Impact of exercise training on cancer-induced cardiac dysfunction

Cachexia is a complex syndrome characterized by severe weight loss frequently observed in cancer patients and associated with poor prognosis. Cancer cachexia is also related to modifications in cardiac muscle structure and metabolism leading to cardiac dysfunction. In order to better understand the cardiac remodeling induced by bladder cancer and the impact of exercise training after diagnosis on its regulation, we used an animal model of bladder cancer induced by exposition to N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) in the drinking water. Healthy animals and previously BBN exposed animals were submitted to a training program in a treadmill at a speed of 20m/min, 60 min/day, 5 days/week during 13 weeks. At the end of the protocol, animals exposed to BBN presented a significant decrease of body weight, in comparison with control groups, supporting the presence of cancer cachexia. Morphological analysis of the cardiac muscle sections revealed the presence of fibrosis and a significant decrease of cardiomyocyte’s cross-sectional area, suggesting the occurrence of cardiac dysfunction associated with bladder cancer. These modifications were accompanied by heart metabolic remodeling characterized by a decreased fatty acid oxidation given by diminished levels of ETFDH and of complex II subunit  from the respiratory chain. Exercise training promoted an increment of connexin 43, a protein involved in cardioprotection, and of c-kit, a protein present in cardiac stem cells. These results suggest an improved heart regenerative capacity induced by exercise training. In conclusion, endurance training seems an attractive non-pharmacological therapeutic option for the management of cardiac dysfunction in cancer cachexia.

Perceived Social Pressures and the Internalization of the Mesomorphic Ideal: the Role of Drive for Muscularity and Autonomy in Physically Active Men

BACKGROUND: Researchers have tested the beliefs of sportspeople and sports medicine specialists that cognitive strategies influence strength performance. Few investigators have synthesised the literature. OBJECTIVES: The specific objectives were to review evidence regarding (a) the cognitive strategy-strength performance relationship; (b) participant skill level as a moderator; and (c) cognitive, motivational, biomechanical/physiological, and emotional mediators. METHOD: Studies were sourced via electronic databases, reference lists of retrieved articles, and manual searches of relevant journals. Studies had to be randomised or counterbalanced experiments with a control group or condition, repeated measures, and a quality control score above 0.5 (out of 1). Cognitive strategies included goal setting, imagery, self-talk, preparatory arousal, and free choice. Dependent variables included maximal strength, local muscular endurance, or muscular power. RESULTS: Globally, cognitive strategies were reliability associated with increased strength performance (results ranged from 61 to 65 %). Results were mixed when examining the effects of specific strategies on particular dependent variables, although no intervention had an overall negative influence. Indeterminate relationships emerged regarding hypothesised mediators (except cognitive variables) and participant skill level as a moderator. CONCLUSIONS: Although cognitive strategies influence strength performance, there are knowledge gaps regarding specific types of strength, especially muscular power. Cognitive variables, such as concentration, show promise as possible mediators.

Influência de um programa de exercícios específicos em estudantes de violino

Introdução: A elevada prevalência de problemas musculosqueléticos relacionados com a performance musical (PMRPM) em estudantes universitários de música, sobretudo violinistas, justifica uma abordagem preventiva junto destes, nomeadamente, através do exercício. Este deve ser específico e baseado nos padrões de movimento durante a performance musical do violinista. Objetivos: verificar a influência de um programa de exercícios específicos (PEE) nos sintomas relacionados com a prática musical, na incapacidade funcional e na autoperceção da performance física e musical, em estudantes universitários de violino. Métodos: estudo quase-experimental baseado num estudo piloto com 24 estudantes para pesquisa da sintomatologia, e 4 para análise cinemática e cinética do gesto técnico. No estudo principal participaram 22 violinistas divididos equitativamente, e por disponibilidade, entre grupo experimental (GE) e grupo de controlo (GC). O GE realizou o PEE bissemanalmente, durante 8 semanas. No momento inicial e após 8 semanas, os participantes preencheram: Questionário de Performance (incluiu Escala Visual Analógica), Disabilities of the Arm, Shoulder and Hand, Oswestry Disability Index versão 2.0, Pain Catastrophizing Scale e Escala de Borg Modificada. Resultados: do estudo piloto constatou-se que os sintomas mais frequentes, dor e fadiga, localizavam-se na cintura escapular, ombros e coluna lombar; os ombros aparentavam maior risco de PMRPM; era necessário aumentar a endurance dos mobilizadores dos membros superiores (principalmente deltóide) e relaxar os estabilizadores da coluna cervical (sobretudo trapézio superior). No final do PEE, o GE apresentou significativamente melhores pontuações do que o GC na percentagem de violinistas com “dor na coluna lombar esquerda” (p=0,007), frequência da dor (U=8,5; W=29,5; p=0,016), número de locais com sintomas (U=18; W=84; p=0,003) e amplificação (U=26; W=92; p=0,021). Conclusão: Um PEE pode produzir efeitos positivos na diminuição dos sintomas relacionados com a prática musical e incapacidade funcional, e na melhoria de alguns parâmetros da performance física autoreportada, em estudantes universitários de violino.

