Body composition and fuel metabolism after kidney grafting

Kidney transplant patients display decreased muscle mass and increased fat mass. Whether this altered body composition is due to glucocorticoid induced altered fuel metabolism is unclear. To answer this question, 16 kidney transplant patients were examined immediately after kidney transplantation (12 +/- 4 days, mean +/- SEM) and then during months 2, 5, 11 and 16, respectively, by whole body dual energy X-ray absorptiometry (Hologic QDR 1000W) and indirect calorimetry. Results were compared with those of 16 age, sex and body mass index matched healthy volunteers examined only once. All patients received dietary counselling with a step 1 diet of the American Heart Association and were advised to restrict their caloric intake to the resting energy expenditure plus 30%. Immediately after transplantation, lean mass of the trunk was higher by 7 +/- 1% (P < 0.05) and that of the limbs was lower by more than 10% (P < 0.01) in patients than in controls. In contrast, no difference in fat mass and resting energy expenditure could be detected between patients and controls. During the 16 months of observation, total fat mass increased in male (+4.9 +/- 1.5 kg), but not in female patients (0.1 +/- 0.8 kg). The change in fat mass observed in men was due to an increase in all subregions of the body analysed (trunk, arms+legs as well as head+neck), whereas in women only an increase in head+neck by 9 +/- 2% (P = 0.05) was detected. Body fat distribution remained unchanged in both sexes over the 16 months of observation. Lean mass of the trunk mainly decreased between days 11 and 42 (P < 0.01) and remained stable thereafter. After day 42, lean mass of arms and legs (mostly striated muscle) and head+neck progressively increased over the 14 months of observation by 1.6 +/- 0.6 kg (P < 0.05) and 0.4 +/- 0.1 kg (P < 0.01), respectively. Resting energy expenditure was similar in controls and patients at 42 days (30.0 +/- 0.7 vs. 31.0 +/- 0.9 kcal kg-1 lean mass) and did not change during the following 15 months of observation. However, composition of fuel used to sustain resting energy expenditure in the fasting state was altered in patients when compared with normal subjects, i.e. glucose oxidation was higher by more than 45% in patients (P < 0.01) during the second month after grafting, but gradually declined (P < 0.01) over the following 15 months to values similar to those observed in controls. Protein oxidation was elevated in renal transplant patients on prednisone at first measurement, a difference which tended to decline over the study period. In contrast to glucose and protein oxidation, fat oxidation was lower in patients 42 days after grafting (P < 0.01), but increased by more than 100% reaching values similar to those observed in controls after 16 months of study. Mean daily dose of prednisone per kg body weight correlated with the three components of fuel oxidation (r > 0.93, P < 0.01), i.e. protein, glucose and fat oxidation. These results indicate that in prednisone treated renal transplant patients fuel metabolism is regulated in a dose-dependent manner. Moreover, dietary measures, such as caloric and fat intake restriction as well as increase of protein intake, can prevent muscle wasting as well as part of the usually observed fat accumulation. Furthermore, the concept of preferential upper body fat accumulation as consequence of prednisone therapy in renal transplant patients has to be revised.

Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography

Purpose: The purpose of this study was to evaluate the diagnostic accuracy of full-body linear X-ray scanning (LS) in multiple trauma patients in comparison to 128-multislice computed tomography (MSCT). Materials and Methods: 106 multiple trauma patients (female: 33; male: 73) were retrospectively included in this study. All patients underwent LS of the whole body, including extremities, and MSCT covering the neck, thorax, abdomen, and pelvis. The diagnostic accuracy of LS for the detection of fractures of the truncal skeleton and pneumothoraces was evaluated in comparison to MSCT by two observers in consensus. Extremity fractures detected by LS were documented. Results: The overall sensitivity of LS was 49.2 %, the specificity was 93.3 %, the positive predictive value was 91 %, and the negative predictive value was 57.5 %. The overall sensitivity for vertebral fractures was 16.7 %, and the specificity was 100 %. The sensitivity was 48.7 % and the specificity 98.2 % for all other fractures. Pneumothoraces were detected in 12 patients by CT, but not by LS. 40 extremity fractures were detected by LS, of which 4 fractures were dislocated, and 2 were fully covered by MSCT. Conclusion: The diagnostic accuracy of LS is limited in the evaluation of acute trauma of the truncal skeleton. LS allows fast whole-body X-ray imaging, and may be valuable for detecting extremity fractures in trauma patients in addition to MSCT. Key Points: • The overall sensitivity of LS for truncal skeleton injuries in multiple-trauma patients was < 50 %.• The diagnostic reference standard MSCT is the preferred and reliable imaging modality.• LS may be valuable for quick detection of extremity fractures. Citation Format: • Jöres APW., Heverhagen JT, Bonél H et al. Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multiple Trauma Patients in Comparison to Computed Tomography. Fortschr Röntgenstr 2016; 188: 163 - 171.

Validation and aplication of Bioelectrical Impedance (BIA) method to determine body and carcass composition and nutrient retention of growing rabbits = Validación y aplicación de la técnica de la Impedancia Bioeléctrica (BIA) para determinar la composición corporal, de la canal y la retención de nutrientes de conejos en crecimiento

