Endogenously produced itaconate negatively regulates innate-driven cytokine production and drives global ubiquitination in human macrophages.

A wide variety of electrophilic derivatives of itaconate, the Kreb's cycle-derived metabolite, are immunomodulatory, yet these derivatives have overlapping and sometimes contradictory activities. Therefore, we generated a genetic system to interrogate the immunomodulatory functions of endogenously produced itaconate in human macrophages. Endogenous itaconate is driven by multiple innate signals restraining inflammatory cytokine production. Endogenous itaconate directly targets cysteine 13 in IRAK4 (disrupting IRAK4 autophosphorylation and activation), drives the degradation of nuclear factor κB, and modulates global ubiquitination patterns. As a result, cells unable to make itaconate overproduce inflammatory cytokines such as tumor necrosis factor alpha (TNFα), interleukin-6 (IL-6), and IL-1ß in response to these innate activators. In contrast, the production of interferon (IFN)ß, downstream of LPS, requires the production of itaconate. These data demonstrate that itaconate is a critical arbiter of inflammatory cytokine production downstream of multiple innate signaling pathways, laying the groundwork for the development of itaconate mimetics for the treatment of autoimmunity.

The reliability and discriminant validity of physical, technical, and perceptual-physiological measures during a game-specific basketball activity simulation protocol.

Activity simulation protocols offer useful applications in research and practice; however, the specificity of such protocols to basketball game-play is currently lacking. Consequently, this study aimed to develop a game-specific basketball activity simulation protocol representative of typical playing durations and assess its reliability and discriminant validity. The simulation protocol was modified from an original version (i.e., Basketball Exercise Simulation Test) to incorporate regular breaks indicative of time-outs, free-throws, and substitutions. Twelve competitive male and female adult basketball players competing in the fourth or fifth Spanish basketball division underwent repeated trials of the simulation protocol (min. 4 to max. 14 days apart) for reliability analyses. In turn, 13 competitive male (fifth division), 9 competitive female (fourth division), and 13 recreational male adult basketball players completed the simulation protocol to assess discriminant validity via comparisons between sexes (competitive players) and playing levels (males). A range of physical, technical, and perceptual-physiological variables were collected during and following the simulation protocol. Several physical and heart rate variables displayed the strongest reliability (intraclass correlation coefficient [ICC] = 0.72-0.96; coefficient of variation [CV] = 1.78-6.75%), with physical decrement, technical, blood lactate concentration, and rating of perceived exertion (RPE) variables having the weakest (ICC = 0.52-0.75; CV = 10.34-30.85%). Regarding discriminant analyses between sexes, males demonstrated significantly greater physical outputs in several variables and lower RPE compared to females (p < 0.05, moderate-to-large effects). Comparisons between playing levels revealed competitive males had significantly greater physical outputs across many variables, alongside higher mean heart rate and lower RPE than recreational males (p < 0.05, moderate-to-large effects). This study presents a novel game-specific basketball activity simulation protocol replicating actual playing durations and game configurations that might be successfully applied for both training and research purposes. Reliability statistics are provided for several variables to inform end-users on potential measurement error when implementing the simulation protocol. Discriminant validity of the simulation protocol was supported for several variables, suggesting it may hold practical utility in benchmarking or selecting players. Future research on this topic is encouraged examining wider samples of male and female basketball players at different levels as well as additional forms of validity for the protocol.

Medication adherence star ratings measures, health care resource utilization, and cost.

