Potential for using simulated altitude as a means of prehabilitation: a physiology study.

The current pandemic of surgical complications necessitates urgent and pragmatic innovation to reduce postoperative morbidity and mortality, which are associated with poor pre-operative fitness and anaemia. Exercise prehabilitation is a compelling strategy, but it has proven difficult to establish that it improves outcomes either in isolation or as part of a multimodal approach. Simulated altitude exposure improves performance in athletes and offers a novel potential means of improving cardiorespiratory and metabolic fitness and alleviating anaemia within the prehabilitation window. We aimed to provide an initial physiological foundation for 'altitude prehabilitation' by determining the physiological effects of one week of simulated altitude (FI O2 15%, equivalent to approximately 2438 m (8000 ft)) in older sedentary volunteers. The study used a randomised, double-blind, sham-controlled crossover design. Eight participants spent counterbalanced normoxic and hypoxic weeks in a residential hypoxia facility and underwent repeated cardiopulmonary exercise tests. Mean (SD) age of participants was 64 (7) y and they were unfit, with mean (SD) baseline anaerobic threshold 12 (2) ml.kg-1 .min-1 and mean (SD) peak V̇O2 15 (3) ml.kg-1 .min-1 . Hypoxia was mild (mean (SD) Sp O2 93 (2) %, p < 0.001) and well-tolerated. Despite some indication of greater peak exercise capacity following hypoxia, overall there was no effect of simulated altitude on anaerobic threshold or peak V̇O2 . However, hypoxia induced a substantial increase in mean (SD) haemoglobin of 1.5 (2.7) g.dl-1 (13% increase, p = 0.028). This study has established the concept and feasibility of 'altitude prehabilitation' and demonstrated specific potential for improving haematological fitness. Physiologically, there is value in exploring a possible role for simulated altitude in pre-operative optimisation.

Changes in circulating insulin-like growth factor-binding protein-1 (IGFBP-1) during prolonged exercise: effect of carbohydrate feeding.

Plasma levels of glucose, insulin, the insulin-like growth factor (IGF-I and -II) and IGFBP-1 were determined in four young healthy males performing cycle exercise to fatigue while being fed either placebo (trial C) or glucose polymer solution (trial G). There was a significant decline in glucose and insulin from rest to fatigue in C (P < 0.01 and P < 0.05, respectively), but not in G. IGF-I or IGF-II levels did not change significantly in either of the trials. IGFBP-1 levels increased 12-fold in C (11.4 +/- 1.6 ng/ml at rest to 136.5 +/- 19.7 ng/ml at fatigue P < 0.01), and 5.6-fold in G (11.0 +/- 2.3 ng/ml to 62.2 +/- 15 ng/ml, P < 0.05). In C a significant negative correlation was found between IGFBP-1 and glucose (r = 0.69, P < 0.01) and IGFBP-1 and insulin (r = -0.612, P < 0.05) in C, but not in G. These results suggest that during prolonged exercise factors other than insulin or glucose may regulate IGFBP-1 and that IGFBP-1 may serve a role other than to prevent the hypoglycaemic action of the IGFs.

Determination of human skeletal muscle buffer value by homogenate technique: methods of measurement.

The human muscle buffer value (beta) is most frequently determined by either fixed acid titration of a homogenate ["in vitro" beta (beta vit)] or measurement of the change in lactate concentration (delta [La]) relative to the change in muscle homogenate pH after high-intensity exercise ["in vitro" beta = - delta [La]/delta pH (beta viv)]. We sought to compare beta viv, determined after isometric and dynamic exercise to exhaustion (approximately 60 s), with beta vit. Resting (R) and postexercise (E) biopsy samples were taken from vastus lateralis muscles of 43 human volunteers. Freeze-dried muscle was homogenized (30 mg/ml) in NaF (0.01 M) for the measurement of muscle pH (R and E). beta vit was determined by HCl (0.01 M) titration of the homogenate over the pH range 7.1-6.5. Muscle lactate was measured by enzymatic assay. There was no significant difference between beta viv determined after isometric (n = 35) or dynamic (n = 8) exercise to fatigue (170 vs. 168 mmol H+.kg dry muscle mass-1.pH-1, respectively; P > 0.05). Values for beta vit in the corresponding muscle samples (R) were approximately 7-8% lower (156 +/- 25 vs. 157 +/- 18 mmol H+.kg dry muscle mass-1.pH-1, respectively). There was no significant difference (P = 0.278) between the measured decline in muscle homogenate pH after exercise and the reduction in pH predicted from beta vit and delta [La], indirectly confirming the lack of any significant difference between beta viv and beta vit.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of behavioural risk factors on osteoporosis in Irish women.

