Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID: an intensive longitudinal cohort study.

Background: Symptom fluctuations within and between individuals with long COVID are widely reported, but the extent to which severity varies following different types of activity and levels of exertion, and the timing of symptoms and recovery, have not previously been quantified. We aimed to characterise timing, severity, and nature of symptom fluctuations in response to effortful physical, social and cognitive activities, using Ecological Momentary Assessments. Methods: We recorded activity, effort, and severity of 8 core symptoms every 3 h for up to 24 days, in cohorts from both clinic and community settings. Symptom severities were jointly modelled using autoregressive and moving average processes. Findings: Consent was received from 376 participants providing ≥1 week's measurements (273 clinic-based, 103 community-based). Severity of all symptoms was elevated 30 min after all categories of activity. Increased effort was associated with increased symptom severity. Fatigue severity scores increased by 1.8/10 (95% CI: 1.6-1.9) following the highest physical exertions and by 1.5 (1.4-1.7) following cognitive efforts. There was evidence of only mild delayed fatigue 3 h (0.3, 0.2-0.5) or one day later (0.2, 0.0- 0.5). Fatigue severity increased as the day progressed (1.4, 1.0-1.7), and cognitive dysfunction was 0.2 lower at weekends (0.1-0.3). Interpretation: Cognitive, social, self-care and physical activities all triggered increased severity across every symptom, consistent with associated common pathways as potential therapeutic targets. Clear patterns of symptom fluctuations emerged that support more targeted self-management. Funding: National Institute for Health and Care Research.

Cardiac decompression and right ventricular function improvement after bar removal in patients with pectus excavatum.

Pectus excavatum, the most frequent malformation of the chest wall, has been related to cardiac compression and exercise intolerance. Cardiac outcomes after minimally invasive repair of pectus excavatum with retrosternal implants, particularly after removal (> 2 years postoperative) are generally unknown. We evaluated stress echocardiography outcomes before repair and after bar removal. This study comprised a retrospective cohort of patients with diagnosis of isolated pectus excavatum who underwent stress echocardiography before minimally invasive repair with retrosternal implants, and after bar removal. The diastolic function was evaluated by means of the trans tricuspid flow and tissue doppler imaging. The compression of the atrioventricular groove was assessed using the trans tricuspid gradient and the tricuspid area. We included 43 patients, with a mean age of 15.7 ± 4.0 years (91% male). After bar removal, 83% of patients referred improvement of exercise capacity. Furthermore, we found a significant improvement in right ventricular filling patterns, including a better E/A ratio profile during exercise (p = 0.001), lower filling pressures both at rest (p < 0.0001) and during exercise (p = 0.031), and lower rates of resting paradoxical septal motion [70% vs. 20%, p = 0.0007]. The trans tricuspid mean gradient during exercise was significantly lower after bar removal (p < 0.0001). In this study involving patients with minimally invasive repair of pectus excavatum, we demonstrated a beneficial impact of such intervention after bar removal, with significant improvements related to the right ventricular function, as well as signs of relief of cardiac compression.

Crocus Sativus Linnaeus (Saffron) intake does not affect physiological and perceptual responses during a repeated sprint test in healthy active young males.

The study aimed to investigate the effects of acute ingestion of saffron (SAF) on physiological (i.e., heart rate and blood lactate) and perceptual (i.e., ratings of perceived exertion [RPE] and feeling scale) measures in response to a repeated-sprint ability test (RSS) in healthy young males (N = 22; mean ± SD: age, 21.7 ± 1.24 yrs.). All participants completed two experimental trials with a one-week washout period using a double-blind, placebo-controlled, crossover design. In each session, the participants were randomly chosen to receive either a capsule of saffron (300 mg) (SAF session) or a capsule of lactose (PLB session) two hours before performing the RSS.No significant differences (p > 0.05) were found for heart rate, RPE, and feeling scale between the SAF or PLB sessions at pre- and post-RSS. There were no significant changes (p > 0.05) in peak time, total time, fatigue index, and blood lactate in either the SAF or PLB sessions. Acute SAF ingestion did not significantly improve RSS performance nor physiological and perceptual measures in active young males. Future trials should address the topic by using shortened/prolonged higher doses of SAF on biological, physical, physiological, and perceptual responses to acute and chronic exercise.