Los objetivos de esta tesis fueron 1) obtener y validar ecuaciones de predicción para determinar in vivo la composición corporal y de la canal de conejos en crecimiento de 25 a 77 días de vida utilizando la técnica de la Impedancia Bioeléctrica (BIA), y 2) evaluar su aplicación para determinar diferencias en la composición corporal y de la canal, así como la retención de nutrientes de animales alimentados con diferentes fuentes y niveles de grasa. El primer estudio se realizó para determinar y después validar, usando datos independientes, las ecuaciones de predicción obtenidas para determinar in vivo la composición corporal de los conejos en crecimiento. Se utilizaron 150 conejos a 5 edades distintas (25, 35, 49, 63 y 77 días de vida), con un rango de pesos entre 231 y 3138 g. Para determinar los valores de resistencia (Rs,) and reactancia (Xc,) se usó un terminal (Model BIA-101, RJL Systems, Detroit, MI USA) con cuatro electrodos. Igualmente se registró la distancia entre electrodos internos (D), la longitud corporal (L) y el peso vivo (PV) de cada animal. En cada edad, los animales fueron molidos y congelados (-20 ºC) para su posterior análisis químico (MS, grasa, proteína, cenizas y EB). El contenido en grasa y energía de los animales se incrementó, mientras que los contenidos en proteína, cenizas y agua de los animales disminuyeron con la edad. Los valores medios de Rs, Xc, impedancia (Z), L y D fueron 83.5 ± 23.1 , 18.2 ± 3.8 , 85.6 ± 22.9 , 30.6 ± 6.9 cm y 10.8 ± 3.1 cm. Se realizó un análisis de regresión lineal múltiple para determinar las ecuaciones de predicción, utilizando los valores de PV, L and Z como variables independientes. Las ecuaciones obtenidas para estimar los contenidos en agua (g), PB (g), grasa (g), cenizas (g) and EB (MJ) tuvieron un coeficiente de determinación de (R2) de 0.99, 0.99, 0.97, 0.98 y 0.99, y los errores medios de predicción relativos (EMPR) fueron: 2.79, 6.15, 24.3, 15.2 y 10.6%, respectivamente. Cuando el contenido en agua se expresó como porcentaje, los valores de R2 y EMPR fueron 0.85 and 2.30%, respectivamente. Al predecir los contenidos en proteína (%MS), grasa (%MS), cenizas (%MS) y energía (kJ/100 g MS), se obtuvieron valores de 0.79, 0.83, 0.71 y 0.86 para R2, y 5.04, 18.9, 12.0 y 3.19% para EMPR. La reactancia estuvo negativamente correlacionada con el contenido en agua, cenizas y PB (r = -0.32, P < 0.0001; r = -0.20, P < 0.05; r = -0.26, P < 0.01) y positivamente correlacionada con la grasa y la energía (r = 0.23 y r = 0.24; P < 0.01). Sin embargo, Rs estuvo positivamente correlacionada con el agua, las cenizas y la PB (r = 0.31, P < 0.001; r = 0.28, P < 0.001; r = 0.37, P < 0.0001) y negativamente con la grasa y la energía (r = -0.36 y r = -0.35; P < 0.0001). Igualmente la edad estuvo negativamente correlacionada con el contenido en agua, cenizas y proteína (r = -0.79; r = -0.68 y r = -0.80; P < 0.0001) y positivamente con la grasa y la energía (r = 0.78 y r = 0.81; P < 0.0001). Se puede concluir que el método BIA es una técnica buena y no invasiva para estimar in vivo la composición corporal de conejos en crecimiento de 25 a 77 días de vida. El objetivo del segundo estudio fue determinar y validar con datos independientes las ecuaciones de predicción obtenidas para estimar in vivo la composición de la canal eviscerada mediante el uso de BIA en un grupo de conejos de 25 a 77 días, así como testar su aplicación para predecir la retención de nutrientes y calcular las eficacias de retención de la energía y del nitrógeno. Se utilizaron 75 conejos agrupados en 5 edades (25, 35, 49, 63 y 77 días de vida) con unos pesos que variaron entre 196 y 3260 g. Para determinar los valores de resistencia (Rs, ) y reactancia (Xc, ) se usó un terminal (Model BIA-101, RJL Systems, Detroit, MI USA) con cuatro electrodos. Igualmente se registró la distancia entre electrodos internos (D), la longitud corporal (L) y el peso vivo (PV) del cada animal. En cada edad, los animales fueron aturdidos y desangrados. Su piel, vísceras y contenido digestivo fueron retirados, y la canal oreada fue pesada y molida para posteriores análisis (MS, grasa, PB, cenizas y EB). Los contenidos en energía y grasa aumentaron mientras que los de agua, cenizas y proteína disminuyeron con la edad. Los valores medios de Rs, Xc, impedancia (Z), L y D fueron 95.9±23.9 , 19.5±4.7 , 98.0±23.8 , 20.6±6.3 cm y 13.7±3.1 cm. Se realizó un análisis de regresión linear múltiple para determinar las ecuaciones de predicción, utilizando los valores de PV, L and Z como variables independientes. Los coeficientes de determinación (R2) de las ecuaciones obtenidas para estimar los contenidos en agua (g), PB (g), grasa (g), cenizas (g) and EB (MJ) fueron: 0.99, 0.99, 0.95, 0.96 y 0.98, mientras que los errores medios de predicción relativos (EMPR) fueron: 4.20, 5.48, 21.9, 9.10 y 6.77%, respectivamente. Cuando el contenido en agua se expresó como porcentaje, los valores de R2 y EMPR fueron 0.79 y 1.62%, respectivamente. Cuando se realizó la predicción de los contenidos en proteína (%MS), grasa (%MS), cenizas (%MS) y energía (kJ/100 g MS), los valores de R2 fueron 0.68, 0.76, 0.66 and 0.82, y los de RMPE: 3.22, 10.5, 5.82 and 2.54%, respectivamente. La reactancia estuvo directamente correlacionada con el contenido en grasa (r = 0.24, P < 0.05), mientras que la resistencia guardó una correlación positiva con los contenidos en agua, cenizas y proteína (r = 0.55, P < 0.001; r = 0.54, P < 0.001; r = 0.40, P < 0.005) y negativa con la grasa y la energía (r = -0.44 y r = -0.55; P < 0.001). Igualmente la edad estuvo negativamente correlacionada con los contenidos en agua, cenizas y PB (r = -0.94; r = -0.85 y r = -0.75; P < 0.0001) y positivamente con la grasa y la energía (r = 0.89 y r = 0.90; P < 0.0001). Se estudió la eficacia global de retención de la energía (ERE) y del nitrógeno (ERN) durante todo el periodo de cebo (35-63 d), Los valores de ERE fueron 20.4±7.29%, 21.0±4.18% and 20.8±2.79% en los periodos 35 a 49, 49 a 63 y 35 a 63 d, respectivamente. ERN fue 46.9±11.7%, 34.5±7.32% y 39.1±3.23% para los mismos periodos. La energía fue retenida en los tejidos para crecimiento con una eficiencia del 52.5% y la eficiencia de retención de la energía como proteína y grasa fue de 33.3 y 69.9% respectivamente. La eficiencia de utilización del nitrógeno para crecimiento fue cercana al 77%. Este trabajo muestra como el método BIA es técnica buena y no invasiva para determinar in vivo la composición de la canal y la retención de nutrientes en conejos en crecimiento de 25 a 77 días de vida. En el tercer estudio, se llevaron a cabo dos experimentos con el fin de investigar los efectos del nivel de inclusión y de la fuente de grasa, sobre los rendimientos productivos, la mortalidad, la retención de nutrientes y la composición corporal total y de la canal eviscerada de conejos en crecimiento de 34 a 63 d de vida. En el Exp. 1 se formularon 3 dietas con un diseño experimental factorial 3 x 2 con el tipo de grasa utilizada: Aceite de Soja (SBO), Lecitinas de Soja (SLO) y Manteca (L) y el nivel de inclusión (1.5 y 4%) como factores principales. El Exp. 2 también fue diseñado con una estructura factorial 3 x 2, pero usando SBO, Aceite de Pescado (FO) y Aceite de Palmiste como fuentes de grasa, incluidas a los mismos niveles que en el Exp. 1. En ambos experimentos 180 animales fueron alojados en jaulas individuales (n=30) y 600 en jaulas colectivas en grupos de 5 animales (n=20). Los animales alimentados con un 4% de grasa añadida tuvieron unos consumos diarios y unos índices de conversión más bajos que aquellos alimentados con las dietas con un 1.5% de grasa. En los animales alojados en colectivo del Exp. 1, el consumo fue un 4.8% más alto en los que consumieron las dietas que contenían manteca que en los animales alimentados con las dietas SBO (P = 0.036). La inclusión de manteca tendió a reducir la mortalidad (P = 0.067) en torno al 60% y al 25% con respecto a las dietas con SBO y SLO, respectivamente. La mortalidad aumentó con el nivel máximo de inclusión de SLO (14% vs. 1%, P < 0.01), sin observarse un efecto negativo sobre la mortalidad con el nivel más alto de inclusión de las demás fuentes de grasa utilizadas. En los animales alojados colectivo del Exp. 2 se encontró una disminución del consumo (11%), peso vivo a 63 d (4.8%) y de la ganancia diaria de peso (7.8%) con la inclusión de aceite de pescado con respecto a otras dietas (P < 0.01). Los dos últimos parámetros se vieron especialmente más reducidos cuando en las dietas se incluyó el nivel más alto de FO (5.6 y 9.5%, respectivamente, (P < 0.01)). Los animales alojados individualmente mostraron unos resultados productivos muy similares. La inclusión de aceite pescado tendió (P = 0.078) a aumentar la mortalidad (13.2%) con respecto al aceite de palmiste (6.45%), siendo intermedia para las dietas que contenían SBO (8.10%). La fuente o el nivel de grasa no afectaron la composición corporal total o de la canal eviscerada de los animales. Un incremento en el nivel de grasa dio lugar a una disminución de la ingesta de nitrógeno digestible (DNi) (1.83 vs. 1.92 g/d; P = 0.068 en Exp. 1 y 1.79 vs. 1.95 g/d; P = 0.014 en Exp. 2). Debido a que el nitrógeno retenido (NR) en la canal fue similar para ambos niveles (0.68 g/d (Exp. 1) y 0.71 g/d (Exp. 2)), la eficacia total de retención del nitrógeno (ERN) aumentó con el nivel máximo de inclusión de grasa, pero de forma significativa únicamente en el Exp. 1 (34.9 vs. 37.8%; P < 0.0001), mientras que en el Exp. 2 se encontró una tendencia (36.2 vs. 38.0% en Exp. 2; P < 0.064). Como consecuencia, la excreción de nitrógeno en heces fue menor en los animales alimentados con el nivel más alto de grasa (0.782 vs. 0.868 g/d; P = 0.0001 en Exp. 1, y 0.745 vs. 0.865 g/d; P < 0.0001 en Exp.2) al igual que el nitrógeno excretado en orina (0.702 vs. 0.822 g/d; P < 0.0001 en Exp. 1 y 0.694 vs. 0.7999 g/d; P = 0.014 en Exp.2). Aunque no hubo diferencias en la eficacia total de retención de la energía (ERE), la energía excretada en heces disminuyó al aumentar el nivel de inclusión de grasa (142 vs. 156 Kcal/d; P = 0.0004 en Exp. 1 y 144 vs. 154 g/d; P = 0.050 en Exp. 2). Sin embargo, la energía excretada como orina y en forma de calor fue mayor en el los animales del Exp. 1 alimentados con el nivel más alto de grasa (216 vs. 204 Kcal/d; P < 0.017). Se puede concluir que la manteca y el aceite de palmiste pueden ser considerados como fuentes alternativas al aceite de soja debido a la reducción de la mortalidad, sin efectos negativos sobre los rendimientos productivos o la retención de nutrientes. La inclusión de aceite de pescado empeoró los rendimientos productivos y la mortalidad durante el periodo de crecimiento. Un aumento en el nivel de grasa mejoró el índice de conversión y la eficacia total de retención de nitrógeno. ABSTRACT The aim of this Thesis is: 1) to obtain and validate prediction equations to determine in vivo whole body and carcass composition using the Bioelectrical Impedance (BIA) method in growing rabbits from 25 to 77 days of age, and 2) to study its application to determine differences on whole body and carcass chemical composition, and nutrient retention of animals fed different fat levels and sources. The first study was conducted to determine and later validate, by using independent data, the prediction equations obtained to assess in vivo the whole body composition of growing rabbits. One hundred and fifty rabbits grouped at 5 different ages (25, 35, 49, 63 and 77 days) and weighing from 231 to 3138 g were used. A four terminal body composition analyser was used to obtain resistance (Rs, ) and reactance (Xc, ) values (Model BIA-101, RJL Systems, Detroit, MI USA). The distance between internal electrodes (D, cm), body length (L, cm) and live BW of each animal were also registered. At each selected age, animals were slaughtered, ground and frozen (-20 ºC) for later chemical analyses (DM, fat, CP, ash and GE). Fat and energy body content increased with the age, while protein, ash, and water decreased. Mean values of Rs, Xc, impedance (Z), L and D were 83.5 ± 23.1 , 18.2 ± 3.8 , 85.6 ± 22.9 , 30.6 ± 6.9 cm and 10.8 ± 3.1 cm. A multiple linear regression analysis was used to determine the prediction equations, using BW, L and Z data as independent variables. Equations obtained to estimate water (g), CP (g), fat (g), ash (g) and GE (MJ) content had, respectively, coefficient of determination (R2) values of 0.99, 0.99, 0.97, 0.98 and 0.99, and the relative mean prediction error (RMPE) was: 2.79, 6.15, 24.3, 15.2 and 10.6%, respectively. When water was expressed as percentage, the R2 and RMPE were 0.85 and 2.30%, respectively. When prediction of the content of protein (%DM), fat (%DM), ash (%DM) and energy (kJ/100 g DM) was done, values of 0.79, 0.83, 0.71 and 0.86 for R2, and 5.04, 18.9, 12.0 and 3.19% for RMPE, respectively, were obtained. Reactance was negatively correlated with water, ash and CP content (r = -0.32, P < 0.0001; r = -0.20, P < 0.05; r = -0.26, P < 0.01) and positively correlated with fat and GE (r = 0.23 and r = 0.24; P < 0.01). Otherwise, resistance was positively correlated with water, ash and CP (r = 0.31, P < 0.001; r = 0.28, P < 0.001; r = 0.37, P < 0.0001) and negatively correlated with fat and energy (r = -0.36 and r = -0.35; P < 0.0001). Moreover, age was negatively correlated with water, ash and CP content (r = -0.79; r = -0.68 and r = -0.80; P < 0.0001) and positively correlated with fat and energy (r = 0.78 and r = 0.81; P < 0.0001). It could be concluded that BIA is a non-invasive good method to estimate in vivo whole body composition of growing rabbits from 25 to 77 days of age. The aim of the second study was to determine and validate with independent data, the prediction equations obtained to estimate in vivo carcass composition of growing rabbits by using the results of carcass chemical composition and BIA values in a group of rabbits from 25 to 77 days. Also its potential application to predict nutrient retention and overall energy and nitrogen retention efficiencies was analysed. Seventy five rabbits grouped at 5 different ages (25, 35, 49, 63 and 77 days) with weights ranging from 196 to 3260 g were used. A four terminal body composition analyser (Model BIA-101, RJL Systems, Detroit, MI USA) was used to obtain resistance (Rs, ) and reactance (Xc, ) values. The distance between internal electrodes (D, cm), body length (L, cm) and live weight (BW, g) were also registered. At each selected age, all the animals were stunned and bled. The skin, organs and digestive content were removed, and the chilled carcass were weighed and processed for chemical analyses (DM, fat, CP, ash and GE). Energy and fat increased with the age, while CP, ash, and water decreased. Mean values of Rs, Xc, impedance (Z), L and D were 95.9±23.9 , 19.5±4.7 , 98.0±23.8 , 20.6±6.3 cm y 13.7±3.1 cm. A multiple linear regression analysis was done to determine the equations, using BW, L and Z data as parameters. Coefficient of determination (R2) of the equations obtained to estimate water (g), CP (g), fat (g), ash (g) and GE (MJ) content were: 0.99, 0.99, 0.95, 0.96 and 0.98, and relative mean prediction error (RMPE) were: 4.20, 5.48, 21.9, 9.10 and 6.77%, respectively. When water content was expressed as percentage, the R2 and RMPE were 0.79 and 1.62%, respectively. When prediction of protein (%DM), fat (%DM), ash (%DM) and energy (kJ/100 g DM) content was done, R2 values were 0.68, 0.76, 0.66 and 0.82, and RMPE: 3.22, 10.5, 5.82 and 2.54%, respectively. Reactance was positively correlated with fat content (r = 0.24, P < 0.05) while resistance was positively correlated with water, ash and protein carcass content (r = 0.55, P < 0.001; r = 0.54, P < 0.001; r = 0.40, P < 0.005) and negatively correlated with fat and energy (r = -0.44 and r = -0.55; P < 0.001). Moreover, age was negatively correlated with water, ash and CP content (r = -0.97, r = -0.95 and r = -0.89, P < 0.0001) and positively correlated with fat and GE (r = 0.95 and r = 0.97; P < 0.0001). In the whole growing period (35-63 d), overall energy retention efficiency (ERE) and nitrogen retention efficiency (NRE) were studied. The ERE values were 20.4±7.29%, 21.0±4.18% and 20.8±2.79%, from 35 to 49, 49 to 63 and from 35 to 63 d, respectively. NRE was 46.9±11.7%, 34.5±7.32% and 39.1±3.23% for the same periods. Energy was retained in body tissues for growth with an efficiency of approximately 52.5% and efficiency of the energy for protein and fat retention was 33.3 and 69.9%, respectively. Efficiency of utilization of nitrogen for growth was near to 77%. This work shows that BIA it’s a non-invasive and good method to estimate in vivo carcass composition and nutrient retention of growing rabbits from 25 to 77 days of age. In the third study, two experiments were conducted to investigate the effect of the fat addition and source, on performance, mortality, nutrient retention, and the whole body and carcass chemical composition of growing rabbits from 34 to 63 d. In Exp. 1 three diets were arranged in a 3 x 2 factorial structure with the source of fat: Soybean oil (SBO), Soya Lecithin Oil (SLO) and Lard (L) and the dietary fat inclusion level (1.5 and 4%) as the main factors. Exp. 2 had also arranged as a 3 x 2 factorial design, but using SBO, Fish Oil (FO) and Palmkernel Oil (PKO) as fat sources, and included at the same levels than in Exp. 1. In both experiments 180 animals were allocated in individual cages (n=30) and 600 in collectives cages, in groups of 5 animals (n=20). Animals fed with 4% dietary fat level showed lower DFI and FCR than those fed diets with 1.5%. In collective housing of Exp. 1, DFI was a 4.8% higher in animals fed with diets containing lard than SBO (P = 0.036), being intermediate for diet with SLO. Inclusion of lard also tended to reduce mortality (P = 0.067) around 60% and 25% with respect SBO and SLO diets, respectively. Mortality increased with the greatest level of soya lecithin (14% vs. 1%, P < 0.01). In Exp. 2 a decrease of DFI (11%), BW at 63 d (4.8%) and DWG (7.8%) were observed with the inclusion of fish oil with respect the other two diets (P < 0.01). These last two traits impaired with the highest level of fish oil (5.6 and 9.5%, respectively, (P < 0.01)). Animals housed individually showed similar performance results. The inclusion of fish oil also tended to increase (P = 0.078) mortality (13.2%) with respect palmkernel oil (6.45%), being mortality of SBO intermediate (8.10%). Fat source and level did not affect the whole body or carcass chemical composition. An increase of the fat sources addition led to a decrease of the digestible nitrogen intake (DNi) (1.83 vs. 1.92 g/d; P = 0.068 in Exp. 1 and 1.79 vs. 1.95 g/d; P = 0.014 in Exp. 2). As the nitrogen retained (NR) in the carcass was similar for both fat levels (0.68 g/d (Exp. 1) and 0.71 g/d (Exp. 2)), the overall efficiency of N retention (NRE) increased with the highest level of fat, but only reached significant level in Exp. 1 (34.9 vs. 37.8%; P < 0.0001), while in Exp. 2 a tendency was found (36.2 vs. 38.0% in Exp. 2; P < 0.064). Consequently, nitrogen excretion in faeces was lower in animals fed with the highest level of fat (0.782 vs. 0.868 g/d; P = 0.0001 in Exp. 1, and 0.745 vs. 0.865 g/d; P < 0.0001 in Exp.2). The same effect was observed with the nitrogen excreted as urine (0.702 vs. 0.822 g/d; P < 0.0001 in Exp. 1 and 0.694 vs. 0.7999 g/d; P = 0.014 in Exp.2). Although there were not differences in ERE, the energy excreted in faeces decreased as fat level increased (142 vs. 156 Kcal/d; P = 0.0004 in Exp. 1 and 144 vs. 154 g/d; P = 0.050 in Exp. 2). In Exp. 1 the energy excreted as urine and heat production was significantly higher when animals were fed with the highest level of dietary fat (216 vs. 204 Kcal/d; P < 0.017). It can be concluded that lard and palmkernel oil can be considered as alternative sources to soybean oil due to the reduction of the mortality, without negative effects on performances or nutrient retention. Inclusion of fish impaired animals´ productivity and mortality. An increase of the dietary fat level improved FCR and overall protein efficiency retention.

