The cardiopulmonary exercise test in the prognostic evaluation of patients with heart failure and cardiomyopathies: the long history of making a one-size-fits-all suit.

Cardiopulmonary exercise test (CPET) has become pivotal in the functional evaluation of patients with chronic heart failure (HF), supplying a holistic evaluation both in terms of exercise impairment degree and possible underlying mechanisms. Conversely, there is growing interest in investigating possible multiparametric approaches in order to improve the overall HF risk stratification. In such a context, in 2013, a group of 13 Italian centres skilled in HF management and CPET analysis built the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score, based on the dynamic assessment of HF patients and on some other instrumental and laboratory parameters. Subsequently, the MECKI score, initially developed on a cohort of 2716 HF patients, has been extensively validated as well as challenged with the other multiparametric scores, achieving optimal results. Meanwhile, the MECKI score research group has grown over time, involving up to now a total of 27 centres with an available database accounting for nearly 8000 HF patients. This exciting joint effort from multiple HF Italian centres allowed to investigate different HF research field in order to deepen the mechanisms underlying HF, to improve the ability to identify patients at the highest risk as well as to analyse particular HF categories. Most recently, some of the participants of the MECKI score group started to join the forces in investigating a possible additive role of CPET assessment in the cardiomyopathy setting too. The present study tells the ten-year history of the MECKI score presenting the most important results achieved as well as those projects in the pipeline, this exciting journey being far to be concluded.

Effects of fitness on self-reported physical and mental quality of life in professional firefighters: An exploratory study.

BACKGROUND: The work-related stress experienced by firefighters is associated with numerous health issues. In the general population, improving physical fitness is associated with improvements in both mental and physical quality of life. OBJECTIVE: The purpose of the study was to examine whether fitter professional firefighters report greater physical and mental quality of life. METHODS: Twenty-three professional firefighters (males = 21, females = 2; age: 36.78±7.12yrs; height: 176.96±5.67 cm; weight: 88.20±16.02 kg; years of service: 8.70±6.62years) volunteered for the study. Participants completed a fitness protocol that included the wall sit and reach, Y-balance test, vertical jump, 1 repetition maximum bench press, pull-ups to failure, push-ups to failure, a plank hold and 1-mile run. The short form 36 questionnaire was used to assess overall quality of life. Firefighters were divided into "high" and "low" groups for physical and mental quality of life. Group differences in fitness parameters were assessed using a multivariate analysis of covariance with gender, age, years of service, height, and body mass as co-variates. RESULTS: Firefighters with lower mental quality of life had lower body fat percentages (p = 0.003), fat mass (p = 0.036), greater fat free mass (p = 0.015), vertical jump height (p = 0.024) and performed more pull-ups (p = 0.003). There were no significant differences in any of the fitness measures between high and low physical quality of life groups. CONCLUSION: The findings indicate that physical fitness of firefighters is not indicative of overall health. Firefighters might use exercise to cope for psychological stress and a holistic approach to improve firefighter quality of life is recommended.

Physical conditioning in children and adolescents with cerebral palsy: Systematic review and meta-analysis.

INTRODUCTION: Cerebral palsy (CP) can be described as a group of permanent non-progressive disorders that occur in the developing fetal or infant brain. Studies have shown that children and adolescents with CP have low cardiorespiratory fitness and higher energy expenditure during daily activities when compared to typical children. Therefore, interventions focused on the physical conditioning of this population could be critical. OBJECTIVE: To evaluate the effect of physical conditioning training on distance walked and maximum oxygen consumption (VO2 max) in individuals with CP, through a systematic review. METHOD: Two independent researchers performed systematic searches in the PUBMED, SciELO, PEDro, ERIC, and Cochrane databases using the search terms "physical fitness", "aerobic training" or "endurance" combined with "cerebral palsy". INCLUSION CRITERIA: (1) population (children and adolescents with CP between 5 and 18 years old); (2) type of study (experimental studies); (3) type of intervention (physical conditioning protocols); (4) outcome (distance walked in the 6 min walking test - 6MWT, and VO2 max). RESULTS: 386 studies were identified and 5 articles were considered eligible. After physical conditioning training, there was an increase of 46.34 m (p = 0.07) and 5.93. ml. kg-1. min -1 (p < 0.001) in the 6MWT and VO2 max, respectively. CONCLUSION: Physical conditioning training appears to be clinically beneficial to the cardiorespiratory fitness of children and adolescents with CP.