Impact of work pace on cardiorespiratory outcomes, perceived effort and carried load in industrial workers: a randomised cross-over trial.

OBJECTIVES: This study investigates the impact of different work paces on cardiorespiratory outcomes, perceived effort and carried load (CL) in industrial workers. METHODS: A randomised cross-over trial was conducted at a mid-sized steel company. We included 12 healthy industrial workers (8 females, age: mean 44±SD 9 years, height: 1.70±0.08 m, body mass: 79.5±13.4 kg) with at least 6 months of working experience. All participants performed 5 min of piece work at 100% (P100), 115% (P115) and 130% (P130) of the company's internal target yielded in a randomised order, separated by 5 min familiarisation breaks. The primary outcome was energy expenditure (EE), calculated from a respiratory gas exchange using a metabolic analyser. Secondary outcomes were total ventilation, oxygen uptake, carbon dioxide release, respiratory exchange ratio, heart rate and rating of perceived effort (0-10). Furthermore, the metabolic equivalent and the CL were calculated. Data were analysed with repeated measure analyses of variance. RESULTS: For EE, a large 'pace' effect with a small difference between P100 and P130 (165.9±33.4 vs 178.8±40.1 kcal/hour-1, p=0.008, standard mean difference, SMD=0.35) was revealed. Additionally, a large difference in CL between all paces (p<0.001, SMD≥1.10) was revealed. No adverse events occurred. CONCLUSIONS: Cardiorespiratory outcomes rise with increased work pace, but the practical relevance of these differences still needs to be specified. However, the CL will add up over time and may impact musculoskeletal health in the long term.

Follow-up of Cardiopulmonary Responses Using Submaximal Exercise Test in Older Adults with Post-COVID-19.

Background: Data on cardiopulmonary fitness in older adults in the longer term after coronavirus disease 2019 (COVID-19) are of interest as the time required for the full recovery of physical fitness after COVID-19 remains unclear. Some studies have reported that patients do not recover physical fitness for up to 6 or 12 months after COVID-19, whereas other studies have observed full recovery after 12-months. Therefore, this study evaluated and compared the cardiopulmonary responses induced by the 6-minute walk test (6MWT) and 1-minute sit-to-stand-test (STST) results at 3, 6, and 12 months in older adults with and without COVID-19. Methods: This study included 59 older adults with and without a history of COVID-19. The cardiopulmonary response parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (O2 sat), rate of perceived exertion (RPE), and leg fatigue were evaluated in the participants after 6MWT and 1-min-STST assessments. Results: Post-COVID-19, older adults showed statistically significant differences in HR, SBP, DBP, O2 sat, RPE, leg fatigue, 6MWT time, and 1-min-STST step numbers at 3, 6, and 12 months (P < 0.001). Moreover, older adults showed statistically significant differences in HR, SBP, DBP, RPE, leg fatigue, O2 sat, and 6MWT distance at 3 months post-COVID-19 compared with those in older adults without COVID-19 (P < 0.001). Conclusion: While older adults showed recovery of cardiopulmonary response parameters according to 6MWT and 1-min-STST findings at the 12-month follow-up post-COVID-19, these results of these measurements did not return to the values observed in older adults without COVID-19.

Rupture of sinus of Valsalva in a young laborer: A rare case report.

Ruptured sinus of Valsalva (RSOV) upon physical exertion is rare but should be considered in differential in young adults. Symptoms of acute heart failure, hemodynamic instability, and continuous heart murmur raises suspicion for RSOV and requires emergent surgical repair of right ventricular outflow tract.

Rapidly Progressive Apical Hypertrophic Cardiomyopathy: Not Everything is What It Seems.

