Left ventricular mechanics in late second trimester of healthy pregnancy.

OBJECTIVE: To evaluate left ventricular (LV) mechanics in the second trimester of healthy pregnancy and to determine the influence of underpinning hemodynamics (heart rate (HR), preload and afterload) on LV mechanics during gestation. METHODS: This was a cross-sectional study of 18 non-pregnant, 14 nulliparous pregnant (22-26 weeks' gestation) and 13 primiparous postpartum (12-16 weeks after delivery) women. All pregnant and postpartum women had uncomplicated, singleton gestations. Cardiac structure and function were assessed using echocardiography. LV mechanics, specifically longitudinal strain, circumferential strain and twist/untwist, were measured using speckle-tracking echocardiography. Differences between groups were identified using ANCOVA, with age, HR, end-diastolic volume (EDV) and systolic blood pressure (SBP) as covariates. Relationships between LV mechanics and hemodynamics were examined using Pearson's correlation. RESULTS: There were no significant differences in LV structure and traditional measurements of systolic and diastolic function between the three groups. Pregnant women, compared with non-pregnant ones, had significantly higher resting longitudinal strain (-22 ± 2% vs -17 ± 3%; P = 0.002) and basal circumferential strain (-23 ± 4% vs -16 ± 2%; P = 0.001). Apical circumferential strain and LV twist and untwist mechanics were similar between the three groups. No statistically significant relationships were observed between LV mechanics and HR, EDV or SBP within the groups. CONCLUSIONS: Compared to the non-pregnant state, pregnant women in the second trimester of a healthy pregnancy have significantly greater resting systolic function, as assessed by LV longitudinal and circumferential strain. Contrary to previous work, these data show that healthy pregnant women should not exhibit reductions in resting systolic function between 22 and 26 weeks' gestation. The enhanced myocardial contractile function during gestation does not appear to be related to hemodynamic load and could be the result of other physiological adaptations to pregnancy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Functional hemodynamic testing in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics.

In the general population, functional hemodynamic testing, such as that during submaximal aerobic exercise and isometric handgrip, and the cold pressor test, has long been utilized to unmask abnormalities in cardiovascular function. During pregnancy, functional hemodynamic testing places additional demands on an already stressed maternal cardiovascular system. Dysfunctional responses to such tests in early pregnancy may predict the development of hypertensive disorders that develop later in gestation. For each of the above functional hemodynamic tests, these recommendations provide a description of the test, test protocol and equipment required, and an overview of the current understanding of clinical application during pregnancy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Exercise testing and training in people with Huntington's disease.

OBJECTIVE: To explore exercise response in people with Huntington's disease (HD). DESIGN: Experimental observational study with a randomly allocated subgroup before/after interventional study. SETTING: Community. SUBJECTS: People with HD (n=30) and a healthy comparator group (n=20). Thirteen people from the HD group were randomly allocated to an exercise training program. MAIN MEASURES: Heart rate (HR) and perceived exertion on the Borg-CR10 scale (RPE) during a submaximal cycle ergometer exercise test (three minute unloaded and nine minute 65%-75%HRmaximum phase). Expired air and lactate measures were available for 8 people with HD during the exercise. INTERVENTION: A 12 week gym and home walking exercise programme (n=13). RESULTS: People with HD achieved a lower work rate at nine minutes (82±42(0-195) v 107±35(50 -185) Watts (p<0.05)), but higher RPE at both three (3±2(0-7) v 1±1(0-4)) and nine minutes (7±3(1-10) v 5± 2(2-9)) both p<0.01, compared to the healthy group and did not achieve a steady state HR during unloaded cycling. People with HD also demonstrated higher than expected lactate at three 2.5±2.5(1.1-8)mmo.L-1 and nine 3.8±1.9(1.2-6.6)mmo.L-1 minutes and respiratory exchange ratio at three 0.78±0.03 (0.74-0.81) and nine minutes 0.94±0.11(0.81-1.15). After exercise training there were no changes observed in HR or RPE responses during the exercise test. CONCLUSIONS: There was a large variability in the observed metabolic and physiological responses to exercise in people with HD. The observed exercise responses suggest that altered exercise prescription parameters may be required for people with HD and that exercise response and factors' affecting this requires further investigation.

Inspiratory muscle training improves rowing performance.

