High Physical Activity Volume Is Associated With an Increase in the Calibre of the Lower Limb Veins Without Impact on Functional Discomfort: the VARISPORT Study.

OBJECTIVE: The relationship between physical activity and lower limb veins is complex. If a sedentary lifestyle is considered to be negative on lower limb veins, specific information on physical activity varicose vein volume is sparse, especially the effect of high physical activity volume. The main objective of the VARISPORT study was to evaluate lower limb veins (clinically, morphologically, and haemodynamically) and chronic venous disease symptoms in subjects exposed to high physical activity volume compared with a group of non-exposed subjects. METHODS: A cross sectional study compared a group of high exercise training volume volunteers (more than eight hours of uninterrupted vigorous intensity physical activity per week for more than six months: high physical activity volume group, HPAV group) with a volunteer control group matched for age, sex, and body mass index. Clinical examination was performed to determine the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of each subject and the Carpentier score was used to assess symptoms related to possible chronic venous disease. Duplex ultrasonography was used to assess vein diameters and reflux in the deep and superficial veins. RESULTS: One hundred and nineteen subjects were included in each group. The lower limb veins (deep and superficial) were significantly more dilated in the HPAV group. More reflux was found in the great saphenous veins and non-saphenous veins in the HPAV group. High physical activity volume was associated with a higher frequency of visible varicose veins (stage C2 of the CEAP classification), odds ratio 3.37 (95% confidence interval 1.66 - 7.25) without impact on functional discomfort (44 subjects with a Carpentier score ≥ 1 in each group). CONCLUSION: The VARISPORT study reported an increase in the calibre of the lower limb veins without impact on functional discomfort. Further studies are needed to determine whether these athletic veins are truly pathological varicose veins or simply an adaptation to high physical activity volumes.

Cardiorespiratory and Autonomic Nervous System Responses to Prolonged Eccentric Cycling.

Offering large muscle benefits despite low metabolic demand, continuous eccentric exercise appears to be an interesting alternative to concentric exercise. Nevertheless, further knowledge is needed about prolonged eccentric exercise. This work sought to investigate the cardiovascular responses to prolonged constant-load eccentric compared to concentric cycling. Ten healthy males performed two 45-min exercise sessions of either concentric or eccentric cycling separated by a month and matched for heart rate during the first 5 min of exercise. Cardiorespiratory, autonomic nervous system and vascular responses were assessed at rest, and during exercise and recovery. During cycling, oxygen uptake, cardiac output and systolic blood pressure were similar but heart rate and diastolic blood pressure were greater whereas stroke volume was lower during eccentric than concentric cycling (118±21 vs. 104±10 bpm; 77±9 vs. 65±8 mmHg; 122±12 vs. 135±13 mL). Baroreflex and noradrenaline concentration were altered during eccentric cycling, and after eccentric exercise, vascular tone was greater than after concentric cycling. We observed increased cardiovascular strain and altered baroreflex activity during eccentric compared with concentric exercise, suggesting eccentric cycling triggers greater sympathetic activity.

Physiological Pattern Changes in Response to a Simulated Competition in Elite Women's Artistic Gymnasts.

Isacco, L, Ennequin, G, Cassirame, J, and Tordi, N. Physiological pattern changes in response to a simulated competition in elite women's artistic gymnasts. J Strength Cond Res 33(10): 2768-2777, 2019-The outstanding progress in women's artistic gymnastics in recent decades has led to increased technical and physiological demands. The aim of this study was to investigate (a) the physiological demands of elite French gymnasts and (b) the impact of a competitive routine on physiological pattern changes. Fourteen French elite female gymnasts performed anthropometric measurements, physical fitness tests, and a simulated 4-event competition. Heart rate (HR) was continuously recorded throughout the duration of the simulated competition. Blood lactate concentrations were assessed at rest, before the beginning and at 2, 4, and 10 minutes after completion of the routine on each apparatus. Isometric handgrip strength and anaerobic endurance and power were assessed during the simulated competition. The highest values of HR and blood lactate concentrations were reached during the floor and uneven bar exercises. Blood lactate concentrations and HR kinetics were apparatus dependent and values remained significantly increased at 10 minutes of recovery compared with resting data. Anaerobic endurance and power decreased significantly as the competition progressed (p < 0.001). The present results show specifically cardiorespiratory and anaerobic apparatus-dependent responses throughout a simulated competition. Recovery approaches seem relevant to prevent and minimize fatigue and optimize performance in these athletes.

