Effect of prehabilitation programmes on functional capacity in patients awaiting oncological resections: a systematic review and meta-analysis of randomised controlled trials.

PURPOSE: To investigate the effects of prehabilitation on the perioperative functional capacity of patients awaiting oncological resections. METHODS: A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and within the databases Cochrane Library, EBSCOhost, Google Scholar, MEDLINE PubMed, and Web of Science. The eligibility criteria were set to include peer-reviewed randomised control trials including only adult (≥ 18 years old) patients undergoing any type of prehabilitation (PREHAB) prior to any type of oncological resection. The studies had to feature at least one control group undergoing standard care (SC) and had to assess functional capacity by means of a 6-min walk distance (6MWD) or peak oxygen uptake (VO2Peak) at different stages pre- and post- operatively. RESULTS: Twenty-seven randomised controlled trials involving 1994 patients were included. After processing the data, the number of patients was 1889. Studies featured different cancer specialties: lung (11), colorectal (5), urological (4), abdominal (3), esophagogastric (2), liver (1), and gastrointestinal (1). Overall, PREHAB enhanced both 6MWD (g = 0.273, 95% CI 0.174 to 0.371, Z = 5.406, p < 0.001) and VO2Peak (g = 0.615, 95% CI 0.243 to 0.987, Z = 3.240, p = 0.001) compared with SC. The 6MWD subgroup analysis revealed a small mean effect size favouring both unimodal and multimodal PREHAB interventions. CONCLUSION: These findings support that prehabilitation, whether implemented as unimodal or multimodal format, elicits small preoperative improvements in functional capacity in patients awaiting oncological resections. PROSPERO registration number CRD42023428676.

Commentary: Key Aspects of Multimodal Prehabilitation in Surgical Patients With Cancer. A Practical Approach to Integrating Resistance Exercise Programmes.

Surgical prehabilitation aims to optimise patients' physiological reserves to better withstand the stress of surgery, reduce the risk of postoperative complications, and promote a faster and optimal recovery. The purpose of this commentary is to outline the key aspects of prehabilitation before surgery for cancer which seem to impact its effectiveness and wider implementation. Particular attention is paid to the role and integration of resistance training programmes as a key component of multimodal prehabilitation for patients with cancer. We firstly analyse some of the barriers currently hindering the implementation of prehabilitation programmes in the National Health Service (United Kingdom). Later, we describe essential aspects of resistance training design, such as exercise modality and order execution, volume and intensity, rest periods between sets or exercises, and workout frequency. Furthermore, we propose a methodology to use the perception of effort to control patients' progression during a prehabilitation programme.

Physiological effects of microcurrent and its application for maximising acute responses and chronic adaptations to exercise.

Microcurrent is a non-invasive and safe electrotherapy applied through a series of sub-sensory electrical currents (less than 1 mA), which are of a similar magnitude to the currents generated endogenously by the human body. This review focuses on examining the physiological mechanisms mediating the effects of microcurrent when combined with different exercise modalities (e.g. endurance and strength) in healthy physically active individuals. The reviewed literature suggests the following candidate mechanisms could be involved in enhancing the effects of exercise when combined with microcurrent: (i) increased adenosine triphosphate resynthesis, (ii) maintenance of intercellular calcium homeostasis that in turn optimises exercise-induced structural and morphological adaptations, (iii) eliciting a hormone-like effect, which increases catecholamine secretion that in turn enhances exercise-induced lipolysis and (iv) enhanced muscle protein synthesis. In healthy individuals, despite a lack of standardisation on how microcurrent is combined with exercise (e.g. whether the microcurrent is pulsed or continuous), there is evidence concerning its effects in promoting body fat reduction, skeletal muscle remodelling and growth as well as attenuating delayed-onset muscle soreness. The greatest hindrance to understanding the combined effects of microcurrent and exercise is the variability of the implemented protocols, which adds further challenges to identifying the mechanisms, optimal patterns of current(s) and methodology of application. Future studies should standardise microcurrent protocols by accurately describing the used current [e.g. intensity (µA), frequency (Hz), application time (minutes) and treatment duration (e.g. weeks)] for specific exercise outcomes, e.g. strength and power, endurance, and gaining muscle mass or reducing body fat.

Effects of adding post-workout microcurrent in males cross country athletes.