Using Inertial and Physiological Sensors to Investigate the Effects of a High-Intensity Interval Training and Plyometric Program on the Performance of Young Judokas.

The use of inertial and physiological sensors in a sport such as judo is scarce to date. The information provided by these sensors would allow practitioners to have a better understanding of sports performance, which is necessary for an accurate training prescription. The purpose of this study was to use inertial and physiological sensors in order to investigate the effect of a plyometric and high-intensity interval training (HIIT) training program on Special Judo Fitness Test (SJFT) performance and speed of execution of throws in young judokas. A total of 32 participants were divided into two groups: experimental and control. The intervention consisted of six sessions with a duration of 60 min for 3 weeks. Physiological sensors collected heart rate data to assess the Special Judo Fitness Test, and inertial sensors collected angular velocity. The results show a significant decrease in the SJFT index (Score pre: 22.27 ± 2.73; Score post: 19.65 ± 1.70; p ≤ 0.05; d = 0.61) and a significant increase in the angular velocity of the X-axis (Pre: 320.87 ± 51.15°/s; Post: 356.50 ± 40.47°/s; p ≤ 0.05; d = 0.45) and Y-axis (Pre: 259.40 ± 41.99°/s; Post: 288.02 ± 65.12°/s; p ≤ 0.05; d = 0.31) in the experimental group. In conclusion, this study demonstrates that using inertial and physiological sensors allowed us to analyze the effect that a high-intensity interval training program and plyometrics had on the performance of young judokas. Strength and conditioning coaches should consider these results because including plyometric training and HIIT in judokas' workout programming can be especially positive for eliciting increases in performance. However, future training interventions should investigate the training adaptations to longer interventions.

V̇/Q̇ Mismatch: A Novel Target for COPD Treatment.

In people with COPD, pulmonary gas-exchange efficiency may be impaired because of abnormal alveolar ventilation (V˙A), capillary perfusion (Q˙c), or both. Both have been reported in early and mild stages of the disease. Such derangements often accompany significant clinical consequences such as activity-related dyspnea and exercise intolerance. Although much attention has been paid to pharmacologic treatment of mechanical abnormalities in COPD (eg, bronchodilators to deflate the lungs), increasing neurochemical afferent activity, secondary to gas-exchange inefficiency, has remained elusive as a therapeutic target. Hence, in this invited review, we first summarize how dyspnea, leading to poor exercise tolerance in COPD, may be explained by an increased venous admixture resulting from low V˙A/Q˙c, or wasted ventilation related to high V˙A/Q˙c, or both. We review the conflicting evidence supporting current treatments for gas-exchange inefficiency and exercise tolerance that act primarily on V˙A (bronchodilators, antiinflammatory medications) or Q˙c (oral and inhaled vasodilators, almitrine, and supplemental oxygen). Finally, to address the current knowledge and health care gaps, we propose two independent clinical research foci that may lead to a better understanding of the role of pulmonary gas-exchange inefficiency and activity-related dyspnea in COPD: (1) enhanced and deeper phenotyping of patients with COPD with V˙A/Q˙c abnormalities and (2) evaluation of existing and novel pharmacologic treatments to improve gas-exchange inefficiency, exertional dyspnea, and exercise tolerance across the spectrum of COPD severity.

A new taekwondo-specific field test for estimating aerobic power, anaerobic fitness, and agility performance.

