Effects of morning vs. evening combined strength and endurance training on physical performance, sleep and well-being

The aim of the present study was to examine how combined strength and endurance training in the morning and evening influences the adaptations in strength and endurance performance, perception of time management, psychological well-being and sleep. The combined training period lasted for 24 weeks and the participants were divided into the morning training (MG, n = 18), evening training (EG, n = 24) and control groups (CG, n = 10). Isometric leg press force (iLP), maximal oxygen consumption (VO₂max), sleep behavior, fatigue, time management, motivation, self-esteem and health-related quality of life (HRQoL) were assessed. Morning to evening difference in iLP was observed in both MG and EG at Pre and Post, with higher force values in the evening, but not for VO₂max. iLP force increased significantly in EG in the morning (p < 0.001) and evening (p = 0.010). VO₂max increased in MG and EG both in the morning (both p < 0.001) and in the evening (MG: p < 0.001; EG: p = 0.003). Participants of the present study slept 7-8 h per night and the self-reported sleep duration, get-up time and the average time to go to bed were similar between the groups and did not change from Pre to Post. From HRQoL dimensions, the score for bodily pain decreased in MG (p = 0.029) and significant between-group differences were observed for Pre-Post changes in MG and EG (p = 0.001) as well as between MG and CG (p < 0.001). In vitality, a significant between-group difference was observed for Pre to Post changes in MG and EG (p = 0.014). Perception of time management decreased in EG (p = 0.042) but stayed unchanged for MG and CG. For the intrinsic motivation to participate, significant between-group differences were observed for MG and EG (p = 0.033) and between MG and CG (p = 0.032) for Pre to Post changes. Self-esteem improved in MG (p = 0.029) and EG (p = 0.024). The present combined strength and endurance training program performed in the morning and in the evening led to similar improvements in strength and endurance performance. Training in the morning or in the evening did not disrupt the already good sleep behavior and it was able to further increase the self-esteem. Although training in the morning hours may leave more time for free time activities or social life (i.e. family and friends) compared to the evening training, it might be more challenging to stay motivated to participate in prolonged training programs in the morning hours.

Metabolic syndrome associates with left atrial dysfunction

BACKGROUND AND AIMS

Obesity and metabolic syndrome (MetS) are risk factors of atrial fibrillation (AF), but limited data exist on their effect on left atrial (LA) function. The aim of the study was to evaluate the effects of cardiac, hepatic and intra-abdominal ectopic fat depots and cardiometabolic risk factors on LA function in non-diabetic male subjects.

METHODS AND RESULTS

Myocardial and hepatic triglyceride contents were measured with 1.5T ¹H-magnetic resonance spectroscopy and LA and left ventricular function, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), epicardial and pericardial fat by magnetic resonance imaging (MRI) in 33 men with MetS and 40 men without MetS. LA volumes were assessed using a novel three-chamber orientation based MRI approach. LA ejection fraction (EF) was lower in MetS patients than in the control group (44 ± 7.7% in MetS vs. 49 ± 8.6% in controls, p = 0.013) without LA enlargement, indicating LA dysfunction. LA EF correlated negatively with waist circumference, body mass index, SAT, VAT, fasting serum insulin, and homeostasis model assessment of insulin resistance index, and positively with fasting serum high-density lipoprotein cholesterol. VAT was the best predictor of reduced LA EF.

CONCLUSIONS

MetS associates with subclinical LA dysfunction. Multiple components of MetS are related to LA dysfunction, notably visceral obesity and insulin resistance. Further studies are needed to elucidate the role of mechanical atrial remodeling in the development of AF.

Biomarkers and prediction of myocardial triglyceride content in non-diabetic men

BACKGROUND AND AIMS

Lipid oversupply to cardiomyocytes or decreased utilization of lipids leads to cardiac steatosis. We aimed to examine the role of different circulating metabolic biomarkers as predictors of myocardial triglyceride (TG) content in non-diabetic men.