Post-exercise microcurrent based treatments have shown to optimise exercise-induced adaptations in athletes. We compared the effects of endurance training in combination with either, a microcurrent or a sham treatment, on endurance performance. Additionally, changes in body composition, post-exercise lactate kinetics and perceived delayed onset of muscle soreness (DOMS) were determined. Eighteen males (32.8 ± 6.3 years) completed an 8-week endurance training programme involving 5 to 6 workouts per week wearing a microcurrent (MIC, n=9) or a sham (SH, n=9) device for 3-h post-workout or in the morning during non-training days. Measurements were conducted at pre- and post-intervention. Compared to baseline, both groups increased (P < 0.01) maximal aerobic speed (MIC, pre = 17.6 ± 1.3 to post=18.3 ± 1.0; SH, pre=17.8 ± 1.5 to post = 18.3 ± 1.3 km.h-1) with no changes in V˙O2peak. No interaction effect per group and time was observed (P=0.193). Although both groups increased (P < 0.05) trunk lean mass (MIC, pre=23.2 ± 2.7 to post=24.2 ± 2.0; SH, pre=23.4 ± 1.7 to post=24.3 ± 1.6 kg) only MIC decreased (pre=4.8 ± 1.5 to post=4.5 ± 1.5, p=0.029) lower body fat. At post-intervention, no main differences between groups were observed for lactate kinetics over the 5 min recovery period. Only MIC decreased (P<0.05) DOMS at 24-h and 48-h, showing a significant average lower DOMS score over 72-h after the completion of the exercise-induced muscle soreness protocol. In conclusion, a 3-h daily application of microcurrent over an 8-week endurance training programme produced no further benefits on performance in endurance-trained males. Nonetheless, the post-workout microcurrent application promoted more desirable changes in body composition and attenuated the perception of DOMS over 72-h post-exercise.

Effects of Multi-Ingredient Preworkout Supplementation across a Five-Day Resistance and Endurance Training Microcycle in Middle-Aged Adults.

Preworkout multi-ingredient admixtures are used to maximise exercise performance. The present double-blind, cross-over study compared the acute effects of ingesting a preworkout multi-ingredient (PREW) admixture vs. carbohydrate (CHO) over a week (microcycle) comprising three resistance training (RT) workouts alternated with two 30-min low-intensity endurance sessions (END) on RT volume (kg lifted) and END substrate oxidation. Additionally, postworkout decreases of muscle function and subjective responses were analysed. Following a baseline assessment, fourteen recreationally trained, middle-aged adults (seven females, 48.8 ± 4.7 years old) completed two identical microcycles separated by a two-week washout period while receiving either PREW or CHO (15 min prior to workout). The RT volume, per session (SVOL) and for the entire week (WVOL), was calculated. Fatty acid oxidation (FAO) during 30-min cycling corresponding to their individually determined maximal fat oxidation was measured using expired gasses and indirect calorimetry. Assessments of performance and tensiomyography were conducted within 20 min after each RT. Higher (p = 0.001) SVOL and WVOL along with a larger proportion of FAO (p = 0.05) during the second END workout were determined under the PREW treatment. No other statistically significant differences were observed between conditions. Compared to CHO, a preworkout multi-ingredient appears to increase resistance volume and favour fat oxidation during low-intensity endurance exercises.

Correction to: Effectiveness of combining microcurrent with resistance training in trained males.

The original version of this article unfortunately contained a mistake.

Effectiveness of combining microcurrent with resistance training in trained males.

INTRODUCTION: Microcurrent has been used to promote tissue healing after injury or to hasten muscle remodeling post exercise. PURPOSE: To compare the effects of resistance training in combination with either, microcurrent or sham treatment, on-body composition and muscular architecture. Additionally, changes in performance and perceived delayed onset muscle soreness (DOMS) were determined. METHODS: Eighteen males (25.7 ± 7.6 years) completed an 8-week resistance training program involving 3 workouts per week (24 total sessions) wearing a microcurrent (MIC, n = 9) or a sham (SH, n = 9) device for 3-h post-workout or in the morning during non-training days. Measurements were conducted at pre and post intervention. RESULTS: Compared to baseline, both groups increased (p < 0.05) muscle thickness of the elbow flexors (MIC + 2.9 ± 1.4 mm; SH + 3.0 ± 2.4 mm), triceps brachialis (MIC + 4.3 ± 2.8 mm; SH + 2.7 ± 2.6 mm), vastus medialis (MIC + 1.5 ± 1.5 mm; SH + 0.9 ± 0.8 mm) and vastus lateralis (MIC + 6.8 ± 8.0 mm; SH + 3.2 ± 1.8 mm). Although both groups increased (p < 0.01) the pennation angle of vastus lateralis (MIC + 2.90° ± 0.95°; SH + 1.90° ± 1.35°, p < 0.01), the change measured in MIC was higher (p = 0.045) than that observed in SH. Furthermore, only MIC enlarged (p < 0.01) the pennation angle of brachialis (MIC + 1.93 ± 1.51). Both groups improved (p < 0.05) bench press strength and power but only MIC enhanced (p < 0.01) vertical jump height. At post intervention, only MIC decreased (p < 0.05) DOMS at 12-h, 24-h, and 48-h after performing an exercise-induced muscle soreness protocol. CONCLUSION: A 3-h daily use of microcurrent maximized muscular architectural changes and attenuated DOMS with no added significant benefits on body composition and performance.

