Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features

Objective National guidelines for management of intermediate risk patients with suspected acute coronary syndrome, in whom AMI has been excluded, advocate provocative testing to final risk stratify these patients into low risk (negative testing) or high risk (positive testing suggestive of unstable angina). Adults less than 40 years have a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated Methods A retrospective analysis of exercise stress testing performed on patients less than 40 years was evaluated. Patients were enrolled on a chest pain pathway and had negative serial ECGs and cardiac biomarkers before exercise stress testing to rule-out acute coronary syndrome. Chart review was completed on patients with positive stress tests. Results The 3987 patients with suspected intermediate risk acute coronary syndrome underwent exercise stress testing. One thousand and twenty-seven (25.8%) were aged less than 40 years (age 33.3 ± 4.8 years). Four of these 1027 patients had a positive exercise stress test (0.4% incidence of positive exercise stress testing). Of those, three patients had subsequent non-invasive functional testing that yielded a negative result. One patient declined further investigations. Assuming this was a true positive exercise stress test, the incidence of true positive exercise stress testing would have been 0.097% (95% confidence interval: 0.079–0.115%) (one of 1027 patients). Conclusions Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome

Acute and chronic effects of dietary nitrate supplementation on blood pressure and the physiological responses to moderate-intensity and incremental exercise

Dietary nitrate (NO3−) supplementation with beetroot juice (BR) over 4–6 days has been shown to reduce the O2 cost of submaximal exercise and to improve exercise tolerance. However, it is not known whether shorter (or longer) periods of supplementation have similar (or greater) effects. We therefore investigated the effects of acute and chronic NO3− supplementation on resting blood pressure (BP) and the physiological responses to moderate-intensity exercise and ramp incremental cycle exercise in eight healthy subjects. Following baseline tests, the subjects were assigned in a balanced crossover design to receive BR (0.5 l/day; 5.2 mmol of NO3−/day) and placebo (PL; 0.5 l/day low-calorie juice cordial) treatments. The exercise protocol (two moderate-intensity step tests followed by a ramp test) was repeated 2.5 h following first ingestion (0.5 liter) and after 5 and 15 days of BR and PL. Plasma nitrite concentration (baseline: 454 ± 81 nM) was significantly elevated (+39% at 2.5 h postingestion; +25% at 5 days; +46% at 15 days; P < 0.05) and systolic and diastolic BP (baseline: 127 ± 6 and 72 ± 5 mmHg, respectively) were reduced by ∼4% throughout the BR supplementation period (P < 0.05). Compared with PL, the steady-state V̇o2 during moderate exercise was reduced by ∼4% after 2.5 h and remained similarly reduced after 5 and 15 days of BR (P < 0.05). The ramp test peak power and the work rate at the gas exchange threshold (baseline: 322 ± 67 W and 89 ± 15 W, respectively) were elevated after 15 days of BR (331 ± 68 W and 105 ± 28 W; P < 0.05) but not PL (323 ± 68 W and 84 ± 18 W). These results indicate that dietary NO3− supplementation acutely reduces BP and the O2 cost of submaximal exercise and that these effects are maintained for at least 15 days if supplementation is continued.

Influence of acute vitamin C and/or carbohydrate ingestion on hormonal, cytokine, and immune responses to prolonged exercise

Davison, G. and Gleeson, M. (2005). Influence of Acute Vitamin C and/or Carbohydrate Ingestion on Hormonal, Cytokine, and Immune Responses to Prolonged Exercise. International Journal of Sport Nutrition and Exercise Metabolism. 15(5), pp.465-479 RAE2008

Exercise elicits phase shifts and acute alterations of melatonin that vary with circadian phase

To examine the immediate phase-shifting effects of high-intensity exercise of a practical duration (1 h) on human circadian phase, five groups of healthy men 20-30 yr of age participated in studies involving no exercise or exposure to morning, afternoon, evening, or nocturnal exercise. Except during scheduled sleep/dark and exercise periods, subjects remained under modified constant routine conditions allowing a sleep period and including constant posture, knowledge of clock time, and exposure to dim light intensities averaging (±SD) 42 ± 19 lx. The nocturnal onset of plasma melatonin secretion was used as a marker of circadian phase. A phase response curve was used to summarize the phase-shifting effects of exercise as a function of the timing of exercise. A significant effect of time of day on circadian phase shifts was observed (P < 0.004). Over the interval from the melatonin onset before exercise to the first onset after exercise, circadian phase was significantly advanced in the evening exercise group by 30 ± 15 min (SE) compared with the phase delays observed in the no-exercise group (-25 ± 14 min, P < 0.05). Phase shifts in response to evening exercise exposure were attenuated on the second day after exercise exposure and no longer significantly different from phase shifts observed in the absence of exercise. Unanticipated transient elevations of melatonin levels were observed in response to nocturnal exercise and in some evening exercise subjects. Taken together with the results from previous studies in humans and diurnal rodents, the current results suggest that 1) a longer duration of exercise exposure and/or repeated daily exposure to exercise may be necessary for reliable phase-shifting of the human circadian system and that 2) early evening exercise of high intensity may induce phase advances relevant for nonphotic entrainment of the human circadian system.