Self-mated tribological systems based on multilayer micro/nanocrystalline CVD diamond coatings

The tribological response of multilayer micro/nanocrystalline diamond coatings grown by the hot filament CVD technique is investigated. These multigrade systems were tailored to comprise a starting microcrystalline diamond (MCD) layer with high adhesion to a silicon nitride (Si3N4) ceramic substrate, and a top nanocrystalline diamond (NCD) layer with reduced surface roughness. Tribological tests were carried out with a reciprocating sliding configuration without lubrication. Such composite coatings exhibit a superior critical load before delamination (130–200 N), when compared to the mono- (60–100 N) and bilayer coatings (110 N), considering ∼10 µm thick films. Regarding the friction behaviour, a short-lived initial high friction coefficient was followed by low friction regimes (friction coefficients between 0.02 and 0.09) as a result of the polished surfaces tailored by the tribological solicitation. Very mild to mild wear regimes (wear coefficient values between 4.1×10−8 and 7.7×10−7 mm3 N−1 m−1) governed the wear performance of the self-mated multilayer coatings when subjected to high-load short-term tests (60–200 N; 2 h; 86 m) and medium-load endurance tests (60 N; 16 h; 691 m).

Testes de resistência, flexibilidade, e ativação/controlo muscular da região lombo pélvica em futebolistas amadores com e sem dor lombar

Introdução: A dor lombar é comum manifestar-se em atletas de futebol, pelo que se torna importante utilizar testes clínicos como forma de detetar alterações que estejam associadas à presença de dor lombar. Objetivo: Identificar a relação entre a presença de dor lombar e os testes de resistência, flexibilidade e ativação/controlo muscular da região lombo pélvica em futebolistas com e sem dor lombar. Métodos: Realizou-se o presente estudo transversal numa amostra de 25 futebolistas amadores, dos quais 8 apresentavam dor lombar. Foi avaliada a resistência e os rácios dos músculos globais do tronco, a flexibilidade dos flexores e extensores da anca bem como a ativação/controlo dos músculos transverso do abdómen e multífidos. Resultados: Os atletas com lombalgia apresentaram uma diminuição significativa do tempo de resistência muscular dos vários grupos musculares do tronco e da flexibilidade muscular comparativamente aos atletas sem lombalgia. Foi também identificado um aumento significativo no rácio flexores/extensores do tronco. Relativamente aos testes de ativação muscular, não foram encontradas associações com a presença de dor lombar. Conclusão: A aplicação de testes de resistência e flexibilidade parece diferenciar os indivíduos com e sem dor lombar, não se tendo verificado o mesmo quanto à ativação do transverso do abdómen e dos multífidos.

Influência de um programa de treino da musculatura do core em jogadoras ado-lescentes de voleibol

Introdução: Apesar de na reabilitação e nas atividades da vida diária já se perceber que o treino do core tem bastantes benefícios, no desporto ainda não há provas conclusivas deste mesmo benefício e de como o treino do core deve ser elaborado. Objectivo(s): Avaliar a eficácia de um programa de intervenção sobre a musculatura do core em jogadoras de voleibol Métodos: O presente estudo quasi experimental longitudinal teve uma amostra final de 56 indivíduos – grupo controlo (GC) (n= 27), e grupo experimental (GE) (n=29). Avaliou-se os testes de endurance, e respectivos rácios, descritos por McGill. Ambos os grupos foram avaliados antes (Momento 0) e após (Momento 1) a aplicação de um programa de intervenção. Resultados: Na análise entre os 2 grupos, tanto no Momento 0 como no Momento 1, não se registou diferenças estatisticamente significativas, nem nas médias de tempo dos testes de McGill nem nos rácios. Já na análise intragrupo, o GC não apresentou resultados estatisti-camente significativos, nem nas médias de tempo dos testes do McGill nem nos rácios, enquanto o GE apenas apresentou valores estatisticamente significativos nas médias de tempo da prancha lateral direita (p = 0,04) e prancha lateral esquerda (p = 0,03). Conclusão: Atletas jovens e do sexo feminino, apresentaram um fraco de-sempenho da musculatura extensora do tronco que as torna mais passíveis de contrair lesões lumbopélvicas. Será necessário implementar um programa de intervenção, diferente do aplicado neste estudo, e com maior ênfase na musculatura extensora para equilibrar os rácios propostos por McGill, e assim, diminuir o risco de lesão.