BACKGROUND: Osteoporosis constitutes a major public health concern and its underlying pathogenesis is complex and multifactorial. Although hereditary factors strongly contribute to bone health, behavioural factors can modulate the genetically determined pattern of skeletal modelling and remodelling. AIM: The aim of this study was to investigate the effect(s) of behavioural risk factors on osteoporosis in Irish women. METHODS: Pre- and post-menopausal adult women (n = 189; 44 ± 15 years) participated in this cross-sectional study. Demographic, anthropometric and lifestyle data were collected during a single clinic visit. Dietary calcium intake and lifetime physical activity (PA) were assessed for each subject. Lumbar and femoral bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA). Multivariate analysis was used to determine the independent predictors of low BMD. RESULTS: Low BMD was present in 59% of subjects (42% pre- and 77% post-menopausal). Smoking was the strongest behavioural predictor of lumbar and femoral BMD. Age, height, family history, smoking, metabolic (MET) and mechanical (MECH) PA (lifetime) and weight (body mass) accounted for 39% of the variance in lumbar BMD. Age, height, family history, alcohol consumption, MET and MECH PA (lifetime) and weight accounted for 41% of the variance in femoral BMD. CONCLUSIONS: Prevalence of osteopenia and osteoporosis is high in Irish women and is associated with modifiable risk factors. A clearer focus should be paid to educate Irish women on preventative health behaviours for osteoporosis to curb the prevalence of this disease and the human and fiscal costs associated with it.

Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study.

OBJECTIVE: It is not established whether myalgic encephalomyelitis/chronic fatigue syndrome (CFS) is associated with structural brain changes. The aim of this study was to investigate this by conducting the largest voxel-based morphometry study to date in CFS. METHODS: High-resolution structural 3 T cerebral MRI scanning was carried out in 26 patients with CFS and 26 age- and gender-matched healthy volunteers. Voxel-wise generalised linear modelling was applied to the processed MR data using permutation-based non-parametric testing, forming clusters at t>2.3 and testing clusters for significance at p<0.05, corrected for multiple comparisons across space. RESULTS: Significant voxels (p<0.05, corrected for multiple comparisons) depicting reduced grey matter volume in the CFS group were noted in the occipital lobes (right and left occipital poles; left lateral occipital cortex, superior division; and left supracalcrine cortex), the right angular gyrus and the posterior division of the left parahippocampal gyrus. Significant voxels (p<0.05, corrected for multiple comparisons) depicting reduced white matter volume in the CFS group were also noted in the left occipital lobe. CONCLUSION: These data support the hypothesis that significant neuroanatomical changes occur in CFS, and are consistent with the complaint of impaired memory that is common in this illness; they also suggest that subtle abnormalities in visual processing, and discrepancies between intended actions and consequent movements, may occur in CFS.

Raman spectroscopy of the human nail: a potential tool for evaluating bone health?

Dual X-ray absorptiometry (DEXA) is the current gold standard for the diagnosis of osteoporosis. However, patients can suffer osteoporotic fractures despite normal bone mineral density, partly because of unmeasured influences of both the protein and mineral phases of bone that are affected in osteoporosis. There is currently no clinically applicable method of evaluating the health of the protein phase. The proteins in human nail (keratin) and bone (collagen) require sulphation and disulphide bond (S-S) formation for structural integrity and disorders of either sulphur metabolism or cystathione beta-synthase can lead to structural abnormalities in these tissues. Raman protein spectra provide a method of non-invasive measurement of the degree of sulphation of structurally related proteins that may be indicative of bone health. Raman spectroscopy was used to evaluate the disulphide (S-S) content of fingernails. The nail samples came from from 169 women (84 pre- and 85 post-menopausal), of which 39 had a history of osteoporotic fracture. BMD was measured by DXA at the spine. Analyses included parametric and non-parametric tests, dependent on the distribution of the test variable. Mean disulphide content of the nail reduced with age and was slightly higher in pre-, compared to post-menopausal women (P = 0.187). Significantly lower disulphide content was observed in nails obtained from subjects with a history of fracture (P = 0.025). When either disulphide content or BMD was used as a predictor, the odds ratio of these two measures were found to be comparable predictors for fracture status. This suggests that measurements of change in the protein phase of structural proteins such as keratin in the human nail may be correlated with clinically relevant changes in bone proteins that are important in fracture risk.

