Beyond muscles: Investigating immunoregulatory myokines in acute resistance exercise - A systematic review and meta-analysis.

Myokines, released from the muscle, enable communication between the working muscles and other tissues. Their release during physical exercise is assumed to depend on immune-hormonal-metabolic interactions concerning mode (endurance or resistance exercise), duration, and intensity. This meta-analysis aims to examine the acute changes of circulating myokines inducing immunoregulatory effects caused by a bout of resistance exercise and to consider potential moderators of the results. Based on this selection strategy, a systematic literature search was conducted for resistance exercise intervention studies measuring interleukin (IL-) 6, IL-10, IL-1ra, tumor necrosis factor (TNF-) α, IL-15, IL-7, transforming growth factor (TGF-) ß1, and fractalkines (FKN) before and immediately after resistance exercise in healthy individuals. Random-effects meta-analysis was performed for each myokine. We identified a moderate positive effect of resistance exercise for IL-6 and IL-1ra. Regarding IL-15 and TNF-α, small to moderate effects were found. For IL-10, no significant effect was observed. Due to no data, meta-analyses for IL-7, TGF-ß1, and FKN could not be performed. No moderators (training status, type of exercise, risk of bias, age, sex, time of day, exercise volume, exercise intensity, exercise dose) of the results were detected for all tested myokines. Taken together, this systematic review and meta-analysis showed immediate positive effects of an acute resistance exercise session on IL-6, IL-1ra, TNF-α, and IL-15 levels.

Mobile primary healthcare for post-COVID patients in rural areas: a proof-of-concept study.

INTRODUCTION: Post-COVID syndrome is increasingly recognized as a new clinical entity after SARS-CoV-2 infection. Patients living in rural areas may have to travel long with subjectively great effort to be examined using all necessary interdisciplinary tools. This problem could be addressed with mobile outpatient clinics. METHODS: In this prospective observational study, we investigated physical fitness, fatigue, depression, cognitive dysfunction, and dyspnea in patients with post-COVID syndrome in a mobile interdisciplinary post-COVID outpatient clinic. Upon referral from their primary care physician, patients were offered an appointment at a mobile post-COVID outpatient clinic close to their home. RESULTS: We studied 125 patients (female, n = 79; 63.2%) in our mobile unit. All patients reported symptoms lasting for more than 12 weeks after acute infection. 88.3% and 64.1% of patients reported significant impairment in physical and mental quality of life. Patients reported a median of three symptoms. The most frequently reported symptoms were fatigue (86.4%), cognitive dysfunction (85.6%), and dyspnea (37.6%). 56.0% of patients performed at < 2.5th percentile at the 1 min sit-to-stand test compared to age- and sex-matched healthy controls, and 25 patients (20.0%) exhibited a drop in oxygen saturation. A questionnaire given to each patient regarding the mobile unit revealed a very high level of patient satisfaction. CONCLUSION: There is an increasing need for high-quality and locally available care for patients with post-COVID syndrome. A mobile post-COVID outpatient clinic is a new concept that may be particularly suitable for use in rural regions. Patients' satisfaction following visits in such units is very high.

Post-COVID-19 condition is not only a question of persistent symptoms: structured screening including health-related quality of life reveals two separate clusters of post-COVID.

PURPOSE: Some patients experience long-term sequelae after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, despite a present post-COVID condition, defined as "any symptom lasting longer than 12 weeks," only a subset of patients search for medical help and therapy. METHOD: We invited all adults with a positive real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 between March 2020 and September 2021 (n = 4091) in the city of Jena to answer a standardized questionnaire including demographic information, the course of the acute infection and current health status. K-means-clustering of quality of life (QoL) was used to explore post-COVID subgroups. RESULTS: A total of 909 participants at a median interval of 367 (IQR 291/403) days after acute infection were included in the analysis. Of those, 643 (70.7%) complained of having experienced persistent symptoms at the time of the survey. Cluster analysis based on QoL revealed two subgroups of people with persistent post-COVID symptoms. Whereas 189/643 participants (29.4%) showed markedly diminished QoL, normal QoL was detected in 454/643 individuals (70.6%). CONCLUSION: Despite persistent symptoms being reported by nearly three quarters of participants, only one-third of these described a significant reduction in QoL (cluster 1), whereas the other two-thirds reported a near-normal QoL (cluster 2), thus indicating a differentiation between "post-COVID disease" and "post-COVID condition". The prevalence of clinically relevant post-COVID disease was at least 20.7%. Health policies should focus on this subset.