The present study aimed to propose a new multidimensional taekwondo-specific test to estimate aerobic power, anaerobic fitness, and agility. Out of sixty-five male volunteers, forty-six, forty-eight, and fifty athletes (18-35 years; black- and red-belt level) were included in the final analysis for aerobic, anaerobic, and agility assessments, respectively. Maximum oxygen uptake (VO2max, using a graded exercise test on a treadmill), anaerobic power (using the 30-s Wingate anaerobic test, WAnT), and agility performance (using the agility T-Test) were measured via non-specific laboratory and field tests across a two-week period. The taekwondo-specific aerobic-anaerobic-agility (TAAA) test comprised six 20-s intervals of shuttle sprints over a 4-m distance, and the execution of roundhouse kicks alternating the legs at the end of each distance, with 10-s rest intervals between the sets. The multiple linear regression revealed that the difference between heart rate (HR) after and 1 minute after the TAAA test (p < 0.001), and body mass index (BMI; p = 0.006) were significant to estimate VO2max. Likewise, there was a very large (R = 0.79) and large (R = 0.55) correlation between the average and maximum number of kicks performed in the TAAA test and the WAnT mean and peak power, respectively (p < 0.001). Moreover, a linear relationship was found between the T-Test and agility performance acquired in the TAAA test (R = 0.74; p < 0.001). The TAAA test can be considered a valid simple tool for monitoring VO2max, anaerobic fitness, and agility in male taekwondo athletes.

Cardiopulmonary Exercise Testing: The ABC for the Clinical Cardiologist.

BACKGROUND: Cardiopulmonary exercise testing (CPET) is the most comprehensive technique which allows a holistic approach to cardiopulmonary diseases. SUMMARY: This article provides basic information addressed to the Clinical Cardiologist regarding the utility and the indications of the CPET technique in the everyday clinical practice. Clinical application of CPET continues to evolve and protocols should be adapted to each specific patient to obtain the most reliable and useful information. Key Messages: Clinical Cardiologists with an interest over CPET may become familiar with this exercise method and its main measured variables, refresh their knowledge regarding the underlying pathophysiological mechanisms of oxygen transport chain, learn how to interpret the CPET results and promote appropriate patient referrals to experts.

Development of a modified cross-over hop test to reduce measurement errors in return-to-competition testing.

CONTEXT: Hop tests play an important role in the rehabilitation process after injuries. A comparison of the jumping distances of both extremities allows for an evaluation of the injured limb. In the conventional cross-over hop test for distance, the jump width (medial vs. lateral) that the athlete has to cross during the jump is not standardised and therefore highly variable. This affects the absolute jump length in each jump series. HYPOTHESIS: Modifying the test may reduce the jump length variance between test series of an athlete as well as the test-dependent variations in the cross-over hop for distance. METHODS: N = 47 athletes from the German and French national Judo youth teams were included in the study (age: 15.3 years ±â€Š13-17). A modified version of the cross-over hop for distance was developed with a cross-over width of 50 cm and a fixed landing zone of 10 cm. The jump lengths of the conventional test and the modified test were documented. The change in jump length variations of the two sexes were compared. RESULTS: The mean value of the coefficient of variation decreased significantly from 4.09 % to 2.83 % (p < 0.01) due to the test modification. This resulted in an absolute improvement in accuracy of 1.26 % and a relative improvement of 30.8 %. A comparison of the limb symmetry index between the conventional and the modified cross-over hop for distance revealed no significant differences. CONCLUSION: The modified cross-over hop for distance showed a significantly lower variation in jump lengths compared with the conventional cross-over hop for distance. As a result, more accurate statements can be made regarding the patient's return-to-competition progress.

Bilateral Throw Execution in Young Judokas for a Maximum All Year Round Result.

