Physical activity and antibody persistence 6 months after the second dose of CoronaVac in immunocompromised patients.

This prospective cohort study within an open-label, single-arm, phase 4 vaccination trial (clinicaltrials.gov #NCT04754698) aimed to investigate the association between physical activity and persistent anti-SARS-CoV-2 antibodies 6 months after two-dose schedule of CoronaVac in autoimmune rheumatic diseases (ARD) patients (n = 748). Persistent immunogenicity 6 months after the full-course vaccination was assessed using seroconversion rates of total anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG (GMT), and frequency of positive neutralizing antibodies (NAb). Physical activity was assessed trough questionnaire. Adjusted point estimates from logistic regression models indicated that physically active patients had greater odds of seroconversion rates (OR: 1.5 [95%CI: 1.1 to 2.1]) and NAb positivity (OR: 1.5 [95%CI: 1.0 to 2.1]), and approximately 43% greater GMT (42.8% [95%CI: 11.9 to 82.2]) than inactive ones. In conclusion, among immunocompromised patients, being physically active was associated with an increment in antibody persistence through 6 months after a full-course of an inactivated SARS-CoV-2 vaccine.

Increased sympathetic and haemodynamic responses to exercise and muscle metaboreflex activation in post-menopausal women with rheumatoid arthritis.

KEY POINTS: Rheumatoid arthritis (RA) patients present exacerbated blood pressure responses to exercise, but little is known regarding the underlying mechanisms involved.  This study assessed autonomic and haemodynamic responses to exercise and to the isolated activation of muscle metaboreflex in post-menopausal women with RA.  Participants with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These responses were associated with multiple pro- and anti-inflammatory cytokines and with pain.  The results of the present study support the suggestion that an abnormal reflex control of circulation is an important mechanism underlying the exacerbated cardiovascular response to exercise and increased cardiovascular risk in RA. ABSTRACT: Studies have reported abnormal cardiovascular responses to exercise in rheumatoid arthritis (RA) patients, but little is known regarding the underlying mechanisms involved. This study assessed haemodynamic and sympathetic responses to exercise and to the isolated activation of muscle metaboreflex in women diagnosed with RA. Thirty-three post-menopausal women diagnosed with RA and 10 matched controls (CON) participated in this study. Mean arterial pressure (MAP), heart rate (HR) and muscle sympathetic nerve activity (MSNA frequency and incidence) were measured during a protocol of isometric knee extension exercise (3 min, 30% of maximal voluntary contraction), followed by post-exercise ischaemia (PEI). Participants with RA showed greater increases in MAP and MSNA during exercise and PEI than CON (ΔMAPexercise  = 16 ± 11 vs. 9 ± 6 mmHg, P = 0.03; ΔMAPPEI  = 15 ± 10 vs. 5 ± 5 mmHg, P = 0.001; ΔMSNAexercise  = 17 ± 14 vs. 7 ± 9 bursts min-1 , P = 0.04; ΔMSNAPEI  = 14 ± 10 vs. 6 ± 4 bursts min-1 , P = 0.04). Autonomic responses to exercise showed significant (P < 0.05) association with pro- (i.e. IFN-γ, IL-8, MCP-1 and TNFα) and anti-inflammatory (i.e. IL-1ra and IL-10) cytokines and with pain. In conclusion, post-menopausal women with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These findings provide mechanistic insights that may explain the abnormal cardiovascular responses to exercise in RA.

High SARS-CoV-2 infection rate after resuming professional football in São Paulo, Brazil.