Changes in body water distribution during treatment with inhaled steroid in pre-school children

Primary objective: The study aimed to examine the changes in water distribution in the soft tissue during systemic steroid activity. Research design: A three-way cross-over, randomized, placebo-controlled, double-blind trial was used, including 4 weeks of fluticasone propionate pMDI 200 mug b.i.d. delivered via Babyhaler(R), budesonide pressurized metered dose inhaler (pMDI) 200 mug b.i.d. delivered via Nebuchamber(R) and placebo. Spacers were primed before use. In total, 40 children aged 1-3 years, with mild intermittent asthma were included. Twenty-five of the children completed all three treatments. At the end of each treatment period body impedance and skin ultrasonography were measured. Methods and procedures: We measured changes in water content of the soft tissues by two methods. Skin ultrasonography was used to detect small changes in dermal water content, and bioelectrical impedance was used to assess body water content and distribution. Main outcomes and results: We found an increase in skin density of the shin from fluticasone as measured by ultrasonography (p = 0.01). There was a tendency for a consistent elevation of impedance parameters from active treatments compared to placebo although overall this effect was not statistically significant (0.1< p <0.2). However, sub-analyses indicated a significant effect on whole-body and leg impedance from budesonide treatment (p <0.05). Conclusion: Decreased growth during inhaled steroid treatment seems to partly reflect generalized changes in body water.

