Inflammatory and psychological consequences of chronic high exposure firefighting.

OBJECTIVES: This study aimed to examine the impact of extreme heat exposure frequency on inflammation and well-being in UK Fire Service personnel. METHODS: 136 Fire personnel and 14 controls (CON) were recruited [92 Firefighters (FF), 44 Breathing Apparatus Instructors (BAI)]. BAI were split into low (LBAI; ≤15 exposures per month) and high (HBAI; ≥20 exposures per month) categories. Measures of inflammation, mood and fatigue were collected at 0, 3 and 6 month times points. These variables were analysed for differences between groups and association with frequency of exposure. RESULTS: HBAI exhibited raised IL-1ß, IL-6, IL-10, IgE and lower IgM (p < 0.05). In addition, IL-1ß, IL-6, IL-10 and IgM were associated with monthly exposure number, with exposures accounting for 15.4% of the variance in IL-6, 11.8% of IL-1ß and 25.2% of IL-10. No differences in mood or fatigue were reported (p > 0.05). CONCLUSION: High exposure firefighting consistently causes systemic inflammation without perceptual recognition of potential health risks.

Extreme occupational heat exposure is associated with elevated haematological and inflammatory markers in Fire Service Instructors.

NEW FINDINGS: What is the central question of this study? Fire service instructors are frequently exposed to live fire scenarios, representing the most extreme chronic occupational heat exposure. These individuals report a series of unique health issues. We sought to identify whether the number of exposures completed was associated with inflammatory and immunological markers and symptoms of ill health. What is the main finding and its importance? Fire service instructors exhibit greater levels of inflammatory markers in comparison to firefighters. The number of exposures to fire is positively related to the prevalence of ill health and inflammation. Implementation of a proposed limit of nine exposures per month might be appropriate to minimize health issues. ABSTRACT: Fire Service Instructors (FSIs) experience ∼10 times more fire exposures than firefighters (FFs), and the increased physiological stress from this potentially puts them at risk of ill health and future cardiac events. The aim of the study was to establish whether FSIs exhibit elevated biomarkers associated with cardiac event risk, identify whether FSIs experience systemic inflammation linked to the frequency of fire exposure and evaluate a proposed exposure limit of nine exposures per month. Blood samples were collected from 110 Fire Service personnel (mean ± SD, age,44 ± 7 years; height, 178.1 ± 7.1 cm; and body mass, 84.3 ± 12.0 kg; FSIs n = 53 and FFs n = 57) for biomarker analysis. Work history details were collected from all participants. Participants with biomarker concentrations above healthy reference ranges were classified as being 'at risk'. The neutrophil-to-lymphocyte ratio, platelet count, cardiac troponin T, interleukin (IL)-6, IL-1ß, C-reactive protein and immunoglobulin G were greater in FSIs than in FFs (P < 0.05). Multiple regression analysis revealed that 18.8% of IL-6, 24.9% of IL-1ß, 29.2% of C-reactive protein and 10.9% of immunoglobulin G variance could be explained by the number of exposures to heat per month. Odds ratios revealed that those FSIs above the nine per month exposure limit were six to 12 times more likely to be classified as 'at risk' and were 16 times more likely to experience symptoms of ill health. Increased cytokine levels suggest that FSIs experience systemic inflammation, which is related to symptoms of ill health. We propose that an exposure limit could reduce the prevalence of these biomarker risk factors and ill health.

Integrin-associated ILK and PINCH1 protein content are reduced in skeletal muscle of maintenance haemodialysis patients.

