Skeletal muscle fiber type and TMS-induced muscle relaxation in unfatigued and fatigued knee-extensor muscles

The force drop after transcranial magnetic stimulation (TMS) delivered to the motor cortex during voluntary muscle contractions could inform about muscle relaxation properties. Because of the physiological relation between skeletal muscle fiber-type distribution and size and muscle relaxation, TMS could be a noninvasive index of muscle relaxation in humans. By combining a noninvasive technique to record muscle relaxation in vivo (TMS) with the gold standard technique for muscle tissue sampling (muscle biopsy), we investigated the relation between TMS-induced muscle relaxation in unfatigued and fatigued states, and muscle fiber-type distribution and size. Sixteen participants (7F/9M) volunteered to participate. Maximal knee-extensor voluntary isometric contractions were performed with TMS before and after a 2-min sustained maximal voluntary isometric contraction. Vastus lateralis muscle tissue was obtained separately from the participants' dominant limb. Fiber type I distribution and relative cross-sectional area of fiber type I correlated with TMS-induced muscle relaxation at baseline (r = 0.67, adjusted P = 0.01; r = 0.74, adjusted P = 0.004, respectively) and normalized TMS-induced muscle relaxation as a percentage of baseline (r = 0.50, adjusted P = 0.049; r = 0.56, adjusted P = 0.031, respectively). The variance in the normalized peak relaxation rate at baseline (59.8%, P < 0.001) and in the fatigue resistance (23.0%, P = 0.035) were explained by the relative cross-sectional area of fiber type I to total fiber area. Fiber type I proportional area influences TMS-induced muscle relaxation, suggesting TMS as an alternative method to noninvasively inform about skeletal muscle relaxation properties.NEW & NOTEWORTHY Transcranial magnetic stimulation (TMS)-induced muscle relaxation reflects intrinsic muscle contractile properties by interrupting the drive from the central nervous system during voluntary muscle contractions. We showed that fiber type I proportional area influences the TMS-induced muscle relaxation, suggesting that TMS could be used for the noninvasive estimation of muscle relaxation in unfatigued and fatigued human muscles when the feasibility of more direct method to study relaxation properties (i.e., muscle biopsy) is restricted.

Non-specific and ski-specific performance development in peri-pubertal cross-country skiers

PURPOSE

To evaluate non-specific and ski-specific performance development in male (M) and female (F) peri-pubertal cross-country skiers and to evaluate their relationship with cross-country skiing (XCS) performance and biological maturation within each age category and sex.

METHODS

Twenty-one and 19 athletes under 14 and 16 years old, respectively (U14 and U16), were tested for biological maturation; non-specific speed, agility, strength, endurance, and balance; ski-specific speed, agility, and endurance. XCS index was considered as average percentage time-gap from the winner in four official races. Sex and age-category effects were verified and a model predicting XCS index was extrapolated for each group.

RESULTS

Performance capacities raised across age categories (p < 0.05) except for non-specific speed, agility, balance, and relative arm strength (p > 0.05). F showed advanced biological maturation and greater balance than M (p < 0.05), while M showed higher performance capacities (p < 0.05). XCS index was not related to biological maturation within each group (p > 0.05); its variance was explained by non-specific speed and ski-specific upper-body endurance in M-U14 (p = 0.014), lower-limb strength and ski-specific agility in M-U16 and F-U14 (both p = 0.001), ski-specific upper-body endurance in F-U16 (p = 0.002).

CONCLUSION

Ski-specific performance capacities still develop during peri-puberty, with peri-pubertal M overperforming with respect to F of comparable performance level. XCS index was not influenced by biological maturation withing each age category, but it was rather explained by specific parameters that commonly undergo the "adolescent spurts", accordingly to the average biological maturation level of M and F athletes of each age category.

What is the role of physical exercise in the era of cancer prehabilitation? A systematic review

PURPOSE

Exercise before surgery, as part of prehabilitation, aiming to enhance patients' functional and physiological capacity, has become widespread, necessitating an in-depth understanding.

METHODS

A systematic search was conducted on Pubmed, Cochrane, and Scopus to examine the effect of exercise as prehabilitation, alone or in combination with other interventions, in patients with cancer. Interventional studies applying a single-arm, randomized controlled, or nonrandomized design were included.

RESULTS

A total of 97 studies were included, and categorized according to cancer types, i.e., gynecological, breast, urological, gastrointestinal and lung cancer. For each cancer site, the effect of exercise, on physical fitness parameters and postoperative outcomes, including length of hospital stay and postoperative complications, was reported.

CONCLUSION

Exercise as prehabilitation may have an important role in improving physical fitness, postoperative outcomes, and accelerating recovery, especially in certain types of malignancies.

Sex differences in neuromuscular and biological determinants of isometric maximal force

AIM

Force expression is characterized by an interplay of biological and molecular determinants that are expected to differentiate males and females in terms of maximal performance. These include muscle characteristics (muscle size, fiber type, contractility), neuromuscular regulation (central and peripheral factors of force expression), and individual genetic factors (miRNAs and gene/protein expression). This research aims to comprehensively assess these physiological variables and their role as determinants of maximal force difference between sexes.

METHODS

Experimental evaluations include neuromuscular components of isometric contraction, intrinsic muscle characteristics (proteins and fiber type), and some biomarkers associated with muscle function (circulating miRNAs and gut microbiome) in 12 young and healthy males and 12 females.

RESULTS

Male strength superiority appears to stem primarily from muscle size while muscle fiber-type distribution plays a crucial role in contractile properties. Moderate-to-strong pooled correlations between these muscle parameters were established with specific circulating miRNAs, as well as muscle and plasma proteins.

CONCLUSION

Muscle size is crucial in explaining the differences in maximal voluntary isometric force generation between males and females with similar fiber type distribution. Potential physiological mechanisms are seen from associations between maximal force, skeletal muscle contractile properties, and biological markers.

Independent, additive and interactive effects of acute normobaric hypoxia and cold on submaximal and maximal endurance exercise

PURPOSE

To evaluate the independent and combined effects of hypoxia (FiO2 = 13.5%) and cold (- 20 °C) on physiological and perceptual responses to endurance exercise.

METHODS

14 trained male subjects ( V . O2max: 64 ± 5 mL/kg/min) randomly performed a discontinuous maximal incremental test to exhaustion on a motorized treadmill under four environmental conditions: Normothermic-Normoxia (N), Normothermic-Hypoxia (H), Cold-Normoxia (C) and Cold-Hypoxia (CH). Performance and physiological and perceptual responses throughout exercise were evaluated.

RESULTS

Maximal WorkLoad (WL) and WL at lactate threshold (LT) were reduced in C (- 2.3% and - 3.5%) and H (- 18.0% and - 21.7%) compared to N, with no interactive (p = 0.25 and 0.81) but additive effect in CH (- 21.5% and - 24.6%). Similarly, HRmax and Vemax were reduced in C (- 3.2% and - 14.6%) and H (- 5.0% and - 7%), showing additive effects in CH (- 7.7% and - 16.6%). At LT, additive effect of C (- 2.8%) and H (- 3.8%) on HR reduction in CH (- 5.7%) was maintained, whereas an interactive effect (p = 0.007) of the two stressors combined was noted on Ve (C: - 3.1%, H: + 5.5%, CH: - 10.9%). [La] curve shifted on the left in CH, displaying an interaction effect between the 2 stressors on this parameter. Finally, RPE at LT was exclusively reduced by hypoxia (p < 0.001), whereas TSmax is synergistically reduced by cold and hypoxia (interaction p = 0.047).

CONCLUSION

If compared to single stress exposure, exercise performance and physiological and perceptual variables undergo additive or synergistic effects when cold and hypoxia are combined. These results provide new insight into human physiological responses to extreme environments.

Fostering quality of life in young adults living with multiple sclerosis: a pilot study of a co-created integrated intervention

Introduction

Multiple sclerosis (MS) is generally diagnosed at an early age, making the acceptance of this chronic disease challenging. Research dedicated to young adults with MS (YawMS) is still limited. A biopsychosocial co-created intervention for YawMS integrating social, physical and psychological activities was developed (ESPRIMO intervention) in order to improve the quality of life (QoL) and well-being. This pre-post intervention assessment study examines the feasibility of the ESPRIMO intervention and its signal of efficacy.

Methods

Inclusion criteria were: age 18-45 years, MS diagnosis, Expanded Disability Status Scale score < 3.5. After giving informed consent, YawMS completed a battery of questionnaires, which was repeated after the intervention. The battery included a bespoke feasibility scale, the COOP/WONCA charts, and the Short Form-12 Health Survey (SF-12).

Results

Fifty-three YAwMS were enrolled and 43 (81.1%) completed the intervention. The majority of the sample positively rated the pleasantness, usefulness and feasibility of the intervention. A significant change in the COOP/WONCA "general QoL" chart (t = 3.65; p < 0.01) and SF-12 mental wellbeing component (t = -3.17; p < 0.01) was found.

Discussion

ESPRIMO is an innovative intervention that is feasible; preliminary results show an improvement in QoL and mental wellbeing. Further studies are needed to test its efficacy and evaluate future implementation in health services.Clinical trial registration: ClinicalTrials.gov, NCT04431323.