OBJECTIVE: To examine the SARS-CoV-2 infection rate in a cohort of 6500 professional athletes and staff during the 2020 football (soccer) season in São Paulo, Brazil. METHODS: This retrospective cohort study included 4269 players (87% male, age: 21.7±4.2 years) and 2231 staff (87% male, age: 42.6±11.9 years) from 122 teams (women: n=16) involved in eight leagues (women: n=2), which took place in São Paulo, Brazil. Between 4 July 2020 and 21 December 2020, swab samples were collected weekly (n=29 507) and tested for SARS-Cov-2 via reverse transcription-PCR by an accredited laboratory commissioned by the São Paulo Football Federation. We contacted the medical staff of each team with positive cases to collect information on disease severity. RESULTS: Among 662 PCR-confirmed cases, 501 were athletes and 161 were staff. The new infection rate was 11.7% and 7.2% for athletes and staff, respectively. Athletes were more susceptible to infection than staff (OR: 1.71, 95% CI: 1.42, 2.06, p<0.001), although with lower chance for moderate to severe disease (OR: 0.06, 95% CI: 0.01, 0.54, p=0.012). Six teams had ≥20 individuals testing positive for SARS-CoV-2, whereas 19 teams had ≥10 confirmed cases. Twenty-five mass outbreaks were identified (≥5 infections within a team in a 2-week period). The prevalence of SARS-CoV-2 infections was similar in athletes and staff as the general population in São Paulo. CONCLUSION: Despite weekly testing and other preventive measures, we found a high SARS-CoV-2 infection rate in athletes and staff after resuming football, which coincides with the high prevalence of infection in the community during the same period. These data may assist policy-makers and sports federations for determining if and when it is safe to resume competitions.

Immunological Implications of Physical Inactivity among Older Adults during the COVID-19 Pandemic.

Social distancing has been adopted worldwide to control severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Social isolation is likely to lead to a decline in physical activity, which could result in immune system dysfunction, thereby increasing infection susceptibility and exacerbating the pathophysiology of conditions that are common among older adults, including cardiovascular disease, cancer, and inflammatory disorders. Older adults and people living with these comorbidities are at a greater risk for complications during coronavirus disease 2019 (COVID-19). In this review, we discuss the negative impact of physical inactivity on immune function and showcase evidence that regular physical activity may be an effective strategy to counter some of the deleterious effects of social isolation. Furthermore, we briefly highlight key research questions in exercise immunology, with a focus on older adults in the context of COVID-19. Although it is worth emphasizing that there is no direct evidence that physical activity can prevent or treat -COVID-19, promoting an active lifestyle is a key intervention to counteract the effects of social isolation, especially in older adults and other at-risk individuals, such as those living with chronic diseases associated with ageing and lifestyle.

Chronotropic Incompetence and Reduced Heart Rate Recovery in Rheumatoid Arthritis.

BACKGROUND/OBJECTIVE: Recent studies have indicated that cardiac autonomic dysfunction is an early sign of cardiovascular impairment in rheumatoid arthritis (RA). Previous studies have mainly focused on resting assessments; however, analysis of heart rate (HR) responses to exercise might provide additional information on cardiac autonomic dysfunction in this disease. Thus, we aimed to assess the HR responses during and after a maximal graded exercise test in patients with RA and healthy controls (CONs). METHODS: This was a cross-sectional study in which 27 female RA patients and 14 female CONs frequency matched by physical activity, age, and body mass index were compared for HR responses during and after a maximal graded exercise test. RESULTS: Rheumatoid arthritis patients showed reduced chronotropic response (94.3% ± 16.3% vs. 106.1% ± 10.3%, p = 0.02) and lower HR recovery (HRR) at 30 seconds (8.6 ± 6.7 vs. 13.4 ± 5.2 beats/min [bpm], p = 0.02), 60 seconds (16.5 ± 7.8 vs. 24.0 ± 9.9 bpm, p = 0.01), 120 seconds (32.6 ± 9.9 vs. 40.7 ± 12.3 bpm, p = 0.03), and 180 seconds (46.5 ± 12.6 vs. 55.5 ± 13.4 bpm, p = 0.05) post-maximal exercise test when compared with CONs. Moreover, the prevalence of chronotropic incompetence (i.e., failure to reach 80% of the HR-predicted response) and abnormal HRR (i.e., HRR ≤12 bpm) were, respectively, 22.2% and 37.1% in RA patients. CONCLUSIONS: Patients with RA showed reduced chronotropic response to exercise and slower postexercise HRR. These abnormal autonomic responses to exercise indicate the presence of cardiac autonomic dysfunction and increased cardiovascular risk in this population.

