cell Model Using Ex Vivo Human Serum

Fish-derived proteins, particularly fish protein hydrolysates (FPH), offer potential as high-quality sources of dietary protein, whilst enhancing economic and environmental sustainability. This study investigated the impact of a blue whiting-derived protein hydrolysate (BWPH) on aminoacidaemia in vivo and skeletal muscle anabolism in vitro compared with whey protein isolate (WPI) and an isonitrogenous, non-essential amino acid (NEAA) control (0.33 g·kg⁻¹·body mass⁻¹) in an ex vivo, in vitro experimental design. Blood was obtained from seven healthy older adults (two males, five females; age: 72 ± 5 years, body mass index: 24.9 ± 1.6 kg·m²) in three separate trials in a randomised, counterbalanced, double-blind design. C2C12 myotubes were treated with ex vivo human serum-conditioned media (20%) for 4 h. Anabolic signalling (phosphorylation of mTOR, p70S6K, and 4E-BP1) and puromycin incorporation were determined by immunoblotting. Although BWPH and WPI both induced postprandial essential aminoacidaemia in older adults above the NEAA control, peak and area under the curve (AUC) leucine and essential amino acids were more pronounced following WPI ingestion. Insulin was elevated above baseline in WPI and BWPH only, a finding reinforced by higher peak and AUC values compared with NEAA. Muscle protein synthesis, as measured by puromycin incorporation, was greater after incubation with WPI-fed serum compared with fasted serum (P = 0.042), and delta change was greater in WPI (P = 0.028) and BWPH (P = 0.030) compared with NEAA. Myotube hypertrophy was greater in WPI and BWPH compared with NEAA (both P = 0.045), but was similar between bioactive conditions (P = 0.853). Taken together, these preliminary findings demonstrate the anabolic potential of BWPH in vivo and ex vivo, thus providing justification for larger studies in older adults using gold-standard measures of acute and chronic MPS in vivo.

Profile of reticulated platelets in the early, subacute and late phases after transient ischemic attack or ischemic stroke

Information regarding the profile of reticulated platelets (RP) in ischemic cerebrovascular disease (CVD) patients is limited. Data from two prospective, observational, case-control studies were combined to compare the %RP using whole blood flow cytometry in patients ≤ 4 weeks of TIA/stroke onset (baseline, N = 210), and 14 ±7 days (14d, N = 182) and ≥ 90 days (90d, N = 145) after starting or changing antiplatelet therapy with healthy controls (N = 34). There were no differences in median %RP between the overall CVD patient population at baseline or 14d vs. controls (P ≥ 0.2). However, the median %RP was significantly higher in CVD patients overall at 90d (P = .036), and in the subgroup of patients with "lacunar" TIA/ischemic stroke at baseline (P = .04) and at 90d (P = .01), but not at 14d (P = .06) vs. controls. There were no significant differences in the median %RP between other TIA/stroke subgroups and controls (P ≥ 0.05). Elevated circulating reticulated platelets, as a marker of increased platelet production/turnover, may occur following an ischemic event in a well-phenotyped TIA/ischemic stroke population overall, but may precede symptom onset at least in the subgroup with small vessel occlusion. These data improve our understanding of the profile of reticulated platelets in CVD patients.

No Benefit of Ingestion of a Ketone Monoester Supplement on 10-km Running Performance

PURPOSE

Preexercise ingestion of exogenous ketones alters the metabolic response to exercise, but effects on exercise performance have been equivocal.

METHODS

On two occasions in a double-blind, randomized crossover design, eight endurance-trained runners performed 1 h of submaximal exercise at approximately 65% V˙O2max immediately followed by a 10-km self-paced time trial (TT) on a motorized treadmill. An 8% carbohydrate-electrolyte solution was consumed before and during exercise, either alone (CHO + PLA), or with 573 mg·kg of a ketone monoester supplement (CHO + KME). Expired air, HR, and RPE were monitored during submaximal exercise. Serial venous blood samples were assayed for plasma glucose, lactate, and β-hydroxybutyrate concentrations.

RESULTS

CHO + KME produced plasma β-hydroxybutyrate concentrations of approximately 1.0 to 1.3 mM during exercise (P < 0.001), but plasma glucose and lactate concentrations were similar during exercise in both trials. V˙O2, running economy, respiratory exchange ratio, HR, and RPE were also similar between trials. Performance in the 10-km TT was not different (P = 0.483) between CHO + KME (mean, 2402 s; 95% confidence interval, 2204-2600 s) and CHO + PLA (mean, 2422 s; 95% confidence interval, 2217-2628 s). Cognitive performance, measured by reaction time and a multitasking test, did not differ between trials.