External training load and performance recovery after small-sided games in soccer: Insights for return-to-play management

The return-to-play process' characteristics can vary by injury and sport type but are typically composed of phases of different durations, training targets, and intensities that gradually increase the physiological and mechanical load. In team sports, contact drills are a necessary part of the last phases of this process, and they should be planned using the optimal mechanical load. The present study investigated the external load and kinetic recovery in U19 soccer players performing 6vs6 and 3vs3 small-sided games. A global positioning system (GPS) measured external load metrics. The rate of perceived exertion (RPE) was registered at the end. Total quality of recovery (TQR) was collected at the beginning of the training session and after 24 h. Moreover, before and after the small-sided games (SSGs) and at 24 h, delayed-onset muscle soreness (DOMS) of the legs, sprinting time, and vertical jump height (CMJ) were collected. 6vs6 presented higher values in total distance low-, moderate-, high, and very-high-speed distance, and maximum speed (p < 0.05). However, 3vs3 showed higher number of sprints, acceleration, and deceleration at different intensities. Furthermore, no difference was shown in RPE. The effect of fatigue on sprint seems greater for 6vs6, showing an impairment persistent at 24 h (p < 0.05). Moreover, CMJ height was impaired after 6vs6 and at 24 h (p < 0.05) but did not change after 3vs3 (p > 0.05). DOMS values after SSGs and at 24 h were higher than baseline for both conditions (p < 0.05), while TQR decreased at 24 h in both conditions (p < 0.05). Based on our results, it seems that 6vs6, leading to a greater high-speed running distance, might cause a training load that needs more time to recover. This point may be crucial in a return-to-play process, especially when hamstring muscles are involved.

Feasibility of a novel exercise program for patients with breast cancer offering different modalities and based on patient preference

PURPOSE

Exercise improves quality of life and reduces the side effects of cancer therapies. Nevertheless, attendance to exercise programs remains a challenge for patients. This study explored the feasibility of an exercise program in which women with breast cancer may be allowed to choose among three exercise delivery modalities.

METHODS

Forty-seven patients with breast cancer (stage I-IV) participated in a 12-week combined aerobic and resistance training program. The exercise modality was chosen by patients according to their preferences and needs among three options: the personal training program, the home-based program, or the group-based program. Exercise prescription was similar between the three modalities. Whereas the primary endpoint was feasibility, assessed through recruitment rate, attendance, adherence, dropout rate, tolerability, and safety, secondary endpoints included health-related skills and quality of life.

RESULTS

Out of 47 recruited patients, 24 chose the home-based program, 19 the personal training program, and four the group-based program. Six dropouts (13%) were registered, and no severe adverse events were recorded. The median program attendance was 98% for personal training programs, 96% for home-based programs, and 100% for group-based programs, whereas compliance resulted in more than 90% in each modality. At postintervention, a significant increase in cardiorespiratory fitness, lower body flexibility, and body weight was observed. Different quality-of-life domains were improved following the intervention, including physical and social functioning, fatigue, and appetite loss. No significant changes in other parameters were detected.

CONCLUSIONS

An exercise prescription based on a patient-preferred delivery modality showed high feasibility in women with breast cancer.

Umbrella Systematic Review and Meta-Analysis: Physical Activity as an Effective Therapeutic Strategy for Improving Psychosocial Outcomes in Children and Adolescents

OBJECTIVE

Physical activity (PA) interventions are part of many interdisciplinary programs for the management of children and adolescents with or without physical or psychological conditions or disabilities. Aiming to summarize the available evidence, we conducted an umbrella review of meta-analyses of PA interventions that included psychosocial outcomes in populations of children and adolescents.

METHOD

Literature searches were conducted in PubMed, Cochrane Central, Web of Science, Medline, SPORTDiscus, and PsychInfo from January 1, 2010, to May 6, 2022. Meta-analyses of randomized and quasi-randomized studies investigating the efficacy of PA interventions for psychosocial outcomes in children and adolescents were included. Summary effects were recalculated using common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small study effects, and whether the results of the observed positive studies were greater than expected due to chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Quality was assessed using the AMSTAR 2 tool. This study is registered with the Open Science Framework, https://osf.io/ap8qu.

RESULTS

A total of 112 studies from 18 meta-analyses generating 12 new meta-analyses comprising 21,232 children and adolescents in population groups including attention-deficit/hyperactivity disorder, cancer, cerebral palsy, chronic respiratory diseases, depression, neuromotor impairment, and obesity and in general populations were included. PA interventions were efficacious in reducing psychological symptoms in all meta-analyses across the different population groups using random-effects models. However, umbrella review criteria suggested a weak strength of association for this outcome, and GRADE credibility of evidence ranged from moderate to very low. For psychological well-being, 3 out of 5 meta-analyses identified significant effects, but the strength of these associations was weak, and GRADE credibility of evidence ranged from moderate to very low. Similarly, for social outcomes, meta-analyses reported a significant summary effect, but the strength of association was weak, and GRADE credibility of evidence ranged from moderate to very low. For self-esteem, one meta-analysis in children with obesity failed to show any effect.

CONCLUSION

Even though existing meta-analyses suggested a beneficial effect of PA interventions on psychosocial outcomes across different population groups, the strength of associations was weak, and the credibility of evidence was variable depending on the target population, outcome, and condition or disability. Randomized studies of PA interventions in children and adolescents with and without different physical and psychological conditions or disabilities should always include psychosocial outcomes as an important dimension of social and mental health.

STUDY PREREGISTRATION INFORMATION

Prenatal Maternal Infection and Adverse Neurodevelopment: A Structural Equation Modelling Approach to Downstream Environmental Hits; https://osf.io/; ap8qu.

Analysis of Sprint Ski Mountaineering Performance

Ski mountaineering sprint competitions are short individual races involving 3 uphill sections (U), 3 transitions (T), and a final descent. To date, relatively little is known about this novel Olympic discipline, and here we examined (1) the contribution of the time spent on U, T, and final descent to overall finishing time and (2) the potential relationships with final ranking. During the different rounds of 2 International Ski Mountaineering Federation World Cup sprint competitions, male and female ski mountaineers were video recorded. Correlation and multiple linear regression analyses were used to investigate the impact of U, T, and final descent on the best overall finishing time. Linear-mixed model analysis was applied to explore potential interactions between section times, rounds, and final ranking. Overall, U (r = .90-.97) and T (r = .57-.89) were closely correlated with the best overall finishing time (all P < .05). U explained approximately 80% to 90% of the variation in the best finishing time for both sexes, with U + T explaining approximately 95% to 98% of this variation. In each successive round, the ski mountaineers eliminated were all slower on U than the Top 3 (all P < .05). The fastest skiers increased their performance on U in the later rounds of the competitions, while those eliminated showed a tendency toward a decrease. Our findings reveal that world-class sprint ski mountaineers conduct transitions optimally and perform effectively uphill. Training for such competitions should aim to improve short supramaximal uphill performance (∼1.5-2.5 min), ensuring that this does not decline with multiple efforts. These insights into ski mountaineering sprint performance are of considerable value in connection with training for the 2026 Winter Olympics.

A Feasibility Study Investigating an Exercise Program in Metastatic Cancer Based on the Patient-Preferred Delivery Mode

BACKGROUND

Feasibility of exercise in patients with metastatic cancer is still a challenge. This study aimed to determine the feasibility and preliminary efficacy of an exercise intervention based on a patient-preferred delivery mode in patients affected by metastatic cancer.

MATERIALS AND METHODS

Forty-four patients with a confirmed diagnosis of metastatic cancer were recruited in a 3-month exercise program. Whereas the exercise program consisted of aerobic and resistance activities performed twice a week, the participants may choose the mode of delivery: home based, personal training, or group based. The primary endpoint was the feasibility, defined by recruitment rate, attendance, adherence, dropout rate, tolerability (comparing the session RPE with the target RPE), and safety (using the Common Terminology Criteria for Adverse Events, version 5.0). Secondary endpoints included cardiorespiratory fitness (six minutes walking test), muscle strength (handgrip strength test and isometric leg press test), flexibility (the back scratch and chair sit and reach tests), anthropometric parameters (body mass index and waist-hip ratio), quality of life (EORTC QLQ C-30 questionnaire), and amount of physical exercise (Godin's Shepard Leisure Time Exercise Questionnaire). Descriptive statistics, Student t test, and Wilcoxon signed rank test were used to analyze data.

RESULTS

The study recruitment rate was 81%. Out of 44 recruited patients, 28 chose the personal training program, 16 chose the home-based program, and none chose the group-based program. Nine dropouts occurred (20%), 6 in the personal training program, and 3 in the home-based intervention. The median attendance rate was 92%, adherence was 88%, tolerability was 100%, and 9 nonsevere adverse events were registered during the exercise sessions. An increase in cardiorespiratory fitness (P < .001) and flexibility (P = .011 for chair sit and reach; P = .040 for back scratch) was observed at the end of the intervention, while no changes in anthropometric values and muscle strength were detected. Different quality-of-life domains were improved following the intervention, including physical (P = .002), emotional (P < .001), and role functioning (P = .018), fatigue (P = .030), and appetite loss (P = .005).

CONCLUSION

A 3-month exercise program based on a patient-preferred delivery mode is feasible in patients with metastatic cancer and may improve physical function and quality of life.

TRIAL REGISTRATION

NCT04226508.