Acute effects of concurrent muscle power and sport-specific endurance exercises on markers of immunological stress response and measures of muscular fitness in highly trained youth male athletes.

PURPOSE: To examine the acute effects of concurrent muscle power and sport-specific endurance exercises order on immunological stress responses, muscular-fitness, and rating-of-perceived-exertion (RPE) in highly trained youth male judo athletes. METHODS: Twenty male participants randomly performed two concurrent training (CT) sessions; power-endurance and endurance-power. Measures of immune response (e.g., white blood cells), muscular-fitness (i.e., counter-movement-jump [CMJ]), RPE, blood-lactate, and -glucose were taken at different time-point (i.e., pre, mid, post, and post6h). RESULTS: There were significant time*order interactions for white blood cells, lymphocytes, granulocytes, granulocyte-lymphocyte-ratio, and systemic-inflammation-index. Power-endurance resulted in significantly larger pre-to-post increases in white blood cells and lymphocytes while endurance-power resulted in significantly larger pre-to-post increases in the granulocyte-lymphocyte-ratio and systemic-inflammation-index. Likewise, significantly larger pre-to-post6h white blood cells and granulocytes increases were observed following power-endurance compared to endurance-power. Moreover, there was a significant time*order interaction for blood-glucose and -lactate. Following endurance-power, blood-lactate and -glucose increased from pre-to-mid but not from pre-to-post. Meanwhile, in power-endurance blood-lactate and -glucose increased from pre-to-post but not from pre-to-mid. A significant time*order interaction was observed for CMJ-force with larger pre-to-post decreases in endurance-power compared to power-endurance. Further, CMJ-power showed larger pre-to-mid performance decreases following power-endurance, compared to endurance-power. Regarding RPE, significant time*order interactions were noted with larger pre-to-mid values following endurance-power and larger pre-to-post values following power-endurance. CONCLUSION: CT induced acute and delayed order-dependent immune cell count alterations in highly trained youth male judo athletes. In general, power-endurance induced higher acute and delayed immunological stress responses compared to endurance-power. CMJ-force and RPE fluctuated during both CT sessions but went back to baseline 6 h post-exercise.

Acute effects of heavy resistance exercise on biomarkers of neuroendocrine-immune regulation in healthy adults: a systematic review.

BACKGROUND: The nervous system integrates the immune system in the systemic effort to maintain or restore the organism's homeostasis. Acute bouts of exercise may alter the activity of specific pathways associated with neuroendocrine regulation of the immune system. OBJECTIVE: To examine the acute effects of heavy resistance exercise on biomarkers of neuroendocrine-immune regulation in healthy adults. METHODS: A systematic literature search was conducted using PubMed, Cochrane Controlled Trials Register, Web of Science and SportDiscus with no date restrictions up to March 2021. Clinical trials in English or German were included if they measured the blood plasma or serum concentrations of specific biomarkers of neuroendocrine-immune regulation (adrenaline, noradrenaline, acetylcholine, vasoactive intestinal peptide (VIP), cortisol, growth hormone, calcitonin gene-related peptide (CGRP), substance p, serotonin, brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) or glia-derived neurotrophic factor (GDNF)) in a resting state prior to and no later than 60 minutes after an acute bout of heavy resistance exercise in healthy adults. RESULTS: 7801 records were identified through literature search, of which 36 studies, with a total of 58 intervention groups, met the inclusion criteria. Evidence was found that an acute bout of heavy resistance exercise increased the levels of adrenaline (median: 185%), noradrenaline (median: 113%) and GH (median: 265%) immediately after the exercise. Mixed results were found for cortisol (median: 0%), suggesting that its response might be more sensitive to the configuration of the exercise scheme. The limited evidence regarding the effects on BDNF and ACTH allows no firm conclusions to be drawn about their response to heavy resistance exercise. The vast majority of the included studies reported a return of the biomarker concentrations to their baseline value within one hour after the termination of the exercise bout. No studies were identified that investigated the response of acetylcholine, VIP, CGRP, substance p, serotonin, NGF or GDNF to heavy resistance exercise. CONCLUSIONS: A bout of heavy resistance exercise alters the circulating concentrations of selected biomarkers of neuroendocrine-immune regulation. Both subject characteristics, such as sex as well as exercise parameters, such as rest intervals appear to have the potential to influence these effects.