Effects of Protein Versus Carbohydrate Supplementation on Markers of Immune Response in Master Triathletes: A Randomized Controlled Trial.

Objective: This study examines the long-term effects of ingesting hydrolyzed beef protein versus carbohydrate on indirect markers of immunity during 10 weeks of endurance training in master-aged triathletes (n = 16, age 35-60 years). Methods: Participants were randomly assigned to either a hydrolyzed beef protein (PRO, n = 8) or nonprotein isoenergetic carbohydrate (CHO, n = 8) condition, which consisted of ingesting 20 g of each supplement, mixed with water, once a day immediately post workout, or before breakfast on nontraining days. Salivary human neutrophil peptides (HNP1-3) were measured before and after performing an incremental endurance test to volitional exhaustion at both pre and post intervention. Additionally, baseline levels of platelets, neutrophils, eosinophil basophils, monocytes, and lymphocytes were determined at pre and post intervention. Results: No significant changes in baseline concentration and secretion rate of salivary HNP1-3 were observed for either treatment. The CHO group showed a nonsignificant decrease in resting HNP1-3 concentrations following the intervention (p = 0.052, effect size d = 0.53). Protein supplementation demonstrated a significant reduction in lymphocyte counts pre to post intervention (mean [SD]: 2.30 [0.57] vs. 1.93 [0.45] 103/mm3, p = 0.046, d = 0.77), along with a moderate but not statistically significant increase (d = 0.75, p = 0.051) of the neutrophil-to-lymphocyte ratio. Conclusions: In master-aged triathletes, postworkout ingestion of only protein, with no carbohydrate, may not be as effective as carbohydrate alone to attenuate negative long-term changes of some salivary and cellular immunological markers. Future studies should consider the co-ingestion of both macronutrients.

Comparison of 2 weekly-equalized volume resistance-training routines using different frequencies on body composition and performance in trained males.

The present study compared the effects of 2 weekly-equalized volume and relative load interventions on body composition, strength, and power. Based on individual baseline maximal strength values, 18 recreationally trained men were pair-matched and consequently randomly assigned to one of the following experimental groups: a low volume per session with a high frequency (LV-HF, n = 9) group who trained for 4 days (Mondays, Tuesdays, Thursdays, and Fridays) or a high volume per session and low frequency (HV-LF, n = 9) group who trained for 2 days (Mondays and Thursdays). Both groups performed 2 different routines over 6 weeks. Participants were tested pre- and post- intervention for maximal strength, upper body power, fat-free mass, limb circumferences, and muscle thickness. Compared with baseline values, both groups increased their fat-free mass (HV-LF: +1.19 ± 1.94; LV-HF: +1.36 ± 1.06 kg, p < 0.05) and vastus medialis thickness (HV-LF: +2.18 ± 1.88, p < 0.01; LV-HF: +1.82 ± 2.43 mm, p < 0.05), but only the HV-LF group enhanced arm circumference (1.08 ± 1.47 cm, p < 0.05) and elbow flexors thickness (2.21 ± 2.81 mm, P < 0.01) values and decreased their fat mass (-2.41 ± 1.10, P < 0.01). Both groups improved (p < 0.01) the maximal loads lifted in the bench press (LV-HF: +0.14 ± 0.01; HV-LF: +0.14 ± 0.01 kg·body mass-1) and the squat (LV-HF: +0.14 ± 0.06; HV-LF: 0.17 ± 0.01 kg·body mass-1) exercises as well as in upper body power (LV-HF: +0.22 ± 0.25; HV-LF: +0.27 ± 0.22 W·body mass-1) Although both training strategies improved performance and lower body muscle mass, only the HV-LF protocol increased upper body hypertrophy and improved body composition.

Carbohydrates Alone or Mixing With Beef or Whey Protein Promote Similar Training Outcomes in Resistance Training Males: A Double-Blind, Randomized Controlled Clinical Trial.