Muscle Oxygenation Responses to Low-intensity Steady Rate Concentric and Eccentric Cycling.

Muscle deoxygenation responses provide information about the training impulse of an exercise session enabling adaptation to be predicted. Our aim was to investigate muscle oxygenation profiles during prolonged low-intensity eccentric and concentric cycling. Twelve healthy men performed two 45-min exercise sessions of concentric (CON) and eccentric (ECC) cycling, matched for the same heart rate at the start of each session. Mechanical power output during ECC was ~2.5 times that of CON (210±40 W vs. 82±16 W). Oxygen uptake, blood lactate, cardiac output and systolic arterial pressure responses did not differ between exercises. Heart rate was similar at 5 min of each exercise bout but progressively increased during ECC and was higher at 15, 30 and 45 min of ECC compared to CON (+10 bpm), with a trend for a lower stroke volume. Diastolic and mean blood pressures were higher during ECC. No significant differences were observed in muscle oxygenation profiles. Muscle oxygenation responses during prolonged low-intensity exercise were not affected by the type of muscle action at the same metabolic demand and cardiac output.

Benefits of Compression Garments Worn During Handball-Specific Circuit on Short-Term Fatigue in Professional Players.

Ravier, G, Bouzigon, R, Beliard, S, Tordi, N, and Grappe, F. Benefits of compression garments worn during handball-specific circuit on short-term fatigue in professional players. J Strength Cond Res 32(12): 3528-3536, 2018-The purpose of this study was to investigate the benefits of full-leg length compression garments (CGs) worn during a handball-specific circuit exercises on athletic performance and acute fatigue-induced changes in strength and muscle soreness in professional handball players. Eighteen men (mean ± SD: age 23.22 ± 4.97 years; body mass: 82.06 ± 9.69 kg; height: 184.61 ± 4.78 cm) completed 2 identical sessions either wearing regular gym short or CGs in a randomized crossover design. Exercise circuits of explosive activities included 3 periods of 12 minutes of sprints, jumps, and agility drills every 25 seconds. Before, immediately after and 24 hours postexercise, maximal voluntary knee extension (maximal voluntary contraction, MVC), rate of force development (RFD), and muscle soreness were assessed. During the handball-specific circuit sprint and jump performances were unchanged in both conditions. Immediately after performing the circuit exercises MVC, RFD, and PPT decreased significantly compared with preexercise with CGs and noncompression clothes. Decrement was similar in both conditions for RFD (effect size, ES = 0.40) and PPT for the soleus (ES = 0.86). However, wearing CGs attenuated decrement in MVC (p < 0.001) with a smaller decrease (ES = 1.53) in CGs compared with regular gym shorts condition (-5.4 vs. -18.7%, respectively). Full recovery was observed 24 hours postexercise in both conditions for muscle soreness, MVC, and RFD. These findings suggest that wearing CGs during a handball-specific circuit provides benefits on the impairment of the maximal muscle force characteristics and is likely to be worthwhile for handball players involved in activities such as tackles.

An interdisciplinary framework to optimize the anticipation skills of high-level athletes using virtual reality.