PURPOSE: This study investigates bilateral performance with the Special Judo Fitness Test (SJFT) and its associations with competition performance (CP) and competition volume (CV) in judo. METHODS: The SJFT compared movement patterns of the dominant (D) and nondominant (ND) sides on a sample of 27 youth judoka. Repeated-measures analysis of variance was used to determine differences in SJFT execution to the D and ND side, and for associations, the Pearson correlation was used (P < .05). RESULTS: The total number of throws is significantly higher on the D side, with better performance in the final SJFT index. The CP showed positive correlations with the D side of SJFT executions in the second part of SJFT (P = .042) and the total number of throws (P = .036). On the ND side, the CP showed a positive correlation with the second part of the SJFT (P = .014), a negative correlation with the third part of the SJFT (P = .035), and a positive correlation in the total number of throws (P = .027). CV shows significant correlations with all parameters of the SJFT in the D and ND sides, with stronger correlations on the ND side. CONCLUSIONS: The study presents significantly better performance in judokas' D side in SJFT. Associations between CP and CV with the SJFT were significant in connection to both body sides. It highlights the importance of bilateral movement development and good execution of the throwing techniques for the D and ND body sides of youth judoka to achieve greater CP all year round.

In-hospital pulmonary rehabilitation after completion of primary respiratory disease treatment improves physical activity and ADL performance: A prospective intervention study.

INTRODUCTION: Pulmonary rehabilitation improves the physical condition of patients with chronic respiratory disease; however, there are patients who cannot leave the hospital because of their low activities of daily living (ADLs), despite the completion of primary respiratory disease treatment and rehabilitation during treatment. Therefore, this study demonstrated that those patients recovered their ADLs through in-hospital pulmonary rehabilitation after treatment completion. METHODS: We prospectively studied 24 hospitalized patients who had some remaining symptoms and showed low ADL scores of 9 points or less on the short physical performance battery after undergoing treatment for respiratory disease in Fukujuji Hospital from October 2018 to October 2019, excluding 2 patients who had re-exacerbation and 1 patient who could not be examined using the incremental shuttle walk test (ISWT). After completion of the primary respiratory disease treatment, patients moved to the regional comprehensive care ward, and they received pulmonary rehabilitation for 2 weeks. In the ward, patients who could not yet leave the hospital could undergo pulmonary rehabilitation for up to 60 days. Data were evaluated three times: upon treatment completion (baseline), postrehabilitation, and 3 months after baseline. The main outcome was an improvement in the incremental shuttle walk test (ISWT) postrehabilitation. RESULTS: The median age of the patients was 80 (interquartile range (IQR): 74.8-84.5), and 14 patients (58.3%) were male. The ISWT distance significantly increased postrehabilitation (median [IQR]: 60 m [18-133] vs 120 m [68-203], P < .001). The Barthel Index (BI) (P < .001), the modified Medical Research Council (P < .001), and other scale scores were also improved. Among patients with acute respiratory diseases such as pneumonia, chronic obstructive pulmonary disease, and interstitial pneumonia, ISWT and other data showed improvement at the postrehabilitation timepoint. Ten patients who could perform examinations at 3 months after baseline were evaluated 3 months after taking baseline data prior to starting rehabilitation. The ISWT showed significant improvement 3 months after baseline compared to baseline (P = .024), and the ISWT distance was maintained after rehabilitation. DISCUSSION AND CONCLUSIONS: Physical activity, symptoms, mental health, and ADL status in patients who had not recovered after primary treatment completion for respiratory diseases could improve through in-hospital pulmonary rehabilitation.

Fitness testing in tennis: Influence of anthropometric characteristics, physical performance, and functional test on serve velocity in professional players.

The aims of this study were to examine the relationship between anthropometric variables, physical performance, and functional test with serve velocity regarding tennis players' level and to design regression models that effectively predict serve velocity. A sample of sixteen male tennis players participated in this study (national level = 8, professional level = 7). Anthropometric measurements (body mass, height, body mass index and body segments) and physical test (hand strength, countermovement jump, jump on serve, and serve velocity) and functional test (medicine ball throw overhead and shot put) were performed. No differences in anthropometrics and physical test were found between national and professional levels. A significant positive correlation (p < 0.05, ranging for 0.603 to 0.932) was found between some anthropometrics measurements (body mass, height, arm, forearm, and leg segments), physical parameters (hand strength, countermovement jump) and functional test (medicine ball throw shot put and overhead) with serve velocity for all tennis players. Multiple regression analysis indicated that medicine ball throw shot put was the most important test to explain serve velocity (r2 = 0.869). The results showed how the combination of physical and anthropometric factors have an impact on serve velocity. In addition, a new functional fitness test (medicine ball throw shot put) is proposed as an alternative to traditional medicine ball throw overhead due to its high reproducibility (inter-trial reliability) and predictive validity values, as well as by multi-segmental coordination movement similar to tennis serve.