Wearable devices for gait and posture monitoring via telemedicine in people with movement disorders and multiple sclerosis: a systematic review

INTRODUCTION

Wearable devices and telemedicine are increasingly used to track health-related parameters across patient populations. Since gait and postural control deficits contribute to mobility deficits in persons with movement disorders and multiple sclerosis, we thought it interesting to evaluate devices in telemedicine for gait and posture monitoring in such patients.

METHODS

For this systematic review, we searched the electronic databases MEDLINE (PubMed), SCOPUS, Cochrane Library, and SPORTDiscus. Of the 452 records retrieved, 12 met the inclusion/exclusion criteria. Data about (1) study characteristics and clinical aspects, (2) technical, and (3) telemonitoring and teleconsulting were retrieved, The studies were quality assessed.

RESULTS

All studies involved patients with Parkinson's disease; most used triaxial accelerometers for general assessment (n = 4), assessment of motor fluctuation (n = 3), falls (n = 2), and turning (n = 3). Sensor placement and count varied widely across studies. Nine used lab-validated algorithms for data analysis. Only one discussed synchronous patient feedback and asynchronous teleconsultation.

CONCLUSIONS

Wearable devices enable real-world patient monitoring and suggest biomarkers for symptoms and behaviors related to underlying gait disorders. thus enriching clinical assessment and personalized treatment plans. As digital healthcare evolves, further research is needed to enhance device accuracy, assess user acceptability, and integrate these tools into telemedicine infrastructure.

PROSPERO REGISTRATION

CRD42022355460.

Physiological determinants of mechanical efficiency during advanced ageing and disuse

This study aimed to determine which physiological factors impact net efficiency (ηnet) in oldest-old individuals at different stages of skeletal muscle disuse. To this aim, we examined ηnet, central haemodynamics, peripheral circulation, and peripheral factors (skeletal muscle fibre type, capillarization and concentration of mitochondrial DNA [mtDNA]). Twelve young (YG; 25 ± 2 years), 12 oldest-old mobile (OM; 87 ± 3 years), and 12 oldest-old immobile (OI; 88 ± 4 years) subjects performed dynamic knee extensor (KE) and elbow flexors (EF) exercise. Pulmonary oxygen uptake, photoplethysmography, Doppler ultrasound and muscle biopsies of the vastus lateralis and biceps brachii were used to assess central and peripheral adaptations to advanced ageing and disuse. Compared to the YG (12.1 ± 2.4%), the ηnet of lower-limb muscle was higher in the OM (17.6 ± 3.5%, P < 0.001), and lower in the OI (8.9 ± 1.9%, P < 0.001). These changes in ηnet during KE were coupled with significant peripheral adaptations, revealing strong correlations between ηnet and the proportion of type I muscle fibres (r = 0.82), as well as [mtDNA] (r = 0.77). No differences in ηnet were evident in the upper-limb muscles between YG, OM and OI. In view of the differences in limb-specific activity across the lifespan, these findings suggest that ηnet is reduced by skeletal muscle inactivity and not by chronological age, per se. Likewise, this study revealed that the age-related changes in ηnet are not a consequence of central or peripheral haemodynamic adaptations, but are likely a product of peripheral changes related to skeletal muscle fibre type and mitochondrial density. KEY POINTS: Although the effects of ageing and muscle disuse deeply impact the cardiovascular and skeletal muscle function, the combination of these factors on the mechanical efficiency are still a matter of debate. By measuring both upper- and lower-limb muscle function, which experience differing levels of disuse, we examined the influence of central and peripheral haemodynamics, and skeletal muscle factors linked to mechanical efficiency. Across the ages and degree of disuse, upper-limb muscles exhibited a preserved work economy. In the legs the oldest-old without mobility limitations exhibited an augmented mechanical efficiency, which was reduced in those with an impairment in ambulation. These changes in mechanical efficiency were associated with the proportion of type I muscle fibres. Recognition that the mechanical efficiency is not simply age-dependent, but the consequence of inactivity and subsequent skeletal muscle changes, highlights the importance of maintaining physical activity across the lifespan.

Decreased neural drive affects the early rate of force development after repeated burst-like isometric contractions

The neural drive to the muscle is the primary determinant of the rate of force development (RFD) in the first 50 ms of a rapid contraction. It is still unproven if repetitive rapid contractions specifically impair the net neural drive to the muscles. To isolate the fatiguing effect of contraction rapidity, 17 male adult volunteers performed 100 burst-like (i.e., brief force pulses) isometric contractions of the knee extensors. The response to electrically-evoked single and octet femoral nerve stimulation was measured with high-density surface electromyography (HD-sEMG) from the vastus lateralis and medialis muscles. Root mean square (RMS) of each channel of HD-sEMG was normalized to the corresponding M-wave peak-to-peak amplitude, while muscle fiber conduction velocity (MFCV) was normalized to M-wave conduction velocity to compensate for changes in sarcolemma properties. Voluntary RFD 0-50 ms decreased (d = -0.56, p < 0.001) while time to peak force (d = 0.90, p < 0.001) and time to RFDpeak increased (d = 0.56, p = 0.034). Relative RMS (d = -1.10, p = 0.006) and MFCV (d = -0.53, p = 0.007) also decreased in the first 50 ms of voluntary contractions. Evoked octet RFD 0-50 ms (d = 0.60, p = 0.020), M-wave amplitude (d = 0.77, p = 0.009) and conduction velocity (d = 1.75, p < 0.001) all increased. Neural efficacy, i.e., voluntary/octet force ratio, largely decreased (d = -1.50, p < 0.001). We isolated the fatiguing impact of contraction rapidity and found that the decrement in RFD, particularly when calculated in the first 50 ms of muscle contraction, can mainly be explained by a decrease in the net neural drive.

Randomised controlled trial combining vitamin E-functionalised chocolate with physical exercise to reduce the risk of protein-energy malnutrition in predementia aged people: study protocol for Choko-Age

OBJECTIVE

Protein-energy malnutrition and the subsequent muscle wasting (sarcopenia) are common ageing complications. It is knowing to be also associated with dementia. Our programme will test the cytoprotective functions of vitamin E combined with the cortisol-lowering effect of chocolate polyphenols (PP), in combination with muscle anabolic effect of adequate dietary protein intake and physical exercise to prevent the age-dependent decline of muscle mass and its key underpinning mechanisms including mitochondrial function, and nutrient metabolism in muscle in the elderly.

METHODS AND ANALYSIS

In 2020, a 6-month double-blind randomised controlled trial in 75 predementia older people was launched to prevent muscle mass loss, in respond to the 'Joint Programming Initiative A healthy diet for a healthy life'. In the run-in phase, participants will be stabilised on a protein-rich diet (0.9-1.0 g protein/kg ideal body weight/day) and physical exercise programme (high-intensity interval training specifically developed for these subjects). Subsequently, they will be randomised into three groups (1:1:1). The study arms will have a similar isocaloric diet and follow a similar physical exercise programme. Control group (n=25) will maintain the baseline diet; intervention groups will consume either 30 g/day of dark chocolate containing 500 mg total PP (corresponding to 60 mg epicatechin) and 100 mg vitamin E (as RRR-alpha-tocopherol) (n=25); or the high polyphenol chocolate without additional vitamin E (n=25). Muscle mass will be the primary endpoint. Other outcomes are neurocognitive status and previously identified biomolecular indices of frailty in predementia patients. Muscle biopsies will be collected to assess myocyte contraction and mitochondrial metabolism. Blood and plasma samples will be analysed for laboratory endpoints including nutrition metabolism and omics.

ETHICS AND DISSEMINATION

All the ethical and regulatory approvals have been obtained by the ethical committees of the Azienda Ospedaliera Universitaria Integrata of Verona with respect to scientific content and compliance with applicable research and human subjects' regulation. Given the broader interest of the society toward undernutrition in the elderly, we identify four main target audiences for our research activity: national and local health systems, both internal and external to the project; targeted population (the elderly); general public; and academia. These activities include scientific workshops, public health awareness campaigns, project dedicated website and publication is scientific peer-review journals.

TRIAL REGISTRATION NUMBER

NCT05343611.

Effects of sports experience on children's gross motor coordination level

Background

Gross motor coordination (GMC) development could be influenced by age, gender, weight status, geographical area, living setting, home environment, socio-economic status, sports practice.

Purpose

To verify whether practicing sports and practicing different sports could influence children's GMC level.

Methods

A total of 295 children aged 8-11 years were involved in the study and divided into 5 groups in relation to the sport they practiced: gymnastics group (n = 67; 51F, 16M), cycling group (n = 64; 15F, 49M), athletics group (n = 47; 22F, 25M), swimming group (n = 35; 20F, 15M), control group (n = 82; 42F, 40M). The four subtests of the Körperkoordinations Test für Kinder (KTK) assessed children's GMC level. The scores from each of the four subtests were summed into the KTK total raw score (RS) and then converted into a gender- and age-specific motor quotient (MQ).

Results

Children practicing sports showed significantly higher RS and MQ score than children of control group (203.14 ± 38.55 vs. 163.63 ± 43.50 and 98.56 ± 15.79 vs. 83.01 ± 16.71, respectively; p < 0.001). Children practicing gymnastics had a significantly higher RS and MQ than children of cycling, swimming, and control groups (p < 0.05), children of control group had a significantly lower RS and MQ than children of all other groups (p < 0.05). Children practicing gymnastics performed better walking backwards subtest than all other children's groups (p < 0.001). Children of control group performed worse jumping sideways subtest than children of gymnastics, athletics and swimming groups (p < 0.01). Children practicing gymnastics performed better moving sideways subtest than children of athletics, cycling and control groups (p < 0.01); children of control group performed worse than children of all other groups (p < 0.01). Children of control group performed worse hopping for height subtest than children of gymnastics, athletics and cycling groups (p < 0.05); children practicing gymnastics performed better than children of swimming and control groups (p < 0.05).