The design and rationale of an interdisciplinary, non-prescriptive, and Health at Every Size®-based clinical trial: The "Health and Wellness in Obesity" study.

BACKGROUND: This manuscript describes the design and rationale of a clinical trial that aims to investigate the multiple physiological, attitudinal, nutritional, and behavioral effects of a new interdisciplinary intervention based on the Health at Every Size® (HAES®) approach in obese women. METHODS: This will be a prospective, 7-month, randomized (2:1), mixed-method clinical trial. Obese women will be recruited and randomly allocated into two groups. The intervention group (I-HAES®; proposed n = 40) will undertake a novel HAES®-based intervention. Participants will take part in an exercise program, nutrition counseling sessions, and philosophical workshops, all aligned with the principles of the HAES® approach. The control group (CTRL; proposed n = 20) will participate in a program using a traditional HAES®-based group format, characterized by bimonthly lectures about the same topics offered to the experimental group, encouraging the adoption of a healthy lifestyle. The following multiple quantitative outcomes will be assessed pre and post intervention: health-related quality of life, cardiovascular risk factors, anthropometric assessments, physical activity level, physical capacity and function, and psychological and behavioral assessments. Qualitative analysis will be used to evaluate the experiences of the participants throughout the intervention, as assessed by focus groups and semi-structured interviews. CONCLUSIONS: The interdisciplinary research team leading this study has varied and complementary expertise. The knowledge arising from this study will help to guide new interdisciplinary interventions with the potential to holistically improve the health of obese individuals. This trial is registered at Clinicaltrials.gov (NCT02102061).

Increased Prolonged Sitting in Patients with Rheumatoid Arthritis during the COVID-19 Pandemic: A Within-Subjects, Accelerometer-Based Study.

BACKGROUND: Social distancing measures designed to contain the COVID-19 pandemic can restrict physical activity, a particular concern for high-risk patient groups. We assessed rheumatoid arthritis patients' physical activity and sedentary behavior level, pain, fatigue, and health-related quality of life prior to and during the social distancing measures implemented in Sao Paulo, Brazil. METHODS: Post-menopausal females diagnosed with rheumatoid arthritis were assessed before (from March 2018 to March 2020) and during (from 24 May to 7 July 2020) social distancing measures to contain COVID-19 pandemic, using a within-subjects, repeated-measure design. Physical activity and sedentary behavior were assessed using accelerometry (ActivPAL micro). Pain, fatigue, and health-related quality of life were assessed by questionnaires. RESULTS: Mean age was 60.9 years and BMI was 29.5 Kg/m2. Disease activity ranged from remission to moderate activity. During social distancing, there were reductions in light-intensity activity (13.0% [-0.2 h/day, 95% CI: -0.4 to -0.04; p = 0.016]) and moderate-to-vigorous physical activity (38.8% [-4.5 min/day, 95% CI: -8.1 to -0.9; p = 0.015]), but not in standing time and sedentary time. However, time spent in prolonged bouts of sitting ≥30 min increased by 34% (1.0 h/day, 95% CI: 0.3 to 1.7; p = 0.006) and ≥60 min increased by 85% (1.0 h/day, 95% CI: 0.5 to 1.6). There were no changes in pain, fatigue, and health-related quality of life (all p > 0.050). CONCLUSIONS: Imposed social distancing measures to contain the COVID-19 outbreak were associated with decreased physical activity and increased prolonged sedentary behavior, but did not change clinical symptoms sitting among patients with rheumatoid arthritis.

The utility of cardiopulmonary exercise testing in athletes and physically active individuals with or without persistent symptoms after COVID-19.

Introduction: Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. Methods: Participants' assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis. Results: A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO2 slope; p<0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p=0.007), PETCO2 max (p=0.009), and dysfunctional breathing (p=0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing (p=0.008). Discussion: A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.

Health at Every Size®-Based Interventions May Improve Cardiometabolic Risk and Quality of Life Even in the Absence of Weight Loss: An Ancillary, Exploratory Analysis of the Health and Wellness in Obesity Study.

