Effects of a nighttime melatonin ingestion on dynamic postural balance and muscle strength the following morning in people living with multiple sclerosis: A preliminary study.

BACKGROUND: Decreased endogenous melatonin concentrations in people with multiple sclerosis (PwMS) are associated with fatigue and pain that impair postural balance and muscle strength. Melatonin ingestion had analgesic and anti-fatigue effects. However, the acute effect of exogenous melatonin on dynamic postural stability and muscle strength has not been studied yet in PwMS. This study aimed to investigate the safety and the efficacy of a nighttime melatonin intake on dynamic postural balance and lower-extremity muscle strength the following morning in PwMS. METHODS: Fourteen PwMS (28.36 ± 6.81 years) were assessed (8 a.m.) pre- and post-acute intake of melatonin or placebo (6mg, 30 minutes before nocturnal bedtime). Evaluated parameters included dynamic postural balance (force platform), lower-extremity muscle strength [Five-Repetition Sit-To-Stand Test (5-STST)], hand dexterity (Nine-Hole Peg Test), nociceptive pain [Visual Analogue Scale (VAS)], neuropathic pain [Neuropathic Pain 4 Questions (DN4)], sleep quality and fatigue perception [Hooper Index (HI)]. RESULTS: In the frontal plane, melatonin reduced the center of pressure (CoP) path length (CoPL), CoPL in the anteroposterior axis (CoPLY) and CoP sway area (CoPAr) compared with placebo by 7.56% (p=0.02, Cohens'd (d)=1.24), 19.27% (p<0.001, d=2.60) and 13.82% (p<0.001, d=2.02), respectively. Melatonin induced a higher decrease in these posturographic parameters compared with placebo in the sagittal plane [CoPL: 9.10% (p=0.005, d=1.02), CoPLY: 4.29% (p=0.025, d=1.07) and CoPAr: 7.45% (p=0.038, d=0.74)]. Melatonin decreased 5-STST duration as well as VAS, DN4, HI-fatigue and HI-sleep scores compared with placebo by 8.19% (p=0.008, d=1.19), 5.74% (p=0.04, d=0.82), 27.30% (p=0.023, d=0.98), 40.15% (p=0.044, d=0.85) and 30.16% (p=0.012, d=1.10), respectively. CONCLUSION: This preliminary study, among PwMS, showed that acute melatonin ingestion was safe and efficient for improving dynamic postural stability and lower-extremity muscle strength probably through its analgesic and anti-fatigue effects.

Is moderate-intensity interval training more tolerable than high-intensity interval training in adults with obesity?

Interval training (IT) has been shown to be a time-effective alternative to traditional training programmes in the management of obesity. Nevertheless, studies comparing the effects of different IT intensities on inflammation, muscle and liver damage, and perceptual responses in people with obesity are relatively scarce. This study aimed to compare the acute effects of two different IT protocols matched by the mean load and duration on biochemical and perceptual responses in sedentary adults with obesity. Twenty-two volunteers (age = 33.40 ± 10.01 years, BMI = 38.29 ± 7.09 kg/m²) were randomized to perform two conditions: moderate-intensity IT (MIIT) 5 × 3 min (70% of peak power output (PPO))/2 min (45%PPO) and high-intensity IT (HIIT) 8 × 1 min (90%PPO)/2 min (45%PPO). Blood samples were drawn before and after exercise for biochemical and haematological measurements. Rating of perceived exertion (RPE) was assessed during and after exercise. Perceptual pain was evaluated before, throughout and after exercise. C-reactive protein, white blood cells and neutrophils increased only after HIIT (p < 0.001, for all). Aspartate aminotransferase, alanine aminotransferase, creatine kinase and lactate dehydrogenase increased in both HIIT and MIIT (p < 0.001, for all), without any difference between sessions. HIIT induced a greater increase of blood lactate compared to MIIT (p < 0.05). Pain and RPE scores were higher during HIIT vs. MIIT (p < 0.001 and p < 0.01, respectively). MIIT induced fewer immune system perturbations and less muscle pain and was perceived as more tolerable compared to HIIT session. Therefore, MIIT could be used as a first step to promote body adaptations before starting a HIIT programme in sedentary people with obesity.

Melatonin intake before intradialytic exercise reverses oxidative stress and improves antioxidant status in hemodialysis patients.