The ambition of our contribution is to show how an interdisciplinary framework can pave the way for the deployment of innovative virtual reality training sessions to improve anticipation skills in top-level athletes. This improvement is so challenging that some authors say it is like "training for the impossible". This framework, currently being implemented as part of a project to prepare athletes for the 2024 Olympic Games in Paris, based on the ecological-dynamics approach to expertise, is innovative in its interdisciplinary nature, but also and above all because it overcomes the limitations of more traditional training methods in the field designed to optimize anticipation skills in top-level athletes. The ambition is to tackle successive challenges ranging from the design of virtual partners and opponents to the deployment of training programs in virtual reality, while ensuring the acceptability and acceptance of such innovative virtual reality training protocols and measuring associated workloads.

Is it possible to individualize intensity of eccentric cycling exercise from perceived exertion on concentric test?

OBJECTIVE: To assess the safety and acute effects of a procedure using perceived exertion during a prior submaximal concentric (CON) test to individualize eccentric (ECC) cycling exercise intensity. DESIGN: Prospective, monocentric open study. SETTING: Technological investigation platform at a physical medicine and rehabilitation department in a university hospital. PARTICIPANTS: Healthy subjects (N=18; 15 men, 3 women) aged between 22 and 37 years. INTERVENTIONS: The subjects performed 3 cycling exercises: (1) incremental CON test to determine the comfortable pedaling power (CPP) corresponding to a Borg scale rating of 12 (rate of perceived exertion); (2) steady-state CON exercise at the CPP workload to determine the corresponding plantar pressure; and (3) steady-state ECC exercise with an imposed resistance corresponding to the CPP plantar pressure. MAIN OUTCOME MEASURES: Rate of perceived exertion on Borg scale, oxygen uptake (V˙o2), heart rate, cardiac output, and stroke volume using inert gas rebreathing techniques were measured during steady-state CON and ECC exercises. Muscle soreness was rated on a visual analog scale immediately, 24, and 48 hours after the tests. RESULTS: No adverse effects were reported. V˙o2 was about 5 times the resting value during CON exercise, while it was twice that during ECC exercise. Cardiac output was lower during ECC exercise (P<.05). This moderate increase of cardiac output was exclusively linked to a greater increase in stroke volume during ECC exercise than during CON exercise (P<.05). CONCLUSIONS: Moderate-intensity ECC cycling exercise tailored according to perceived exertion during a prior CON test is well tolerated. It corresponds to a limited muscular use of oxygen and to an isolated increase in stroke volume. It appears to be a feasible procedure for preconditioning before ECC training.

Cardiovascular Responses to Eccentric Cycling Based on Perceived Exertion Compared to Concentric Cycling, Effect of Pedaling Rate, and Sex.

Interest in eccentric exercises has increased over the last decades due to its efficiency in achieving moderate-high intensity muscular work with reduced metabolic demands. However, individualizing eccentric exercises in rehabilitation contexts remains challenging, as concentric exercises mainly rely on cardiovascular parameters. To overcome this, perceived exertion could serve as an individualization tool, but the knowledge about cardiovascular responses to eccentric cycling based on perceived exertion are still scarce. For this purpose, the cardiorespiratory parameters of 26 participants were assessed during two 5 min bouts of concentric cycling at 30 and 60 rpm and two bouts of eccentric cycling at 15 and 30 rpm matched for rating of perceived exertion. With this method, we hypothesized higher exercise efficiency during eccentric cycling for a same perceived exertion. The results revealed significantly elevated heart rate and cardiac index at higher pedalling rates during concentric (p < 0.001), but not during eccentric cycling (p ≈ 1). Exercise efficiency was higher during concentric cycling (64%), decreasing with pedalling rate, while eccentric cycling exhibited increased work rates (82%), and increased by over 100% with higher pedalling rate. Hence, eccentric cycling, with lower cardiorespiratory work for the same perceived exertion, facilitates higher work rates in deconditioned populations. However, further studies are needed for effective individualization.

Effects of an Exercise Program and Cold-Water Immersion Recovery in Patients with Rheumatoid Arthritis (RA): Feasibility Study.