OBJECTIVE: To examine the association between missed CMS Star Ratings quality measures for medication adherence over 3 years for diabetes, hypertension, and hyperlipidemia medications (9 measures) and health care utilization and relative costs. STUDY DESIGN: Retrospective cohort study. METHODS: The study examined eligible patients who qualified for the diabetes, statin, and renin-angiotensin system antagonist medication adherence measures in 2018, 2019, and 2020 and were continuously enrolled in a Medicare Advantage prescription drug plan from 2017 through 2021. A total of 103,900 patients were divided into 4 groups based on the number of adherence measures missed (3 medication classes over 3 years): (1) missed 0 measures, (2) missed 1 measure, (3) missed 2 or 3 measures, and (4) missed 4 or more measures. To achieve a quality measure, patients had to meet the Pharmacy Quality Alliance 80% threshold of proportion of days covered during the calendar year. RESULTS: The mean age of the cohort was 71.1 years, and 49.9% were female. Compared with patients who missed 0 of 9 adherence measures, those who missed 1 measure, 2 or 3 measures, and 4 or more measures experienced 12% to 26%, 22% to 42%, and 24% to 50% increased risks, respectively, of all-cause and diabetes-related inpatient stays and all-cause and diabetes-related emergency department visits (all  P  values < .01). Additionally, patients who missed 1, 2 or 3, and 4 or more adherence measures experienced 14%, 19%, and 20% higher monthly medical costs, respectively. CONCLUSIONS: Missing Star Ratings quality measures for medication adherence was associated with an increased likelihood of health care resource utilization and increased costs for patients taking medications to treat diabetes, hypertension, and hyperlipidemia.

Correction: Nutrikinetics and urinary excretion of phenolic compounds after a 16-week supplementation with a flavanone-rich ingredient.

Correction for 'Nutrikinetics and urinary excretion of phenolic compounds after a 16-week supplementation with a flavanone-rich ingredient' by Jananee Muralidharan et al., Food Funct., 2023, 14, 10506-10519, https://doi.org/10.1039/D3FO02820H.

HIV preexposure prophylaxis treatment patterns in a national health plan population.

BACKGROUND: Medication nonadherence diminishes the benefits of preexposure prophylaxis (PrEP) for the 1.2 million Americans at risk for HIV exposure. OBJECTIVE: To describe HIV PrEP treatment patterns among Medicare Advantage Prescription Drug (MAPD) plan and commercially insured beneficiaries. METHODS: This retrospective cohort study identified patients aged 16 to 89 years with at least 1 dispensing of emtricitabine-tenofovir disoproxil fumarate from July 2012, through December 2020, or emtricitabine-tenofovir alafenamide from October 2019 through December 2020, and who were continuously enrolled at least 12 months prior to and following the earliest PrEP claim. Outcomes were HIV PrEP adherence measured by proportion of days covered (PDC) using 2 binary thresholds of 0.60 (4 doses/week) and 0.80 (5-6 doses/week) and duration of index treatment episode, total time on treatment, and total number of prescription fills. RESULTS: The study cohort of 707 (292 MAPD plan, 415 commercial) was predominantly made up of male patients (90.0%) and resided in the South (78.9%) with a mean age of 46.2 years (MAPD plan: 54.5, commercial: 40.4). Both populations engaged in high-risk sexual behavior (All: 18.7%, MAPD plan: 16.8%, commercial: 20.0%) and experienced sexually transmitted infections (All: 3.3%, MAPD plan: 2.1%, commercial: 4.1%). The mean index treatment episode length was 297.0 days (MAPD plan: 283.6, commercial: 306.5). Total time on treatment was 477.3 days (MAPD plan: 450.7, commercial 496.0). At 3 months, 84.9% (MAPD plan: 83.6%, commercial: 85.8%) and at 12 months, 58.7% (MAPD plan: 57.2, commercial: 59.8) of patients achieved a PDC of at least 0.80. At 3 months, 100.0% (MAPD plan: 100.0%, commercial: 100.0%), and at 12 months, 74.3% (MAPD plan: 70.2%, commercial: 76.9%) of patients achieved a PDC of at least 0.60. The cohort had a mean of 16.4 fills of 30 days (MAPD plan: 16.4, commercial: 16.3) supply. CONCLUSIONS: There is an opportunity for clinical programs to focus on improving longer-term PrEP adherence among individuals at risk for HIV exposure.

Nutrikinetics and urinary excretion of phenolic compounds after a 16-week supplementation with a flavanone-rich ingredient.