Does trunk muscle training with an oscillating rod improve urinary incontinence after radical prostatectomy? A prospective randomized controlled trial.

OBJECTIVE: To investigate the effect of a new therapeutic approach, using an oscillating rod to strength the pelvic floor and deep abdominal musculature and to speed up recovery of continence after radical prostatectomy. DESIGN: Prospective randomized controlled clinical trial. SETTING: Inpatient uro-oncology rehabilitation clinic. SUBJECTS: Ninety-three (intervention group (IG)) and ninety-one patients (control group (CG)) with urinary incontinence after prostatectomy were examined. INTERVENTION: All patients were randomly allocated to either standard pelvic floor muscle exercises and oscillating rod therapy (IG) or standard pelvic floor muscle exercises and relaxation therapy (CG). MAIN OUTCOME MEASURES: Urinary incontinence (1- and 24-hour pad test) was assessed, and health-related quality of life (HRQL; Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire) was measured for all patients before and after three weeks of treatment. RESULTS: One hundred and eighty-four patients (mean (SD) age: 64.1 (6.94) years) completed the study. The IG showed a significant reduction in urinary incontinence (1-hour pad test: P = 0.008, 24-hour pad test: P = 0.012) and a significant improvement of HRQL (P = 0.017) compared with CG. Continence was significantly improved in both groups (1-hour pad test: 22.6-8.5 g (IG) vs. 23.0-18.1 g (CG)/24-hour pad test: 242.9-126.7 g (IG) vs. 237.6-180.9 g (CG)). CONCLUSION: The study demonstrated that a combination of conventional continence exercises and the new oscillation rod training increased abdominal and pelvic floor musculature and speeded up recovery of continence after radical prostatectomy.

Boosting the Motor Outcome of the Untrained Hand by Action Observation: Mirror Visual Feedback, Video Therapy, or Both Combined-What Is More Effective?

Action observation (AO) allows access to a network that processes visuomotor and sensorimotor inputs and is believed to be involved in observational learning of motor skills. We conducted three consecutive experiments to examine the boosting effect of AO on the motor outcome of the untrained hand by either mirror visual feedback (MVF), video therapy (VT), or a combination of both. In the first experiment, healthy participants trained either with MVF or without mirror feedback while in the second experiment, participants either trained with VT or observed animal videos. In the third experiment, participants first observed video clips that were followed by either training with MVF or training without mirror feedback. The outcomes for the untrained hand were quantified by scores from five motor tasks. The results demonstrated that MVF and VT significantly increase the motor performance of the untrained hand by the use of AO. We found that MVF was the most effective approach to increase the performance of the target effector. On the contrary, the combination of MVF and VT turns out to be less effective looking from clinical perspective. The gathered results suggest that action-related motor competence with the untrained hand is acquired by both mirror-based and video-based AO.

Using ultrasound to assess the thickness of the transversus abdominis in a sling exercise.