Rheumatoid Arthritis (RA) patients present is an increased cardiovascular risk (CVR) linked to systemic inflammatory manifestations. A physical activity program with known positive effects on CVR, followed by cryotherapy because of its analgesic and anti-inflammatory effects, may be interesting. However, there are no reports in the literature of such a program. This study aimed to determine the feasibility (acceptability, safety, and effectiveness) of an individualized Intermittent Exercise Program followed by cold-water immersion as a recovery for RA patients. The program was conducted three times per week by eighteen RA patients (one man) with means of age and BMI of 55 (11.9) years and 25.5 (4.7) kg·m-2. Outcomes were assessed before and after nine and seventeen sessions and included evaluation of acceptability by perceived exertion (Borg) and water temperature (VAS) measures at each session; safety by a number of painful and swollen joints (echography); physical function (health assessment questionnaire); general health status (Short Form-36) measures; and effectiveness by arterial stiffness (pulse wave velocity, or PWV) measures. The results showed good acceptability of the program; no patient dropped out of the protocol or even presented difficulties or perceived pain. The HR and PWV values decreased significantly (70.2 ± 8.4 to 66 ± 5.5; p < 0.05 and 8.9 ± 1.2 to 7.0 ± 0.8; p < 0.001) after nine exercise sessions. No aggravation of symptoms has been noted. This program is acceptable, safe, and effective; consider tailoring it for supervised home-based use.

ATHLETIQUE: interest of an adapted physical activity program in patients with juvenile idiopathic arthritis: a feasibility and preliminary effectiveness study.

Background: Juvenile Idiopathic Arthritis (JIA) is associated with joint inflammation, pain and limited joint mobility, impacting the practice of physical activities. Adapted Physical Activities (APA) are an increasingly used method of rehabilitation, but additional studies are needed to define the nature of the most appropriate physical activity for patients with JIA. The "ATHLETIQUE" project aims to evaluate the impact of a program integrating APA sessions with use of a pedometer watch, on disease activity in patients with JIA. Methods: This study will be a randomized, multicenter, open-label, controlled clinical trial with 2 parallel arms. The patients included in this study will be children and adolescents with JIA, aged 6 to 17 years. The experimental group (30 patients) will participate in an APA program for 3 months and will use a pedometer watch for one year. We will evaluate and compare the change in disease activity measurements (primary objective), fatigue, pain, quality of life, level of physical activity, functional capacities, and muscle strength (secondary objectives) after 14, 26 and 50 weeks. The control group (10 patients) will undergo the same evaluations as the experimental group but will not participate in the APA program and will not wear the pedometer watch. Expected results: The APA program may help to promote an active lifestyle with regular physical activity, preventing comorbidities and motor disability. Promising results on disease activity, functional capacities and quality of life would enable us to envisage a larger research program with a view to optimizing and assessing APA for children with JIA. Discussion: This study will be conducted in the short and medium-term, with one-year follow-up, including 3 months of APA sessions for the experimental group. The sessions proposed during the APA program will mainly be aerobic and bodyweight exercises. Furthermore, in contrast to previous studies on this topic, our study will integrate a novel element, namely the use of a pedometer watch. This watch will help to implement strategies to address motivation. This study aims to improve physical and mental well-being, provide a basis for the design of a larger study, and propose recommendations adapted to children with JIA. Trial registration: Registered with ClinicalTrials.gov under the number NCT05572424.

Role of left ventricular untwisting in diastolic dysfunction after long duration exercise.