Background: Polyphenols are a broad group of compounds with a complex metabolic fate. Flavanones and their metabolites provide cardiovascular protection and assistance in long-term body composition management. Objective: This study evaluates the nutrikinetics and the bioavailability of phenolic compounds after both acute and chronic supplementation with a flavanone-rich product, namely Sinetrol® Xpur, in healthy overweight and obese volunteers. Design: An open-label study including 20 volunteers was conducted for 16 weeks. Participants received Sinetrol® Xpur, either a low dose (900 mg per day) or a high dose (1800 mg per day), in capsules during breakfast and lunch. They were advised to follow an individualized isocaloric diet and avoid a list of polyphenol-rich foods 48 hours before and during the pharmacokinetic measurements. Results: Over 20 phase II and colonic metabolites were measured in the plasma. Two peaks were observed at 1 h and 7h-10 h after the first capsule ingestion. No significant differences in the AUC were observed in circulating metabolites between both doses. In urine excretion, 53 metabolites were monitored, including human phase II and colonic metabolites, at weeks 1 and 16. Cumulative urine excretion was higher after the high dose than after the low dose in both acute and chronic studies. Total urinary metabolites were significantly lower in week 16 compared to week 1. Conclusion: Although the urinary excreted metabolites reduced significantly over 16 weeks, the circulating metabolites did not decrease significantly. This study suggests that chronic intake might not offer the same bioavailability as in the acute study, and this effect does not seem to be dose-dependent. The clinical trial registry number is NCT03823196.

Early vs late filling of new heart failure prescription and its association with avoidable hospital admissions.

BACKGROUND: Individuals with heart failure (HF) are at increased risk for hospitalization and readmission after discharge. The impact of timing to new prescription filling on avoidable HF hospitalization is understudied in HF management. The Agency of Healthcare Research and Quality identifies HF-related inpatient admissions as potentially avoidable if they could be managed successfully in outpatient settings. OBJECTIVE: To compare avoidable HF hospitalization rate and all-cause and HF-related costs in patients who were early fillers (≤30 days) vs late fillers (>30 days) of newly prescribed HF medications following an HF-related inpatient stay or emergency department visit. METHODS: This retrospective cohort study used the Humana Research Database to identify patients with at least 1 claim for a new HF medication from January 1, 2018, to June 30, 2019. Eligible patients were enrolled in a Medicare Advantage Prescription Drug plan for at least 12 months pre-index and 6-months post-index (ie, first new HF prescription). Individuals who were early (n = 794) vs late fillers (n = 397) were propensity-score matched in a 2:1 ratio to balance baseline characteristics. A logistic regression model was fitted to compare avoidable HF hospitalization in those who were late fillers vs early fillers. Mean cost differences were compared using paired t-test. Outcomes were measured 6-months post-index. RESULTS: Late fillers had greater odds of experiencing an avoidable HF hospitalization compared with early fillers (odds ratio = 1.65; P = 0.001). Late filling was associated with a 49.5% increase in average all-cause medical costs (P < 0.0001), a 13.6% decrease in average all-cause pharmacy costs (P = 0.0929), and a 39.4% increase in average all-cause total costs (P < 0.0001). HF-related costs showed similar trends. CONCLUSION: Compared with patients who filled their prescription within 30 days of discharge following an HF admission, those who delayed the filling of a new HF prescription experienced increased likelihood of an avoidable readmission, and late filling was associated with increased 6-month total and medical costs. DISCLOSURES: Humana Healthcare Research, Inc., funded the research and article development. No external funds were used in the creation of this work. All authors are/were employees of Humana Inc. and/or Humana Healthcare Research, Inc., at the time of the work.

Effects and optimal dosage of resistance training on strength, functional capacity, balance, general health perception, and fatigue in people with multiple sclerosis: a systematic review and meta-analysis.