Apical hypertrophic cardiomyopathy (HCM) is a rare variant of HCM. A 43-year-old female with a past medical history significant for hypertension and kidney transplantation presented with recurrent syncopal episodes and dyspnea on exertion. Electrocardiogram showed characteristic diffuse giant T-waves inversion, and cardiac magnetic resonance showed HCM with circumferential apical thickening. This case highlights the rapid development of apical HCM and its challenging diagnostic characteristics.

A Comparative Analysis of Acute Physiological and Perceptual Responses in Whole-Body and Ergometer-Based High-Intensity Interval Training Protocols.

The primary aim of the present investigation was to compare the acute physiological and perceptual responses between two modes of interval training using a randomized crossover design. More specifically, eleven young adult participants (23 ± 4 years, 77 ± 13 kg, 178 ± 7 cm) performed two protocols: one composed of whole-body calisthenics exercises and another on a cycle ergometer. Both protocols encompassed eight 20 s bouts at intensities equivalent to all-out (HIIT-WB) and 170% of the maximal power output (HIIT-C), respectively, interspersed with 10 s of passive rest. The peak and average heart rate, the rating of perceived effort, and blood lactate, creatine kinase, and lactate dehydrogenase concentrations were measured. Aside from blood lactate (HIIT-WB = 9.4 ± 1.8 mmo/L; HIIT-C = 12.5 ± 2.5 mmol/L, p < 0.05) and the rating of perceived exertion (HIIT-WB = 8.8 ± 0.9; HIIT-C = 9.6 ± 0.5, p < 0.05), physiological responses did not significantly differ between protocols (all p > 0.05), with high average heart rate values (HIIT-WB = 86 ± 6% HRmax; HIIT-C = 87 ± 4% HRmax) and a low magnitude of muscle damage, as inferred by CK and LDH concentrations (HIIT-WB = 205.9 ± 56.3 and 203.5 ± 72.4 U/L; HIIT-C = 234.5 ± 77.1 and 155.1 ± 65.3 U/L), respectively. It can be concluded that both protocols elicit vigorous heart rate responses and a low magnitude of muscle damage and, therefore, appear as viable alternatives to improve aerobic fitness. The inclusion of a whole-body HIIT protocol may be an interesting alternative for training prescription in relation to more common interval training protocols.

Comparison of distance covered, physiological cost, and perceived exertion in four six-minute walk test protocols.

Objective: There is evidence that indicates that the Walked Distance (WD) in the 6-Minute Walk Test (6MWT) would be sensitive to the type of track and encouragement. The aim of study was compared the impact of track type and verbal encouragement provided in the 6MWT on WD, physiological cost, perceived exertion, and gait efficiency in healthy young adults unfamiliar with the test. Method: WD, heart rate, subjective sensation of dyspnea (SSD), and fatigue (SSF) were measured in four 6MWT protocols: i) 30 m linear track and protocolized encouragement (LT + PE), ii) 30 m linear track and constant encouragement (LT + CE), iii) 81 m elliptical track and protocolized encouragement (ET + PE), and iv) 81 m elliptical track and constant encouragement (ET + CE). In addition, the Gait Efficiency Index (GIE) associated with physiological cost, dyspnea and fatigue was calculated and compared between the different protocols. Results: The WD was significantly higher in the ET + CE protocol. The percentage of the heart rate reserve used (%HRRu) at minute 6 was higher in the ET + CE protocol. The SSD and SSD had difference in startup time between the protocols. The GEI was higher in %HRRu, SSD, and SSF for the ET + CE protocol. Conclusion: The ET + CE protocol showed a significant increase in WD during the 6MWT in healthy young adults. Although it obtained the highest physiological cost, it did not present perceptual differences when entering cardiopulmonary assessment windows relevant to a more efficient test for the participant. It is advisable to discuss, based on the findings, the fundamental objective of the 6MWT and national and international recommendations to achieve a result as close as possible to the real maximal effort.