We examined whether weight loss following HAES®-based interventions associates with changes in cardiometabolic risk factors and quality of life of women with obesity. This was an exploratory, ancillary analysis of a 7-month, mixed-method, randomized controlled trial. Fifty-five women (age: 33.0 ± 7.2; BMI: 30-39.9 kg/m2) were included in this study. Body weight, cardiovascular risk factors, clustered cardiometabolic risk, and quality of life were assessed before (Pre) and after HAES®-based interventions (Post). Delta scores (Post-Pre) were calculated for each outcome and used in linear regression models. After adjusting by potential confounders, weight loss was associated with improvements in waist circumference (ß = 0.83, p <0.001), fasting glycemia (ß = 0.45, p = 0.036), total cholesterol (ß = 1.48, p = 0.024), LDL (ß = 1.33, p = 0.012), clustered cardiometabolic risk (ß = 0.18, p = 0.006), and quality of life (ß = -1.05, p = 0.007). All participants but one who reduced body weight (n = 11) improved clustered cardiometabolic risk and quality of life. Of relevance, 34% and 73% of the participants who maintained or gained weight improved clustered cardiometabolic risk and quality of life, respectively, although the magnitude of improvements was lower than that among those who lose weight. Improvements in cardiovascular risk factors and quality of life following HAES®-based interventions associated with weight loss as expected. However, most of the participants who maintained or even gained weight experienced benefits to some extent. This suggests that weight-neutral, lifestyle-modification interventions may improve wellness and health-related outcomes, even in the absence of weight loss.

Gaps on rheumatologists' knowledge of physical activity.

To assess the rheumatologists' knowledge and willingness to prescribe physical activity, we conducted a nationwide survey. All adult and paediatric rheumatologist members of the Brazilian Rheumatology Society were invited to fulfil a questionnaire on their knowledge and willingness to promote physical activity. Four hundred twenty-eight rheumatologists participated in the survey, representing approximately 25% of the society's members. Forty-five percent of the rheumatologists reported having had training to prescribe physical activity, and 68% believe that physical activity is a part of patients' treatment. Most reported assessing physical activity levels (86%) and recommending physical activity (98%) always or most of the time. However, 48% do not know the minimum physical activity recommendations for health maintenance, nor do they know how much vigorous activity should be done in replacement of moderate activity. In addition, only 20% are aware of physical activity recommendation for paediatric patients, whereas 31% know that very light-intensity physical activity promotes health-related beneficial effects. Year of graduation, having been trained on physical activity prescription, and regularly recommending physical activity to patients did not associate with the overall score of correct answers (OR: 1.00 [0.99, 1.02], p = 0.391; OR: 0.99 [0.69, 1.44], p = 983; OR: 0.90 [0.61, 1.32], p = 0.576; respectively). Rheumatologists are highly willing to promote physical activity, but major gaps in their knowledge were identified. Given the widespread recognition of physical activity as a key element on the management of rheumatic patients, these data hint to the need of incorporating physical activity in the rheumatologist' training. Key Points • This survey showed that rheumatologists are highly prone to promote physical activity. • However, rheumatologists have major gaps in knowledge of physical activity. • Adding physical activity to rheumatologist's training programs is key to improve physical activity promotion.

"Can A Ballerina Eat Ice Cream?": A Mixed-Method Study on Eating Attitudes and Body Image in Female Ballet Dancers.