Comparison of two field methods for estimating body fat in different Spanish Dance disciplines

The purpose of the present study was to investigate percentage body fat (%BF) differences in three Spanish dance disciplines and to compare skinfold and bioelectrical impedance predictions of body fat percentage in the same sample. Seventy-six female dancers, divided into three groups, Classical (n=23), Spanish (n=29) and Flamenco (n=24), were measured using skinfold measurements at four sites: triceps, subscapular, biceps and iliac crest, and whole body multi-frequency bioelectrical impedance (BIA). The skin-fold measures were used to predict body fat percentage via Durnin and Womersley's and Segal, Sun and Yannakoulia equations by BIA. Differences in percent fat mass between groups (Classical, Spanish and Flamenco) were tested by using repeated measures analysis (ANOVA). Also, Pearson's product-moment correlations were performed on the body fat percentage values obtained using both methods. In addition, Bland-Altman plots were used to assess agreement, between anthropometric and BIA methods. Repeated measures analysis of variance did not found differences in %BF between modalities (p<0.05). Fat percentage correlations ranged from r= 0.57 to r=0.97 (all, p<0.001). Bland-Altman analysis revealed differences between BIA Yannakoulia as a reference method with BIA Segal (-0.35 ± 2.32%, 95%CI: -0.89to 0.18, p=0.38), with BIA Sun (-0.73 ± 2.3%, 95%CI: -1.27 to -0.20, p=0.014) and Durnin-Womersley (-2.65 ± 2,48%, 95%CI: -3.22 to -2.07, p<0.0001). It was concluded that body fat percentage estimates by BIA compared with skinfold method were systematically different in young adult female ballet dancers, having a tendency to produce underestimations as %BF increased with Segal and Durnin-Womersley equations compared to Yannakoulia, concluding that these methods are not interchangeable.

Body composition changes assessed by bioelectrical impedance and their associations with functional class deterioration in stable heart failure patients

Background: Heart failure (HF) patients develop important changes in body composition, but only a small number of studies have evaluated the associations between these changes and functional class deterioration in a prospective manner. Objective: The aim of this study was to evaluate whether changes in bioimpedance parameters were associated with NYHA functional class deterioration over six months. Methods: A total of 275 chronic stable HF patients confirmed by echocardiography were recruited. Body composition measurements were obtained by whole body bioelectrical impedance with multiple frequency equipment (BodyStat QuadScan 4000). We evaluated functional class using the New York Heart Association (NYHA) classification at baseline and after six months. Results: According to our results, 66 (24%) subjects exhibited functional class deterioration, while 209 improved or exhibited no change. A greater proportion of patients exhibited higher extracellular water (> 5%), and these patients developed hypervolemia, according to location on the resistance/reactance graph. A 5% decrease in resistance/height was associated with functional class deterioration with an OR of 1.42 (95% CI 1.01-2.0, p = 0.04). Conclusions: Body composition assessment through bioelectrical impedance exhibited a valuable performance as a marker of functional class deterioration in stable HF patients.

Ethnic differences in the BMI-%BF relationships between young Japanese and Australian-Caucasian males living in Australia using dual-energy X-ray absorptiometry

The Body Mass Index (BMI) has been used worldwide as an indicator of fatness. However, the universal cut-off points by the World Health Organisation (WHO) classification may not be appropriate for every ethnic group when consider the relationship with their actual total body fatness(%BF). The application of population-specific classifications to assess BMI may be more relevant to public health. Ethnic differences in the BMI%BF relationship between 45 Japanese and 42 Australian-Caucasian males were assessed using whole body dual-energy X-ray absorptiometry (DXA) scan and anthropometry using a standard protocol. Japanese males had significantly (p<0.05) greater %BF at given BMI values than Australian males. When this is taken into account the newly proposed Asia-Pacific BMI classification of BMI 23 as overweight and 25 as obese may better assess the level of obesity that is associated increased health risks for this population. To clarify the current findings, further studies that compare the relationships across other Japanese populations are recommended.