PURPOSE: The present study aimed to investigate for the first time the effects of melatonin (MEL) intake on oxidative stress and cellular damage during intradialytic exercise (IEX). METHODS: Thirteen hemodialysis (HD) patients volunteered to participate in the current randomized crossover trial. Participants performed four HD sessions in four different conditions: (Exercise (EX)-MEL), (EX-Placebo (PLA)), (Control (C)-MEL), and (C-PLA). 3 mg of MEL or PLA were taken 60 min before starting exercise, or at the equivalent time in the C conditions. Blood samples were taken before HD (T0), immediately after the end of IEX (T1), 60 min after IEX (T2), or at the corresponding times in the C conditions to measure free radicals damage, antioxidant biomarkers, as well as biomarkers of muscle and liver damage. RESULTS: Malondialdehyde and Advanced Oxidation Protein Products decreased in (C-MEL) (p < 0.05, d = 2.19; p < 0.01, d = 0.99, respectively) at T2 compared to T0. Catalase and total thiol levels increased in (C-MEL) (p < 0.01, d = 1.51; p < 0.01, d = 1.56, respectively) and in (EX-MEL) (p = 0.01, d = 1.28; p < 0.01, d = 1.52, respectively) at T1 compared to T0. Total bilirubin levels increased in (EX-MEL) and (C-MEL) at T2 compared to T0 (p < 0.001, d = 2.77; p < 0.001, d = 1.36, respectively), but only at T2 compared to T1 in (EX-MEL) (p < 0.001, d = 1.67). In all conditions, uric acid levels decreased at T1 compared to T0 and at T2 compared to T1, while biomarkers of muscle and liver damage remained unchanged. CONCLUSION: This pilot study is the first to show that MEL ingestion, alone or combined with IEX, could improve oxidant-antioxidant balance during HD.

Effectiveness of Ramadan diurnal intermittent fasting and concurrent training in the management of obesity: is the combination worth the weight?

BACKGROUND AND AIMS: We investigated, in men with obesity, the efficacy of the combination of two strategies (Ramadan diurnal intermittent fasting 'RDIF' strategy vs RDIF plus concurrent training program 'RDIF-CT' strategy) known for their positive impact on body composition and then we explored the possible impact on metabolic and inflammatory biomarkers. METHODS AND RESULTS: Twenty obese men, age: 31.8 ± 7.05 years, BMI: 33.1 ± 4.2 kg m-2, performing regularly RDIF, were randomized into two groups: RDIF-CT (n = 10) and RDIF without training (RDIF-NCT) (n = 10). The RDIF-CT group participated in High intensity interval training (HIIT) program combined with resistance exercises for 4 weeks. Body composition, blood glucose, lipid profile, liver biomarkers and inflammation were assessed before and after 4-week RDIF. Both groups showed a significant decrease in weight, fat mass (FM), fat percentage (Fat%) and waist circumference (WC) and an improvement in blood glucose, lipid profile and inflammation. Fat free mass decreased significantly in RDIF-NCT (p < 0.05) while remaining unchanged in RDIF-CT. However, RDIF-CT induced greater improvements in body composition (i.e., weight, FM, Fat% and WC (p < 0.05, p < 0.01, p < 0.01 and p < 0.05; respectively)) as well as greater decrease in lipid biomarkers (i.e., TC, TG and LDL (p < 0.01 for all)), inflammation (i.e., CRP (p < 0.05)), and liver damage (i.e., ASAT, ALAT and Gamma-GT (p < 0.01, p < 0.05 and p < 0.001; respectively)) compared to RDIF-NCT group pre-post intervention. CONCLUSIONS: Our results suggest that a combination of RDIF and CT induces greater changes in body composition, lipid profile, inflammation and liver biomarkers compared to RDIF strategy alone. CLINICAL TRIAL REGISTER: PACTR202203475387226.

Effects of intradialytic exercise in combination with melatonin supplementation on functional capacity, postural balance, and quality of life in hemodialysis patients.

INTRODUCTION: We evaluated the effect of intradialytic concurrent (resistance-endurance) training combined with melatonin (MEL) supplementation on functional capacity, muscle strength, postural balance, and quality of life (QoL) in hemodialysis (HD) patients. METHODS: Thirty-three HD patients were randomized into three groups: Exercise (EX)-MEL (n = 11); EX-Placebo (PLA) (n = 11) and Control (C)-PLA (n = 11). Participants included in the EX-MEL and EX-PLA groups were submitted to concurrent training for 12 weeks. RESULTS: EX-MEL and EX-PLA improved functional capacity, muscle strength, QoL, and postural balance parameters in eyes open and eyes closed conditions. Parameters of postural balance in the dual task condition were improved only in EX-MEL. EX-MEL induced better results in some domains of QoL compared with EX-PLA. CONCLUSION: Intradialytic concurrent training induced beneficial effects on physical function, muscle strength, postural balance, and QoL in HD patients. MEL supplementation combined with intradialytic exercise lead to better improvements in postural balance and QoL.

Combined effect of gender differences and fatiguing task on postural balance, functional mobility and fall risk in adults with multiple sclerosis: A preliminary study.

