Recommendations to Improve Quality of Probiotic Systematic Reviews With Meta-Analyses.

Importance: Systematic reviews and meta-analyses often report conflicting results when assessing evidence for probiotic efficacy, partially because of the lack of understanding of the unique features of probiotic trials. As a consequence, clinical decisions on the use of probiotics have been confusing. Objective: To provide recommendations to improve the quality and consistency of systematic reviews with meta-analyses on probiotics, so evidence-based clinical decisions can be made with more clarity. Evidence Review: For this consensus statement, an updated literature review was conducted (January 1, 2020, to June 30, 2022) to supplement a previously published 2018 literature search to identify areas where probiotic systematic reviews with meta-analyses might be improved. An expert panel of 21 scientists and physicians with experience on writing and reviewing probiotic reviews and meta-analyses was convened and used a modified Delphi method to develop recommendations for future probiotic reviews. Findings: A total of 206 systematic reviews with meta-analysis components on probiotics were screened and representative examples discussed to determine areas for improvement. The expert panel initially identified 36 items that were inconsistently reported or were considered important to consider in probiotic meta-analyses. Of these, a consensus was reached for 9 recommendations to improve the quality of future probiotic meta-analyses. Conclusions and Relevance: In this study, the expert panel reached a consensus on 9 recommendations that should promote improved reporting of probiotic systematic reviews with meta-analyses and, thereby, assist in clinical decisions regarding the use of probiotics.

Reliability and Validity of a Flume-Based Maximal Oxygen Uptake Swimming Test.

A mode-specific swimming protocol to assess maximal aerobic uptake (VO2maxsw) is vital to accurately evaluate swimming performance. A need exists for reliable and valid swimming protocols that assess VO2maxsw in a flume environment. The purpose was to assess: (a) reliability and (b) "performance" validity of a VO2maxsw flume protocol using the 457-m freestyle pool performance swim (PS) test as the criterion. Nineteen males (n = 9) and females (n = 10) (age, 28.5 ± 8.3 years.; height, 174.7 ± 8.2 cm; mass, 72.9 ± 12.5 kg; %body fat, 21.4 ± 5.9) performed two flume VO2maxsw tests (VO2maxswA and VO2maxswB) and one PS test [457 m (469.4 ± 94.7 s)]. For test-retest reliability (Trials A vs. B), moderately strong relationships were established for VO2maxsw (mL·kg-1·min-1)(r= 0.628, p = 0.002), O2pulse (mL O2·beat-1)(r = 0.502, p = 0.014), VEmax (L·min-1) (r = 0.671, p = 0.001), final test time (sec) (0.608, p = 0.004), and immediate post-test blood lactate (IPE (BLa)) (0.716, p = 0.001). For performance validity, moderately strong relationships (p < 0.05) were found between VO2maxswA (r =-0.648, p = 0.005), O2pulse (r= -0.623, p = 0.008), VEmax (r = -0.509 p = 0.037), and 457-m swim times. The swimming flume protocol examined is a reliable and valid assessment of VO2maxsw., and offers an alternative for military, open water, or those seeking complementary forms of training to improve swimming performance.

A Classification System for Defining and Estimating Dietary Intake of Live Microbes in US Adults and Children.

BACKGROUND: Consuming live microbes in foods may benefit human health. Live microbe estimates have not previously been associated with individual foods in dietary databases. OBJECTIVES: We aimed to estimate intake of live microbes in US children (aged 2-18 y) and adults (≥19 y) (n = 74,466; 51.2% female). METHODS: Using cross-sectional data from the NHANES (2001-2018), experts assigned foods an estimated level of live microbes per gram [low (Lo), <104 CFU/g; medium (Med), 104-107 CFU/g; or high (Hi), >107 CFU/g]. Probiotic dietary supplements were also assessed. The mean intake of each live microbe category and the percentages of subjects who ate from each live microbe category were determined. Nutrients from foods with live microbes were also determined using the population ratio method. Because the Hi category comprised primarily fermented dairy foods, we also looked at aggregated data for Med or Hi (MedHi), which included an expanded range of live microbe-containing foods, including fruits and vegetables. RESULTS: Our analysis showed that 52%, 20%, and 59% of children/adolescents, and 61%, 26%, and 67% of adults, consumed Med, Hi, or MedHi foods, respectively. Per capita intake of Med, Hi, and MedHi foods was 69, 16, and 85 g/d for children/adolescents, and 106, 21, and 127 g/d for adults, respectively. The proportion of subjects who consumed live microbes and overall per capita intake increased significantly over the 9 cycles/18-y study period (0.9-3.1 g/d per cycle in children across categories and 1.4 g/d per cycle in adults for the Med category). CONCLUSIONS: This study indicated that children, adolescents, and adults in the United States steadily increased their consumption of foods with live microbes between the earliest (2001-2002) and latest (2017-2018) survey cycles. Additional research is needed to determine the relations between exposure to live microbes in foods and specific health outcomes or biomarkers.