Effects of two external cooling strategies on physiological and perceptual responses of athletes with tetraplegia during and after exercise in the heat.

Athletes with tetraplegia may experience marked hyperthermia while exercising under environmental heat stress due to their limited ability to dissipate heat through evaporative means. This study investigated the effectiveness of two external cooling strategies (i.e., spraying water onto the body surface or using a cooling vest) on physiological and perceptual variables in tetraplegic athletes during and after an aerobic exercise session in a hot environment. Nine male wheelchair rugby players performed an incremental test to determine their maximum aerobic power output. After that, they were subjected to three experimental trials in a counter-balanced order: control (CON, no body cooling), cooling vest (CV), and water spraying (WS). During these trials, they performed 30 min of a submaximal exercise (at 65% of their maximum aerobic power) inside an environmental chamber set to maintain the dry-bulb temperature at 32 °C. The following variables were recorded at regular intervals during the exercise and for an additional 30 min following the exertion (i.e., post-exercise recovery) with the participants also exposed to 32 °C: body core temperature (TCORE), skin temperature (TSKIN), heart rate (HR), rating of perceived exertion (RPE), thermal comfort (TC), and thermal sensation (TS). While exercising in CON conditions, the tetraplegic athletes had the expected increases in TCORE, TSKIN, HR, RPE, and TC and TS scores. HR, TC, and TS decreased gradually toward pre-exercise values after the exercise, whereas TCORE and TSKIN remained stable at higher values. Using a cooling vest decreased the temperature measured only on the chest and reduced the scores of RPE, TC, and TS during and after exercise but did not influence the other physiological responses of the tetraplegic athletes. In contrast, spraying water onto the athletes' body surface attenuated the exercise-induced increase in TSKIN, led to lower HR values during recovery, and was also associated with better perception during and after exercise. We conclude that water spraying is more effective than the cooling vest in attenuating physiological strain induced by exercise-heat stress. However, although both external cooling strategies do not influence exercise hyperthermia, they improve the athletes' thermal perception and reduce perceived exertion.

Type 2 diabetes is linked to higher physiologic markers of effort during exercise.

Background: People with type 2 diabetes (T2D) have lower rates of physical activity (PA) than the general population. This is significant because insufficient PA is linked to cardiovascular morbidity and mortality, particularly in individuals with T2D. Previously, we identified a novel barrier to physical activity: greater perceived effort during exercise in women. Specifically, women with T2D experienced exercise at low-intensity as greater effort than women without T2D at the same low-intensity - based on self-report and objective lactate measurements. A gap in the literature is whether T2D confers greater exercise effort in both sexes and across a range of work rates. Objectives: Our overarching objective was to address these gaps regarding the influence of T2D and relative work intensity on exercise effort. We hypothesized that T2D status would confer greater effort during exercise across a range of work rates below the aerobic threshold. Methods: This cross-sectional study enrolled males and post-menopausal females aged 50-75 years. Measures of exercise effort included: 1) heart rate, 2) lactate and 3) self-report of Rating of Perceived Exertion (RPE); each assessment was during the final minute of a 5-minute bout of treadmill exercise. Treadmill exercise was performed at 3 work rates: 1.5 mph, 2.0 mph, and 2.5 mph, respectively. To determine factors influencing effort, separate linear mixed effect models assessed the influence of T2D on each outcome of exercise effort, controlling for work rate intensity relative to peak oxygen consumption (%VO2peak). Models were adjusted for any significant demographic associations between effort and age (years), sex (male/female), baseline physical activity, or average blood glucose levels. Results: We enrolled n=19 people with T2D (47.4% female) and n=18 people (55.6% female) with no T2D. In the models adjusted for %VO2peak, T2D status was significantly associated with higher heart rate (p = 0.02) and lactate (p = 0.01), without a significant association with RPE (p = 0.58). Discussions: Across a range of low-to-moderate intensity work rates in older, sedentary males and females, a diagnosis of T2D conferred higher objective markers of effort but did not affect RPE. Greater objective effort cannot be fully attributed to impaired fitness, as it persisted despite adjustment for %VO2peak. In order to promote regular exercise and reduce cardiovascular risk for people with T2D, 1) further efforts to understand the mechanistic targets that influence physiologic exercise effort should be sought, and 2) comparison of the effort and tolerability of alternative exercise training prescriptions is warranted.