PURPOSE: To analyze the effectiveness of resistance training programs (RTP) on strength, functional capacity, balance, general health perception, and fatigue for people with Multiple Sclerosis (MS) and to determine the most effective dose of RTP in this population. METHODS: Studies examining the effect of RTP on strength, functional capacity, balance, general health perception, and fatigue in MS patients were included. 44 studies were included. The meta-analysis, subgroup analysis and meta-regression methods were used to calculate the mean difference and standardized mean difference. RESULTS: Significant group differences were observed in knee extensor (p = 0.01) and flexor (p < 0.001), but not in 1-repetition maximum. Regarding functional capacity and balance, differences between groups, in favour of the RTP group, were found in the Timed Up and Go Test (p = 0.001), walking endurance, (p = 0.02) gait speed (p = 0.02) and balance (p = 0.02). No significant differences between groups were observed in fatigue or general health perception. The results regarding the optimal dose are inconsistent. CONCLUSIONS: RTP improves strength, functional capacity, balance, and fatigue in people with MS. Registration: (PROSPERO): CRD42020182781Implications for rehabilitationResistance training is a valid strategy to improve isometric strength and functional capacity in MS patients.RTP using long durations (more than 6 weeks), high intensity (more than 80% 1-RM) and two-day weekly training frequency may be a correct stimulus to improve strength, functional capacity, balance, and fatigue in people with MS.Trainers and rehabilitators should consider these indicators in order to maximize muscular and functional adaptations in this population.

Association of medication adherence quality measures for diabetes, hypertension, and hyperlipidemia with cognitive decline.

Background: While diabetes, hypertension, and hyperlipidemia each are associated with increased risk of cognitive decline, little is known regarding how nonadherence to medications for these conditions is associated with cognitive decline risk. Methods: We identified patients enrolled in a Medicare Advantage Prescription Drug plan who were eligible for inclusion in the CMS Star Medication Adherence quality measures for diabetes, hypertension, and hyperlipidemia in 2018, 2019, and 2020. To achieve an adherence quality measure, patients had to meet 80% of the proportion of days for the medication. We used propensity score with inverse probability of treatment weighting to balance outcomes for baseline characteristics and logistic regression models to compare odds of cognitive decline outcomes across patient groups. Results: The study population of 99,774 individuals had a mean age of 71.0 years and was 49.1% female, 73.9% White, and 17.8% Black, with 62.0% living in an urban setting. Compared with patients who missed zero adherence measures, those who missed one measure had 23%-33% increased odds of cognitive decline (any decline OR = 1.23; dementia OR = 1.33; Alzheimer's disease OR = 1.27; all P values <0.01). Patients who missed 2-3 measures had 37%-96% increased odds of cognitive decline (any decline OR = 1.37; dementia OR = 1.58; Alzheimer's disease OR = 1.96; all P values <0.01). Patients who missed ≥4 adherence measures had the greatest odds of cognitive decline (any decline OR = 1.64; dementia OR = 2.05; Alzheimer's disease OR = 2.48; all P values <0.01). Conclusion: Not achieving CMS Star Medication Adherence quality measures for diabetes, hypertension, and hyperlipidemia therapies was associated with increased risk of cognitive decline outcomes.

Exposure to (Poly)phenol Metabolites after a Fruit and Vegetable Supplement Intake: A Double-Blind, Cross-Over, Randomized Trial.

Dietary (poly)phenol intake derived from the daily consumption of five portions of fruits and vegetables could protect against the development of non-communicable diseases. However, the general population does not meet the recommended intake. Supplementation with (poly)phenol-rich ingredients, within a varied and balanced diet, could help in filling this nutritional gap. This study aimed to validate the proof-of-concept of a (poly)phenolic supplementation developed to enhance the daily consumption of potentially bioactive compounds. Oxxynea® is a (poly)phenol-rich ingredient developed to provide the quantity and the variety corresponding to five-a-day fruit and vegetable consumption. In this double-blind, randomized cross-over study, 10 participants were supplemented with 450 mg of a (poly)phenol-based supplement or a placebo. Pharmacokinetics and urinary excretion profiles were measured for 24 and 48 h, respectively, using UPHLC-MS/MS analysis. The pharmacokinetic profile displayed a triphasic absorption, indicating peaks of circulating metabolites at 1.75 ± 0.25 h, 4.50 ± 0.34 h, 9.50 ± 0.33 h and an average Tmax (time of maximal plasma concentration) of 6.90 ± 0.96 h. Similarly, the urinary profile showed maximum metabolite excretion at 3-6 h, 6-10 h and 14-24 h after supplement consumption. Compared to individual metabolites belonging to different (poly)phenolic subfamilies, the total circulating and excreted metabolites showed a reduced coefficient of variation (CV 38%). The overall bioavailability estimated was 27.4 ± 3.4%. Oxxynea® supplementation may provide a sustained exposure to several (poly)phenolic metabolites and catabolites and reduces the inter-individual variation that could arise from supplementing only one class of (poly)phenol.