KEY POINTS: Patients with renal failure undergoing maintenance haemodialysis are associated with insulin resistance and protein metabolism dysfunction. Novel research suggests that disruption to the transmembrane protein linkage between the cytoskeleton and the extracellular matrix in skeletal muscle may contribute to reduced amino acid metabolism and insulin resistance in haemodialysis. ILK, PINCH1 and pFAKTyr397 were significantly decreased in haemodialysis compared to controls, whereas Rac1 and Akt2 showed no different between groups. Rac1 deletion in the Rac1 knockout model did not alter the expression of integrin-associated proteins. Phenylalanine kinetics were reduced in the haemodialysis group at 30 and 60 min post meal ingestion compared to controls; both groups showed similar levels of insulin sensitivity and ß-cell function. Key proteins in the integrin-cytoskeleton linkage are reduced in haemodialysis patients, suggesting for the first time that integrin-associated proteins dysfunction may contribute to reduced phenylalanine flux without affecting insulin resistance in haemodialysis patients. ABSTRACT: Muscle atrophy, insulin resistance and reduced muscle phosphoinositide 3-kinase-Akt signalling are common characteristics of patients undergoing maintenance haemodialysis (MHD). Disruption to the transmembrane protein linkage between the cytoskeleton and the extracellular matrix in skeletal muscle may contribute to reduced amino acid metabolism and insulin resistance in MHD patients. Eight MHD patients (age: 56 ± 5 years: body mass index: 32 ± 2 kg m-2 ) and non-diseased controls (age: 50 ± 2 years: body mass index: 31 ± 1 kg m-2 ) received primed continuous l-[ring-2 H5 ]phenylalanine before consuming a mixed meal. Phenylalanine metabolism was determined using two-compartment modelling. Muscle biopsies were collected prior to the meal and at 300 min postprandially. In a separate experiment, skeletal muscle tissue from muscle-specific Rac1 knockout (Rac1 mKO) was harvested to investigate whether Rac1 depletion disrupted the cytoskeleton-integrin linkage, allowing for cross-model examination of proteins of interest. ILK, PINCH1 and pFAKTyr397 were significantly lower in MHD (P < 0.01). Rac1 and Akt showed no difference between groups for the human trial. Rac1 deletion in the Rac1 mKO model did not alter the expression of integrin-associated proteins. Phenylalanine rates of appearance and disappearance, as well as metabolic clearance rates, were lower in the MHD group at 30 and 60 min post meal ingestion compared to controls (P < 0.05). Both groups showed similar levels of insulin sensitivity and ß-cell function. Key proteins in the integrin-cytoskeleton linkage are reduced in MHD patients, suggesting for the first time that integrin-associated proteins dysfunction may contribute to reduced phenylalanine flux without affecting insulin resistance in haemodialysis patients.

Differences in Achilles tendon stiffness in people with gout: a pilot study.

BACKGROUND: Gout has been associated with weaker foot/leg muscles and altered gait patterns. There is also evidence of on-going foot pain and an increased risk of tendinopathy, with the Achilles and patella tendons most frequently affected in gout. Additionally, the inflammation associated with gout may change tissue elasticity. Ultrasound imaging utilising shear wave elastography (SWE) offers a non-invasive method of quantifying changes in tendon stiffness. SWE findings have not previously been reported in individuals with gout. We sought to determine differences in Achilles tendon stiffness in people with gout compared to controls (non-gout). METHODS: A cross sectional study comparing 24 people with gout and 26 age/sex-matched controls. Clinical and demographic data were collated, and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Ten shear wave elastography (SWE) measures were taken along the centre of a longitudinal section of the mid-portion of each Achilles tendon. Prior to data collection, intra-observer error was good (>0.69). Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare SWE measures between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI). RESULTS: A small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons. There was no statistically significant difference in tendon thickness between groups. Neo-vascularity was present in a third of gout participants. SWE findings demonstrated significantly reduced tendon stiffness in those with gout compared to controls: right Achilles mdiff =1.04 m/s (95% CI (0.38 to 1.7) p = 0.003 and left Achilles mdiff = 0.7 m/s (95% CI 0.09 to 1.32) p = 0.025. No relationship between the presence of tophi and SWE values were detected. CONCLUSION: Subjects with chronic gout show significantly reduced Achilles tendon stiffness compared to non-gout controls. From a clinical standpoint, our findings were similar to SWE measurements in subjects with Achilles tendinopathy and who did not have gout.

Heat tolerance of Fire Service Instructors.