A doença pulmonar obstrutiva crónica e o exercício: impacto da doença no declínio funcional e importância do treino de exercício nos benefícios para a saúde

RESUMO: A reabilitação respiratória (RR) é uma intervenção abrangente e interdisciplinar dirigida aos doentes respiratórios crónicos e inclui o treino de exercício, programas de educação e de modificação comportamental, entre outros, desenhados individualmente para melhorar o desempenho físico e psicossocial e promover a adesão a longo prazo a comportamentos promotores de saúde. A doença pulmonar obstrutiva crónica (DPOC) é uma doença comum, afetando cerca de 210 milhões de pessoas em todo o mundo, com elevada mortalidade e com custos económicos significativos decorrentes do agravamento progressivo da doença, das hospitalizações e de reinternamentos frequentes. Apesar do crescente conhecimento da DPOC e do papel da RR nos benefícios para a saúde, existem aspetos ainda não esclarecidos que têm impacto na prática clínica e de investigação e nas decisões das autoridades de saúde. A primeira parte desta tese focou a DPOC e o seu impacto negativo e incluiu: o estudo da prevalência da DPOC em Portugal; os fatores clínicos e funcionais que se associam à mortalidade em doentes com DPOC avançada; a morbilidade, impacto funcional e risco dos doentes se tornarem dependentes para as atividades diárias e a influência da inflamação sistémica. A prevalência estimada da DPOC de 14,2% indica que esta é uma doença comum em Portugal e alerta para a necessidade de uma maior sensibilização da população, dos profissionais de saúde e autoridades de saúde com vista a um diagnóstico precoce e à alocação dos recursos terapêuticos adequados. A elevada taxa de mortalidade em doentes com DPOC avançada - 36,6% em 3 anos - associou-se a insuficiência respiratória, a elevado número de exacerbações, ao cancro do pulmão e a reduzida capacidade funcional para a marcha, salientando a importância da referenciação precoce para RR, a identificação e o tratamento das comorbilidades e a prevenção das exacerbações. A aplicação de um questionário que avaliou as atividades da vida diária básicas e instrumentais, permitiu identificar um marcador clínico do risco de dependência, complementando as avaliações funcionais e associando-se a outros marcadores de mau prognóstico, como as exacerbações. Em doentes com DPOC, com FEV1 médio de 46,76% (desvio padrão: 20,90%), 67% da categoria D do GOLD, verificou-se uma associação positiva entre a expressão de genes inflamatórios avaliada pela reação em cadeia da polimerase (ARN mensageiro de IFNg, IL1b, IL6, IL8, TNFa, TGFb1, iNOS) e o índice de massa corporal em repouso, acentuando-se após o exercício. Este estudo aponta a inflamação como o potencial elo de ligação entre a obesidade e a inflamação sistémica em doentes com DPOC. A segunda parte da tese focou a RR, nomeadamente os seus efeitos em doentes das categorias GOLD A, B, C e D; o impacto das comorbilidades nos resultados da RR e os resultados de diferentes intensidades de treino aeróbio. Após o programa de RR, verificaram-se melhorias significativas na capacidade de exercício funcional e de endurance e no estado geral de saúde dos doentes de todas as categorias GOLD. Esta classificação não distingue os doentes que melhor poderão beneficiar desta intervenção, indicando que devem ser referenciados para RR, os doentes sintomáticos ou com repercussão na qualidade de vida, independentemente da categoria da DPOC a que pertençam. A prevalência das comorbilidades no grupo de doentes com DPOC que é referenciado para RR, é elevada, sendo as mais frequentes, as cardiovasculares, as respiratórias e as psicológicas. Apesar de poderem diminuir o impacto da RR, os resultados desta foram semelhantes independentemente do número de comorbilidades. A identificação e o tratamento sistemáticos das comorbilidades conferem maior segurança clínica a esta intervenção terapêutica a qual, por apresentar bons resultados, não deve limitar a referenciação dos doentes. Com o programa de RR, verificou-se melhoria significativa em todos os resultados centrados no doente para ambas as intensidades de treino aeróbio, a 60% e a 80% da potência aeróbica máxima (Wmax), com melhoria do estado geral de saúde, nos sintomas e na capacidade para o exercício, o que questiona a indicação sistemática de elevadas intensidades de treino em doentes com DPOC para a obtenção de benefícios a curto prazo. Na terceira e última parte da tese foi estudado o papel da atividade física na DPOC, focando os fatores que influenciam a atividade física diária; a evolução da capacidade funcional e o estado de saúde 2 anos após um programa de RR e o papel da telemonitorização na quantificação e monitorização da atividade física. Confirmámos que os doentes com DPOC são marcadamente sedentários e os fatores que se associaram ao sedentarismo nestes doentes foram a dispneia e a distância percorrida na prova de marcha de seis minutos. Este estudo sublinha a importância do controlo sintomático, nomeadamente da dispneia, bem como, mais uma vez, o potencial papel da reabilitação respiratória no aumento da capacidade funcional para o exercício e na aquisição de hábitos de vida fisicamente ativa. Verificámos que, apesar de os doentes com DPOC apresentarem benefícios clinicamente significativos na capacidade funcional para o exercício e no estado geral de saúde com o programa de RR, apenas os que se mantêm ativos, podem, no final dos dois anos de seguimento, manter os efeitos benéficos desse programa. O sistema de telemonitorização que combina a oximetria e a quantificação da atividade física provou ser clinicamente útil na avaliação da necessidade de oxigenoterapia de longa duração (OLD) e na aferição do débito de oxigénio em repouso, no esforço e no sono, podendo contribuir para uma melhor adequação da prescrição da OLD. A monitorização dos níveis de atividade física regular é um importante instrumento de avaliação dos programas de RR e o seu uso potencial na telereabilitação permitirá prolongar a eficácia dos programas e reduzir os custos associados aos cuidados de saúde.