CONCLUSIONS

Compared with carbohydrate alone, coingestion of KME by endurance-trained athletes elevated plasma β-hydroxybutyrate concentrations, but did not improve 10-km running TT or cognitive performance.

The interaction between maternal smoking, illicit drug use and alcohol consumption associated with neonatal outcomes

BACKGROUND

The adverse effects of smoking on neonatal outcomes, such as small-for-gestational-age (SGA), has been extensively studied however, the consequences of smoking combined with alcohol and/or drug use is less clear.

METHODS

This retrospective observational study analyzed clinical and sociodemographic details of 40156 women who delivered a singleton baby between the years 2011 and 2015.

RESULTS

Compared with women who had never smoked, smokers who did not engage in alcohol or drug use had an odds ratio (OR) of delivering a baby who was SGA of 3.2 (95% CI: 3.1-3.5). Smokers who used illicit drugs in isolation or in combination with alcohol during pregnancy had higher ORs for SGA (1.4, 95% CI: 1.1-1.7, P = 0.006 and 1.8, 95% CI: 1.2-2.7, P = 0.007) compared to women who smoked but did not engage in alcohol or drug use in pregnancy. These women also delivered babies with lower mean birthweights (125 g, P < 0.001 and 181.4 g, P = 0.003) and head circumferences (0.4 cm, P < 0.001 and 0.3 cm, P = 0.048). Women who smoked and used alcohol, but not illicit drugs were not associated adverse outcomes above that of smoking in isolation.

CONCLUSION

Illicit drug use combined with maternal smoking during pregnancy increases the risk of adverse neonatal outcomes above that of smoking in isolation.

A longitudinal, observational study of women who persisted in smoking in successive pregnancies

BACKGROUND

This longitudinal study examined the profile and pregnancy-related behaviours of women who reported smoking in two successive pregnancies when they presented for prenatal care in a large maternity hospital.

METHODS

Using the hospital electronic medical records, women who delivered two successive singleton pregnancies during the years 2011-15 were analyzed. Standardized data were computerized by a midwife at the first prenatal visit, following delivery and before discharge.

RESULTS

Over the 5 years, 6647 women delivered twice. Overall 5754 (86.6%) were persistent non-smokers in both pregnancies, 609 (9.2%) were persistent smokers in both pregnancies and between pregnancies 202 (3.0%) quit and 82 (1.2%) started smoking. Compared with persistent non-smokers, persistent smokers had higher rates of reported illicit drug use, alcohol consumption and psychological problems and lower rates of planned pregnancy, folic acid supplementation and breastfeeding in both pregnancies (all P < 0.001). In persistent smokers, folic acid supplementation practices deteriorated and illicit drug use increased in the subsequent pregnancy.

CONCLUSIONS

We found that approximately one in 10 women smoked in two consecutive pregnancies. Furthermore, compared with non-smokers, persistent smokers were more likely to report other health behaviours associated with adverse pregnancy outcomes and may require additional multidisciplinary support.

Designing a mHealth clinical decision support system for Parkinson's disease: a theoretically grounded user needs approach

Background

Despite the established evidence and theoretical advances explaining human judgments under uncertainty, developments of mobile health (mHealth) Clinical Decision Support Systems (CDSS) have not explicitly applied the psychology of decision making to the study of user needs. We report on a user needs approach to develop a prototype of a mHealth CDSS for Parkinson’s disease (PD), which is theoretically grounded in the psychological literature about expert decision making and judgement under uncertainty.

Methods

A suite of user needs studies was conducted in 4 European countries (Greece, Italy, Slovenia, the UK) prior to the development of PD_Manager, a mHealth-based CDSS designed for Parkinson’s disease, using wireless technology. Study 1 undertook Hierarchical Task Analysis (HTA) including elicitation of user needs, cognitive demands and perceived risks/benefits (ethical considerations) associated with the proposed CDSS, through structured interviews of prescribing clinicians (N = 47). Study 2 carried out computational modelling of prescribing clinicians’ (N = 12) decision strategies based on social judgment theory. Study 3 was a vignette study of prescribing clinicians’ (N = 18) willingness to change treatment based on either self-reported symptoms data, devices-generated symptoms data or combinations of both.