Effects of fast-velocity concentric resistance training in people with multiple sclerosis: A randomized controlled trial.

OBJECTIVES: To analyze the effects of a fast-velocity concentric resistance training (FVCRT) program on maximum strength of upper and lower limb, gait speed, walking endurance, fatigue, physical self-perception, and catastrophizing pain in people with multiple sclerosis (MS). MATERIALS AND METHODS: Participants were randomized to either an experimental [EG] (n = 18) or a control [CG] (n = 12) group. The EG carried out 10-weeks of lower limb FVCRT. The CG did not perform any intervention. The maximum isometric voluntary contraction (MVIC) during knee extension, hand-grip strength, gait speed, walking endurance, fatigue, physical self-perception, and catastrophizing pain were measured. RESULTS: Inter-group differences after intervention were found on the right and left sides in MVIC (p = .032; ES = -0.7 and p = .009; ES = -0.9), and hand grip strength (p = .003; ES = -1.0 and p = .029; ES = -0.7). After FVCRT, there was in increase in MVIC (p < .001; ES = -1.7 and p < .001; ES = -1.3) and hand grip strength (p < .001; ES = -1.3 and p < .001; ES = -1.3) on both right and left sides, respectively. In addition, gait speed (p = .023; ES = 1.3), walking endurance (p < .001; ES = -1.0), symptomatic fatigue (p = .004; ES = 0.6), and catastrophizing pain (p < .001; ES = 1.0) improved in EG. CONCLUSION: Lower limb FVCRT improved the upper and lower limb strength, walking, symptomatic fatigue, and catastrophizing pain in MS participants.

Biomarker Changes in Oxygen Metabolism, Acid-Base Status, and Performance after the Off-Season in Well-Trained Cyclists.

During the off-season, cyclists reduce their volume and intensity of training in order to recover the body from the high workload during the competitive season. Some studies have examined the effects of the off-season on cardiovascular, metabolic, and performance levels but have not evaluated oxygen metabolism, acid-base status, and electrolytes in cyclists. Therefore, our main objective was to analyze these markers in the off-season period (8 weeks) via finger capillary blood gasometry in well-trained cyclists. We found an increase in oxygen saturation (sO2) and oxyhemoglobin (O2Hb) (p ≤ 0.05) and a decrease in fat oxidation at maximum fat oxidation (FatMax) (p ≤ 0.05). In addition, we observed a decreasing trend of VO2 in the ventilatory threshold 2 (VT2) and maximum oxygen consumption (VO2MAX) (p ≤ 0.06) after the off-season in well-trained cyclists. Negative correlations were found between the pre-post off-season differences in the VO2 at ΔFatMax and ΔHCO3- (bicarbonate ion) and between power generated at the ΔeFTP (functional power threshold) and the ΔVO2MAX with the pH (r ≥ -0.446; p ≤ 0.05). After the off-season period, well-trained cyclists had increased markers of oxygen metabolism, decreased fat oxidation at low exercise intensities, and decreased VO2 at the VT2 and VO2MAX. Relationships were found between changes in the ΔeFTP and VO2MAX with changes in the pH and between the pH and HCO3- with changes in La-.

Can strength training modify voluntary activation, contractile properties and spasticity in Multiple Sclerosis?: A randomized controlled trial.

