The Day-by-Day Periodization Strategies of a Giro d'Italia Podium Finisher.

PURPOSE: The aim of this study was to describe the day-by-day training and racing characteristics in preparation for the Giro d'Italia of 1 world-class road cyclist who achieved a place on the podium in the final general classification of the Giro d'Italia. METHODS: Day-by-day power meter training and racing data of 1 study subject (road cyclist; age 25 y; relative maximum oxygen consumption 81 mL·min-1·kg-1; relative 20-min record power output 6.6 W·kg-1) covering the 152 days leading up to the podium in the Giro d'Italia final general classification were retrospectively analyzed. Daily load, daily volume, and intensity distribution were considered. RESULTS: During training a pattern alternating "hard days" versus "easy days" was observed, as significant amounts of medium or high intensity, or load, were not performed for more than 2 consecutive days This pattern was achieved combining high volume (>4 h) with a significant amount of medium and high intensity within the same training sessions. During training, when training load and intensity increased, the density of "easy days" augmented. In 1-week stage races and the Giro d'Italia, 3 to 8 consecutive days with significant amounts of medium and high intensity were performed. A high number of training sessions with small amounts of medium- and high-intensity volume was observed: 38 days accumulating 3 to 10 minutes at medium intensity and 29 days spending 1 to 9 minutes at high intensity. CONCLUSION: These data provide novel insights about the day-by-day periodization strategies leading to a top 3 in the Giro d'Italia general classification.

Effects of a Partially Supervised Conditioning Program in Cystic Fibrosis: An International Multicenter, Randomized Controlled Trial (ACTIVATE-CF).

Rationale: The long-term effects of vigorous physical activity (PA) on lung function in cystic fibrosis are unclear. Objectives: To evaluate effects of a 12-month partially supervised PA intervention using motivational feedback. Methods: In a parallel-arm multicenter randomized controlled trial (ACTIVATE-CF), relatively inactive patients aged at least 12 years were randomly assigned (1:1 ratio) to an intervention group or control group. The intervention group consented to add 3 hours of vigorous PA per week, whereas the control group was asked not to change their PA behavior. Primary endpoint was change in percent predicted FEV1 (ΔFEV1) at 6 months. Secondary endpoints included PA, exercise capacity, exercise motives, time to first exacerbation and exacerbation rates, quality of life, anxiety, depression, stress, and blood glucose control. Data were analyzed using mixed linear models. Measurements and Main Results: A total of 117 patients (40% of target sample size) were randomized to an intervention (n = 60) or control group (n = 57). After 6 months, ΔFEV1 was significantly higher in the control group compared with the intervention group (2.70% predicted [95% confidence interval, 0.13-5.26]; P = 0.04). The intervention group reported increased vigorous PA compared with the control group at each study visit, had higher exercise capacity at 6 and 12 months, and higher PA at 12 months. No effects were seen in other secondary outcomes. Conclusions: ACTIVATE-CF increased vigorous PA and exercise capacity, with effects carried over for the subsequent 6 months, but resulted in better FEV1 in the control group.

Prehabilitation exercise therapy before elective abdominal aortic aneurysm repair.

BACKGROUND: An abdominal aortic aneurysm (AAA) is an abnormal dilation in the diameter of the abdominal aorta of 50% or more of the normal diameter or greater than 3 cm in total. The risk of rupture increases with the diameter of the aneurysm, particularly above a diameter of approximately 5.5 cm. Perioperative and postoperative morbidity is common following elective repair in people with AAA. Prehabilitation or preoperative exercise is the process of enhancing an individual's functional capacity before surgery to improve postoperative outcomes. Studies have evaluated exercise interventions for people waiting for AAA repair, but the results of these studies are conflicting. OBJECTIVES: To assess the effects of exercise programmes on perioperative and postoperative morbidity and mortality associated with elective abdominal aortic aneurysm repair. SEARCH METHODS: We searched the Cochrane Vascular Specialised register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Physiotherapy Evidence Database (PEDro) databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 6 July 2020. We also examined the included study reports' bibliographies to identify other relevant articles. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) examining exercise interventions compared with usual care (no exercise; participants maintained normal physical activity) for people waiting for AAA repair. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, assessed the included studies, extracted data and resolved disagreements by discussion. We assessed the methodological quality of studies using the Cochrane risk of bias tool and collected results related to the outcomes of interest: post-AAA repair mortality; perioperative and postoperative complications; length of intensive care unit (ICU) stay; length of hospital stay; number of days on a ventilator; change in aneurysm size pre- and post-exercise; and quality of life. We used GRADE to evaluate certainty of the evidence. For dichotomous outcomes, we calculated the risk ratio (RR) with the corresponding 95% confidence interval (CI). MAIN RESULTS: This review identified four RCTs with a total of 232 participants with clinically diagnosed AAA deemed suitable for elective intervention, comparing prehabilitation exercise therapy with usual care (no exercise). The prehabilitation exercise therapy was supervised and hospital-based in three of the four included trials, and in the remaining trial the first session was supervised in hospital, but subsequent sessions were completed unsupervised in the participants' homes. The dose and schedule of the prehabilitation exercise therapy varied across the trials with three to six sessions per week and a duration of one hour per session for a period of one to six weeks. The types of exercise therapy included circuit training, moderate-intensity continuous exercise and high-intensity interval training. All trials were at a high risk of bias. The certainty of the evidence for each of our outcomes was low to very low. We downgraded the certainty of the evidence because of risk of bias and imprecision (small sample sizes). Overall, we are uncertain whether prehabilitation exercise compared to usual care (no exercise) reduces the occurrence of 30-day (or longer if reported) mortality post-AAA repair (RR 1.33, 95% CI 0.31 to 5.77; 3 trials, 192 participants; very low-certainty evidence). Compared to usual care (no exercise), prehabilitation exercise may decrease the occurrence of cardiac complications (RR 0.36, 95% CI 0.14 to 0.92; 1 trial, 124 participants; low-certainty evidence) and the occurrence of renal complications (RR 0.31, 95% CI 0.11 to 0.88; 1 trial, 124 participants; low-certainty evidence). We are uncertain whether prehabilitation exercise, compared to usual care (no exercise), decreases the occurrence of pulmonary complications (RR 0.49, 95% 0.26 to 0.92; 2 trials, 144 participants; very low-certainty evidence), decreases the need for re-intervention (RR 1.29, 95% 0.33 to 4.96; 2 trials, 144 participants; very low-certainty evidence) or decreases postoperative bleeding (RR 0.57, 95% CI 0.18 to 1.80; 1 trial, 124 participants; very low-certainty evidence). There was little or no difference between the exercise and usual care (no exercise) groups in length of ICU stay, length of hospital stay and quality of life. None of the studies reported data for the number of days on a ventilator and change in aneurysm size pre- and post-exercise outcomes. AUTHORS' CONCLUSIONS: Due to very low-certainty evidence, we are uncertain whether prehabilitation exercise therapy reduces 30-day mortality, pulmonary complications, need for re-intervention or postoperative bleeding. Prehabilitation exercise therapy might slightly reduce cardiac and renal complications compared with usual care (no exercise). More RCTs of high methodological quality, with large sample sizes and long-term follow-up, are needed. Important questions should include the type and cost-effectiveness of exercise programmes, the minimum number of sessions and programme duration needed to effect clinically important benefits, and which groups of participants and types of repair benefit most.

