Perceptions, behaviours and barriers towards exercise practices in inflammatory bowel disease

Inflammatory bowel disease (IBD), a chronic disease affecting the digestive tract, has a significant impact on health-related quality of life. Pharmaceutical treatment is typically adopted, yet exercise is increasingly becoming recognized as an adjunct therapy. This study aimed to explore the perspectives, behaviours, and barriers of IBD patients in terms of their exercise habits. A 16-item closed-ended questionnaire was completed by 463 adult IBD patients (Ulcerative colitis = 57.02%, Crohn's dis-ease = 40.60% and Other = 2.38%) (Female = 76.67%, Male = 22.46 and Non-binary = 0.86%). The questionnaire was divided into three sections: baseline/demographic characteristics, disease characteristics, and exercise perceptions, beliefs, and behaviours. Significantly (P<0.001) more participants (63.07%) reported that they engage regularly with exercise compared to those who do not; however, engagement was significantly lower in female patients (59.72%) compared to males (74.04%). Respondents also rated significantly (P<0.001) that a combination of factors prevents engagement in exercise (74.30%). Moderate intensity exercise was the predominant (P<0.001) aerobic modality (39.04%), the majority (P<0.001) response was that patients undertake no resistance training (27.74%), and significantly more (P<0.001) patients indicated that they don't know whether resistance training can influence IBD either positively (57.53%) or negatively (62.33%). Whilst it is encouraging that IBD patients are engaging regularly with exercise, the reduced levels of engagement in females and lack of knowledge/ engagement with resistance training, indicate that future implementation and educational developments are necessary to enhance exercise in females and resistance training engagement in all IBD patients.

Assessing the role of biomarker feedback in a 12-week community weight management programme among overweight men: A pilot study

BACKGROUND

The primary objective of this study was to examine the feasibility of recruitment, retention, and delivery of biomarker feedback among men partaking in Shape Up, a physical activity for health programme. Secondarily, it explored the potential effects of biomarker feedback on participants' adherence and motivation levels.

METHODS

In this two-arm non-randomised pilot study, 46 men (mean±SD age 46.0±8.6 years) participating in the 12-week Shape Up programme were assigned to a control group or biomarker feedback group. Biomarker feedback consisted of 3 blood test panels: at baseline, 12 weeks, and 24 weeks (follow-up), each with a doctor's report. Both groups completed questionnaires (Short Active Lives Survey [SALS], Treatment Self-Regulation Questionnaire [TSRQ], and EQ-5D-5L) to gauge levels of motivation and engagement. The mean difference was calculated between baseline and programme end. Recruitment, retention, and attendance rates were determined.

RESULTS

Mean recruitment (approach-to-consent), retention, and attendance rates were 96.3%, 92.3%, and 83.7% in the control group, and 85.2%, 86.2%, and 81.5% in the biomarker feedback group, respectively. Of biomarker feedback group participants, 86.4% attended their 12-week blood test and 45.5% attended their follow-up blood test. The mean 12-week differences (95% CI) for the control group and biomarker feedback group were 138.1 (2.7, 273.5) and 467.3 (249.4, 685.2) for active minutes per week, 0.2 (-0.8, 1.2) and 0.4 (0.0, 0.8) for autonomous TSRQ domains, 0.2 (-0.3, 0.8) and 0.8 (0.1, 1.4) for controlled TSRQ domains, and 19 (12.7, 26.5) and 27.2 (19.8, 34.6) for EQ-5D-5L scores, respectively.

CONCLUSION

Biomarker feedback was well-received by participants and deemed feasible, with high recruitment and retention rates for the duration of the 12-week programme. Biomarker feedback may affect aspects of motivation but did not appear to influence adherence to the programme. Biomarker data may provide additional evidence of programme efficacy. Important design considerations are provided for definitive larger-scale trials.

Effects of exercise on obsessive-compulsive disorder symptoms: a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis assessed the efficacy of exercise in reducing OCD symptoms.

METHODS

We searched PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Scopus and grey literature until March 2022. The study was preregistered at Prospero (CRD42021283931). We included randomised controlled and pre-post trials assessing physical activity as an intervention for OCD. Risk of bias was assessed using the Cochrane ROBINS-I tool and the RoB2 tool.

RESULTS

The analysis included 6 trials (N = 92); 2 were RCTS and 4 were pre-post design studies. A random-effects meta-analysis of pre-post data identified a large reduction of OCD symptoms following exercise (g = 1.33 [95%CI 1.06-1.61]; k = 6). Exercise was also associated with significant pre-post reductions in anxiety (g = 0.71 [95%CI 0.37-1.05; k = 4) and depression (g = 0.57 [95%CI 0.26-0.89]; k = 2). Risk of bias was moderate-high in uncontrolled trials on the ROBINS-I and RCTs showed 'some concerns' on the RoB2.

CONCLUSION

Exercise was associated with a large pre-post reduction of OCD symptoms; however, few trials were of robust quality and all were at risk of bias. Further well-powered and better quality RCTs are required to assess the role of exercise as an intervention for OCD.KEY POINTSStudies exploring exercise as an adjunct therapy for OCD have small participant numbers, therefore a systematic review and meta-analysis is needed to estimate potential efficacy.Pre-post analysis shows that exercise was associated with a large reduction of OCD symptomsThe current systematic review and meta-analysis points to the potential for exercise to be beneficial for the treatment for OCD symptoms. However, more well-powered and better controlled RCTs are required to fully assess the benefit of exercise for the treatment of OCD symptoms.