Aim: We aimed to explore how a group of classical ballet dancers perceived their eating attitudes and their bodies, with special attention to the potential presence of eating disorders (EDs) symptoms and body image (dis)satisfaction. Methods: A cross-sectional, mixed-method study was conducted on fourteen trained classical ballet dancers (18-30 years old). Their experiences, perceptions, and feelings regarding eating attitudes and body image concerning classical ballet were acquired through qualitative focus groups. The presence of EDs symptoms and perception and (dis)satisfaction with body image was analyzed quantitatively through self-report questionnaires. Results: Participants reported concerning eating attitudes during the focus groups, such as the regular practice of several restrictive popular diets, constant restriction of foods considered "heavy" or "fatty," meal skipping and ignoring signs of hunger, presence of overeating episodes due to stress and anxiety, feeling guilty about breaking their usual diet, classifying foods as "good" and "bad" or "lean" and "fat," and excluding some of those foods from their usual diets. These reports were partially reflected in the questionnaires, with 50% of the ballerinas showing bulimic symptoms indicative of an unusual eating pattern (only two of them with a significant risk index), 7.1% showing symptoms of moderate binge eating, and 14.3% symptoms of EDs in general. Additionally, when considering their bodies in the context of everyday life, participants were satisfied; however, in the "classical ballet" context, they reported feeling dissatisfied with their shape. These findings were in line with results from the Stunkard's Scale, which revealed that 50% of the sample was dissatisfied with their current body shape and 57.1% indicated that their desired body shape was a leaner figure than one they considered healthy. Conclusions: The constant practice of restrictive diets and other weight-loss strategies to achieve a leaner body were associated with symptoms of EDs and body dissatisfaction in this sample. Importantly, the questionnaires used seemed to underestimate the presence of a disordered eating pattern reported by the participants during focus groups. These data could help to inform psychological and nutritional strategies aimed at improving performance, physical and psychological well-being, and quality of life of ballet dancers.

Influence of Body Mass Index on Eating Habits and Food Choice Determinants Among Brazilian Women During the COVID-19 Pandemic.

Changes in emotional state due to the COVID-19 pandemic may potentially modify eating habits, which may differ as a function of body mass index (BMI). Using a self-reported, questionnaire-based survey we evaluated Brazilian women during the pandemic for: (i) the influence of BMI on changes in eating habits, food choice determinants, and psychological symptoms; (ii) associations between eating habits, food choice determinants and psychological symptoms. General characteristics, anthropometric data, eating habits before and during the pandemic, food choice determinants and psychological symptoms during the pandemic were collected between June and September, 2020. Participants (n = 1,183) were normal weight (60.4%), overweight (26.2%) and obese (13.4%). A higher frequency of "cooking" (72.3-77.6%, p = 0.004) and "use of delivery service" (29.8-48.8%, p < 0.001) was reported during, in comparison to before the pandemic. Additionally, a higher prevalence of "snacking" (57.1-63.8%, p = 0.005) and "eating at table" (78.5-82.7%, p < 0.001) was reported during the pandemic, while the number of participants reporting "dieting" decreased (28.7-20.4%, p < 0.001). "Health", "natural concerns" and "need and hunger" were less important determinants for participants with overweight/obesity compared to normal weight. Regression analysis indicated that (i) "health", "natural concerns" and "affect regulation"; (ii) "health", "pleasure", "convenience", and "natural concerns"; and (iii) "visual appeal" and "pleasure" were the food choice determinants more associated with eating habits among women with normal weight, overweight, and obesity, respectively. In conclusion, eating habits were modified during the pandemic despite BMI, whereas food choice determinants differed between overweight/obesity and normal weight women.

Poor Eating Habits and Selected Determinants of Food Choice Were Associated With Ultraprocessed Food Consumption in Brazilian Women During the COVID-19 Pandemic.