Numerous studies have reported that long duration exercise induces transient left ventricular (LV) dysfunction. Using 2D-strain echocardiography, we aimed to describe cardiac mechanics following 2 h of exercise. We focused especially on LV twist since untwisting is crucial in the development of intraventricular pressure gradient, a key element of LV early filling. Twenty healthy males (20-41 years) underwent a resting echocardiography including a 2D-strain evaluation based on velocity vector imaging before and after 2-h of cycling at a moderate intensity. Measurements included LV longitudinal, radial and circumferential strains, and LV rotations and twist. After the prolonged exercise, the depressed diastolic function (peak E: 77.5 ± 11.4 vs. 71.9 ± 10.9, P < 0.01) was associated with a delay in peak untwisting velocity (110 ± 14 vs. 119 ± 14% of systolic duration, P < 0.05), whereas LV peak diastolic strain rates, indexes of LV relaxation, were unchanged. LV global systolic function and LV peak systolic strain rates remained normal after the exercise (fractional shortening: 36.8 ± 2.8 vs. 36.9 ± 5.7, NS). In conclusion, the present study gives new insight into cardiac dysfunction following long duration exercise. It demonstrates that depressed diastolic function is associated with delayed untwisting velocity, but depressed LV relaxation and contractility following exercise remains controversial.

The perceived exertion to regulate a training program in young women.

The aim of this study was to compare the heart rate (HR) and the perceived exertion (PE) regulation of a training program in women and their effects on the cardiorespiratory responses. Twenty-seven women (mean age 22.4 ± 2.7 years) were randomly assigned to a control group (CG, n = 9), a heart rate group (HRG, n = 9), or a perceptive group (PG, n = 9). All subjects performed a maximal graded test (MGT) on a cycle ergometer before and after 6 weeks. The HR, V(O2)peak, maximal tolerated power (MTP), and PE were recorded during both MGTs. A 6-week interval training program was performed by both the HRG and PG. HR targets were used for the HRG and PE for the PG to readjust the power output. The results show that the V(O2)peak and the MTP increased significantly (p < 0.05) for both training groups, whereas the CG obtained no changes. As a consequence, PE could be a valuable tool to readjust the training load during an interval training program.

Key role of left ventricular untwisting in endurance cyclists at onset of exercise.

The rise in oxygen consumption during the transition from rest to exercise is faster in those who are endurance-trained than those who have sedentary lifestyles, partly due to a more efficient cardiac response. However, data regarding this acute cardiac response in trained individuals are limited to heart rate (HR), stroke volume, and cardiac output. Considering this, we compared cardiac kinetics, including left ventricular (LV) strains and twist/untwist mechanics, between endurance-trained cyclists and their sedentary counterparts. Twenty young, male, trained cyclists and 23 untrained participants aged 18-25 yr performed five similar constant workload exercises on a cyclo-ergometer (target HR: 130 beats/min). During each session, LV myocardial diastolic and systolic linear strains, as well as torsional mechanics, were assessed using speckle-tracking echocardiography. Cardiac function was evaluated every 15 s during the first minute and every 30 s thereafter, until 240 s. Stroke volume increased during the first 30-45 s in both groups but to a significantly greater extent in trained cyclists (31% vs. 24%). Systolic parameters were similar in both groups. Transmitral peak filling velocity and peak filling rate responded faster to exercise and with greater amplitude in trained cyclists. Left ventricular filling pressure was lower in the former, whereas LV relaxation was greater but only at the base of the left ventricle. Basal rotation and peak untwisting rate responded faster and to a greater extent in the cyclists. This study provides new mechanical insights into the key role of LV untwisting in the more efficient acute cardiac response of endurance-trained athletes at onset of exercise.NEW & NOTEWORTHY Our study assessed for the first time, to our knowledge, the kinetics of left ventricular function during the transition from rest to constant-load exercise in endurance-trained subjects. We observed a faster cardiac response in cyclists characterized by a faster response of cardiac output, left ventricular transmitral filling, basal rotation, and untwisting. This study highlighted the key role of left ventricular twisting mechanics in the more efficient acute cardiac response of endurance-trained athletes at onset of exercise.

Intermittent versus constant aerobic exercise: effects on arterial stiffness.