OBJECTIVES: Fire Service Instructors (FSI) experience repeated fire exposures a median of 13 ±â€¯8 times a month; consequently they may develop an acclimatised state. However, the chronic immunological implications of heat acclimation are yet to be understood. This study aimed to establish whether FSI exhibit an increased heat tolerance and altered immunological response to heat exposures, compared to non-exposed individuals. The study also aimed to identify if heat tolerance is related to symptoms of ill health. METHODS: Twenty-two participants were recruited: 11 FSI (age: 41 ±â€¯7 yrs, body mass: 77.4 ±â€¯12.2 kg, height: 174.1 ±â€¯8.2 cm) and 11 non-exposed controls (CON) (age: 41 ±â€¯7 yrs, body mass: 75.9 ±â€¯12.2 kg, height: 177.0 ±â€¯8.1 cm). Participants completed a 40 min heat occupational tolerance test (HOTT) exercising at 6 W kg-1 (50.0 ±â€¯1.0 °C, 12.3 ±â€¯3.3% relative humidity) on two occasions, separated by 2 months. Physiological and perceptual measures were collected throughout and venous blood samples were collected prior to and post exposure. RESULTS: FSI displayed significantly reduced peak rectal temperature (Tre) (-0.42 °C), change in Tre (-0.33 °C), and thermal sensation (-1.0) and increased sweat rate (+0.25 L h-1) at the end of the HOTT compared to CON (p < 0.05). FSI exhibited similar responses to the HOTT as CON for all haematological variables. However, resting interleukin-6, interleukin-1ß, and immunoglobulin G were significantly greater in FSI than CON. There was no difference in responses following the 2 month working period. FSI peak Tre was negatively correlated with symptoms of ill health (rpb = -0.473, p = 0.026) and the number of fire exposures in the previous 2 weeks (rs = -0.589, p = 0.004). CONCLUSION: Despite increased heat tolerance compared to non-exposed individuals, FSI may develop a maladaptation to repeated fire exposures, with elevated resting cytokine levels and an increased prevalence of ill health symptoms.

The acute effect of training fire exercises on fire service instructors.

Fire service instructors (FSI) regularly experience different types of fire exercises, however the strain experienced from these scenarios is not well understood. This study aims to identify the physiological and perceptual strain of Fire Service Instructors (FSI) to three training exercises: DEMO, ATTACK, COMPARTMENT, and the different roles performed: SETTER, INSTRUCTOR. The study also aims to assess the effect that different exercise patterns over a day (BOX, MULTI, COMBINATION) have on immunological responses. Sixteen FSI (age: 41 ± 8 years, body mass: 83.7 ± 6.7 kg, height: 177.0 ± 6.7 cm) were recruited, with 10 FSI completing the three exercises. Physiological and perceptual measures were collected prior to and immediately post each exercise. Venous blood samples were collected at the beginning and end of each day. One-way analysis of variance (ANOVA) were conducted to assess differences in physiological variables between exercise types, independent samples t-tests were conducted between roles. Day changes in hematological variables were assessed by paired sample t-tests and analyzed by one-way ANOVAs to identify differences between exercise patterns. The COMPARTMENT exercise resulted in a greater change in rectal temperature (ΔTre) (0.49 ± 0.28 °C) than both the DEMO (0.23 ± 0.19 °C, p = 0.045) and ATTACK (0.27 ± 0.22 °C, p = 0.016). Within the COMPARTMENT exercise, the SETTER resulted in a greater ΔTre and rating of perceived exertion than the INSTRUCTOR (0.67 ± 0.29 °C vs. 0.43 ± 0.18 °C, p = 0.027 and 14 ± 2 vs. 11 ± 2, p = 0.001, respectively). Following a day of fire exercises white blood cells (WBC), neutrophils, lymphocytes (LYMPH), monocytes (MONO), platelets (PLT), mean platelet volume (MPV), Interleukin (IL)-6, and cardiac troponin T (cTnT) all increased (p < 0.05). Exercise patterns containing a COMPARTMENT exercise resulted in greater PLT, MPV, and IL-6. Total daily variation in ΔTre was correlated with post-exercise WBC, MONO, and LYMPH. COMPARTMENT exercises produce the greatest physiological strain, with the SETTER role within this exercise causing the greatest ΔTre. Although predominately physiological responses remain within safe limits. Exercise patterns that include a COMPARTMENT exercise also generate a greater inflammatory response.