Amino acid metabolism, branched-chain amino acid feeding and brain monoamine function.

Although fatigue during prolonged exercise has traditionally been associated with peripheral factors relating to muscle metabolism, such as the depletion of muscle glycogen, more recent research has generated a renewed interest in amino acid metabolism per se and in the role of amino acids as precursors of brain neurotransmitter function. The concept of a 'central fatigue hypothesis' has done much to stimulate scientists to explore the functional role of the brain and CNS in the aetiology of the fatigue process. The concept has also generated a number of testable hypotheses by which it is possible to examine how the 'central' component of fatigue may act. The present review has attempted to bring together the current research in this area. There is good reason to believe that nutritional intervention may play an important role in relation to fatigue residing within the brain and CNS. Although an exciting possibility exists that nutritional manipulation may affect brain neurochemistry and ultimately sports performance, the experimental evidence to support this claim is, as yet, equivocal. A greater understanding of amino acid metabolism and, in particular, amino acid transport, will greatly improve future experimental designs used to test the efficacy of nutritional manipulation of amino acids and their effect on the central component of the fatigue process.

Effects of isokinetic training of the knee extensors on high-intensity exercise performance and skeletal muscle buffering.

Twenty-three subjects isokinetically trained the right and left quadriceps femoris, three times per week for 16 weeks; one group (n = 13) trained at an angular velocity of 4.19 rad.s-1 and a second group (n = 10), at 1.05 rad.s-1. A control group (n = 10) performed no training. Isometric endurance time at 60% quadriceps maximum voluntary contraction (MVC), mean power output and work done (W) during all-out cycling, and the muscle buffer value (B) and carnosine concentration of biopsy samples from the vastus lateralis, were all assessed before and after training. The two training groups did not differ significantly from each other in their training response to any of these variables (P < 0.05). No significant difference in either 60% MVC endurance time or impulse [(endurance time x force) at 60% MVC] was observed for any group after the 16 week period (P > 0.05). However, the post-training increase (9%) in W during high-intensity cycling was greater in the training group than in the control group (P = 0.04). Neither B nor carnosine concentration showed any significant change following training (P = 0.56 and P = 0.37, respectively). It is concluded that 16 weeks of isokinetic training of the knee extensors enables subjects to do more work during high-intensity cycling. Although the precise adaptations responsible for the improved performance have yet to be identified, they are unlikely to include an increase in B.

A review of research in sports physiology.

The physiology of sport encompasses a wide and diverse range of scientific interests. The intention, and major challenge of the review, is to collate the most pertinent of these interests into a coherent strategy for future research in sports physiology. The unifying concept of this review is the potential contribution of future research in sports physiology to the development of the elite competitor. The review promotes this theme through an indepth appraisal of current knowledge and identification of key areas of research that would most profitably advance the understanding and application of sports physiology. Central to this theme are the physiological limitations to exercise performance of the elite competitor and the adaptation of these physiological systems to further training, possibly leading to overtraining. Indeed, the potential to adapt to, or recover from, the ever increasing demands of training and competition is considered in sections on the development of strength and power, the child athlete and the limitations to performance in multiple sprint activities such as hockey and football. Throughout the review it is recognized that sports physiology is increasingly reliant upon advances in analytical techniques and quantitative measurement. Physiological measurement, the validity and accuracy of present and future procedures, and the correct interpretation of these data are therefore considered in detail in the final section of the review.

Cellular immune activity in response to increased training of elite oarsmen prior to Olympic competition.

This study investigated the changes in urinary neopterin, a biochemical marker of cellular immune activity, in elite male rowers undertaking a progressive increase in training prior to Olympic competition. Twenty-seven male rowers of the 1992 Great Britain team provided daily urine samples for a 4-week period of training that included 17 days of altitude training and 10 days of heat acclimatization. The mean (+/- S.D.) ratio of neopterin/creatinine in urine increased from pre-training values of 135 +/- 32 to a peak of 219 +/- 121 mumol neopterin per mol creatinine on day 19 of training (P < 0.05). Changes in the ratio of neopterin/creatinine with training were found to be transient and highly variable between subjects, ranging from no change to peak values five-fold greater than baseline. On the basis of the in vivo measurement of cell-mediated immunity employed in this study, we conclude that elite athletes engaged in high-intensity training prior to competition show either no change or a moderate increase in cellular immune activation.