Background: The aim of this study was to investigate possible associations between food consumption and eating habits and food choice determinants in women during COVID-19 pandemic. Methods: This is a cross-sectional survey conducted in Brazil between June and September, 2020, during which time social distancing measures were in place. Results: Participants (n = 629) were aged 34.0 years and mostly within normal weight according to BMI (60.4%). "Snacking" and "liking" associated with increased energy (ß = 164.27 and ß = 110.24) and carbohydrate intake (ß = 1.97 and ß = 1.80), and with reduced protein intake (ß = -1.54 and ß = -1.18). In contrast, "dieting" and "weight control" associated with reduced energy (ß = -162.57 and ß = -111.49) and carbohydrate intake (ß = -2.78 and ß = -2.07), and with increased protein intake (ß = 3.78 and ß = 1.65). "Dieting" (ß = 7.27), "need and hunger" (ß = 3.34), and "health" (ß = 4.94) associated with an increased consumption of unprocessed and minimally processed foods, whereas "replacing main meals with snacks" (ß = -8.98), "snacking" (ß = -6.92) and binge eating symptoms (ß = -0.34) associated with reduced consumption of foods within this processing level. In contrast, "use of delivery services" (ß = 3.39), "replacing main meals with snacks" (ß = 5.49), "visual appeal" (ß = 2.17), "social norms" (ß = 2.19) and "affect regulation" (ß = 2.01) associated with increased ultraprocessed food consumption. Overall, associations were more frequent and pronounced when analyzing food consumption by processing level rather than by macronutrient intake. Conclusion: Some eating habits and food choice determinants ("snacking," "replacing meals with snacks," "use of delivery services") observed during the COVID-19 pandemic were associated with an unhealthy diet (high energy and carbohydrate consumption, increased ultraprocessed food consumption and reduced unprocessed/minimally processed foods consumption) in Brazilian women.

Changes in Eating Habits and Sedentary Behavior During the COVID-19 Pandemic in Adolescents With Chronic Conditions.

Introduction: Among healthy adolescents, school closures and home confinement were shown to increase unhealthier eating habits and sedentary behavior. It remains unknown to which extent the pandemic has impacted the lifestyle of adolescents with chronic conditions. Thus, the aim of this study is to report on the impact of the COVID-19 outbreak on eating habits and sedentary behavior among adolescents with multiple chronic conditions (n = 347) from a tertiary, referral hospital vs. healthy peers. Methods: This observational study was conducted in São Paulo (Brazil) between July and October 2020, period in which a set of social distancing measures to contain the pandemic. Results: The main findings of this study were that adolescents with chronic conditions and health peers showed important changes in eating habits (e.g., more often cooking and eating in front of television than before quarantine). Also, 86.8% of adolescents with chronic conditions and 91.6% of healthy adolescents reported increasing screen time during pandemic. No major differences were observed between patients and controls. Conclusions: Adolescents with chronic conditions and healthy peers exposed to pandemic showed substantial changes in lifestyle, stressing the need for specific care to mitigate poor eating habits and excessive sedentary behavior for patients and healthy adolescents.

Creatine Supplementation (3 g/d) and Bone Health in Older Women: A 2-Year, Randomized, Placebo-Controlled Trial.

BACKGROUND: Creatine supplementation could be a nonexpensive, safe, and effective dietary intervention to counteract bone loss. The aim of this study was to investigate whether long-term creatine supplementation can improve bone health in older, postmenopausal women. METHODS: A double-blind, placebo-controlled, parallel-group, randomized trial was conducted between November 2011 and December 2017 in Sao Paulo, Brazil. Two hundred postmenopausal women with osteopenia were randomly allocated to receive either creatine monohydrate (3 g/d) or placebo for 2 years. At baseline and after 12 and 24 months, we assessed areal bone mineral density (aBMD; primary outcome), lean and fat mass (through dual X-ray absorptiometry), volumetric BMD and bone microarchitecture parameters, biochemical bone markers, physical function and strength, and the number of falls and fractures. Possible adverse effects were self-reported. RESULTS: Lumbar spine (p < .001), femoral neck (p < .001), and total femur aBMD (p = .032) decreased across time; however, no interaction effect was observed (all p > .050). Bone markers, microarchitecture parameters, and the number of falls/fractures were not changed with creatine (all p > .050). Lean mass and appendicular skeletal muscle mass increased throughout the intervention (p < .001), with no additive effect of creatine (p = .731 and p = .397, respectively). Creatine did not affect health-related laboratory parameters. CONCLUSION: Creatine supplementation more than 2 years did not improve bone health in older, postmenopausal women with osteopenia, nor did it affect lean mass or muscle function in this population. This refutes the long-lasting notion that this dietary supplement alone has osteogenic or anabolic properties in the long run. CLINICAL TRIAL REGISTRY: Clinicaltrials.gov: NCT: 01472393.

"Despite being an athlete, I am also a human-being": Male elite gymnasts' reflections on food and body image.

