Mechanisms by which exercise training benefits patients with copd mecanismos pelo qual o treinamento de exercício beneficia pacientes com dpoc running title: exercise training / Mecanismos pelos quais o treinamento de exercício beneficia pacientes com o título dpoc running: treinamento de exercício / Mecanismos por los que el entrenamiento de ejercicio beneficia a los pacientes con epoc mecanismos por los que el entrenamiento de ejercicio beneficia a los pacientes con epoc running title: exercise training

The clinical consequences of chronic obstructive pulmonary disease (COPD) include fatigue, dyspnea and progressive impairment of exercise capacity. It also produces significant systemic consequences such as nutritional depletion, physical deconditioning, systemic inflammation, and structural and functional changes in the respiratory and locomotor muscles. Regular exercise provides improvements in the health of patients with stable COPD and can relieve the symptoms, increasing the exercise capacity and improving the quality of life, while also reducing hospitalization and, to some extent, the risk of morbidity and mortality. Training with progressive exercises is associated with metabolic and neurohumoral adaptations, heart rate variability, with adaptations in the pulmonary and skeletal muscles, as well as the inflammatory, cardiovascular and respiratory systems. This review will focus on current knowledge of the mechanisms by which physical training can provide beneficial effects in COPD patients. Results: After analyzing the titles, abstracts and content, out of 500 articles found, 489 were excluded, leaving 11 articles. Studies have shown the beneficial effect of aerobic training on COPD. Conclusion: Physical training should be considered a therapeutic option in patients with COPD, regardless of being terrestrial or aquatic, as it can have beneficial effects on the systems.

As consequências clínicas da doença pulmonar obstrutiva crônica (DPOC) são: fadiga, dispnéia e comprometimento progressivo da capacidade do exercício, além disso, também produz consequências sistêmicas significativas como depleção nutricional, descondicionamento físico, inflamação sistêmica, mudanças estruturais e funcionais de músculos respiratórios e locomotores. O treinamento físico regular traz como beneficíos efeitos da melhoria da saúde em pacientes com DPOC estável e pode aliviar os sintomas, melhorar a capacidade de exercício e a qualidade de vida, reduzir a hospitalização e, em certa medida, o risco de morbi-mortalidade. Já o treinamento com exercícios progressivos está associado a adaptações metabólicas, neurohumorais, variabilidade da frequência cardíaca, inflamatórias, dos músculos pulmonares e esqueléticos, cardiovasculares e respiratórias. Esta revisão enfocará o conhecimento atual dos mecanismos pelos quais o treinamento físico pode ter efeitos benéficos em pacientes com DPOC. Resultados: Após análise dos títulos, resumos e conteúdo, dos 500 artigos encontrados, 489 foram excluídos, restando 11 artigos. Estudos têm demonstrado o efeito benéfico do treinamento aeróbico na DPOC. Conclusão: O treinamento físico deve ser considerado uma opção terapêutica em pacientes com DPOC, independente de ser terrestre ou aquático, pois pode ter efeitos benéficos nos sistemas.

Las consecuencias clínicas de la enfermedad pulmonar obstructiva crónica (EPOC) incluyen fatiga, disnea y deterioro progresivo de la capacidad de ejercicio. También produce importantes consecuencias sistémicas como el agotamiento nutricional, el desacondicionamiento físico, la inflamación sistémica y los cambios estructurales y funcionales en los músculos respiratorios y locomotores. El ejercicio regular proporciona mejoras en la salud de los pacientes con EPOC estable y puede aliviar los síntomas, aumentando la capacidad de ejercicio y mejorando la calidad de vida, al tiempo que reduce la hospitalización y, en cierta medida, el riesgo de morbilidad y mortalidad. El entrenamiento con ejercicios progresivos se asocia a adaptaciones metabólicas y neurohumorales, a la variabilidad de la frecuencia cardíaca, con adaptaciones en los músculos pulmonares y esqueléticos, así como en los sistemas inflamatorio, cardiovascular y respiratorio. Esta revisión se centrará en el conocimiento actual de los mecanismos por los que el entrenamiento físico puede proporcionar efectos beneficiosos en los pacientes con EPOC. Resultados: Tras analizar los títulos, resúmenes y contenido, de los 500 artículos encontrados se excluyeron 489, quedando 11 artículos. Los estudios han demostrado el efecto beneficioso del entrenamiento aeróbico en la EPOC. Conclusiones: El entrenamiento físico debe considerarse una opción terapéutica en pacientes con EPOC, independientemente de que sea terrestre o acuático, ya que puede tener efectos beneficiosos sobre los sistemas.

Impact on fatigue of different types of physical exercise during adjuvant chemotherapy and radiotherapy in breast cancer: systematic review and meta-analysis.

BACKGROUND: Physical exercise in women with breast cancer has shown benefits in reducing fatigue levels during adjuvant radiotherapy and chemotherapy. However, it is not well understood which type of exercise is more effective. OBJECTIVE: Assess the impact of different types of physical exercises on fatigue and which is the most effective in reducing this adverse effect during adjuvant treatment in breast cancer. METHODS: The inclusion criteria were randomized clinical trials of physical exercise in women diagnosed with breast cancer in stages I to IV, above 18 years, evaluating fatigue using validated questionnaires. The meta-analysis pooled results by standardized mean difference (SMD). RESULTS: A total of 20 randomized clinical trials involving 1793 participants revealed that the practice of physical exercise was statistically effective in reducing fatigue (SMD = - 0.46; 95% CI: - 0.66, - 0.27). Our analysis of subgroups suggests that the supervised combination of resistance training (RT) with aerobic training (AT) is the most effective physical exercise to reduce fatigue (SMD = - 1.13; 95% CI: - 2.09, - 0.17). The supervised RT was more effective (SMD = - 0.30; 95% CI: - 0.46, - 0.15) than supervised AT or mind-body techniques. It was observed that only during chemotherapy, women with breast cancer in the intervention groups showed a significant reduction in fatigue (SMD = - 0.38; 95% CI: - 0.55 to - 0.20). CONCLUSION: Physical exercise during adjuvant chemotherapy and/or radiotherapy in women with breast cancer can be considered beneficial in reducing fatigue, especially for women undergoing chemotherapy and for supervised training of resistance or combined RT and AT.