Reproducibility of shear wave elastography measuresof the Achilles tendon.

OBJECTIVE: To assess the reproducibility of shear wave elastography (SWE) measures in the Achilles tendon (AT) in vivo. MATERIALS AND METHODS: Shear wave velocity (SWV) of 14 healthy volunteers [7 males, 7 females; mean age 26.5 ± 3.8 years, mean height 171.6 ± 10.9 cm, mean Victorian Institute of Sports Assessment Achilles questionnaire (VISA-A) score 99.4 ± 1.2] was measured with the foot relaxed and fixed at 90°. Data were collected over five consecutive measures and 5 consecutive days. RESULTS: Mean SWV values ranged from 7.91 m/s-9.56 m/s ± 0.27-0.50 m/s. Coefficient of variation (CV), correlations and intra-class correlation coefficient (ICC) scores ranged from 2.9%-6.3%, 0.4-0.7 and 0.54-0.85 respectively. No significant differences were noted for longitudinal or transverse data with respect to protocol or time and no significant differences were noted for foot position in transverse data. Significant differences in SWV values were noted between foot positions for longitudinal scanning (p = <0.05), with a relaxed foot position providing SWV values on average 0.47 m/s faster than a fixed position. Increased reproducibility was obtained with the foot relaxed. ICC between operators was 0.70 for transverse and 0.80 for longitudinal scanning. CONCLUSIONS: Reproducible SWE measures were obtained over a 1-h period as well as a period of 5 consecutive days with more reliable measures obtained from a longitudinal plane using a relaxed foot position. SWE also has a high level of agreement between operators making SWE a reproducible technique for quantitatively assessing the mechanical properties of the human AT in vivo.

A new occupational heat tolerance test: A feasibility study.

Heat tolerance tests identify those susceptible to heat illnesses and monitor heat adaptations. Currently, tolerance tests do not replicate the uncompensable heat strain environments experienced in some occupations. In addition, tests can take up to 2 h to complete, and cannot offer intra and inter individual comparisons, due to the use of a fixed exercise intensity. This study aimed to assess the validity and reliability of a new heat occupational tolerance test (HOTT: 40 min at 6 W kg-1 metabolic heat production, 50 °C 10% RH, in protective clothing) to the standard heat tolerance test (HTT: 2 h walk at 5 km h-1 1% gradient, 40 °C 40% RH, in shorts and t-shirt). Eighteen participants (age: 21 ±â€¯3 yrs, body mass: 81.3 ±â€¯5.9 kg) completed trials to assess the validity and/or reliability of the HOTT. Peak rectal temperature (Tre) displayed strong agreement and low measurement error (0.19 °C) between HTT (38.7 ±â€¯0.4 °C) and HOTT (38.6 ±â€¯0.4 °C). Strong agreement was also displayed for physiological and perceptual measures between the two HOTT trials, including peak Tre (38.5 ±â€¯0.4 °C vs. 38.5 ±â€¯0.4 °C) and peak heart rate (182 ±â€¯20 b min-1 vs. 182 ±â€¯21 b min-1). The HOTT is the first tolerance test that assesses individuals' responses whilst wearing protective clothing in high temperatures. It can consistently identify individuals' levels of heat tolerance within a reduced time frame. In addition, it allows for participant monitoring over time and comparisons between individuals to be made. A continuum based approach is recommended when assessing individuals' responses to the HOTT.

Short-Term Heat Acclimation and Precooling, Independently and Combined, Improve 5-km Time Trial Performance in the Heat.