Effects of multimodal prehabilitation on muscle size, myosteatosis, and dietary intake of surgical patients with lung cancer - a randomized feasibility study.

Many patients with lung cancer undergo surgery, which can increase the risk for muscle loss, leading to worsened outcomes. A multimodal prehabilitation intervention integrating dietary and muscle assessment may help clinicians better understand changes in these outcomes. This pilot assessed feasibility of multimodal prehabilitation in early-stage surgical lung cancer patients and explored relationships between body composition, muscle characteristics and dietary intake, as well as muscle changes due to prehabilitation. Patients were randomized to 1 of 2 groups: multimodal prehabilitation including nutritional supplements (fish oil with vitamin D3 + whey protein with leucine), exercise and relaxation, or standard of care. Physical function, dietary intake and muscle were evaluated at 0 and 4 weeks pre-operatively. Of 87 patients assessed for eligibility, 34 (39%) were randomized and 3 (9%) were lost to follow-up. Median age was 69 years and baseline protein intake was 1.0 g/kg/day. Adherence to exercise (86%) and supplements was high (93%); 3 patients (16%) reported side effects. Supplements significantly increased protein, omega-3 fatty acid, leucine and vitamin D intake. There were no significant changes in muscle characteristics. Multimodal prehabilitation with dietary and muscle analyses proved to be feasible. An adequately powered randomized controlled trial is warranted. ClinicalTrials.gov registration no: NCT04610606. Novelty: Multimodal prehabilitation incorporating dietary assessment and muscle analysis is feasible for early-stage surgical lung cancer patients. An adequately powered randomized controlled trial is warranted to further explore functional and post-operative outcomes.

Effects of Including Sprints in LIT Sessions during a 14-d Camp on Muscle Biology and Performance Measures in Elite Cyclists.

PURPOSE: This study investigated the effects of including sprints within low-intensity training (LIT) sessions during a 14-d training camp focusing on LIT, followed by 10-d recovery (Rec), on performance and performance-related measures in elite cyclists. METHODS: During the camp, a sprint training group (SPR; n = 9) included 12 × 30-s maximal sprints during five LIT sessions, whereas a control group (CON; n = 9) performed distance-matched LIT only. Training load was equally increased in both groups by 48% ± 27% during the training camp and subsequently decreased by -56% ± 23% during the recovery period compared with habitual training. Performance tests were conducted before the training camp (Pre) and after Rec. Muscle biopsies, hematological measures, and stress/recovery questionnaires were collected Pre and after the camp (Post). RESULTS: Thirty-second sprint (SPR vs CON: 4% ± 4%, P < 0.01) and 5-min mean power (SPR vs CON: 4% ± 8%, P = 0.04) changed differently between groups. In muscle, Na+-K+ ß1 protein content changed differently between groups, decreasing in CON compared with SPR (-8% ± 14%, P = 0.04), whereas other proteins showed similar changes. SPR and CON displayed similar increases in red blood cell volume (SPR: 2.6% ± 4.7%, P = 0.07; CON: 3.9% ± 4.5%, P = 0.02) and V˙O2 at 4 mmol·L-1 [BLa-] (SPR: 2.5% ± 3.3%, P = 0.03; CON: 2.2% ± 3.0%, P = 0.04). No changes were seen for V˙O2max, Wmax, hematological measures, muscle enzyme activity, and stress/recovery measures. CONCLUSIONS: Inclusion of 30-s sprints within LIT sessions during a high-volume training camp affected competition-relevant performance measures and Na+-K+ ß1 protein content differently from LIT only, without affecting sport-specific stress/recovery or any other physiological measure in elite cyclists.