The effect of oral creatine supplementation on the 1000-m performance of competitive rowers.

This study investigated the change in 1000-m simulated rowing performance in two matched groups of 19 competitive rowers following a 5-day period of supplementation with placebo (CON group) or creatine at a dose equivalent to 0.25 g creatine monohydrate per kilogram of body mass (BM) (EXP group). Creatine uptake was calculated from the difference between the amount fed and the amount recovered in urine during each 24-h period of supplementation. Total creatine uptake for the EXP group over the 5-day period of supplementation averaged 34.9 +/- 10.9 g (range 20.1-54.9 g), which equated to 3.54 +/- 0.93 mmol kg BM-1. The estimated creatine uptake into muscle was 38.1 +/- 10.0 (range 22.6-56.6) mmol kg dry weight-1 for these subjects. After supplementation with placebo, the CON group showed no change in 1000-m rowing performance (214.0 +/- 30.9 vs 214.1 +/- 31.5 s; P = 0.88). Of these subjects, 7 decreased and 10 increased their performance times (range - 3.1 to 2.7%). By contrast, 16 of the 19 subjects in the EXP group improved their performance times. The mean improvement in rowing performance for the EXP group was 2.3 s (211.0 +/- 21.5 vs 208.7 +/- 21.8 s; P < 0.001), an overall improvement of just over 1% (range - 0.4 to 3.4%). We conclude that in competitive rowers, a 5-day period of creatine supplementation was effective in raising whole-body creatine stores, the magnitude of which provided a positive, though statistically non-significant (r = 0.426, P = 0.088), relationship with 1000-m rowing performance.

Effects of isokinetic training of the knee extensors on isometric strength and peak power output during cycling.

Isokinetic training of right and left quadriceps femoris was undertaken three times per week for 16 weeks. One group of subjects (n = 13) trained at an angular velocity of 4.19 rad.s-1 and a second group (n = 10) at 1.05 rad.s-1. A control group (n = 10) performed no training. Maximal voluntary contraction (MVC) of the quadriceps, and peak pedal velocity nu p,peak) and peak power output (Wpeak) during all-out cycling (against loads equivalent to 9, 10, 11, 12, 13 and 14% MVC) were assessed before and after training. The two training groups did not differ significantly from each other in their training response to any of the performance variables (P > 0.05). No significant difference in MVC was observed for any group after the 16-week period (P = 0.167). The post-training increases in average Wpeak (7%) and nu p,peak (6%) during the cycle tests were each significantly different from the control group response (P = 0.018 and P = 0.008, respectively). It is concluded that 16 weeks of isokinetic strength training of the knee extensors is able to significantly improve nu p, peak and Wpeak during spring cycling, an activity which demands considerable involvement of the trained muscle group but with its own distinct pattern of coordination.

Skeletal muscle buffer value, fibre type distribution and high intensity exercise performance in man.

Interrelationships between quadriceps femoris muscle buffer value (beta), fibre type distribution, and lactate concentration and pH following short-term high intensity exercise were examined in eighteen young healthy human volunteers. Muscle biopsy samples were taken from the lateral portion of the quadriceps femoris muscle at rest and after fatiguing dynamic or isometric exercise. Isometric exercise required the maintenance of 60% quadriceps maximum voluntary contraction, and dynamic exercise, the performance of a modified Wingate Test. The muscle buffer value displayed a positive, but non-significant correlation with the relative area of the muscle occupied by type II fibres (r = 0.42, P = 0.09). An elevated beta was associated with a lesser decrement in muscle pH during intensive exercise but did not permit the accumulation of a higher muscle lactate concentration or allow for an enhanced dynamic or isometric exercise performance. A superior performance during dynamic exercise was associated with a high concentration of muscle lactate and a low muscle pH post-exercise; in turn, each of these factors was positively dependent on the relative area of the muscle occupied by type II fibres. The converse was found for isometric exercise, where there was a tendency for an enhanced performance to be associated with a low muscle lactate and high muscle pH post-exercise. No significant relationship between the relative type II fibre area and isometric performance capacity could be established. It was concluded that the muscle buffer value is not a major limiting factor to the performance of high intensity exercise, suggesting that the involvement of intramuscular acidosis in the development of fatigue may be indirect. The most important determinant of high intensity exercise capacity appears to be the proportional area of the muscle occupied by type II fibres, where a high value provides for a superior dynamic but inferior isometric exercise performance.