Health Benefits of Montmorency Tart Cherry Juice Supplementation in Adults with Mild to Moderate Ulcerative Colitis: A Protocol for a Placebo Randomized Controlled Trial

Ulcerative colitis, characterized by its relapsing and remissive nature, negatively affects perception, body image, and overall quality of life. The associated financial burden underscores the need for alternative treatment approaches with fewer side effects, alongside pharmaceutical interventions. Montmorency tart cherries, rich in anthocyanins, have emerged as a potential natural anti-inflammatory agent for ulcerative colitis. This manuscript outlines the study protocol for a randomized placebo-controlled trial investigating the effects of Montmorency tart cherry in individuals with ulcerative colitis. The trial aims to recruit 40 participants with mild to moderate disease activity randomly assign them to either a Montmorency tart cherry or placebo group. The intervention will span 6 weeks, with baseline and 6-week assessments. The primary outcome measure is the Inflammatory Bowel Disease Quality of Life Questionnaire. Secondary outcomes include other health-related questionnaires and biological indices. Statistical analysis will adhere to an intention-to-treat approach using linear mixed effect models. Ethical approval has been obtained from the University of Hertfordshire (cLMS/SF/UH/05240), and the trial has been registered as a clinical trial (NCT05486507). The trial findings will be disseminated through a peer-reviewed publication in a scientific journal.

The Participation of Trans Women in Competitive Fencing and Implications on Fairness: A Physiological Perspective Narrative Review

Debate has surrounded whether the participation of trans women in female sporting categories is fair, specifically the retained male physiological advantage due to increased testosterone compared to cisgender females. Recently, individual sporting organisations have been investigating and assessing policies regarding trans women athlete participation in female categories, resulting in several banning participation. This review aims to discuss the scientific evidence and provide appropriate guidance for the inclusion of trans women in elite competitive female fencing categories. Fencing is an intermittent sport, where competitions can span 1 to 3 days. The lunge is the most common movement used to attack opponents, where a successful hit relies on the speed of the action. Male puberty induced increased circulating testosterone promotes a greater stature, cardiovascular function, muscle mass, and strength compared to cisgender females, culminating in a ~12-40% sport performance advantage. Elite cisgender male fencers perform significantly higher, ~17-30%, jump heights and leg power measures compared to elite cisgender female fencers, resulting in faster lunges. Trans women receiving androgen-suppression therapy for 12 months showed significant reductions in strength, lean body mass, and muscle surface area, but even after 36 months, the measurements of these three indices remained above those for cisgender females. Previous male muscle mass and strength can be retained through continuation of resistance training. The literature reviewed shows that there is a retained physiological advantage for trans women who have undergone male puberty when participating in the elite competitive female fencing category. A proposed solution of an open or third gender category for elite fencing competition promotes fair competition, while allowing trans women to compete in their chosen sport.

Effects of a Home-Based Physical Activity Program on Blood Biomarkers and Health-Related Quality of Life Indices in Saudi Arabian Type 2 Diabetes Mellitus Patients: A Randomized Controlled Trial

The purpose of this study was to undertake a randomized control trial examining the effects of a 12-week home-based physical activity program on Saudi Arabian adults with type 2 diabetes. Sixty-four patients with type 2 diabetes mellitus were recruited from the Jazan Diabetes and Endocrinology Center, located in the Jazan region of southwestern Saudi Arabia. Patients were randomly assigned to either control, i.e., usual care (males = 46.9% and females = 53.1%, age  =  45.88 ± 8.51 years, mass  =  76.30 ± 15.16 kg, stature  =  160.59 ± 8.94 cm, body mass index (BMI)  =  29.73 ± 6.24 kg/m², years since diagnosis  =  8.12 ± 6.22 years) or a home-based physical activity (males = 50% and females = 50%, age  =  42.07 ± 9.72 years, mass  =  74.58 ± 13.67 kg, stature  =  158.94 ± 9.38 cm, BMI  =  29.44 ± 4.38 kg/m², years since diagnosis  =  12.17 ± 8.38 years) trial arms. The home-based physical activity group was required to undertake aerobic training by increasing their habitual step count by 2000 steps per day and performing resistance training 3 times per week for 12 weeks. The primary outcome was hemoglobin A1c (HbA1c), and secondary measures of anthropometrics, blood biomarkers, physical fitness, and patient-reported quality of life outcomes pertinent to type 2 diabetes were measured at timepoints, i.e., baseline, 12 weeks, and 24 weeks (follow-up). Intention-to-treat analyses revealed no significant alterations in the primary outcome (control: baseline = 8.71%, 12-weeks = 8.35%, and follow-up = 8.72%; home-based physical activity: baseline = 8.32%, 12-weeks = 8.06%, and follow-up = 8.39%) between trial arms. However, improvements in psychological wellbeing at follow-up measured using the Patient Health Questionnaire-9 were significantly greater in the home-based physical activity group (baseline = 6.84, 12-weeks = 5.96, and follow-up = 5.00) compared to the control (baseline = 6.81, 12-weeks = 5.73, and follow-up = 8.53). No other statistically significant observations were observed. Home-based physical activity is not effective in mediating improvements in HbA1c levels or secondary hematological, blood pressure, anthropometric, or fitness indices. However, given the link between psychological wellbeing and the etiology/progression of disease activity in type 2 diabetes, home-based physical activity may be effective for tertiary disease management. Future trials should examine the efficacy of relative exercise intensities greater than those in the current study.