Results

Study 1 indicated that system development should move away from the traditional silos of ‘motor’ and ‘non-motor’ symptom evaluations and suggest that presenting data on symptoms according to goal-based domains would be the most beneficial approach, the most important being patients’ overall Quality of Life (QoL). The computational modelling in Study 2 extrapolated different factor combinations when making judgements about different questions. Study 3 indicated that the clinicians were equally likely to change the care plan based on information about the change in the patient’s condition from the patient’s self-report and the wearable devices.

Conclusions

Based on our approach, we could formulate the following principles of mHealth design: 1) enabling shared decision making between the clinician, patient and the carer; 2) flexibility that accounts for diagnostic and treatment variation among clinicians; 3) monitoring of information integration from multiple sources. Our approach highlighted the central importance of the patient-clinician relationship in clinical decision making and the relevance of theoretical as opposed to algorithm (technology)-based modelling of human judgment.

Longitudinal Study of Maternal BMI in Successive Pregnancies

OBJECTIVE

This longitudinal observational study examined BMI changes between successive pregnancies.

METHODS

The computerized medical records of women who attended a large maternity hospital between 2009 and 2017 for their first and second singleton deliveries were analyzed. Women who had their weight first measured after 15 weeks of gestation in either pregnancy were excluded.

RESULTS

Of the 9,724 women, the incidence of obesity increased from 11.6% in the first pregnancy to 16.0% in the second. The mean interpregnancy interval was 32.5 ± 15.7 months, and median BMI change was +0.6 kg/m² (interquartile range 2.2; P < 0.001). Overall, 10.3% (1,006/9,724) developed overweight and 5.9% (571/9,724) developed obesity by the second pregnancy. Of the nulliparas in the overweight category, 20.6% (526/2,558) entered the obesity category. The development of obesity by the second pregnancy was independently associated with a longer interpregnancy interval, formula feeding at hospital discharge, taking antidepressants or anxiolytics, and postnatal depression. Professional/managerial employment was associated with a lower odds ratio of developing obesity.

CONCLUSIONS

Maternal obesity increased between the first and second pregnancy, with one-fifth of nulliparas in the overweight category developing obesity. Pregnancy-related factors were identified as predictors of developing obesity. Further research is needed to assess whether interventions targeting these related factors could optimize maternal weight management between pregnancies.

Comparison of hot water immersion at 37.8°C with or without salt for rapid weight loss in mixed martial arts athletes

Hot water immersion, known as a hot bath, is used by MMA athletes to produce rapid weight loss (RWL) by means of passive fluid loss. This study investigated the magnitude of body mass losses using a standardized hot bath protocol with or without the addition of salt. In a crossover design, eleven male MMA athletes (28.5 ± 4.6 y; 1.83 ± 0.07 m; 82.5 ± 9.1 kg) performed a 20-min immersion at 37.8°C followed by a 40-min wrap in a warm room. This bath and wrap was performed twice per visit. During one visit, only fresh water was used (FWB), and in the other visit, magnesium sulphate (1.6% wt/vol) was added to the bath (SWB). Prior to each visit, 24 h of carbohydrate, fibre, and fluid restriction was undertaken as part of the RWL protocol. Body mass losses induced by the hot bath protocols were 1.63 ± 0.75 kg and 1.60 ± 0.80 kg for FWB and SWB, respectively, and equivalent to ~2.1% body mass. Under the conditions employed, the magnitude of body mass loss in SWB was similar to FWB. However, further research should explore bathing in a temperature that is consistent with that habitually used by fighters, and/or higher concentrations of salt.

Habitual protein intake, protein distribution patterns and dietary sources in Irish adults with stratification by sex and age

BACKGROUND

Given the importance of habitual dietary protein intake, distribution patterns and dietary sources in the aetiology of age-related declines of muscle mass and function, the present study examined these factors as a function of sex and age in Irish adults aged 18-90 years comprising The National Adult Nutrition Survey (NANS).

METHODS

In total, 1051 (males, n = 523; females, n = 528) undertook a 4-day semi-weighed food diary. Total, body mass relative intake and percentage contribution to total energy intake of dietary protein were determined in addition to protein distribution scores (PDS), as well as the contribution of food groups, animal- and plant-based foods to total protein intake.