METHODS AND RESULTS

Myocardial and hepatic TG contents were measured with 1.5 T magnetic resonance (MR) spectroscopy, and LV function, visceral adipose tissue (VAT), abdominal subcutaneous tissue (SAT), epicardial and pericardial fat by MR imaging in 76 non-diabetic men. Serum concentration of circulating metabolic biomarkers [adiponectin, leptin, adipocyte-fatty acid binding protein 4 (A-FABP 4), resistin, and lipocalin-2] including β-hydroxybuturate (β-OHB) were measured. Subjects were stratified by tertiles of myocardial TG into low, moderate, and high myocardial TG content groups. Concentrations of β-OHB were lower (p = 0.003) and serum levels of A-FABP 4 were higher (p < 0.001) in the group with high myocardial TG content compared with the group with low myocardial TG content. β-OHB was negatively correlated with myocardial TG content (r = -0.316, p = 0.006), whereas A-FABP 4 was not correlated with myocardial TG content (r = 0.192, p = 0.103). In multivariable analyses β-OHB and plasma glucose levels were the best predictors of myocardial TG content independently of VAT and hepatic TG content. The model explained 58.8% of the variance in myocardial TG content.

CONCLUSION

Our data showed that β-OHB and fasting glucose were the best predictors of myocardial TG content in non-diabetic men. These data suggest that hyperglycemia and alterations in lipid oxidation may be associated with cardiac steatosis in humans.

Electrocardiographic changes associated with insulin resistance

BACKGROUND AND AIM

Cardiac steatosis has been related to increased risk of heart disease. We investigated the association between cardiac steatosis, electrocardiographic (ECG) abnormalities, and individual components of the metabolic syndrome (MetS).

METHODS AND RESULTS

A 12-lead ECG and laboratory data were examined in 31 men with the MetS and in 38 men without the MetS. Myocardial triglyceride (MTG) content was measured with 1.5 T magnetic resonance (MR) spectroscopy and epicardial and pericardial fat by MR imaging. MTG content, epicardial and pericardial fat depots were higher in men with the MetS compared with subjects without the MetS (p < 0.001). The heart rate was increased (p < 0.001), the PR interval was longer (p < 0.044), the frontal plane QRS axis shifted to the left (p < 0.001), and the QRS voltage (p < 0.001) was lower in subjects with the MetS. The frontal plane QRS axis and the QRS voltage were inversely correlated with MTG content, waist circumference (WC), body mass index (BMI), TGs, and fasting blood glucose. High-density lipoprotein cholesterol correlated positively and measures of insulin resistance negatively with the QRS voltage. MTG content and hypertriglyceridemia were determinants of the frontal plane QRS and WC and hyperglycemia were predictors of the QRS voltage.

CONCLUSION

The MetS and cardiac steatosis appear to associate with multiple changes on 12-lead ECG. The frontal plane QRS axis is shifted to the left and the QRS voltage is lower in subjects with the MetS. Standard ECG criteria may underestimate the presence of left ventricular hypertrophy in obese subjects with cardiometabolic risk factors.

Load carrying walking test and its relationships to endurance and neuromuscular capabilities in women and men of different ages

The aim of this study was to examine load carrying walking test (TMload) performance on the treadmill and its associations to endurance and neuromuscular capabilities in women and men of different ages. Sixty participants (aged 28 to 71 years) were divided into young, middle-aged and old groups of both genders. Clinical stress test was performed by stationary cycle ergometer (CEload). Peak oxygen uptake (VO2peak), heart rate and lactate concentration were measured using maximal TMload test. Isometric strength and EMG-activity of upper and lower extremities were measured before and after TMload. VO2peak of TMload correlated significantly with TMload exercise time (ET) in all other groups (r=0.67 to 0.91 and p ≤ 0.05 to p<0.001) except old men. Leg extension force decreased (p ≤ 0.05 to p<0.001) after TMload in all groups, grip force in young groups (p ≤ 0.05), while plantar flexion force and all EMGs remained unchanged. In men VO2peak explained 81% and in women VO2peak and age explained 87% of the total variation of the TMload ET. In conclusion, ET of TMload is associated with high VO2peak, but not with muscle strength or its changes during the loading. The present load carrying walking test may be used for testing workers with heavy loading in their occupation or in rehabilitation purposes. Further research is needed to examine in more detailed the loading model of the present study as well as the effects of different types of training on load carrying performance.