BACKGROUND: A randomized controlled trial was conducted to analyze the effects of 10 weeks of strength training (ST) on voluntary activation, muscle activity, muscle contractile properties, and spasticity in people with MS. METHODS: 30 participants were randomized to either an experimental [EG] (n = 18) or a control [CG] (n = 12) group. The EG carried out 10-weeks of ST, where the concentric phase was performed at maximum voluntary velocity. Muscle activity of the vastus lateralis (surface electromyography (sEMG) during the first 200 ms of contraction), maximal neural drive (peak sEMG), voluntary activation (central activation ratio), and muscle contractile function (via electrical stimulation) of the knee extensor muscles, as well as spasticity, were measured pre- and post-intervention. RESULTS: The EG showed a significant improvement with differences between groups in muscle activity in EMG0-200 (p = 0.031; ES = -0.8) and maximal neural drive (p = 0.038; ES = -0.8), as well as improvement in the ST group with a trend towards significance in EMG0-100 (p = 0.068; ES = -0.6). CAR increased after intervention in ST group (p = 0.010; ES=-0.4). Spasticity also improved in the ST group, with differences between group after intervention, in first swing excursion (right leg: p = 0.006; ES = -1.4, left leg: p = 0.031; ES = -1.2), number of oscillations (right leg: p = 0.001; ES = -0.4, left leg: p = 0.031; ES = -0.4) and duration of oscillations (left leg: p = 0.002; ES = -0.6). Contractile properties remain unchanged in both ST group and CG. CONCLUSIONS: 10 weeks of ST improves muscle activity during the first 200 ms of contraction, maximal neural conduction, and spasticity in people with MS. However, ST does not produce adaptations in muscle contractile properties in this population.

The Impact of Resistance Training Program on Static Balance in Multiple Sclerosis Population: A Randomized Controlled Trial Study.

BACKGROUND: Multiple sclerosis (MS) is a neurological disease that affects balance. Among the non-pharmacological strategies to improve this variable, physical exercise is one of the most widely used. However, the benefits of some types of training, such as resistance training, on static balance in this population are still unclear. This study aims to analyze the effects of a resistance training (RT) intervention on balance in people with MS. METHODS: Thirty people with MS were randomized to either an experimental (n = 18) or a control (n = 12) group. The RT group performed 10 weeks of lower limb resistance training with a concentric phase at maximum velocity. Static balance was measured before and after intervention. RESULTS: No significant group × time interaction effects were found (ANOVA test) in any of the variables at the end of the intervention. No intragroup differences were found before or after the intervention in the balance variables. CONCLUSIONS: Resistance training with a concentric phase at maximum velocity showed no impact on balance in our sample. Future studies should examine programs of longer duration or combined with other types of training, such as balance training, with the aim of obtaining improvements in this variable in people with MS.

Fast-velocity Resistance Training Improves Force Development and Mobility in Multiple Sclerosis.

This study aimed to analyze the benefits of a lower-limb fast-velocity concentric resistance training on rate of force development, mobility, and quality of life in people with Multiple Sclerosis. A randomized controlled trial was conducted in 30 people with Multiple Sclerosis, who were randomly assigned to either an experimental (n=18) or a control (n=12) group. The experimental group carried out 10-weeks of fast-velocity concentric resistance training, while the control group did not perform any intervention. Early and late rate of force development during knee extension in both legs, sit-to-stand and Timed Up and Go tests and quality life questionnaire were evaluated before and after intervention. The training program evoked an increase in early rate of force development in experimental group (0-30; Rightleg: 63.9%, p<0.001; ES=-1.4; Leftleg: 52.7%, p<0.001; ES=-1.0) compared to control group (showed modest increases). Furthermore, experimental group improved mobility after training (Sit-to-stand: 22.2%, p<0.001; ES=1.0; Timed Up and Go Test: 10.1%, p<0.001; ES=1.1) and increased the perception of quality of life after training, while control showed no changes. The fast-velocity concentric resistance training has the potential to improve early rate of force development and mobility after 10-weeks of training. In addition, the increase in self-perceived quality of life following this training modality demonstrates promising results in the Multiple Sclerosis population.

10-Weeks of resistance training improves sleep quality and cardiac autonomic control in persons with multiple sclerosis.