The skin awareness study : promoting thorough skin self-examination for skin cancer among men 50 years or older

Background: Incidence and mortality from skin cancers including melanoma are highest among men 50 years or older. Thorough skin self-examination may be beneficial to improve skin cancers outcomes.--------- Objectives: To develop and conduct a randomized-controlled trial of a video-based intervention to improve skin self-examination behavior among men 50 years or older.--------- Methods: Pilot work ascertained appropriate targeting of the 12-minute intervention video towards men 50 years or older. Overall, 968 men were recruited and 929 completed baseline telephone assessment. Baseline analysis assessed randomization balance and demographic, skin cancer risk and attitudinal factors associated with conducting a whole-body skin self-examination or receiving a whole-body clinical skin examination by a doctor during the past 12 months.--------- Results: Randomization resulted in well-balanced intervention and control groups. Overall 13% of men reported conducting a thorough skin self-examination using a mirror or the help of another person to check difficult to see areas, while 39% reported having received a whole-body skin examination by a doctor within the past 12 months. Confidence in finding time for and receiving advice or instructions by a doctor to perform a skin self-examination were among the factors associated with thorough skin self-examination at baseline.---------- Conclusions: Men 50 years or older can successfully be recruited to a video-based intervention trial with the aim reduce their burden through skin cancer. Randomization by computer generated randomization list resulted in good balance between control and intervention group and baseline analysis determined factors associated with skin cancer early detection behavior at baseline.

Image acquisition and manipulation protocols for CT-PET fusion to improve the accuracy of gross tumour volume localisation for 3D conformal radiotherapy for lung cancer

Aims: To develop clinical protocols for acquiring PET images, performing CT-PET registration and tumour volume definition based on the PET image data, for radiotherapy for lung cancer patients and then to test these protocols with respect to levels of accuracy and reproducibility. Method: A phantom-based quality assurance study of the processes associated with using registered CT and PET scans for tumour volume definition was conducted to: (1) investigate image acquisition and manipulation techniques for registering and contouring CT and PET images in a radiotherapy treatment planning system, and (2) determine technology-based errors in the registration and contouring processes. The outcomes of the phantom image based quality assurance study were used to determine clinical protocols. Protocols were developed for (1) acquiring patient PET image data for incorporation into the 3DCRT process, particularly for ensuring that the patient is positioned in their treatment position; (2) CT-PET image registration techniques and (3) GTV definition using the PET image data. The developed clinical protocols were tested using retrospective clinical trials to assess levels of inter-user variability which may be attributed to the use of these protocols. A Siemens Somatom Open Sensation 20 slice CT scanner and a Philips Allegro stand-alone PET scanner were used to acquire the images for this research. The Philips Pinnacle3 treatment planning system was used to perform the image registration and contouring of the CT and PET images. Results: Both the attenuation-corrected and transmission images obtained from standard whole-body PET staging clinical scanning protocols were acquired and imported into the treatment planning system for the phantom-based quality assurance study. Protocols for manipulating the PET images in the treatment planning system, particularly for quantifying uptake in volumes of interest and window levels for accurate geometric visualisation were determined. The automatic registration algorithms were found to have sub-voxel levels of accuracy, with transmission scan-based CT-PET registration more accurate than emission scan-based registration of the phantom images. Respiration induced image artifacts were not found to influence registration accuracy while inadequate pre-registration over-lap of the CT and PET images was found to result in large registration errors. A threshold value based on a percentage of the maximum uptake within a volume of interest was found to accurately contour the different features of the phantom despite the lower spatial resolution of the PET images. Appropriate selection of the threshold value is dependant on target-to-background ratios and the presence of respiratory motion. The results from the phantom-based study were used to design, implement and test clinical CT-PET fusion protocols. The patient PET image acquisition protocols enabled patients to be successfully identified and positioned in their radiotherapy treatment position during the acquisition of their whole-body PET staging scan. While automatic registration techniques were found to reduce inter-user variation compared to manual techniques, there was no significant difference in the registration outcomes for transmission or emission scan-based registration of the patient images, using the protocol. Tumour volumes contoured on registered patient CT-PET images using the tested threshold values and viewing windows determined from the phantom study, demonstrated less inter-user variation for the primary tumour volume contours than those contoured using only the patient’s planning CT scans. Conclusions: The developed clinical protocols allow a patient’s whole-body PET staging scan to be incorporated, manipulated and quantified in the treatment planning process to improve the accuracy of gross tumour volume localisation in 3D conformal radiotherapy for lung cancer. Image registration protocols which factor in potential software-based errors combined with adequate user training are recommended to increase the accuracy and reproducibility of registration outcomes. A semi-automated adaptive threshold contouring technique incorporating a PET windowing protocol, accurately defines the geometric edge of a tumour volume using PET image data from a stand alone PET scanner, including 4D target volumes.

Throwing frame and performance of elite male seated shot-putters

Seated shot-putters rely on a customized assistive device called a throwing frame. Currently, the construction of each individual throwing frame is mainly driven by an empirical approach. One way to refine the conception is to improve the basic understanding of performance of seated shot-putters. The relationship between performance and throwing technique has been well described. Remarkably, the relationship between performance and throwing frame characteristics has received limited attention. The primary objective of this study was to present a cataloguing of characteristics of throwing frames used by seated shot-putters. This cataloguing consisted of defining and grouping 26 characteristics into three main categories (i.e., whole body, foot and upper limb specific characteristics) and seven sub-categories. The secondary objective of this study was to provide raw characterisations of the throwing frames for a group of athletes who participated in a world-class event. The characterisation consisted of describing the characteristics of each throwing frame. Potential relationships between characteristics, performance and classification were also identified. The cataloguing was achieved using a 6-step heuristic approach, involving expert opinions and the analysis of 215 attempts produced by 55 male athletes during the 2006 IPC Athletics World Championships. The distribution of samples across characteristics suggested a relevant level of comprehensiveness for the proposed cataloguing. The raw data, the profile of best athletes and the frequency of characteristics provided key benchmark information for construction of a throwing frame as well as coaching, classification and officiating. Analysis of data sets relating to characteristics, performance and classification were inconclusive.