PURPOSE: To investigate the effects of a period of resistive inspiratory muscle training (IMT) upon rowing performance. METHODS: Performance was appraised in 14 female competitive rowers at the commencement and after 11 wk of inspiratory muscle training on a rowing ergometer by using a 6-min all-out effort and a 5000-m trial. IMT consisted of 30 inspiratory efforts twice daily. Each effort required the subject to inspire against a resistance equivalent to 50% peak inspiratory mouth pressure (PImax) by using an inspiratory muscle training device. Seven of the rowers, who formed the placebo group, used the same device but performed 60 breaths once daily with an inspiratory resistance equivalent to 15% PImax. RESULTS: The inspiratory muscle strength of the training group increased by 44 +/- 25 cm H2O (45.3 +/- 29.7%) compared with only 6 +/- 11 cm H2O (5.3 +/- 9.8%) of the placebo group (P < 0.05 within and between groups). The distance covered in the 6-min all-out effort increased by 3.5 +/- 1.2% in the training group compared with 1.6 +/- 1.0% in the placebo group (P < 0.05). The time in the 5000-m trial decreased by 36 +/- 9 s (3.1 +/- 0.8%) in the training group compared with only 11 +/- 8 s (0.9 +/- 0.6%) in the placebo group (P < 0.05). Furthermore, the resistance of the training group to inspiratory muscle fatigue after the 6-min all-out effort was improved from an 11.2 +/- 4.3% deficit in PImax to only 3.0 +/- 1.6% (P < 0.05) pre- and post-intervention, respectively. CONCLUSIONS: IMT improves rowing performance on the 6-min all-out effort and the 5000-m trial.

Low-intensity exercise enhances expression of markers of alternative activation in circulating leukocytes: roles of PPARγ and Th2 cytokines.

OBJECTIVE: Pharmacological activation of the nuclear receptor PPARγ is linked to numerous beneficial effects in the contexts of inflammation, lipid homeostasis, Type-2 Diabetes (T2D) and atherosclerosis. These beneficial effects include priming of circulating monocytes for differentiation towards an 'alternative' anti-inflammatory M2 macrophage phenotype. As we have recently shown that participation in low-intensity exercise increases PPARγ expression and activity in leukocytes from previously sedentary individuals, we aimed to elucidate whether low-intensity exercise elicited a pattern of gene expression similar to that reported for M2 monocyte-macrophage differentiation. METHODS: 17 sedentary individuals undertook an 8-week low-intensity exercise programme (walking 10,000steps/day, three times/week). Changes in expression of PPARs and the PPARγ co-activators PGC-1α and PGC-1ß; Th2 (IL-4; IL-10) and Th1 (IL-6) cytokines; and markers for the M2 (AMAC1, CD14, MR, IL-4) and the 'classical' pro-inflammatory M1 (MCP-1, TNFα, IL-6) phenotypes, were determined using RT-PCR (to assess leukocyte mRNA expression) and ELISA (to assess plasma cytokine levels). RESULTS: Exercise was associated with upregulation of M2 markers, PGC-1α and PGC-1ß, and with downregulation of M1 markers. Moreover, plasma levels of Th2 cytokines increased after exercise, while those of Th1 cytokines decreased. However, other PPARs (PPARα; PPARß/δ) did not undergo marked exercise-induced activation or upregulation. Thus, participation in low-intensity exercise may prime monocytes for differentiation towards an M2 macrophage phenotype via PPARγ/PGC-1α/ß. CONCLUSION: Given the similarities between these effects and pharmacologically induced M2 polarisation, we propose that exercise-induced PPARγ/PGC-1α/ß-mediated M2 polarisation may constitute a novel anti-inflammatory benefit of low-intensity exercise.

Effects of chronic bicarbonate ingestion on the performance of high-intensity work.

We have evaluated whether sodium bicarbonate, taken chronically (0.5 g x kg(-1) body mass) for a period of 5 days would improve the performance of eight subjects during 60 s of high-intensity exercise on an electrically braked cycle ergometer. The first test was performed prior to chronic supplementation (pre-ingestion) while the post-ingestion test took place 6 days later. A control test took place approximately 1 month after the cessation of all testing. Acid-base and metabolite data (n = 7) were measured from arterialised blood both pre- and post-exercise, as well as daily throughout the exercise period. The work completed by the subjects in the control and pre-ingestion test [21.1 (0.9) and 21.1 (0.9) MJ, respectively] was less than (P<0.05) that completed in the post-ingestion test [24.1 (0.9) MJ; F(2,21) = 3.4, P<0.05, power = 0.57]. Peak power was higher after the 5-day supplementation period (P<0.05). Ingestion of the sodium bicarbonate for a period of 5 days resulted in an increase in pH (F(5,36) = 12.5, P<0.0001, power = 1.0) over the 5-day period. The blood bicarbonate levels also rose during the trial (P<0.05) from a resting level of 22.8 (0.4) to 28.4 (1.1) mmol x l(-1) after 24 h of ingestion. In conclusion, the addition of sodium bicarbonate to a normal diet proved to be of ergogenic benefit in the performance of short-term, high-intensity work.