PURPOSE: To examine the acute and chronic effects of 10-weeks of progressive resistance training on sleep quality and sleeping heart rate variability in persons with Multiple Sclerosis (pwMS). METHODS: Eighteen pwMS (age = 44.8 ± 10.6 years; EDSS = 3.1 ± 1.7) completed a 10-week of resistance training, with three training sessions per week. Each session consisted of 4 lower body exercises, performing 2-4 sets of each exercise, with 8-15 repetitions each set, at an intensity ranging from 60 to 75% of 1-repetition maximum. Subjective and actigraphic sleep quality and sleeping heart rate variability were carried out at 4 different times: (1) Before the starting of the intervention on a rest day; (2) the night after training week 1 (3) the night after training week 10 and 4) after completing the resistance training program on a rest day. RESULTS: Regarding subjective sleep quality, significant main effects were observed on the variables of sleep quality, sleep comfort, easy of falling sleep, easy of waking up and felling of rest. Sleep quality, sleep comfort and easy of falling sleep were greater in rest night in week 1 vs. rest night in week 10. Actigraphic sleep quality also improved after the training program (rest night in week 1 vs. rest night in week 10). In the pair-wise comparison showed an acute effect in the session after the training program (rest night in week 10< training night in week 10) on HF, pNN50 and RMMSD. CONCLUSIONS: Resistance training is a non-pharmacological treatment that has the capacity to improve the regulation of autonomic system and, consequently, the sleep quality in pwMS.Implications for rehabilitation10 Weeks of resistance training improves the sleep quality of persons with multiple sclerosis.Resistance training can modulate autonomic cardiac control in this population.Improving the sleep quality is essential for persons with MS because of its close relationship to other variables, such as symptomatic fatigue.

Factors that affect heart rate variability following acute resistance exercise: A systematic review and meta-analysis.

BACKGROUND: There is controversial evidence regarding the effect of acute resistance exercise (ARE) on heart rate variability (HRV) parameters, which indicates the activities of the cardiac autonomic nervous system. The aim of this study was to perform a systematic review and meta-analysis of the literature on the effect of ARE on HRV parameters and identify its possible moderating factors. METHODS: The PubMed-Medline, Web of Science, SPORTDiscus, and Cochrane Library databases were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration was followed, and the methodological quality of the studies was evaluated. The level of significance was set at p ≤ 0.05. Twenty-six studies met the inclusion criteria. Main effect analyses between pre- and post-test interventions demonstrated an increase in normalized units low frequency (p < 0.001; standardized mean difference (SMD) = 0.78; 95% confidence interval (95%CI): 0.46‒1.11) and low frequency/high frequency ratio (p < 0.001; SMD = 0.82; 95%CI: 0.64‒0.99) and a decrease in standard deviation of the normal-to-normal (NN) interval (p < 0.001; SMD = -0.58; 95%CI: -0.85 to -0.30), root mean square of the successive differences (p < 0.001; SMD = -1.01; 95%CI: -1.29 to -0.74), and normalized units high frequency (p < 0.001; SMD: -1.08; 95%CI: -1.43 to -0.73) following ARE in healthy individuals range: 15 ± 1 to 48 ± 2 years; mean ± SD). RESULTS: There were differences between the subgroups in the number of sets used in an exercise (p = 0.05) for root mean square of the successive differences, as well as for exercise intensity (p = 0.01) and rest between sets (p = 0.05) for normalized units high frequency. Interestingly, there were differences between the subgroups in training volume for root mean square of the successive differences (p = 0.01), normalized units high frequency (p = 0.003) and normalized units low frequency (p = 0.02). CONCLUSION: Overall, there was a withdrawal of cardiac parasympathetic and activation of cardiac sympathetic modulations following ARE, and these changes were greater with higher training volume ∼30 min after ARE in healthy individuals. Furthermore, the number of sets, intensity, and rest between sets affected HRV parameters. However, gender, body mass index, and training status did not influence the changes in HRV parameters as a response to ARE.

Impact of Lockdown during COVID-19 Pandemic on Central Activation, Muscle Activity, Contractile Function, and Spasticity in People with Multiple Sclerosis.