The 'nurdle to leg' and other ways of winning cricket matches

The emergence of Twenty20 cricket at the elite level has been marketed on the excitement of the big hitter, where it seems that winning is a result of the muscular batter hitting boundaries at will. This version of the game has captured the imagination of many young players who all want to score runs with “big hits”. However, in junior cricket, boundary hitting is often more difficult due to size limitations of children and games played on outfields where the ball does not travel quickly. As a result, winning is often achieved via a less spectacular route – by scoring more singles than your opponents. However, most standard coaching texts only describe how to play boundary scoring shots (e.g. the drives, pulls, cuts and sweeps) and defensive shots to protect the wicket. Learning to bat appears to have been reduced to extremes of force production, i.e. maximal force production to hit boundaries or minimal force production to stop the ball from hitting the wicket. Initially, this is not a problem because the typical innings of a young player (<12 years) would be based on the concept of “block” or “bash” – they “block” the good balls and “bash” the short balls. This approach works because there are many opportunities to hit boundaries off the numerous inaccurate deliveries of novice bowlers. Most runs are scored behind the wicket by using the pace of the bowler’s delivery to re-direct the ball, because the intrinsic dynamics (i.e. lack of strength) of most children means that they can only create sufficient power by playing shots where the whole body can contribute to force production. This method works well until the novice player comes up against more accurate bowling when they find they have no way of scoring runs. Once batters begin to face “good” bowlers, batters have to learn to score runs via singles. In cricket coaching manuals (e.g. ECB, n.d), running between the wickets is treated as a separate task to batting, and the “basics” of running, such as how to “back- up”, carry the bat, calling and turning and sliding the bat into the crease are “drilled” into players. This task decomposition strategy focussing on techniques is a common approach to skill acquisition in many highly traditional sports, typified in cricket by activities where players hit balls off tees and receive “throw-downs” from coaches. However, the relative usefulness of these approaches in the acquisition of sporting skills is increasingly being questioned (Pinder, Renshaw & Davids, 2009). We will discuss why this is the case in the next section.

Determinants of skin self-examination (SSE) in men aged 50 years or older

Background: Queensland men aged 50 years and older are at high risk for melanoma. Early detection via skin self examination (SSE) (particularly whole-body SSE) followed by presentation to a doctor with suspicious lesions, may decrease morbidity and mortality from melanoma. Prevalence of whole-body SSE (wbSSE) is lower in Queensland older men compared to other population subgroups. With the exception of the present study no previous research has investigated the determinants of wbSSE in older men, or interventions to increase the behaviour in this population. Furthermore, although past SSE intervention studies for other populations have cited health behaviour models in the development of interventions, no study has tested these models in full. The Skin Awareness Study: A recent randomised trial, called the Skin Awareness Study, tested the impact of a video-delivered intervention compared to written materials alone on wbSSE in men aged 50 years or older (n=930). Men were recruited from the general population and interviewed over the telephone at baseline and 13 months. The proportion of men who reported wbSSE rose from 10% to 31% in the control group, and from 11% to 36% in the intervention group. Current research: The current research was a secondary analysis of data collected for the Skin Awareness Study. The objectives were as follows: • To describe how men who did not take up any SSE during the study period differed from those who did take up examining their skin. • To determine whether the intervention program was successful in affecting the constructs of the Health Belief Model it was aimed at (self-efficacy, perceived threat, and outcome expectations); and whether this in turn influenced wbSSE. • To determine whether the Health Action Process Approach (HAPA) was a better predictor of wbSSE behaviour compared to the Health Belief Model (HBM). Methods: For objective 1, men who did not report any past SSE at baseline (n=308) were categorised as having ‘taken up SSE’ (reported SSE at study end) or ‘resisted SSE’ (reported no SSE at study end). Bivariate logistic regression, followed by multivariable regression, investigated the association between participant characteristics measured at baseline and resisting SSE. For objective 2 proxy measures of self-efficacy, perceived threat, and outcome expectations were selected. To determine whether these mediated the effect of the intervention on the outcome, a mediator analysis was performed with all participants who completed interviews at both time points (n=830) following the Baron and Kenny approach, modified for use with structural equation modelling (SEM). For objective 3, control group participants only were included (n=410). Proxy measures of all HBM and HAPA constructs were selected and SEM was used to build up models and test the significance of each hypothesised pathway. A likelihood ratio test compared the HAPA to the HBM. Results: Amongst men who did not report any SSE at baseline, 27% did not take up any SSE by the end of the study. In multivariable analyses, resisting SSE was associated with having more freckly skin (p=0.027); being unsure about the statement ‘if I saw something suspicious on my skin, I’d go to the doctor straight away’ (p=0.028); not intending to perform SSE (p=0.015), having lower SSE self-efficacy (p<0.001), and having no recommendation for SSE from a doctor (p=0.002). In the mediator analysis none of the tested variables mediated the relationship between the intervention and wbSSE. In regards to health behaviour models, the HBM did not predict wbSSE well overall. Only the construct of self-efficacy was a significant predictor of future wbSSE (p=0.001), while neither perceived threat (p=0.584) nor outcome expectations (p=0.220) were. By contrast, when the HAPA constructs were added, all three HBM variables predicted intention to perform SSE, which in turn predicted future behaviour (p=0.015). The HAPA construct of volitional self-efficacy was also associated with wbSSE (p=0.046). The HAPA was a significantly better model compared to the HBM (p<0.001). Limitations: Items selected to measure HBM and HAPA model constructs for objectives 2 and 3 may not have accurately reflected each construct. Conclusions: This research added to the evidence base on how best to target interventions to older men; and on the appropriateness of particular health behaviour models to guide interventions. Findings indicate that to overcome resistance those men with more negative pre-existing attitudes to SSE (not intending to do it, lower initial self-efficacy) may need to be targeted with more intensive interventions in the future. Involving general practitioners in recommending SSE to their patients in this population, alongside disseminating an intervention, may increase its success. Comparison of the HBM and HAPA showed that while two of the three HBM variables examined did not directly predict future wbSSE, all three were associated with intention to self-examine skin. This suggests that in this population, intervening on these variables may increase intention to examine skin, but not necessarily the behaviour itself. Future interventions could potentially focus on increasing both the motivational variables of perceived threat and outcome expectations as well as a combination of both action and volitional self-efficacy; with the aim of increasing intention as well as its translation to taking up and maintaining regular wbSSE.