Temporal demands of elite fencing

There is no published study that analyses the temporal demands of fencing, in its six Olympic modalities in the same high-level competition. The only existing publications date back decades, with already obsolete regulations, or focus on a specific modality. The aim of this study is to carry out a chronometric analysis of elite fencing at the 2014 Fencing World Championships to determine the existence of differences between its weapons (épée, foil and sabre) and between genders. A total of 96 elite fencers (48 women) of 24 different nationalities were analysed in the final rounds (direct elimination). We undertook observational methodology based on an open and systematic process with ideographic, point and multi-dimensional design. We analysed the work time, rest time, total time, number of stops and work-to-rest ratio. The Lince software was used to record and analyse video data. The coding and recording process of the 83 fights analysed generated a matrix of 5900 records. The quality of the data was verified by checking the validity of the observation instrument and the intraobserver reliability. The mean work time (between Allez and Halte) was 17.9 ± 3.1 s for épée, 5.8 ± 2.5 s for foil and 1 .7 ± 0.4 s for sabre. The fight work-to-rest ratios recorded were 1:0.9, 1:2.6 and 1:9.2 for épée, foil and sabre respectively. The results showed significant differences (p < .05) in the work and rest times between the three fencing weapons. However, there were no differences between fencers of the same weapon according to gender.

Variability in exercise tolerance and physiological responses to exercise prescribed relative to physiological thresholds and to maximum oxygen uptake

NEW FINDINGS

What is the central question of this study? Does prescribing exercise intensity using physiological thresholds create a more homogeneous exercise stimulus than using traditional intensity anchors? What is the main finding and its importance? Prescribing exercise using physiological thresholds, notably critical power, reduced the variability in exercise tolerance and acute metabolic responses. At higher intensities, approaching or exceeding the transition from heavy to severe intensity exercise, the imprecision of using fixed %V ̇ O 2 max ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{max}}}}$  as an intensity anchor becomes amplified.

ABSTRACT

The objective of this study was to determine whether the variability in exercise tolerance and physiological responses is lower when exercise is prescribed relative to physiological thresholds (THR) compared to traditional intensity anchors (TRAD). Ten individuals completed a series of maximal exercise tests and a series of moderate (MOD), heavy (HVY) and severe intensity (HIIT) exercise bouts prescribed using THR intensity anchors (critical power and gas exchange threshold) and TRAD intensity anchors (maximum oxygen uptake;V ̇ O 2 max ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{max}}}}$ ). There were no differences in exercise tolerance or acute response variability between MODTHR and MODTRAD . All individuals completed HVYTHR but only 30% completed HVYTRAD . Compared to HVYTHR , where work rates were all below critical power, work rates in HVYTRAD exceeded critical power in 70% of individuals. There was, however, no difference in acute response variability between HVYTHR and HVYTRAD . All individuals completed HIITTHR but only 20% completed HIITTRAD . The variability in peak (F = 0.274) and average (F = 0.318) blood lactate responses was lower in HIITTHR compared to HIITTRAD . The variability in W' depletion (the finite work capacity above critical power) after the final interval bout was lower in HIITTHR compared to HIITTRAD (F = 0.305). Using physiological thresholds to prescribe exercise intensity reduced the heterogeneity in exercise tolerance and physiological responses to exercise spanning the boundary between the heavy and severe intensity domains. To increase the precision of exercise intensity prescription, it is recommended that, where possible, physiological thresholds are used in place ofV ̇ O 2 max ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{max}}}}$ .

Exercise improves depression through positive modulation of brain-derived neurotrophic factor (BDNF). A review based on 100 manuscripts over 20 years

The aim of this review was to explore the relevant neurobiology and the association between peripheral levels of brain-derived neurotrophic factor (BDNF) and acute and short to long-term exercise regimes, as well as its relation to depression and antidepressant treatment. A 20-year literature search was conducted. The screening process resulted in 100 manuscripts. Antidepressants as well as acute exercise, particularly high-intensity, elevates BDNF in healthy humans and clinical populations, as evidenced from aerobic and resistance-based studies. Although exercise is increasingly recognised in the management of depression, acute and short-term exercise studies have failed to establish a relationship between the severity of depression and changes in peripheral BDNF. The latter rapidly returns to baseline, possibly indicating a quick re-uptake by the brain, aiding its neuroplasticity functions. The timescale of administration needed for the antidepressants to stimulate biochemical changes is longer than similar increases with acute exercise.

Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review

Increasingly popular, ultra-endurance participation exposes athletes to extremely high levels of functional and structural damage. Ultra-endurance athletes commonly develop acute kidney injury (AKI) and other pathologies harmful to kidney health. There is strong evidence that non-steroidal anti-inflammatory drugs, common amongst ultra-athletes, is linked to increased risk and severity of AKI and potentially ischaemic renal injury, i.e., acute tubular necrosis. Ultra-endurance participation also increases the risk of exertional rhabdomyolysis, exercise-associated hyponatremia, and gastrointestinal symptoms, interlinked pathologies all with potential to increase the risk of AKI. Hydration and fuelling both also play a role with the development of multiple pathologies and ultimately AKI, highlighting the need for individualised nutritional and hydration plans to promote athlete health. Faster athletes, supplementing nitrates, and being female also increase the risk of developing AKI in this setting. Serum creatinine criteria do not provide the best indicator for AKI for ultra-athletes therefore further investigations are needed to assess the practicality and accuracy of new renal biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL). The potential of recurring episodes of AKI provide need for further research to assess the longitudinal renal health impact of ultra-participation to provide appropriate advice to athletes, coaches, medical staff, and event organisers.

Maximal Fat Oxidation during Incremental Upper and Lower Body Exercise in Healthy Young Males

The aim of this study is to determine the magnitude of maximal fat oxidation (MFO) during incremental upper and lower body exercise. Thirteen non-specifically trained male participants (19.3 ± 0.5 y, 78.1 ± 9.1 kg body mass) volunteered for this repeated-measures study, which had received university ethics committee approval. Participants undertook two incremental arm crank (ACE) and cycle ergometry (CE) exercise tests to volitional exhaustion. The first test for each mode served as habituation. The second test was an individualised protocol, beginning at 40% of the peak power output (PO_peak) achieved in the first test, with increases of 10% PO_peak until volitional exhaustion. Expired gases were recorded at the end of each incremental stage, from which fat and carbohydrate oxidation rates were calculated. MFO was taken as the greatest fat oxidation value during incremental exercise and expressed relative to peak oxygen uptake (%V˙O_2peak). MFO was lower during ACE (0.44 ± 0.24 g·min^-1) than CE (0.77 ± 0.31 g·min^-1; respectively, p < 0.01) and occurred at a lower exercise intensity (53 ± 21 vs. 67 ± 18%V˙O_2peak; respectively, p < 0.01). Inter-participant variability for MFO was greatest during ACE. These results suggest that weight loss programs involving the upper body should occur at lower exercise intensities than for the lower body.