Conclusions

The performance model and therefore the specialized training that each sport discipline required, could justified the differences in children's GMC level among sports groups. Thus, coaches should plan individualized interventions and choose activity contents to support children's GMC development.

Gross motor coordination in relation to weight status: a longitudinal study in children and pre-adolescents

Introduction

Gross Motor Coordination (GMC) is crucial for the adequate development of motor competence. Our purpose in this semi-longitudinal study was to evaluate the influence of BMI on GMC in children and pre-adolescents of both sexes, across school years (classes).

Methods

We evaluated 117 subjects (aged 8-13 years) belonging to three different cohorts for 4 consecutive years, providing data over 6 years (classes). GMC was assessed through the Körperkoordinationstest für Kinder (KTK) test. Class and weight status effects were then evaluated by dividing the subjects into a normal weight group and an overweight group based on their weight status.

Results

A significant increase across classes was found for BMI (p < 0.001) and KTK raw score (p < 0.001) and a decrease was found for KTK normalized score (MQ) (p = 0.043). Significantly lower MQ values were found for girls. Absolute GMC increased across the years and there was no difference between boys and girls. Correlations between GMC scores and BMI were negative and significant in 5 of 6 classes. It was confirmed that overweight subjects had lower MQ and RAW values than normal-weight subjects, with no class-by-weight status interaction.

Discussion

The level of competence and its development are strictly dependent on weight status during childhood and pre-adolescence. The present investigation suggests that the adequate development of GMC requires not only targeted physical education programs but also the promotion of healthy habits aimed at maintaining a normal weight status during childhood and pre-adolescence.

Do poles really "save the legs" during uphill pole walking at different intensities?

PURPOSE

In sky- and trail-running competitions, many athletes use poles. The aims of this study were to investigate whether the use of poles affects the force exerted on the ground at the feet (Ffoot), cardiorespiratory variables and maximal performance during uphill walking.

METHODS

Fifteen male trail runners completed four testing sessions on different days. On the first two days, they performed two incremental uphill treadmill walking tests to exhaustion with (PWincr) and without poles (Wincr). On the following days, they performed submaximal and maximal tests with (PW80 and PWmax) and without (W80 and Wmax) poles on an outdoor trail course. We measured cardiorespiratory parameters, the rating of perceived exertion, the axial poling force and Ffoot.

RESULTS

When walking on the treadmill, we found that poles reduced maximum Ffoot (- 2.8 ± 6.4%, p = 0.03) and average Ffoot (- 2.4 ± 3.3%, p = 0.0089). However, when outdoors, we found pole effect only for average Ffoot (p = 0.0051), which was lower when walking with poles (- 2.6 ± 3.9%, p = 0.0306 during submaximal trial and - 5.21 ± 5.51%, p = 0.0096 during maximal trial). We found no effects of poles on cardiorespiratory parameters across all tested conditions. Performance was faster in PWmax than in Wmax (+ 2.5 ± 3.4%, p = 0.025).

CONCLUSION

The use of poles reduces the foot force both on the treadmill and outdoors at submaximal and maximal intensities. It is, therefore, reasonable to conclude that the use of poles "saves the legs" during uphill without affecting the metabolic cost.

Effect of exercise across the head and neck cancer continuum: a systematic review of randomized controlled trials

PURPOSE

This study aims to systematically explore the impact of physical exercise as supportive therapy for head and neck cancer.

METHODS

A systematic search on PubMed/MEDLINE, Cochrane, and SPORTDiscus was conducted. Randomized controlled trials exploring the effects of a physical exercise intervention in comparison with usual care on outcomes in patients with head and neck cancer were selected. The RoB 2 tool was used to determine the study quality. The extracted data are reported as qualitative synthesis.

RESULTS

Among the 527 records examined, nine studies were included. No trials investigating exercise as prehabilitation were found, whereas eight studies involving 452 patients with head and neck cancer were conducted during anticancer treatment. Most trials did not report improvements in body mass index or body composition, while 2/4 and 3/5 investigations found a significant increase in muscle strength and cardiorespiratory fitness, respectively. Regarding the patients' reported outcomes, 4 out of 7 studies observed enhancements in some domains of quality of life, and two trials out of 3 detected an amelioration in fatigue following the exercise intervention. Analyzing the exercise programs, it seems that combining aerobic and resistance training could be more beneficial compared to a single type of full-body exercise in counteracting physical decline and controlling symptoms in the anticancer therapy phase. One trial has investigated the effect of resistance exercise on patients who had terminated the anticancer treatments, reporting significant improvements in lean mass, muscle strength, and quality of life.

CONCLUSION

Exercise may be a promising approach in patients with head and neck cancer. Future studies are needed to consolidate these results.

Exploring the feasibility of a combined exercise program for patients with advanced lung or pancreatic cancer

Objective

This study aims to assess the safety, feasibility, and potential benefits of a combined aerobic and resistance exercise intervention for patients diagnosed with advanced pancreatic or lung cancer.

Methods

A prospective, single-arm study was conducted, enrolling patients with advanced lung or pancreatic cancer. Participants engaged in a 12-week exercise intervention comprising personalized bi-weekly aerobic and resistance training tailored to individual baseline conditions. The primary study outcomes focused on safety (absence of serious adverse events) and feasibility. Secondary outcomes included assessments of functional capacity using the "Six minutes walking test", strength measured through handgrip and leg press tests, anthropometric measures including body mass index and waist-hip ratio, quality of life (QoL), and changes in blood parameters.

Results

The study involved twelve patients (mean age 57.66 ​± ​7.40 years), with seven having pancreatic cancer and five having lung cancer. The recruitment rate was 50%, and assessment adherence was 100%, with an 84% adherence to the exercise program and no dropouts. No exercise-related adverse events were recorded, while three non-severe, non-exercise-related adverse events were observed: treatment-related dermatitis (Grade 2), axillary lymphadenopathy (Grade 2), and migraine (Grade 1). Significant enhancements in functional capacity, emotional well-being, and social functioning within the QoL domains were observed. Anthropometric measures, specifically waist-hip ratio and body mass index, remained stable.

Conclusions

The findings suggest that a tailored 12-week exercise intervention is both feasible and safe for patients with advanced lung or pancreatic cancer. This intervention appears to enhance functional capacity, specific aspects of QoL, and contribute to maintaining body weight.

Impact of active lifestyle on the primary school children saliva microbiota composition

The aim of the study was to evaluate the effects of Active or Sedentary lifestyle on saliva microbiota composition in Italian schoolchildren.

Methods

Male (114) and female children (8-10 years) belonging to five primary schools in the neighborhoods of Turin were classified as active (A) or sedentary (S) based on PAQ-C-It questionnaire. PCR amplification of salivary DNA targeted the hypervariable V3-V4 regions of the 16S rRNA bacterial genes. DADA2 workflow was used to infer the Amplicon Sequence Variants and the taxonomic assignments; the beta-diversity was obtained by PCoA with the UniFrac method; LEfSe algorithm, threshold at 5%, and Log LDA cutoff at ±0.5 were used to identify differently abundant species in A compared to S saliva sample. Daily food intake was assessed by 3-Days food record. The metabolic potential of microbial communities was assessed by PICRUSt.

Results

No significant differences were found in individual's gender distribution (p = 0.411), anthropometry, BMI (p > 0.05), and all diet composition between A and S groups (p > 0.05). Eight species were differently abundant: Prevotella nigrescens (LDA score = -3.76; FDR = 1.5×10-03), Collinsella aerofaciens (LDA score = -3.17; FDR = 7.45×10-03), Simonsiella muelleri (LDA score = -2.96; FDR = 2.76×10-05), Parabacteroides merdae (LDA score = -2.43; FDR = 1.3×10-02) are enriched in the A group; Gemella parahaemolysans, Prevotella aurantiaca (LDA score = -3.9; FDR = 5.27×10-04), Prevotella pallens (LDA score = 4.23; FDR = 1.93×10-02), Neisseria mucosa (LDA score = 4.43; FDR = 1.31×10-02; LDA score = 2.94; FDR = 7.45×10-03) are enriched in the S group. A prevalence of superpathway of fatty acid biosynthesis initiation (E. coli) and catechol degradation II (meta-cleavage pathway) was found in saliva from A compared to S children.

Conclusion

Our results showed that active children had an enrichment of species and genera mainly associated with a healthier profile. By contrast, the genera and the species enriched in the sedentary group could be linked to human diseases.

Circadian and sex differences in post-ischemic vasodilation and reactive hyperemia in young individuals and elderly with and without type 2 diabetes

OBJECTIVE

Cardiovascular events show morning preference and sex differences, and are related to aging and type 2 diabetes. We assessed circadian variations and sex differences in vascular conductance (VC) and blood flow (BF) regulations following a brief bout of forearm ischemia.

METHODS

Young healthy individuals (H18-30) and elderly without (H50-80) and with type 2 diabetes (T2DM50-80) of both sexes were included. Forearm VC and BF, and mean arterial pressure (MAP) at baseline and following circulatory reperfusion were measured at 6 a.m. and 9 p.m.