James, CA, Richardson, AJ, Watt, PW, Willmott, AGB, Gibson, OR, and Maxwell, NS. Short-term heat acclimation and precooling, independently and combined, improve 5-km time trial performance in the heat. J Strength Cond Res 32(5): 1366-1375, 2018-Following heat acclimation (HA), endurance running performance remains impaired in hot vs. temperate conditions. Combining HA with precooling (PC) demonstrates no additive benefit in intermittent sprint, or continuous cycling exercise protocols, during which heat strain may be less severe compared to endurance running. This study investigated the effect of short-term HA (STHA) combined with mixed methods PC, on endurance running performance and directly compared PC and HA. Nine amateur trained runners completed 5-km treadmill time trials (TTs) in the heat (32° C, 60% relative humidity) under 4 conditions; no intervention (CON), PC, short-term HA (5 days-HA) and STHA with PC (HA + PC). Mean (±SD) performance times were; CON 1,476 (173) seconds, PC 1,421 (146) seconds, HA 1,378 (116) seconds and HA + PC 1,373 (121) seconds. This equated to the following improvements versus CON; PC -3.7%, HA -6.6% and HA + PC -7.0%. Statistical differences were only observed between HA and CON (p = 0.004, d = 0.68, 95% CI [-0.27 to 1.63]) however, similar effect sizes were observed for HA + PC vs. CON (d = 0.70, 95% CI [-0.25 to 1.65]), with smaller effects between PC vs. CON (d = 0.34, 95% CI [-0.59 to 1.27]), HA vs. PC (d = 0.33, 95% CI [-0.60 to 1.26]) and HA + PC vs. PC (d = 0.36, 95% CI [-0.57 to 1.29]). Pilot testing revealed a TT typical error of 16 seconds (1.2%). Precooling offered no further benefit to performance in the acclimated individual, despite modest alleviation of physiological strain. Maintenance of running speed in HA + PC, despite reduced physiological strain, may indicate an inappropriate pacing strategy therefore, further familiarization is recommended to optimize a combined strategy. Finally, these data indicate HA, achieved through cycle training, yields a larger ergogenic effect than PC on 5-km running performance in the heat, although PC remains beneficial when HA is not possible.

Poor reproducibility of compression elastography in the Achilles tendon: same day and consecutive day measurements.

OBJECTIVE: To determine the reproducibility of compression elastography (CE) when measuring strain data, a measure of stiffness of the human Achilles tendon in vivo, over consecutive measures, consecutive days and when using different foot positions. MATERIALS AND METHODS: Eight participants (4 males, 4 females; mean age 25.5 ± 2.51 years, range 21-30 years; height 173.6 ± 11.7 cm, range 156-189 cm) had five consecutive CE measurements taken on one day and a further five CE measures taken, one per day, at the same time of day, every day for a consecutive 5-day period. These 80 measurements were used to assess both the repeatability and reproducibility of the technique. Means, standard deviations, coefficient of variation (CV), Pearson correlation analysis (R) and intra-class correlation coefficients (ICC) were calculated. RESULTS: For CE data, all CVs were above 53%, R values indicated no-to-weak correlations between measures at best (range 0.01-0.25), and ICC values were all classified in the poor category (range 0.00-0.11). CVs for length and diameter measures were acceptably low indicating a high level of reliability. CONCLUSIONS: Given the wide variation obtained in the CE results, it was concluded that CE using this specific system has a low level of reproducibility for measuring the stiffness of the human Achilles tendon in vivo over consecutive days, consecutive measures and in different foot positions.

Short-term heat acclimation prior to a multi-day desert ultra-marathon improves physiological and psychological responses without compromising immune status.

Multistage, ultra-endurance events in hot, humid conditions necessitate thermal adaptation, often achieved through short term heat acclimation (STHA), to improve performance by reducing thermoregulatory strain and perceptions of heat stress. This study investigated the physiological, perceptual and immunological responses to STHA prior to the Marathon des Sables. Eight athletes (age 42 ± 4 years and body mass 81.9 ± 15.0 kg) completed 4 days of controlled hyperthermia STHA (60 min·day‒1, 45°C and 30% relative humidity). Pre, during and post sessions, physiological and perceptual measures were recorded. Immunological measures were recorded pre-post sessions 1 and 4. STHA improved thermal comfort (P = 0.02), sensation (P = 0.03) and perceived exertion (P = 0.04). A dissociated relationship between perceptual fatigue and Tre was evident after STHA, with reductions in perceived Physical (P = 0.04) and General (P = 0.04) fatigue. Exercising Tre and HR did not change (P > 0.05) however, sweat rate increased 14% (P = 0.02). No changes were found in white blood cell counts or content (P > 0.05). Four days of STHA facilitates effective perceptual adaptations, without compromising immune status prior to an ultra-endurance race in heat stress. A greater physiological strain is required to confer optimal physiological adaptations.