Absent or Mild Coronary Calcium Predicts Low-Risk Stress Test Results and Outcomes in Patients Considered for Flecainide Therapy.

BACKGROUND: Flecainide is a useful antiarrhythmic for atrial fibrillation (AF). However, because of ventricular proarrhythmia risk, a history of myocardial infarction (MI) or coronary artery disease (CAD) is a flecainide exclusion, and stress testing is used to exclude ischemia. We assessed whether absent/mild coronary artery calcium (CAC) can supplement or avoid the need for stress testing. METHODS: We assessed ischemic burden using regadenoson Rb-82 PET/CT in 1372 AF patients ≥50 years old without symptoms or signs of clinical CAD. CAC was determined qualitatively by low dose attenuation computed tomography (CT) (n = 816) or by quantitative CT (n = 556). Ischemic burden and clinical outcomes were compared by CAC burden. RESULTS: Patients with CAC absent or mild (n = 766, 57.2%) were younger, more frequently female, and had higher BMI but lower rates of diabetes, hypertension, and dyslipidemia. Average ischemic burden was lower in CAC-absent/mild patients, and CAC-absent/mild patients showed greater coronary flow reserve, had fewer referrals for coronary angiography, and less often had obstructive CAD. Revascularization at 90 days was lower, and the rate of longer-term major adverse cardiovascular events was favorable. CONCLUSIONS: An easily administered, inexpensive, low radiation CAC scan can identify a subset of flecainide candidates with a low ischemic burden on PET stress testing that rarely needs coronary angiography/intervention and has favorable outcomes. Absent or mild CAC-burden combined with other clinical information may avoid or complement routine stress testing. However, additional, ideally randomized and multicenter trials are indicated to confirm these findings before replacing stress testing with CAC screening in selecting patients for flecainide therapy in clinical practice.

Influence of behavioral state on the neuromodulatory effect of low-intensity transcranial ultrasound stimulation on hippocampal CA1 in mouse.

In process of brain stimulation, the influence of any external stimulus depends on the features of the stimulus and the initial state of the brain. Understanding the state-dependence of brain stimulation is very important. However, it remains unclear whether neural activity induced by ultrasound stimulation is modulated by the behavioral state. We used low-intensity focused ultrasound to stimulate the hippocampal CA1 regions of mice with different behavioral states (anesthesia, awake, and running) and recorded the neural activity in the target area before and after stimulation. We found the following: (1) there were different spike firing rates and response delays computed as the time to reach peak for all behavioral states; (2) the behavioral state significantly modulates the spike firing rate linearly increased with an increase in ultrasound intensity under different behavioral states; (3) the mean power of local field potential induced by TUS significantly increased under anesthesia and awake states; (4) ultrasound stimulation enhanced phase-locking between spike and ripple oscillation under anesthesia state. These results suggest that ultrasound stimulation-induced neural activity is modulated by the behavioral state. Our study has great potential benefits for the application of ultrasound stimulation in neuroscience.

Maximal and Submaximal Cardiorespiratory Responses to a Novel Graded Karate Test.

