Effectiveness of Bio-K+ for the prevention of Clostridioides difficile infection: Stepped-wedge cluster-randomized controlled trial

OBJECTIVE

To evaluate the impact of administering probiotics to prevent Clostridioides difficile infection (CDI) among patients receiving therapeutic antibiotics.

DESIGN

Stepped-wedge cluster-randomized trial between September 1, 2016, and August 31, 2019.

SETTING

This study was conducted in 4 acute-care hospitals across an integrated health region.

PATIENTS

Hospitalized patients, aged ≥55 years.

METHODS

Patients were given 2 probiotic capsules daily (Bio-K+, Laval, Quebec, Canada), containing 50 billion colony-forming units of Lactobacillus acidophilus CL1285, L. casei LBC80R, and L. rhamnosus CLR2. We measured hospital-acquired CDI (HA-CDI) and the number of positive C. difficile tests per 10,000 patient days as well as adherence to administration of Bio-K+ within 48 and 72 hours of antibiotic administration. Mixed-effects generalized linear models, adjusted for influenza admissions and facility characteristics, were used to evaluate the impact of the intervention on outcomes.

RESULTS

Overall adherence of Bio-K+ administration ranged from 76.9% to 84.6% when stratified by facility and periods. Rates of adherence to administration within 48 and 72 hours of antibiotic treatment were 60.2% -71.4% and 66.7%-75.8%, respectively. In the adjusted analysis, there was no change in HA-CDI (incidence rate ratio [IRR], 0.92; 95% confidence interval [CI], 0.68-1.23) or C. difficile positivity rate (IRR, 1.05; 95% CI, 0.89-1.24). Discharged patients may not have received a complete course of Bio-K+. Our hospitals had a low baseline incidence of HA-CDI. Patients who did not receive Bio-K+ may have differential risks of acquiring CDI, introducing selection bias.

CONCLUSIONS

Hospitals considering probiotics as a primary prevention strategy should consider the baseline incidence of HA-CDI in their population and timing of probiotics relative to the start of antimicrobial administration.

Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection

BACKGROUND

Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +).

METHODS

We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research.

RESULTS

A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals.

CONCLUSIONS

Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.

More than energy cost: multiple benefits of the long Achilles tendon in human walking and running

Elastic strain energy that is stored and released from long, distal tendons such as the Achilles during locomotion allows for muscle power amplification as well as for reduction of the locomotor energy cost: as distal tendons perform mechanical work during recoil, plantar flexor muscle fibres can work over smaller length ranges, at slower shortening speeds, and at lower activation levels. Scant evidence exists that long distal tendons evolved in humans (or were retained from our more distant Hominoidea ancestors) primarily to allow high muscle-tendon power outputs, and indeed we remain relatively powerless compared to many other species. Instead, the majority of evidence suggests that such tendons evolved to reduce total locomotor energy cost. However, numerous additional, often unrecognised, advantages of long tendons may speculatively be of greater evolutionary advantage, including the reduced limb inertia afforded by shorter and lighter muscles (reducing proximal muscle force requirement), reduced energy dissipation during the foot-ground collisions, capacity to store and reuse the muscle work done to dampen the vibrations triggered by foot-ground collisions, reduced muscle heat production (and thus core temperature), and attenuation of work-induced muscle damage. Cumulatively, these effects should reduce both neuromotor fatigue and sense of locomotor effort, allowing humans to choose to move at faster speeds for longer. As these benefits are greater at faster locomotor speeds, they are consistent with the hypothesis that running gaits used by our ancestors may have exerted substantial evolutionary pressure on Achilles tendon length. The long Achilles tendon may therefore be a singular adaptation that provided numerous physiological, biomechanical, and psychological benefits and thus influenced behaviour across multiple tasks, both including and additional to locomotion. While energy cost may be a variable of interest in locomotor studies, future research should consider the broader range of factors influencing our movement capacity, including our decision to move over given distances at specific speeds, in order to understand more fully the effects of Achilles tendon function as well as changes in this function in response to physical activity, inactivity, disuse and disease, on movement performance.

Ischemic Preconditioning, But Not Priming Exercise, Improves Exercise Performance in Trained Rock Climbers