Efficacy of an Aquatic Exercise Program for 3 Cases of Rett Syndrome.

PURPOSE: To examine functional, physiological effects of participating in an aquatic exercise program by 3 girls, diagnosed with Rett syndrome (RS), to explore areas for possible new research. SUMMARY OF KEY POINTS: RS is a severe neurodevelopmental disorder, which causes multiple disabilities and serious impairments in neuromotor and cognitive abilities. Three girls (4, 6, and 7 years), diagnosed stage III RS, participated in 20 months of aquatic exercise, with individually tailored, full body exercises, progressively targeting functional, cardiorespiratory, muscle, and flexibility training. Assessments included resting and exercise heart rates, anthropometric measures, functional, clinical aspects, and psychosocial abilities. CONCLUSIONS: The participants improved functional ability, mood status, relations with family and schoolmates, joint mobility, muscle strength, and endurance during functional activities. Periodic evaluation of exercise heart rates averaged an increase in intensity of 33% above baseline, indicating cardiorespiratory stimulus. This pilot program provides clinical rationale for future studies and clinical interventions for RS children.

Effects of land vs water jump exercise: Implications for exercise design targeting bone health.

PURPOSE: To quantify ground reaction force (GRF), osteogenic index (OI), muscle activity, and blood lactate levels during continuous jumping performed in water and on land. METHODS: Thirteen post-menopausal women (59.5 ± 6.8 years) performed two bouts of jumping, on land (LND) and in water at a depth of 1 m (WEX). Each 10-minute, 40-second bout consisted of 2 consecutive sets of squat, lunge, jumping jax, countermovement, and single legged jumps as intervals: 10 seconds maximal effort and 60 seconds recovery at 50% of heart rate reserve (HRR). Pre- and post-exercise lower extremity rate of perceived exertion (RPE) was recorded, and 10-µL earlobe blood samples were collected to assess lactate concentration. During exercise, data were collected for electromyography, GRF, and heart rate. Total GRF (TGRF) and total muscular activity (TMA) during each 10 seconds of jumping were measured. OI for one bout of continued jumps was determined by averaging GRF·ln (number of jumps + 1). RESULTS: There were no differences between WEX and LND for percent HRR and RPE. TGRF, OI, TMA, and lactate concentration on LND jumps were significantly higher than WEX. CONCLUSION: At similar cardiorespiratory and RPE levels, the lower impact loading of 10 minutes 40 seconds of interval continuous jumping exercise in 1-m depth was less osteogenic than on land. However, one daily bout of water jumping, 5 days per week resulted in a similar OI as 3 days of jumping on land. WEX might substitute or provide an adjunct to LND exercise to promote bone health.

Reliability and Accuracy of a Standardized Shallow Water Running Test to Determine Cardiorespiratory Fitness.

A standardized fitness assessment is critical for the development of an individualized exercise prescription. Although the benefits of aquatic exercise have been well established, there remains the need for a standardized nonswimming protocol to accurately assess cardiorespiratory fitness (CRF) in shallow water. The present investigation was designed to assess (a) the reliability of a standardized shallow water run (SWR) test of CRF and (b) the accuracy of a standardized SWR compared with a land-based treadmill (LTM) test. Twenty-three healthy women (20 ± 3 years), with body mass index (23.5 ± 3 kg·m), performed 2 shallow water peak oxygen consumption (V[Combining Dot Above]O2peak) running tests (SWRa and SWRb), and 1 V[Combining Dot Above]O2max LTM. Intraclass correlation coefficients indicated moderately strong reliability for V[Combining Dot Above]O2peak (ml·kg·min) (r = 0.73, p < 0.01), HRpeak (b·min) (r = 0.82; p < 0.01), and O2pulse (V[Combining Dot Above]O2 [ml·kg·min]·HR [b·min]) (r = 0.77, p < 0.01). Using paired t-tests and Pearson's correlations, SWR V[Combining Dot Above]O2peak and HRpeak were significantly lower than during LTM (p ≤ 0.05) and showed moderate correlations of 0.60 and 0.58 (p < 0.001) to LTM. O2pulse was similar (p > 0.05) for the SWR and LTM tests with a moderate correlation of 0.63. A standardized SWR test as a measure of CRF is a reliable, and to some degree, valid alternative to conventional protocols and may be used by strength and conditioning professionals to measure program outcomes and monitor training progress. Furthermore, this protocol provides a water-based option for CRF assessment among healthy women and offers insight toward the development of an effective protocol that can accommodate individuals with limited mobility, or those seeking less musculoskeletal impact from traditional land-based types of training.