Absence of risk of sarcopenia protects cancer patients from fatigue.

BACKGROUND: Cancer and its treatments often lead to sarcopenia and fatigue. However, whether these factors are associated remains unproven. OBJECTIVE: To evaluate whether the risk of sarcopenia predicts the presence of fatigue. METHODS: A cross-sectional study was completed and included 198 cancer patients of both sexes, undergoing in- and outpatient treatment. The Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) and the Functional Assessment of Cancer Therapy Fatigue (FACT-F) were used to assess the risk of sarcopenia and the presence of fatigue, respectively. The cut-off values used to identify the risk of sarcopenia and the severity of fatigue scale were SARC-F ≥ 4 and Fatigue <34, respectively. Logistic regression analysis was performed to evaluate the association between SARC-F and the FACT-F. RESULTS: Out of 198 patients, 35% were at risk of sarcopenia and of these 87% had fatigue. Patients at risk of sarcopenia had lower scores in the FACT-F subscales, lower handgrip strength, lower performance status, were mostly hospitalized and were sedentary. Logistic regression analysis revealed that patients with SARC-F < 4 had a lower risk of fatigue in both models, crude (OR: 0.83; CI 95% [0.79-0.88], p < 0.0001) as well as adjusted for age, gender, BMI, physical activity, current use of alcoholic beverages, smoking, performance status, cancer type, clinical setting and use of supplements (OR: 0.87; CI 95% [0.81-0.92], p < 0.0001). CONCLUSION: In patients with cancer, 35% presented risk of sarcopenia and of these 87% had fatigue. In addition, the absence of sarcopenia was considered protective against fatigue.

The efficiency of a mixed exercise program on quality of life and fatigue levels in patients with breast cancer.

OBJECTIVE: Exercise is a nonpharmacological supportive therapy which has been specifically identified to reduce postoperative complications or adverse events of cancer or treatments. Although there are few studies combining resistance and aerobic exercise in cancer survivors, exercise programs are very rare in different places in the literature. This study aims to investigate the effects of mixed-type exercise in different venues on weight, body mass index, fatigue, and quality of life in cancer survivors. METHODS: This is a descriptive, intervention study. Participants were included in the study, and the exercise process was between January and November 2019. The exercise group consisted of 32 patients who had just completed their breast cancer treatment and did not have distant metastases, and they applied a mixed exercise program including resistance at home and aerobic exercise in the fitness center for 12 weeks. The patients with breast cancer in the control group (30 patients) did not receive any exercise program. RESULTS: Subjective feelings of fatigue and decrease in concentration, motivation, and physical activity significantly decreased after exercise (p<0.001, p<0.001, p=0.006, p=0.008, and p<0.001, respectively) in the study group. The results also showed that physical health, general health status, and emotional and social health status significantly increased with the exercise program (p<0.001, p<0.001, p=0.004, and p=0.003, respectively). CONCLUSION: Our results show that a mixed (fitness center and home) 12-week exercise program provides an improvement in general health and reduces the side effects of the treatments and fatigue in patients with breast cancer. For a good prognostic process after medical treatment, exercise can be recommended in every accessible area.

Kefir Is a Viable Exercise Recovery Beverage for Cancer Survivors Enrolled in a Structured Exercise Program.

PURPOSE: This study investigated the effects of 12 wk of postexercise kefir consumption in cancer survivors who have undergone chemotherapy and/or radiation therapy. METHODS: All participants were enrolled in a structured exercise training program and separated into kefir (KEF) or control (CON) treatment groups. KEF consumed 8 oz. of kefir after exercise sessions (3 d·wk-1) for 12 wk. Outcome measures included assessments for body size and composition, aerobic fitness and muscular strength, medical history, and psychological state at pre- and postintervention time points. Blood was collected and analyzed for C-reactive protein (CRP), interleukin 6 (IL-6), and lipopolysaccharide (LPS) concentrations, and LPS-stimulated whole blood IL-6 and tumor necrosis factor α production were obtained using enzyme-linked immunosorbent assays at both time points. Monocyte numbers and phenotype were obtained using flow cytometry. RESULTS: Participants (N = 24; 9 males and 15 females) were an average of 61 ± 9.9 yr old. Kefir consumption was associated with 6.3% (P = 0.034) improvements in lean body mass, as well as 51.4% (P = 0.046), 39.3% (P = 0.017), and 64.7% (P = 0.021) improvements in measures of depression, fatigue, and gastric distress, respectively. KEF also experienced a significant 35.4% (P = 0.01) reduction in circulating LPS along with an 18.0% increase (P < 0.001) in classical monocytes % and a 22.3% decrease (P = 0.04) in nonclassical monocytes %. There were no significant changes in any other variables. CONCLUSION: Twelve weeks of kefir consumption improved lean body mass, depression, fatigue, gastric distress, and a biomarker of gut dysbiosis. Kefir improved overall and classical monocyte numbers. Kefir should be considered as a component of a postexercise dietary regimen for cancer survivors.