BACKGROUND: Activation of the deep stabilizing trunk muscle transversus abdominis (TrA) is important for trunk stabilization and spine stability. Sling exercises are used for the activation of trunk muscles, therefore we determined the thickness of the TrA in a standardized sling exercise in comparison to rest and abdominal press. Furthermore we propose a standardized measurement method, which can be used to compare relative muscle thickness levels in different exercises. METHODS: The main objective of the study was to assess and to compare the thickness of the TrA during different conditions; resting condition, sling exercise condition (non-voluntary contraction), and abdominal press condition (voluntary contraction) using a non-invasive ultrasound-based measurement method. Ultrasound measurement (USM; 8.9 MHz, B-mode) was employed to measure the thickness of the TrA in twenty healthy volunteers (13 m, 7 f), each one measured three times with breaks of 48 h. On each measurement day, the subjects were measured on three different conditions: resting condition (RC), sling condition (SC), and abdominal press condition (APC). The USM images were analyzed using a custom-made MatLab script, to determine the thickness of the TrA. RESULTS: A two-way repeated-measurements ANOVA was performed with a significant effect of the factor condition [F(2,38) = 47.82, p < 0.0001, η(2) = 0.72], no significant effect of the factor time [F(2.38) = 2.45, p = 0.1, η(2) = 0.11], and no significant interaction effect [F(4,76) = 0.315, p = 0.867, η(2) = 0.02]. Statistically corrected post-hoc t-tests revealed significant differences in TrA thickness showing that RC < SC (p < 0.001; η(2) = 0.19; d = 0.96), SC < APC (p < 0.0001; η(2) = 0.23; d = 1.10), RC < APC (p < 0.0001; η(2) = 0.53; d = 2.11). As for the test-retest reliability the intra-class correlation coefficient (ICC) yielded a value of 0.71, 0.54, and 0.29, on the conditions RC, SC, and APC, respectively. CONCLUSIONS: We showed that the investigated sling exercise can be used to significantly increase the TrA thickness, and that the TrA thickness was significantly different on the three conditions (RC, SC, APC) using the ultrasound-based method.

Correct, fake and absent pre-information does not affect the occurrence and magnitude of the bilateral force deficit.

The present study examined whether different pre-information conditions could lead to a volitional modulation of the occurrence and magnitude of the bilateral force deficit (BFD) during isometric leg press. Twenty trained male adults (age: 24.5 ± 1.7 years; weight: 77.5 ± 7.1 kg; height: 1.81 ± 0.05 m) were examined on three days within a week. Isometric leg press was performed on a negatively inclined leg press slide. Each participant completed three maximal isometric strength test sessions with different pre-information conditions given in a graphical chart: no pre-information (NPI; first day), false pre-information (FPI; bilateral force > sum of unilateral forces; second or third day) and correct pre-information (CPI; bilateral force < sum of unilateral forces; second or third day) during bilateral, unilateral-left and unilateral-right leg-press. The sum of left- and right-sided force values were calculated for bilateral (FBL = FBL_left + FBL_right) and unilateral (FUL = FUL_left + FUL_right) analyses. Force data for NPI revealed: Mean (SD): FUL_NPI = 3023 N (435) vs. FBL_NPI = 2812 (453); FPI showed FUL_FPI = 3013 N (459) vs. FBL_FPI = 2843 (446) and the CPI revealed FUL_CPI = 3035 (425) vs. FBL_CPI = 2844 (385). The three (no, false, correct) x 2 (FUL, FBL) rANOVA revealed a high significant main effect of Force (F = 61.82, p < 0.001). No significant main effect of the factor Condition and no significant interaction between Force x Condition was observed. The BFD does not rely on the trueness of the given pre-information (no, false, correct). Cognition-based volitional influences on the BFD on supra-spinal level seem negligible. Key pointsBFD is reliable occurring phenomenonAvailable theoretical knowledge does not affect the BFDAlternating sport should include alternating strength exercises.

The gastrointestinal microbiota in the development of ME/CFS: a critical view and potential perspectives.

Like other infections, a SARS-CoV-2 infection can also trigger Post-Acute Infection Syndromes (PAIS), which often progress into myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS, characterized by post-exercise malaise (PEM), is a severe multisystemic disease for which specific diagnostic markers or therapeutic concepts have not been established. Despite numerous indications of post-infectious neurological, immunological, endocrinal, and metabolic deviations, the exact causes and pathophysiology remain unclear. To date, there is a paucity of data, that changes in the composition and function of the gastrointestinal microbiota have emerged as a potential influencing variable associated with immunological and inflammatory pathways, shifts in ME/CFS. It is postulated that this dysbiosis may lead to intestinal barrier dysfunction, translocation of microbial components with increased oxidative stress, and the development or progression of ME/CFS. In this review, we detailed discuss the findings regarding alterations in the gastrointestinal microbiota and its microbial mediators in ME/CFS. When viewed critically, there is currently no evidence indicating causality between changes in the microbiota and the development of ME/CFS. Most studies describe associations within poorly defined patient populations, often combining various clinical presentations, such as irritable bowel syndrome and fatigue associated with ME/CFS. Nevertheless, drawing on analogies with other gastrointestinal diseases, there is potential to develop strategies aimed at modulating the gut microbiota and/or its metabolites as potential treatments for ME/CFS and other PAIS. These strategies should be further investigated in clinical trials.