Molecular signaling in muscle is affected by the specificity of resistance exercise protocol

Mammalian target of rapamycin and mitogen-activated protein kinase (MAPK) signaling pathways have been highlighted as important for muscle adaptations and thus, they may distinguish adaptations to different exercises. Typically, resistance exercise designed for muscle hypertrophy has moderate intensity (60-80% of one repetition maximum, 1 RM) while one prioritizing maximal strength with minor hypertrophy has a higher intensity (≥90% of 1 RM). Eight untrained men (28.4 ± 3.7 years) conducted two different bilateral leg press exercise protocols: hypertrophic (5 × 10 RM) and pure maximal strength (15 × 1 RM) in a counterbalanced, cross-over design with 1 week between exercises. Vastus lateralis muscle biopsies were taken before and 0.5 h after resistance exercise, or in six controls (26.5 ± 3.6 years) who rested. The phosphorylation of p70S6K (Thr(421) /Ser(424) ), rpS6 (Ser(240/244) and Ser(235/236) ) and MAPK p38 as increased (∼2-16 fold) after both exercise protocols. However, the phosphorylation of MAPK Erk1/2 and p70S6K at Thr(389) increased only after 5 × 10 RM. The increase in the phosphorylation of p70S6K (Thr(421) /Ser(424) ), rpS6 (Ser(235/236) ) and Erk1/2 were higher after 5 × 10 RM (P<0.05). No changes were seen in controls. In conclusion, MAPK signaling is greater after hypertrophic than maximal strength exercise protocol. This may mediate adaptations specific to these different types of training regimens.

Effects of prolonged combined strength and endurance training on physical fitness, body composition and serum hormones in women with rheumatoid arthritis and in healthy controls

OBJECTIVE

The effects of a 21-week combined strength and endurance training period on physical fitness, serum hormone concentrations, and subcutaneous fat in 23 women with rheumatoid arthritis (RA) and in 12 matched healthy subjects was studied.

METHODS

The measurements included leg extension forces and EMG activity, muscle and fat thickness on thigh, maximal oxygen uptake (VO2max) and serum concentrations of testosterone, free testosterone, growth hormone, insulin-like growth factor-I (IGF-I), dehydroepiandrosterone sulphate (DHEAS), and cortisol.

RESULTS

During the training period significant increases took place in VO2max, muscle strength and EMG activity in both groups. The increases of the quadriceps femoris thickness were 6.5% (p < 0.001) in the healthy controls and 7.4% (p < 0.001) in the RA cases. The decreases in subcutaneous fat thicknesses were 9.9% (p < 0.001) and 12.3% (p < 0.001), respectively. No significant changes were found in serum hormone concentrations, but RA women showed lower levels of IGF-I during the whole follow-up.

CONCLUSIONS

In RA women with stable disease the combined strength and endurance training increases physical fitness. Further the training increases muscle mass and decreases subcutaneous fat. It may decrease risks of cardiovascular diseases in RA patients. The intensive training had minor effects on serum hormone concentrations.

Effects of concurrent strength and endurance training in women with early or longstanding rheumatoid arthritis: Comparison with healthy subjects

OBJECTIVE

To investigate the effects of a 21-week concurrent strength and endurance training protocol on physical fitness profile in women with early or longstanding rheumatoid arthritis (RA) compared with healthy subjects.