RESULTS

In the morning compared to evening, following reperfusion, the VC and BF increments were similar in H18-30 (p>.71), but lower in H50-80 (p<.001) and T2DM50-80 (p<.01). VC and BF following circulatory reperfusion were higher in men than women in H18-30 (p<.001), but similar between sexes in the older groups (p>.23).

CONCLUSIONS

Forearm vasodilation following reperfusion is attenuated in the morning in the elderly, impairing BF towards an ischemic area. Diabetes does not affect the circadian regulation of VC and BF, but that of MAP. There are sex differences in VC and BF at baseline and after circulatory reperfusion at a young age, being greater in men, which disappear with aging without being affected by diabetes.

Comparison between conventional and neuronavigated strategies to assess corticospinal responsiveness in unfatigued and fatigued knee-extensor muscles

In studying neuromuscular fatigability, researchers commonly use functional criteria to position and hold the transcranial magnetic stimulation (TMS) coil during testing sessions. This could influence the magnitude of corticospinal excitability and inhibition responses due to imprecise and unsteady positions of the coil. To reduce coil position and orientation variability, neuronavigated TMS (nTMS) could be used. We evaluated the accuracy of nTMS and a standardized function-guided procedure for maintaining TMS coil position both in unfatigued and fatigued knee extensors. Eighteen participants (10F/8M) volunteered in two identical and randomized sessions. Maximal and submaximal neuromuscular evaluations were performed with TMS three times before (PRE_1) and three times after (PRE_2) a 2 min resting session and one time immediately after (POST) a 2-min sustained maximal voluntary isometric contraction (MVIC). The located "hotspot" [the location that evoked the largest motor-evoked potential (MEP) responses in the rectus femoris] was maintained either with or without nTMS. MEP, silent period (SP) and the distance between the "hotspot" and the actual coil position were recorded. A time × contraction intensity × testing session × muscle interaction was not observed for MEP, SP, and distance. Bland-Altman plots presented adequate agreements for MEP and SP. Spatial accuracy of TMS coil position over the motor cortex did not influence corticospinal excitability and inhibition in unfatigued and fatigued knee extensors. The variability in MEP and SP responses may be due to spontaneous fluctuations in corticospinal excitability and inhibition, and it is not altered by the spatial stability of the stimulation point.

Flat versus Simulated Mountain Trail Running: A Multidisciplinary Comparison in Well-Trained Runners

This paper compares cardiopulmonary and neuromuscular parameters across three running aerobic speeds in two conditions that differed from a treadmill's movement: flat condition (FC) and unpredictable roll variations similar to mountain trail running (URV). Twenty well-trained male runners (age 33 ± 8 years, body mass 70.3 ± 6.4 kg, height 1.77 ± 0.06 m, V˙O₂max 63.8 ± 7.2 mL·kg^-1·min^-1) voluntarily participated in the study. Laboratory sessions consisted of a cardiopulmonary incremental ramp test (IRT) and two experimental protocols. Cardiopulmonary parameters, plasma lactate (BLa^-), cadence, ground contact time (GT) and RPE values were assessed. We also recorded surface electromyographic (sEMG) signals from eight lower limb muscles, and we calculated, from the sEMG envelope, the amplitude and width of peak muscle activation for each step. Cardiopulmonary parameters were not significantly different between conditions (V˙O₂: p = 0.104; BLa^-: p = 0.214; HR: p = 0.788). The amplitude (p = 0.271) and width (p = 0.057) of sEMG activation peaks did not change between conditions. The variability of sEMG was significantly affected by conditions; indeed, the coefficient of variation in peak amplitude (p = 0.003) and peak width (p < 0.001) was higher in URV than in FC. Since the specific physical demands of running can differ between surfaces, coaches should resort to the use of non-traditional surfaces, emphasizing specific surface-related motor tasks that are normally observed in natural running environments. Seeing that the variability of muscle activations was affected, further studies are required to better understand the physiological effects induced by systematic surface-specific training and to define how variable-surface activities help injury prevention.

The effects of a 6-hour ultra-endurance run on postexercise parasympathetic reactivation responses

BACKGROUND

Alterations in cardiac autonomic control reflecting depressed parasympathetic activity have been previously reported after ultra-endurance events at rest and during dynamic tasks assessing cardiac autonomic responsiveness. This study investigated the impact of a 6-hour ultra-endurance run on parasympathetic reactivation indices, using an exercise-recovery transition approach.

METHODS

Nine trained runners (VO<inf>2max</inf> 67±12 mL/kg/min) completed a 6-hour run (EXP) whilst other six runners (VO<inf>2max</inf> 66±10 mL/kg/min) served as a control (CON). Before (PRE) and after the run/control period (POST) participants completed standard cardiac autonomic activity assessments. Postexercise parasympathetic reactivation was assessed by means of heart rate recovery (HRR) and vagal-related time-domain HRV indices.

RESULTS

HR was increased at rest (P<0.001, ES=3.53), during exercise (P<0.05, ES=0.38) and recovery (all P<0.001, ES from 0.91 to 1.46) at POST in EXP and not in CON (all P>0.05). At POST vagal-related HRV indices were significantly decreased at rest (P<0.001, ES from -2.38 to -3.54) and during postexercise recovery (all P<0.001, ES from -0.97 to -1.58) only in EXP. HRR at 30 and 60 s were markedly reduced at POST in EXP both when expressed in bpm and normalized for the exercising HR (all P<0.001, ES from -1.21 to -1.74).

CONCLUSIONS

A 6-hour run markedly impacted upon postexercise parasympathetic reactivation responses causing a decrease in HRR and HRV recovery indices. For the first time, this study attested blunted postexercise parasympathetic reactivation responses following an acute bout of ultra-endurance exercise.

Participation and performance by women and men in ski-mountaineering sprint races during the past decade

BACKGROUND

The sprint is one of the two ski-mountaineering disciplines that will be held at the coming Milano Cortina 2026 Winter Olympics (Italy). To date little information exists on this novel Olympic discipline.

METHODS

We characterized retrospectively the participation and performance in international male and female ski mountaineering sprint races from November 2012 to April 2022. Potential associations between sex and season with participation, as well as between sex, period, round and final ranking with parameters of performance were examined with linear-mixed models.

RESULTS

The minimal performance time required for success (i.e., being eligible for the next round/winning a medal) decreased progressively from the qualifications (Qs) to the final (F). Finalists adopted a conservative strategy in the Qs, improving their performance in the quarter-finals (QFs) and semifinals (SFs). The best and second-best male skier and the best female skier improved their performances even further in the F, which appears to be a key feature for success. For women, the number of participants and level of competition increased over the decade, whereas male participation did not. During the last two seasons, male sprint winners performed relatively more slowly in the preliminary rounds leaving more room for improvement in the F, which could reflect increased specialization in this discipline.

CONCLUSIONS

Our findings provide novel insights into ski-mountaineering sprint races that can guide competition strategies and could be of considerable importance in connection with the Milano Cortina 2026 Winter Olympics (Italy).

Mental stress augments central artery stiffness in young individuals of both sexes

Mental stress is a daily stimulus that can acutely activate the sympathetic nervous system. Whether sympathetic stimulation can augment central artery stiffness (CAS) has not yet been well documented. Moreover, sex differences in sympathetic neurovascular transduction have been reported. We assessed whether mental stress augments CAS in both sexes and whether any CAS increase is blunted in women compared with men. The hf-PWV (heart-femoral pulse wave velocity; index of CAS), MAP (mean arterial pressure), PP (pulse pressure), TPR (total peripheral resistance), and HR (heart rate) were measured in 26 young individuals (13 men, 13 women) at rest and throughout a 10-minute bout of stress induced by mental arithmetic. Data over the mental stress period were compared to the preceding baseline values and between sexes. Mental stress increased hf-PWV, MAP, PP, and HR from baseline throughout the entire stimulation period (p < .005). TPR diminished in the first minute of stimulation (p < .001) in both sexes and increased in the last minutes in women only (p < .005). Hf-PWV was lower in women than men (p < .001) at rest and during mental stress, but the changes from baseline were similar in both sexes. There were sex differences in the PP and TPR changes, which were evident at different times of stimulation. Mental stress increased CAS in both sexes throughout the stimulation period. Although values of CAS were lower in women both at rest and during mental stress, the CAS increase due to mental stress was similar in both sexes.

Neural and contractile determinants of burst-like explosive isometric contractions of the knee extensors

Walking and running are based on rapid burst-like muscle contractions. Burst-like contractions generate a Gaussian-shaped force profile, in which neuromuscular determinants have never been assessed. We investigated the neural and contractile determinants of the rate of force development (RFD) in burst-like isometric knee extensions. Together with maximal voluntary force (MVF), voluntary and electrically evoked (8 stimuli at 300 Hz, octets) forces were measured in the first 50, 100, and 150 ms of burst-like quadriceps contractions in 24 adults. High-density surface electromyography (HDsEMG) was adopted to measure the root mean square (RMS) and muscle fiber conduction velocity (MFCV) from the vastus lateralis and medialis. The determinants of voluntary force at 50, 100, and 150 ms were assessed by stepwise multiple regression analysis. Force at 50 ms was explained by RMS (R²  = 0.361); force at 100 ms was explained by octet (R²  = 0.646); force at 150 ms was explained by MVF (R²  = 0.711) and octet (R²  = 0.061). Peak RFD (which occurred at 60 ± 10 ms from contraction onset) was explained by MVF (R²  = 0.518) and by RMS₅₀ (R²  = 0.074). MFCV did not emerge as a determinant of RFD. Muscle excitation was the sole determinant of early RFD (50 ms), while contractile characteristics were more relevant for late RFD (≥100 ms). As peak RFD is mostly determined by MVF, it may not be more informative than MVF itself. Therefore, a time-locked analysis of RFD provides more insights into the neuromuscular characteristics of explosive contractions.