The present study aimed to propose and assess the physiological responses of a novel graded karate test. Ten male national-level karate athletes (age 26 ± 5 yrs; body mass 69.5 ± 11.6 kg; height 1.70 ± 0.09 m) performed two exercise tests (separated by 2-7 days): 1) a running-based cardiopulmonary exercise test; 2) a graded karate test. The cardiopulmonary exercise test was comprised of an individualized ramp protocol for treadmill running, and the graded karate test was comprised of a sequence of 'kisami-gyaku-zuki" punching at a fixed frequency of a stationary target that becomes progressively distant. Cardiorespiratory responses, blood lactate concentration, and perceived exertion were measured. A verification phase was also performed in both tests to confirm the maximal physiological outcomes. The graded karate test evoked similar maximal responses to the running protocol: V̇O2 (57.4 ± 5.1 vs 58.3 ± 3.5 mL·kg-1·min-1; p = 0.53), heart rate (192 ± 6 vs 193 ± 10]beats.min-1; p = 0.62) and blood lactate (14.6 ± 3.4 vs 13.1 ± 3.0 mmol·L-1; p = 0.14) with a shorter duration (351 ± 71 vs 640 ± 9 s; p < 0.001). Additionally, the graded karate test evoked higher V̇O2 (72.6 ± 6.5 vs 64.4 ± 4.3 %V̇O2MAX; p = 0.005) and heart rate (89.4 ± 4.6 vs 77.3 ± 7.2 %HRMAX p < 0.001) at the ventilatory threshold and a higher heart rate (97.0 ± 2.4 vs 92.9 ± 2.2 %HRMAX; p = 0.02) at the respiratory compensation point. Incremental and verification phases evoked similar responses in V̇O2 and minute-ventilation during both tests. This novel displacement-based sport-specific test evoked similar maximal and higher submaximal responses, indicating a superior pathway to assess karate athletes.

Transcutaneous Spinal Neuromodulation Reorganizes Neural Networks in Patients with Cerebral Palsy.

Spinal neuromodulation and activity-based rehabilitation triggers neural network reorganization and enhances sensory-motor performances involving the lower limbs, the trunk, and the upper limbs. This study reports the acute effects of Transcutaneous Electrical Spinal Cord Neuromodulation (SCONE™, SpineX Inc.) on 12 individuals (ages 2 to 50) diagnosed with cerebral palsy (CP) with Gross Motor Function Classification Scale (GMFCS) levels ranging from I to V. Acute spinal neuromodulation improved the postural and locomotor abilities in 11 out of the 12 patients including the ability to generate bilateral weight bearing stepping in a 2-year-old (GMFCS level IV) who was unable to step. In addition, we observed independent head-control and weight bearing standing with stimulation in a 10-year-old and a 4-year old (GMFCS level V) who were unable to hold their head up or stand without support in the absence of stimulation. All patients significantly improved in coordination of flexor and extensor motor pools and inter and intralimb joint angles while stepping on a treadmill. While it is assumed that the etiologies of the disruptive functions of CP are associated with an injury to the supraspinal networks, these data are consistent with the hypothesis that spinal neuromodulation and functionally focused activity-based therapies can form a functionally improved chronic state of reorganization of the spinal-supraspinal connectivity. We further suggest that the level of reorganization of spinal-supraspinal connectivity with neuromodulation contributed to improved locomotion by improving the coordination patterns of flexor and extensor muscles by modulating the amplitude and firing patterns of EMG burst during stepping.

Nicotinamide mononucleotide supplementation enhances aerobic capacity in amateur runners: a randomized, double-blind study.

BACKGROUND: Recent studies in rodents indicate that a combination of exercise training and supplementation with nicotinamide adenine dinucleotide (NAD+) precursors has synergistic effects. However, there are currently no human clinical trials analyzing this. OBJECTIVE: This study investigates the effects of a combination of exercise training and supplementation with nicotinamide mononucleotide (NMN), the immediate precursor of NAD+, on cardiovascular fitness in healthy amateur runners. METHODS: A six-week randomized, double-blind, placebo-controlled, four-arm clinical trial including 48 young and middle-aged recreationally trained runners of the Guangzhou Pearl River running team was conducted. The participants were randomized into four groups: the low dosage group (300 mg/day NMN), the medium dosage group (600 mg/day NMN), the high dosage group (1200 mg/day NMN), and the control group (placebo). Each group consisted of ten male participants and two female participants. Each training session was 40-60 min, and the runners trained 5-6 times each week. Cardiopulmonary exercise testing was performed at baseline and after the intervention, at 6 weeks, to assess the aerobic capacity of the runners. RESULTS: Analysis of covariance of the change from baseline over the 6 week treatment showed that the oxygen uptake (VO2), percentages of maximum oxygen uptake (VO2max), power at first ventilatory threshold, and power at second ventilatory threshold increased to a higher degree in the medium and high dosage groups compared with the control group. However, there was no difference in VO2max, O2-pulse, VO2 related to work rate, and peak power after the 6 week treatment from baseline in any of these groups. CONCLUSION: NMN increases the aerobic capacity of humans during exercise training, and the improvement is likely the result of enhanced O2 utilization of the skeletal muscle. TRIAL REGISTRATION NUMBER: ChiCTR2000035138 .