The efficiency of a mixed exercise program on quality of life and fatigue levels in patients with breast cancer

SUMMARY OBJECTIVE: Exercise is a nonpharmacological supportive therapy which has been specifically identified to reduce postoperative complications or adverse events of cancer or treatments. Although there are few studies combining resistance and aerobic exercise in cancer survivors, exercise programs are very rare in different places in the literature. This study aims to investigate the effects of mixed-type exercise in different venues on weight, body mass index, fatigue, and quality of life in cancer survivors. METHODS: This is a descriptive, intervention study. Participants were included in the study, and the exercise process was between January and November 2019. The exercise group consisted of 32 patients who had just completed their breast cancer treatment and did not have distant metastases, and they applied a mixed exercise program including resistance at home and aerobic exercise in the fitness center for 12 weeks. The patients with breast cancer in the control group (30 patients) did not receive any exercise program. RESULTS: Subjective feelings of fatigue and decrease in concentration, motivation, and physical activity significantly decreased after exercise (p<0.001, p<0.001, p=0.006, p=0.008, and p<0.001, respectively) in the study group. The results also showed that physical health, general health status, and emotional and social health status significantly increased with the exercise program (p<0.001, p<0.001, p=0.004, and p=0.003, respectively). CONCLUSION: Our results show that a mixed (fitness center and home) 12-week exercise program provides an improvement in general health and reduces the side effects of the treatments and fatigue in patients with breast cancer. For a good prognostic process after medical treatment, exercise can be recommended in every accessible area.

Guided imagery relaxation in quality of life of patients undergoing hematopoietic stem cell transplantation: a quasi-experiment.

OBJECTIVE: The aim of this study was to evaluate the effects of the relaxation technique with guided imagery by means of virtual reality on health-related quality of life in patients undergoing hematopoietic stem cell transplantation. METHODS: A quasi-experiment conducted in a Bone Marrow Transplantation Service of a public hospital in southern Brazil. From October 2019 to October 2020, forty-two adult participants who underwent transplantation were included, 35 in the intervention group and seven in the control group. A guided imagery intervention, with audio guiding the relaxation associated with nature images in 360º, was performed during the hospitalization period. Data were collected on the first day of hospitalization, on the transplantation day, during the neutropenia stage, and at pre-hospital discharge. The Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) and Functional Assessment of Cancer Therapy-Neutropenia (FACT-N) were used to assess health-related quality of life, fatigue and neutropenia. Data were analyzed using the Generalized Linear Mixed Model for the evolution of the health-related quality of life assessments over time, considering the groups and stages. Pearson's correlation coefficient was adopted for the correlation analyses. RESULTS: Allogeneic transplantation was predominant: 28 (80%) in the intervention group and 5 (71.43%) in the control group. There were improvements in the health-related quality of life scores, although not significant. A significant difference was found among the stages (p <0.050) and a significant positive correlation (p <0.000) among the variables on general quality of life, additional concerns, fatigue and neutropenia in all stages. CONCLUSION: Patients undergoing hematopoietic stem cell transplantation suffer changes in their quality of life. Interventions based on integrative practices emerge as an option to minimize them. 
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The relieving effect of sun-dried protein tonic on sports fatigue / O efeito calmante na fadiga esportiva da proteína tônica secada ao sol / El efecto calmante en la fatiga deportiva de la proteína tónica secada al sol

ABSTRACT Fatigue is a comprehensive process that involves many physiological and biochemical factors. It is a normal physiological reaction when human physical or mental activities reach a certain level. In recent years, it has been verified that free radicals are closely related to exercise-induced fatigue. Cardamine bursa purified selenoprotein has good oxygen-free radical scavenging ability and anti-lipid peroxide. It could protect mitochondria, liver, and red blood cells from peroxide injury. Therefore, it was speculated that the purification of selenoprotein Cardamine may play an active role in attenuating exercise-induced fatigue by scavenging free radicals. This study cleared the selenite protein Capsella bursa (SPC) as a research object, and evaluated its structural characteristics in relieving exercise-induced fatigue. The selenoprotein index system for exercise-induced fatigue was constructed by combining two AHP methods, principal component analysis and factor analysis. Purity, subunit composition, amino acid composition and RCM content were evaluated. The corresponding RCM protein was preliminarily predicted. The results showed that SPCH could significantly prolong the swimming time (P <0.01), improve the lactate clearance capacity (P <0.01), increase the glycogen content of the liver (P <0.01), and reduce the level of the BUN (P <0.05). SPCH has a good effect in relieving exercise-induced fatigue in mice, so it can be considered for development as a nutritional supplement to alleviate exercise-induced fatigue.