The effect of elevated muscle fluid volume on indices of muscle damage following an acute bout of eccentric exercise

The primary purpose of the current investigation was to develop an elevated muscle fluid level using a human in-vivo model. The secondary purpose was to determine if an increased muscle fluid content could alter the acute muscle damage response following a bout of eccentric exercise. Eight healthy, recreationally active males participated in a cross-over design involving two randomly assigned trials. A hydration trial (HYD) consisting of a two hour infusion of a hypotonic (0.45%) saline at a rate of 20mL/minVl .73m"^ and a control trial (CON), separated by four weeks. Following the infusion (HYD) or rest period (CON), participants completed a single leg isokinetic eccentric exercise protocol of the quadriceps, consisting of 10 sets of 10 repetitions with a one minute rest between each set. Muscle biopsies were collected prior to the exercise, immediately following and at three hours post exercise. Muscle analysis included determination of wet-dry ratios and quantification of muscle damage using toluidine blue staining and light microscopy. Blood samples were collected prior to, immediately post, three and 24 hours post exercise to determine changes in creatine kinase (CK), lactate dehydrogenase (LD), interleukin-6 (IL-6) and Creactive protein (CRP) levels. Results demonstrated an increased muscle fluid volume in the HYD condition following the infusion when compared to the CON condition. Isometric peak torque was significantly reduced following the exercise in both the HYD and CON conditions. There were no significant differences in the number of areas of muscle damage at any of the time points in either condition, with no differences between conditions. CK levels were significantly greater 24hour post exercise compared to pre, immediately and three hours post similarly in both conditions. LD in the HYD condition followed a similar trend as CK with 24 hour levels higher than pre, immediately post and three hours post and LD levels were significantly greater 24 hours post compared to pre levels in the CON condition, with no differences between conditions. A significant main effect for time was observed for CRP (p<0.05) for time, such that CRP levels increased consistently at each subsequent time point. However, CRP and IL-6 levels were not different at any of the measured time points when comparing the two conditions. Although the current investigation was able to successfully increase muscle fluid volume and an increased CK, LD and CRP were observed, no muscle damage was observed following the eccentric exercise protocol in the CON or HYD conditions. Therefore, the hypotonic infusion used in the HYD condition proved to be a viable method to acutely increase muscle fluid content in in-vivo human skeletal muscle.

The acute effects of differential dietary fatty acids on PDHa activity in human skeletal muscle at the onset of exercise

Pyruvate dehydrogenase (PDH) is an important regulator of carbohydrate oxidation during exercise and its activity can be down-regulated by an increase in dietary fat. The purpose of this study was to determine the acute metabolic effects of differential dietary fatty acids on the activation of PDH in its active form (PDHa) at rest and at the onset of moderate-intensity exercise. University-aged male subjects (n=7) underwent 2 fat loading trials spaced at least 2 weeks apart. Subjects consumed saturated (SFA) or polyunsaturated (PUFA) fat over the course of 5 hours. Following this, participants cycled at 65% VO2 max for 15 min. Muscle biopsies were taken prior to and following fat loading and at 1 min exercise. Plasma free fatty acids increased from 0.15 ± 0.07 to 0.54 ± 0.19 mM over 5 hours with SFA and from 0.1 1 ± 0.04 to 0.35 ±0.13 mM with PUFA. PDHa activity was unchanged following fat loading, but increased at the onset of exercise in the SFA trial, from 1 .4 ± 0.4 to 2.2 ± 0.4 /xmol/min/kg wet wt. This effect was negated in the PUFA trial (1 .2 ± 0.3 to 1 .3 ± 0.3 pimol/min/kg wet wt.). PDH kinase (PDK) was unchanged in both trials, suggesting that the attenuation of PDHa activity with PUFA was a result of changes in the concentrations of intramitochondrial effectors, more specifically intramitochondrial NADH or Ca^*. Our findings suggest that attenuated PDHa activity participates in the preferential oxidation of PUFA during moderateintensity exercise.

THE ACUTE EFFECTS OF A SINGLE SESSION OF PLYOMETRIC EXERCISE ON MARKERS OF BONE TURNOVER IN BOYS AND MEN

The study objective was to compare the response of bone markers to an exercise session consisting of high mechanical loading (144 jumps) between boys (n=12, 10.2 ± 0.4 years) and men (n=18, 22.5 ± 0.7 years). Blood samples were collected at pre-, 5, 60 minutes post-, and 24 hours post-exercise) to measure bone-specific alkaline phosphatase (BAP), amino-terminal cross-linking telopeptide (NTx), osteoprotegrin (OPG) and receptor activator of nuclear factor kb ligand (RANKL). Boys had higher BAP levels at all time points, with an increase 24 hours post-exercise. No such increase was observed in men. Likewise, NTx levels were higher in boys, with a greater increase over time than in men. OPG and RANKL levels were similar in boys and men at all times. In summary, even one session of exercise stimulates bone turnover, as reflected in the increase in both BAP and NTx, in boys (but not men) within 24 hours.

