Effects of β-hydroxy-β-methylbutyrate (HMB) supplementation in addition to multicomponent exercise in adults older than 70 years living in nursing homes, a cluster randomized placebo-controlled trial: the HEAL study protocol

Background

Evidence supports the fact that multicomponent exercise and HMB supplementation are, separately, effective in improving older adult’s health and palliate functional metabolic diseases in older people. However, the true effect of HMB supplementation combined with a tailored exercise program in frail older adults is still unknown. Thus, the aim of the HEAL (HMB + Exercise = Adults Living longer) study is to assess the effects of the combination of a daily multicomponent exercise and resistance training (VIVIFRAIL program) intervention in addition to HMB supplementation on older adults’ health.

Methods/design

A 24-week cluster randomized, double-blind, placebo-controlled study will be conducted on 104 adults ≥70 years. Nursing homes will be randomized to either of four groups: Ex-HMB (exercise intervention with HMB), Ex-Plac (exercise intervention with placebo), NoEx-HMB (no exercise intervention with HMB), and Controls (No exercise and no HMB). Intervention groups which include exercise will complete the individualized multicomponent (strength, balance and cardiovascular exercises) training program VIVIFRAIL. Intervention groups which include HMB supplementation will receive a 3 g/daily dose of free acid HMB in powder form. The primary outcome measure is the functional capacity. Secondary outcome measures are muscle strength and power, frailty and fall risk, body composition, biochemical analyses and cardiometabolic risk factor, disability and comorbidity, cognitive function and depression.

Discussion

The findings of the HEAL study will help professionals from public health systems to identify cost-effective and innovative actions to improve older people’s health and quality of life, and endorse exercise practice in older adults and people living in nursing homes.

Trial registration

NCT03827499; Date of registration: 01/02/2019.

Muscle contraction velocity, strength and power output changes following different degrees of hypohydration in competitive olympic combat sports

Background

It is habitual for combat sports athletes to lose weight rapidly to get into a lower weight class. Fluid restriction, dehydration by sweating (sauna or exercise) and the use of diuretics are among the most recurrent means of weight cutting. Although it is difficult to dissuade athletes from this practice due to the possible negative effect of severe dehydration on their health, athletes may be receptive to avoid weight cutting if there is evidence that it could affect their muscle performance. Therefore, the purpose of the present study was to investigate if hypohydration, to reach a weight category, affects neuromuscular performance and combat sports competition results.

Methods

We tested 163 (124 men and 39 woman) combat sports athletes during the 2013 senior Spanish National Championships. Body mass and urine osmolality (U_OSM) were measured at the official weigh-in (PRE) and 13–18 h later, right before competing (POST). Athletes were divided according to their U_SOM at PRE in euhydrated (EUH; U_OSM 250–700 mOsm · kgH₂O⁻¹), hypohydrated (HYP; U_OSM 701–1080 mOsm · kgH₂O⁻¹) and severely hypohydrated (S-HYP; U_OSM 1081–1500 mOsm · kgH₂O⁻¹). Athletes’ muscle strength, power output and contraction velocity were measured in upper (bench press and grip) and lower body (countermovement jump - CMJ) muscle actions at PRE and POST time-points.

Results

At weigh-in 84 % of the participants were hypohydrated. Before competition (POST) U_OSM in S-HYP and HYP decreased but did not reach euhydration levels. However, this partial rehydration increased bench press contraction velocity (2.8-7.3 %; p < 0.05) and CMJ power (2.8 %; p < 0.05) in S-HYP. Sixty-three percent of the participants competed with a body mass above their previous day’s weight category and 70 of them (69 % of that sample) obtained a medal.

Conclusions

Hypohydration is highly prevalent among combat sports athletes at weigh-in and not fully reversed in the 13–18 h from weigh-in to competition. Nonetheless, partial rehydration recovers upper and lower body neuromuscular performance in the severely hypohydrated participants. Our data suggest that the advantage of competing in a lower weight category could compensate the declines in neuromuscular performance at the onset of competition, since 69 % of medal winners underwent marked hypohydration.