RESUMO Fadiga é um processo abrangente envolvendo muitos fatores fisiológicos e bioquímicos. É uma reação fisiológica normal quando as atividades físicas ou mentais humanas atingem um certo nível. Nos últimos anos, verificou-se que os radicais livres estão intimamente relacionados com a fadiga induzida pelo exercício. A selenoproteina purificada de Cardamina bursa tem boa capacidade de depuração de radicais sem oxigénio e de peróxido anti-lípido. Poderia proteger as mitocôndrias, fígado e glóbulos vermelhos de lesões por peróxido. Por conseguinte, especulou-se que a purificação da selenoproteina de Cardamina pode desempenhar um papel activo na atenuação da fadiga induzida pelo exercício por meio de radicais livres de scavenging. Este estudo depurou a proteína selenita Capsella bursa (SPC) como objeto de pesquisa, e avaliou as suas características estruturais no alívio da fadiga induzida pelo exercício. O sistema de índice de selenoproteinas para a fadiga induzida pelo exercício foi construído por meio da combinação dos métodos de AHP, análise principal de componentes e a análise de fatores. Foram avaliados a pureza, a composição sub-unitária, a composição de aminoácidos e o conteúdo do RCM. A proteína correspondente do RCM foi prevista preliminarmente. Os resultados mostraram que o SPCH poderia prolongar significativamente o tempo de natação (P < 0.01), melhorar a capacidade de depuração do lactato (P< 0.01), aumentar o conteúdo do glicogênio do fígado (P < 0.01), e reduzir o nível do BUN (P< 0.05). o SPCH tem um bom efeito em aliviar a fadiga induzida pelo exercício em ratos, de modo que pode ser considerado para desenvolvê-lo como um suplemento nutricional para aliviar a fadiga induzida pelo exercício.

RESUMEN La fatiga es un proceso abarcador que envuelve muchos factores fisiológicos y bioquímicos. Es una reacción fisiológica normal cuando las actividades físicas o mentales humanas alcanzan un cierto nivel. En los últimos anos, se verificó que los radicales libres están íntimamente relacionados con la fatiga inducida por el ejercicio. La selenoproteína purificada de Cardamina bursa tiene buena capacidad de depuración de radicales sin oxígeno y de peróxido antilipídico. Podría proteger las mitocondrias, el hígado y los glóbulos rojos de lesiones por peróxido. Por consiguiente, se especuló que la purificación de la selenoproteína de Cardamina puede desempeñar un papel activo en la atenuación de la fatiga inducida por el ejercicio por medio de radicales libres de scavenging. Este estudio depuró la proteína selenita Capsella bursa (SPC) como objeto de investigación, y evaluó sus características estructurales en el alivio de la fatiga inducida por el ejercicio. El sistema de índice de selenoproteínas para a fatiga inducida por el ejercicio fue construido por medio de la combinación dos métodos de AHP, el análisis principal de componentes y el análisis de factores. Fueron evaluados la pureza, la composición sub-unitaria, la composición de aminoácidos y el contenido del RCM. La proteína correspondiente del RCM fue prevista preliminarmente. Los resultados mostraron que el SPCH podría prolongar significativamente el tiempo de natación (P < 0.01), mejorar la capacidad de depuración del lactato (P< 0.01), aumentar el contenido del glicógeno del hígado (P < 0.01), y reducir el nivel del BUN (P< 0.05). el SPCH tiene un buen efecto en aliviar la fatiga inducida por el ejercicio en ratones, de modo que puede ser considerado para desarrollarlo como un suplemento nutricional para aliviar la fatiga inducida por el ejercicio.

The curative effect of traditional chinese medicine compounded medications in relieving racewalking fatigue / O efeito curativo dos medicamentos manipulados da medicina chinesa tradicional para aliviar a fadiga da marcha atlética / Observación del efecto curativo del compuesto de medicina tradicional china para aliviar la fatiga de la carrera

ABSTRACT Racewalking fatigue is a kind of fatigue symptom after a period of racewalking, which may lead to limb weakness, mental fatigue, muscle fatigue and other phenomena. If we do not timely adjust the stretching and effective treatment after exercise, it is very easy to produce sports injury and seriously affect the athletes' physical function. In order to effectively alleviate the fatigue of racewalking, this study focused on the traditional Chinese medicine (TCM) compounded medication, analyzed the mechanism of action and medicinal effectiveness of the TCM compound, and carried out control experiment on 80 male ICR mice. The mice in the experimental group were given sedentary training and racewalking training in groups. The results showed that the two groups of ICR mice, after racewalking training, had exercise fatigue symptoms and a large amount of serum lactic acid and other substances, while mice in group D treated by gavage of traditional Chinese medicine compounded medication had the symptoms of exercise fatigue, but the contents of blood urea nitrogen and lactic acid were decreased, the gastrocnemius muscle fibers were evenly arranged, the transverse lines were neat, and a rebound of protein expression. This shows that Chinese medicine compound can play a significant role in relieving racewalking fatigue.

RESUMO A fadiga causada pela marcha atlética é um tipo de sintoma que acomete os atletas após um período de prática do exercício, que pode ocasionar fraqueza dos membros, fadiga mental, fadiga muscular e outros fenômenos. Na ausência de alongamento e tratamento eficaz após o exercício, as lesões causadas pelo esporte podem afetar seriamente a função física dos atletas. A fim de aliviar de maneira eficaz a fadiga causada pela marcha atlética, o presente estudo se concentrou nos medicamentos manipulados na medicina tradicional chinesa (MTC), analisou o mecanismo de ação e eficácia medicinal dos medicamentos da MTC, e realizou experimentos de controle em 80 camundongos do tipo ICR masculinos. Os camundongos do grupo experimental receberam treinamento sedentário e treinamento de corrida em grupo. Os resultados mostraram que os dois grupos de camundongos ICR, após treino de marcha atlética, apresentavam sintomas de fadiga, e grande quantidade de ácido láctico sérico, além de outras substâncias, enquanto os camundongos do grupo D tratados com gavagem do medicamento manipulado tiveram sintomas de fadiga, mas com redução do teor sanguíneo de ureia e ácido láctico, fibras musculares gastrocnêmias uniformemente arranjadas, linhas transversais regulares, e efeito rebote da expressão proteica. Isto mostra que os medicamentos manipulados da medicina chinesa podem desempenhar um papel significativo no alívio da fadiga causada pela marcha atlética.