ABSTRACT

MacDougall, KB, McClean, ZJ, MacIntosh, BR, Fletcher, JR, and Aboodarda, SJ. Ischemic preconditioning, but not priming exercise, improves exercise performance in trained rock climbers. J Strength Cond Res 37(11): 2149-2157, 2023-To assess the effects of ischemic preconditioning (IPC) and priming exercise on exercise tolerance and performance fatigability in a rock climbing-specific task, 12 rock climbers completed familiarization and baseline tests, and constant-load hangboarding tests (including 7 seconds on and 3 seconds off at an intensity estimated to be sustained for approximately 5 minutes) under 3 conditions: (a) standardized warm-up (CON), (b) IPC, or (c) a priming warm-up (PRIME). Neuromuscular responses were assessed using the interpolated twitch technique, including maximum isometric voluntary contraction (MVC) of the finger flexors and median nerve stimulation, at baseline and after the performance trial. Muscle oxygenation was measured continuously using near-infrared spectroscopy (NIRS) across exercise. Time to task failure (T lim ) for IPC (316.4 ± 83.1 seconds) was significantly greater than CON (263.6 ± 69.2 seconds) ( p = 0.028), whereas there was no difference between CON and PRIME (258.9 ± 101.8 seconds). At task failure, there were no differences in MVC, single twitch force, or voluntary activation across conditions; however, recovery of MVC and single twitch force after the performance trial was delayed for IPC and PRIME compared with CON ( p < 0.05). Despite differences in T lim , there were no differences in any of the NIRS variables assessed. Overall, despite exercise tolerance being improved by an average of 20.0% after IPC, there were no differences in neuromuscular responses at task failure, which is in line with the notion of a critical threshold of peripheral fatigue. These results indicate that IPC may be a promising precompetition strategy for rock climbers, although further research is warranted to elucidate its mechanism of action.

Is Running Power a Useful Metric? Quantifying Training Intensity and Aerobic Fitness Using Stryd Running Power Near the Maximal Lactate Steady State

We sought to determine the utility of Stryd, a commercially available inertial measurement unit, to quantify running intensity and aerobic fitness. Fifteen (eight male, seven female) runners (age = 30.2 [4.3] years; V·O2max = 54.5 [6.5] ml·kg-1·min-1) performed moderate- and heavy-intensity step transitions, an incremental exercise test, and constant-speed running trials to establish the maximal lactate steady state (MLSS). Stryd running power stability, sensitivity, and reliability were evaluated near the MLSS. Stryd running power was also compared to running speed, V·O2, and metabolic power measures to estimate running mechanical efficiency (EFF) and to determine the efficacy of using Stryd to delineate exercise intensities, quantify aerobic fitness, and estimate running economy (RE). Stryd running power was strongly associated with V·O2 (R2 = 0.84; p < 0.001) and running speed at the MLSS (R2 = 0.91; p < 0.001). Stryd running power measures were strongly correlated with RE at the MLSS when combined with metabolic data (R2 = 0.79; p < 0.001) but not in isolation from the metabolic data (R2 = 0.08; p = 0.313). Measures of running EFF near the MLSS were not different across intensities (~21%; p > 0.05). In conclusion, although Stryd could not quantify RE in isolation, it provided a stable, sensitive, and reliable metric that can estimate aerobic fitness, delineate exercise intensities, and approximate the metabolic requirements of running near the MLSS.

Validity of the Entralpi force plate in the assessment of finger flexor performance metrics in rock climbers

This study assessed the validity of the Entralpi force plate in the assessment of finger flexor performance in rock climbers. In addition to a static force evaluation, peak force, peak impulse, and total impulse were measured during 30 all-out performance trials by 15 participants, in which force during the trials was recorded simultaneously by the Entralpi and a Pasco force plate. Agreement between devices was assessed by a variety of statistical analyses, including intraclass correlation coefficient (ICC), coefficient of variation (CV), and Bland-Altman analyses. The static force evaluation showed a mean relative error of 0.41% and excellent day-to-day reliability (ICC = 1; CV = 0.03%). Peak force, peak impulse, and total impulse from the performance trials demonstrated strong agreement (ICC ≥ 0.991, CV ≤ 1.9%, Bland-Altman mean bias ≤ 0.5%). These results illustrate that the Entralpi force plate provides accurate and reliable data for rock climbing related tasks at an affordable cost.

Test-Retest Reliability of a 4-Minute All-Out Critical Force Test in Rock Climbers

The purpose of this study was to assess the test-retest reliability of a 4-minute all-out critical force test in well-trained rock climbers. Thirteen rock climbers (n=4 females) completed a familiarization session and two all-out critical force tests on different days. During each trial, participants completed 24 repetitions of 7s right-handed, maximal effort hangs from a 20mm edge interspersed with 3 s rest. The end-test force (EF; i.e., critical force), impulse above EF (IEF), and peak force achieved during the test were analyzed with paired t-tests to determine differences between trials. Intraclass correlation coefficient (ICC), coefficient of variation (CV), and Bland-Altman analysis were performed to quantify the relative and absolute reliability of the measure, respectively. The level of significance for this study was set at p<0.05. There were no significant differences between trials for any of the reported variables (P≥0.455). For EF, IEF, and peak force, ICC was 0.848, 0.820, and 0.938, respectively; and CV was 21.0%, 13.2%, and 5.6%, respectively. Bland-Altman analyses showed a mean relative bias of -2.3%, -2.8%, and -1.3%, with 95% limits of agreement (LoA) of -62.6% to 58.1%, -40.5% to 30.9%, and -17.2% to 14.6% for EF, IEF, and peak force, respectively, however linear regression revealed a significant proportional bias for EF (p = 0.026, R2 = 0.377). The reliability of this protocol was good to excellent for all parameters; however, there was larger intra-individual variability for EF and IEF. This study suggests that when using the 4-min all-out critical force test in rock climbers, coaches and athletes should be aware that there may be a trade-off between the test's practicality and the precision of its results.