Eager to set a record in a vertical race? Test your VO2max first!

We investigated the relationship between maximal oxygen consumption (VO_2max) and performance in vertical races (VRs). In total, 270 performances, from 26 VRs, and cardiopulmonary data of 64 highly-trained mountain runners (53 M, V O_2max: 75.7±5.8 mL/min/kg; 11 F: 65.7±3.4 mL/min/kg), collected over a 11-year period (2012-2022), were analysed. The relationship between performance and VO_2max was modelled separately for national (NVRs), international (IVRs), and VRs of current pole-unassisted and pole-assisted vertical kilometre (VK) records (RVRs). Three different (p<0.001) exponential models described the relationship between performance and VO_2max in IVRs (R²=0.96, p<0.001), NRs (R²=0.91, p<0.001) and RVRs (R²=0.97, p<0.001). Estimated VO_2max requirements (with 95% CI) to win/set a record time in IVRs were 86.2(85.3-87.1)/89.4(88.2-90.5) and 74.0(73.6-74.4)/76.8(76.4-77.3) mL/min/kg, for males and females, respectively, 86.1(85.0-87.1)/90.4(89.0-91.8) and 74.8(74.2-75.3)/77.1(77.6-77.7) mL/min/kg in RVRs, decreasing to 83.7(82.5-84.9)/87.6(86.0-89.2) and 66.8(65.9-67.7)/70.7(70.1-71.4) mL/min/kg in NVRs. Our study also suggested a tendency towards a non-uniform variation in the metabolic demand of off-road running, likely attributable to the different features of the VRs (e.g., terrain, technical level, use of poles). These data provide mean VO_2max requirements for mountain runners to win and establish new records in VRs and stimulate new research on the energy cost of off-road running.

The role of muscle mass in vascular remodeling: insights from a single-leg amputee model

PURPOSE

Both muscle mass and physical activity are independent mechanisms that play a role in vascular remodeling, however, the direct impact of muscle mass on the structure and function of the vessels is not clear. The aim of the study was to determine the impact of muscle mass alteration on lower limbs arterial diameter, blood flow, shear rate and arterial stiffness.

METHODS

Nine (33 ± 13 yrs) male individuals with a single-leg amputation were recruited. Vascular size (femoral artery diameter), hemodynamics (femoral artery blood flow and shear rate were measured at the level of the common femoral artery in both amputated (AL) and whole limbs (WL). Muscle mass of both limbs, including thigh for AL and thigh and leg for WL, was measured with a DXA system.

RESULTS

AL muscle mass was reduced compared to the WL (3.2 ± 1.2 kg vs. 9.4 ± 2.1 kg; p = 0.001). Diameter of the femoral artery was reduced in the AL (0.5 ± 0.1 cm) in comparison to the WL (0.9 ± 0.2 cm, p = 0.001). However, femoral artery blood flow normalized for the muscle mass (AL = 81.5 ± 78.7ml min^-1 kg^-1,WL = 32.4 ± 18.3; p = 0.11), and blood shear rate (AL = 709.9 ± 371.4 s^-1, WL = 526,9 ± 295,6; p = 0.374) were non different between limbs. A correlation was found only between muscle mass and femoral artery diameter (p = 0.003, R = 0.6561).

CONCLUSION

The results of this study revealed that the massive muscle mass reduction caused by a leg amputation, but independent from the level of physical activity, is coupled by a dramatic arterial diameter decrease. Interestingly, hemodynamics and arterial stiffness do not seem to be impacted by these structural changes.

Circadian Variations in Sympathetic Vasoconstriction in Older Adults with and Without Type 2 Diabetes

INTRODUCTION

An impact of the sympathetic nervous system in the higher rate of cardiovascular events in the early morning compared to the evening has been claimed. Augmented sympathetic vasoconstriction increases cardiovascular risk by augmenting pulse pressure and cardiac afterload. Type 2 diabetes (T2DM) further increases sympathetic neurovascular transduction and cardiovascular risk.

AIM

We assessed whether peripheral vasoconstriction triggered by a standardized sympathetic stressor is augmented at 6am vs 9pm in adults between 50-80 years with type 2 diabetes (T2DM50-80) vs healthy ones (H50-80).

METHODS

Mean values of sympathetic vasoconstrictor responsiveness (SVR), vascular conductance (VC), brachial artery blood flow, and mean arterial pressure were measured on the contralateral forearm over two 5-minute bouts of rest and handgrip-mediated sympathetic stimulation, respectively.

RESULTS

Although baseline VC values were lower (p < 0.01) in the morning vs evening in both groups, SVR values in response to sympathoexcitation were similar in H50-80 (- 0.43 ± 12.44 vs - 2.57 ± 11.63 %, p = 0.73) and T2DM50-80 (+6.64 ± 10.67 vs +5.21 ± 7.64 %, p = 0.90), but higher (p < 0.01) in T2DM50-80 vs H50-80 at both day hours. Individuals with T2DM reported positive SVR values and VC change-scores, while healthy individuals reported statistically different (p < 0.02) negative SVR values and VC change-scores.

CONCLUSION

Peripheral vasoconstriction triggered by a standardized sympathetic stressor is similar between morning and evening, regardless of T2DM and different baseline VC values. However, peripheral vasoconstriction responsiveness is blunted in individuals with T2DM as handgrip-mediated sympathoexcitation induces vasodilation in the contralateral forearm in adults with T2DM and vasoconstriction in healthy age-matched controls, highlighting a neurovascular response altered by T2DM.

Co-Occurrence of a Pathogenic HSD3B2 Variant and a Duplication on 10q22.3-q23.2 Detected in Newborn Twins with Salt-Wasting Congenital Adrenal Hyperplasia

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders caused by enzyme deficiencies required for cortisol biosynthesis in the adrenal cortex. The majority of CAH are due to the deficiency of the 21-hydroxylase enzyme, while 3β-hydroxysteroid dehydrogenase type 2 deficiency accounts for less than five percent of all CAH cases. We report two Moroccan twins from a spontaneous triplet pregnancy. The 46,XY newborn exhibited a disorder of sexual differentiation (DSD) with hypo virilization, while the 46,XX newborn had normal female external genitalia. In the first week of life, they showed hyponatremia and primary adrenal insufficiency with a slight 17OHP elevation and increased DHEAS and renin levels. The aCGH-SNP analysis disclosed a 8.36 Mb long contiguous stretch of homozygosity (LCSH) on chromosome 1p13.2-p11.2 including the candidate HSD3B2 gene, a LCSH of 7.3 Mb on 14q31.1-q32.11, and a 7 Mb duplication on 10q22.3-q23.2. Clinical exome sequencing revealed the biallelic c.969T > G (p.Asn323Lys) HSD3B2, likely pathogenic, variant in both of the affected twins. This case emphasizes the importance of a prompt molecular diagnosis performed through the combination of aCGH and clinical exome, both for establishment of correct therapy and for follow-up, as the newborns also carry a genomic rearrangement with possible clinical implications.

Promoting participatory research in chronicity: The ESPRIMO biopsychosocial intervention for young adults with multiple sclerosis

Background

Co-creation allows to develop tailored interventions in chronicity and to increase patients’ engagement. Considering the interacting nature of physical, psychological, and social domains in multiple sclerosis (MS), a biopsychosocial approach to care is crucial.

Aims

This paper aims to present (i) an example of a co-creation process in the context of chronic diseases (ii) preferences and perspectives of young adults with multiple sclerosis (YawMS; aged 18–45) and healthcare professionals (HCPs) on the relevance, objectives, and modalities of a biopsychosocial intervention (named ESPRIMO) and on strategies/barriers to participation.

Methods

A participatory mixed-method approach in three consecutive steps was implemented: online surveys with YawMS (n = 121) and HCPs (n = 43), online focus groups (FGs) with YawMS, consultation with an advisory board (AB) composed by YawMS, HCPs and researchers. For the survey, descriptive statistics and inductive content analysis have been used for quantitative and qualitative analysis, respectively. FGs and AB were used to deepen the understanding of the survey’s results.

Results

An integrated intervention is extremely relevant according to the perspectives of the main stakeholders. Helping disease acceptance, providing stress management strategies, and supporting emotional expression emerged as the most relevant psychological objectives according to participants. Having tangible benefits, being tailored, and fostering interpersonal relationships emerged as the main preferred characteristics of physical activity. Preferences emerged on the modalities and timing of the intervention, with a venue unrelated to the disease strongly supported. Both HCPs and YawMS highlighted as the most valuable advantages of conducting the intervention online the increased accessibility, while the main limit was the restriction to social interaction (recognized as already limited during the COVID-19 pandemic). Accessibility and lack of time resulted as the main barriers to participation.

Conclusion

The co-creation process gave valuable information on preferences and perspectives of main stakeholders on objectives, modalities, and strategies to improve participation which has been used in the design of the ESPRIMO biopsychosocial intervention. Those results might inform future intervention development in the field of chronicity. The current paper outlined a co-creation methodology which might be replicated in future research on other conditions of vulnerability.