Effect of a Hypertensive Response During Exercise on Growth Rates of Aortic Diameters.

BACKGROUND: Aortic diameters are related to age, sex, and body size. There is a scarcity of data on the long-term sequelae of a hypertensive response to exercise (HRE) on aortic diameters. In this retrospective cohort study, we aimed to evaluate the relationship between the growth rates of the aorta in individuals with a HRE. METHODS: Our analysis included follow-up data of 649 patients recruited between January 2009 and December 2014 with a HRE. Participants with known connective tissue disease or a history of acute aortic syndrome were excluded. Sinus of Valsalva (SoV) and ascending aorta (AscAo) diameters were measured by transthoracic echocardiography using leading edge to leading edge convention at end-diastole. RESULTS: At baseline, median age, maximum systolic blood pressure (BP), body mass index (BMI), diameter of the SoV, and AscAo were 62 years, 208 mm Hg, 26.9 kg/m2, 35 mm, and 35 mm respectively. 32% of patients were female and 67% had hypertension. After a median follow-up of 7.1 years, mean yearly growth rates (±SD) of the SoV and AscAo were 0.09 (0.41) mm and 0.13 (0.56) mm, respectively. No significant associations were observed between growth rates of aortic diameters and maximum systolic and diastolic BP or when considering only individuals with a baseline diameter >40 mm. CONCLUSIONS: In this large cohort study, maximum systolic and diastolic BP during exercise showed no association with growth rates of aortic diameters. Furthermore, the mean growth rates of aortic diameters in this population were in line with growth rates in a normal population.

Physical Activity and Self-Determination towards Exercise among Esports Athletes.

BACKGROUND: Esports is competitive video gaming, performed within teams or individually, across multiple genres. Players are required to be sedentary for extended periods and require a high-level of cognitive skills for successful competitive performance. There are conflicting findings within the physical activity research in the esports industry. The aim of this research is to explore self-reported physical activity through accelerometer-assessed physical activity, to gain a better insight into the physical activity behaviours of international e'athletes. METHOD: Participants (n = 796) across multiple popular esports games, holding any in-game rank, competing at any level, were recruited. The survey consisted of demographic details, esports experience, the International Physical Activity Questionnaire-Long Form (IPAQ-LF), and Behavioural Regulations towards Exercise Questionnaire (BREQ-3). Within a convenience sample, local intervarsity e'athletes (n = 18) were recruited to wear a wrist-worn accelerometer to measure physical activity for 7-days and then complete the survey. Results from the accelerometers were compared to the survey results to explore physical activity reporting within this population. RESULTS: When comparing IPAQ-LF to accelerometer data, players significantly over-report moderate-to-vigorous physical activity and weekly MET-min- 1 (p = .018, r = .63 and p ≤ .001, r = .92). The BREQ-3 showed that e'athletes categorised as high physical activity displayed significantly higher levels of intrinsic motivation, when compared to players categorised as low and moderate physical activity. CONCLUSIONS: E'athletes significantly over report physical activity time when measured through the IPAQ-LF, suggesting previous surveys may overestimate physical activity and further research is needed. Given the exponential growth of the industry and the level of physical inactivity, esports may contribute to global physical inactivity levels.

The levels of physical activity and fatigue among teachers in Poland and the United Kingdom in the first year after the COVID-19 pandemic.