Our aim was to investigate the prevalence of symptoms related to eating disorders, disordered eating and body image perception, and attitudes toward eating in a group of elite male artistic gymnastics. Seventeen athletes took part in this quali-quantitative, cross-sectional study. Presence of eating disorders symptoms, and body image perception and satisfaction were assessed using validated questionnaires. Focus groups were held to discuss their attitudes toward eating and body image perception in more detail. Little to no evidence of symptoms consistent with eating disorders was observed, and this was supported by the qualitative data. However, some concerning practices and attitudes were described. Negative emotional eating cycles appeared prevalent (e.g. feelings of anger, stress and anxiety creating a desire to eat "junk foods", followed by guilt and regret). Body image perception and attitudes toward body weight's influence on performance varied widely. Some athletes expressed a desire to lose weight and believed that this would positively impact their performance, while others believed weight to be irrelevant and focused on feeling strong and vital. Athletes believed their female counterparts experienced far greater pressure to maintain low body weight and described some very concerning practices. We conclude that eating disorders and disordered eating did not appear to be prevalent among these elite male artistic gymnastics. However, some concerning attitudes and practices were observed and should be addressed with nutritional support programmes encompassing psychological and behavioural aspects of eating. These programmes should be extended to support staff and significant others, in addition to athletes.

A randomized controlled trial to reduce sedentary time in rheumatoid arthritis: protocol and rationale of the Take a STAND for Health study.

BACKGROUND: Patients with rheumatoid arthritis spend most of their daily hours in sedentary behavior (sitting), a predisposing factor to poor health-related outcomes and all-cause mortality. Interventions focused on reducing sedentary time could be of novel therapeutic relevance. However, studies addressing this topic remain scarce. We aim to investigate the feasibility and efficacy of a newly developed intervention focused on reducing sedentary time, and potential clinical, physiological, metabolic and molecular effects in rheumatoid arthritis. METHODS: The Take a STAND for Health study is a 4-month, parallel-group, randomized controlled trial, in which postmenopausal patients with rheumatoid arthritis will set individually tailored, progressive goals to replace their sedentary time with standing and light-intensity activities. Patients will be recruited from the Clinical Hospital (School of Medicine, University of Sao Paulo) and will be assessed at baseline and after a 4-month follow up. Outcomes will include objectively measured sedentary behavior (primary outcome) and physical activity levels, clinical parameters, anthropometric parameters and body composition; aerobic fitness, muscle function, blood pressure, cardiovascular autonomic function, vascular function and structure, health-related quality of life, and food intake. Blood and muscle samples will be collected for assessing potential mechanisms, through targeted and non-targeted approaches. DISCUSSION: Findings will be of scientific and clinical relevance with the potential to inform new prescriptions focused on reducing sedentary behavior, a modifiable risk factor that thus far has been overlooked in patients with rheumatoid arthritis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03186924. Registered on 14 June 2017.

Ultra-processed food consumption associates with higher cardiovascular risk in rheumatoid arthritis.

To investigate the association between food consumption stratified by processing level and cardiovascular risk factors in rheumatoid arthritis. In this cross-sectional study, 56 patients (age: 62.5 ± 7.9 years, BMI: 28.4 ± 5.1 kg/m2) had food consumption evaluated according to the processing level (e.g., unprocessed or minimally processed foods, processed foods, and ultra-processed foods) and associated with cardiovascular risk factors. The most prevalent food processing level was unprocessed or minimally processed foods (42.6 ± 12.6% of total energy intake [TEI]), followed by processed (24.2 ± 11.9%TEI), ultra-processed (18.1 ± 11.8%TEI), and culinary ingredients (15.1 ± 6.4%TEI). Adjusted regression models showed that higher consumption of ultra-processed foods was positively associated with Framingham risk score (ß = 0.06, CI: 95% 0.001, 0.11, p = 0.045) and glycated hemoglobin (ß = 0.04, CI: 95% 0.01, 0.08, p = 0.021). In contrast, higher consumption of unprocessed or minimally processed foods was associated with lower 10-year risk of developing cardiovascular diseases (ß = -0.05, CI: 95% - 0.09, -0.003, p = 0.021) and LDL (ß = -1.09, CI: 95% - 1.94, -0.24, p = 0.013). Patients with rheumatoid arthritis consuming more ultra-processed foods showed worse metabolic profile, whereas those consuming more unprocessed or minimally processed foods had lower cardiovascular risks. A food pattern characterized by a high ultra-processed food consumption appears to emerge as a novel, modifiable risk factor for cardiovascular diseases in rheumatoid arthritis. Key-Points • Higher ultra-processed food consumption was associated with worse metabolic profile and increased cardiovascular risk, whereas higher unprocessed or minimally processed food consumption was associated with lower 10-year risk of developing cardiovascular diseases. • A food pattern characterized by a high ultra-processed food consumption appears to emerge as a novel, modifiable risk factor for cardiovascular diseases in rheumatoid arthritis.

