Feasibility of home-based exercise training in men with metastatic castration-resistant prostate cancer.

BACKGROUND: Home-based training increases accessibility to exercise and mitigates the side effects of hormone therapy for prostate cancer (PC). However, it is unknown if men with more advanced disease are willing to partake in such interventions. PURPOSE: To determine the feasibility of a home-based exercise intervention in men with metastatic castration-resistant prostate cancer (mCRPC). METHODS: mCRPC patients on androgen receptor signaling inhibitors (ARSI) were prescribed a 12-week, home-based exercise intervention using resistance bands and walking. Feasibility was assessed using recruitment, retention, adherence, and outcome capture. Physiological changes and patient reported outcomes were assessed before and after the intervention. RESULTS: Of the 62 referrals, 47 were eligible with 22 men performing baseline testing (47% recruitment rate) and 16 completing the intervention (73% retention). Task completion was >86% for all physiological tests. Walking adherence was 80% and resistance training was 63%, the latter falling short of the study target (75%). Training increased thigh muscle cross-sectional area by 22%, time to exhaustion by 19% (both p < 0.05) and peak oxygen uptake by 6% (p = 0.057). Improvements in short physical performance battery scores and 400 m walk demonstrated moderate effect sizes that did not reach significance. CONCLUSIONS: Home-based exercise is feasible during ARSI treatment for mCRPC. Greater endurance capacity and localized hypertrophy appear as the primary improvements following training. These preliminary findings suggest home-based training may increase exercise accessibility, with important lessons that will inform subsequent trials investigating the efficacy of home-based exercise interventions during mCRPC.

Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical, and Practical Implications for the Female Athlete.

Problem: If athletes develop low energy availability (LEA), it can lead to a Relative Energy Deficiency in Sport (RED-S) syndrome which has severe health consequences if not treated. Methodology: A narrative review of the most recent and pertinent literature on the topic, with special emphasis on women. Results: In assessing the current literature, we have synthesized: i) the scientific implications of LEA and RED-S, ii) the clinical manifestations of the conditions currently available for detection, as well as iii) the practical implications for healthcare and support for female athletes and teams in planning intervention or prevention strategies (maintaining EA >45 kcal/kg FFM/day). Discussion: The 'Female Athlete Triad" emerged in the 1990s as researchers understood more of the etiological adaptation of female athlete health to sports training. In the last 10 years, the scientific community has recognized that the 'Triad' approach was too narrow in focus, and the broader concept of RED-S emerged. Both the Triad and RED-S are consequences of a frequently prevalent LEA in athletes (<30 kcal/kg FFM/day). Developing LEA and RED-S compromises training adaptation, performance capacity, and health in athletes. For these reasons, it is critical that an athlete's support team recognize the behaviors that may indicate RED-S evolution. In this way, we can assist female athletes in reaching their full potential in sports while protecting their health.

Association of Quality of Life With Moderate-to-Vigorous Physical Activity After Anterior Cruciate Ligament Reconstruction.

CONTEXT: Better knee function is linked to psychological readiness to return to sport after anterior cruciate ligament reconstruction (ACLR). Individuals with ACLR participate in less physical activity than matched uninjured control individuals, yet the association between knee function and physical activity post-ACLR remains unclear. OBJECTIVE: To determine the associations between (1) patient-reported knee function measured using the Knee Injury and Osteoarthritis Outcome Score Knee-Related Quality of Life (KOOS-QOL), daily steps, and minutes spent in moderate-to-vigorous physical activity (MVPA) of individuals with ACLR and (2) KOOS-QOL and daily steps and MVPA in individuals with ACLR who presented with (ie, symptomatic) or without (ie, asymptomatic) clinically meaningful knee-related symptoms. DESIGN: Cross-sectional study. SETTING: Laboratory, free-living conditions. PATIENTS OR OTHER PARTICIPANTS: A total of 66 individuals with primary unilateral ACLR (36 women, 30 men; age = 22 ± 4 years, height = 1.71 ± 0.1 m, mass = 71.3 ± 12.6 kg, body mass index = 24.2 ± 2.9, time post-ACLR = 28 ± 33 months). MAIN OUTCOME MEASURE(S): We collected KOOS data and retrospectively stratified participants into those with (symptomatic group, n = 30) or without (asymptomatic group, n = 36) clinically meaningful knee-related symptoms based on previously defined KOOS cutoffs. We assessed daily steps and MVPA using accelerometers that participants wore on the right hip for 7 days. We conducted linear regressions to determine associations between KOOS-QOL and daily steps and MVPA. RESULTS: In the entire sample, no associations existed between KOOS-QOL and daily steps (ΔR2 = 0.01, P = .50) or MVPA (ΔR2 = 0.01, P = .36). In the symptomatic group, a greater KOOS-QOL was associated with more time in MVPA (ΔR2 = 0.12, P = .05). In the asymptomatic group, no associations were identified between the KOOS-QOL and daily steps and MVPA. CONCLUSIONS: Individuals with symptoms post-ACLR who spent more time in MVPA reported higher QOL.