Effect of acute caffeine supplementation before intermittent high-intensity exercise on cytokine levels and psychobiological parameters: A randomized, cross-over, placebo-controlled trial.

The present study aimed to verify the effects of caffeine supplementation on psychobiological parameters and its relationship with inflammatory cytokines in non-athlete subjects. We hypothesized that IL-10 may be responsible for the reduction in fatigue perception in response to caffeine supplementation. It was a randomized, double-blinded, cross-over, placebo-controlled study. Ten non-athlete subjects (26.9 ± 4.01 years old; 73.44 ± 9.57 kg; 15.94 ± 4.32 body fat kg) were evaluated. Sixty-min after caffeine (6 mg-1.kg-1 body mass) or placebo supplementation, high-intensity interval exercise test (1 min at 90% of Wmax and 2 min at 50% of Wmax) was performed to maximum voluntary exhaustion. Cytokine concentrations and psychobiological parameters were evaluated before (BE), immediately after (post-PE) and 1 h after exercise (1 h post-PE). We verify that IL-6 (0.35; 95% CI: 0.13 to 0.56; z = 3.24; p = 0.001; d = 1.14) and IL-10 (9.06; 95% CI 0.41 to 17.70; z = 2.05; p = 0.04; d = 1.12) increases post-PE in CAF group versus PLA group. Still, IL-10 levels were higher in CAF group 1 h post-PE (25.04; 95% CI: 8.95 to 41.31; z = 3.05; p = 0.002; d = 1.9) than PLA group. Moreover, 1 h post-PE vigor level was higher in the CAF group versus PLA group (4.53; 95% CI: 1.27 to 7.80; z = 2.72; p = 0.006; d = 0.46), and fatigue was lower in CAF group than PLA group (-5.08; 95% CI: -9.93 to -0.227; z = -2.05; p = 0.040; d = 0.67). We conclude that 1 h post-PE caffeine was able to decrease fatigue and increase vigor perception. IL-10 levels were higher 1 h post-PE in CAF group, suggesting, according to our hypothesis, that IL-10 may be associated with decrease fatigue perceptions after exercise.

Vertebral fracture during one repetition maximum testing in a breast cancer survivor: A case report.

RATIONALE: One repetition maximum (1-RM) testing is a standard strength assessment procedure in clinical exercise intervention trials. Because no adverse events (AEs) are published, expert panels usually consider it safe for patient populations. However, we here report a vertebral fracture during 1-RM testing. PATIENT CONCERNS: A 69-year-old breast cancer survivor (body-mass-index 31.6 kg/m2), 3 months after primary therapy, underwent 1-RM testing within an exercise intervention trial. At the leg press, she experienced pain accompanied by a soft crackling. DIAGNOSIS: Imaging revealed a partially unstable cover plate compression fracture of the fourth lumbar vertebra (L4) with a vertical fracture line to the base plate, an extended bone marrow edema and a relative stenosis of the spinal canal. INTERVENTIONS: It was treated with an orthosis and vitamin D supplementation. Another imaging to exclude bone metastases revealed previously unknown osteoporosis. OUTCOMES: The patient was symptom-free 6.5 weeks after the event but did not return to exercise. CONCLUSION: This case challenges safety of 1-RM testing in elderly clinical populations. LESSONS: Pre-exercise osteoporosis risk assessment might help reducing fracture risk. However, changing the standard procedure from 1-RM to multiple repetition maximum (x-RM) testing in studies with elderly or clinical populations would be the safest solution.