RESUMEN La fatiga causada por la marcha atlética es un tipo de síntoma que afecta los atletas después de un período de práctica del ejercicio, que puede ocasionar debilidad de los miembros, fatiga mental, fatiga muscular y otros fenómenos. En ausencia de elongación y tratamiento eficaz después del ejercicio, las lesiones causadas por el deporte pueden afectar seriamente la función física de los atletas. A fin de aliviar de manera eficaz la fatiga causada por la marcha atlética, el presente estudio se concentró en los medicamentos manipulados en la medicina tradicional china (MTC), analizó el mecanismo de acción y eficacia medicinal de los medicamentos da MTC, y realizó experimentos de control en 80 ratones del tipo ICR masculinos. Los ratones del grupo experimental recibieron entrenamiento sedentario y entrenamiento de carrera en grupo. Los resultados mostraron que los dos grupos de ratones ICR, después de entrenamiento de marcha atlética, presentaban síntomas de fatiga, y gran cantidad de ácido láctico sérico, además de otras sustancias, mientras que los ratones del grupo D tratados con gavaje del medicamento manipulado tuvieron síntomas de fatiga, pero con reducción del tenor sanguíneo de urea y ácido láctico, fibras musculares del gastrocnemio uniformemente arregladas, líneas transversales regulares, y efecto rebote de la expresión proteica. Esto muestra que los medicamentos manipulados de la medicina china pueden desempeñar un papel significativo en el alivio de la fatiga causada por la marcha atlética.

Optimizing the regulation and control of sports injury and fatigue of winter olympic ice and snow athletes based on injury prevention / Otimização da regulação e controle de lesões esportivas e fadiga de atletas do gelo e da neve nos jogos olímpicos de inverno com base na prevenção de lesões / Optimización del control de lesiones deportivas y fatiga de los atletas de hielo y nieve en los juegos olímpicos de invierno basada en la prevención de lesiones deportivas

ABSTRACT This study reveals the characteristics and relationship of sports injury and fatigue of the Winter Olympics athletes, and monitors the athletes' psychological condition through case analysis of excellent athletes, and provides empirical evidence for athletes' psychological training and preparation for the physical and mental health services of Winter Olympics. Through questionnaires, literature review and other methods to study the injury situation of Winter Olympics ice and snow athletes, the results show that the proportion of chronic lumbar and knee joint injuries, and repeated muscle strains of Chinese Winter Olympics ice and snow athletes is large, and the cure rate is not high. The preparation activities are neither paid enough attention or sufficient, and the rationality of training plan arrangement is insufficient. The main cause of injury is insufficient understanding of the mechanism of injury and illness among athletes and coaches. Individual elite athletes need to improve their coping skills and pay attention to their psychological fatigue. In view of the sports' psychological characteristics and the problems faced by winter athletes, personalized psychological intervention programs should be formulated.

RESUMO O presente estudo revela as características e a relação de lesões desportivas e fadiga de atletas participantes dos Jogos Olímpicos de Inverno, e monitora as condições psicológicas dos atletas através da análise de casos de atletas de alto desempenho, além de apresentar provas empíricas para o treino e a preparação psicológico dos atletas para os serviços de saúde física e mental dos Jogos de Inverno. Através de questionários, revisão de literatura e outros métodos de estudo das lesões que acometem os atletas dos Jogos Olímpicos de Inverno, em esportes que envolvem gelo e neve, os resultados mostram que é grande a proporção de lesões lombares crônicas, lesões articulares do joelho e recorrência de distensões musculares, e a taxa de cura não é alta. As atividades de preparação não são suficientemente consideradas e a racionalidade do plano de treinos é insuficiente. A principal causa de lesão é a falta de compreensão dos mecanismos que ocasionam lesões e enfermidades entre atletas e treinadores. Atletas individuais de elite precisam melhorar suas habilidades de enfrentamento e prestar atenção à sua fadiga psicológica. Tendo em conta as características psicológicas desportivas e os problemas existentes entre os atletas dos Jogos de Inverno, programas de intervenção psicológica personalizados devem ser formulados.

RESUMEN A través del análisis de casos de atletas de élite, este trabajo revela las características y la relación entre las lesiones deportivas y la fatiga de los atletas en los Juegos Olímpicos de invierno, monitorea el estado psicológico de los atletas y proporciona evidencia empírica para el entrenamiento psicológico de los atletas y la preparación del Servicio de salud física y mental En los Juegos Olímpicos de invierno.Juegos Olímpicos.Los resultados mostraron que la proporción de lesiones crónicas de la cintura y la rodilla y la tensión muscular repetida de los atletas de hielo y nieve en los Juegos Olímpicos de invierno en China era mayor.La tasa de curación no es alta.No se presta suficiente atención a las actividades preparatorias y a la racionalidad del plan de capacitación.La razón principal de la lesión es que los atletas y entrenadores no entienden el mecanismo de la lesión y la enfermedad.Los atletas individuales deben mejorar su capacidad de enfrentamiento y prestar atención a la fatiga psicológica.De acuerdo con las características psicológicas de los atletas de invierno y los problemas existentes, se formula un plan de Intervención Psicológica individualizado.

Health-related quality of life and fatigue in patients with chronic hepatitis C with therapy with direct-acting antivirals agents interferon-free.