The efficacy of a tart cherry drink for the treatment of patellofemoral pain in recreationally active individuals: a placebo randomized control trial

Purpose

This study aimed to explore the efficacy of U.S. Montmorency tart cherry in treating recreationally active individuals with patellofemoral pain.

Methods

Twenty-four recreationally active participants with patellofemoral pain were randomly separated into either placebo (males N = 8, females N = 4, age = 43.30 ± 7.86 yrs, mass = 72.10 ± 17.89 kg, stature = 171.16 ± 10.17, BMI = 24.31 ± 3.75 kg/m2, symptom duration = 30.18 ± 10.90) or Montmorency tart cherry (males N = 9, females N = 3, age = 41.75 ± 7.52 yrs, mass = 76.96 ± 16.64 kg, stature = 173.05 ± 7.63, BMI = 25.53 ± 4.03 kg/m2, symptom duration = 29.73 ± 11.88) groups. Both groups ingested 60 mL of either Montmorency tart cherry concentrate or taste matched placebo daily for 6 weeks. Measures of self-reported pain (KOOS-PF), psychological wellbeing (COOP WONCA), and sleep quality (PSQI) alongside blood biomarkers (C-reactive protein, uric acid, TNF alpha, creatinine, and total antioxidant capacity) and knee biomechanics were quantified at baseline and 6 weeks. Differences between groups were examined using linear mixed-effects models.

Results

There was 1 withdrawal in the cherry and 0 in the placebo group and no adverse events were noted in either condition. The placebo condition exhibited significant improvements (baseline = 67.90 ± 16.18 & 6 weeks = 78.04 ± 14.83) in KOOS-PF scores compared to the tart cherry group (baseline = 67.28 ± 12.55& 6 weeks = 67.55 ± 20.61). No other statistically significant observations were observed.

Conclusion

Tart cherry supplementation as specifically ingested in the current investigation does not appear to be effective in mediating improvements in patellofemoral pain symptoms in recreationally active individuals.

Effects of Montmorency Tart Cherry and Blueberry Juice on Cardiometabolic and Other Health-Related Outcomes: A Three-Arm Placebo Randomized Controlled Trial

The current study aimed to investigate the influence of tart cherry and blueberry juices on cardiometabolic and other health indices following a 20-day supplementation period. Forty-five adults were randomly assigned to receive tart cherry, blueberry, or a placebo, of which they drank 60 mL per day for 20 days. The primary outcome, which was systolic blood pressure, and secondary measures, including anthropometric, energy expenditure, substrate oxidation, hematological, diastolic blood pressure/resting heart rate, psychological wellbeing, and sleep efficacy, were measured before and after the intervention. There were no statistically significant differences (p > 0.05) for systolic blood pressure; however, total and LDL cholesterol were significantly improved with blueberry intake (pre: total cholesterol = 4.36 mmol/L and LDL cholesterol = 2.71 mmol/L; post: total cholesterol = 3.79 mmol/L and LDL cholesterol = 2.23 mmol/L) compared to placebo (pre: total cholesterol = 4.01 mmol/L and LDL cholesterol = 2.45 mmol/L; post: total cholesterol = 4.34 mmol/L and LDL cholesterol = 2.67 mmol/L). Furthermore, psychological wellbeing indices measured using the Beck Depression Inventory, State Trait Anxiety Inventory, and COOP WONCA improved statistically in the blueberry arm compared to placebo. Given the clear association between lipid concentrations and the risk of cardiovascular disease as well as the importance of psychological wellbeing to health-related quality of life, this investigation indicates that it could be an effective approach to assist in managing cardiometabolic disease.

Effects of a Home-Based Physical Activity Programme on Blood Biomarkers and Health-Related Quality of Life Indices in Saudi Arabian Type-2 Diabetes Mellitus Patients: Protocol for a Randomised Controlled Trial

The Kingdom of Saudi Arabia is renowned for its high incidence of type-2 diabetes mellitus, with a prevalence rate of around 33%, which is expected to increase to 45.8% by 2030. Engagement in regular physical activity has been shown to significantly attenuate non-communicable diseases including type-2 diabetes. However, the overall rate of physical inactivity among Saudi Arabian adults is currently 80.5%, owing to time pressures, high-density traffic, poor air quality, lack of suitable exercise places/sports facilities, lack of social/friends support, gender, cultural barriers, low self-confidence, lack of time and environmental factors. Previous analyses have shown that home-based activity interventions can be effective. Therefore, given the aforementioned barriers to physical activity in Saudi Arabia; a home-based physical activity may be an ideal solution in type-2 diabetic patients. This manuscript describes the study protocol for a randomized control trial, examining the effects of a home-based physical activity intervention in Saudi Arabian adults with type-2 diabetes. The study will recruit 62 individuals with type-2 diabetes from the Jazan region of the Kingdom of Saudi Arabia, who will be individually randomized to either a physical activity or control group. This 24-week investigation will involve 12-weeks of physical activity in the physical activity group and feature three examination points i.e., baseline, 12-weeks and 24-weeks (follow-up). The primary study outcome is the between-group difference in blood HbA1c levels relative to controls. Secondary outcomes measures will be between-group differences in anthropometric, blood lipid, physical fitness, and patient-reported quality of life outcomes pertinent to type-2 diabetes. Statistical analysis will be conducted on an intention-to-treat basis. The trial has been granted ethical approval by Jazan University, Health Research Ethics Committee (REF: 2177) and formally registered as a trial (NCT04937296). We expect dissemination of the study findings from this investigation to be through publication in a leading peer-reviewed journal.