How do differences in Achilles' tendon moment arm lengths affect muscle-tendon dynamics and energy cost during running?

Introduction

The relationship between the Achilles tendon moment arm length (AT_MA) and the energy cost of running (E_run) has been disputed. Some studies suggest a short AT_MA reduces E_run while others claim a long AT_MA reduces E_run. For a given ankle joint moment, a short AT_MA permits a higher tendon strain energy storage, whereas a long AT_MA reduces muscle fascicle force and muscle energy cost but shortening velocity is increased, elevating the metabolic cost. These are all conflicting mechanisms to reduce E_run, since AT energy storage comes at a metabolic cost. Neither of these proposed mechanisms have been examined together.

Methods

We measured AT_MA using the tendon travel method in 17 males and 3 females (24 ± 3 years, 75 ± 11 kg, 177 ± 7 cm). They ran on a motorized treadmill for 10 min at 2.5 m · s^-1 while E_run was measured. AT strain energy storage, muscle lengths, velocities and muscle energy cost were calculated during time-normalized stance from force and ultrasound data. A short (SHORT n = 11, AT_MA = 29.5 ± 2.0 mm) and long (LONG, n = 9, AT_MA = 36.6 ± 2.5 mm) AT_MA group was considered based on a bimodal distribution of measured AT_MA.

Results

Mean E_run was 4.9 ± 0.4 J · kg^-1 · m^-1. The relationship between AT_MA and E_run was not significant (r ² = 0.13, p = 0.12). Maximum AT force during stance was significantly lower in LONG (5,819 ± 1,202 N) compared to SHORT (6,990 ± 920 N, p = 0.028). Neither AT stretch nor AT strain energy storage was different between groups (mean difference: 0.3 ± 1 J · step^-1, p = 0.84). Fascicle force was significantly higher in SHORT (508 ± 93 N) compared to LONG (468 ± 84 N. p = 0.02). Fascicle lengths and velocities were similar between groups (p > 0.72). Muscle energy cost was significantly lower in LONG (0.028 ± 0.08 J · kg · step^-1) compared to SHORT (0.045 ± 0.14 J · kg · step^-1 p = 0.004). There was a significant negative relationship between AT_MA and total muscle energy cost relative to body mass across the stance phase (r = -0.699, p < 0.001).

Discussion

Together these results suggest that a LONG AT_MA serves to potentially reduce E_run by reducing the muscle energy cost of the plantarflexors during stance. The relative importance of AT energy storage and return in reducing E_run should be re-considered.

Can changes in midsole bending stiffness of shoes affect the onset of joint work redistribution during a prolonged run?

PURPOSE

This study aimed to investigate if changing the midsole bending stiffness of athletic footwear can affect the onset of lower limb joint work redistribution during a prolonged run.

METHODS

Fifteen trained male runners (10-km time of <44 min) performed 10-km runs at 90% of their individual speed at lactate threshold (i.e., when change in lactate exceeded 1 mmol/L during an incremental running test) in a control and stiff shoe condition on 2 occasions. Lower limb joint kinematics and kinetics were measured using a motion capture system and a force-instrumented treadmill. Data were acquired every 500 m.

RESULTS

Prolonged running resulted in a redistribution of positive joint work from distal to proximal joints in both shoe conditions. Compared to the beginning of the run, less positive work was performed at the ankle (approximately 9%; p ≤ 0.001) and more positive work was performed at the knee joint (approximately 17%; p ≤ 0.001) at the end of the run. When running in the stiff shoe condition, the onset of joint work redistribution at the ankle and knee joints occurred at a later point during the run.

CONCLUSION

A delayed onset of joint work redistribution in the stiff condition may result in less activated muscle volume, because ankle plantar flexor muscles have shorter muscles fascicles and smaller cross-sectional areas compared to knee extensor muscles. Less active muscle volume could be related to previously reported decreases in metabolic cost when running in stiff footwear. These results contribute to the notion that footwear with increased stiffness likely results in reductions in metabolic cost by delaying joint work redistribution from distal to proximal joints.

Triceps Surae Muscle-Tendon Properties as Determinants of the Metabolic Cost in Trained Long-Distance Runners

Purpose: This study aimed to determine whether triceps surae’s muscle architecture and Achilles tendon parameters are related to running metabolic cost (C) in trained long-distance runners.