AIM: To investigate the gender difference effect on postural balance, functional mobility, and fall risk after performing a fatiguing task in adults with multiple sclerosis (MS). METHODS: Eleven women (30.91 ± 8.19 years) and seven men (30.29 ± 7.99 years) with relapsing-remitting MS performed a fatiguing task: three sets of the Five-repetition Sit-To-Stand Test (5-STST) were performed before and after the six-minute WalkTest (6MWT). Bipedal postural balance in eyes open and eyes closed conditions were assessed prefatigue (T0) and postfatigue (T3) using a force platform. Unipedal balance, functional mobility (Timed Up and Go Test), fall risk (Four Square Step Test) and fatigue [Visual Analogue Scale of Fatigue (VASF)] were assessed at T0 and T3. Heart rate (HR) and Rating of Perceived Exertion (RPE) were recorded before (only for HR), during and after the fatiguing task. RESULTS: Compared to women, men showed an impairment of posturographic parameters [mean center of pressure (CoP) velocity (CoPVm) in both conditions (p < 0.05); CoP sway area (CoPAr) in both conditions (p < 0.01)], unipedal balance on the dominant leg (p <0.001), mobility (p<0.001) and an increased fall risk (p < 0.05). No gender differences were observed in 6MWT, 5-STST, HR, RPE, and VASF. CONCLUSION: This preliminary study showed that fatiguing task negatively affected postural control, mobility and fall risk only in men. These gender differences were inconclusive but could be taken into account in postural balance rehabilitation programs for MS persons.

Melatonin reduces muscle damage, inflammation and oxidative stress induced by exhaustive exercise in people with overweight/obesity.

BACKGROUND: Intense physical exercise leads to inflammation, oxidative stress and muscle damage, and these responses are of greater magnitude in people with obesity. Melatonin (MLT) is considered an endogenous antioxidant which may have beneficial effects against inflammation, oxidative stress and promote tissue repair after exercise. The aim of this study was to examine the effect of MLT on inflammatory parameters, oxidative stress and muscle damage in people with overweight/obesity after a high-intensity interval exercise (HIIE). METHODS: A total of 23 subjects with obesity (9 men and 14 women) age: 33.26 ± 9.81 years, BMI: 37.75 ± 8.87 kg.m-2 were randomized to participate in two experimental sessions: HIIE + Placebo and HIIE + MLT (3 mg). The HIIE protocol corresponds to 8 intervals of 1 min (90% of the maximal aerobic power (MAP)) alternating with 2 min recovery (45% of the MAP). Blood samples were drawn before and 5 min after each exercise session. RESULTS: MLT ingestion attenuated the increase of inflammation (C-reactive protein, white blood cells (P < 0.001, ηp2 = 0.45; for both) and Neutrophils (P < 0.01, ηp2 = 0.36)) and hepatic and muscle damage (Aspartate aminotransferase (P < 0.01, ηp2 = 0.25), Alanine aminotransferase (P < 0.01, ηp2 = 0.27) and Creatine kinase (P = 0.02, ηp2 = 0.23). MLT also attenuated the exercise induced lipid and protein peroxidation (i.e., Malondialdehyde (P = 0.03, ηp2 = 0.19) and AOPP (P < 0.001, ηp2 = 0.55)). Concerning the antioxidant status, MLT intake increased Thiol (P < 0.01, ηp2 = 0.26) and Catalase (P < 0.01, ηp2 = 0.32) and decreased Uric acid (P = 0.02, ηp2 = 0.2) and Total bilirubin (P < 0.01, ηp2 = 0.33). CONCLUSIONS: MLT intake before HIIE reduced muscle damage by modulating oxidative stress and preventing overexpression of the pro-inflammatory mediators in people with obesity.

Melatonin ingestion before intradialytic exercise improves immune responses in hemodialysis patients.

PURPOSE: The present study aimed to investigate the effects of melatonin (MEL) intake on systemic inflammation and immune responses during intradialytic exercise. METHODS: Thirteen hemodialysis (HD) patients volunteered to participate in the current randomized-crossover study. Immunological responses were monitored in four HD sessions at different conditions: [Exercise (EX) + MEL], [EX + Placebo (PLA)], [Control (CON) + MEL] and [CON + PLA]. MEL (3 mg) or PLA was ingested 1 h before starting exercise or the equivalent time in CON condition. During all sessions, peripheral blood samples were collected to assess c-reactive protein, complete blood count, and immune cells phenotypes before HD (T0), immediately after exercise (T1) and 1 h after exercise (T2) or at corresponding times in the CON condition. RESULTS: HD therapy induced a significant decrease in natural killer (NK) (p = 0.001, d = 0.85; p < 0.001, d = 1.19, respectively) and CD8+ T-lymphocytes rates (p = 0.001, d = 0.57; p < 0.001, d = 0.75, respectively) at T1 and T2 compared to T0. MEL intake prevented the decrease in NK and CD8+ T-lymphocytes, increased the proportion of CD4+ T-lymphocytes at T1 and T2 compared to T0 (p = 0.002, d = 1.18; p = 0.001, d = 1.04, respectively) and decreased the proportion of CD14++CD16+ Monocytes at T2 compared to T0 (p = 0.02, d = 1.57) in peripheral blood during HD therapy. Similar results were found in [EX + MEL] and [EX + PLA] conditions. CONCLUSION: This pilot study provides the first evidence that MEL intake alone or associated with intradialytic exercise displays potential immunoregulatory and anti-inflammatory effects. The combination of MEL with intradialytic exercise may be an appropriate anti-inflammatory therapy for HD patients.