INTRODUCTION: Interferon (IFN)-free regimens for the treatment of chronic hepatitis C have shown high rates of sustained virological response (SVR) and improved patient-reported outcomes (PROs). The aim of this study was to evaluate the health-related quality of life (HRQoL) and fatigue of patients with chronic hepatitis C (HCV) treated with IFN-free direct-acting antiviral (DAA) agents that achieved SVR following treatment and identify the predictive factors related to HRQoL. METHODS: Prospective cohort study that included patients with HCV treated with DAA who obtained an SVR. The patients answered three self-reported questionnaires (PROs): Short Form 36 (SF-36), the Chronic Liver Diseases Questionnaire (CLDQ), and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire at baseline, weeks 6 and 12 of treatment, and at 12 weeks after therapy. Patients were treated with DAA with or without ribavirin (RBV). The PRO scores were compared using analysis of variance (ANOVA). A comparison of PROs and serum hemoglobin levels was performed between the group that used ribavirin and the one that did not use ribavirin using the t student test. Predictive factors were calculated using a multiple linear regression model. RESULTS: Among the 113 patients selected, 105 presented an SVR and were included in the study, in which, 54% men, 80% genotype 1, 44% cirrhosis and 46% with RBV. At 12 weeks after the end of treatment, there was a significant improvement in the scores of the patient self-reports (PROs) when compared with baseline for the CLDQ (+10.52%, p<0.001), SF-36-Physical Summary (+19%, p<0.001), and FACIT (+17.34%, p<0.001). Patients who used RBV had worse PROs and serum hemoglobin levels compared to the group that did not use RBV (p<0,05). As predictors of worsening of the PROs we had the presence of diabetes mellitus, liver cirrhosis and HIV co-infected. CONCLUSION: Patients treated with IFN free regimens presents significant improvement in PROs. The presence of diabetes mellitus, cirrhosis, and HIV co-infected has a negative effect on HRQoL before, during and after treatment of hepatitis C. The addition of ribavirin to the antiviral regimens used compromises the HRQoL indexes during antiviral therapy.

Caffeine Supplementation for 4 Days Does Not Induce Tolerance to the Ergogenic Effects Promoted by Acute Intake on Physiological, Metabolic, and Performance Parameters of Cyclists: A Randomized, Double-Blind, Crossover, Placebo-Controlled Study.

The present study investigated whether the caffeine supplementation for four days would induce tolerance to the ergogenic effects promoted by acute intake on physiological, metabolic, and performance parameters of cyclists. A double-blind placebo-controlled cross-over design was employed, involving four experimental trials; placebo (4-day)-placebo (acute)/PP, placebo (4-day)-caffeine (acute)/PC, caffeine (4-day)-caffeine (acute)/CC and caffeine (4-day)-placebo (acute)/CP. Fourteen male recreationally-trained cyclists ingested capsules containing either placebo or caffeine (6 mg∙kg-1) for 4 days. On day 5 (acute), capsules containing placebo or caffeine (6 mg∙kg-1) were ingested 60 min before completing a 16 km time-trial (TT). CC and PC showed improvements in time (3.54%, ES = 0.72; 2.53%, ES = 0.51) and in output power (2.85%, ES = 0.25; 2.53%, ES = 0.20) (p < 0.05) compared to CP and PP conditions, respectively. These effects were accompanied by increased heart rate (2.63%, ES = 0.47; 1.99%, ES = 0.34), minute volume (13.11%, ES = 0.61; 16.32%, ES = 0.75), expired O2 fraction (3.29%, ES = 0.96; 2.87, ES = 0.72), lactate blood concentration (immediately after, 29.51% ES = 0.78; 28.21% ES = 0.73 recovery (10 min), 36.01% ES = 0.84; 31.22% ES = 0.81), and reduction in expired CO2 fraction (7.64%, ES = 0.64; 7.75%, ES = 0.56). In conclusion, these results indicate that caffeine, when ingested by cyclists in a dose of 6 mg∙kg-1 for 4 days, does not induce tolerance to the ergogenic effects promoted by acute intake on physiological, metabolic, and performance parameters.

Effect of strength training and antioxidant supplementation on perceived and performance fatigability in breast cancer survivors: a randomized, double-blinded, placebo-controlled study.

This randomized, double-blinded, placebo-controlled study aimed to investigate the effect of strength training (ST) combined with vitamin C and E supplementation on perceived and performance fatigability in breast cancer survivors (BCS). Twenty-five BCS were randomly assigned to 1 of 2 groups: vitamins (VIT; n = 12; 51.0 ± 9.0 years) or placebo (PLA; n = 13; 48.2 ± 8.3 years). Both groups performed a 10-week ST protocol, twice a week. The VIT group was supplemented with vitamins C (500 mg/day) and E (180 mg/day) and the PLA group with polydextrose (1 g/day), once a day after breakfast. At the beginning and at the end of the training period, perceived fatigability was assessed using Multidimensional Fatigue Inventory (MFI)-20 (general fatigue and physical fatigue). Performance fatigability was assessed during 30 maximal isokinetic knee extensions at 120°/s. General fatigue decreased similarly in the VIT (p = 0.004) and PLA (p = 0.011) groups. Physical fatigue decreased similarly in the VIT (p = 0.011) and PLA (p = 0.001) groups. Performance fatigability also decreased similarly in the VIT (p = 0.026) and PLA (p < 0.001) groups. There was no difference between groups at any moment (p > 0.05). In summary, antioxidant supplementation does not add any positive synergistic effect to ST in terms of improving perceived or performance fatigability in BCS. This clinical trial is registered in the Brazilian Clinical Trials Registry, number RBR-843pth (UTN no.: U1111-1222-6511). Novelty ST with maximal repetitions reduces perceived and performance fatigability of BCS. Vitamins C and E supplementation does not add any positive synergistic effect to ST in terms of reducing fatigability in BCS.