Beef powder is a new high-quality protein source scarcely researched relative to exercise performance. The present study examined the impact of ingesting hydrolyzed beef protein, whey protein, and carbohydrate on strength performance (1RM), body composition (via plethysmography), limb circumferences and muscular thickness (via ultrasonography), following an 8-week resistance-training program. After being randomly assigned to one of the following groups: Beef, Whey, or Carbohydrate, twenty four recreationally physically active males (n = 8 per treatment) ingested 20 g of supplement, mixed with orange juice, once a day (immediately after workout or before breakfast). Post intervention changes were examined as percent change and 95% CIs. Beef (2.0%, CI, 0.2-2.38%) and Whey (1.4%, CI, 0.2-2.6%) but not Carbohydrate (0.0%, CI, -1.2-1.2%) increased fat-free mass. All groups increased vastus medialis thickness: Beef (11.1%, CI, 6.3-15.9%), Whey (12.1%, CI, 4.0, -20.2%), Carbohydrate (6.3%, CI, 1.9-10.6%). Beef (11.2%, CI, 5.9-16.5%) and Carbohydrate (4.5%, CI, 1.6-7.4%), but not Whey (1.1%, CI, -1.7-4.0%), increased biceps brachialis thickness, while only Beef increased arm (4.8%, CI, 2.3-7.3%) and thigh (11.2%, 95%CI 0.4-5.9%) circumferences. Although the three groups significantly improved 1RM Squat (Beef 21.6%, CI 5.5-37.7%; Whey 14.6%, CI, 5.9-23.3%; Carbohydrate 19.6%, CI, 2.2-37.1%), for the 1RM bench press the improvements were significant for Beef (15.8% CI 7.0-24.7%) and Whey (5.8%, CI, 1.7-9.8%) but not for carbohydrate (11.4%, CI, -0.9-23.6%). Protein-carbohydrate supplementation supports fat-free mass accretion and lower body hypertrophy. Hydrolyzed beef promotes upper body hypertrophy along with similar performance outcomes as observed when supplementing with whey isolate or maltodextrin.

Acute effectiveness of a "fat-loss" product on substrate utilization, perception of hunger, mood state and rate of perceived exertion at rest and during exercise.

BACKGROUND: Achieving fat-loss outcomes by ingesting multi-ingredient mixtures may be further enhanced during exercise. This study tested the acute thermogenic effectiveness of a commercially available multi-ingredient product (Shred-Matrix®), containing Green Tea Extract, Yerba Maté, Guarana Seed Extract, Anhydrous caffeine, Saw palmetto, Fo-Ti, Eleuthero root, Cayenne Pepper, and Yohimbine HCI, on fatty acid oxidation (FAO), perception of hunger, mood state and rate of perceived exertion (RPE) at rest and during 30 min of submaximal exercise. METHODS: Following institutional ethical approval, twelve healthy recreationally active participants, five females and seven males, were randomized to perform two separate experimental ergometry cycling trials, and to ingest 1.5 g (3 × capsules) of either a multi-ingredient supplement (SHRED) or placebo (PL). Participants rested for 3 h, before performing a 30-min cycling exercise corresponding to their individually-determined intensity based on their maximal fat oxidation (Fatmax). Fatty acid oxidation (FAO) was determined at rest, 3 h before exercise (Pre1), immediately before exercise (Pre2) and during exercise (Post), using expired gasses and indirect calorimetry. Rate of perceived exertion (RPE) was measured every 3 min during the 30-min exercise. Additionally both mood state and perception of hunger were assessed at Pre1, Pre2 and Post exercise. A repeated measures ANOVA design and Cohen's d effect sizes were used to analyze potential differences between times and treatment conditions. RESULTS: FAO increased in SHRED from Pre1 to Pre2 [0.56 ± 0.26 to 0.96 ± 0.37, (p = 0.003, d =1.34)] but not in PL [0.67 ± 0.25 to 0.74 ± 0.19, (p = 0.334) d = 0.49], with no differences were found between conditions (p = 0.12, d = 0.49). However, Cohen's d = 0.77 revealed moderate effect size in favor of SHRED from Pre to Post exercise. RPE values were lower in SHRED compared to Pl (p< 0.001). Mood state and perception of hunger were not different between conditions, with no interaction effects. However, a trend was shown towards improved satiety in SHRED compared with PL, [F(1,11) = 3.58, p = 0.085]. CONCLUSIONS: The multi-ingredient product's potential enhancement of FAO during exercise, satiety, and RPE reduction suggests an acute effectiveness of SHRED in improving the exercise-related fat loss benefits.