Nutritional and Non-Nutritional Strategies in Bodybuilding: Impact on Kidney Function

Bodybuilders routinely engage in many dietary and other practices purported to be harmful to kidney health. The development of acute kidney injury, focal segmental glomerular sclerosis (FSGS) and nephrocalcinosis may be particular risks. There is little evidence that high-protein diets and moderate creatine supplementation pose risks to individuals with normal kidney function though long-term high protein intake in those with underlying impairment of kidney function is inadvisable. The links between anabolic androgenic steroid use and FSGS are stronger, and there are undoubted dangers of nephrocalcinosis in those taking high doses of vitamins A, D and E. Dehydrating practices, including diuretic misuse, and NSAID use also carry potential risks. It is difficult to predict the effects of multiple practices carried out in concert. Investigations into subclinical kidney damage associated with these practices have rarely been undertaken. Future research is warranted to identify the clinical and subclinical harm associated with individual practices and combinations to enable appropriate and timely advice.

Effects of Montmorency Tart Cherry and Blueberry Juice on Cardiometabolic Outcomes in Healthy Individuals: Protocol for a 3-Arm Placebo Randomized Controlled Trial

Cardiometabolic disease is recognized as the predominant cause of global mortality and healthcare expenditure. Whilst pharmaceutical interventions are effective in the short term, their long-term efficacy remain equivocal and their associated side-effects are concerning. Owing to their high levels of anthocyanins, Montmorency tart cherries and blueberries have been cited as potentially important natural treatment/preventative modalities for cardiometabolic disease. This study proposed a randomized controlled trial, aims to test the effects of consumption of Montmorency tart cherry and blueberry juice on cardiometabolic outcomes compared to placebo. This 20-day, parallel, single-blind, randomized, placebo-controlled trial will recruit 45 individuals, who will be assigned to receive 60 mL per day of either Montmorency tart cherry juice, blueberry juice or a cherry/blueberry flavoured placebo. The primary study outcome is the between-group difference in systolic blood pressure from baseline to post-intervention. Secondary outcome measures will be between-group differences in anthropometric, energy expenditure and substrate oxidation (during rest and physical activity), haematological, blood pressure/resting heart rate, psychological wellbeing and sleep efficacy indices. Statistical analysis will be conducted on an intention-to-treat basis. This study has been granted ethical approval by the University of Central Lancashire, Health Research Ethics Committee (ref: HEALTH 0016) and formally registered as a trial. Dissemination of the study findings from this investigation will be through publication in a leading peer-reviewed journal.

The Effects of Sprint vs. Resisted Sled-Based Training; an 8-Week in-Season Randomized Control Intervention in Elite Rugby League Players

The aim of the current study was to examine the efficacy of resisted sled-based training compared to traditional unresisted sprint training in terms of mediating improvements in speed, agility, and power during an eight-week period of in-season training in elite rugby league players. Participants were randomly separated into either resisted sled or traditional sprint-based training groups and they completed an eight-week in-season training block with training prescribed based on the group to which they were assigned. Measures of 5 m, 10 m, and 20 m sprint times in addition to countermovement jump height and 505-agility test time were measured at baseline, four-weeks and eight-weeks. For sprint-based outcomes, although both groups improved significantly, there were no statistical differences between the two training methods. However, at the eight-week time point there were significant improvements in 505-agility test (sprint group: baseline = 2.45 and eight-weeks = 2.42 s/sled group: baseline = 2.43 and eight-weeks = 2.37 s) and countermovement jump (sprint group: baseline = 39.18 and eight-weeks = 39.49 cm/sled group: baseline = 40.43 and eight-weeks = 43.07 cm) performance in the sled training group. Therefore, the findings from this investigation may be important to strength and conditioning coaches working in an elite rugby league in that resisted sled training may represent a more effective method of sprint training prescription.

Biological and methodological factors affecting V ̇ O 2 max response variability to endurance training and the influence of exercise intensity prescription

NEW FINDINGS

What is the topic of this review? Biological and methodological factors associated with the variable changes in cardiorespiratory fitness in response to endurance training. What advances does it highlight? Several biological and methodological factors exist that each contribute, to a given extent, to response variability. Notably, prescribing exercise intensity relative to physiological thresholds reportedly increases cardiorespiratory fitness response rates compared to when prescribed relative to maximum physiological values. As threshold-based approaches elicit more homogeneous acute physiological responses among individuals, when repeated over time, these uniform responses may manifest as more homogeneous chronic adaptations thereby reducing response variability.

ABSTRACT

Changes in cardiorespiratory fitness (CRF) in response to endurance training (ET) exhibit large variations, possibly due to a multitude of biological and methodological factors. It is acknowledged that ∼20% of individuals may not achieve meaningful increases in CRF in response to ET. Genetics, the most potent biological contributor, has been shown to explain ∼50% of response variability, whilst age, sex and baseline CRF appear to explain a smaller proportion. Methodological factors represent the characteristics of the ET itself, including the type, volume and intensity of exercise, as well as the method used to prescribe and control exercise intensity. Notably, methodological factors are modifiable and, upon manipulation, alter response rates to ET, eliciting increases in CRF regardless of an individual's biological predisposition. Particularly, prescribing exercise intensity relative to a physiological threshold (e.g., ventilatory threshold) is shown to increase CRF response rates compared to when intensity is anchored relative to a maximum physiological value (e.g., maximum heart rate). It is, however, uncertain whether the increased response rates are primarily attributable to reduced response variability, greater mean changes in CRF or both. Future research is warranted to elucidate whether more homogeneous chronic adaptations manifest over time among individuals, as a result of exposure to more homogeneous exercise stimuli elicited by threshold-based practices.