The role of age in the physiological adaptations and psychological responses in bikini-physique competitor contest preparation: a case series.

The increased popularity of the bikini-physique competitions has not translated to greater research identifying the influence of age on adaptations during contest preparation. The purpose of this case series was to observe how age may influence the adaptations normally seen during preparation and the exploration of newer protocols to address adaptations more relative to the judging standards. Over a 16-week pre-contest preparation, a 32-y bikini competitor (BC) and 44-y master's bikini competitor (MBC) visited the laboratory bi-weekly to observe changes in body fat mass (BF), lean body mass (LBM), bone mineral density (BMD), total body water (TBW); exploratory measures of deltoid cross-sectional area (DeltCSA), gluteus maximus muscle thickness (GMMT), and subcutaneous adipose tissue thickness (SAT); reproductive hormones estradiol (E2), luteinizing hormone (LH), and energy balance hormones triiodothyronine (T3), leptin and ghrelin; hydration status during contest preparation and the week of competition; resting metabolic rate (RMR); psychometric data related to perceived anxiety, stress, and body image were assessed. No differences between BC and MBC were observed in BF, LBM, BMD, and TBW. Both competitors showed a small loss in LBM. Both BC and MBC showed a contrasting increase in DeltCSA and a loss in GMMT. MBC showed to be slightly more dehydrated (1.025 vs 1.021 g·mL- 1) than BC. Both competitors maintained a euhydration status the day of the competition. No time differences were found between BC and MBC during RMR. BC showed a higher mean difference RMR compared to MBC (2.66 ± 0.75 kcal·kgLBM- 1·d- 1). MBC showed a higher mean difference in LH concentration (84.6 ± 6.01 IU·L- 1), which may be explained by perimenopausal status. MBC had a higher mean difference concentration of leptin (2.51 ± 0.24 ng·mL- 1·kgFM- 1), which was unperturbed by fat loss may be interrelated LH. BC self-reported a higher mean energy intake (15.07 ± 3.43 kcal·kgLBM- 1·d- 1) and higher aerobic training volume (93.26 ± 40.68 min·d). BC and MBC showed similar composition changes, slightly differing metabolic rates, and differing hormonal LH and leptin responses. This finding is in contrast to previous work showing both LH inhibition and leptin diurnal disturbance in younger, female athletes with low energy availability. The exploratory measures may have some benefit for bikini-physique competitors related to the judging criteria. Age did not seem to play a role in contest preparation adaptations.

Small-sided games as additional training in elite basketball nonstarters players / Juegos reducidos como entrenamiento adicional para jugadores suplentes de baloncesto de élite / Jogo reduzido como treino adicional para jogadores reservas de basquetebol de elite

ABSTRACT Introduction: Among the main challenges faced by coaches of team sports are to create an environment and conditions that will enable players to reach their optimal level of physical performance at the start of the competitive season, and to maintain this level throughout the season. Objective: The purpose of this study was to assess the effects of six weeks of additional training with 3-against-3 (3v3) small-sided games (SSG) on the physical performance of elite nonstarter basketball players. Methods: Eleven professional basketball players (five starters and six nonstarters) performed the same training program throughout the regular season, with the only difference that after each game, the starters (S) performed low intensity shooting drills while the nonstarters (NS) performed half-court 3v3 SSG. At the start and end of the six-week period, the athletes were assessed for muscle power, speed, agility and aerobic power. Two-way analysis of variance and effect sizes were used. Magnitude-based inferential analyses were used to complement the parametric tests. Results: After the six weeks, the S and NS showed improvement (p<0.05) in the squat jump (S=5.8% and NS=7.1%), counter movement jump (S=3.7% and NS=3.6%), 20m-sprint (S=3.4% and NS=2.0%), agility T test (S=3.6% and NS=3.1%) and Yo-yo intermittent recovery (S=5.2% and NS=2.5%). No differences were found between groups and moments. The effect sizes showed moderate effect on agility and little effect on jumping ability, for both groups; moderate, for S, and little, for NS, on speed and aerobic conditioning. Magnitude-based inferences indicated that S were likely to outperform NS in terms of improvement in 20-m sprint ability and possibly also in agility. In regard to the other physical performance variables, the analyses of magnitude-based inferences were inconclusive. Conclusions: The results of this study showed that 3v3 SSG in the short-term on half-court, as an additional training routine for NS, can bring positive results for the physical performance for these players. Level of evidence II; Investigating the Results of Treatment.

