RESUMEN
This article reviews the PAPRICA (Physical Activity promotion in PRImary CAre) program fifteen years after the first training course in physical activity counseling for primary care physicians in French-speaking Switzerland. Subsequent developments are also presented, based on the PAPRICA experience. The article then looks at the national strategy for promoting physical activity in the medical practice, the issues involved in financing the services, and the situation in other comparable countries. The article concludes with a discussion of new challenges and future prospects for a program like PAPRICA.
Cet article dresse un bilan du programme PAPRICA (Physical Activity promotion in PRImary CAre) quinze ans après la première formation au conseil en activité physique destinée aux médecins de premier recours en Suisse romande. Sont également présentés les développements ultérieurs qui se sont appuyés sur l'expérience de PAPRICA. Cet état des lieux se penche ensuite sur la stratégie nationale en matière de promotion de l'activité physique au cabinet médical, les enjeux de financement des prestations, ainsi que la situation dans d'autres pays comparables. L'article se termine par l'évocation de nouveaux enjeux et les perspectives d'évolution pour un programme comme PAPRICA.
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Ejercicio Físico , Atención Primaria de Salud , Humanos , SuizaRESUMEN
The health benefits of regular physical activity are undeniable. There is a dose-response relationship between total physical activity and health outcomes, and thus every opportunity should be seized to exercise more. Among the methods used to increase the level of physical activity, physical activity counselling delivered in clinical practice is effective. The Pas à Pas+ project presented in this article allows to extend the advice from the healthcare professional and to lead up the patient to a physically more active lifestyle, providing a support in physical activity on prescription. There are several -challenges that need to be addressed in order to anchor definitely physical activity counselling and its delegation to professionals in adapted physical activity in the healthcare setting.
Les bénéfices d'une activité physique régulière pour la santé sont indéniables. Il existe une relation dose-réponse entre la quantité totale d'activités physiques pratiquées et la santé, si bien que chaque occasion doit être saisie pour bouger davantage. Parmi les moyens permettant d'augmenter le niveau d'activité physique de la population, le conseil réalisé en pratique clinique est efficace. Le projet Pas à Pas+ présenté dans cet article permet de prolonger le conseil du ou de la professionnelle de santé et d'accompagner concrètement le ou la patiente vers un mode de vie plus actif à travers une prestation de suivi en activité physique sur délégation médicale. Plusieurs défis doivent être relevés afin d'ancrer solidement dans le domaine des soins le conseil en matière d'activité physique et sa délégation vers des professionnelles de l'activité physique adaptée.
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Consejo , Ejercicio Físico/fisiología , Terapia por Ejercicio , Humanos , Estilo de VidaRESUMEN
Electrical neuroimaging is a promising method to explore the spontaneous brain function after physical exercise. The present study aims to investigate the effect of acute physical exercise on the temporal dynamic of the resting brain activity captured by the four conventional map topographies (microstates) described in the literature, and to associate these brain changes with the post-exercise neuromuscular function. Twenty endurance-trained subjects performed a 30-min biking task at 60% of their maximal aerobic power followed by a 10 km all-out time trial. Before and after each exercise, knee-extensor neuromuscular function and resting EEG were collected. Both exercises resulted in a similar increase in microstate class C stability and duration, as well as an increase in transition probability of moving toward microstate class C. After the first exercise, the increase in class C global explained variance was correlated with the indice of muscle alterations (100 Hz paired stimuli). After the second exercise, the increase in class C mean duration was correlated with the 100 Hz paired stimuli, but also with the reduction in maximal voluntary force. Interestingly, microstate class C has been associated with the salience resting-state network, which participates in integrating multisensory modalities. We speculate that temporal reorganization of the brain state after exercise could be partially modulated by the muscle afferents that project into the salience resting-state network, and indirectly participates in modulating the motor behavior.