Methods: Seventeen trained male recreational long-distance runners (mean age = 34 years) participated in this study. C was measured during submaximal steady-state running (5 min) at 12 and 16 km h^–1 on a treadmill. Ultrasound was used to determine the gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and soleus (SO) muscle architecture, including fascicle length (FL) and pennation angle (PA), and the Achilles tendon cross-sectional area (CSA), resting length and elongation as a function of plantar flexion torque during maximal voluntary plantar flexion. Achilles tendon mechanical (force, elongation, and stiffness) and material (stress, strain, and Young’s modulus) properties were determined. Stepwise multiple linear regressions were used to determine the relationship between independent variables (tendon resting length, CSA, force, elongation, stiffness, stress, strain, Young’s modulus, and FL and PA of triceps surae muscles) and C (J kg^–1m^–1) at 12 and 16 km h^–1.

Results: SO PA and Achilles tendon CSA were negatively associated with C (r² = 0.69; p < 0.001) at 12 km h^–1, whereas SO PA was negatively and Achilles tendon stress was positively associated with C (r² = 0.63; p = 0.001) at 16 km h^–1, respectively. Our results presented a small power, and the multiple linear regression’s cause-effect relation was limited due to the low sample size.

Conclusion: For a given muscle length, greater SO PA, probably related to short muscle fibers and to a large physiological cross-sectional area, may be beneficial to C. Larger Achilles tendon CSA may determine a better force distribution per tendon area, thereby reducing tendon stress and C at submaximal speeds (12 and 16 km h^–1). Furthermore, Achilles tendon morphological and mechanical properties (CSA, stress, and Young’s modulus) and triceps surae muscle architecture (GM PA, GM FL, SO PA, and SO FL) presented large correlations with C.

Successful treatment of a chronic oroantral fistula infected with extensively drug resistant bacteria using long-term oesophageal tube feeding and several non-conventional treatments in a horse

BACKGROUND

Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses.

CASE REPORT

An 8-year-old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim-sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug-resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116.

CONCLUSION

These non-conventional therapeutics, antimicrobials and long-term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.

How Can Biomechanics Improve Physical Preparation and Performance in Paralympic Athletes? A Narrative Review

Recent research in Paralympic biomechanics has offered opportunities for coaches, athletes, and sports practitioners to optimize training and performance, and recent systematic reviews have served to summarize the state of the evidence connecting biomechanics to Paralympic performance. This narrative review serves to provide a comprehensive and critical evaluation of the evidence related to biomechanics and Paralympic performance published since 2016. The main themes within this review focus on sport-specific body posture: the standing, sitting, and horizontal positions of current summer Paralympic sports. For standing sports, sprint and jump mechanics were assessed in athletes with cerebral palsy and in lower-limb amputee athletes using running-specific prostheses. Our findings suggest that running and jumping-specific prostheses should be ‘tuned’ to each athlete depending on specific event demands to optimize performance. Standing sports were also inclusive to athletes with visual impairments. Sitting sports comprise of athletes performing on a bike, in a wheelchair (WC), or in a boat. WC configuration is deemed an important consideration for injury prevention, mobility, and performance. Other sitting sports like hand-cycling, rowing, and canoeing/kayaking should focus on specific sitting positions (e.g., arm-crank position, grip, or seat configuration) and ways to reduce aero/hydrodynamic drag. Para-swimming practitioners should consider athlete-specific impairments, including asymmetrical anthropometrics, on the swim-start and free-swim velocities, with special considerations for drag factors. Taken together, we provide practitioners working in Paralympic sport with specific considerations on disability and event-specific training modalities and equipment configurations to optimize performance from a biomechanical perspective.

Age-related reductions in the number of serial sarcomeres contribute to shorter fascicle lengths but not elevated passive tension

We investigated age-related changes to fascicle length, sarcomere length and serial sarcomere number (SSN), and how this affects passive force. Following mechanical testing to determine passive force, the medial gastrocnemius muscle of young (n=9) and old (n=8) Fisher 344BN hybrid rats was chemically fixed at the optimal muscle length for force production; individual fascicles were dissected for length measurement, and laser diffraction was used to assess sarcomere length. Old rats had ∼14% shorter fascicle lengths than young rats, which was driven by a ∼10% reduction in SSN, with no difference in sarcomere length (∼4%). Passive force was greater in the old than in the young rats at long muscle lengths. Shorter fascicle lengths and reduced SSN in the old rats could not entirely explain increased passive forces for absolute length changes, owing to a slight reduction in sarcomere length in old rats, resulting in similar sarcomere length at long muscle lengths.