A randomised controlled trial of energetic activity for depression in young people (READY): a multi-site feasibility trial protocol

BACKGROUND

Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effectiveness and the impact of exercise intensity are lacking. This study aims to test whether a randomised controlled trial (RCT) of an intervention targeting young people living with depression is feasible by determining whether it is possible to recruit and retain young people, develop and deliver the intervention as planned, and evaluate training and delivery.

METHODS

The design is a three-arm cluster randomised controlled feasibility trial with embedded process evaluation. Participants will be help-seeking young people, aged 13-17 years experiencing mild to moderate low mood or depression, referred from three counties in England. The intervention will be delivered by registered exercise professionals, supported by mental health support workers, twice a week for 12 weeks. The three arms will be high-intensity exercise, low-intensity exercise, and a social activity control. All arms will receive a 'healthy living' behaviour change session prior to each exercise session and the two exercise groups are energy matched. The outcomes are referral, recruitment, and retention rates; attendance at exercise sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data; adverse events, all measured at baseline, 3, and 6 months; resource use; and reach and representativeness.

DISCUSSION

UK National Health Service (NHS) policy is to provide young people with advice about using exercise to help depression but there is no evidence-based exercise intervention to either complement or as an alternative to medication or talking therapies. UK National Institute for Health and Care Excellence (NICE) guidelines suggest that exercise can be an effective treatment, but the evidence base is relatively weak. This feasibility trial will provide evidence about whether it is feasible to recruit and retain young people to a full RCT to assess the effectiveness and cost-effectiveness of an exercise intervention for depression.

TRIAL REGISTRATION

ISRCTN, ISRCTN66452702 . Registered 9 April 2020.

Effect of a Carbohydrate-Electrolyte Solution on Fluid Balance and Performance at a Thermoneutral Environment in International-Level Fencers

Chryssanthopoulos, C, Tsolakis, C, Bottoms, L, Toubekis, A, Zacharogiannis, E, Pafili, Z, and Maridaki, M. Effect of a carbohydrate-electrolyte solution on fluid balance and performance at a thermoneutral environment in international-level fencers. J Strength Cond Res 34(1): 152-161, 2020-The purpose of the study was to examine a possible effect of a carbohydrate-electrolyte (CHO-E) solution on fluid balance and performance in fencing at a thermoneutral environment. Sixteen fencers performed two 120-minute training sessions separated by 7-14 days under similar environmental conditions (temperature: 20.3° C and humidity: 45-47%). Each session consisted of 60-minute conditioning exercises followed by 10 bouts of 3 minutes against the same opponent with 3-minute interval between each bout. Participants ingested at regular intervals either a 6% CHO-E solution or an artificially sweetened water (PL) in a counterbalanced order. No difference was observed between conditions in the heart rate responses, perceived exertion, changes in plasma volume, urine specific gravity, number of bouts won or lost, or points for and against. Considerable variability was observed in body mass changes that revealed significant differences at the time level (i.e., pre- vs. post-exercise) (F1,15 = 9.31, p = 0.008, η = 0.38), whereas no difference was found between conditions (i.e., CHO-E vs. PL) (F1,15 = 0.43, p = 0.52, η = 0.03) and conditions × time interaction (F1,15 = 3.57, p = 0.078, η = 0.19). Fluid loss was not significantly different between conditions (p = 0.08, d = 0.47). The blood glucose level was higher (p < 0.01) after exercise in CHO-E, whereas the blood lactate level was similar between conditions. In conclusion, the CHO-E solution was as effective as the artificially sweetened water in terms of fluid balance and fencing performance at a thermoneutral environment. Because of large individual variability, fencers should monitor their fluid intake and body fluid loss in training and competition.

Affective and enjoyment responses to 12 weeks of high intensity interval training and moderate continuous training in adults with Crohn's disease

The aim was to undertake secondary data analysis from a three-arm randomised feasibility trial of high intensity interval training (HIIT), moderate intensity continuous training (MICT), and usual care control in adults with Crohn’s disease (CD; n = 36), with a primary focus on exploring affective and enjoyment responses. Twenty-five participants with quiescent or mildly-active CD were randomised to one of the two exercise groups: HIIT (n = 13) and MICT (n = 12). Both groups were offered thrice weekly sessions for 12 weeks. MICT consisted of cycling for 30 minutes at 35% peak power (Wpeak), whereas HIIT involved ten 1-minute bouts at 90% Wpeak, interspersed with 1-minute bouts at 15% Wpeak. Heart rate (HR), differentiated ratings of perceived exertion for legs (RPE-L) and central (RPE-C), along with feeling state (Feeling Scale; FS) were measured at 92.5% of each session. Enjoyment was measured at the end of training using the Physical Activity Enjoyment Scale (PACES). Post-hoc exploratory analysis involved a mixed-model two-way ANOVA to compare HR, RPE-L, RPE-C and FS for the exercise sessions in weeks 1, 6 and 12 between groups. Overall, HR was greater (p < 0.01) during HIIT (173 ± 8 bpm) compared with MICT (128 ± 6 bpm). Similarly, RPE-L and RPE-C responses were greater overall (p = 0.03 and p = 0.03, respectively) during HIIT (5.5 ± 1.6 and 5.1 ± 1.7, respectively) compared to MICT (3.3 ± 1.5 and 2.9 ± 1.5, respectively). Overall, FS was 2.2 ± 1.9 for HIIT and 2.1 ± 1.4 for MICT with no effect of treatment group (p = 0.25) or time (p = 0.94). There was also no significant difference in PACES scores between HIIT (99.4 ± 12.9) and MICT (101.3 ± 17.4; p = 0.78). The findings suggest HIIT and MICT protocols elicited similar enjoyment and affect in adults with quiescent or mildly-active CD.