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Encéfalo/fisiología , Ejercicio Físico/fisiología , Descanso/fisiología , Adulto , Ciclismo , Mapeo Encefálico , Electroencefalografía , Humanos , Masculino , Contracción Muscular/fisiología , Consumo de Oxígeno , Resistencia Física , Esfuerzo Físico , Probabilidad , Músculo Cuádriceps/fisiología , Factores de TiempoRESUMEN
This study aimed to investigate the impact of an extreme mountain ultramarathon (MUM) on spontaneous electrical brain activity in a group of 16 finishers. By using 4-minute high-density electroencephalographic (EEG) recordings with eyes closed before and after a 330-km race (mean duration: 125 ± 17 h; sleep duration: 7.7 ± 2.9 h), spectral power, source localization and microstate analyses were conducted. After the race, power analyses revealed a centrally localized increase in power in the delta (0.5-3.5 Hz) and theta (4.0-7.5 Hz) frequency bands and a decrease in alpha (8.0-12.0 Hz) power at the parieto-occipital sites. Higher brain activation in the alpha frequency band was observed within the left posterior cingulate cortex, left angular gyrus and visual association areas. Microstate analyses indicated a significant decrease in map C predominance and an increase in the global field power (GFP) for map D at the end of the race. These changes in power patterns and microstate parameters contrast with previously reported findings following short bouts of endurance exercises. We discuss the potential factors that explain lower alpha activity within the parieto-occipital regions and microstate changes after MUMs. In conclusion, high-density EEG resting-state analyses can be recommended to investigate brain adaptations in extreme sporting activities.
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Mapeo Encefálico , Electroencefalografía , Encéfalo/fisiología , Ojo , Humanos , Lóbulo ParietalRESUMEN
Recent findings suggest that an acute physical exercise modulates the temporal features of the EEG resting microstates, especially the microstate map C duration and relative time coverage. Microstate map C has been associated with the salience resting state network, which is mainly structured around the insula and cingulate, two brain nodes that mediate cardiovascular arousal and interoceptive awareness. Heart rate variability (HRV) is dependent on the autonomic balance; specifically, an increase in the sympathetic (or decrease in the parasympathetic) tone will decrease variability while a decrease in the sympathetic (or increase in the parasympathetic) tone will increase variability. Relying on the functional interaction between the autonomic cardiovascular activity and the salience network, this study aims to investigate the effect of exercise on the resting microstate and the possible interplay with this autonomic cardiovascular recovery after a single bout of endurance exercise. Thirty-eight young adults performed a 25-min constant-load cycling exercise at an intensity that was subjectively perceived as "hard." The microstate temporal features and conventional time and frequency domain HRV parameters were obtained at rest for 5 min before exercise and at 5, 15, 30, 45, and 60 min after exercise. Compared to the baseline, all HRV parameters were changed 5 min after exercise cessation. The mean durations of microstate B and C, and the frequency of occurrence of microstate D were also changed immediately after exercise. A long-lasting effect was found for almost all HRV parameters and for the duration of microstate C during the hour following exercise, indicating an uncompleted recovery of the autonomic cardiovascular system and the resting microstate. The implication of an exercise-induced afferent neural traffic is discussed as a potential modulator of both the autonomic regulation of heart rate and the resting EEG microstate.
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Exercise-induced fatigue affects the motor control and the ability to generate a given force or power. Surface electroencephalography allows researchers to investigate movement-related cortical potentials (MRCP), which reflect preparatory brain activity 1.5 s before movement onset. Although the MRCP amplitude appears to increase after repetitive single-joint contractions, the effects of large-muscle group dynamic exercise on such pre-motor potential remain to be described. Sixteen volunteers exercised 30 min at 60% of the maximal aerobic power on a cycle ergometer, followed by a 10-km all-out time trial. Before and after each of these tasks, knee extensor neuromuscular function was investigated using maximal voluntary contractions (MVC) combined with electrical stimulations of the femoral nerve. MRCP was recorded during 60 knee extensions after each neuromuscular sequence. The exercise resulted in a significant decrease in the knee extensor MVC force after the 30-min exercise (-10 ± 8%) and the time trial (-21 ± 9%). The voluntary activation level (VAL; -6 ± 8 and -12 ± 10%), peak twitch (Pt; -21 ± 16 and -32 ± 17%), and paired stimuli (P100 Hz; -7 ± 11 and -12 ± 13%) were also significantly reduced after the 30-min exercise and the time trial. The first exercise was followed by a decrease in the MRCP, mainly above the mean activity measured at electrodes FC1-FC2, whereas the reduction observed after the time trial was related to the FC1-FC2 and C2 electrodes. After both exercises, the reduction in the late MRCP component above FC1-FC2 was significantly correlated with the reduction in P100 Hz (r = 0.61), and the reduction in the same component above C2 was significantly correlated with the reduction in VAL (r = 0.64). In conclusion, large-muscle group exercise induced a reduction in pre-motor potential, which was related to muscle alterations and resulted in the inability to produce a maximal voluntary contraction.