BACKGROUND: The COVID-19 disease has a negative impact on the psychophysiological health of populations worldwide, including a decrease in overall physical performance and an increase in fatigue. Fatigue was one of the main symptoms reported by patients and persisted for several weeks after infection with COVID-19. Although the phenomenon of fatigue is still poorly understood, physical activity can be a supportive factor in combating feelings of fatigue and lack of energy. The purpose of this research was to assess the physical activity (PA) and fatigue levels of teachers in Poland and the United Kingdom in the first year after the COVID-19 pandemic. MATERIAL AND METHODS: The online research was carried out among 410 teachers from Poland and the United Kingdom. The PA level was assessed using the International Physical Activity Questionnaire (IPAQ). The level of fatigue was measured using the Modified Fatigue Impact Scale (MFIS). RESULTS: Polish teachers, regardless of sex, are more physically active (the differences relate mainly to walking and moderate activity). When assessing the level of fatigue, there is a significant difference between men and women - the former indicate a higher degree of fatigue, with the difference between the sexes being particularly large in the Polish community. Quite clearly, there is an association between less activity (except walking) and more fatigue. All models show a statistically significant effect of total fatigue on total effort. Physical activity is not very strongly correlated with age but the level of fatigue increases with age. CONCLUSIONS: The problem of teacher fatigue is unfortunately widespread. They should be encouraged to engage in as much PA as possible during the day. When planning and targeting fatigue reduction campaigns, PA should be encouraged and variables such as age, sex should be taken into account. Med Pr Work Health Saf. 2024;75(2):103-112.

Effect of High-Intensity Interval Exercise versus Continuous Low-Intensity Aerobic Exercise with Blood Flow Restriction on Psychophysiological Responses: A Randomized Crossover Study.

This study compared the effect of continuous low-intensity aerobic exercise with blood flow restriction (LI-AE-BFR) versus high-intensity interval exercise (HIIE), matching total external mechanical work between conditions, on perceptual (exertion, pain, affective and pleasure) and physiological responses (heart rate [HR], blood lactate [BL] and muscle fatigue). Ten healthy untrained men (25.6 ± 3.78 years old; 75.02 ± 12.02 kg; 172.2 ± 6.76 cm; 24.95 ± 3.16 kg/m²) completed three visits to the laboratory. In visit 1, anthropometry, blood pressure and peak running velocity on the treadmill were measured. In visits 2 and 3, participants were randomly assigned to HIIE or LI-AE-BFR, both in treadmill. HIIE consisted of 10 one-minute stimuli at 80% of peak running velocity interspersed with one-minute of passive recovery. LI-AE-BFR consisted of 20-minutes of continuous walking at 40% of peak running velocity with bilateral cuffs inflated to 50% of arterial occlusion pressure. BL and maximum isometric voluntary contraction (MIVC - fatigue measure) were measured pre- and immediately post-exercise. HR, rating of perceived exertion (RPE), and rating of perceived pain (RPP) were recorded after each stimulus in HIIE and every two minutes in LI-AE-BFR. Affective response to the session, pleasure, and future intention to exercise (FIE) were assessed 10 minutes after the intervention ended. Increases in BL concentrations were greater in HIIE (p = 0.028; r = 0.51). No effects time or condition were reported for MIVC. HR was higher in HIIE at all analyzed time points (p < 0.001; d = 3.1 to 5.2). RPE did not differ between conditions (p > 0.05), while average session RPP was higher in LI-AE-BFR (p = 0.036; r = 0.46). Affective positive response (p = 0.019; d = 0.9) and FIE (p = 0.013; d = 0.97) were significantly higher in HIIE. Therefore, HIIE elicited higher physiological stress, positive affective response, and intention to engage in future exercise bouts compared to LI-AE-BFR.

Development and validation of the physical effort scale (PES).