Impact of a Real-World Lifestyle Intervention in an Entire Latin American City with More Than 50,000 People.

OBJECTIVE: The aim of this study was to assess the impact of a real-world citywide intervention on physical activity and eating habits in a Latin American city with more than 50,000 inhabitants. METHODS: This was a plausibility assessment of a real-life intervention. A probabilistic sample (n = 1,424) from Jaguariuna (Sao Paulo, Brazil) was assessed before and after a 7-month intervention aimed at increasing physical activity levels and improving eating habits at a city level. Primary outcomes were physical activity, sedentary behavior, and eating habits assessed by a valid telephone inquiry. The secondary outcome was body weight. RESULTS: The proportion of individuals achieving the recommended intake of fruits and vegetables increased (18%; 95% CI: 2% to 36%; P = 0.031), whereas the number of individuals consuming soft drinks and exchanging main meals for snacks or junk food decreased (-35%; 95% CI: -45% to -22%; P < 0.001 and -16%; 95% CI: -29% to -1%; P = 0.037). The number of active individuals increased during leisure time (37%; 95% CI: 19% to 58%; P < 0.001), at work (17%; 95% CI: 4% to 32%; P = 0.009), and in the household (14%; 95% CI: 0% to 31%; P = 0.047). Body weight decreased among individuals with overweight or obesity. CONCLUSIONS: This intervention promoted pronounced lifestyle changes (i.e., increased physical activity and healthier food choices) in the entire city, providing scientific-based evidence on which to build effective public health policies in Latin America.

"I put it in my head that the supplement would help me": Open-placebo improves exercise performance in female cyclists.

This study investigated the effect of open-placebo on cycling time-trial (TT) performance. Twenty-eight trained female cyclists completed a 1-km cycling TT following a control session or an open-placebo intervention. The intervention consisted of an individual presentation, provided by a medic, in which the concept of open-placebo was explained to the participant, before she ingested two red and white capsules containing flour; 15 min later, they performed the TT. In the control session, the participant sat quietly for 20 min. Heart rate and ratings of perceived exertion (RPE) were monitored throughout exercise, while blood lactate was determined pre- and post-exercise. Post-exercise questionnaires were employed to gain insight into the perceived influence of the supplement on performance. Open-placebo improved time-to-completion (P = 0.039, 103.6±5.0 vs. 104.4±5.1 s, -0.7±1.8 s, -0.7±1.7%) and mean power output (P = 0.01, 244.8±34.7 vs. 239.7±33.2, +5.1±9.5 W) during the TT. Individual data analysis showed that 11 individuals improved, 13 remained unchanged and 4 worsened their performance with open-placebo. Heart rate, RPE and blood lactate were not different between sessions (all P>0.05). Positive expectation did not appear necessary to induce performance improvements, suggesting unconscious processes occurred, although a lack of an improvement appeared to be associated with a lack of belief. Open-placebo improved 1-km cycling TT performance in trained female cyclists. Although the intervention was successful for some individuals, individual variation was high, and some athletes did not respond or even performed worse. Thus, open-placebo interventions should be carefully considered by coaches and practitioners, while further studies are warranted.