---------------------------------------------------------------------------------------------------ABSTRACT: Pulmonary rehabilitation (PR) is a comprehensive interdisciplinary intervention that includes, but is not limited to, exercise training, education, and behavior change, individually designed to improve physical and psychological conditions of people with chronic respiratory disease and to promote long-term adherence to health-enhancing behaviors. Chronic obstructive pulmonary disease (COPD) is a common disease, affecting about 210 million people worldwide, with high mortality and significant health-related costs due to disease progression, hospitalizations and frequent hospital readmissions. Although the increasing knowledge about COPD and benefitial outcomes of PR, some aspects with impact in clinical practice, research and health authorities’ decisions, remain to be clarified. The first part of this thesis focused on COPD and its negative impact, including the study of COPD prevalence in Portugal; clinical and functional factors associated with mortality in advanced COPD patients; morbidity, functional impact and risk of others’ dependance to perform activities of daily living; and the role of systemic inflammation. The evidence of 14.2% estimated COPD prevalence as a common disease in Portugal raises the need of an increasing awareness of population, health care professionals and health authorities towards an earlier diagnosis and apropriate treatment resources allocation. High mortality in patients with advanced COPD – 36.6% in 3 years - was associated with respiratory failure, high frequency of exacerbations, lung cancer and a low functional capacity in walking. This highlightens the importance of an earlier referral to PR, comorbidity identification and treatment, and prevention of exacerbations. A questionnaire evaluated basic and instrumental activities of daily living, and identified a clinical marker of the risk of becoming dependent. This clinical marker complemented other functional evaluations and was associated with prognosis markers such as the number of exacerbations. In COPD patients with a mean FEV1 46.76% (SD 20.90%), 67% belonging to GOLD grade D, we found a positive association between inflammatory gene expression evaluated by polymerase chain reaction (IFNg, IL1b, IL6, IL8, TNFa, TGFb1, iNOS RNA messenger) and body mass index at rest, and a further increase with exercise. This study evidenced obesity as one potential link between COPD and systemic inflammation. The second part of this thesis focused PR, namely its outcomes in patients of GOLD categories A, B, C and D; comorbidities impact in PR outcomes, and the impact of different exercise training intensities in patient related outcomes. xviii With PR intervention, we found significant improvement in functional exercise capacity, endurance exercise capacity and health status in patients of all GOLD categories. This classification did not differentiate which patients would benefit more from PR, hence all symptomatic patients with a negative impact in health status should be referred to PR, regardless of the GOLD category they belong to. There is a high prevalence of comorbidities in COPD patients referred to PR, being cardiovascular, respiratory and psychological, the most prevalent. Although some comorbidities might reduce PR impact, the results were similar regardless of the number of comorbidities. Systematic comorbidities identification and treatment provides safety to PR intervention, and its good results should not preclude patients referral. With PR intervention we found a significant improvement in all patient reported outcomes for exercise training intensities at 60% and 80% maximum work rate (Wmax), namely in health status, symptoms and exercise capacity. These findings challenge the current systematic indication of high exercise training intensities to achieve PR short-term benefits. In the third and last part of the thesis, the role of physical activity in COPD was studied, focusing factors that may influence daily physical activity; the evolution of functional capacity and health status two years after a PR program, and the role of a telemonitoring system in physical activity quantification and monitoring. We confirmed that COPD patients are markedly inactive and factors associated with a sedentary lifestyle are dyspnea and 6 minute walking distance. This study emphasized the importance of symptom control, namely of dyspnea, as well as, once again, the potential role of PR in functional exercise improvement and in integrating physically active habits in daily life. We verified that, although COPD patients improve functional exercise capacity and health status after a PR program, only those who kept physical activity habits were able to maintain those effects after 2 years of follow-up. A telemonitoring system that combines oximetry and physical activity quantification proved to be clinically useful in the evaluation of long-term oxygen therapy (LTOT) indication, as well as in the titration of oxygen levels at rest, exertion, and sleeping, which might contribute to a more adequate LTOT prescription. Monitoring of daily physical activity levels is an important PR evaluation instrument and its potential use in telerehabilitation might allow lengthening programs efficacy, while reducing health-care costs.