Safety of Bifidobacterium animalis Subsp. Lactis (B. lactis) Strain BB-12-Supplemented Yogurt in Healthy Children.

OBJECTIVES: Probiotics are live microorganisms that may provide health benefits to the individual when consumed in sufficient quantities. For studies conducted on health or disease endpoints on probiotics in the United States, the Food and Administration has required those studies to be conducted as investigational new drugs. This phase I, double-blinded, randomized, controlled safety study represents the first requirement of this pathway. The purpose of the study was to determine the safety of Bifidobacterium animalis subsp. lactis (B lactis) strain BB-12 (BB-12)-supplemented yogurt when consumed by a generally healthy group of children. The secondary aim was to assess the effect of BB-12-supplemented yogurt on the gut microbiota of the children. METHODS: Sixty children ages 1 to 5 years were randomly assigned to consume 4 ounces of either BB-12-supplemented yogurt or nonsupplemented control yogurt daily for 10 days. The primary outcome was to assess safety and tolerability, as determined by the number of reported adverse events. RESULTS: A total of 186 nonserious adverse events were reported, with no significant differences between the control and BB-12 groups. No significant changes due to probiotic treatment were observed in the gut microbiota of the study cohort. CONCLUSIONS: BB-12-supplemented yogurt is safe and well-tolerated when consumed by healthy children. The present study will form the basis for future randomized clinical trials investigating the potential effects of BB-12-supplemented yogurt in different disease states.

Aquatic High Intensity Interval Training for Cardiometabolic Health: Benefits and Training Design.

High-intensity interval training (HIIT) has emerged as an attractive alternative to traditional continuous exercise training (CT) programs for clinical and healthy populations who find that they can achieve equal or greater fitness benefits in less time. Land-based HIIT may not be an appropriate choice for some participants. Few studies have explored the acute responses and chronic adaptations of HIIT in an aquatic environment, and no study has compared the cardiometabolic responses of an aquatic-based program to a land-based HIIT program. Shallow-water aquatic exercise (AE) programs utilizing HIIT have elicited comparable and, in some cases, greater physiological responses compared with constant-intensity or continuous AE regimens. Factors that may explain why HIIT routines evoke greater cardiometabolic responses than CT protocols may be based on the types of exercises and how they are cued to effectively manipulate hydrodynamic properties for greater intensities. Favorable aquatic HIIT protocols such as the S.W.E.A.T. system may serve as a beneficial alternative to land-based HIIT programs for clinical, and athletic populations, potentially reducing the likelihood of associated musculoskeletal and orthopedic complications. Hence, the purpose of this review is to examine the role of AE as an alternative safe and effective HIIT modality.

Energy expenditure, cardiorespiratory, and perceptual responses to shallow-water aquatic exercise in young adult women.

INTRODUCTION: Aquatic exercise (AE) is a popular form of physical activity, yet few studies have assessed the individual's energy expenditure (EE) associated with a continuous bout of AE. Studies using indirect calorimetry to measure EE have reported limitations associated with test methodology and the ability to control individual's exercise intensity or tempo. PURPOSE: To evaluate EE and cardiorespiratory (CR) responses during a 40-minute shallow-water AE session in young adult women. METHODS: Twenty-one healthy women (aged 21.7 ± 3.4 years) completed an orientation practice session and a 40-minute shallow-water AE session using a traditional exercise class format and the SWEAT video-based instructional cuing program. The high-intensity interval format included the following segments: 1) warm-up (3 minutes); 2) CR segment ( 22 minutes); 3) muscular endurance segment (ME; 10 minutes); and 4) cool-down (5 minutes). Subject oxygen consumption (VO2; mL/kg/min), heart rate (HR) and OMNI overall ratings of perceived exertion (RPE-O) were assessed each minute. Average kcal/min1, metabolic equivalents (METs; 1 MET = 3.5 mL/kg/min), and total kcals per segment and for the overall session were calculated. RESULTS: The total subject EE throughout the 40-minute trial (including warm-up and cool-down segments) was 264 kcals, with an overall average of 6.3 kcals/min (5.6 METs).The average kcals/min expended throughout CR segments 2 through 6 was 8.05 (7.1 METs), with the Hoverjog segment producing the greatest average kcals/min at 8.3 (7.3 METs). The CR portion (22 min) contributed 65% of the total EE (171 kcals) of the 40-minute AE trial. For the overall AE trial, the highest and average subject VO2 achieved were 33.3 and 19.7 mL/kg/min, respectively. The average highest subject heart rate achieved was 177 beats per minute (bpm), equivalent to 90% of the participant's age-predicted HRmax. CONCLUSION: Energy expenditure during a 40-minute AE session met national recommendations for a daily moderate-to-vigorous bout of physical activity offering a viable alternative to land-based exercise. Because AE serves as a partial-weight bearing modality, future studies are needed to clarify the EE of shallow-water AE in apparently healthy and clinical populations.