Aerobic exercises (of sufficient duration and intensity) decreases arterial stiffness. However, the direct relationship between the type of aerobic exercise (i.e. constant versus interval) and the alteration in arterial stiffness has been poorly explored. We evaluated the hemodynamic responses of 11 healthy males (22.5 +/- 0.7 years, height 177.7 +/- 1.1 cm, body mass 70.5 +/- 2.4 kg) following acute constant (CE) and intermittent cycling exercise (IE). Exercise duration and intensity (mean heart rate) were matched during both exercises (142.9 +/- 2.4 bpm for CE and 144.2 +/- 2.4 bpm for IE). Heart rate (HR) and cardiac output (CO) were measured throughout the whole session, while blood pressure and pulse wave velocity (PWV) were measured during pre exercise and 30 min recovery. Arterial stiffness and cardiac autonomic control were assessed through PWV and heart rate variability, respectively. After IE, lower limb arterial stiffness was significantly and steadily decreased compared to pre exercise value (from 8.6 +/- 0.1 to m s(-1) to 7.6 +/- 0.3 to m s(-1) at 30 min) and was lower than after CE (8.2 +/- 0.3 m s(-1) at 30 min, which did not significantly change compared to pre exercise: 8.7 +/- 0.2 m s(-1)). We hypothesized that the higher HR and lower arterial stiffness after IE were likely due to variations in peripheral vascular changes during the exercise which may trigger the release of endothelial or metabolic vasoactive factors. These data appear to show that IE may result in a greater stimulus for vascular adaptations when compared to CE.

1H-NMR-Based Analysis for Exploring Knee Synovial Fluid Metabolite Changes after Local Cryotherapy in Knee Arthritis Patients.

Rehabilitation using cryotherapy has widely been used in inflammatory diseases to relieve pain and decrease the disease activity. The aim of this study was to explore the metabolite changes in inflammatory knee-joint synovial fluids following local cryotherapy treatment (ice or cold CO2). We used proton nuclear magnetic resonance (1H NMR) spectroscopy to assess the metabolite patterns in synovial fluid (SF) in patients with knee arthritis (n = 46) before (D0) and after (D1, 24 h later) two applications of local cryotherapy. Spectra from aqueous samples and organic extracts were obtained with an 11.75 Tesla spectrometer. The metabolite concentrations within the SF were compared between D1 and D0 using multiple comparisons with the application of a false discovery rate (FDR) adjusted at 10% for each metabolite. A total of 32 metabolites/chemical structures were identified including amino acids, organic acids, fatty acids or sugars. Pyruvate, alanine, citrate, threonine was significantly higher at D1 vs D0 (p < 0.05). Tyrosine concentration significantly decreases after cryotherapy application (p < 0.001). We did not observe any effect of gender and cooling technique on metabolite concentrations between D0 and D1 (p > 0.05). The present study provides new insight into a short-term effect of cold stimulus in synovial fluid from patients with knee arthritis. Our observations suggest that the increased level of metabolites involved in energy metabolism may explain the underlying molecular pathways that mediate the antioxidant and anti-inflammatory capacities of cryotherapy.

Can shoulder muscle coordination during the support scale at ring height be replicated during training exercises in gymnastics?

The support scale at ring height, the swallow, is a difficult strength element, usually performed in gymnastics. Coaches try to simulate the swallow position during training to strengthen muscles, specifically in the position used for competition. However, the real effect of this position's simulation on muscle force and coordination and consequently on the muscle activity has not been determined. The purpose of the study was to compare muscle activity and coordination during a swallow performed on the rings, using a counterweight and during 2 training exercises using dumbbells or barbells, respectively. Six top-level gymnasts participated in the study. Electromyograms from the biceps brachii, triceps brachii, deltoideus (clavicular part), pectoralis major, serratus anterior, infraspinatus, trapezius (middle part), and latissimus dorsi in the right shoulder were collected during the 4 exercises and analyzed using root mean square (RMS) and mean power frequency (MPF). The RMS were normalized to the maximal voluntary contraction, and a co-activation index was also determined between biceps and triceps brachii. Our results show specific shoulder muscle coordination for each exercise. As compared with the swallow on the rings, the pectoralis major participates less in shoulder flexion during the counterweight exercise, whereas the deltoideus is more activated during the dumbbells exercise (p < 0.05). The barbell exercise reduces the participation of the serratus anterior in stabilizing the scapula (p < 0.05). Training exercises must therefore be chosen with knowledge of the specific muscle coordination induced by each. The counterweight exercise preserves the pectoralis major. The barbell exercise reduces participation of the serratus anterior. The dumbbells exercise may be useful to prepare the rotator cuff muscles carefully for use.