Perceived behavioral changes in early multiple sclerosis.

Acquired behavioral changes have essentially been described in advanced multiple sclerosis (MS). The present study was designed to determine whether behavioral modifications specifically related to the MS pathological process could be identified in the initial phase of the disease, as compared to control patients with chronic, relapsing and progressive inflammatory disorders not involving the central nervous system (CNS). Eighty-eight early MS patients (Expanded Disability Status Scale score <or= 2.5) and 48 controls were tested. Perceived changes by informants in behavioral control, goal-directed behavior, decision making, emotional expression, insight and interpersonal relationships were assessed using the Iowa Scale of Personality Change (ISPC). Executive behavioral disturbances were screened using the Dysexecutive Questionnaire (DEX). The mean change between the premorbid and postmorbid ISPC ratings was similar in the MS [12.2 (SD 15.6)] and in the control [11.5 (SD 15.1)] group. The perceived behavioral changes (PBCs) most frequently reported in both groups were lack of stamina, lability/moodiness, anxiety, vulnerability to stress and irritability. Pathological scores in the DEX were also similar in both groups. Correlations between PBCs and DEX scores were different in MS and control groups. MS patients with cognitive impairment had a marginally higher number of PBCs than control patients (p=0.056) and a significantly higher DEXp score (p=0.04). These results suggest that (1) PBCs occurring in early MS patients were not different from those induced by comparable chronic non-CNS disorders, (2) qualitative differences in the relationship between behavioral symptoms and executive-behavioral changes may exist between MS and control groups, and (3) behavioral symptoms seem associated with cognitive deficits in MS. We further plan to assess these observations longitudinally.

Fatigue et réduction de la performance motrice chez le sportif, syndrome de surentraînement [Fatigue and reduction in motor performance in sportspeople or overtraining syndrome].

The main goal of training activities is to improve motor performance. After strenuous workouts, it is physiological to experience fatigue, which relieves within two weeks, and then induce an improvement in motor capacities. An overtraining syndrome is diagnosed when fatigue is postponed beyond two weeks, and affects mainly endurance athletes. It is a condition of chronic fatigue, underperformance and an increased vulnerability to infection leading to recurrent infections. The whole observed spectrum of symptoms is physiological, psychological, endocrinogical and immunological. All play a role in the failure to recover. Monitoring of athletes activities helps to prevent the syndrome with days with no sports. Rest, patience and empathy are the only ways of treatment options.

Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial.

INTRODUCTION: In recent decades the treatment of non-specific low back pain has turned to active modalities, some of which were based on cognitive-behavioural principles. Non-randomised studies clearly favour functional multidisciplinary rehabilitation over outpatient physiotherapy. However, systematic reviews and meta-analysis provide contradictory evidence regarding the effects on return to work and functional status. The aim of the present randomised study was to compare long-term functional and work status after 3-week functional multidisciplinary rehabilitation or 18 supervised outpatient physiotherapy sessions. METHODS: 109 patients with non-specific low back pain were randomised to either a 3-week functional multidisciplinary rehabilitation programme, including physical and ergonomic training, psychological pain management, back school and information, or 18 sessions of active outpatient physiotherapy over 9 weeks. Primary outcomes were functional disability (Oswestry) and work status. Secondary outcomes were lifting capacity (Spinal Function Sort and PILE test), lumbar range-of-motion (modified-modified Schöber and fingertip-to-floor tests), trunk muscle endurance (Shirado and Biering-Sörensen tests) and aerobic capacity (modified Bruce test). RESULTS: Oswestry disability index was improved to a significantly greater extent after functional multidisciplinary rehabilitation compared to outpatient physiotherapy at follow-up of 9 weeks (P = 0.012), 9 months (P = 0.023) and 12 months (P = 0.011). Work status was significantly improved after functional multidisciplinary rehabilitation only (P = 0.012), resulting in a significant difference compared to outpatient physiotherapy at 12 months' follow-up (P = 0.012). Secondary outcome results were more contrasted. CONCLUSIONS: Functional multidisciplinary rehabilitation was better than outpatient physiotherapy in improving functional and work status. From an economic point of view, these results should be backed up by a cost-effectiveness study.