The acute effects of pre- and mid-exercise carbohydrate ingestion on the immunoregulatory stress hormone release in experienced endurance athletes-a systematic review.

Background: In times of physical stress, the body orchestrates a multisystemic regulatory response. The hormones epinephrine and norepinephrine play a role in the immediate regulation chain, while cortisol is involved in delayed regulation. The release of those stress hormones in response to exercise has previously been reported to elicit diverse immune reactions. Objective: The aim of this systematic review was to examine and present the acute effects of immediate pre- and mid-exercise carbohydrate ingestion on cortisol, epinephrine and norepinephrine levels in experienced endurance athletes. Methods: A systematic literature search was conducted using PubMed, Cochrane Library and Web of Science in accordance with PRISMA guidelines up to February 2023. Randomized controlled trials in English or German language were included if baseline and at least two follow-up measures of blood plasma or serum of chosen stress hormones (cortisol, epinephrine, norepinephrine) were collected in response to prolonged continuous endurance activity. Eligibility furthermore required an acute carbohydrate ingestion of at least 30 g of carbohydrates per hour no more than 30 min before start of the exercise, as well as a placebo-controlled study design. Results: Eleven studies of moderate to high quality were included in this review. Carbohydrate ingestion of at least 30 g per hour was able to attenuate rises in cortisol concentration in majority of the included studies. Epinephrine levels were considerably lower with ingestion of carbohydrates compared to placebo in all studies. Norepinephrine concentrations were largely unaffected by acute carbohydrate feeding. Conclusion: Pre- and mid-exercise ingestion of carbohydrates seems an effective dietary strategy to attenuate rises in cortisol and epinephrine levels and, thus, an effective countermeasure for endurance exercise-induced increases in stress hormone levels.

Covid Pandemic Effects on the Physical Fitness of Primary School Children: Results of the German EMOTIKON Project.

BACKGROUND: In spring of 2020, the Sars-CoV-2 incidence rate increased rapidly in Germany and around the world. Throughout the next 2 years, schools were temporarily closed and social distancing measures were put in place to slow the spread of the Covid-19 virus. Did these social restrictions and temporary school lockdowns affect children's physical fitness? The EMOTIKON project annually tests the physical fitness of all third-graders in the Federal State of Brandenburg, Germany. The tests assess cardiorespiratory endurance (6-min-run test), coordination (star-run test), speed (20-m sprint test), lower (powerLOW, standing long jump test), and upper (powerUP, ball-push test) limbs muscle power, and static balance (one-legged stance test with eyes closed). A total of 125,893 children were tested in the falls from 2016 to 2022. Primary analyses focused on 98,510 keyage third-graders (i.e., school enrollment according to the legal key date, aged 8 to 9 years) from 515 schools. Secondary analyses included 27,383 older-than-keyage third-graders (i.e., OTK, delayed school enrollment or repetition of a grade, aged 9 to 10 years), who have been shown to exhibit lower physical fitness than expected for their age. Linear mixed models fitted pre-pandemic quadratic secular trends, and took into account differences between children and schools. RESULTS: Third-graders exhibited lower cardiorespiratory endurance, coordination, speed and powerUP in the Covid pandemic cohorts (2020-2022) compared to the pre-pandemic cohorts (2016-2019). Children's powerLOW and static balance were higher in the pandemic cohorts compared to the pre-pandemic cohorts. From 2020 to 2021, coordination, powerLOW and powerUP further declined. Evidence for some post-pandemic physical fitness catch-up was restricted to powerUP. Cohen's |ds| for comparisons of the pandemic cohorts 2020-2022 with pre-pandemic cohorts 2016-2019 ranged from 0.02 for powerLOW to 0.15 for coordination. Within the pandemic cohorts, keyage children exhibited developmental losses ranging from approximately 1 month for speed to 5 months for cardiorespiratory endurance. For powerLOW and static balance, the positive pandemic effects translate to developmental gains of 1 and 7 months, respectively. Pre-pandemic secular trends may account for some of the observed differences between pandemic and pre-pandemic cohorts, especially in powerLOW, powerUP and static balance. The pandemic further increased developmental delays of OTK children in cardiorespiratory endurance, powerUP and balance. CONCLUSIONS: The Covid-19 pandemic was associated with declines in several physical fitness components in German third-graders. Pandemic effects are still visible in 2022. Health-related interventions should specifically target those physical fitness components that were negatively affected by the pandemic (cardiorespiratory endurance, coordination, speed).