Impact of the s.w.e.a.T.™ water-exercise method on activities of daily living for older women.

Older women may have chronic or age-related conditions that increase the risk of falls or that limit their ability to remain active. It is unclear if a water-based exercise program provides a safe and effective alternative to land-based exercise. The purpose of this study was to evaluate the impact of a water-based exercise program method on land-based functional activities of daily living (ADL) for women 60 years and older. This study used a quasi- experimental, nonequivalent control group design. Sixty-six women (60-89 yr of age) self- selected to a water exercise (WEX) group (n = 48) or control (C) group (n = 18). The training consisted of a 16-week (45 min·day(-1), 3 d·wk(-1)) supervised WEX program that included 10 min of warm-up and warm down/stretching and 35 min training using the S.W.E.A.T.™ method in shallow water 1.0-1.2 m, with water temperature approximately 28-29°C. Participants were required to attendat least 94% of the sessions. Assessments for participants included ADL functional field tests. In comparison to the C group, WEX participantsimproved (p < 0.05) flexibility (8%), sit- to-stand (31%), walking speed (16%) and stride length (10%), agility (20%), stair climb (22%), arm curl (39%), and static (42-48%) balance, but not dynamic balance. Results indicate that the S.W.E.A.T.™ method applied to this water exercise program provides a well-rounded, safe, and effective exercise program where older women can improve functional ADL and static balance. Key PointsOlder women with a variety of health conditions participated in 16 weeks of exercise (92% adherence) with no injuries.The S.W.E.A.T.™ method applied to this water-based program was found to significantly improve several aspects of physical function, including postural balance.This shallow water program provided a well-rounded, safe and effective activity for women to improve functional ADL on land.

Probiotics to minimize the disruption of faecal microbiota in healthy subjects undergoing antibiotic therapy.

A novel combination of culturing and DNA-based terminal restriction fragment length polymorphism (TRFLP) analysis was used to investigate the effect of probiotics on antibiotic-induced gut microbiota alterations to determine if a probiotic preparation containing bifidobacteria and lactobacilli, taken during and after antibiotic therapy, can minimize antibiotic disturbance of faecal microbiota. Healthy subjects administered amoxicillin/clavulanate were randomized and concomitantly received a placebo or probiotic mixture. The primary end point was similarity of faecal microbiota as determined by culturing and TRFLP from subjects taking probiotics compared to those taking a placebo measured by comparing data from baseline to post-treatment for each subject. TRFLP analysis revealed a high subject to subject variation in the baseline faecal microbiota. The most common antibiotic-induced disturbance was a relative increase in Clostridium, Eubacterium, Bacteroides and Enterobacteraceae. The mean similarity to the baseline increased over time in both treatment groups, although the probiotic group was less disturbed according to both TRFLP and culture data. The culture method revealed that post-antibiotic faecal microbiota in probiotic-consuming subjects were more similar to the baseline microbiota than the control group (P=0.046). Changes in Enterobactereaceae (P=0.006) and Bifidobacterium (P=0.030) counts were significantly different between the groups. Analysis of TRFLP data reinforced the trend between groups but was not statistically significant (P=0.066). This study indicates this mixture of probiotics promotes a more rapid return to pre-antibiotic baseline faecal bacterial microbiota.

Probiotics and prebiotics in dietetics practice.

Probiotics and prebiotics share a unique role in human nutrition, largely centering on manipulation of populations or activities of the bacteria that colonize our bodies. Benefits of regular consumption of probiotics or prebiotics include enhanced immune function, improved colonic integrity, decreased incidence and duration of intestinal infections, down-regulated allergic response, and improved digestion and elimination. Research has shown that probiotics and prebiotics may be useful in achieving these and other positive effects, provided that proper strain, product selection, and dosing guidelines of commercial products are followed. There is a need to consolidate the basic and applied research on probiotics and prebiotics into useful tools for food and nutrition professionals. Information on probiotic species, applications for specific strains, dosages and forms, safety, and shelf life is not sufficiently summarized to allow practical and consistent recommendations to be made by most food and nutrition professionals. In addition, prebiotic fibers-although providing nutraceutical and nutritional value-are a group of diverse carbohydrate ingredients that are poorly understood in regard to their origin, fermentation profiles, and dosages required for health effects. The science and practice-based guidelines presented here will enhance clinician and client understanding of probiotics and prebiotics, with the aim of improving appropriate recommendation and informed use of these emerging dietary ingredients and the products containing them.