Prevalence of Triad-RED-S symptoms in high-level Kenyan male and female distance runners and corresponding control groups.

PURPOSE: This study examined and compared select Triad-RED-S components/risk factors in high-level Kenyan male and female distance runners to corresponding control groups; focusing on examining energy intake (EI), bone indices, and hormonal markers. METHODS: A cross-sectional, observational design was used in which Kenyan male and female (n = 30 and n = 26, respectively) middle- and long-distance runners and corresponding male and female control groups (n = 29 and n = 29, respectively) were examined. The participant's bone mineral density (BMD) at the lumbar spine, right femur, and total body were measured using a dual-energy X-ray absorptiometry analysis. Complete blood counts (CBC) were done on the whole blood specimens and hormonal measurements were performed on plasma specimens. In addition, athletes completed metabolic testing to determine maximal oxygen uptakes and 7-day dietary diaries. RESULTS: Overall daily EI across runners and controls within each sex were low, but not significantly different (p > 0.05). Prevalence of low BMD values (Z score < - 2.0) was comparable across groups in each sex (p > 0.05). CBC measures suggested that both runners and controls were healthy. Finally, slight hormonal differences between runners and their respective controls existed (p < 0.05), but were not clinically meaningful or observed in typical Triad-RED-S-related parameters. CONCLUSION: High-level Kenyan male and female runners had low daily EI, but no tendency toward a higher prevalence of low BMD, or Triad-RED-S-related hormonal abnormalities. The occurrence of low EI was not a major risk factor in our athletes; this calls into question whether the current criteria for Triad-RED-S are entirely applicable for athletes of African ethnicity.

Body composition, physical function and quality of life in healthy men and across different stages of prostate cancer.

BACKGROUND: Androgen deprivation therapy (ADT) for prostate cancer (PC) has detrimental effects on physical function and quality of life (QoL), but the addition of androgen receptor signalling inhibitors (ARSI) on these outcomes is unclear. PURPOSE: To compare body composition, physical function, and QoL across progressive stages of PC and non-cancer controls (CON). METHODS: In men with hormone sensitive PC (HSPC, n = 43) or metastatic castration-resistant PC (mCRPC, n = 22) or CON (n = 37), relative and absolute lean and fat mass, physical function (6 m walk, chair stands, timed up and go [TUG], stair climb), and QoL were determined. RESULTS: Relative body composition differed amongst all groups, along with ~39% greater absolute fat mass in mCRPC vs. CON. TUG and chair stands were ~71% and ~33% slower in mCRPC compared to both CON and HSPC, whereas stair climb was ~29% and 6 m walk was ~18% slower in mCRPC vs. CON. Relative body composition was correlated with physical function (r = 0.259-0.385). Clinically relevant differences for mCRPC were observed for overall QoL and several subscales vs. CON, although body composition and physical function did not influence QoL. CONCLUSIONS: PC progression is associated with deteriorations in body composition and physical function. As ADT length was similar between groups, ARSI use for mCRPC likely contributed in part to these changes. Given the difficulties of improving lean mass during ADT, interventions that reduce adiposity may lessen the side effects of hormone therapy.

Influence of the Menstrual Cycle Phase on Marathon Performance in Recreational Runners.