High-intensity interval training and moderate-intensity continuous training in adults with Crohn's disease: a pilot randomised controlled trial

BACKGROUND

This study assessed the feasibility and acceptability of two common types of exercise training-high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT)-in adults with Crohn's disease (CD).

METHODS

In this mixed-methods pilot trial, participants with quiescent or mildly-active CD were randomly assigned 1:1:1 to HIIT, MICT or usual care control, and followed up for 6 months. The HIIT and MICT groups were offered three exercise sessions per week for the first 12 weeks. Feasibility outcomes included rates of recruitment, retention, outcome completion, and exercise attendance. Data were collected on cardiorespiratory fitness (e.g., peak oxygen uptake), disease activity, fatigue, quality of life, adverse events, and intervention acceptability (via interviews).

RESULTS

Over 17 months, 53 patients were assessed for eligibility and 36 (68%) were randomised (47% male; mean age 36.9 [SD 11.2] years); 13 to HIIT, 12 to MICT, and 11 to control. The exercise session attendance rate was 62% for HIIT (288/465) and 75% for MICT (320/429), with 62% of HIIT participants (8/13) and 67% of MICT participants (8/12) completing at least 24 of 36 sessions. One participant was lost to follow-up. Outcome completion rates ranged from 89 to 97%. The mean increase in peak oxygen uptake, relative to control, was greater following HIIT than MICT (2.4 vs. 0.7 mL/kg/min). There were three non-serious exercise-related adverse events, and two exercise participants experienced disease relapse during follow-up.

CONCLUSIONS

The findings support the feasibility and acceptability of the exercise programmes and trial procedures. A definitive trial is warranted. Physical exercise remains a potentially useful adjunct therapy in CD. [ID: ISRCTN13021107].

Full gait cycle analysis of lower limb and trunk kinematics and muscle activations during walking in participants with and without ankle instability

BACKGROUND

Chronic ankle instability (CAI) has previously been linked to altered lower limb kinematics and muscle activation characteristics during walking, though little research has been performed analysing the full time-series across the stance and swing phases of gait.

RESEARCH QUESTION

The aim of this study was to compare trunk and lower limb kinematics and muscle activity between those with chronic ankle instability and healthy controls.

METHODS

Kinematics and muscle activity were measured in 18 (14 males, 4 females) healthy controls (age 22.4 ± 3.6 years, height 177.8 ± 7.6 cm, mass 70.4 ± 11.9 kg, UK shoe size 8.4 ± 1.6), and 18 (13 males, 5 females) participants with chronic ankle instability (age 22.0 ± 2.7 years, height 176.8 ± 7.9 cm, mass 74.1 ± 9.6 kg, UK shoe size 8.1 ± 1.9) during barefoot walking trials, using a combined Helen Hayes and Oxford foot model. Surface electromyography (sEMG) was recorded for the tibialis anterior and gluteus medius. Full curve statistical parametric mapping was performed using independent and paired-samples T-tests.

RESULTS

No significant differences were observed in kinematic or sEMG variables between or within groups for the duration of the swing phase of gait. A significantly increased forefoot-tibia inversion was seen in the CAI affected limb when compared to the CAI unaffected limb at 4-16% stance (p = 0.039). No other significant differences were observed.

SIGNIFICANCE

There appears to be no differences in muscle activation and movement between CAI and healthy control groups. However, participants with CAI exhibited increased inversion patterns during the stance phase of gait in their affected limb compared to their unaffected limb. This may predispose those with CAI to episodes of giving way and further ankle sprains.

Feasibility of high-intensity interval training and moderate-intensity continuous training in adults with inactive or mildly active Crohn's disease: study protocol for a randomised controlled trial

Background

Structured exercise training has been proposed as a useful adjunctive therapy for Crohn’s disease by improving immune function and psychological health, reducing fatigue and promoting gains in muscle and bone strength. However, the evidence for exercise in Crohn’s disease is sparse, with only a handful of small prospective trials [1, 2], with methodological limitations, including the use of non-randomised and non-controlled study designs and small sample sizes. Here, we describe the protocol for a study that aims to assess the feasibility and acceptability of two common types of exercise training—high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT)—in adults with inactive or mildly active Crohn’s disease (CD).

Methods

This is a randomised, controlled, assessor-blinded, feasibility trial with three parallel groups. Forty-five adults with inactive or mildly active Crohn’s disease will be randomly assigned 1:1:1 to HIIT, MICT or usual care control. Participants in the HIIT and MICT groups will be invited to undertake three sessions of supervised exercise each week for 12 consecutive weeks. HIIT sessions will consist of ten 1-min intervals of cycling exercise at 90% of peak power output separated by 1 min of active recovery. MICT sessions will involve 30 min of continuous cycling at 35% of peak power output. Participants will be assessed before randomisation and 13 and 26 weeks after randomisation. Feasibility outcomes include rates of recruitment, retention and adherence. Interviews with participants will explore the acceptability of the exercise programmes and study procedures. Clinical/health outcomes include cardiorespiratory fitness, body mass index, resting blood pressure, markers of disease activity (faecal calprotectin and Crohn’s Disease Activity Index) and activated T cell cytokine profiles. Study questionnaires include the Inflammatory Bowel Disease Quality of Life Questionnaire, EQ-5D-5L, IBD Fatigue Scale, Hospital and Anxiety Depression Scale, and International Physical Activity Questionnaire.