The impact of a short course of three lipid lowering drugs on fat oxidation during exercise in healthy volunteers.

We examined the impact of three lipid lowering drugs on fat oxidation during a 120 minute treadmill walk, at an exercise intensity of 50% maximal oxygen uptake (VO2 max). Subjects (N = 24) were healthy male volunteers with normal serum chemistry, assigned to three groups (n = 8). Group A received simvastatin 20 mg twice daily, Group B received gemfibrozil 600 mg twice daily, Group C received acipimox 600 mg twice daily. Each subject performed two 120 minute walks, once with drug, and once with placebo (4 days treatment plus a final dose on the morning of the exercise trial). Treatment order was reversed for half of each group. Compared to placebo, simvastatin treatment, had no impact on fat oxidation (40.9 +/- 8.6% vs 40.9 +/- 9.7%), or on plasma concentration of free fatty acids (FFA), glycerol or glucose. Treatment with gemfibrozil, showed lower fat oxidation (32.3 +/- 13.9% vs 39.7 +/- 7.9%), and lower plasma concentrations of FFA and glycerol, but differences did not reach significance at the 0.05 level. Acipimox treatment, produced significantly lower fat oxidation (36.9 +/- 12.8% vs 50.2 +/- 16.1%, P = 0.011), and lower plasma concentrations of FFA and glycerol (P = < 0.0001 and P = < 0.0001, respectively). Plasma glucose showed a trend toward lower values with acipimox (P = 0.088). These data demonstrate that selective lipid lowering drugs can reduce fat availability for exercise metabolism, placing increased demands on carbohydrates which may reduce exercise tolerance.

Evidence for downregulation of hypothalamic 5-hydroxytryptamine receptor function in endurance-trained athletes.

Serum prolactin (PRL) was used as a hormone marker of serotoninergic function following oral administration of an acute dose of a serotoninergic agonist. Five male endurance-trained athletes (ET) and five healthy non-endurance-trained controls (NT) were studied. The peak PRL concentration was lower (P = 0.031) for the ET athletes (486 +/- 208 mU l-1; mean +/- S.D.) than for the NT controls (1000 +/- 385 mU l-1); the total release of PRL was also lower (P = 0.042) for the ET subjects. The lower neuroendocrine response to a serotoninergic agonist in the endurance-trained athletes suggests a downregulation of central serotoninergic receptor function in response to endurance training in man.

Carnosine and anserine concentrations in the quadriceps femoris muscle of healthy humans.

The content of anserine and carnosine in the lateral portion of the quadriceps femoris muscle of 50 healthy, human subjects has been studied. Anserine was undetectable in all muscle samples examined. Muscle carnosine values for the group conformed to a normal distribution with a mean (SD) value of 20.0 (4.7) mmol.kg-1 of dry muscle mass. The concentration of carnosine was significantly higher in the muscle of male subjects (21.3, 4.2 mmol.kg-1 dry mass) than in females of a similar age and training status (17.5, 4.8 mmol.kg-1 dry mass) (P less than 0.005). The test-retest reliability of measures was determined on a subgroup of 17 subjects. No significant difference in mean carnosine concentration was found between the two trials [21.5 (4.0) and 22.0 (5.2) mmol.kg-1 dry muscle mass; P greater than 0.05]. The importance of carnosine as a physicochemical buffer within human muscle was examined by calculating its buffering ability over the physiological pH range. From the range of carnosine concentrations observed (7.2-30.7 mmol.kg-1 dry muscle mass), it was estimated that the dipeptide could buffer between 2.4 and 10.1 mmol H+.kg-1 dry mass over the physiological pH range 7.1-6.5, contributing, on average, approximately 7% to the total muscle buffering. This suggests that in humans, in contrast to many other species, carnosine is of only limited importance in preventing the reduction in pH observed during high intensity exercise.

Is human skeletal muscle capillary supply modelled according to fibre size or fibre type?

Analysis of muscle supply usually relies on estimating either the numerical capillary to fibre ratio or capillary density. Both indices are scale dependent, i.e. they vary with fibre size. We have examined the use of an alternative approach based on the anatomical supply area of individual capillaries, which allows the calculation of a local capillary to fibre ration or density based on area, rather than number of fibres. The results suggest that, in human skeletal muscle, capillary supply is primarily scaled according to fibre size, and is relatively independent of fibre type.