Clown Intervention on Psychological Stress and Fatigue in Pediatric Patients With Cancer Undergoing Chemotherapy.

BACKGROUND: Clown intervention has been shown to enhance emotional and behavioral processes, but few studies have comprehensively examined the effectiveness of this practice using biomarkers. OBJECTIVE: The aim of this study was to evaluate the effect of a clown intervention on the levels of psychological stress and cancer-related fatigue in pediatric patients with cancer undergoing chemotherapy. METHODS: Sixteen patients who met all criteria from a pediatric oncology inpatient unit in a Brazilian comprehensive cancer care hospital participated in this quasi-experimental study. Eight saliva samples were collected, comprising 4 at baseline and 4 after clown intervention (+1, +4, +9, and +13 hours after awakening). Salivary cortisol and α-amylase levels were determined using high-sensitivity enzyme-linked immunosorbent assay kits. Stress and fatigue were measured by the Child Stress Scale-ESI and the PedsQL Multidimensional Fatigue Scale, respectively. Relationships among stress, fatigue, and biomarker levels were investigated using nonparametric statistics. RESULTS: In comparison with baseline measurements, the total psychological stress and fatigue levels improved after the clown intervention at the collection time point +4 hours (P = .003 and P = .04, respectively). Salivary cortisol showed a significant decrease after clown intervention at the collection time points +1, +9, and +13 hours (P < .05); however, α-amylase levels remained unchanged. CONCLUSION: These findings provide preliminary evidence that clown intervention merits further study as a way to reduce stress and fatigue in pediatric cancer inpatients, and that self-report and biomarker measures are feasible to collect in this patient group. IMPLICATIONS FOR PRACTICE: Clown intervention as a nonpharmacological intervention may improve stress and fatigue levels in pediatric inpatients with cancer undergoing chemotherapy.

Glutamine as an Anti-Fatigue Amino Acid in Sports Nutrition.

Glutamine is a conditionally essential amino acid widely used in sports nutrition, especially because of its immunomodulatory role. Notwithstanding, glutamine plays several other biological functions, such as cell proliferation, energy production, glycogenesis, ammonia buffering, maintenance of the acid-base balance, among others. Thus, this amino acid began to be investigated in sports nutrition beyond its effect on the immune system, attributing to glutamine various properties, such as an anti-fatigue role. Considering that the ergogenic potential of this amino acid is still not completely known, this review aimed to address the main properties by which glutamine could delay fatigue, as well as the effects of glutamine supplementation, alone or associated with other nutrients, on fatigue markers and performance in the context of physical exercise. PubMed database was selected to examine the literature, using the keywords combination "glutamine" and "fatigue". Fifty-five studies met the inclusion criteria and were evaluated in this integrative literature review. Most of the studies evaluated observed that glutamine supplementation improved some fatigue markers, such as increased glycogen synthesis and reduced ammonia accumulation, but this intervention did not increase physical performance. Thus, despite improving some fatigue parameters, glutamine supplementation seems to have limited effects on performance.

Benefits of Physical Activity for Depression and Fatigue in Multiple Sclerosis: A Longitudinal Analysis.

OBJECTIVES: To examine the longitudinal relationship between physical activity and fatigue and depression among youth with demyelinating conditions. STUDY DESIGN: From September 2013 to March 2017, we performed a longitudinal study of consecutive youth diagnosed at their first visit with pediatric onset multiple sclerosis (POMS) or monophasic acquired demyelinating syndromes (mono-ADS) at a neuroinflammatory disorders clinic in a tertiary children's hospital. Fatigue was determined at each visit by the Pediatric Quality of Life Multidimensional Fatigue Scale, depressive symptoms by the Center of Epidemiologic Studies Depression Children Rating Scale, and physical activity level by the Godin Leisure Time Exercise Questionnaire. Mixed linear models were used to examine the associations of moderate-to-vigorous physical activity (MVPA) with fatigue and depression over time, adjusting for age, time from incident demyelination, sex, number of relapses, relapse within 30 days, and disability. RESULTS: In 182 patients (48 POMS, age 15 ± 1.7 years, 35 female; and 134 mono-ADS, age 12 ± 3.6 years 67 female) with 538 visits (mean follow-up 3.6 ± 2.7 years and 4.2 ± 3.3 years, respectively), a trajectory of increased fatigue over time was observed in POMS (2.28 points/year, P = .008) and mono-ADS (1.33 points/year, P = .007) patients. Youth with POMS had more depressive symptoms (estimate = 11.4 points, P < .002) than mono-ADS. Depressive symptoms increased over time in female patients with POMS (estimate = 1.4 points/year, P < .02). MVPA was associated with lower depression (-0.09, P < .001) and general fatigue (0.13, P = .02) over time in POMS. CONCLUSIONS: Youth with POMS who have higher levels of MVPA demonstrate lesser depressive symptoms and lower fatigue over time. Our results may inform future interventions to manage mood and fatigue in POMS.

Supervised walking improves cardiorespiratory fitness, exercise tolerance, and fatigue in women with primary Sjögren's syndrome: a randomized-controlled trial.