PURPOSE: To examine the potential impact of fluctuations in sex steroid hormones across the menstrual cycle (MC) on marathon running performance of recreational female athletes. METHODS: A survey questionnaire was administered to recreational, nonelite runners who had completed multiple marathons within the last 18 months. RESULTS: A total of 599 questionnaires were returned and deemed viable for review. From these, 185 survey participants were found to have complete information and eligibility to have their surveys used in the statistical analysis. A total of 106 women had their best marathon performance in the luteal phase (high sex steroid hormones) of the MC, and 79 had their best performance in the follicular phase (low sex steroid hormones) of the MC (responses were significantly different; z-score value = 1.11; P < .05). CONCLUSION: Recreational female runners have varying performances in the marathon across their MC phases, specifically performing better in the luteal phase of the cycle.

Birth sex ratio in the offspring of professional male soccer players: influence of exercise training load.

STUDY QUESTION: Can the exercise training load of elite male athletes influence the sex ratio of their offspring? SUMMARY ANSWER: This is the first study assessing the influence of exercise training load on the offspring sex ratio of children from male professional athletes, observing a bias toward more females being born as a result of both high-intensity and high-volume loads, with intensity having the greatest effect. WHAT IS KNOWN ALREADY: There is a relatively constant population sex ratio of males to females among various species; however, certain events and circumstances may alter this population sex ratio favoring one sex over the other. STUDY DESIGN, SIZE, DURATION: Observational, descriptive cross-sectional study with a duration of 3 months. PARTICIPANTS/MATERIALS, SETTING, METHODS: Seventy-five male professional soccer players from First Division soccer teams. Offspring variables were sex of the offspring, number of children and order of birth. Exercise training variables were volume and intensity. MAIN RESULTS AND THE ROLE OF CHANCE: Total offspring was 122 children (52 males (42.6%), 70 females (57.4%)). Analysis revealed that increase in either the volume (P < 0.001) or intensity (P < 0.001) of training by the players shifted the birth offspring ratio more toward females. Within the sample of females born, more births (i.e. number) were observed as a consequence of training at the highest intensity (45 out of 70; P < 0.001), no such pattern occurred within males (P > 0.05). When female versus male births were compared within each intensity, only the high-intensity comparison was significant (45 (75%) females vs 15 (25%) males, P < 0.001). LIMITATIONS, REASONS FOR CAUTION: While this is the first study assessing differences in the sex ratio of the offspring of male athletes (i.e. soccer players), we acknowledge there are limitations and confounders within our approach; e.g. small sample size, ethnic background and variations in the timing of intercourse relative to ovulation as well as in sex hormone levels. As such, we propose that future research is needed to confirm or refute our findings. It is recommended that such work expand on the measurements obtained and conduct direct assessment of sperm characteristics. WIDER IMPLICATIONS OF THE FINDINGS: The findings of the study support the fact that different stressors on the body may alter the sex of the offspring. While in the present study the stressor is the excessive training load of soccer players, other events may lead to similar results. The bias in offspring sex ratio may have important implications for demography and population dynamics, as well as genetic trait inheritance. STUDY FUNDING/COMPETING INTEREST(S): There is no funding nor competing interests. TRIAL REGISTRATION NUMBER: N/A.

Exercise, Dietary Protein, and Combined Effect on IGF-1.

Insulin-like growth factor 1 (IGF-1) is a dichotomous hormone. While beneficial for growth/repair, and regulating muscle hypertrophy, high concentrations of IGF-1 are associated with increased risk of cancer and mortality. Factors thought to mediate IGF-1 include dietary protein and exercise. The purpose of this study was to analyze acute effects of dietary protein and/or exercise on plasma free IGF-1 and the time-course thereof to inform individuals who may benefit from increased IGF-1 (muscle growth/repair) or reduced IGF-1 (risk/diagnosis of cancer). Twenty-four participants (11 females, 24.9±4.6y) completed the three-way crossover study consisting of: (1)a high protein (42g) meal; (2)exercise (20min with four 30sec sprints); and (3)exercise followed by a high protein meal. Blood samples were collected fasted at rest, immediately after rest (or 5min after exercise), and at regular intervals throughout a 5h recovery. An additional fasted venipuncture was performed the morning following each condition (24h after baseline). Free IGF-1 was higher at immediately after exercise in the exercise condition (p=0.04). In the protein condition the 24h IGF-1 was 17.5% higher (p=0.02) than baseline. IGF-1 did not change over time in response to exercise with protein. The data gleaned from this study can enhance the knowledge of the time-course effects from protein and/or exercise on IGF-1. This study can provide a foundation for future research to investigate optimal timing and dosage to enhance muscle protein synthesis for athletes, as well as investigate whether consistent high protein meals may chronically elevate IGF-1 and increase the risk of deleterious health outcomes.