NCoR1 is a conserved physiological modulator of muscle mass and oxidative function.

Transcriptional coregulators control the activity of many transcription factors and are thought to have wide-ranging effects on gene expression patterns. We show here that muscle-specific loss of nuclear receptor corepressor 1 (NCoR1) in mice leads to enhanced exercise endurance due to an increase of both muscle mass and of mitochondrial number and activity. The activation of selected transcription factors that control muscle function, such as MEF2, PPARβ/δ, and ERRs, underpins these phenotypic alterations. NCoR1 levels are decreased in conditions that require fat oxidation, resetting transcriptional programs to boost oxidative metabolism. Knockdown of gei-8, the sole C. elegans NCoR homolog, also robustly increased muscle mitochondria and respiration, suggesting conservation of NCoR1 function. Collectively, our data suggest that NCoR1 plays an adaptive role in muscle physiology and that interference with NCoR1 action could be used to improve muscle function.

Optimal slopes and speeds in uphill ski mountaineering: a laboratory study.

The purpose of this study was to estimate the energy cost of linear (EC) and vertical displacement (ECvert), mechanical efficiency and main stride parameters during simulated ski mountaineering at different speeds and gradients, to identify an optimal speed and gradient that maximizes performance. 12 subjects roller skied on a treadmill at three different inclines (10, 17 and 24 %) at three different speeds (approximately 70, 80 and 85 % of estimated peak heart rate). Energy expenditure was calculated by indirect calorimetry, while biomechanical parameters were measured with an inertial sensor-based system. At 10 % there was no significant change with speed in EC, ECvert and mechanical efficiency. At 17 and 24 % the fastest speed was significantly more economical. There was a significant effect of gradient on EC, ECvert and mechanical efficiency. The most economical gradient was the steepest one. There was a significant increase of stride frequency with speed. At steep gradients only, relative thrust phase duration decreased significantly, while stride length increased significantly with speed. There was a significant effect of gradient on stride length (decrease with steepness) and relative thrust phase duration (increase with steepness). A combination of a decreased relative thrust phase duration with increased stride length and frequency decreases ECvert. To minimize the energy expenditure to reach the top of a mountain and to optimize performance, ski-mountaineers should choose a steep gradient (~24 %) and, provided they possess sufficient metabolic scope, combine it with a fast speed (~6 km h(-1)).

Same Performance Changes after Live High-Train Low in Normobaric vs. Hypobaric Hypoxia.

PURPOSE: We investigated the changes in physiological and performance parameters after a Live High-Train Low (LHTL) altitude camp in normobaric (NH) or hypobaric hypoxia (HH) to reproduce the actual training practices of endurance athletes using a crossover-designed study. METHODS: Well-trained triathletes (n = 16) were split into two groups and completed two 18-day LTHL camps during which they trained at 1100-1200 m and lived at 2250 m (P i O2 = 111.9 ± 0.6 vs. 111.6 ± 0.6 mmHg) under NH (hypoxic chamber; FiO2 18.05 ± 0.03%) or HH (real altitude; barometric pressure 580.2 ± 2.9 mmHg) conditions. The subjects completed the NH and HH camps with a 1-year washout period. Measurements and protocol were identical for both phases of the crossover study. Oxygen saturation (S p O2) was constantly recorded nightly. P i O2 and training loads were matched daily. Blood samples and VO2max were measured before (Pre-) and 1 day after (Post-1) LHTL. A 3-km running-test was performed near sea level before and 1, 7, and 21 days after training camps. RESULTS: Total hypoxic exposure was lower for NH than for HH during LHTL (230 vs. 310 h; P < 0.001). Nocturnal S p O2 was higher in NH than in HH (92.4 ± 1.2 vs. 91.3 ± 1.0%, P < 0.001). VO2max increased to the same extent for NH and HH (4.9 ± 5.6 vs. 3.2 ± 5.1%). No difference was found in hematological parameters. The 3-km run time was significantly faster in both conditions 21 days after LHTL (4.5 ± 5.0 vs. 6.2 ± 6.4% for NH and HH), and no difference between conditions was found at any time. CONCLUSION: Increases in VO2max and performance enhancement were similar between NH and HH conditions.