T-cell-derived TNF-α and a cluster of immunological parameters from plasma allow a separation between SARS-CoV-2 convalescent versus vaccinated elite athletes.

Guidelines for medical clearing after SARS-CoV-2 infection in elite athletes do not include T-cell immunity aspects despite its relevance in the course of COVID-19 disease. Therefore, we aimed to analyze T-cell-related cytokines before and after in-vitro activation of CD4+ T-cells. We sampled professional indoor sports athletes at medical clearing after SARS-CoV-2 infection obtaining clinical, fitness data, and serological data including CD4+ T-cell cytokines. All data were analyzed by principal component analysis and 2 × 2 repeated measures ANOVA. CD4+ T-cells were sampled for cell culture activation with anti-CD3/anti-CD28 tetramers. At medical clearing, CD4+ T-cells from convalescent athletes secreted increased levels of TNF-α 72 h after in-vitro activation compared to vaccinated athletes. IL-18 levels in plasma were elevated and a cluster of parameters differentiated convalescent from vaccinated athletes by 13 parameters at the timepoint of medical clearing. All clinical data indicate infection is resolved, while increased TNF-α may reflect altered proportions of peripheral T-cells as a hangover of infection.

Optimization Reduces Knee-Joint Forces During Walking and Squatting: Validating the Inverse Dynamics Approach for Full Body Movements on Instrumented Knee Prostheses.

Because of the redundancy of our motor system, movements can be performed in many ways. While multiple motor control strategies can all lead to the desired behavior, they result in different joint and muscle forces. This creates opportunities to explore this redundancy, for example, for pain avoidance or reducing the risk of further injury. To assess the effect of different motor control optimization strategies, a direct measurement of muscle and joint forces is desirable, but problematic for medical and ethical reasons. Computational modeling might provide a solution by calculating approximations of these forces. In this study, we used a full-body computational musculoskeletal model to (a) predict forces measured in knee prostheses during walking and squatting and (b) study the effect of different motor control strategies (i.e., minimizing joint force vs. muscle activation) on the joint load and prediction error. We found that musculoskeletal models can accurately predict knee joint forces with a root mean squared error of <0.5 body weight (BW) in the superior direction and about 0.1 BW in the medial and anterior directions. Generally, minimization of joint forces produced the best predictions. Furthermore, minimizing muscle activation resulted in maximum knee forces of about 4 BW for walking and 2.5 BW for squatting. Minimizing joint forces resulted in maximum knee forces of 2.25 BW and 2.12 BW, that is, a reduction of 44% and 15%, respectively. Thus, changing the muscular coordination strategy can strongly affect knee joint forces. Patients with a knee prosthesis may adapt their neuromuscular activation to reduce joint forces during locomotion.

Variations and Predictors of Post-COVID Syndrome Severity in Patients Attending a Post-COVID Outpatient Clinic.

A relevant proportion of patients suffer from long-lasting impairments following an acute SARS-CoV-2 infection. The proposed post-COVID syndrome (PCS) score may improve comparison in the course and classification of affected patients. A prospective cohort of 952 patients presenting to the post-COVID outpatient clinic at Jena University Hospital, Germany, was enrolled. Patients received a structured examination. PCS score was calculated per visit. A total of 378 (39.7%) and 129 (13.6%) patients of the entire population visited the outpatient clinic two or three times, respectively (female: 66.4%; age: 49.5 (SD = 13) years). The initial presentation took place, on average, 290 (SD = 138) days after acute infection. The most frequently reported symptoms were fatigue (80.4%) and neurological impairments (76.1%). The mean PCS scores of patients with three visits were 24.6 points (SD = 10.9), 23.0 points (SD = 10.9) and 23.5 points (SD = 11.5) (p = 0.407), indicating moderate PCS. Female sex (p < 0.001), preexisting coagulation disorder (p = 0.021) and coronary artery disease (p = 0.032) were associated with higher PCS scores. PCS is associated with a multitude of long-lasting problems. The PCS score has proven its capability to objectify and quantify PCS symptoms in an outpatient setting. The influence of therapeutic measures on various PCS aspects should be the subject of further analyses.