Effects of differing heat and humidity on the performance and recovery from multiple high intensity, intermittent exercise bouts.

The aim of this study was to determine the effects of different conditions of heat and humidity on two multiple bouts of high intensity cycling with 60 min recovery between each bout. Eight males (age: 25.5+/-1.8 yr, height: 179.0+/-3.7 cm; weight: 72.3+/-4.0 kg; VO2peak: 51.5+/-2.4 ml x kg(-1) x min(-1), Peak Aerobic Power: 366+/-13 W) volunteered for this study. After undertaking VO2peak testing, all participated randomly, in three consecutive 30 s Wingate tests in three different environmental conditions being: Normal (22 degrees C/30% RH), Wet (30 degrees C/85% RH), and Hot (40 degrees C/40% RH). Subjects were then monitored for the 60 min post-exercise period after which time they repeated the Wingate tests and were again monitored for 60 min. Blood samples were taken pre, immediately post exercise, and at 1, 5, 10, 15, 30, 45, and 60 min into each of the recovery periods and analysed for lactate, pH, and hematocrit. Heart rate was monitored continuously throughout exercise (5 s average) and recovery (60 s average). Weight was measured pre exercise and at 15, 30, 45, and 60 min post-exercise. Urine samples were collected at the same time and analysed for osmolality. The results of the experiment indicated that environmental conditions had no effect on the performance of either series 1 or 2 Wingate tests. Neither were there any changes in weight throughout the three conditions or across the condition. Post exercise pH levels were lower than pre exercise values (p < 0.0001) and the reverse was true for blood lactate levels (p < 0.0003). We conclude that anaerobic exercise is not unduly affected by hot or humid conditions when subjects can re-hydrate according to decreases in body weight.

Effect of training intensity on insulin sensitivity as evaluated by insulin tolerance test.

The purpose of this study was to evaluate the role of exercise intensity in the effect of physical training on insulin sensitivity. The insulin tolerance test (ITT) was applied to quantify insulin sensitivity. Eighteen healthy, young, untrained men and women participated in a 4-week, five times per week, 1-h per session bicycle-ergometer training program. Training consisted of 3-min bouts of cycling interspersed with 2 min at a lower exercise intensity. Intensities were 80 and 40% of pretraining maximal power output (W(max)) in the high-intensity (HI) and 40 and 20% W(max) in the low-intensity (LI) group. The insulin sensitivity index (IS(index)) was similar in the HI and LI group before the training intervention [mean (SD) -0.1898 (0.058) and -0.1892 (0.045), respectively]. After training, the IS(index) was -0.2358 (0.051) (P = 0.005 vs pretraining) in the HI group and -0.2050 (0.035) (P = 0. 099 against pretraining) in the LI group. We conclude that improvements in insulin sensitivity are more pronounced with high-intensity training, when exercise frequency and duration are kept similar. We further conclude that the ITT is suitable for use in intervention studies.

A comparison of the lactate Pro, Accusport, Analox GM7 and Kodak Ektachem lactate analysers in normal, hot and humid conditions.

This study aimed to compare the performance of a new portable lactate analyser against other standard laboratory methods in three conditions, normal (20 +/- 1.3 degrees C; 40 +/- 5 % RH), hot (40 +/- 2.5 degrees C; 40 +/- 5 % RH), and humid (20 +/- 1.1 degrees C; 82 +/- 6 % RH) conditions. Seven healthy males, ([Mean +/- SE]: age, 26.3 +/- 1.3 yr; height, 177.7 +/- 1.6 cm; weight, 77.4 +/- 0.9 kg, .VO(2)max, 56.1 +/- 1.9 ml x kg x min(-1)) undertook a maximal cycle ergometry test to exhaustion in the three conditions. Blood was taken every 3 min at the end of each stage and was analysed using the Lactate Pro LT-1710, the Accusport, the Analox GM7 and the Kodak Ektachem systems. The MANOVA (Analyser Type x Condition x Workload) indicated no interaction effect (F(42,660), = 0.45, p > 0.99, Power = 0.53). The data across all workloads indicated that the machines measured significantly differently to each other (F(4,743) = 14.652, p < 0.0001, Power = 1.00). The data were moderately to highly correlated. We conclude that the Lactate Pro is a simple and effective measurement device for taking blood lactate in a field or laboratory setting. However, we would caution against using this machine to compare data from other machines.