RESUMEN Introducción: Uno de los principales desafíos de los entrenadores de deportes colectivos es crear ambiente y las condiciones que permitan a los jugadores alcanzar su nivel ideal de desempeño físico al inicio de la temporada competitiva y mantener ese nivel a lo largo de la temporada. Objetivos: El objetivo de este estudio fue evaluar los efectos de seis semanas de entrenamiento adicional con juegos reducidos (JR) 3 contra 3 (3x3) sobre el desempeño físico de jugadores suplentes del baloncesto de élite. Métodos: Once jugadores profesionales (cinco titulares y seis suplentes) realizaron el mismo programa de entrenamiento durante la temporada regular, con la única diferencia de que, después de cada partido, los titulares (T) realizaban ejercicios de lanzamiento de baja intensidad, mientras que los suplentes (S) realizaban JR 3x3 en media cancha. Al inicio y al final de cada período de seis semanas los atletas fueron evaluados en cuanto a la potencia muscular, velocidad, agilidad y potencia aeróbica. Fueron usados análisis de variancia y tamaños de efecto de dos vías. Fueron usados análisis inferenciales basados en magnitud para complementar los tests paramétricos. Resultados: Después de seis semanas, el grupo T y el S mostraron mejora (p <0,05) en el salto con agachamiento (T = 5,8% y S = 7,1%), salto contramovimiento (T = 3,7% y S = 3,6%), sprint de 20 metros (T = 3,4% y S = 2,0%), test T de agilidad (T = 3,6% y S = 3,1%) y el test de recuperación intermitente Yo-yo (T = 5,2% y S = 2,5%). No fueron encontradas diferencias entre grupos y momentos. Los tamaños de efecto mostraron efecto moderado en la agilidad y pequeño efecto en la capacidad de salto para ambos grupos; efecto moderado para el grupo T y pequeño para el S, en la velocidad y acondicionamiento aeróbico. Las inferencias basadas en la magnitud indicaron que el grupo T probablemente superaría al grupo S en términos de mejora de la habilidad de sprint de 20 metros y posiblemente también en agilidad. El análisis de las inferencias basadas en magnitud no fue concluyente con relación a las otras variables. Conclusiones: Los resultados de este estudio mostraron que JR 3x3 en media cancha como entrenamiento adicional para el grupo S puede ser positivo para el desempeño físico de esos jugadores. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento .

RESUMO Introdução: Um dos principais desafios dos treinadores de esportes coletivos é criar ambiente e as condições que permitam aos jogadores atingir seu nível ideal de desempenho físico no início da temporada competitiva e manter esse nível ao longo da temporada. Objetivos: O objetivo deste estudo foi avaliar os efeitos de seis semanas de treinamento adicional com jogo reduzido (JR) 3 contra 3 (3x3) sobre o desempenho físico de jogadores reservas do basquetebol de elite. Métodos: Onze jogadores profissionais de basquetebol (cinco titulares e seis reservas) realizaram o mesmo programa de treinamento durante a temporada regular, com a única diferença de que, depois de cada jogo, os titulares (T) realizavam exercícios de arremesso de baixa intensidade, enquanto os reservas (R) realizavam JR 3x3 em meia quadra. No início e no final do período de seis semanas, os atletas foram avaliados quanto à potência muscular, velocidade, agilidade e potência aeróbica. Foram usadas análises de variância e tamanhos de efeito de duas vias. As análises inferenciais baseadas em magnitude foram usadas para complementar os testes paramétricos. Resultados: Depois das seis semanas, o grupo T e o R mostraram melhora (p < 0,05) no salto com agachamento (T = 5,8% e R = 7,1%), salto contramovimento (T = 3,7% e R = 3,6%), sprint de 20 metros (T = 3,4% e R = 2,0%), teste T de agilidade (T = 3,6% e R = 3,1%) e o teste de recuperação intermitente Yo-yo (T = 5,2% e R = 2,5%). Não foram encontradas diferenças entre grupos e momentos. Os tamanhos de efeito mostraram efeito moderado na agilidade e pequeno efeito na capacidade de salto para ambos os grupos; efeito moderado para o grupo T e pequeno para o R na velocidade e condicionamento aeróbico. Inferências baseadas na magnitude indicaram que o grupo T provavelmente superaria o grupo R em termos de melhora da habilidade de sprint de 20 m e possivelmente também em agilidade. A análise das inferências baseadas em magnitude foi inconclusiva em relação às outras variáveis. Conclusões: Os resultados deste estudo mostraram que o JR 3x3 em meia quadra como treinamento adicional para o grupo R pode ser positivo para o desempenho físico desses jogadores. Nível de evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento .

Exercise-based cardiac rehabilitation for adults after heart valve surgery.