RESULTS

Total and relative protein intake [mean (SD)] were highest in those aged 18-35 years [96 (3) g day^-1 , 1.32 (0.40) g kg^-1  day^-1 ], with lower protein intakes with increasing age (i.e. in adults aged ≥65 years [82 (22) g, 1.15 (0.34) g kg^-1  day^-1 , P < 0.001 for both]. Differences in protein intake between age groups were more pronounced in males compared to females. Protein distribution followed a skewed pattern for all age groups [breakfast, 15 (10) g; lunch, 30 (15) g; dinner, 44 (17) g]. Animal-based foods were the dominant protein source within the diet [63% (11%) versus 37% (11%) plant protein, P < 0.001].

CONCLUSIONS

Protein intake and the number of meals reaching the purported threshold for maximising post-prandial anabolism were highest in young adults, and lower with increasing age. For main meals, breakfast provided the lowest quantity of protein across all age categories and may represent an opportunity for improving protein distribution, whereas, in older adults, increasing the number of meals reaching the anabolic threshold regardless of distribution pattern may be more appropriate.

Effects of a Six-Month Multi-Ingredient Nutrition Supplement Intervention of Omega-3 Polyunsaturated Fatty Acids, vitamin D, Resveratrol, and Whey Protein on Cognitive Function in Older Adults: A Randomised, Double-Blind, Controlled Trial

OBJECTIVES

To investigate the impact of a six-month multi-ingredient nutrition supplement intervention (Smartfish®), containing omega-3 polyunsaturated fatty acids (PUFAs), vitamin D, resveratrol, and whey protein, on cognitive function in Irish older adults.

DESIGN

Double-blind, randomised controlled trial (ClinicalTrials.gov: NCT02001831). A quantitative, mixed-model design was employed in which the dependent variable (cognitive function) was analysed with a between-subjects factor of group (placebo, intervention) and within-subjects factor of testing occasion (baseline, three-months, six-months).

SETTING

Community-based intervention including assessments conducted at University College Dublin, Ireland.

PARTICIPANTS

Thirty-seven community-dwelling older adults (68-83 years; mean (x̄)= 75.14 years; standard deviation (SD)= 3.64; 18 males) with normal cognitive function (>24 on the Mini Mental State Examination) were assigned to the placebo (n= 17) or intervention (n= 20) via a block randomisation procedure.

INTERVENTION

Daily consumption for six-months of a 200mL liquid juice intervention comprising 3000mg omega-3 PUFAs [1500mg docosahexaenoic acid (DHA) and 1500mg eicosapentaenoic acid (EPA)], 10μg vitamin D3, 150mg resveratrol and 8g whey protein isolate. The placebo contained 200mL juice only.

MEASUREMENTS

A standardised cognitive assessment battery was conducted at baseline and follow-ups. Individual test scores were z-transformed to generate composite scores grouped into cognitive domains: executive function, memory, attention and sensorimotor speed. Motor imagery accuracy and subjective awareness of cognitive failures variables were computed from raw scores.

RESULTS

A hierarchical statistical approach was used to analyse the data; first, by examining overall cognitive function, then by domain, and then by individual test scores. Using mixed between-within subjects, analyses of variance (ANOVAs), no significant differences in overall cognitive function or composite cognitive domains were observed between groups over time. The only significant interaction was for Stroop Color-Word Time (p< 0.05). The intervention group demonstrated reduced task completion time at three- and six-month follow-ups, indicating enhanced performance.

CONCLUSION

The present nutrition intervention encompassed a multi-ingredient approach targeted towards improving cognitive function, but overall had only a limited beneficial impact in the older adult sample investigated. Future investigations should seek to establish any potential clinical applications of such targeted interventions with longer durations of supplementation, or in populations with defined cognitive deficits.

Exercise Maintenance in Older Adults 1 Year After Completion of a Supervised Training Intervention

BACKGROUND/OBJECTIVE

Barriers and facilitators of exercise maintenance and residual effects of exercise training intervention on physical and cognitive function after the cessation of training are inadequately described in older adults.

DESIGN AND SETTING

One year after the cessation of a supervised exercise training intervention, a mixed methods approach employed a quantitative phase that assessed body composition and physical and cognitive function and a qualitative phase that explored determinants of exercise maintenance after participation in the intervention.