The capillary supply of human skeletal muscle in health and disease

BACKGROUND: Capillaries function to provide a surface area for nutrient and waste exchange with cells. The capillary supply of skeletal muscle is highly organized, and therefore, represents an excellent choice to study factors regulating diffusion. Muscle is comprised of three specific fibre types, each with specific contractile and metabolic characteristics, which influence the capillary supply of a given muscle; in addition, both environmental and genetic factors influence the capillary supply, including aging, physical training, and various disease processes. OBJECTIVE: The present study was undertaken to develop and assess the functionality of a data base, from which virtual experiments can be conducted on the capillary supply of human muscle, and the adaptations of the capillary bed in muscle to various perturbations. METHODS: To create the database, an extensive search of the literature was conducted using various search engines, and the three key words - "capillary, muscle, and human". This search yielded 169 papers from which the data for the 46 variables on the capillary supply and fibre characteristics of muscle were extracted for inclusion in the database. A series of statistical analyses (ANOVA) were done on the capillary database to examine differences in skeletal muscle capillarization and fibre characteristics between young and old individuals, between healthy and diseased individuals, and between untrained, endurance trained, endurance welltrained, and resistance trained individuals, using SAS. RESULTS: There was a significantly higher capillarization in the young compared to the old individuals, in the healthy compared to the diseased individuals, and in the endurance-trained and endurance well-trained compared to the untrained individuals. CONCLUSIONS: The results of this study support the conclusion that the capillary supply of skeletal muscle is closely regulated by factors aimed at optimizing oxygen and nutrient supply and/or waste removal in response to changes in muscle mass and/or metabolic activity.

The influence of recreational ball hockey play on cardiovascular risk factors in sedentary males

