The Prevalence of Low Vitamin D in Elite Para-Athletes: A Systematic Review.

BACKGROUND: Vitamin D insufficiency (25OHD, 50-75 nmolˑl- 1) is a common issue within healthy adults and elite athletes and is associated with decreased musculoskeletal health and performance. However, few studies have identified the prevalence and risk factors associated with vitamin D insufficiency within elite Para-Athletes. METHODS: An electronic search was completed on the 5th January 2023 and updated on the 21st June 2024, searching Web of Science, PubMed, Scopus, Cochrane Library and EASY (originally OpenGrey). To meet the eligibility criteria, retrieved studies were required to include at least one baseline measure of a vitamin D biomarker from elite Para-Athletes performing at national or international levels and therefore all quantitative study designs could be included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist (8-item) for analytical cross-sectional studies. Data from the eligible studies was extracted and charted, with a supporting narrative synthesis. RESULTS: The search strategy retrieved 3083 articles, of which ten studies met the inclusion criteria. In total there were n = 355 Para-Athletes, 69.6% of which comprised of males in the included studies. Across the ten included studies, n = 546 samples were taken from n = 355 Para-Athletes across different seasons and based upon the 25(OH)D insufficiency and deficiency thresholds set by each individual study 43.2% of the samples were considered insufficient and 28.1% deficient. During the winter months vitamin D insufficiency was at its most prevalent at 74.1%, compared to 57.1% in summer of the 25(OH)D samples measured in Para-Athletes. Wheelchair athletes who competed in indoor sports were also more susceptible to low vitamin D. CONCLUSION: This review has highlighted that vitamin D insufficiency and deficiency is highly prevalent in elite level Para-Athletes, all year, across both summer and winter months. Therefore, this review highlights the need for education, treatment, and preventative measures in elite Para-Athletes throughout the year. REGISTRATION: The following systematic review was prospectively registered through PROSPERO International prospective register of systematic reviews (PROSPERO registration ID number: CRD42022362149).

Evaluating the effects of hormone therapy termination on skeletal muscle and physical independence in postmenopausal women.

OBJECTIVE: In women, the age-related decline in skeletal muscle structure and function is accelerated after menopause, which implicates the role of decreased circulating estrogen levels. Indeed, boosting estrogen, by means of postmenopausal hormone therapy (HT), generally proves beneficial to skeletal muscle. The evidence regarding whether these benefits persist even after cessation of HT is limited, nor is it clear how physical behavior (PB) impacts on benefits. Hence, this exploratory study focused on the interplay between HT administration/cessation, PB and in vivo skeletal muscle structure and function. METHODS: Fifty healthy women (≥60 y) were included; 19 had an HT administration history (≥9 mo, with now ~8-y hiatus in treatment) and 31 no such history. On seven continuous days, PB data were collected using triaxial accelerometry and analyzed using compositional data analysis. Gastrocnemius medialis muscle volume, architecture, and function were determined using ultrasonography, electromyography, dual x-ray absorptiometry, and dynamometry. Current serum estradiol levels were measured using ELISA. RESULTS: Only fascicle length and duration of HT administration were positively associated. With respect to PB levels, we found a pattern suggesting greater vitality (higher physical activity and lower sedentarism) in previous HT users, compared with nonusers, despite the two groups currently no longer exhibiting significantly different levels of circulating estradiol. CONCLUSIONS: After an 8-year hiatus in treatment, HT provides limited advantages in gastrocnemius medialis muscle properties. Interestingly, it perhaps enhances vitality despite prolonged cessation, which in the longer term would facilitate greater physical independence, especially considering the association of sedentary behavior with greater frailty.

Seasonal variations in vitamin D do not change the musculoskeletal health of physically active ambulatory men with cerebral palsy: a longitudinal cross-sectional comparison study.

Increased levels of vitamin D in the summer months from natural seasonal variations in sun exposure have been linked to improvements in musculoskeletal health and function in UK populations; however, studies have shown that differences in lifestyles because of disability can inhibit the natural vitamin D increase in these populations. We hypothesized that men with cerebral palsy (CP) will experience smaller increases in 25-hydroxyvitamin D (25(OH)D) from winter to summer and men with CP will not experience any improvements in musculoskeletal health and function during the summer. A longitudinal observational study in 16 ambulant men with CP aged 21.0 ± 1.3 years and 16 healthy, physical activity matched, typically developed controls aged 25.4 ± 2.6 years, completed assessments of serum 25(OH)D and parathyroid hormone during winter and summer. Neuromuscular outcomes included vastus lateralis size, knee extensor strength, 10-m sprint, vertical jumps, and grip strength. Bone ultrasounds were performed to obtain radius and tibia T and Z scores. Men with CP and typically developed controls showed a 70.5% and 85.7% increase in serum 25(OH)D from winter to summer months, respectively. Neither group showed seasonal effect on neuromuscular outcomes muscle strength, size, vertical jump, or tibia and radius T and Z scores. A seasonal interaction effect was seen in the tibia T and Z scores (P < .05). In conclusion, there were similar seasonal increases in 25(OH)D observed in men with CP and typically developed controls, but serum 25(OH)D levels were still considered insufficient to improve bone or neuromuscular outcomes.