Aerobic exercise for axial spondyloarthritis - its effects on disease activity and function as compared to standard physiotherapy: A systematic review and meta-analysis.

AIM: To evaluate the impact of an aerobic fitness program on disease activity, defined by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and on C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and the Bath Ankylosing Spondylitis Functional Index (BASFI) in case of axial spondyloarthritis. METHODS: A systematic review of the literature, following the Prisma recommendations, was performed by two reviewers on the PubMed and Embase databases. Controlled trials assessing the efficacy of aerobic exercises compared to physiotherapy on axial spondyloarthritis disease activity were included. The diagnosis of axial spondyloarthritis was meeting the New York criteria and/or the Assessment in Axial Spondyloarthritis International Working Group criteria. Aerobic fitness was defined as an exercise performed at 50%-90% of the maximal heart rate or between 50% and 80% oxygen consumption (VO2 ) peak. RESULTS: Five hundred and twenty abstracts were identified and 93 abstracts were analyzed. Eight studies met the selection criteria and 6 were finally included in this study because of the presence of a control group. Both groups were similar in terms of age, sex ratio, disease duration. Aerobic exercise provided a positive impact on the BASDAI in the intervention group (148 patients) (weighted mean difference [WMD]: -0.52 [95% CI: -0.9 to -0.13]) (I2 : 10.3%, P = 0.35). However, when compared to a control group (152 patients), the improvement of BASDAI didn't reach significance (WMD: -0.25 [95% CI: -0.83 to 0.32]) (I2 : 0%, P = 0.41). Aerobic exercise did not improve BASFI, CRP or ESR. CONCLUSION: Aerobic exercise did not provide beneficial effects either on disease activity or on physical function and biological parameters when compared to a control group in axial spondyloarthritis.

Cryotherapy decreases synovial Doppler activity and pain in knee arthritis: A randomized-controlled trial.

OBJECTIVE: To measure and compare the effects of 2 local cryotherapy techniques on synovial power Doppler activity (primary outcome) and pain in non-septic knee arthritis without any concurrent treatment. METHODS: 30 patients were randomized (ice: 30min, n=15 or cold CO2: 2min, n=15 both applied twice at 8h interval). Contralateral non-treated arthritic knees were used as paired controls (n=11 and n=10 respectively). The PDUS semi-quantitative score (0-3) and pain visual analogic scale were evaluated before/after each cold application, 2min, 2h, 24h after the first application. PDUS scores were checked in double-blind by 2 ultrasonographists. RESULTS: The inter-class effect size of local cryotherapy on the power Doppler score remained significant the day after treatment in local cryotherapy-treated compared to contralateral non-treated knees (Global difference: -1 [95% confidence interval: -1.23; -0.77]; ice: -0.73 [-1.06; -0.4]; CO2: -0.7 [-1.18; -0.22]). Both techniques significantly and to the same extent reduced the power Doppler score and pain visual analogic scale at all evaluation times and globally throughout the 24 hour-study period. No dropout nor adverse event was reported. In multivariate analysis, the Power Doppler score decrease was associated with pain decrease, while pain decrease was associated with the female sex and ice technique. CONCLUSION: Local ice and cold CO2 applied twice equally reduced synovial Power Doppler activity and pain over 24h in knee arthritis. These effects remained significant the day after treatment. ClinicalTrials.gov identifier: NCT02573298.

Divergent endothelial function but similar platelet microvesicle responses following eccentric and concentric cycling at a similar aerobic power output.