BACKGROUND: The impact of exercise-based cardiac rehabilitation (CR) following heart valve surgery is uncertain. We conducted an update of this systematic review and a meta-analysis to assess randomised controlled trial evidence for the use of exercise-based CR following heart valve surgery. OBJECTIVES: To assess the benefits and harms of exercise-based CR compared with no exercise training in adults following heart valve surgery or repair, including both percutaneous and surgical procedures. We considered CR programmes consisting of exercise training with or without another intervention (such as an intervention with a psycho-educational component). SEARCH METHODS: We searched the Cochrane Central Register of Clinical Trials (CENTRAL), in the Cochrane Library; MEDLINE (Ovid); Embase (Ovid); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO); PsycINFO (Ovid); Latin American Caribbean Health Sciences Literature (LILACS; Bireme); and Conference Proceedings Citation Index-Science (CPCI-S) on the Web of Science (Clarivate Analytics) on 10 January 2020. We searched for ongoing trials from ClinicalTrials.gov, Clinical-trials.com, and the World Health Organization International Clinical Trials Registry Platform on 15 May 2020. SELECTION CRITERIA: We included randomised controlled trials that compared exercise-based CR interventions with no exercise training. Trial participants comprised adults aged 18 years or older who had undergone heart valve surgery for heart valve disease (from any cause) and had received heart valve replacement or heart valve repair. Both percutaneous and surgical procedures were included. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data. We assessed the risk of systematic errors ('bias') by evaluating risk domains using the 'Risk of bias' (RoB2) tool. We assessed clinical and statistical heterogeneity. We performed meta-analyses using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence for primary outcomes (all-cause mortality, all-cause hospitalisation, and health-related quality of life). MAIN RESULTS: We included six trials with a total of 364 participants who have had open or percutaneous heart valve surgery. For this updated review, we identified four additional trials (216 participants). One trial had an overall low risk of bias, and we classified the remaining five trials as having some concerns. Follow-up ranged across included trials from 3 to 24 months. Based on data at longest follow-up, a total of nine participants died: 4 CR versus 5 control (relative risk (RR) 0.83, 95% confidence interval (CI) 0.26 to 2.68; 2 trials, 131 participants; GRADE quality of evidence very low). No trials reported on cardiovascular mortality. One trial reported one cardiac-related hospitalisation in the CR group and none in the control group (RR 2.72, 95% CI 0.11 to 65.56; 1 trial, 122 participants; GRADE quality of evidence very low). We are uncertain about health-related quality of life at completion of the intervention in CR compared to control (Short Form (SF)-12/36 mental component: mean difference (MD) 1.28, 95% CI -1.60 to 4.16; 2 trials, 150 participants; GRADE quality of evidence very low; and SF-12/36 physical component: MD 2.99, 95% CI -5.24 to 11.21; 2 trials, 150 participants; GRADE quality of evidence very low), or at longest follow-up (SF-12/36 mental component: MD -1.45, 95% CI -4.70 to 1.80; 2 trials, 139 participants; GRADE quality of evidence very low; and SF-12/36 physical component: MD -0.87, 95% CI -3.57 to 1.83; 2 trials, 139 participants; GRADE quality of evidence very low).  AUTHORS' CONCLUSIONS: Due to lack of evidence and the very low quality of available evidence, this updated review is uncertain about the impact of exercise-CR in this population in terms of mortality, hospitalisation, and health-related quality of life. High-quality (low risk of bias) evidence on the impact of CR is needed to inform clinical guidelines and routine practice.

Impact of baseline serum ferritin and supplemental iron on altitude-induced hemoglobin mass response in elite athletes.

The present study explored the impact of pre-altitude serum (s)-ferritin and iron supplementation on changes in hemoglobin mass (ΔHbmass) following altitude training. Measures of Hbmass and s-ferritin from 107 altitude sojourns (9-28 days at 1800-2500 m) with world-class endurance athletes (males n = 41, females n = 25) were analyzed together with iron supplementation and self-reported illness. Altitude sojourns with a hypoxic dose [median (range)] of 1169 (912) km·h increased Hbmass (mean ± SD) 36 ± 38 g (3.7 ± 3.7%, p < 0.001) and decreased s-ferritin -11 (190) µg·L-1 (p = 0.001). Iron supplements [27 (191) mg·day-1 ] were used at 45 sojourns (42%), while only 11 sojourns (10%) were commenced with s-ferritin <35 µg/L. Hbmass increased by 4.6 ± 3.7%, 3.4 ± 3.3%, 4.2 ± 4.3%, and 2.9 ± 3.4% with pre-altitude s-ferritin ≤35 µg·L-1 , 36-50 µg·L-1 , 51-100 µg·L-1 , and >100 µg·L-1 , respectively, with no group difference (p = 0.400). Hbmass increased by 4.1 ± 3.9%, 3.0 ± 3.0% and 3.7 ± 4.7% without, ≤50 mg·day-1 or >50 mg·day-1 supplemental iron, respectively (p = 0.399). Linear mixed model analysis revealed no interaction between pre-altitude s-ferritin and iron supplementation on ΔHbmass (p = 0.906). However, each 100 km·h increase in hypoxic dose augmented ΔHbmass by an additional 0.4% (95% CI: 0.1-0.7%; p = 0.012), while each 1 g·kg-1 higher pre-altitude Hbmass reduced ΔHbmass by -1% (-1.6 to -0.5; p < 0.001), and illness lowered ΔHbmass by -5.7% (-8.3 to -3.1%; p < 0.001). In conclusion, pre-altitude s-ferritin or iron supplementation were not related to the altitude-induced increase in Hbmass (3.7%) in world-class endurance athletes with clinically normal iron stores.

Can exercise training enhance the repeated remote ischaemic preconditioning stimulus on peripheral and cerebrovascular function in high-risk individuals?

BACKGROUND: Repeated exposure to remote ischaemic preconditioning (rIPC; short bouts of non-lethal ischaemia) enhances peripheral vascular function within 1 week; whereas, longer periods of rIPC (~ 1 year) may improve cerebral perfusion. Increasing the 'dose' of rIPC may lead to superior effects. Given the similarities between exercise and rIPC, we examined whether adding exercise to the rIPC stimulus leads to greater adaptation in systemic vascular function. METHODS: Nineteen individuals with increased risk for cardiovascular disease (CVD) were randomly allocated to either 8 weeks of rIPC (n = 9) or 8 weeks of rIPC + exercise (rIPC + Ex) (n = 10). rIPC was applied three times per week in both conditions, and exercise consisted of 50 min (70% heart rate max) of cycling 3 times per week. Peripheral endothelial function was assessed using flow-mediated dilation (FMD) before and after ischaemia-reperfusion (IR). Cerebrovascular function was assessed by dynamic cerebral autoregulation (dCA) and cerebrovascular reactivity (CVR), and cardio-respiratory fitness (VO2peak) using a maximal aerobic capacity test. RESULTS: FMD% increased by 1.6% (95% CI, 0.4, 2.8) following rIPC + Ex and by 0.3% (- 1.1, 1.5) in the only rIPC but this did not reach statistical significance (P = 0.65). Neither intervention evoked a change in dCA or in CVR (P > 0.05). VO2peak increased by 2.8 ml/kg/min (1.7, 3.9) following the rIPC + Ex and by 0.1 ml/kg/min (- 1.0, 1.4) following the rIPC only intervention (P = 0.69). CONCLUSION: Combining exercise with rIPC across an 8-week intervention does not lead to superior effects in cerebrovascular and peripheral vascular function compared to a repeated rIPC intervention in individuals at risk of CVD.