Mechanisms of reduced plantarflexor function in Cerebral palsy: smaller triceps surae moment arm and reduced muscle force

Both muscle forces, and moment arm (MA) could contribute to reduced muscle moment in people with Cerebral Palsy (CP). Current reports in CP are conflicting. The tendon travel method of estimating MA requires constant force, but passive force is high and variable in CP, and range of motion is limited. Therefore, the purpose of this study was to examine triceps surae muscle MA in 12 subjects with mild to moderate CP (15-32 years) and 10 typically developing peers (TD, 17-26 years) by tendon travel and by visually measuring the apparent MA. MA was calculated at 90° and at a reference angle (∼106°) with zero net passive moment. The tendon travel (28.8 ± 5.6 mm) and visual methods (29.1 ± 5.5 mm) yielded similar MA in CP (p = 0.94) at the reference angle. TD had significantly larger triceps surae muscle MA than CP subjects (p = 0.002), 35.4 ± 4.1 mm at the reference angle for tendon travel and 35.4 ± 3.6 mm by the visual method. Test/retest revealed less bias (0.8 mm) using the visual method. Calculated active peak isometric force was significantly less in CP (1983.8 ± 887.0 N) than TD (4104.9 ± 1154.9 N, p < 0.001). There are challenges in estimating MA in CP, but the visual method is more reliable. Although a shorter moment arm would reduce the joint moment, joint angular velocity for a given velocity of muscle shortening would be enhanced. Strength training may mitigate the effects of the smaller moment arm and reduced joint moment generated in those with CP.

The Effects of Increased Midsole Bending Stiffness of Sport Shoes on Muscle-Tendon Unit Shortening and Shortening Velocity: a Randomised Crossover Trial in Recreational Male Runners

BACKGROUND

Individual compliances of the foot-shoe interface have been suggested to store and release elastic strain energy via ligamentous and tendinous structures or by increased midsole bending stiffness (MBS), compression stiffness, and resilience of running shoes. It is unknown, however, how these compliances interact with each other when the MBS of a running shoe is increased. The purpose of this study was to investigate how structures of the foot-shoe interface are influenced during running by changes to the MBS of sport shoes.

METHODS

A randomised crossover trial was performed, where 13 male, recreational runners ran on an instrumented treadmill at 3.5 m·s-1 while motion capture was used to estimate foot arch, plantar muscle-tendon unit (pMTU), and shank muscle-tendon unit (sMTU) behaviour in two conditions: (1) control shoe and (2) the same shoe with carbon fibre plates inserted to increase the MBS.

RESULTS

Running in a shoe with increased MBS resulted in less deformation of the arch (mean ± SD; stiff, 7.26 ± 1.78°; control, 8.84 ± 2.87°; p ≤ 0.05), reduced pMTU shortening (stiff, 4.39 ± 1.59 mm; control, 6.46 ± 1.42 mm; p ≤ 0.01), and lower shortening velocities of the pMTU (stiff, - 0.21 ± 0.03 m·s-1; control, - 0.30 ± 0.05 m·s-1; p ≤ 0.01) and sMTU (stiff, - 0.35 ± 0.08 m·s-1; control, - 0.45 ± 0.11 m·s-1; p ≤ 0.001) compared to a control condition. The positive and net work performed at the arch and pMTU, and the net work at the sMTU were significantly lower in the stiff compared to the control condition.

CONCLUSION

The findings of this study showed that if a compliance of the foot-shoe interface is altered during running (e.g. by increasing the MBS of a shoe), the mechanics of other structures change as well. This could potentially affect long-distance running performance.

Does increased midsole bending stiffness of sport shoes redistribute lower limb joint work during running?

OBJECTIVES

To investigate if lower limb joint work is redistributed when running in a shoe with increased midsole bending stiffness compared to a control shoe.

DESIGN

Within-subject with two conditions: (1) commercially available running shoe and (2) the same shoe with carbon fibre inserts to increase midsole bending stiffness.

METHODS

Thirteen male, recreational runners ran on an instrumented treadmill at 3.5m/s in each of the two shoe conditions while motion capture and force platform data were collected. Positive and negative metatarsophalangeal (MTP), ankle, knee, and hip joint work were calculated and statistically compared between conditions.

RESULTS

Running in the stiff condition (with carbon fibre inserts) resulted in significantly more positive work and less negative work at the MTP joint, and less positive work at the knee joint.

CONCLUSIONS

Increased midsole bending stiffness resulted in a redistribution of positive lower limb joint work from the knee to the MTP joint. A larger MTP joint plantarflexor moment due to increased vGRF at the instant of peak positive power and an earlier onset of MTP joint plantarflexion velocity were identified as the reasons for lower limb joint work redistribution.