The HarmonyGrid : music, space and performance in grid music systems

This research explores music in space, as experienced through performing and music-making with interactive systems. It explores how musical parameters may be presented spatially and displayed visually with a view to their exploration by a musician during performance. Spatial arrangements of musical components, especially pitches and harmonies, have been widely studied in the literature, but the current capabilities of interactive systems allow the improvisational exploration of these musical spaces as part of a performance practice. This research focuses on quantised spatial organisation of musical parameters that can be categorised as grid music systems (GMSs), and interactive music systems based on them. The research explores and surveys existing and historical uses of GMSs, and develops and demonstrates the use of a novel grid music system designed for whole body interaction. Grid music systems provide plotting of spatialised input to construct patterned music on a two-dimensional grid layout. GMSs are navigated to construct a sequence of parametric steps, for example a series of pitches, rhythmic values, a chord sequence, or terraced dynamic steps. While they are conceptually simple when only controlling one musical dimension, grid systems may be layered to enable complex and satisfying musical results. These systems have proved a viable, effective, accessible and engaging means of music-making for the general user as well as the musician. GMSs have been widely used in electronic and digital music technologies, where they have generally been applied to small portable devices and software systems such as step sequencers and drum machines. This research shows that by scaling up a grid music system, music-making and musical improvisation are enhanced, gaining several advantages: (1) Full body location becomes the spatial input to the grid. The system becomes a partially immersive one in four related ways: spatially, graphically, sonically and musically. (2) Detection of body location by tracking enables hands-free operation, thereby allowing the playing of a musical instrument in addition to “playing” the grid system. (3) Visual information regarding musical parameters may be enhanced so that the performer may fully engage with existing spatial knowledge of musical materials. The result is that existing spatial knowledge is overlaid on, and combined with, music-space. Music-space is a new concept produced by the research, and is similar to notions of other musical spaces including soundscape, acoustic space, Smalley's “circumspace” and “immersive space” (2007, 48-52), and Lotis's “ambiophony” (2003), but is rather more textural and “alive”—and therefore very conducive to interaction. Music-space is that space occupied by music, set within normal space, which may be perceived by a person located within, or moving around in that space. Music-space has a perceivable “texture” made of tensions and relaxations, and contains spatial patterns of these formed by musical elements such as notes, harmonies, and sounds, changing over time. The music may be performed by live musicians, created electronically, or be prerecorded. Large-scale GMSs have the capability not only to interactively display musical information as music representative space, but to allow music-space to co-exist with it. Moving around the grid, the performer may interact in real time with musical materials in music-space, as they form over squares or move in paths. Additionally he/she may sense the textural matrix of the music-space while being immersed in surround sound covering the grid. The HarmonyGrid is a new computer-based interactive performance system developed during this research that provides a generative music-making system intended to accompany, or play along with, an improvising musician. This large-scale GMS employs full-body motion tracking over a projected grid. Playing with the system creates an enhanced performance employing live interactive music, along with graphical and spatial activity. Although one other experimental system provides certain aspects of immersive music-making, currently only the HarmonyGrid provides an environment to explore and experience music-space in a GMS.

Interactive processes link the multiple symptoms of fatigue in sport competition

Muscle physiologists often describe fatigue simply as a decline of muscle force and infer this causes an athlete to slow down. In contrast, exercise scientists describe fatigue during sport competition more holistically as an exercise-induced impairment of performance. The aim of this review is to reconcile the different views by evaluating the many performance symptoms/measures and mechanisms of fatigue. We describe how fatigue is assessed with muscle, exercise or competition performance measures. Muscle performance (single muscle test measures) declines due to peripheral fatigue (reduced muscle cell force) and/or central fatigue (reduced motor drive from the CNS). Peak muscle force seldom falls by >30% during sport but is often exacerbated during electrical stimulation and laboratory exercise tasks. Exercise performance (whole-body exercise test measures) reveals impaired physical/technical abilities and subjective fatigue sensations. Exercise intensity is initially sustained by recruitment of new motor units and help from synergistic muscles before it declines. Technique/motor skill execution deviates as exercise proceeds to maintain outcomes before they deteriorate, e.g. reduced accuracy or velocity. The sensation of fatigue incorporates an elevated rating of perceived exertion (RPE) during submaximal tasks, due to a combination of peripheral and higher CNS inputs. Competition performance (sport symptoms) is affected more by decision-making and psychological aspects, since there are opponents and a greater importance on the result. Laboratory based decision making is generally faster or unimpaired. Motivation, self-efficacy and anxiety can change during exercise to modify RPE and, hence, alter physical performance. Symptoms of fatigue during racing, team-game or racquet sports are largely anecdotal, but sometimes assessed with time-motion analysis. Fatigue during brief all-out racing is described biomechanically as a decline of peak velocity, along with altered kinematic components. Longer sport events involve pacing strategies, central and peripheral fatigue contributions and elevated RPE. During match play, the work rate can decline late in a match (or tournament) and/or transiently after intense exercise bursts. Repeated sprint ability, agility and leg strength become slightly impaired. Technique outcomes, such as velocity and accuracy for throwing, passing, hitting and kicking, can deteriorate. Physical and subjective changes are both less severe in real rather than simulated sport activities. Little objective evidence exists to support exercise-induced mental lapses during sport. A model depicting mind-body interactions during sport competition shows that the RPE centre-motor cortex-working muscle sequence drives overall performance levels and, hence, fatigue symptoms. The sporting outputs from this sequence can be modulated by interactions with muscle afferent and circulatory feedback, psychological and decision-making inputs. Importantly, compensatory processes exist at many levels to protect against performance decrements. Small changes of putative fatigue factors can also be protective. We show that individual fatigue factors including diminished carbohydrate availability, elevated serotonin, hypoxia, acidosis, hyperkalaemia, hyperthermia, dehydration and reactive oxygen species, each contribute to several fatigue symptoms. Thus, multiple symptoms of fatigue can occur simultaneously and the underlying mechanisms overlap and interact. Based on this understanding, we reinforce the proposal that fatigue is best described globally as an exercise-induced decline of performance as this is inclusive of all viewpoints.

Is –110°C cold air cryotherapy effective in improving post-exercise recovery in sports people?

Whole body cryotherapy (WBC) involves repeatedly exposing an individual, dressed in minimal clothing, to extremely cold air (–100 to –130°C) for a short period. One specific claim that is often made is that WBC is effective in treating exercise-induced muscle soreness and damage. However, our results suggest that two bouts of WBC were ineffective in improving recovery from eccentric exercise when administered 24 hours after eccentric exercise.