Physical training and exercise in myasthenia gravis.

Myasthenia gravis is characterized by muscle weakness and fatigue. As sustained muscle use increases the weakness, the value of physical training programs has previously been questioned. This is a review to clarify the safety and usefulness of systematic training in myasthenia gravis, based on a systematic search in available databases using the relevant key words. Ten intervention studies including 159 patients with generalized disease have been published regarding the effect of systematic physical training, three of them on respiratory muscles. Muscle strength improved, and in the majority of the studies also daily function and quality of life. The feeling of fatigue not directly related to actual muscle weakness was less influenced by physical training. Continuous training was necessary to maintain the improved function. Physical training and exercise are safe in myasthenia gravis. This can improve both muscle strength and daily function. Type and intensity of systematic training should be adapted in the individual patient. A minimum of 150 min of exercise per week is recommended for myasthenia gravis patients with mild and moderate disease.

Physiological and Metabolic Responses to Exercise on Treadmill, Elliptical Trainer, and Stepper: Practical Implications for Training.

Elliptical trainers and steppers are proposed as useful exercise modalities in the rehabilitation of injured runners due to the reduced stress on muscles and joints when compared to running. This study compared the physiological responses to submaximal running (treadmill) with exercise on the elliptical trainer and stepper devices at three submaximal but identical workloads. Authors had 18 trained runners (male/female: N = 9/9, age: mean ± SD = 23 ± 3 years) complete randomized maximal oxygen consumption tests on all three modalities. Submaximal tests of 3 min were performed at 60%, 70%, and 80% of peak workload individually established for each modality. Breath-by-breath oxygen consumption, heart rate, fuel utilization, and energy expenditure were determined. The value of maximal oxygen consumption was not different between treadmill, elliptical, and stepper (49.3 ± 5.3, 48.0 ± 6.6, and 46.7 ± 6.2 ml·min-1·kg-1, respectively). Both physiological measures (oxygen consumption and heart rate) as well as carbohydrate and fat oxidation differed significantly between the different exercise intensities (60%, 70%, and 80%) but did not differ between the treadmill, elliptical trainer, and stepper. Therefore, the elliptical trainer and stepper are suitable substitutes for running during periods when a reduced running load is required, such as during rehabilitation from running-induced injury.

Can Exercise Targeting Mid-Thoracic Spine Segmental Movement Reduce Back Pain and Improve Sensory Perception in Cross-Country Skiers?

OBJECTIVE: To assess the role of exercise targeting proper trunk stabilization and segmental spinal movement in back pain and sensory perception among cross-country skiers. DESIGN: Randomized, controlled trial with blinded outcome assessors. SETTING: University Hospital, Department of Rehabilitation and Sports Medicine. PARTICIPANTS: Twenty elite cross-country skiers aged 17 to 27 years. INTERVENTIONS: Ten cross-country skiers integrated 3 types of exercise targeting segmental motion in mid-thoracic spine into their routine training practice for 2 months. The 10 controls performed routine athletic training. MAIN OUTCOME MEASURES: The Young Spine Questionnaire to measure intensity and frequency of back pain was completed at the start and end of study. Tactile sensory perception using 10-g Semmes-Weinstein monofilament, thermic perception using TIP THERM device, graphesthesia assessed by a touch monitor pencil, 2-point discrimination assessed by a digital caliper, and vibration perception assessed by a 128-Hz tuning fork measured in mid-thoracic spine 5 times. RESULTS: No significant group differences in pain and sensory perception were identified at baseline. Over the 2-month study interval, repeated-measures analysis of variance revealed that the experimental group improved significantly relative to the control group on pain intensity (P = 0.005 for cervical, P = 0.004 for thoracic, and P = 0.014 for lumbar) and frequency of pain in the thoracic area only (P = 0.011). Improvements were also observed in the experimental relative to control group on graphesthesia (P < 0.001), vibration perception (P = 0.002), and 2-point discrimination (P < 0.001). CONCLUSIONS: Exercise targeting the mid-thoracic spine may decrease back pain and improve sensory perception in cross-country skiers. LEVEL OF EVIDENCE: Original research, level I.

Postactivation Potentiation Effect of Heavy Sled Towing on Subsequent Sprints.