METHODS

Twenty-three female patients with RA volunteered for the study. Twelve had early RA and eleven had longstanding RA. Twelve healthy women served as controls. Maximal strength of different muscle groups was measured by dynamometers, walking speed with light cells, and vertical squat jump on the force platform to mirror explosive force. Maximal oxygen uptake was measured by gas analyzer. Six training sessions (3 strength training and 3 endurance training) were carried out in a 2-week period for 21 weeks.

RESULTS

The training led to large gains in maximal strength both in women with RA and in healthy women (P < 0.043-0.001). The strength gains were accompanied by increases in walking speed (P < 0.034-0.001) and vertical squat jump (P < 0.034-0.001). Significant improvements also occurred in maximal aerobic capacity in all groups (P < 0.023-0.014).

CONCLUSIONS

Both early and longstanding RA patients with stable disease can safely improve all characteristics of their physical fitness profile using a progressive concurrent strength and endurance training protocol.

[Feedback on prescribing profiles at a primary health center. Important element in quality assurance of drug prescription]

DU90%--the number of drugs that account for 90% of DDDs--and adherence to guidelines in this segment were proposed by the Swedish Medical Quality Council (MKR) as indicators for assessing the quality of drug prescribing. We tested these indicators at a primary health care (PHC) center in Stockholm. Bar-coded prescriptions purchased at pharmacies were compared with the guidelines issued by the regional drug committee. The data were presented and discussed at the PHC center. Although the DU90% method neither examines the appropriateness of use nor provides outcome data, it was shown to be an inexpensive, flexible and simple method for assessing the general quality of drug prescribing.

24-hour ambulatory blood pressure monitoring in elderly normotensive individuals and its reproducibility after one year

To study ambulatory blood pressure (ABP) and its reproducibility in healthy normotensive elderly subjects, 34 individuals were randomly selected. Their ages were 65 years (n = 10), 70 years (n = 10), 75 years (n = 8) and 80 years (n = 6). SpaceLabs 90207 system was used and one initial and a follow-up measurement after one year was performed. It was found that 24h ABP easily could be recorded in elderly subjects. A mean of 97% of the measurements were successful and only two of 34 subjects dropped out because of measurement failures. Nocturnal blood pressures were lower in all age groups and in both sexes. The standard deviations of the differences between the baseline and one year measurements were for the daytime period 8/4 mmHg and for the nighttime period 12/8 mmHg. In conclusion, ABP is easily accepted as a clinical method in normotensive elderly subjects. In all subjects there is a reduction of the nocturnal blood pressure and the reproducibility of ABP after one year is good.

Why palliative care?

And so there we have it in a nutshell--palliative care is about caring. Caring for those who are dying and for those who look after them and then grieve their loss. Palliative care has risen like a phoenix from the ashes of neglect and bad management which, until recently, had been the lot of the dying. Perhaps this new specialty may become a guiding beacon leading a profession, somewhat bewitched and side tracked by its own scientific cleverness, back to the road of caring. I sincerely hope that as the specialty gains recognition it does not lose its present identify and fine sense of purpose.

Interocular asymmetry of optic disc size and its relevance to visual field loss in normal-tension glaucoma

We evaluated the relevance of interocular asymmetry of optic disc size to the level of intraocular pressure and the extent of optic disc and visual field changes in normal-tension glaucoma (NTG). Fifty-two eyes of 26 patients with NTG were measured for optic disc topography using a computerized image analysis system (IMAGEnet, Topcon), diurnal intraocular pressure (IOP), and Octopus automated visual field. Of the 26 patients, 22 had interocular asymmetry of the optic disc area of at least 0.01 mm2 and of mean IOP of at least 0.3 mmHg. Of these 22 patients, 8 had the higher mean IOP in the eye with the larger optic disc. In these 8 patients, the visual field defect was significantly more advanced in the eye with the larger optic disc (Wilcoxon signed ranks test, P < 0.05). These findings appear to support the hypothesis that an eye with a large optic disc may be more vulnerable to a rise in IOP.