Acute endocrine responses to plyometrics versus resistance exercise in children

The purpose of this study was to examine the acute hormonal responses to a bout of resistance versus plyometric exercise in young male athletes. Specifically, changes in salivary cortisol, testosterone and testosterone-to-cortisol ratio from pre- to post-exercise between the two different exercise protocols were examined. Twenty-six peri-pubertal active boys participated in this cross-over study, completing two exercise sessions. During each session, participants first completed a 30 min control period, which did not include any exercise, and then was randomly assigned to perform a 45 min of either a resistance exercise or a plyometric exercise protocol. All participants crossed over to perform the other exercise protocol during their second exercise session, a week later. Four saliva samples during each protocol were taken at: baseline, pre-exercise, 5 min post-exercise and 30 min post-exercise. Significant increases in testosterone values were reported 5 min post-exercise following the resistance protocol, but not the plyometric protocol. Both exercise protocols resulted in significant cortisol decreases overtime, as well as significant testosterone-to-cortisol ratio increases. The post-exercise increases in salivary testosterone and testosterone-to-cortisol ratio followed the typical exercise induced anabolic response seen in adults. However, the post-exercise decrease in salivary cortisol was different than the typical adult response indicating an insufficient stimulus for this age group maybe due to their stage of the biological development. Thus, in the adolescent boys, exercise appears to change the anabolic to catabolic balance in favor of anabolism.

Acute exhaustive exercise regulates IL-2, IL-4 and MyoD in skeletal muscle but not adipose tissue in rats

Background: The purpose of this study was to evaluate the effect of exhaustive exercise on proteins associated with muscle damage and regeneration, including IL-2, IL-4 and MyoD, in extensor digitorum longus (EDL) and soleus muscles and mesenteric (MEAT) and retroperitoneal adipose tissues (RPAT). Methods: Rats were killed by decapitation immediately (E0 group, n = 6), 2 (E2 group, n = 6) or 6 (E6 group, n = 6) hours after the exhaustion protocol, which consisted of running on a treadmill at approximately 70% of VO(2max) for fifty minutes and then at an elevated rate that increased at one m/min every minute, until exhaustion. Results: The control group (C group, n = 6) was not subjected to exercise. IL-2 protein expression increased at E0 in the soleus and EDL; at E2, this cytokine returned to control levels in both tissues. In the soleus, IL-2 protein expression was lower than that in the control at E6. IL-4 protein levels increased in EDL at E6, but the opposite result was observed in the soleus. MyoD expression increased at E6 in EDL. Conclusion: Exhaustive exercise was unable to modify IL-2 and IL-4 levels in MEAT and RPAT. The results show that exhaustive exercise has different effects depending on which muscle is analysed.

STAT3 signaling is activated in human skeletal muscle following acute resistance exercise

The transcription factor signal transducer and activator of transcription 3 (STAT3) has been identified as a mediator of cytokine signaling and implicated in hypertrophy; however, the importance of this pathway following resistance exercise in human skeletal muscle has not been investigated. In the present study, the phosphorylation and nuclear localization of STAT3, together with STAT3-regulated genes, were measured in the early recovery period following intense resistance exercise. Muscle biopsy samples from healthy subjects (7 males, 23.0 + 0.9 yr) were harvested before and again at 2, 4, and 24 h into recovery following a single bout of maximal leg extension exercise (3 sets, 12 repetitions). Rapid and transient activation of phosphorylated (tyrosine 705) STAT3 was observed at 2 h postexercise. STAT3 phosphorylation paralleled the transient localization of STAT3 to the nucleus, which also peaked at 2 h postexercise. Downstream transcriptional events regulated by STAT3 activation peaked at 2 h postexercise, including early responsive genes c-FOS (800-fold), JUNB (38-fold), and c-MYC (140-fold) at 2 h postexercise. A delayed peak in VEGF (4-fold) was measured 4 h postexercise. Finally, genes associated with modulating STAT3 signaling were also increased following exercise, including the negative regulator SOCS3 (60-fold). Thus, following a single bout of intense resistance exercise, a rapid phosphorylation and nuclear translocation of STAT3 are evident in human skeletal muscle. These data suggest that STAT3 signaling is an important common element and may contribute to the remodeling and adaptation of skeletal muscle following resistance exercise.

Effect of heavy dynamic resistive exercise on acute upper-body power

There is limited research to support the notion that heavy resistive exercise immediately before a power movement may acutely enhance performance. Upper-body acute power enhancement during a stretch-shorten cycle (SSC) movement has not been previously investigated. The aim of this project was to determine whether a set of 5 repetitions of 5 repetition maximum (RM) bench press preceding explosive pushups would significantly influence indicators of power: impulse and maximum rate of force development. Subjects randomly performed either explosive push-ups only over a force platform or a set of 5RM bench press before the explosive push-ups. There were no significant differences for any of the force platform data when the explosive push-ups were preceded by a set of 5RM bench press. It appears that heavy dynamic resistive upper-body exercise on its own before an upper-body power activity is inadequate in augmenting short-term power.