Ischaemic preconditioning does not alter the determinants of endurance running performance in the heat.

PURPOSE: Ischaemic preconditioning (IP) has been shown to be ergogenic for endurance performance in normothermic conditions and alleviate physiological strain under hypoxia, potentially through haemodynamic and/or metabolic mechanisms. Exertional hyperthermia is characterised by competition for blood flow between the muscles and skin, an enhanced metabolic strain and impaired endurance performance. This study investigated the effect of IP on the determinants of endurance performance, through an incremental exercise test in the heat. METHOD: Eleven males completed two graded exercise tests in the heat (32 °C, 62 % RH) until volitional exhaustion, preceded by IP (4 × 5 min 220 mmHg bilateral upper leg occlusion) or a control (CON) condition (4 × 5-min 50 mmHg bilateral). RESULT: IP did not improve running speeds at fixed blood lactate concentrations of 2 and 4 mMol L(-1) (p = 0.828), or affect blood glucose concentration throughout the trial [mean (±SD); CON 5.03 (0.94) mMol L(-1), IP 5.47 (1.38) mMol L(-1), p = 0.260). There was no difference in [Formula: see text]O2max [CON 55.5 (3.7) mL kg(-1) min(-1), IP 56.0 (2.6) mL kg(-1) min(-1), p = 0.436], average running economy [CON 222.3 (18.0) mL kg(-1) km(-1), IP 218.9 (16.5) mL kg(-1) km(-1), p = 0.125], or total running time during graded exercise [CON 347 (42) s, IP 379 (68) s, p = 0.166]. The IP procedure did not change muscle temperature [CON ∆ = 0.55 (0.57) °C, IP ∆ = 0.78 (0.85) °C, p = 0.568], but did reduce T CORE during exercise (~-0.1 °C, p = 0.001). CONCLUSION: The novel application of IP prior to exercise in the heat does not enhance the determinants of endurance performance. For events where IP appears ergogenic, muscle warming strategies are unnecessary as IP does not influence deep muscle temperature.

Physiological and psychological responses in Fire Instructors to heat exposures.

AIM: Fire Service Instructors (FSI) are exposed to many repeated periods of high environmental temperatures when training firefighters. Such repeated exposures will impose significant strains on the function of instructors. We aimed to measure the effects of a training programme including repeated exposures to heat, termed "Wears" in the fire service, on the physiological, psychological some immunological markers of Fire Service Instructors. METHODS: Six FSI and six physiologically matched controls completed blood and cardiovascular tests pre and post a 4wk heat instruction training block, controls completed the tests only. FSI were given a 7wk period of no heat exposure prior to starting the training. Physiological and perceptual measures were taken pre and post the first and last Wear of the 4wk training protocol. RESULTS: There were acute effects of a Wear on core temperature and physiological strain index, as well as measures of fatigue. The acute exposure to heat during a Wear led to a consistent decrease in CRP (-10% to -40%), increased IL6 concentrations 33-45%) as well as increased RPE and TSS. Over the training programme significantly lower quantities of white cells, particularly neutrophils, leukocytes and monocytes were found in the FSI group. Between the start and the end of the 4 week training programme the FSI showed a significantly greater physiological strain index (PSI) to the Wears, which nearly doubled from 2.5 to 4.7 (p<0.05). CONCLUSION: Physiological and psychological measures indicate that FSI may be experiencing symptoms and changes to their health consistent with an overtraining type condition.

Long-Term High-Effort Endurance Exercise in Older Adults: Diminishing Returns for Cognitive and Brain Aging.

While there is evidence that age-related changes in cognitive performance and brain structure can be offset by increased exercise, little is known about the impact long-term high-effort endurance exercise has on these functions. In a cross-sectional design with 12-month follow-up, we recruited older adults engaging in high-effort endurance exercise over at least 20 years, and compared their cognitive performance and brain structure with a nonsedentary control group similar in age, sex, education, IQ, and lifestyle factors. Our findings showed no differences on measures of speed of processing, executive function, incidental memory, episodic memory, working memory, or visual search for older adults participating in long-term high-effort endurance exercise, when compared without confounds to nonsedentary peers. On tasks that engaged significant attentional control, subtle differences emerged. On indices of brain structure, long-term exercisers displayed higher white matter axial diffusivity than their age-matched peers, but this did not correlate with indices of cognitive performance.