Impact of an online guided physical activity training on cognition and gut-brain axis interactions in older adults: protocol of a randomized controlled trial.

Introduction: By 2050, the worldwide percentage of people 65 years and older is assumed to have doubled compared to current numbers. Therefore, finding ways of promoting healthy (cognitive) aging is crucial. Physical activity is considered an effective approach to counteract not only physical but also cognitive decline. However, the underlying mechanisms that drive the benefits of regular physical activity on cognitive function are not fully understood. This randomized controlled trial aims to analyze the effect of an eight-week standardized physical activity training program in older humans on cognitive, brain, and gut-barrier function as well as the relationship between the resulting changes. Methods and analysis: One-hundred healthy participants aged 60 to 75 years will be recruited. First, participants will undergo an extensive baseline assessment consisting of neurocognitive tests, functional and structural brain imaging, physical fitness tests, and gut-microbiome profiling. Next, participants will be randomized into either a multi-component physical activity group (experimental condition) or a relaxation group (active control condition), with each training lasting 8 weeks and including an equal number and duration of exercises. The whole intervention will be online-based, i.e., participants will find their intervention schedule and all materials needed on the study website. After the intervention phase, participants will have their post-intervention assessment, which consists of the same measures and tests as the baseline assessment. The primary outcome of this study is the change in the cognitive parameter of visual processing speed from baseline to post-measurement, which will on average take place 10 weeks after the randomization. Secondary outcomes related to cognitive, brain, and microbiome data will be analyzed exploratory. Clinical trial registration: https://drks.de/search/de/trial/DRKS00028022.

Understanding, diagnosing, and treating Myalgic encephalomyelitis/chronic fatigue syndrome - State of the art: Report of the 2nd international meeting at the Charité Fatigue Center.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a devastating disease affecting millions of people worldwide. Due to the 2019 pandemic of coronavirus disease (COVID-19), we are facing a significant increase of ME/CFS prevalence. On May 11th to 12th, 2023, the second international ME/CFS conference of the Charité Fatigue Center was held in Berlin, Germany, focusing on pathomechanisms, diagnosis, and treatment. During the two-day conference, more than 100 researchers from various research fields met on-site and over 700 attendees participated online to discuss the state of the art and novel findings in this field. Key topics from the conference included: the role of the immune system, dysfunction of endothelial and autonomic nervous system, and viral reactivation. Furthermore, there were presentations on innovative diagnostic measures and assessments for this complex disease, cutting-edge treatment approaches, and clinical studies. Despite the increased public attention due to the COVID-19 pandemic, the subsequent rise of Long COVID-19 cases, and the rise of funding opportunities to unravel the pathomechanisms underlying ME/CFS, this severe disease remains highly underresearched. Future adequately funded research efforts are needed to further explore the disease etiology and to identify diagnostic markers and targeted therapies.

Enhanced sensitivity to punctate painful stimuli in female patients with chronic low back pain.

BACKGROUND: Chronic low back pain (CLBP) has been shown to be associated with various pathophysiological changes at several level of the sensorimotor system, pointing to a general hypersensitivity in CLBP patients. The aim of the present study was to investigate signs of generalized mechanical pain hypersensitivity in CLBP patients on the hand and on the painful site of the back. METHODS: Pinprick stimulation according to a validated standardized quantitative sensory testing protocol was used in 14 female CLBP patients and 14 healthy controls (HC) matched for sex and age. Stimulus response functions to pinprick stimulation on the skin were examined at the affected back and reference sites (hand palmar and hand dorsum). Data from CLBP patients were compared with HC and with reference data from the German Research Network on Neuropathic Pain. RESULTS: We found significant differences in the stimulus response functions between CLBP patients and HC. Pain ratings to the pinpricks were increased for low and moderate pinprick stimuli in CLBP patients. Importantly, this kind of specific pinprick hyperalgesia was found not only for the affected body site (back), but also for the remote reference sites (hand dorsum and hand palmar). CONCLUSIONS: We interpret our results as pointing to changes in the nociceptive processing in CLBP at higher levels of the neuraxis, possibly thalamus and/or attentional control, rather than changes of spinal processing. Alternatively, there might be a higher vulnerability to noxious stimulation in CLBP patients.