Pseudoephedrine and circadian rhythm interaction on neuromuscular performance

This study analyzed the effects of pseudoephedrine (PSE) provided at different time of day on neuromuscular performance, side effects, and violation of the current doping cut-off threshold [World Anti-Doping Agency (WADA)]. Nine resistance-trained males carried out bench press and full squat exercises against four incremental loads (25%, 50%, 75%, and 90% one repetition maximum [1RM]), in a randomized, double-blind, cross-over design. Participants ingested either 180 mg of PSE (supra-therapeutic dose) or placebo in the morning (7:00 h; AM(PLAC) and AM(PSE)) and in the afternoon (17:00 h; PM(PLAC) and PM(PSE)). PSE enhanced muscle contraction velocity against 25% and 50% 1RM loads, only when it was ingested in the mornings, and only in the full squat exercise (4.4-8.7%; P < 0.05). PSE ingestion raised urine and plasma PSE concentrations (P < 0.05) regardless of time of day; however, cathine only increased in the urine samples. PSE ingestion resulted in positive tests occurring in 11% of samples, and it rose some adverse side effects such us tachycardia and heart palpitations. Ingestion of a single dose of 180 mg of PSE results in enhanced lower body muscle contraction velocity against low and moderate loads only in the mornings. These mild performance improvements are accompanied by undesirable side effects and an 11% risk of surpassing the doping threshold.

Higher insulin-sensitizing response after sprint interval compared to continuous exercise

This study investigated which exercise mode (continuous or sprint interval) is more effective for improving insulin sensitivity. Ten young, healthy men underwent a non-exercise trial (CON) and 3 exercise trials in a cross-over, randomized design that included 1 sprint interval exercise trial (SIE; 4 all-out 30-s sprints) and 2 continuous exercise trials at 46% VO2peak (CELOW) and 77% VO2peak (CEHIGH). Insulin sensitivity was assessed using intravenous glucose tolerance test (IVGTT) 30 min, 24 h and 48 h post-exercise. Energy expenditure was measured during exercise. Glycogen in vastus lateralis was measured once in a resting condition (CON) and immediately post-exercise in all trials. Plasma lipids were measured before each IVGTT. Only after CEHIGH did muscle glycogen concentration fall below CON (P<0.01). All exercise treatments improved insulin sensitivity compared with CON, and this effect persisted for 48-h. However, 30-min post-exercise, insulin sensitivity was higher in SIE than in CELOW and CEHIGH (11.5±4.6, 8.6±5.4, and 8.1±2.9 respectively; P<0.05). Insulin sensitivity did not correlate with energy expenditure, glycogen content, or plasma fatty acids concentration (P>0.05). After a single exercise bout, SIE acutely improves insulin sensitivity above continuous exercise. The higher post-exercise hyperinsulinemia and the inhibition of lipolysis could be behind the marked insulin sensitivity improvement after SIE.

Muscle conduction velocity, strength, neural activity, and morphological changes after eccentric and concentric training

This study compared the effects of concentric and eccentric training on neuromuscular adaptations in young subjects. Twenty-two men and women were assigned to one of two groups: concentric (CON, n = 11) and eccentric (ECC, n = 11) training. Training consisted of 6 weeks of isokinetic exercise, performed twice weekly, starting with two sets of eight repetitions, and progressing to five sets of 10 repetitions. Subjects were tested in strength variables [concentric, eccentric, and isometric peak torque (PT), and rate of force development (RFD)], muscle conduction velocity (CV), neuromuscular activity, vastus lateralis (VL) muscle thickness, and echo intensity as determined by ultrasonography. There were similar increases in the concentric and eccentric PTs in both the CON and ECC groups (P < 0.01), but only the ECC group showed an increase in isometric PT (P < 0.001). Similarly, both groups exhibited increased VL muscle thickness, CV, and RFD, and reduced VL echo intensity (P < 0.05). Significant correlations were observed among the relative changes in the neuromuscular outcomes and training variables (e.g., total work, average PT) (r = 0.68-0.75, P < 0.05). The results showed that both training types similarly improved dynamic PT, CV, RFD, and muscle thickness and quality during the early weeks of training.

Velocity- and power-load relationships of the bench pull vs. bench press exercises

This study compared the velocity- and power-load relationships of the antagonistic upper-body exercises of prone bench pull (PBP) and bench press (BP). 75 resistance-trained athletes performed a progressive loading test in each exercise up to the one-repetition maximum (1RM) in random order. Velocity and power output across the 30-100% 1RM were significantly higher for PBP, whereas 1RM strength was greater for BP. A very close relationship was observed between relative load and mean propulsive velocity for both BP (R2=0.97) and PBP (R2=0.94) which enables us to estimate %1RM from velocity using the obtained prediction equations. Important differences in the load that maximizes power output (Pmax) and the power profiles of both exercises were found according to the outcome variable used: mean (MP), peak (PP) or mean propulsive power (MPP). When MP was considered, the Pmax load was higher (56% BP, 70% PBP) than when PP (37% BP, 41% PBP) or MPP (37% BP, 46% PBP) were used. For each variable there was a broad range of loads at which power output was not significantly different. The differing velocity- and power-load relationships between PBP and BP seem attributable to the distinct muscle architecture and moment arm levers involved in these exercises.