Endothelial function and microvesicle concentration changes after acute bouts of continuous eccentric exercise have not been assessed previously nor compared with concentric exercise at similar aerobic power outputs. This method of training may be useful among some clinical populations, but acute responses are not well described. As such, 12 healthy males completed 2 experimental sessions of either 45 min of eccentric or concentric cycling at a matched aerobic power output below the ventilatory threshold. Brachial artery vascular function was assessed throughout 5 min of forearm ischemia and 3 min thereafter, before and at 5 and 40 min of recovery following each exercise session [flow-mediated dilation (FMD)]. Venous blood samples were acquired before each vascular function assessment. FMD significantly decreased after eccentric cycling by 40 min of recovery (P < 0.05), but was unaltered after concentric exercise. No differences in peak hyperemic blood flow velocity occurred neither between modalities nor at any time point (P > 0.05). Platelet-derived microvesicles increased by ~20% after both exercise modalities (P < 0.05) while endothelial-derived microvesicles were unchanged (P > 0.05). Moderate relationships with cardiac output, a surrogate for shear stress, and norepinephrine were apparent (P < 0.05), but there were no relationships with inflammatory or acute phase proteins. In summary, eccentric endurance exercise induced macrovascular endothelial dysfunction; however, endothelial activation determined by endothelial microvesicles did not occur suggesting that this modality may induce oxidative stress but no significant endothelial damage. In addition, the increase in platelet microvesicle concentrations may induce beneficial microvascular adaptations as suggested by previous research.NEW & NOTEWORTHY Continuous eccentric cycling exercise induces substantial skeletal muscle, tendon, and bone strain providing a potentially beneficial stimulus among clinical populations. This modality also induces temporary endothelial dysfunction but no apparent damage or activation of the endothelium indicated by microvesicle production, whereas proangiogenic platelet microvesicles are released similarly following both concentric and eccentric cycling and may relate to the shear stress and catecholamine response to exercise.

The practice of physical activity and cryotherapy in rheumatoid arthritis: systematic review.

INTRODUCTION: Rheumatoid arthritis (RA) is an autoimmune, chronic and inflammatory disease, which the affected patients present a higher cardiovascular mortality rate. Physical activities have been identified as the most important strategy to prevent cardiovascular diseases. However, the articular damage and the chronic pain caused by RA challenges its regular practice. Moreover, persons with RA tend to avoid PA due to the fear of exacerbating the inflammatory potential and pain. One alternative to avoid the collateral effects of the PA could be the cryotherapy. Therefore, this study aimed to review studies focused on the use of both PA and cryotherapy in RA patients and to identify evidences that both therapies could be combined in order to optimize the symptomatic treatment. EVIDENCE ACQUISITION: Four databases (MEDLINE, CINAHL, Elsevier and PEDro) were searched to identify publications regarding RA patients, PA and cryotherapy intervention by the terms and operators (rheumatoid arthritis AND exercise OR physical activity OR activity OR training OR reconditioning OR cryotherapy OR cold OR immersion). The selected studies should at least present one measure of the aerobic capacity, disease activity or pain relief. Among 19 studies with RA patients identified, only 4 studies used PA combined with cryotherapy. The other 13 studies used physical activities and 2 studies used cryotherapy intervention. EVIDENCE SYNTHESIS: The results of the physical activities combined with cryotherapy studies showed an improvement in the disease activity and pain relief, however without details of the physical activities intervention and an aerobic capacity. Among the physical activities studies, evidence was found suggesting that aerobic exercises and multiactivity exercises with high intensity are the more effective for improve the aerobic capacity. CONCLUSIONS: Even if few studies on cryotherapy were found, there are enough evidences in the literature that demonstrate the benefits of this intervention on pain relief and disease activity. In summary, neither study found associated physical activities to improve aerobic capacity with cryotherapy to improve disease activity and pain relief. This may be an innovative therapeutic strategy to improve the aerobic capacity in arthritis patients and consequently reduce their cardiovascular risk while minimizing pain and disease activity.