Relationships between training dose and record power outputs in professional road cyclists: insights and threats to validity.

Testing short-term (4-8 weeks) correlations between training dose and performance in professional road cyclists can help improve their training and performance. Multilevel mixed-modeling was used to correlate training dose (Time, Edwards' Trimp-eTRIMP, Training Stress Score-TSS, time spent in power output zones-Z1, Z2, Z3, Polarization Index-PI) and Record Power Output (RPO) over 1 minute (RPO1), 5 (RPO5), 20 (RPO20), and 40 minutes (RPO40) across four different time periods: training dose of the previous month with RPOs of the subsequent month (Monthly-analysis); training dose of the 8 weeks preceding All, Grand tours, One-day races with RPOs of these races. In Monthly-analysis, small positive relationships between all the training dose parameters, except for PI, and RPO1, RPO5, RPO20, RPO40 were found (p ≤ 0.001). In Grand tours analysis, Z3 showed a positive association with RPO40 (r: 0.45; p = 0.007, moderate) and was positively related to RPO1 and RPO5 (r between 0.32 and 0.34; p = 0.053-0.059, moderate). PI was small positively related to RPO1 (r = 0.29, p = 0.076, small). In One-day races analysis, eTRIMP was positively related to RPO5 (r = 0.30, p = 0.035, moderate), Z1 negatively related to RPO40 (r = -0.31, p = 0.031, moderate), PI positively related to RPO5 (r = 0.24, p = 0.068, small) and Z2 was negatively related to RPO20 (r = -0.29, p = 0.051, small). A certain degree of responsiveness to training dose exists in professional road cyclists. To improve RPOs an appropriate preparation pattern seems to be increasing high intensity training for Grand Tours and fostering high intensity and overall training load (eTRIMP and TSS) in a more polarized-fashion for one-day races. Systematic and precise data collection during training and racing is highly advocated.

Peripheral muscle function during repeated changes of direction in professional soccer players.

PURPOSES: To evaluate peripheral muscle function of the knee extensors during repeated changes of direction in professional soccer players by examining differences between competitive levels, periods of the season and playing positions, and to investigate the relationships between peripheral muscle function and physical activities during matches. METHODS: Knee extensor peripheral muscle function (twitch peak torque, PT) of 593 male soccer players from 13 European professional clubs competing at 3 different levels was evaluated 4 times during the season. The main outcomes were PTmax (maximal PT, muscle contractility), MPmax (maximal metabolic power exercise intensity) and PTdec (PT decline, muscle fatigability) obtained during intermittent runs of increasing intensity with multiple changes of direction interspersed with electrically evoked contractions. Relative total and sprint distances covered during a whole match and during short intervals were quantified from a sub-sample. RESULTS: PTmax and MPmax were higher for first than for second division (p < 0.047; d = 0.15-0.23) and Under-19 players (p < 0.007; d = 0.17-0.25). MPmax was lower (p < 0.016; d = 0.23-0.32) and PTdec was higher (p < 0.004; d = 0.26-0.39) in the pre-season compared to all the other time points. MPmax was higher for fullbacks than attackers and defenders (p < 0.041; d = 0.20-0.22). PTdec was higher for defenders than fullbacks, midfielders and wings (p < 0.029; d = 0.21-0.28). PTmax was associated with whole-match relative total distance (p = 0.004; d = 0.26). PTdec was associated with whole-match relative total distance and relative short-interval sprint distance (p < 0.050; d = 0.18-0.22). CONCLUSION: The ability to sustain repeated change of direction efforts at high intensities while preserving peripheral muscle function should be considered an important determinant of soccer physical performance.

The physical profile of adult male basketball players: Differences between competitive levels and playing positions.

This study examined the physical differences in adult male basketball players of different competitive level and playing position using a large cohort. In the middle of the regular season, 129 players from four different Divisions completed a Yo-YoIR1 and, after 3-to-8 days, they performed a 6-min continuous running test (Mognoni's test), a counter-movement jump (CMJ) test and a 5-min High-intensity Intermittent running test (HIT). Magnitude-based inferences revealed that differences in HIT were very likely moderate between Division I and II and likely small between Division II and III. The differences in absolute peak power and force produced during CMJs between Division I and II and between Division II and III were possibly small. Differences in Yo-YoIR1 and Mognoni's test were very likely-to-almost certain moderate/large between Division III and VI. We observed possibly-to-likely small differences in HIT and Mognoni's test between guards and forwards and almost certainly moderate differences in absolute peak power and force during CMJs between guards and centres. The ability to sustain high-intensity intermittent efforts (i.e. HIT) and strength/power characteristics can differentiate between competitive level, while strength/power characteristics discriminate guards from forwards/centres. These findings inform practitioners on the development of identification programs and training activities in basketball.

Assessment of the Quantitative Value Usefulness of the Aldosterone-Renin Ratio (ARR) for Primary Aldosteronism (AQUARR) Study.

Current guidelines recommend use of the aldosterone-renin ratio (ARR) for the case detection of primary aldosteronism (PA), the most common cause of secondary hypertension, in selected hypertensive patients. "Confirmatory" tests are then recommended in patients who tested positive at the ARR to exclude from further diagnostic work-up false positive results. Based on our experience we hypothesized that the ARR carries quantitative information, which can avoid the need of confirmatory tests. We herein describe a study protocol to identify the ARR cut-off value with a high specificity for the exclusion of aldosterone-producing adenoma (APA) based on analysis of two large prospectively collected datasets of patients in which a conclusive diagnosis of APA was made by the four corners criteria. This will also serve to investigate the diagnostic gain provided over this ARR cut-off value by one confirmatory test, the captopril challenge test. Hence, with this protocol we expect to identify an ARR cut-off value that might prevent further testing in patients with either a low or a high probability of APA. This could translate in a higher diagnostic accuracy and, by preventing unnecessary invasive testing, into a substantial saving of money, time, and resources.