The effect of torsional shoe sole stiffness on knee moment and gross efficiency in cycling

Altering torsional stiffness of cycling shoe soles may be a novel approach to reducing knee joint moments and overuse injuries during cycling. We set out to determine if the magnitude of three-dimensional knee moments were different between cycling shoe soles with different torsional stiffnesses. Eight trained male cyclists cycled at 90% lactate threshold power output in one of two cycling shoe conditions in a randomized crossover design. The shoe sole was considered torsionally flexible (FLEX) compared to a relatively stiffer (STIFF) sole. Gross efficiency (GE) and knee joint moments were quantified. No significant effect of shoe condition was seen in GE (21.4 ± 1.1% and 20.9 ± 1.6% for FLEX and STIFF, respectively, P = 0.12), nor in three-dimensional knee moments. 4 of the 8 subjects had reduced knee moments in at least 2 of the 3 moment directions. These "responders" were significantly shorter (1.73 ± 0.02 m vs 1.81 ± 0.04 m, P = 0.017) and had a higher relative maximal aerobic power (MAP) (4.6 ± 0.3 W∙kg-1 vs 3.9 ± 0.3 W∙kg-1, P = 0.024) compared to non-responders. These results suggest that certain shoe characteristics may influence certain individuals differently because these participants belong to different "functional groups"; certain individuals may respond positively to FLEX, while others may not. Further studies should test this proposed hypothesis.

Changes in Achilles tendon stiffness and energy cost following a prolonged run in trained distance runners

During prolonged running, the magnitude of Achilles tendon (AT) length change may increase, resulting in increased tendon strain energy return with each step. AT elongation might also affect the magnitude of triceps surae (TS) muscle shortening and shortening velocity, requiring greater activation and increased muscle energy cost. Therefore, we aimed to quantify the tendon strain energy return and muscle energy cost necessary to allow energy storage to occur prior to and following prolonged running. 14 trained male (n = 10) and female (n = 4) distance runners (24±4 years, 1.72±0.09 m, 61±10 kg, [Formula: see text] 64.6±5.8 ml•kg-1•min-1) ran 90 minutes (RUN) at approximately 85% of lactate threshold speed (sLT). Prior to and following RUN, AT stiffness and running energy cost (Erun) at 85% sLT were determined. AT energy return was calculated from AT stiffness, measured with dynamometry and ultrasound and estimated TS force during stance. TS energy cost was estimated on the basis of AT force and assumed crossbridge mechanics and energetics. Following RUN, AT stiffness was reduced from 328±172 N•mm-1 to 299±148 N•mm-1 (p = 0.022). Erun increased from 4.56±0.32 J•kg-1•m-1 to 4.62±0.32 J•kg-1•m-1 (p = 0.049). Estimated AT energy return was not different following RUN (p = 0.99). Estimated TS muscle energy cost increased significantly by 11.8±12.3 J•stride-1, (p = 0.0034), accounting for much of the post-RUN increase in Erun (8.6±14.5 J•stride-1,r2 = 0.31). These results demonstrate that a prolonged, submaximal run can reduce AT stiffness and increase Erun in trained runners, and that the elevated TS energy cost contributes substantially to the elevated Erun.

Estimates of Achilles Tendon Moment Arm Length at Different Ankle Joint Angles: Effect of Passive Moment

The length of a muscle's moment arm can be estimated noninvasively using ultrasound and the tendon excursion method. The main assumption with the tendon excursion method is that the force acting on the tendon during passive rotation is constant. However, passive force changes through the range of motion, and thus moment arm is underestimated. The authors attempted to account for passive force on the measurement of Achilles tendon moment arm using the tendon excursion method in 8 male and female runners. Tendon excursion was measured using ultrasound while the ankle was passively rotated at 0.17 rad·s-1. Moment arm was calculated at 5° intervals as the ratio of tendon displacement to joint rotation from 70° to 115°. Passive moment (MP) was measured using a dynamometer. The displacement attributable to MP was calculated by monitoring tendon displacement during a ramp isometric maximum contraction. MP was 5.7 (2.1) N·m at 70° and decreased exponentially from 70° to 90°. This resulted in MP-corrected moment arms that were significantly larger than uncorrected moment arms at joint angles where MP was present. Furthermore, MP-corrected moment arms did not change with ankle angle, which was not the case for uncorrected moment arms.

Theoretical considerations for muscle-energy savings during distance running

We have recently demonstrated that the triceps surae muscles energy cost (EC_TS) represents a substantial portion of the total metabolic cost of running (E_run). Therefore, it seems relevant to evaluate the factors which dictate EC_TS, namely the amount and velocity of shortening, since it is likely these factors will dictate E_run. E_run and triceps surae morphological and AT mechanical properties were obtained in 46 trained and elite male and female distance runners using ultrasonography and dynamometry. EC_TS (J·stride^-1) at the speed of lactate threshold (sLT) was estimated from AT force and crossbridge mechanics and energetics. To estimate the relative impact of these factors on EC_TS, mean values for running speed, body mass, resting fascicle length (L_f), Achilles tendon stiffness and moment arm and maximum isometric plantarflexion torque were obtained. EC_TS was calculated across a range (mean ± 1 sd) of values for each independent factor. Average sLT was 233 m·min^-1. At this speed, EC_TS was 255 J·stride^-1. Estimated fascicle shortening velocity was 0.08 V_max and the level of muscle activation was 84.7% of maximum isometric torque. Compared to the EC_TS calculated from the lowest range of values obtained for each independent factor, higher AT stiffness was associated with a 39% reduction in EC_TS, 81% reduction in fascicle shortening velocity and a 31% reduction in muscle activation. Longer AT moment arms and elevated body masses were associated with an increase in EC_TS of 18% and 23%, respectively. These results demonstrate that a low EC_TS is achieved primarily from a high AT stiffness and low body mass, which is exemplified in elite distance runners.