Including the Eccentric Phase in Resistance Training to Counteract the Effects of Detraining in Women: A Randomized Controlled Trial

ABSTRACT

Coratella, G, Beato, M, Bertinato, L, Milanese, C, Venturelli, M, and Schena, F. Including the eccentric phase in resistance training to counteract the effects of detraining in women: a randomized controlled trial. J Strength Cond Res 36(11): 3023-3031, 2022-The current study compared the effects of concentric-based (CONC), eccentric-based (ECC), and traditional concentric-eccentric (TRAD) resistance training on muscle strength, mass, and architecture and the postdetraining retention of the training-induced effects in women. Sixty women were randomly assigned to unilateral volume-equated CONC, ECC, or TRAD knee extension training or control ( N = 15 per group). Before training, after an 8-week intervention period, and after an 8-week detraining period, isokinetic concentric, eccentric, and isometric torque were measured. In addition, thigh lean mass was assessed by dual X-ray absorptiometry and vastus lateralis thickness, pennation angle, and fascicle length by ultrasound. After training, concentric and isometric torque increased ( p < 0.05) similarly in all groups, whereas eccentric torque increased more in ECC than that in CONC (+13.1%, effect size (ES): 0.71 [0.04-1.38]) and TRAD (+12.6%, ES: 0.60 [0.12-1.08]). Thigh lean mass increased in ECC (+6.1%, ES: 0.47 [0.27-0.67]) and TRAD (+3.1%, ES: 0.33 [0.01-0.65]). Vastus lateralis thickness and pennation angle increased ( p < 0.05) similarly in all groups, whereas fascicle elongation was visible in ECC (+9.7%, ES: 0.92 [0.14-1.65]) and TRAD (+7.1%, ES: 0.64 [0.03-1.25]). After detraining, all groups retained ( p < 0.05) similar concentric torque. ECC and TRAD preserved eccentric torque ( p < 0.05), but ECC more than TRAD (+17.9%, ES: 0.61 [0.21-1.21]). All groups preserved isometric torque ( p < 0.05), but ECC more than CONC (+14.2%, ES: 0.71 [0.04-1.38]) and TRAD (+13.8%, ES: 0.65 [0.10-1.20]). Thigh lean mass and vastus lateralis fascicle length were retained only in ECC ( p < 0.05), pennation angle was preserved in all groups ( p < 0.05), and thickness was retained in CONC and ECC ( p < 0.05). Including the eccentric phase in resistance training is essential to preserve adaptations after detraining.

Circadian and sex differences in carotid-femoral pulse wave velocity in young individuals and elderly with and without type 2 diabetes

The incidence of cardiovascular events is higher in the morning than in the evening and differs between sexes. We tested the hypothesis that aortic stiffness, a compelling cardiovascular risk factor, increases in the morning than in the evening in young, healthy individuals between 18 and 30 years (H18–30) or in older individuals between 50 and 80 years, either healthy (H50–80) or with type 2 diabetes (T2DM50–80). Sex differences were also investigated. Carotid-femoral pulse wave velocity (cf-PWV) recorded via Doppler Ultrasound, blood pressure and heart rate were checked at 6 a.m. and 9 p.m., at rest and during acute sympathetic activation triggered by handgrip exercise. Cf-PWV values were lower in the morning compared to the evening in all groups (p < 0.01) at rest and lower (p = 0.008) in H18–30 but similar (p > 0.267) in the older groups during sympathetic activation. At rest, cf-PWV values were lower in young women compared to young men (p = 0.001); however, this trend was reversed in the older groups (p < 0.04). During sympathetic activation, the cf-PWV was lower in women in H18–30 (p = 0.001), similar between sexes in H50–80 (p = 0.122), and higher in women in T2DM50–80 (p = 0.004). These data do not support the hypothesis that aortic stiffness increases in the morning compared to the evening within any of the considered groups in both rest and sympathetic activation conditions. There are differences between the sexes, which vary according to age and diabetes status. In particular, aortic stiffness is higher in older women than in men with diabetes during acute stress.

How Do Elite Female Athletes Cope with Symptoms of Their Premenstrual Period? A Study on Rugby Union and Football Players' Perceived Physical Ability and Well-Being

Women's participation in sports has recently grown worldwide, including in sports typically associated with men (e.g., rugby and football). Similarly, literature on female athletes has increased, but how they cope with premenstrual (PM) physical and affective symptoms remains a poorly studied topic. Our study aimed to explain which coping strategies elite female rugby and football players use during their PM period to maintain perceived physical ability (PPA) and well-being. A mediation model analysis considering coping strategies (i.e., avoiding harm, awareness and acceptance, adjusting energy, self-care, and communicating) as independent variables, PPA and well-being as dependent variables, and PM physical and affective symptoms and PM cognitive resources as mediators was run on the data collected via an anonymous online survey. A dysfunctional impact of avoiding harm (indirect) and adjusting energy (both direct and indirect) and a functional indirect influence of awareness and acceptance, self-care, and communicating as coping strategies were found on PPA and well-being during the PM period. As predicted, PM physical and affective symptoms as mediators reduced PPA and well-being, while PM cognitive resources enhanced them. These results may inform practitioners on how to support elite female athletes' PPA and well-being by knowing and reinforcing the most functional PM coping strategies for them.

Is handgrip strength a marker of muscle and physical function of the lower limbs? Sex differences in older adults with obesity

BACKGROUND AND AIMS

In this cross-sectional study we investigate the association between handgrip strength (HGS) and muscle function of the lower limbs and the predictors of the appendicular lean mass index (ALMI) in older adults with obesity of both sexes.

METHODS AND RESULTS

Eighty-four older (67 ± 5 years) men (N = 44) and women (N = 40) with obesity (body mass index (BMI) 33 ± 4 kg/m²) performed: the HGS, isokinetic knee extensors (KE) and flexors (KF) muscle strength and power and Short Physical Performance Battery (SPPB). The correlation between HGS and lower limbs muscle function was evaluated, and four multiple hierarchical linear models were built to assess the contribution of each ALMI predictor (i.e., HGS, BMI, SPPB, muscle strength and power). In men, HGS was weakly-to-moderately associated (p < 0.05) with KE, KF muscle function and physical performance. In women, HGS showed a weak association (p < 0.05) with KE muscle function. The significant predictors of ALMI were only the BMI in women, whereas in the group of men BMI, KE maximal strength and power better explain the variance in ALMI than HGS alone.

CONCLUSION

Our results suggest that HGS should not be used alone as a marker of lower muscle nor physical function. Sex differences exist with the BMI that is a contributor of ALMI both in men and women. However, at least in the group of men, markers related to strength and power of the lower limbs can better describe variations in ALMI compared to HGS in this kind of population.

CLINICAL TRIAL REGISTRATION

NA.

Hypoxia and risk preferences: Mild hypoxia impacts choices for low-probability high-payoff bets

Mild degrees of hypoxia are known to exert a detrimental effect on cognitive functions. In a lab study, we assessed the effect of mild hypoxia on risk-taking behavior. Participants (N = 25) were presented with pairs of bets of equal expected monetary value, one having a higher probability of winning/losing a lower payoff (safer bet) and one having a lower probability of winning/losing a higher payoff (riskier bet). We systematically varied the ratio of the probabilities (and corresponding payoffs) of the two bets and examined how this affected participants’ choice between them. Following a familiarization session, participants performed the task twice: once in a normoxic environment (20.9% oxygen concentration) and once in a mildly hypoxic environment (14.1% oxygen concentration). Participants were not told and could not guess which environment they were in. We found a higher preference for the riskier bet in the mild hypoxic than normoxic environment but only in the loss domain. Furthermore, as the probability ratio increased, mild hypoxia increased the preference for the riskier bet in the domain of losses but decreased it for gains. The present findings support that mild hypoxia promotes riskier choices in the loss domain and provide new insights into the impact of mild hypoxia in moderating the effect of probability ratio on risky choices.

Relationship between perceived and neuromuscular fatigue in COPD patients with chronic respiratory failure with long-term oxygen therapy: a cross-sectional study

PURPOSE

To evaluate perceived fatigue (PF) and neuromuscular fatigue (NMF) in patients with COPD and chronic respiratory failure (CRF) on long-term oxygen therapy (CRF-COPD group), and the relationships between PF, NMF, patient's characteristics, comparing severe patients with COPD to patients without CRF (COPD group).

METHODS

This cross-sectional study compared 19 CRF-COPD patients with 10 COPD patients attending a rehabilitation program. PF was determined by Fatigue Severity Scale (FSS), while dyspnea by the Barthel Dyspnea Index (BDI). We assessed quadriceps NMF via electrical nerve stimulation during and following a Maximal Voluntary Contraction (MVC) detecting changes after a Constant Workload Cycling Test (CWCT) at 80% of the peak power output at exhaustion.

RESULTS

CRF-COPD patients showed higher PF (+ 1.79 of FSS score, p = 0.0052) and dyspnea (+ 21.03 of BDI score, p = 0.0023) than COPD patients. After the fatiguing task and normalization for the total work, there was a similar decrease in the MVC (CRF-COPD -1.5 ± 2.4 vs COPD -1.1 ± 1.2% baseline kJ^-1, p = 0.5819), in the potentiated resting twitch force (CRF-COPD -2.8 ± 4.7 vs COPD -2.0 ± 3.3% baseline kJ^-1, p = 0.7481) and in the maximal voluntary activation (CRF-COPD -0.1 ± 3.9 vs COPD -0.9 ± 1.2 -2.0 ± 3.3% baseline kJ^-1, p = 0.4354). FSS and BDI were closely related (R = 0.5735, p = 0.0011), while no correlation between PF and NMF was found.