PARTICIPANTS

Community-dwelling older Irish adults (aged >65 years) who had completed 12 weeks of supervised exercise training 1 year previously.

MEASUREMENTS

Fifty-three participants (male/female ratio = 30:23; age = 70.8 ± 3.9 years) completed the follow-up testing comprising body composition and physical and cognitive function. Semistructured interviews were conducted with 12 participants (male/female ratio = 6:6) using the Theoretical Domains Framework to inform the interview guide.

RESULTS

At 1 year follow-up, body fat increased (mean = 4.3%; 95% confidence limit = 2.2% to 6.3%), while lean body mass (mean = -0.6%; 95% confidence limit = -1.2% to -0.1%), strength (leg press, mean = -5.6%; 95% confidence limit = -8.3% to -2.8%; chest press, mean = -11.0%; 95% confidence limit = -14.8% to -7.8%), and cognitive function (mean = -3.7%; 95% confidence limit = -5.7% to -1.8%) declined (all P < .05). Interviews revealed key facilitators (social aspects and beliefs about benefits of exercise) and barriers (affordability and general aversion to gyms) to exercise maintenance in this population.

CONCLUSION

Key barriers and facilitators to exercise maintenance were identified, which will inform the development of future behavior change interventions to support exercise participation and maintenance in older adults to mitigate adverse changes in body composition and physical and cognitive function with advancing age. J Am Geriatr Soc 68:163-169, 2019.

Relationship between 'on-treatment platelet reactivity', shear stress, and micro-embolic signals in asymptomatic and symptomatic carotid stenosis

BACKGROUND

Assessment of 'high on-treatment platelet reactivity (HTPR)' could enhance understanding of the pathophysiology of first or recurrent vascular events in carotid stenosis patients on antiplatelet therapy.

METHODS

This prospective, multi-centre study assessed antiplatelet-HTPR status and its relationship with micro-emboli signals (MES) in asymptomatic vs. symptomatic ≥ 50-99% carotid stenosis. Platelet function/reactivity was assessed under 'moderately high shear stress' with the PFA-100^® and 'low shear stress' with VerifyNow^® and Multiplate^® analysers. Bilateral 1-h transcranial Doppler ultrasound of the middle cerebral arteries classified patients as MES + ve or MES - ve.

RESULTS

Data from 34 asymptomatic patients were compared with 43 symptomatic patients in the 'early phase' (≤ 4 weeks) and 37 patients in the 'late phase' (≥ 3 months) after TIA/ischaemic stroke. Median daily aspirin doses were higher in early symptomatic (225 mg; P < 0.001), but not late symptomatic (75 mg; P = 0.62) vs. asymptomatic patients (75 mg). There was a lower prevalence of aspirin-HTPR in early (28.6%; P = 0.028), but not late symptomatic (38.9%; P = 0.22) compared with asymptomatic patients (56.7%) on the PFA-100^®, but not on the VerifyNow^® or Multiplate^® (P ≤ 0.53). Early symptomatic patients had a higher prevalence of aspirin-HTPR on the PFA-100^® (28.6%) vs. VerifyNow^® (9.5%; P = 0.049), but not Multiplate^® assays (11.9%, P = 0.10). There was no difference in aspirin-HTPR prevalence between any symptomatic vs. asymptomatic MES + ve or MES - ve subgroup.

DISCUSSION

Recently symptomatic moderate-severe carotid stenosis patients had a lower prevalence of aspirin-HTPR than their asymptomatic counterparts on the PFA-100^®, likely related to higher aspirin doses. The prevalence of antiplatelet-HTPR was positively influenced by higher shear stress levels, but not MES status.

Prevalence, Magnitude and Methods of Rapid Weight Loss Reported by Male Mixed Martial Arts Athletes in Ireland