BACKGROUND: People with multiple sclerosis (MS) suffer from symptoms related to neural control, such as reduced central activation, lower muscle activity, and accentuated spasticity. A forced 9-week home confinement related to COVID-19 in Spain may have worsened these symptoms. However, no study has demonstrated the impact of home confinement on neuromuscular mechanisms in the MS population. This study was aimed at analyzing the effects of a 9-week home confinement on central activation, muscle activity, contractile function, and spasticity in MS patients. METHODS: Eighteen participants were enrolled in the study. Left and right knee extensor maximum voluntary isometric contraction (MVIC), maximal neural drive via peak surface electromyography (EMG) of the vastus lateralis, central activation ratio (CAR), and muscle contractile function via electrical stimulation of the knee extensor muscles, as well as spasticity using the pendulum test, were measured immediately before and after home confinement. RESULTS: Seventeen participants completed the study. CAR significantly decreased after lockdown (ES = 1.271, p < 0.001). Regarding spasticity, there was a trend to decrease in the number of oscillations (ES = 0.511, p = 0.059) and a significant decrease in the duration of oscillations (ES = 0.568, p = 0.038). Furthermore, in the left leg, there was a significant decrease in the first swing excursion (ES = 0.612, p = 0.027) and in the relaxation index (ES = 0.992, p = 0.001). Muscle contractile properties, MVIC, and EMG variables were not modified after confinement. CONCLUSIONS: The results suggest that a home confinement period of 9 weeks may lead to an increase in lower limb spasticity and a greater deficit in voluntary activation of the knee extensors.

The impact of COVID-19 home confinement on neuromuscular performance, functional capacity, and psychological state in Spanish people with Multiple Sclerosis.

BACKGROUND: The COVID-19 pandemic caused a global confinement of more than 2 months in Spain. As a result, the general population has significantly decreased their physical activity levels. The consequences of this abrupt, sedentary lifestyle in Spanish people with Multiple Sclerosis (pwMS) were unknown. Our aim was to examine the impact of COVID-19 home confinement on neuromuscular performance, functional capacity, physical self-perception, and anxiety in pwMS. METHODS: Eighteen pwMS (8:10 men/women, age: 43.41±10.88 years, Expanded Disability Status Scale: 2.85±1.34) participated in the study. Rate of force development (RFD) and maximal voluntary isometric contraction during knee extension in both legs, Timed-Up and Go test (TUG), sit-to-stand test, 6 min walk test, 10 m walk test, Physical-Self Perception Questionnaire (PSPQ) and State-Train Anxiety Inventory (STAI) were performed just before and after home confinement. RESULTS: A non-significant moderate effect (p = 0.07; ES = -0.48) was observed in the time in the sit-to-stand test compared to pre-home confinement. There was a significant increase in the time in TUG (p = 0.02; ES = -0.67). The PSQP score decreased (p = 0.01; ES = 0.79) and STAI-state increased (p = 0.01; ES = -0.65) following home confinement. CONCLUSION: Home confinement had an impact on functional capacity, physical self-perception and state anxiety. However, neuromuscular performance was not altered after home confinement.

8 weeks of 2S-Hesperidin supplementation improves muscle mass and reduces fat in amateur competitive cyclists: randomized controlled trial.

2S-Hesperidin is the main flavonoid of orange (Citrus sinensis). Previous researches have pointed its effects in muscle development and fat accumulation reduction, although most of these results have not been assessed in humans. The objective of this study is to evaluate the effect of chronic (8-weeks) intake of 2S-hesperidin on amateur cyclists' body composition. A double-blind, parallel and randomized trial, was carried out with 40 amateur cyclists that were divided in two groups, one taking 2S-hesperidin (500 mg d-1, n = 20) and another taking placebo (500 mg d-1 microcellulose, n = 20) for 8 weeks. Dual-energy X-ray absorptiometry (DXA) and anthropometric measurements were used to assess the effect of both treatments on body composition. In addition, the resting metabolic rate was measured. In comparison to placebo, DXA analysis showed a decrease in percentage body fat (%BF) (-10.4%; p = 0.035) and lower limb fat mass (-10.5%; p = 0.029) in favour of 2S-hesperidin. After evaluation of anthropometric data, a decrease in %BF (-3.7%; p = 0.006), total body fat (-3.0%; p = 0.047), ∑ of 8 skinfolds (-6.1%; p = 0.008) was observed in 2S-hesperidin group, but not in placebo. Additionally, there was an increase in muscle mass percentage (1.0%; p = <0.001) and total muscle mass (1.7%; p = 0.011) after ingestion of 2S-hesperidin, with no changes in placebo. Chronic intake of 2S-hesperidin decreased fat mass in amateur cyclists, evaluated through different body composition measurement methodologies (DXA and anthropometry). In addition, 2S-hesperidin supplementation showed a promoting effect on muscle development.