OBJECTIVES: Previous literature has primarily viewed physical effort as an aversive experience. However, recent research suggests that effort can also be valued positively. These differences in approach and avoidance tendencies toward physical effort may play a key role in the self-regulation of physical activity behaviors. The aim of this study was to develop a scale that measures these tendencies and contributes to a better understanding of physical effort and how it affects behavior. METHODS: The Physical Effort Scale (PES) was developed in Study 1 based on expert evaluations (n = 9) and cognitive interviews (n = 10). In Study 2 (n = 680, 69% female), content validity and dimensional structure were examined using principal component analysis and confirmatory factor analysis. Item reduction was conducted using item response theory. Preliminary construct validity was explored using regression. Study 3 (n = 297, 71% female) was used to validate dimensional structure, internal consistency, and construct validity, and to assess test-retest reliability. RESULTS: In Study 1, 44 items were rated for content validity, of which 18 were selected and refined based on cognitive interviews. Analyses from Study 2 allowed reducing the scale to 8 items with a two-dimension structure: tendency to approach (n = 4) and to avoid physical effort (n = 4). The two subscales showed high internal consistency (α = 0.897 for the approach dimension and 0.913 for the avoidance dimension) and explained usual levels of physical activity, providing preliminary evidence of construct validity. Study 3 confirmed the two-dimension structure with high internal consistency (α = 0.907 and 0.916 for the approach and avoidance dimension, respectively) and revealed acceptable test-retest reliability (intraclass correlation >0.66). Patterns of associations with other constructs showed expected relationships, confirming the concurrent, convergent, and discriminant validity of the scale. CONCLUSIONS: The PES is a valid and reliable measure of individual differences in the valuation of physical effort. This scale can assess the propensity to engage in physically demanding tasks in non-clinical populations. The PES and its manual are available in the Supplementary Material.

Diastolic Dysfunction as a Positive Predictor of Recurrent Vascular Events in Patients With Noncardioembolic Stroke.

BACKGROUND: This study aimed to assess the effects of left ventricular diastolic dysfunction (LVDD) on vascular outcomes among patients with stroke of noncardioembolic origins. METHODS: This prospective observational study enrolled 563 patients with noncardioembolic stroke (mean age, 67.9 years; 66.7% men and 33.3% women individuals) registered in the Tokyo Women's Medical University Stroke Registry between 2013 and 2020. Then, patients were divided into the LVDD and non-LVDD groups. The primary outcome was a composite of major adverse cardiovascular events, including nonfatal stroke, nonfatal acute coronary syndrome, and vascular death 1 year after stroke onset. The effect of LVDD on vascular events was assessed using multivariable Cox regression analyses. RESULTS: A total of 130 (23.1%) patients had any grade of LVDD, and patients with LVDD had a higher risk of major adverse cardiovascular event at 1 year than those without LVDD (annual rate, 20.9% versus 10.8%; log-rank P=0.001). The multivariable Cox proportional hazards regression model demonstrated that the presence of LVDD was independently associated with the major adverse cardiovascular event risk (hazard ratio, 1.79 [95% CI, 1.02-3.12]; P=0.019). Furthermore, the LVDD grade was proportional to the risk of major adverse cardiovascular events and recurrent stroke. CONCLUSIONS: LVDD may be associated with further vascular events after a noncardioembolic stroke, suggesting the importance of LVDD evaluations in risk stratification and secondary prevention in patients with noncardioembolic stroke. REGISTRATION: URL: https://upload.umin.ac.jp; Unique identifier: UMIN000031913.

Assessment of physical activity levels and back pain among poles and Portuguese in the further year of the COVID-19 pandemic - a pilot study.