ABSTRACT: Williams, JJ, Heron, R, Spradley, B, and Saracino, P. Postactivation potentiation effect of heavy sled towing on subsequent sprints. J Strength Cond Res 35(5): 1229-1233, 2021-Recent research supports heavy sled towing as a tool used to improve subsequent sprints as part of postactivation potentiation (PAP) protocols. The purpose of this study was to examine the effect of heavy sled towing using a velocity decrement (Vdec) on subsequent unloaded sprinting in high school football (soccer) athletes sprinting on artificial turf. A sled load equating to a 40-50% Vdec range was used (66-70% body mass). Fifteen (n = 9 boys and n = 6 girls) high school football players volunteered for this study. The sled-towing intervention consisted of a dynamic warm-up, 3 submaximal sprint efforts (50, 75, and 95%), and 3 maximum speed 15-m sled sprints, separated by 2-minute rests, of which the fastest time was recorded for analysis. Peak preintervention 15-m baseline sprint times were compared with peak post sled-towing 15-m sprint times using a paired samples t-test. Thirteen of 15 athletes ran faster peak post sled-towing sprint times than peak preintervention baseline sprint times (9 boys and 4 girls). On average, peak post sled-towing sprint times (2.60 ± 0.10 seconds) were 0.10 seconds faster (p < 0.0001; Cohen's d = 0.92) than peak preintervention baseline sprint times (2.70 ± 0.09 seconds). This research established that sled-towing protocols using loads corresponding to Vdec of 40-50% significantly improved subsequent sprints in high school football (soccer) athletes running on artificial turf.

High-intensity exercise to improve cardiorespiratory fitness in cancer patients and survivors: A systematic review and meta-analysis.

Improving cardiorespiratory fitness (CRFit) in cancer patients is crucial to increase survivorship, promote health, and improve quality of life. High-intensity training (HIT) has the potential to increase CRFit, perhaps better than other exercise modalities, but the extant evidence has yet to be fully explored. This systematic review and meta-analysis aimed to evaluate the effects of HIT on CRFit in cancer patients and survivors and to identify the optimal characteristics of the interventions (eg, cancer type, intervention timing, exercise modality, intervention's duration, and the number of minutes of high-intensity exercise in each session). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 31 articles (2515 participants) were included in the systematic review and 25 in the meta-analyses. CRFit significantly improved with HIT in comparison with a control group (P < .00001, SMD = 0.44 and a 95% confidence interval from 0.25 to 0.64). The results obtained in the sub-analysis were statistically significant except the comparison with the active group CRFit (P = .13). The results showed that higher effects could be achieved in: patients starting to exercise before treatment, interventions longer than eight weeks, programs including exclusively cardiovascular training and with a high-intensity part of session duration of at least 20 minutes.

Combination of resistance and aerobic exercise for six months improves bone mass and physical function in HIV infected individuals: A randomized controlled trial.

To evaluate the effect of combined resistance and aerobic training (RT+AT) on regional bone mineral density (BMD) and physical performance in people living with HIV (PLWH). Forty PLWH (20 men and 20 women) were randomized into RT+AT group (n = 20; age = 38.3 ± 4.9) or non-exercise control group (n = 20; age = 37.9 ± 5.1). The RT+AT group was required to perform a nonlinear periodized resistance training program targeting large muscle groups followed by 20 min aerobic exercise at 65-80% of maximal heart rate. Participants in RT+AT performed three supervised sessions per week for 6-months, whereas participants in the control group were instructed to continue with their current lifestyle habits. The primary outcome was bone mineral density (lumbar spine (L2-L4), femoral neck, and distal 1/3 radius). Secondary outcomes included physical function, anthropometry, inflammatory markers, and growth factors. The RT+AT group demonstrated a significant increase in BMD at follow-up for the Lumbar spine (L2-L4), femoral neck, and 1/3 radius (all, P < .05), and There were no gender differences in the training response between men and women for any of the BMD regions. Similar findings were also observed for lean body mass, IGF1and Adiponectin (P < .001). We observed a decrease in percent body fat, fat mass, IL-6, TNF-α, and myostatin in the RT+AT group (P < .001). Finally, there was a significant increase in handgrip strength and gait speed for both women and men in the RT+AT group (P < .001). A combination of resistance and aerobic training appears to be a feasible and effective means for counteracting bone loss and improving various inflammatory markers, physical function, and growth hormones in PLWH.

Effects of including sprints during prolonged cycling on hormonal and muscular responses and recovery in elite cyclists.

This study investigated the acute effects of including 30-second sprints during prolonged low-intensity cycling on muscular and hormonal responses and recovery in elite cyclists. Twelve male cyclists (VO2max , 73.4 ± 4.0 mL/kg/min) completed a randomized crossover protocol, wherein 4 hours of cycling at 50% of VO2max were performed with and without inclusion of three sets of 3 × 30 seconds maximal sprints (E&S vs E, work-matched). Muscle biopsies (m. vastus lateralis) and blood were sampled at Pre, immediately after (Post) and 3 hours after (3 h) finalizing sessions. E&S led to greater increases in mRNA levels compared with E for markers of fat metabolism (PDK4, Δ-Log2 fold change between E&S and E ± 95%CI Post; 2.1 ± 0.9, Δ3h; 1.3 ± 0.7) and angiogenesis (VEGFA, Δ3h; 0.3 ± 0.3), and greater changes in markers of muscle protein turnover (myostatin, ΔPost; -1.4 ± 1.2, Δ3h; -1.3 ± 1.3; MuRF1, ΔPost; 1.5 ± 1.2, all P < .05). E&S showed decreased mRNA levels for markers of ion transport at 3h (Na+ -K+ α1; -0.6 ± 0.6, CLC1; -1.0 ± 0.8 and NHE1; -0.3 ± 0.2, all P < .05) and blunted responses for a marker of mitochondrial biogenesis (PGC-1α, Post; -0.3 ± 0.3, 3h; -0.4 ± 0.3, P < .05) compared with E E&S and E showed similar endocrine responses, with exceptions of GH and SHBG, where E&S displayed lower responses at Post (GH; -4.1 ± 3.2 µg/L, SHBG; -2.2 ± 1.9 nmol/L, P < .05). Both E&S and E demonstrated complete recovery in isokinetic knee extension torque 24 hours after exercise. In conclusion, we demonstrate E&S to be an effective exercise protocol for elite cyclists, which potentially leads to beneficial adaptations in skeletal muscle without impairing muscle recovery 24 hours after exercise.