Rapid weight loss (RWL) is frequently practiced in weight category sports, including Mixed Martial Arts (MMA). The aim of the present study was to describe self-reported methods of RWL in a sample of competitive MMA athletes comprising of both amateur and professional fighters. The previously-validated Rapid Weight Loss Questionnaire, with the addition of questions on water loading and hot salt baths, was completed anonymously online by athletes (n = 30; all male, n = 15/15 professional/amateur) from MMA clubs around Dublin, Ireland. All but one (97%) of the athletes surveyed lost weight in order to compete, with the average weight loss being 7.9% ± 3.1% of habitual body mass. The RWL score (mean ± SD) for this sample was 37.9 ± 9.6, and a tendency for higher [6.0 (95%CI; −1.1, 13.1) (p = 0.093; d = 0.64)] RWL scores for professional (40.8 ± 8.9) compared to amateur (34.8 ± 9.6) athletes was observed. Frequencies of “always” or “sometimes” were reported as 90% for water loading, 76% for hot salt baths and 55% for 24 h of fasting. Fellow fighters (41%) and coaches/mentors (38%) were “very influential” on RWL practices of these athletes, with doctors (67%), dietitians (41%), and physical trainers (37%) said to be “not influential”. RWL is highly prevalent in MMA across both amateur and professional athletes, and RWL scores are higher than other combat sports. Water loading and hot salt baths are amongst the most commonly used methods of RWL despite little research on these methods for body mass reduction or effects on performance in weight category sports.

Maternal obesity trends in a large Irish university hospital

OBJECTIVE(S)

This study aimed to examine recent trends in maternal obesity.

STUDY DESIGN

This retrospective observational study used routinely computerised clinical and sociodemographic data of women who presented for antenatal care in a large maternity hospital in Ireland during the eight years 2010-17. Women with complete body mass index (BMI) data who delivered a baby weighing ≥500 g were included in the study. BMI was based on the measurement of weight and height and was categorised into the World Health Organizations (WHO) classifications.

RESULTS

The number of women delivered was 67,949 and 99.1% had complete data. The overall obesity rate increased from 16.0% (95% CI 15.3-16.8%) in 2010 to 18.9% (95% CI 18.0-19.7%) in 2017 (+18.1%, p < 0.001). This increase occurred in the mild, moderate and severe obesity subcategories (all p < 0.01). Overall, obesity was associated with multiparity, maternal age, maternal birth in Ireland or the United Kingdom (UK), depression, unemployment and unplanned pregnancy. The increase in obesity was more pronounced in nulliparas than in multiparas, particularly nulliparas <30 years. The increased obesity levels were accompanied by major sociodemographic changes in the hospital population from 2010 to 2017 with an increase in the average maternal age from 30.5 years to 32.2 years (p < 0.001) and a decrease in the proportion of nulliparas aged <30 years (from 40.6% to 28.8%, p < 0.001).

CONCLUSION(S)

It is likely that the escalating maternal obesity levels will lead to further increases in obstetric complications and interventions. The escalation was accompanied by major sociodemographic changes which have implications for healthcare planning and public health interventions.

Intermittent Running and Cognitive Performance after Ketone Ester Ingestion

PURPOSE

Ingestion of exogenous ketones alters the metabolic response to exercise and may improve exercise performance, but it has not been explored in variable-intensity team sport activity, or for effects on cognitive function.

METHODS

On two occasions in a double-blind, randomized crossover design, 11 male team sport athletes performed the Loughborough Intermittent Shuttle Test (part A, 5 × 15-min intermittent running; part B, shuttle run to exhaustion), with a cognitive test battery before and after. A 6.4% carbohydrate-electrolyte solution was consumed before and during exercise either alone (PLA) or with 750 mg·kg of a ketone ester (KE) supplement. Heart rate, RPE, and 15-m sprint times were recorded throughout, and serial venous blood samples were assayed for plasma glucose, lactate, and β-hydroxybutyrate.

RESULTS

KE resulted in plasma β-hydroxybutyrate concentrations of ~1.5 to 2.6 mM during exercise (P < 0.001). Plasma glucose and lactate concentrations were lower during KE compared with PLA (moderate-to-large effect sizes). Heart rate, RPE, and 15-m sprint times did not differ between trials. Run time to exhaustion was not different (P = 0.126, d = 0.45) between PLA (mean = 268 s, 95% confidence interval [CI] = 199-336 s) and KE (mean = 229 s, 95% CI = 178-280 s). Incorrect responses in a multitasking test increased from pre- to postexercise in PLA (mean = 1.8, 95% CI = -0.6 to 4.1) but not in KE (mean = 0.0, 95% CI = -1.8 to 1.8) (P = 0.017, d = 0.70).

CONCLUSION

Compared with carbohydrate alone, coingestion of a KE by team sport athletes attenuated the rise in plasma lactate concentrations but did not improve shuttle run time to exhaustion or 15-m sprint times during intermittent running. An attenuation of the decline in executive function after exhausting exercise suggests a cognitive benefit after KE ingestion.