Effective microorganism - X attenuates circulating superoxide dismutase following an acute bout of intermittent running in hot, humid conditions.

This study determined the effectiveness of antioxidant supplementation on high-intensity exercise-heat stress. Six males completed a high-intensity running protocol twice in temperate conditions (TEMP; 20.4°C), and twice in hot conditions (HOT; 34.7°C). Trials were completed following7 days supplementation with 70 ml·day(-1) effective microorganism-X (EM-X; TEMPEMX or HOTEMX) or placebo (TEMPPLA or HOTPLA). Plasma extracellular Hsp72 (eHsp72) and superoxide dismutase (SOD) were measured by ELISA. eHsp72 and SOD increased pre-post exercise (p < 0.001), with greater eHsp72 (p < 0.001) increases observed in HOT (+1.5 ng·ml(-1)) compared to TEMP (+0.8 ng·ml(-1)). EM-X did not influence eHsp72 (p > 0.05). Greater (p < 0.001) SOD increases were observed in HOT (+0.22 U·ml(-1)) versus TEMP (+0.10 U·ml(-1)) with SOD reduced in HOTEMX versus HOTPLA (p = 0.001). Physiological and perceptual responses were all greater (p < 0.001) in HOT versus TEMP conditions, with no difference followed EM-X (p > 0.05). EM-X supplementation attenuated the SOD increases following HOT, potentiating its application as an ergogenic aid to ameliorate oxidative stress.

Isothermic and fixed intensity heat acclimation methods induce similar heat adaptation following short and long-term timescales.

Heat acclimation requires the interaction between hot environments and exercise to elicit thermoregulatory adaptations. Optimal synergism between these parameters is unknown. Common practise involves utilising a fixed workload model where exercise prescription is controlled and core temperature is uncontrolled, or an isothermic model where core temperature is controlled and work rate is manipulated to control core temperature. Following a baseline heat stress test; 24 males performed a between groups experimental design performing short term heat acclimation (STHA; five 90 min sessions) and long term heat acclimation (LTHA; STHA plus further five 90 min sessions) utilising either fixed intensity (50% VO2peak), continuous isothermic (target rectal temperature 38.5 °C for STHA and LTHA), or progressive isothermic heat acclimation (target rectal temperature 38.5 °C for STHA, and 39.0 °C for LTHA). Identical heat stress tests followed STHA and LTHA to determine the magnitude of adaptation. All methods induced equal adaptation from baseline however isothermic methods induced adaptation and reduced exercise durations (STHA = -66% and LTHA = -72%) and mean session intensity (STHA = -13% VO2peak and LTHA = -9% VO2peak) in comparison to fixed (p < 0.05). STHA decreased exercising heart rate (-10 b min(-1)), core (-0.2 °C) and skin temperature (-0.51 °C), with sweat losses increasing (+0.36 Lh(-1)) (p<0.05). No difference between heat acclimation methods, and no further benefit of LTHA was observed (p > 0.05). Only thermal sensation improved from baseline to STHA (-0.2), and then between STHA and LTHA (-0.5) (p<0.05). Both the continuous and progressive isothermic methods elicited exercise duration, mean session intensity, and mean T(rec) analogous to more efficient administration for maximising adaptation. Short term isothermic methods are therefore optimal for individuals aiming to achieve heat adaptation most economically, i.e. when integrating heat acclimation into a pre-competition taper. Fixed methods may be optimal for military and occupational applications due to lower exercise intensity and simplified administration.

Peak power output provides the most reliable measure of performance in prolonged intermittent-sprint cycling.