Introduction: The prevalence of coronary artery disease (CAD) is ever increasing in western industrialized societies. An individuals overall risk for CAD may be quantified by integrating a number of factors including, but not limited to, cardiorespiratory fitness, body composition, blood lipid profile and blood pressure. It might be expected that interventions aimed at improving any or all of these independent factors might improve an individual 's overall risk. To this end, the influence of standard endurance type exercise on cardiorespiratory fitness, body composition, blood lipids and blood pressure, and by extension the reduction of coronary risk factors, is well documented. On the other hand, interval training (IT) has been shown to provide an extremely powerful stimulus for improving indices of cardiorespiratory function but the influence of this training type on coronary risk factors is unknown. Moreover, the vast majority of studies investigating the effects of IT on fitness have used laboratory type training protocols. As a result of this, the influence of participation in interval-type recreational sports on cardiorespiratory fitness and coronary risk factors is unknown. Aims: The aim of the present study was to evaluate the effectiveness of recreational ball hockey, a sport associated with interval-type activity patterns, on indices of aerobic function and coronary risk factors in sedentary men in the approximate age range of 30 - 60 years. Individual risk factors were compiled into an overall coronary risk factor score using the Framingham Point Scale (FPS). Methods: Twenty-four sedentary males (age range 30 - 60) participated in the study. Subject activity level was assessed apriori using questionnaire responses. All subjects (experimental and control) were assessed to have been inactive and sedentary prior to participation in the study. The experimental group (43 ± 3 years; 90 ± 3 kg) (n = 11) participated in one season of recreational ball hockey (our surrogate for IT). Member of this group played a total of 16 games during an 11 week span. During this time, the control group (43 ± 2 years; 89 ± 2 kg) (n = 11) performed no training and continued with their sedentary lifestyle. Prior to and following the ball hockey season, experimental and control subjects were tested for the following variables: 1) cardiorespiratory fitness (as V02 Max) 2) blood lipid profile 3) body composition 5) waist to hip ratio 6) blood glucose levels and 7) blood pressure. Subject V02 Max was assessed using the Rockport submaximal walking test on an indoor track. To assess body composition we determined body mass ratio (BMI), % body fat, % lean body mass and waist to hip ratio. The blood lipid profile included high density lipoprotein, low density lipoprotein and total cholesterol levels; in addition, the ratio of total cholesterol to high density was calculated. Blood triglycerides were also assessed. All data were analyzed using independent t - tests and all data are expressed as mean ± standard error. Statistical significance was accepted at p :S 0.05. Results: Pre-test values for all variables were similar between the experimental and control group. Moreover, although the intervention used in this study was associated with changes in some variables for subjects in the experimental group, subjects in the control group did not exhibit any changes over the same time period. BODY COMPOSITION: The % body fat of experimental subjects decreased by 4.6 ± 0.5%, from 28.1 ± 2.6 to 26.9 ± 2.5 % while that of the control group was unchanged at 22.7 ± 1.4 and 22.2 ± 1.3 %. However, lean body mass of experimental and control subjects did not change at 64.3 ± 1.3 versus 66.1 ± 1.3 kg and 65.5 ± 0.8 versus 64.7 ± 0.8 kg, respectively. In terms of body mass index and waist to hip ratio, neither the experimental nor the control group showed any significant change. Respective values for the waist to hip ratio and body mass index (pre and post) were as follows: 1 ± 0.1 vs 0.9 ± 0.1 (experimental) and 0.9 ± 0.1 versus 0.9 ± 0.1 (controls) while for BMI they were 29 ± 1.4 versus 29 ± 1.2 (experimental) and 26 ± 0.7 vs. 26 ± 0.7 (controls). CARDIORESPIRATORY FITNESS: In the experimental group, predicted values for absolute V02 Max increased by 10 ± 3% (i.e. 3.3 ± 0.1 to 3.6 ± 0.1 liters min -1 while that of control subjects did not change (3.4 ± 0.2 and 3.4 ± 0.2 liters min-I). In terms of relative values for V02 Max, the experimental group increased by 11 ± 2% (37 ± 1.4 to 41 ± 1.4 ml kg-l min-I) while that of control subjects did not change (41 ± 1.4 and 40 ± 1.4 ml kg-l min-I). BLOOD LIPIDS: Compared to pre-test values, post-test values for HDL were decreased by 14 ± 5 % in the experiment group (from 52.4 ± 4.4 to 45.2 ± 4.3 mg dl-l) while HDL data for the control group was unchanged (49.7 ± 3.6 and 48.3 ± 4.1 mg dl-l, respectively. On the other hand, LDL levels did not change for either the experimental or control group (110.2 ± 10.4 versus 112.3 ± 7.1 mg dl-1 and 106.1 ± 11.3 versus 127 ± 15.1 mg dl-1, respectively). Further, total cholesterol did not change in either the experimental or control group (181.3 ± 8.7 mg dl-1 versus 178.7± 4.9 mg dl-l) and 190.7 ± 12.2 versus 197.1 ± 16.1 mg dl-1, respectively). Similarly, the ratio of TC/HDL did not change for either the experimental or control group (3.8 ± 0.4 versus 4.5 ± 0.5 and 4 ± 0.4 versus 4.2 ± 0.4, respectively). Blood triglyceride levels were also not altered in either the experimental or control group (100.3 ± 19.6 versus 114.8 ± 15.3 mg dl-1 and 140 ± 23.5 versus 137.3 ± 17.9 mg dl-l, respectively). BLOOD GLUCOSE: Fasted blood glucose levels did not change in either the experimental or control group. Pre- and post-values for experimental and control groups were 92.5 ± 4.8 versus 93.3 ± 4.3 mg dl-l and 92.3 ± 11.3 versus 93.2 ± 2.6 mg dl-1 , respectively. BLOOD PRESSURE: No aspect of blood pressure was altered in either the experimental or control group. For example, pre- and post-test systolic blood pressures were 131 ± 2 versus 129 ± 2 mmHg (experimental) and 123 ± 2 and 125 ± 2 mmHg (controls), respectively. Pre- and post-test diastolic blood pressures were 84 ± 2 and 83 ± 2 mmHg (experimental) and 81 ± 1 versus 82 ± 1 mmHg, respectively. Similarly, calculated pulse pressure was not altered in the experimental or control as pre- and post-test values were 47 ± 1 versus 47 ± 2 mmlHg and 42 ± 2 versus 43 ± 2 mmHg, respectively. FRAMINGHAM POINT SCORE: The concerted changes reported above produced an increased risk in the Framingham Point Score for the subjects in the experimental group. For example, the pre- and post-test FPS increased from 1.4 ± 0.9 to 2.7 ± 0.7. On the other hand, pre- and post-test scores for the control group were 1.8 ± 1 versus 1.8 ± 0.9. Conclusions: Our data confirms previous studies showing that interval-type exercise is a useful intervention for increasing aerobic fitness. Moreover, the increase in V02 Max we found in response to limited participation in ball hockey (i.e. 16 games) suggests that recreational sport may help reduce this aspect of coronary risk in previously sedentary individual. On the other hand, our results showing little or no positive change in body composition, blood lipids or blood pressures suggest that one season of recreational sport in not in of itself a powerful enough stimulus to reduce the overall risk of coronary artery disease. In light of this, it is recommended that, in addition to participation in recreational sport, the performance of regular physical activity is used as an adjunct to provide a more powerful overall stimulus for decreasing coronary risk factors. LIMITATIONS: The increase in the FPS we found for the experimental group, indicative of an increased risk for coronary disease, was largely due to the large decrease in HDL we observed after compared to above one season of ball hockey. In light of the fact that cardiorespiratory fitness was increased and % body fat was decreased, as well as the fact that other parameters such as blood pressure showed positive (but non statistically significant) trends, the possibility that the decrease in HDL showed by our data was anomalous should be considered. FUTURE DIRECTIONS: The results of this study suggesting that recreational sport may be a potentially useful intervention in the reduction of CAD require to be corroborated by future studies specifically employing 1) more rigorous assessment of fitness and fitness change and 2) more prolonged or frequent participants.