Correlation of asymmetry of visual field loss with optic disc topography in normal-tension glaucoma

OBJECTIVE

To compare the differences in optic disc configuration with different stages of visual field loss in normal-tension glaucoma.

DESIGN

Interocular pairwise comparisons.

SETTING

Glaucoma clinic of a teaching hospital.

PATIENTS

Thirteen patients with normal-tension glaucoma and asymmetric visual field loss of at least 2.5 dB in the mean defect of the visual field indexes.

INTERVENTIONS

Areas under the optic disc profiles mapped from values for radial sections of the optic disc measured at intervals of 30 degrees and expressed as percentages of the area of a rectangle were obtained from stereophotographs with a computerized image analysis system. Visual fields were tested with automated perimetry (OCTOPUS), using program G1.

MAIN OUTCOME MEASURE

Correlation analyses between the interocular differences in the areas under the optic disc profile and the interocular differences in the visual field indexes.

RESULTS

The correlation coefficients between the interocular differences in mean defect and those of the area under the optic disc profile in the superior to temporal sections ranged from -.71 to -.61 (.007 < P < .028). The interocular differences in loss variance correlated with the differences in the area under the optic disc profile in the superior section (r = -.61, P = .0252).

CONCLUSION

The differences in visual field loss between the two eyes in normal-tension glaucoma appear mainly to reflect morphometric changes in the superior half of the optic disc.

Intraocular pressure reduction with topically administered pilocarpine, timolol and betaxolol in normal tension glaucoma

The IOP-lowering effect of topical glaucoma medication has been studied mainly in eyes with ocular hypertension or high tension glaucoma. We tested the IOP-lowering effect of the commonly used topical medications (pilocarpine, timolol and betaxolol) in eyes with normal tension glaucoma. Instillation of 2% pilocarpine hydrochloride three times a day had no statistically significant lowering effect on the IOP level (F test, P = 0.0596, n = 18). 0.5% timolol maleate administered twice a day (n = 16) and 0.5% betaxolol hydrochloride administered twice a day (n = 17) led to statistically significant lowering of the IOP level (F test, P < 0.0001 for timolol and P = 0.0001 for betaxolol). There was no statistically significant difference in IOP-reducing effect whether topical IOP-lowering medication had been used previously or not. The results for 11 eyes participating in all three tests were similar to the results for the other eyes in the three test groups.

Toxic effects of human pancreatic and snake and bee venom phospholipases A2 on MCF-7 cells in culture

The toxicity of phospholipase A2 (PLA2) has been suggested to be involved in the pathology of a number of severe diseases including septic shock and acute pancreatitis. However, testing the toxicity of these substances is difficult in vivo. In the present study we compared the toxicity of PLA2s from three snake venoms, bee venom and human pancreas on MCF-7 cells grown in culture. Tetrazolium microculture assays were developed to test the cytostatic and cytotoxic effects of PLA2 on MCF-7 cells. These tests are based on the ability of viable cells to reduce a tetrazolium-based compound MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] to a blue formazan product. Leakage of lactate dehydrogenase (LD) from the cells into the culture medium was also measured. There were marked differences in the toxicity of the PLA2s tested. Cobra (Naja mosambique mosambique) venom PLA2 was toxic to the cells at a concentration of 4.5 U/ml. Light microscopic changes were seen in the injured cells after 3 hr treatment. Sixty-seven per cent of cells were dead after 24 hr treatment. Treatment for 4 hr caused irreversible changes in the cells. Leakage of LD was noted from 4 hr onwards. Other snake (Crotalus adamanteus and Laticauda semifasciata) venom PLA2s, even after continuous exposure to 4.5 U/ml caused only slight decreases in values obtained in the MTT test. No morphologic changes suggesting a cytotoxic effect were seen. PLA2 from bee (Apis mellifera) venom had no toxic effect, either. Continuous exposure of cells to human pancreatic PLA2 caused a 15% decrease in the MTT-test.(ABSTRACT TRUNCATED AT 250 WORDS)