Mineralocorticoid Receptor Antagonists Therapy in Resistant Hypertension: Time to Implement Guidelines!

Despite the availability of anti-hypertensive medications with increasing efficacy up to 50% of hypertensive patients have blood pressure levels (BP) not at the goals set by international societies. Some of these patients are either not optimally treated or are non-adherent to the prescribed drugs. However, a proportion, despite adequate treatment, have resistant hypertension (RH), which represents an important problem in that it is associated to an excess risk of cardiovascular events. Notwithstanding a complex pathogenesis, an abundance of data suggests a key contribution for the mineralocorticoid receptor (MR) in RH, thus fostering a potential role for its antagonists in RH. Based on these premises randomized clinical trials aimed at testing the efficacy of MR antagonists (MRAs) in RH patients have been completed. Overall, they demonstrated the efficacy of MRAs in reducing BP and surrogate markers of target organ damage, such as microalbuminuria, either compared to placebo or to other drugs. In summary, owing to the key role of the MR in the pathogenesis of RH and on the proven efficacy of MRAs we advocate their inclusion as an essential component of therapy in patients with presumed RH. Conversely, we propose that RH should be diagnosed only in patients whose BP values show to be resistant to an up-titrated dose of these drugs.

Bartter/Gitelman syndromes as a model to study systemic oxidative stress in humans.

Reactive oxygen species (ROS) are intermediates in reduction-oxidation reactions that begin with the addition of one electron to molecular oxygen, generating the primary ROS superoxide, which in turn interacts with other molecules to produce secondary ROS, such as hydrogen peroxide, hydroxyl radical, and peroxynitrite. ROS are continuously produced during metabolic processes and are deemed to play an important role in cardiovascular diseases, namely, myocardial hypertrophy and fibrosis and atherosclerosis, via oxidative damage of lipids, proteins, and deoxyribonucleic acid. Angiotensin II (Ang II) is a potent vasoactive agent that also exerts mitogenic, proinflammatory, and profibrotic effects through several signaling pathways, in part involving ROS, particularly superoxide and hydrogen peroxide. Moreover, Ang II stimulates NADPH oxidases, leading to higher ROS generation and oxidative stress. Bartter/Gitelman syndrome patients, despite elevated plasma renin activity, Ang II, and aldosterone levels, exhibit reduced peripheral resistance, normal/low blood pressure, and blunted pressor effect of vasoconstrictors. In addition, notwithstanding the activation of the renin-angiotensin system and the increased plasma levels of Ang II, these patients display decreased production of ROS, reduced oxidative stress, and increased antioxidant defenses. In fact, Bartter/Gitelman syndrome patients are characterized by reduced levels of p22(phox) gene expression and undetectable plasma peroxynitrite levels, while showing increased plasma antioxidant power and expression of antioxidant enzymes, such as heme oxygenase-1. In conclusion, multifarious data suggest that Bartter and Gitelman syndrome patients are a model of low oxidative stress and high antioxidant defenses. The contribution offered by the study of these syndromes in elucidating the molecular mechanisms underlying this favorable status could offer chances for new therapeutic targets in disease characterized by high levels of reactive oxygen species.

Galectin-3 predicts long-term cardiovascular death in high-risk patients with coronary artery disease.

OBJECTIVE: Galectin-3 (Gal-3) can affect atherogenesis by multiple mechanisms, but it remains scarcely known whether plasma Gal-3 levels predict cardiovascular events in patients with coronary artery disease. Therefore, we investigated if Gal-3 predicts cardiovascular death in patients with coronary artery disease of the Genetic and ENvironmental factors In Coronary Artery disease study. APPROACH AND RESULTS: In a prospective cohort study, we measured the plasma levels of Gal-3 in 1013 randomly selected patients who underwent coronary angiography and long-term follow-up to assess incident cardiovascular events. The primary end points were (1) cardiovascular death and (2) a composite of cardiovascular death, acute coronary syndrome, and stroke. Secondary end points entailed (1) acute myocardial infarction, (2) stroke, and (3) a composite fatal ischemic event including fatal myocardial infarction and stroke. The effect of Gal-3 on prognosis was assessed using Kaplan-Meier analysis and multivariate Cox's regression. During long-term follow-up (median, 7.2 years), 115 cardiovascular deaths occurred (15.2%), more commonly in the high Gal-3 tertile (25.2%) than in the intermediate and the low tertiles (13.6% versus 7.5%, respectively; P<0.001). The adverse prognostic effect of high Gal-3 was confirmed in subgroup analysis of the patients with angiographically documented coronary artery disease and also of those with a normal left ventricular ejection fraction. At multivariate analysis, Gal-3 was a predictor of cardiovascular mortality (hazard ratio, 1.79; 95% confidence interval, 1.10-2.93; P=0.020) along with age, left ventricular ejection fraction, and coronary atherosclerotic burden. CONCLUSIONS: In high cardiovascular risk patients referred for coronary angiography Gal-3 is a strong independent predictor of cardiovascular death.