Efficacy of proprioceptive training on the recovery of total joint arthroplasty patients: a meta-analysis.

BACKGROUND: Optimal balance control is of paramount importance for function recovery after total joint arthroplasty (TJA). The study objective of this meta-analysis was to assess the short- and mid-term effects of proprioceptive and balance training for patients undergoing TJA. METHODS: Electronic searches were conducted from PubMed, Cochrane library, and Embase databases to identify eligible RCTs through May 2020. Standard mean difference (SMD) with 95% confidence interval (95%CI) was applied to calculate pooled effect estimates between proprioceptive and balance training and control group. Main outcomes were self-reported functionality, balance, pain, quality of life, and function (range of motion). RESULTS: Seven randomized controlled trials were finally included in this meta-analysis. Pooled results found that balance and proprioceptive trainings have a positive role in improving self-reported functionality at short-term after TJA. Moreover, balance and proprioceptive trainings were associated with an increase of the balance at short- and mid-term after TJA. These results were further confirmed by subgroup analysis between preoperative and postoperative administration of balance and proprioceptive trainings. CONCLUSION: Our meta-analysis suggests that balance and proprioceptive trainings after TJA improved self-reported functionality and balance. These improvements were maintained at mid-terms. More research is needed to confirm balance and proprioceptive trainings for pain and quality of life for TJA.

Effect of repeated bouts versus a single bout of moderate-intensity exercise on postexercise inhibitory control.

We previously demonstrated that duration of aerobic exercise plays an important role in improving cognitive inhibitory control (IC). Repeated bouts of aerobic exercise (R-EX), which are performed with a rest interval, is a useful strategy in improving physical health parameters in similar manners to a single bout of aerobic exercise (S-EX). However, whether R-EX would be effective in improving IC remains unknown. This study compared the effect of R-EX versus S-EX of moderate-intensity exercise on postexercise IC. Twenty healthy, young males performed both R-EX and S-EX in a crossover design. R-EX consisted of two 20-min moderate-intensity bouts (60% of peak oxygen consumption) for 20 min, which were separated by a 20-min rest interval. S-EX consisted of a once-off 40-min moderate-intensity bout without rest interval. To evaluate IC, the color-word Stroop task was administered before exercise, immediately after exercise, and every 10 min during the 30-min postexercise recovery period. The reverse-Stroop interference score, which is a parameter of IC, significantly decreased immediately after both R-EX and S-EX compared with that before each exercise (both Ps < 0.05). The degree of changes in IC following exercise did not differ between the two protocols. By contrast, the results of the present study showed that R-EX may have more beneficial effects on cardiac and perceptual responses than S-EX. Therefore, the present study determined that R-EX changes postexercise IC similar to S-EX. We suggest that R-EX can be used as safe and effective exercise protocol to improve cognitive function in various populations.

Time to Differentiate Postactivation "Potentiation" from "Performance Enhancement" in the Strength and Conditioning Community.

Coaches and athletes in elite sports are constantly seeking to use innovative and advanced training strategies to efficiently improve strength/power performance in already highly-trained individuals. In this regard, high-intensity conditioning contractions have become a popular means to induce acute improvements primarily in muscle contractile properties, which are supposed to translate to subsequent power performances. This performance-enhancing physiological mechanism has previously been called postactivation potentiation (PAP). However, in contrast to the traditional mechanistic understanding of PAP that is based on electrically-evoked twitch properties, an increasing number of studies used the term PAP while referring to acute performance enhancements, even if physiological measures of PAP were not directly assessed. In this current opinion article, we compare the two main approaches (i.e., mechanistic vs. performance) used in the literature to describe PAP effects. We additionally discuss potential misconceptions in the general use of the term PAP. Studies showed that mechanistic and performance-related PAP approaches have different characteristics in terms of the applied research field (basic vs. applied), effective conditioning contractions (e.g., stimulated vs. voluntary), verification (lab-based vs. field tests), effects (twitch peak force vs. maximal voluntary strength), occurrence (consistent vs. inconsistent), and time course (largest effect immediately after vs. ~ 7 min after the conditioning contraction). Moreover, cross-sectional studies revealed inconsistent and trivial-to-large-sized associations between selected measures of mechanistic (e.g., twitch peak force) vs. performance-related PAP approaches (e.g., jump height). In an attempt to avoid misconceptions related to the two different PAP approaches, we propose to use two different terms. Postactivation potentiation should only be used to indicate the increase in muscular force/torque production during an electrically-evoked twitch. In contrast, postactivation performance enhancement (PAPE) should be used to refer to the enhancement of measures of maximal strength, power, and speed following conditioning contractions. The implementation of this terminology would help to better differentiate between mechanistic and performance-related PAP approaches. This is important from a physiological point of view, but also when it comes to aggregating findings from PAP studies, e.g., in the form of meta-analyses, and translating these findings to the field of strength and conditioning.