Effect of aromatherapy on autonomic nervous system regulation with treadmill exercise-induced stress among adolescents.

INTRODUCTION: Stress is a major health issue in adolescents owing to the important transitions experienced during this period. Aromatherapy is an effective method for the reduction of stress in adolescents. PURPOSE: The aims of this study were to examine the effect of aromatherapy on the regulation of the autonomic nervous system (ANS) along with stress relief and to explore the effect of aromatherapy on adolescents with different levels of stress. METHODS: This quasi-experimental study comprised three types of treatments: control (no essential oil), pure essential oil therapy (sandalwood), and blended essential oil therapy (sandalwood-lavender). The heart rate variability (HRV) was calculated to evaluate the post-exercise recovery of the ANS to the baseline level in the recruited adolescents. To examine the efficiency of aromatherapy, Friedman test was used to assess the significance of difference in all parameters (i.e., mean heart rate, SDNN, normalized LF, normalized HF, and LF/HF) between baseline and after exercise among the three treatment conditions. RESULTS: The participants comprised 43 junior college students (8 males and 35 females) with a mean age of 18.21 ± 0.99. Significant differences in changes of two HRV parameters (normalized LF and LF/HF) were associated with both essential oil therapies compared to those in the control group (p<0.05), and one more HRV parameter (normalized HF) exhibited significant difference related to blended essential oil therapy compared to that of the control group. Besides, changes in two HRV parameters (mean heart rate and normalized HF) of both essential oil therapies in the low level stress subgroup showed significant differences compared to those of the control group (p<0.05). CONCLUSIONS: This study demonstrated that aromatherapy could be used for ANS regulation with stress-relieving effects in adolescents. The participants with a low stress level appeared to respond better to the blended essential oil therapy, whereas those with medium to high levels of stress appeared to respond poorly to aromatherapy compared to the control.

Moderate- and High-Intensity Inspiratory Muscle Training Equally Improves Inspiratory Muscle Strength and Endurance-A Double-Blind Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: Inspiratory muscle training (IMT) produced outstanding results in the physical performance of active subjects; however, little is known about the best training intensity for this population. The objective was to investigate the impact of an IMT of high intensity, using the critical inspiratory pressure (CIP), on inspiratory muscle strength (IMS), inspiratory muscle endurance (IME), peak power, and oxygen uptake of recreational cyclists; and to compare these results with moderate-intensity IMT (60% of maximal inspiratory pressure [MIP]). METHODS: Thirty apparently healthy male recreational cyclists, 20-40 years old, underwent 11 weeks of IMT (3 times per week; 55 min per session). Participants were randomized into 3 groups: sham group (6 cmH2O; n = 8); 60% MIP (MIP60; n = 10) and CIP (n = 12). All participants performed the IMS test and incremental IME test at the first, fifth, ninth, and 13th weeks of the experimental protocol. Cardiopulmonary exercise testing was performed on an electromagnetic braking cycle ergometer pre-IMT and post-IMT. Data were analyzed using a 2-way repeated measures ANOVA (group and period factors). RESULTS: IMS increased in CIP and MIP60 groups at the ninth and 13th weeks compared with the sham group (P < .001; ß = 0.99). Regarding IME, there was an interaction between the CIP and MIP60 groups in all periods, except in the initial evaluation (P < .001; ß = 1.00). Peak power (in watts) increased after IMT in CIP and MIP60 groups (P = .01; ß = 0.67). Absolute oxygen uptake did not increase after IMT (P = .49; ß = 0.05). Relative oxygen uptake to lean mass values did not change significantly (P = .48; ß = 0.05). CONCLUSION: High-intensity IMT is beneficial on IMS, IME, and peak power, but does not provide additional gain to moderate intensity in recreational cyclists.