Engineering Approaches to Assessing Hydration Status

Dehydration is a common condition characterized by a decrease in total body water. Acute dehydration can cause physical and cognitive impairment, heat stroke and exhaustion, and, if severe and uncorrected, even death. The health effects of chronic mild dehydration are less well studied with urolithiasis (kidney stones) the only condition consistently associated with it. Aside from infants and those with particular medical conditions, athletes, military personnel, manual workers, and older adults are at particular risk of dehydration due to their physical activity, environmental exposure, and/or challenges in maintaining fluid homeostasis. This review describes the different approaches that have been explored for hydration assessment in adults. These include clinical indicators perceived by the patient or detected by a practitioner and routine laboratory analyses of blood and urine. These techniques have variable accuracy and practicality outside of controlled environments, creating a need for simple, portable, and rapid hydration monitoring devices. We review the wide array of devices proposed for hydration assessment based on optical, electromagnetic, chemical, and acoustical properties of tissue and bodily fluids. However, none of these approaches has yet emerged as a reliable indicator in diverse populations across various settings, motivating efforts to develop new methods of hydration assessment.

Running Economy from a Muscle Energetics Perspective

The economy of running has traditionally been quantified from the mass-specific oxygen uptake; however, because fuel substrate usage varies with exercise intensity, it is more accurate to express running economy in units of metabolic energy. Fundamentally, the understanding of the major factors that influence the energy cost of running (Erun) can be obtained with this approach. Erun is determined by the energy needed for skeletal muscle contraction. Here, we approach the study of Erun from that perspective. The amount of energy needed for skeletal muscle contraction is dependent on the force, duration, shortening, shortening velocity, and length of the muscle. These factors therefore dictate the energy cost of running. It is understood that some determinants of the energy cost of running are not trainable: environmental factors, surface characteristics, and certain anthropometric features. Other factors affecting Erun are altered by training: other anthropometric features, muscle and tendon properties, and running mechanics. Here, the key features that dictate the energy cost during distance running are reviewed in the context of skeletal muscle energetics.

Achilles tendon strain energy in distance running: consider the muscle energy cost

The return of tendon strain energy is thought to contribute to reducing the energy cost of running (Erun). However, this may not be consistent with the notion that increased Achilles tendon (AT) stiffness is associated with a lower Erun. Therefore, the purpose of this study was to quantify the potential for AT strain energy return relative to Erun for male and female runners of different abilities. A total of 46 long distance runners [18 elite male (EM), 12 trained male (TM), and 16 trained female (TF)] participated in this study. Erun was determined by indirect calorimetry at 75, 85, and 95% of the speed at lactate threshold (sLT), and energy cost per stride at each speed was estimated from previously reported stride length (SL)-speed relationships. AT force during running was estimated from reported vertical ground reaction force (Fz)-speed relationships, assuming an AT:ground reaction force moment arm ratio of 1.5. AT elongation was quantified during a maximal voluntary isometric contraction using ultrasound. Muscle energy cost was conservatively estimated on the basis of AT force and estimated cross-bridge mechanics and energetics. Significant group differences existed in sLT (EM > TM > TF; P < 0.001). A significant group × speed interaction was found in the energy storage/release per stride (TM > TF > EM; P < 0.001), the latter ranging from 10 to 70 J/stride. At all speeds and in all groups, estimated muscle energy cost exceeded energy return (P < 0.001). These results show that during distance running the muscle energy cost is substantially higher than the strain energy release from the AT.

Energy cost of running and Achilles tendon stiffness in man and woman trained runners