CONCLUSION

Patients with CRF-COPD develop higher levels of perceived fatigue and dyspnea than patients with COPD; while neuromuscular fatigue is similar, suggesting a mismatch between symptoms and neuromuscular dysfunction.

Exercise and physical performance in older adults with sarcopenic obesity: A systematic review

Background

Sarcopenic obesity is characterized by low muscle mass and high body fat; prevalence increases with age, particularly after age 65 years. For this systematic literature review we searched scientific databases for studies on exercise interventions for improving physical performance in adults with sarcopenic obesity; also, we identified potential gaps in clinical practice guidelines that need to be addressed.

Methods

We followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases were searched for studies published through November 2021 that measured physical performance in adults with sarcopenic obesity.

Results

Most of the studies applied a strength training protocol in which improvement was noted post-treatment on the Time Chair Rise (TCR), 30-s Chair Stand, and Single Leg Stance (SLS) tests. Discrepancies between the studies were observed when resistance training was combined with or without elastic bands or electromyostimulation, as measured with the Short Physical Performance Battery (SPPB), Physical Performance Test (PPT), Gait Speed, and Timed Up & Go (TUG) test. Post-intervention SPPB, PPT, and gait speed scores showed an increase or maintenance of performance, while TUG test scores were higher according to one study but lower according to another.

Conclusions

Engagement in physical exercise, and resistance training in particular, can improve or maintain physical performance in adults with sarcopenic obesity. Study samples should include more men. A future area of focus should be the impact of different types of training (aerobic, power training, combined modalities). Finally, studies with longer intervention periods and follow-up periods are needed to gain a better understanding of the effectiveness of exercise on physical function in adults with sarcopenic obesity.

Exploring the association between handgrip, lower limb muscle strength, and physical function in older adults: A narrative review

Widely used in daily practice, handgrip strength (HGS) is a low cost, easy-to-use, and portable test to assess overall muscle and physical function. It can be used as a stand-alone or a first-line tool for evaluating muscle weakness, though controversy surrounds its use for assessing global or lower limb muscle function. Lower limb mobility and physical activity are reduced with advancing age. This decline is difficult to quantify with isokinetic or isometric devices in routine settings (hospital and nursing home). For this narrative review we explored and summarized the findings of studies that investigated the association between HGS, lower limb muscle strength, and physical performance in older adults. The review also provides directions for future research. We noted contrasting findings for an association between HGS, lower limb strength, and physical performance. We found insufficient evidence for endorsing the handgrip dynamometer as a definitive tool for measuring overall muscle strength and physical function. More evidence is needed from comparable studies involving larger samples of men and women and investigating other areas such as lifestyle, daily physical activity levels, and health-related disorders.

Estimation of carotid-femoral pulse wave velocity from finger photoplethysmography signal

Objective. This project compared a new method to estimate the carotid-femoral pulse wave velocity (cf-PWV) to the gold-standard cf-PWV technique.Approach. The cf-PWV was estimated from the pulse transit time (FPS-PTT) calculated by processing the finger photoplethysmographic signal of Finapres (FPS) and subject's height only (brief mode) as well as along with other variables (age, heart rate, arterial pressure, weight; complete mode). Doppler ultrasound cf-PWVs and FPS-PTTs were measured in 90 participants equally divided into 3 groups (18-30; 31-59; 60-79 years). Predictions were performed using multiple linear regressions (MLR) and with the best regression model identified by using MATLAB Regression Learner App. A validation set approach (60 training datasets, 30 testing datasets; VSA) and leave-one-out cross-validation (LOOCV) were used.Main results. With MLR, the discrepancies were: 0.01 ± 1.21 m s^-1(VSA) and 0.001 ± 1.11 m s^-1(LOOCV) in brief mode; -0.02 ± 0.83 m s^-1(VSA) and 0.001 ± 0.84 m s^-1(LOOCV) in complete mode. Using a linear support vector machine model (SVM) in brief mode, the discrepancies were: 0.01 ± 1.19 m s^-1(VSA) and -0.01 ± 1.06 m s^-1(LOOCV). Using an Exponential Gaussian process regression model (GPR) in complete mode, the discrepancies were: -0.03 ± 0.79 m s^-1(VSA) and 0.01 ± 0.75 m s^-1(LOOCV).Significance. The cf-PWV can be estimated by processing the FPS-PTT and subjects' height only, but the inclusion of other variables improves the prediction performance. Predictions through MLR qualify as acceptable in both brief and complete modes. Predictions via linear SVM in brief mode improve but still qualify as acceptable. Interestingly, predictions through Exponential GPR in complete mode improve and qualify as excellent.

Sympathetic-mediated blunting of forearm vasodilation is similar between young men and women

BACKGROUND

The in-vivo regulation of vascular conductance (VC) is a continuous balance between endothelial vasodilation and sympathetic vasoconstriction. Although women may report blunted sympathetic vasoconstriction along with higher endothelial vasodilation than men, it is currently unknown whether the interaction between vasoconstriction and vasodilation leads to different regulation of VC between sexes. This study assessed sex differences in sympathetic-mediated blunting of endothelial vasodilation after a brief period of ischemia and whether any restriction of vasodilation blunts tissue blood flow (BF) and re-oxygenation.

METHODS

13 young women and 12 young men underwent two 5-min forearm circulatory occlusions followed by reperfusion, one in basal conditions and the other during cold pressor test-induced sympathetic activation (SYMP). Brachial artery diameter and BF, mean arterial pressure, total peripheral resistance (TPR), and thenar eminence oxygenation were collected. Percent changes normalized to baseline values of forearm VC, brachial artery BF and flow-mediated dilation (FMD), TPR, and hand oxygenation after circulatory reperfusion were calculated.

RESULTS

TPR increased during SYMP in men (p = 0.019) but not in women (p = 0.967). Women showed a greater brachial artery FMD than men (p = 0.004) at rest, but sex differences disappeared after normalization to shear rate and baseline diameter (p > 0.11). The percent increases from baseline of peak and average forearm VC after circulatory reperfusion did not differ between sexes in basal conditions (p > 0.98) or during SYMP (p > 0.97), and were restrained by SYMP similarly in both sexes (p < 0.003) without impairing the hand re-oxygenation (p > 0.08) or average hyperemic response (p > 0.09).

CONCLUSIONS

Although women may report blunted sympathetic vasoconstriction than men when assessed separately, the similar sympathetic-mediated restriction of vasodilation suggests a similar dynamic regulation of VC between sexes. SYMP-mediated restrictions of the normal forearm vasodilation do not impair the average hyperemic response and hand re-oxygenation in both sexes.

Effects of Low vs Moderate Dose of Recreational Football on Cardiovascular Risk Factors

This study aimed to compare the effectiveness of recreational football performed once (LOW) vs. twice (MOD) a week on cardiovascular risk factors in healthy, sedentary men. Body composition, resting blood pressure, blood lipid profile and maximal oxygen consumption (VO₂max) were measured at baseline, after a 12-week control and training period, using an interrupted time series study (study 1, n=18: n=8, LOW and n=10, MOD) nested in a randomised parallel trial (study 2, n=34: n=18 LOW and n=16 MOD). After the intervention in the study 1, LDL-Cholesterol (-12.3 mg•dL-¹ [-22.7 to -2.0]) and VO₂max (4.5 ml•kg-¹•min-¹ [1.2 to 7.8 ]) changed in LOW whereas differences were found in weight (-2.1 kg [-3.7 to -0.4]), BMI (-0.7 kg•m^-2 [-1.2 to -0.1]), total cholesterol (-22.2 mg•dL-¹ [-36.0 to -8.4]), no-HDL-cholesterol (-17.5 mg•dL-¹ [-30.5 to -4.5]), LDL-cholesterol (-14.9 mg•dL-¹ [-23.6 to -6.2]) and VO₂max (5.7 ml•kg-¹•min-¹ [2.8 to 8.6]) in MOD. Study 2 showed no evidence of differences between groups. Our results therefore, suggest positive health effects of recreational football even when performed at low frequency as it can happen in real context.

Effect of exercise on functional capacity in patients with advanced cancer: A meta-analysis of randomized controlled trials

PURPOSE

To determine the impact of exercise on functional capacity, measured through the "Six minutes walking test" (6MWT) in patients with advanced cancer stage.

METHODS

Systematic research on PubMed, Cochrane Library, and SportDiscus was conducted. Randomized controlled trials were eligible if they examined the effect of exercise on 6MWT.

RESULTS

Overall, a total of ten trials were included in the primary analysis. Compared to the controls, the exercise intervention was associated with an increase in functional capacity (+20.86 m; CI: -5.90 to 47.72, p = 0.12) although not reaching the statistical significance. Sensitivity analysis revealed an improvement for studies proposing a supervised exercise intervention towards the statistical significance. Few adverse events were associated with exercise training, and the median withdrawals rate was 17%.

CONCLUSIONS

Exercise may have a beneficial role on functional capacity in patients with advanced cancer, especially if supervised.