BACKGROUND: The vast majority of people have experienced the problem of back pain at least once in their lives for a variety of reasons. It is well known that regular physical activity at a moderate level has a number of health benefits regardless of age or gender with positive effects on the musculoskeletal, cardiovascular, respiratory or nervous systems improving fitness levels. During the pandemic, Poland experienced one of the longest periods of school lockdown in Europe. In Portugal, this period was considerably shorter. The aim of this study was to determine the level of physical activity and back pain as well as relationship between physical activity and back pain in a group of Polish and Portuguese students in the following year the COVID-19 pandemic. METHODS: The study was conducted via the Internet among students from Poland and Portugal (398 respondents - 229 from Poland and 169 from Portugal) in October 2022. In the pilot study, the International Physical Activity Questionnaire and The Oswestry Disability Index and Neck Disability Index questionnaires were used to assess the level of back pain. RESULTS: There are no statistically significant differences in the level of physical activity and pain complaints of respondents from the two countries. At least half of the students do not report any pain complaints (median in some groups being 0). In the Portuguese men, there is a correlation between the level of physical activity and the Neck Disability Index score (p = 0.0304). CONCLUSIONS: The following year, after the pandemic COVID-19 was declared, the prevalence of back pain among students in Poland and Portugal is still significant.

Occupational physical demands and menstrual cycle irregularities in flight attendants and teachers.

OBJECTIVES: Flight attendants perform physically demanding work such as lifting baggage, pushing service carts and spending the workday on their feet. We examined if more frequent exposure to occupational physical demands could explain why previous studies have found that flight attendants have a higher reported prevalence of menstrual cycle irregularities than other workers. METHODS: We conducted a cross-sectional analysis of 694 flight attendants and 120 teachers aged 18-44 years from three US cities. Eligible participants were married, had not had a hysterectomy or tubal ligation, were not using hormonal contraception and were not recently pregnant. Participants reported menstrual cycle characteristics (cramps, pain, irregular cycles, flow, bleed length, cycle length) and occupational physical demands (standing, lifting, pushing/pulling, bending/twisting, overall effort). We used modified Poisson regression to examine associations between occupation (flight attendant, teacher) and menstrual irregularities; among flight attendants, we further examined associations between occupational physical demands and menstrual irregularities. RESULTS: All occupational physical demands were more commonly reported by flight attendants than teachers. Flight attendants reported more frequent menstrual cramps than teachers, and most occupational physical demands were associated with more frequent or painful menstrual cramps. Lifting heavy loads was also associated with irregular cycles. CONCLUSIONS: Occupational physical demands were associated with more frequent and worse menstrual pain among flight attendants. The physical demands experienced by these workers may contribute to the high burden of menstrual irregularities reported by flight attendants compared with other occupational groups, such as teachers.

The effect of the ketogenic diet on resistance training load management: a repeated-measures clinical trial in trained participants.

BACKGROUND: The effect of low-carbohydrate high-fat dietary manipulation, such as the ketogenic diet (KD), on muscle strength assessment in resistance-training (RT) participants has focused on the one-repetition maximum test (1-RM). However, a pre-specified 1-RM value during an exercise training program disregards several confounding factors (i.e. sleep, diet, and training-induced fatigue) that affect the exerciser's "true" load and daily preparedness. We aimed to evaluate the effect of a 6-week RT program on load control-related variables in trained subjects following a KD intervention. METHODS: Fourteen resistance-trained individuals (3F, 11 M; 30.1 [6.2] years; 174.2 [7.6] cm; 75.7 [10.8] kg; BMI 24.8 [2.1] kg·m-2) completed this single-arm repeated-measures clinical trial. Load management variables included volume load, number of repetitions, perceived exertion (RPE), movement velocity loss, and exertion index. These primary outcomes were assessed weekly before, during, and at the end of a 6-week RT program that included traditional RT exercises (bench press, femoral lying down, lat pulldown, leg extension, and back squat). RESULTS: There was a significant difference in RPE between weeks (p = 0.015, W = 0.19) with a slight trend in decreasing RPE. We found differences in the volume load per week (p < 0.001; W = 0.73 and p < 0.001, W = 0.81, respectively), with an increase in the last weeks. In the control of the load based on movement velocity, we did not find significant differences between weeks (p = 0.591, W = 0.06), although significant differences were found in the effort index (p = 0.026, W = 0.17). CONCLUSIONS: A KD diet in recreational strength participants does not appear to lead to performance losses during a RT program aimed at improving body composition. However, the lack of adherence and familiarity with the ketogenic diet must be considered specially during first weeks.