Musculoskeletal Health in Active Ambulatory Men with Cerebral Palsy and the Impact of Vitamin D.

PURPOSE: (1) To determine the contribution of diet, time spent outdoors, and habitual physical activity (PA) on vitamin D status in men with cerebral palsy (CP) compared to physical activity matched controls (TDC) without neurological impairment; (2) to determine the role of vitamin D on musculoskeletal health, morphology, and function in men with CP compared to TDC. MATERIALS AND METHODS: A cross-sectional comparison study where 24 active, ambulant men with CP aged 21.0 ± 1.4 years (Gross Motor Function Classification Score (I-II) and 24 healthy TDC aged 25.3 ± 3.1 years completed in vivo assessment of musculoskeletal health, including: vastus lateralis anatomical cross-sectional area (VL ACSA), isometric knee extension maximal voluntary contraction (KE iMVC), 10 m sprint, vertical jumps (VJ), and radius and tibia bone ultrasound (US) Tus and Zus scores. Assessments of vitamin D status through venous samples of serum 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone, dietary vitamin D intake from food diary, and total sun exposure via questionnaire were also taken. RESULTS: Men with CP had 40.5% weaker KE iMVC, 23.7% smaller VL ACSA, 22.2% lower VJ, 14.6% lower KE iMVC/VL ACSA ratio, 22.4% lower KE iMVC/body mass (BM) ratio, and 25.1% lower KE iMVC/lean body mass (LBM) ratio (all p < 0.05). Radius Tus and Zus scores were 1.75 and 1.57 standard deviations lower than TDC, respectively (p < 0.05), whereas neither tibia Tus nor Zus scores showed any difference compared to TDC (p > 0.05). The 25(OH)D was not different between groups, and 90.9% of men with CP and 91.7% of TDC had low 25(OH)D levels when compared to current UK recommendations. The 25(OH)D was positively associated with KE iMVC/LBM ratio in men with CP (r = 0.500, p = 0.020) but not in TDC (r = 0.281, p = 0.104). CONCLUSION: Musculoskeletal outcomes in men with CP were lower than TDC, and despite there being no difference in levels of 25(OH)D between the groups, 25 (OH)D was associated with strength (KE iMVC/LBM) in the CP group but not TDC. The findings suggest that vitamin D deficiency can accentuate some of the condition-specific impairments to musculoskeletal outcomes.

Correction to: The difference in sleep, sedentary behaviour, and physical activity between older adults with 'healthy' and 'unhealthy' cardiometabolic profiles: a cross-sectional compositional data analysis approach.

[This corrects the article DOI: 10.1186/s11556-019-0231-4.].

Using isotemporal substitution to predict the effects of changing physical behaviour on older adults' cardio-metabolic profiles.

BACKGROUND: It has been advocated that older adults should concomitantly spend less time in sedentary behaviour (SB), and engage in sufficient physical activity (PA), to reduce their risk of cardio-metabolic diseases. However, it is not clear what intensity of PA must be done to offset SB engagement. AIM: Model how cardio-metabolic profiles could change if older adults replaced an hour per day (hr·day-1) of a physical behaviour intensity with 1 hr·day-1 of another physical behaviour of a different intensity. METHODS: Older adults (n = 93, 60-89 years old, 55% female) wore a thigh-mounted triaxial accelerometer for seven consecutive free-living days to estimate mean daily hourly engagement in SB, Standing, Light Intensity PA (LIPA), sporadic moderate to vigorous physical activity (sMVPA, bouts <10 continuous minutes), and 10-minute MVPA (10MVPA, bouts ≥10 continuous minutes. Fasting whole blood concentration of plasma glucose, triglyceride, total cholesterol, and glycated haemoglobin (%), along with serum concentration of lipoprotein lipase (LPL), interleukin-6 (IL-6), and procollagen III N-terminal propeptide (PIIINP) were measured. RESULTS: Isotemporal Substitution, with covariate adjustment, suggested that: total cholesterol concentration could theoretically decrease when 1 hr·day-1 of SB is replaced with Standing, when 1 hr.day-1 of LIPA is replaced with Standing, and when 1 hr·day-1 of sMVPA is replaced with Standing. Triglyceride concentration theoretically decreased when 1 hr·day-1 of SB, Standing, LIPA, or sMVPA is replaced with 10MVPA. Triglyceride concentration theoretically increases when 1 hr·day-1 of 10MVPA is replaced with SB, Standing, or LIPA. No associations with time reallocation appears to exist for LPL, HbA1c, IL-6, and PIIINP. CONCLUSION: The type of physical behaviour being replaced could be crucial for total cholesterol maintenance. Engagement in 10MVPA could be necessary to improve triglyceride concentration.