The energy cost of running (E_run), a key determinant of distance running performance, is influenced by several factors. Although it is important to express E_run as energy cost, no study has used this approach to compare similarly trained men and women. Furthermore, the relationship between Achilles tendon (AT) stiffness and E_run has not been compared between men and women. Therefore, our purpose was to determine if sex‐specific differences in E_run and/or AT stiffness existed. E_run (kcal kg⁻¹ km⁻¹) was determined by indirect calorimetry at 75%, 85%, and 95% of the speed at lactate threshold (sLT) on 11 man (mean ± SEM, 35 ± 1 years, 177 ± 1 cm, 78 ± 1 kg, 1 = 56 ± 1 mL kg⁻¹ min⁻¹) and 18 woman (33 ± 1 years, 165 ± 1 cm, 58 ± 1 kg, 2 = 50 ± 0.3 mL kg⁻¹ min⁻¹) runners. AT stiffness was measured using ultrasound with dynamometry. Man E_run was 1.01 ± 0.06, 1.04 ± 0.07, and 1.07 ± 0.07 kcal kg⁻¹ km⁻¹. Woman E_run was 1.05 ± 0.10, 1.07 ± 0.09, and 1.09 ± 0.10 kcal kg⁻¹ km⁻¹. There was no significant sex effect for E_run or RER, but both increased with speed (P < 0.01) expressed relative to sLT. High‐range AT stiffness was 191 ± 5.1 N mm⁻¹ for men and 125 ± 5.5 N mm⁻¹, for women (P < 0.001). The relationship between low‐range AT stiffness and E_run was significant at all measured speeds for women (r² = 0.198, P < 0.05), but not for the men. These results indicate that when E_run is measured at the same relative intensity, there are no sex‐specific differences in E_run or substrate use. Furthermore, differences in E_run cannot be explained solely by differences in AT stiffness.

Here, we show that when energy cost of running is normalized to body mass, at similar relative speeds of running, no sex‐specific differences in substrate use nor in the energy cost of running exist among similarly trained runners. Furthermore, the stiffness of the Achilles tendon (AT) of women is lower than in males, but the relationship between E_run and AT stiffness is not different between the sexes.

Procedures for rat in situ skeletal muscle contractile properties

There are many circumstances where it is desirable to obtain the contractile response of skeletal muscle under physiological circumstances: normal circulation, intact whole muscle, at body temperature. This includes the study of contractile responses like posttetanic potentiation, staircase and fatigue. Furthermore, the consequences of disease, disuse, injury, training and drug treatment can be of interest. This video demonstrates appropriate procedures to set up and use this valuable muscle preparation. To set up this preparation, the animal must be anesthetized, and the medial gastrocnemius muscle is surgically isolated, with the origin intact. Care must be taken to maintain the blood and nerve supplies. A long section of the sciatic nerve is cleared of connective tissue, and severed proximally. All branches of the distal stump that do not innervate the medial gastrocnemius muscle are severed. The distal nerve stump is inserted into a cuff lined with stainless steel stimulating wires. The calcaneus is severed, leaving a small piece of bone still attached to the Achilles tendon. Sonometric crystals and/or electrodes for electromyography can be inserted. Immobilization by metal probes in the femur and tibia prevents movement of the muscle origin. The Achilles tendon is attached to the force transducer and the loosened skin is pulled up at the sides to form a container that is filled with warmed paraffin oil. The oil distributes heat evenly and minimizes evaporative heat loss. A heat lamp is directed on the muscle, and the muscle and rat are allowed to warm up to 37°C. While it is warming, maximal voltage and optimal length can be determined. These are important initial conditions for any experiment on intact whole muscle. The experiment may include determination of standard contractile properties, like the force-frequency relationship, force-length relationship, and force-velocity relationship. With care in surgical isolation, immobilization of the origin of the muscle and alignment of the muscle-tendon unit with the force transducer, and proper data analysis, high quality measurements can be obtained with this muscle preparation.

Economy of running: beyond the measurement of oxygen uptake

The purpose of this study was to compare running economy across three submaximal speeds expressed as both oxygen cost (mlxkg(-1)xkm(-1)) and the energy required to cover a given distance (kcalxkg(-1)xkm(-1)) in a group of trained male distance runners. It was hypothesized that expressing running economy in terms of caloric unit cost would be more sensitive to changes in speed than oxygen cost by accounting for differences associated with substrate utilization. Sixteen highly trained male distance runners [maximal oxygen uptake (Vo(2max)) 66.5 +/- 5.6 mlxkg(-1)xmin(-1), body mass 67.9 +/- 7.3 kg, height 177.6 +/- 7.0 cm, age 24.6 +/- 5.0 yr] ran on a motorized treadmill for 5 min with a gradient of 0% at speeds corresponding to 75%, 85%, and 95% of speed at lactate threshold with 5-min rest between stages. Oxygen uptake was measured via open-circuit calorimetry. Average oxygen cost was 221 +/- 19, 217 +/- 15, and 221 +/- 13 mlxkg(-1)xkm(-1), respectively. Caloric unit cost was 1.05 +/- 0.09, 1.07 +/- 0.08, and 1.11 +/- 0.07 kcalxkg(-1)xkm(-1) at the three trial speeds, respectively. There was no difference in oxygen cost with respect to speed (P = 0.657); however, caloric unit cost significantly increased with speed (P < 0.001). It was concluded that expression of running economy in terms of caloric unit cost is more sensitive to changes in speed and is a more valuable expression of running economy than oxygen uptake, even when normalized per distance traveled.