Discussion

This study will provide useful information on the feasibility and acceptability of supervised exercise training in adults with inactive and mildly active Crohn’s disease and will inform the design of a subsequent, adequately powered, multi-centre trial.

Trial Registration

The trial is registered with the International Standard Randomised Controlled Trial Register (ISRCTN13021107). Date registration assigned was 02/12/2015.

The effect of carbohydrate mouth rinse on a 30-minute arm cranking performance

The aim of this study was to examine the effect of carbohydrate mouth rinse on 30-min arm cranking performance. Twelve healthy, active males (age 21.6, standard deviation (SD)=3.1 years; mass 76.2, SD=12.2 kg) volunteered in a single-blind, randomised crossover design. Firstly they completed an incremental exercise test to exhaustion (VO2max test) on an arm crank (50W for 2 min, increasing by 10W every min). During visit 2 and 3 they arm cranked for maximal distance over 30 min at a resistance equivalent to 50% of their peak power, mouth rinsing for 5 s with either 25 ml of a tasteless 6.4% maltodextrin solution (CHO) or 25 ml of water (placebo) every 6 min. A letter cancellation test was performed pre and post exercise to measure cognitive function. The result showed that cognitive function was not significantly different between trials (P=0.874). There was no significant difference in distance arm cranked between trials (P=0.164) even though 9 out of 12 participants had improved performance on the CHO trial. In conclusion, further research is needed to determine the ergogenic effect of CHO mouth rinsing on upper body exercise performance.

Sex differences on the acute effects of caffeine on maximal strength and muscular endurance

The aim of this study was to look at the effects of caffeine on strength performance and to examine any differences between sexes. Sixteen moderately active, resistance-trained individuals (10 males and 8 females) performed 2 trials (excluding a familiarisation trial). The effect of 5 mg/kg body mass (BM) caffeine or a placebo on bench press (BP) one repetition maximum (1RM), squat 1RM, the number of BP reps to failure at 40% 1RM (total weight lifted; TWL), pain rating (0-10) were recorded after each final successful lift. BP 1RM was significantly greater (P=0.016), with an increase of 5.91% for males and an increase of 10.69% for females. However, there was no sex difference in squat 1RM with males producing 130.3±27.8 and 134.0±28.9 kg and females producing 66.9±6.2 and 65.3±7.0 kg for placebo and caffeine, respectively. TWL tended to increase with caffeine for males from 1,246.8±704.9 to 1,545.5±920.3 kg; with females having no effect of caffeine (397.8±245.1 to 398.8±182.7kg; P=0.06). Caffeine had no effect on pain perception. This study found that 5 mg/kg BM caffeine improved BP 1RM in resistance-trained males and females. However, for TWL there was a tendency towards improvement in males only, suggesting a sex difference to caffeine ingestion for TWL.

Gender differences in patellofemoral load during the epee fencing lunge

Clinical analyses have shown that injuries and pain linked specifically to fencing training/competition were prevalent in 92.8% of fencers. Patellofemoral pain is the most common chronic injury in athletic populations and females are considered to be more susceptible to this pathology. This study aimed to examine gender differences in patellofemoral contact forces during the fencing lunge. Patellofemoral contact forces were obtained from eight male and eight female club level epee fencers using an eight-camera 3D motion capture system and force platform data as they completed simulated lunges. Independent t-tests were performed on the data to determine whether gender differences in patellofemoral contact forces were present. The results show that females were associated with significantly greater patellofemoral contact force parameters in comparison with males. This suggests that female fencers may be at greater risk from patellofemoral pathology as a function of fencing training/competition.

The effect of caffeine mouth rinse on self-paced cycling performance

The aim of the study was to determine whether caffeine mouth rinse would improve 30 min self-paced cycling trial. Twelve healthy active males (age 20.5±0.7 years, mass 87.4±18.3 kg) volunteered for the study. They attended the laboratory on 3 separate occasions performing a 30 min self-paced cycling trial. On one occasion water was given as a mouth rinse for 5 s (PLA), on another occasion a 6.4% maltodextrin (CHO) solution was given for 5 s and finally a caffeine solution (containing 32 mg of caffeine dissolved in 125 ml water; CAF) was given for 5 s. Distance cycled, heart rate, ratings of perceived exertion, cadence, speed and power output were recorded throughout all trials. Distance cycled during the CAF mouth rinse trial (16.2±2.8 km) was significantly greater compared to PLA trial (14.9±2.6 km). There was no difference between CHO and CAF trials (P=0.89). Cadence, power and velocity were significantly greater during the CAF trial compared to both PLA and CHO (P<0.05). There were no differences between trials for heart rate and perceived exertion (P>0.05). Caffeine mouth rinse improves 30 min cycling performance by allowing the participant to increase cadence, power and velocity without a concurrent increase in perceived exertion and heart rate.

The effects of carbohydrate ingestion on 30 minute rowing time trial performance

The aim of the study was to determine whether ingestion of 6.4% carbohydrate solution prior to 30 min rowing had any effect on distance rowed. Twelve male participants (aged 22.21±2.47 years) volunteered to take part. Participants ingested either 500 ml of 6.4% flavourless maltodextrin solution (CHO) or water (PLA) prior to exercise. During 30 min of self-paced rowing heart rate (HR), ratings of perceived exertion (RPE), stroke rate, power output and distance covered were recorded every 6-min throughout. Participants rowed significantly (P<0.05) further during the CHO trial (6,714.2±409.9 m) compared to the PLA trial (6,390.8±448.1 m). Power also increased during the CHO trial compared to the PLA (P<0.05). However, there was no difference in RPE. In conclusion, from the current investigation rowers who wish to improve their time trial performance in longer duration events may benefit from the ingestion of CHO prior to competition.