The difference in sleep, sedentary behaviour, and physical activity between older adults with 'healthy' and 'unhealthy' cardiometabolic profiles: a cross-sectional compositional data analysis approach.

BACKGROUND: Studies have seldom used Compositional Data Analysis (CoDA) to map the effects of sleep, sedentary behaviour, and physical activity on older adults' cardio-metabolic profiles. This study therefore aimed to illustrate how sleep, sedentary behaviour, and physical activity profiles differ between older adult groups (60-89 years), with 'low' compared to those with 'high' concentrations of endocrine cardio-metabolic disease risk markers, using CoDA. METHOD: Ninety-three participants (55% female) wore a thigh-mounted triaxial accelerometer for seven consecutive free-living days. Accelerometer estimates of daily average hours of engagement in sedentary behaviour (SB), standing, light-intensity physical activity (LIPA), sporadic moderate-vigorous physical activity (sMVPA, accumulated with bouts between 1 and 10 min), 10-min moderate-vigorous physical activity (10MVPA, accumulated with bouts ≥10 min), in addition to self-reported sleeping hours were reported. Fasted whole blood concentrations of total cholesterol, triglyceride, glucose, and glycated haemoglobin, and serum lipoprotein lipase (LPL), interleukin-6 (IL-6), and procollagen III N-terminal propeptide were determined. RESULTS: Triglyceride concentration appeared to be highly dependent on 10MVPA engagement as the 'low' and 'high' concentration groups engaged in 48% more and 32% less 10MVPA, respectively, relative to the geometric mean of the entire study sample. Time-use composition of the 'low' LPL group's engagement in 10MVPA was 26% less, while the 'high' LPL group was 7.9% more, than the entire study sample. Time-use composition of the 'high' glucose and glycated haemoglobin groups appeared to be similar as both engaged in more Sleep and SB, and less 10MVPA compared to the study sample. Participants with a 'low' IL-6 concentration engaged in 4.8% more Sleep and 2.7% less 10MVPA than the entire study sample. Time-use composition of the Total Cholesterol groups was mixed with the 'low' concentration group engaging in more Standing and 10MVPA but less Sleep, SB, LIPA, and sMVPA than the entire study sample. CONCLUSION: Older adults should aim to increase 10MVPA engagement to improve lipid profile and decrease SB engagement to improve glucose profile.

Obesity decreases both whole muscle and fascicle strength in young females but only exacerbates the aging-related whole muscle level asthenia.

Obesity has previously been associated with greater muscle strength. Aging, on the other hand, reduces muscle specific force (the force per unit physiological cross-sectional area [PCSA] of muscle). However, neither the effect of obesity on skeletal muscle specific force nor the combined effects of aging and obesity on this parameter are known. This study aimed to describe the interplay between body mass index (BMI)/adiposity, aging, and skeletal muscle specific force. Ninety-four untrained healthy women categorized by age into young (Y; mean ± SD: 25.5 ± 9.0 years) versus old (O; 64.8 ± 7.2 years) were assessed for body composition, gastrocnemius medialis (GM) muscle volume (V), net maximum voluntary contraction (nMVC), and specific force (SF). The young obese, while demonstrating 71% and 29% (P < 0.001) higher V and nMVC compared to normal BMI individuals, were in fact 26% (P = 0.007) weaker than these, where V was used to scale nMVC (i.e., nMVC/V). The weakness associated with obesity was further exemplified in the 34% (P < 0.001) lower SF relative to normal BMI individuals. Similarly, ≥40% body fat was associated with 60% and 27% (P < 0.001) higher V and nMVC, but 11% and 25% (P < 0.01) lower nMVC/V and SF than <40% body fat. The aging-related rates of decline in V (-2 cm(3)/year P < 0.05) and nMVC (-1.2 cm(3)/year P < 0.05) were highest in obesity defined by BMI. This effect was also seen when segregating by >40% adiposity. Interestingly, however, obesity appeared advantageous to the aging-related changes in nMVC/V (P < 0.001) and SF (P < 0.001). Unlike previous reports of greater strength in the obese compared with leaner age-matched counterparts, we in fact demonstrate that the young sedentary obese, are substantially weaker, where the volume of skeletal muscle is used to scale the maximal torque output, or forces are quantified at the fascicular level. The seemingly positive impact of obesity on rate of aging, however, is complex and warrants further investigations.