Sleep behavior and training load in adolescent elite basketball players during COVID-19 pandemic development.

The COVID-19 pandemic caused strong restrictions in organized sports. Specifically, adolescent athletes, whose daily routine is usually determined by school and practice schedules, experienced a sudden lifestyle change. The aim of this study was to examine sleep and training patterns of German elite adolescent basketball players (N = 115, 15.70 ± 1.22 years, female = 32.17%) during different phases of the 2021 lockdown. Sleep and training behavior were documented by a subjective monitoring over 10 days at three different lockdown phases in February, April, and June/July. A linear mixed model approach was conducted for the statistical analyses. Sleep duration and time in bed decreased between phase 1 (prohibition of organized sports) and phase 3 (normal training conditions), while sleep efficiency and quality increased. There was no change in training duration over time, but in training intensity, which peaked in the third phase. This study contains meaningful evidence to analyze the lockdown-related return to practice process. Athletes were able to maintain training duration with alternative protocols during pandemic conditions. Interestingly, athletes slept less under non-lockdown conditions, but reported a better sleep quality. It is recommended to consider athletes' individual preferences when planning training and recovery schedules.

Acute Effects of Aerobic Exercise on Muscle Strength and Power in Trained Male Individuals: A Systematic Review with Meta-analysis.

BACKGROUND: Concurrent training can be an effective and time-efficient method to improve both muscle strength and aerobic capacity. A major challenge with concurrent training is how to adequately combine and sequence strength exercise and aerobic exercise to avoid interference effects. This is particularly relevant for athletes. OBJECTIVE: We aimed to examine the acute effects of aerobic exercise on subsequent measures of muscle strength and power in trained male individuals. DESIGN: We performed a systematic review with meta-analysis. DATA SOURCES: Systematic literature searches in the electronic databases PubMed, Web of Science, and Google Scholar were conducted up to July 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were included that applied a within-group repeated-measures design and examined the acute effects of aerobic exercise (i.e., running, cycling exercise) on subsequent measures of lower limb muscle strength (e.g., maximal isometric force of the knee extensors) and/or proxies of lower limb muscle power (e.g., countermovement jump height) in trained individuals. RESULTS: Fifteen studies met the inclusion criteria. Aerobic exercise resulted in moderate declines in muscle strength (standardized mean difference [SMD] = 0.79; p = 0.003). Low-intensity aerobic exercise did not moderate effects on muscle strength (SMD = 0.65; p = 0.157) while moderate-to-high intensity aerobic exercise resulted in moderate declines in muscle strength (SMD = 0.65; p = 0.020). However, the difference between subgroups was not statistically significant (p = 0.979). Regarding aerobic exercise duration, large declines in muscle strength were found after > 30 min (SMD = 1.02; p = 0.049) while ≤ 30 min of aerobic exercise induced moderate declines in muscle strength (SMD = 0.59; p = 0.013). The subgroup difference was not statistically significant (p = 0.204). Cycling exercise resulted in significantly larger decrements in muscle strength (SMD = 0.79; p = 0.002) compared with running (SMD = 0.28; p = 0.035). The difference between subgroups was statistically significant (p < 0.0001). For muscle power, aerobic exercise did not result in any statistically significant changes (SMD = 0.04; p = 0.846). CONCLUSIONS: Aerobic exercise induced moderate declines in measures of muscle strength with no statistically significant effects on proxies of muscle power in trained male individuals. It appears that higher compared with lower intensity as well as longer compared with shorter aerobic exercise duration exacerbate acute declines in muscle strength. Our results provide evidence for acute interference effects when aerobic exercies is performed before strength exercises. These findings may help practitioners to better prescribe single training sessions, particularly if environmental and/or infrastructural reasons (e.g., availability of training facilities) do not allow the application of strength training before aerobic exercise.