OBJECTIVE: The aim of this study was to evaluate the safety and effectiveness of a supervised walking program in women with primary Sjögren's syndrome (pSS). METHODS: Forty-five sedentary women fulfilling the American European Consensus Criteria for pSS were randomized to a training group (TG, n = 23) or control group (CG, n = 22). Patients in the TG were submitted to supervise walking three times a week for 16 weeks. The patients of the CG were instructed to not perform any kind of regular physical exercise. Physical fitness [maximum oxygen uptake (VO2max) and distance], EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), hematological tests, and Medical Outcomes Study 36 (SF-36) were assessed at baseline and week 16. In addition, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-fatigue), and Beck Depression Inventory (BDI) were measured prior to intervention, after 8 and 16 weeks. Patient global assessment of response to therapy was completed at the final assessment. An intent-to-treat analysis was performed. RESULTS: After 16 weeks, the mean change of VO2max (ml/kg/min), distance, and FACIT-fatigue were higher in the TG than in the CG (p = 0.016, p = 0.043 and p = 0.030, respectively). Improved cardiorespiratory fitness was associated with improvements in fatigue scores and physical components of quality of life (SF-36). Furthermore, improved fatigue scores were associated with reduced depression and improvements in the physical and mental components of SF-36. Overall, 95.4% of patients in the TG rated themselves as clinically improved versus 62% of the patients in the CG (p = 0.049). There was no flare in disease activity and no serious adverse events with exercise. CONCLUSIONS: This supervised walking program was demonstrated to be feasible and safe with improvements in cardiorespiratory fitness, exercise tolerance, fatigue, and patient perception of improvement in pSS patients. TRIAL REGISTRATION: Clinical Trials.gov ID, number NCT02370225.

Can compression stockings reduce the degree of soccer match-induced fatigue in females?

Soccer-induced fatigue and performance are different between the sexes. The effect of compression stockings (CS) use on fatigue during the soccer match in females is unknown. Thus, we evaluated the impact of CS use during a female soccer match on match-induced fatigue. Twenty soccer players were randomly allocated to two groups (n = 10 for each group): CS and Control (regular socks), and equally distributed within two teams. At rest (baseline 48-h before the match) and immediately post-match, we assessed agility T-test, standing heel-rise test and YoYo Intermittent Endurance Test level 2 (YoYoIE2) performance. Effort during the match (heart rate and rating of perceived exertion) was similar (p > 0.05) between groups. The YoYoIE2 performance was decreased post-match (p < 0.05) equally for both groups. Otherwise, the CS group exhibited a greater post-match performance (p < 0.05) for the agility T-test and heel-rise test (large effect sizes). Therefore, we conclude that the use of CS during an amateur female soccer match resulted in less match-induced fatigue.

Carbohydrate Mouth Rinse Fails to Improve Four-Kilometer Cycling Time Trial Performance.

We investigated if a carbohydrate (CHO) mouth rinse may attenuate global fatigue and improve 4-km cycling time trial (TT4km) performance. After a preliminary session, cyclists (n = 9) performed a TT4km after a CHO or placebo (PLA) mouth rinse. Mean power output, time, and ratings of perceived exertion (RPE) were recorded throughout the TT4km. Twitch interpolation responses (%VA; voluntary activation and ∆Tw; delta peak twitch torque) were compared pre and post TT4km with traditional statistics and effect size (ES) analysis. Time-to-complete the 4 km and mean power output were comparable between CHO (386.4 ± 28.0 s) and PLA (385.4 ± 22.4 s). A lower central (p = 0.054) and peripheral (p = 0.02) fatigue in CHO than in PLA were suggested by an extremely-large ES in %VA (manipulation main effect: p = 0.052, d = 1.18; manipulation-by-time interaction effect: p = 0.08, d = 1.00) and an extremely, very-large ES in ∆Tw (manipulation main effect: p = 0.07, d = 0.97; time-by-manipulation interaction effect: p = 0.09, d = 0.89). The RPE increased slower in CHO than in PLA (p = 0.051; d = 0.7). The apparent reduction in global fatigue (central and peripheral) and RPESLOPE with only one CHO mouth rinse were not translated into improved TT4km performance. Further tests may be required to verify if these likely differences in global fatigue might represent an edge in the short-lasting cycling time trial performance.

Heteropterys tomentosa A. Juss: Toxicological and adaptogenic effects in experimental models.

BACKGROUND: The constant pursuit of improved athletic performance characterizes high-performance sport and the use of medicinal plants as dietary supplements is becoming widespread among athletes to enhance long-term endurance performance. AIM: The present study evaluated the toxicity of Heteropterys tomentosa (HEHt) and its acute adaptogenic effects. METHODS: The in vitro safety profile was evaluated on CHO-k1 cells using the alamar Blue assay, at concentrations ranging from 3.125 to 200 µg/mL. In vivo acute oral toxicity was conducted in male and female mice with oral administration of graded doses of HEHt from 400 to 2000 mg/kg. A subchronic oral toxicity study was completed by oral administration of HEHt (50, 200 or 1000 mg/kg) and vehicle for 30 days in male Wistar rats. Clinical observations and toxicological related parameters were determined. Blood was collected for biochemical and hematological analyses, while histological examinations were performed on selected organs. Thereafter, an adaptogenic test consisting of progressive loads until exhaustion was conducted in rats ( n = 5/group) orally pre-treated with the vehicle and HEHt (25, 100 or 400 mg/kg). RESULTS: HEHt exhibited no cytotoxic effects on the CHO-k1 cells and, apparently, no acute toxicity in mice and no subchronic toxicity in rats. An ergogenic effect was observed only at the dose of 25 mg/kg compared with the vehicle in relation to time to exhaustion and exercise load ( p = .011 and .019, respectively). HEHt is safe at up to 400 mg/kg, contains astilbin and taxifolin as the major phytochemical compounds, and exhibited a potential adaptogenic effect. CONCLUSIONS: These results justify its anecdotal usage as a tonic, show that the hydroethanolic maceration of the root does not cause toxicity, and provide scientific evidence of its potential as a source of new adaptogenic substance(s).