The aims of this study were to determine the reliability of an intermittent-sprint cycling protocol and to determine the efficacy of one practice session on main trials. Eleven men, moderately trained team-sport athletes, completed three visits to the laboratory involving a graded-exercise test and practice session and two trials of a cycling intermittent-sprint Protocol separated by three days. Data for practice and main trials were analysed using typical error of measurement, intra-class correlation and least-products regression to determine reliability. Typical error of measurement (expressed as a coefficient of variation) and intra-class correlation for peak power output from all 20 sprints for trial 1 and trial 2 were 2.9 ± 12.8% (95% confidence interval: 2.0-5.0%) and 0.96 (95% confidence interval: 0.85-0.99), respectively. Typical errors of measurement and intra-class correlation for mean power output for all 20 sprints for trials 1 and 2 were 4.2 ± 11.9% (95% confidence interval: 2.9-7.4%) and 0.90 (95% confidence interval: 0.66-0.97), respectively. The results suggest that peak power output provides a more reliable measure than mean power output. The Cycling Intermittent-Sprint Protocol provides reliable measures of intermittent-sprint performance.

A mixed method, phase 2 clinical evaluation of a novel device to treat postpartum haemorrhage.

BACKGROUND: We evaluated the safety, efficacy, and acceptability of a new device designed to facilitate uterine compression in women with postpartum haemorrhage (PPH). METHODS: A prospective, phase two clinical device trial with concurrent qualitative study, conducted in a UK consultant obstetric unit. The device was used in addition to standard care in women unresponsive to initial oxytocin therapy. The primary effectiveness outcome was additional blood loss of over 1000mls, whilst safety was assessed through adverse events. Interviews assessed device feasibility and acceptability, and were analysed using framework analysis. RESULTS: We recruited 57 women with clinical PPH after vaginal birth; 67% were primiparous and 47% had undergone operative birth. All but two (96%) had atony as a cause of the haemorrhage; in addition, 30% also had bleeding from lacerations and 11% had retained tissue. After device use, only one woman had additional blood loss over 1000mls, although 3 women (7%) needed a Bakri balloon and 14% received a blood transfusion. All but one clinician felt that the device was easy to use. Clinicians stated that the device assisted management in 85% of cases. All 56 women who responded stated that if they bled in a future birth they would want the device to be used again. There were no serious adverse events related to the device. However, 3 events were judged as 'possibly' being caused by the device - 2 minor vaginal grazes and one postnatal episiotomy infection and breakdown. Lax vaginal tissue complicated the use of the device in three women. In 47 interviews, participants, birth partners, clinician users and attending midwives viewed the device positively. Clinicians found it useful as a way of stopping blood loss and as an aid to diagnose the source of bleeding. CONCLUSIONS: The PPH Butterfly may provide a rapid, acceptable and effective treatment for postpartum haemorrhage. Clinical Trial Registration prospective with ISRCTN15452399 11/09/2017 (www.isrctn.com/ISRCTN15452399).

Pain Neuroscience Education and Motor Control Exercises versus Core Stability Exercises on Pain, Disability, and Balance in Women with Chronic Low Back Pain.

Background: Several interventions have been used to relieve chronic low back pain (CLBP). This study aimed to compare the effects of pain neuroscience education (PNE) followed by motor control exercises (MCEs) with core stability training (CST) on pain, disability, and balance in women with CLBP. Methods: Thirty-seven women with CLBP were randomly divided into two groups of PNE/MCE (n = 18, 55.2 ± 2.6 years) or CST (n = 19, 54.6 ± 2.4 years). Eight weeks of PNE/MCE or CST were prescribed for each group, independently. Pain intensity (VAS scale), disability (Roland Morris Disability Questionnaire), unipodal static balance, and dynamic balance (time up and go test) were measured at the beginning and 8 weeks after the intervention. Two-way mixed ANOVA was used to analyze the results with alpha of 5%. Results: After 8 weeks, there was a significant difference in VAS scale between groups (p = 0.024), with both PNE/MCE and CST showing 58% and 42% reductions, respectively. There were no differences for all other variables between groups. Regarding pre- to post-comparisons, both groups showed improvements in all dependent variables (p < 0.001). Conclusion: The treatment with PNE/MCE was more effective in improving pain disability and unipodal static and dynamic balance than treatment with CST. Even so, both treatments were shown to be valid and safe in improving all dependent variables analyzed in women with CLBP.