Influence of resistance training and herbal supplementation on plasma apelin and metabolic syndrome risk factors in postmenopausal women.

Purpose ­: Menopause is a normal condition that all women experience as they age. The aim of this study was to assess the effects of circuit resistance exercise training with Zataria multiflora (Avishan-e-Shirazi) dietary supplementation on plasma apelin, glucose, insulin, insulin sensitivity and insulin resistance. Methods ­: Ninety-six volunteer postmenopausal women were allocated into 8 groups. Resistance training consisted of 12 stations had been done for 8 weeks. Blood samples were collected at pre- and -post intervention. Results ­: Circuit RT increases apelin and decreases both insulin and blood glucose, whereas Zataria multiflora has no independent effect on apelin but does decrease blood glucose and is likely to be in some means synergistic with circuit RT effects. Conclusion ­: These results suggest that circuit resistance training augments plasma apelin and decreases both insulin and blood glucose. However, Zataria multiflora has no independent effect on apelin but does decrease blood glucose which is likely to be to some extent synergistic with training effects.

Objectif ­: La ménopause est une situation physiologique qui affecte toutes les femmes autour de la cinquantaine. Le but de cette étude était d'évaluer les effets d'un entraînement en résistance de type « circuit training ¼ avec supplémentation orale en Zataria multiflora (Avishan-e-Shirazi) sur l'apeline plasmatique, le glucose, l'insuline, la sensibilité à l'insuline et la résistance à l'insuline. Méthodologie ­: Quatre-vingt quatre femmes postménopausées bénévoles ont été réparties en 8 groupes. L'entraînement en circuit training comprenait 12 séances sur 8 semaines. Des échantillons sanguins ont été prélevés avant et après intervention. Résultats ­: Le circuit training augmente l'apeline et diminue à la fois l'insuline et la glycémie, alors que Zataria multiflora n'a pas d'effet indépendant sur l'apeline, mais diminue la glycémie et est semble synergique des effets du circuit training. Conclusion ­: Ces résultats suggèrent que le circuit training augmente l'apeline plasmatique et diminue insuline et glucose dans le sang. Cependant, Zataria multiflora n'a pas d'effet indépendant sur l'apeline mais fait diminuer la glycémie, ce qui est susceptible d'être dans une certaine mesure synergique avec les effets de l'entraînement.

Low testosterone: Androgen deficiency, endurance exercise training, and competitive performance.

PURPOSE: Our intent was to (a) characterize weekly changes in resting testosterone (T), cortisol (C), and the T:C ratio in males during an intensive endurance training program, and (b) determine if clinical androgen deficiency (AD) based upon T-level criteria developed. METHODS: An 18-week training program in which individual training volume (km/week) increased at 25% increments over baseline (BL) levels observed prior to the study beginning at 4-week intervals throughout the first 12 weeks. After 12 weeks, the volume was reduced to that of the first 4 weeks until the study end (week 18). Competitive performance running tests were assessed at BL and every 4 weeks, while blood T and C were assessed weekly. RESULTS: Performance improved from BL at weeks 4-16 (p < 0.01). T was reduced (p < 0.01) from BL at weeks 3, and 5-18. The greatest reduction from BL was at week 13, subsequently T returned toward BL at week 18. C was highly variable, and no significant changes from BL were noted. The T:C ratio at weeks 5, 6, and 8-16 was significantly less than at BL (p < 0.01), the greatest reduction at week 13. The T:C ratio values also returned toward BL by week 18. Finally, ∼50% of the subjects reached T levels to be classified as AD. CONCLUSIONS: Sports scientists should recognize decreases in T or T:C ratio is not always indicative of compromised competitive performance potential. Clinicians should be aware increased training loads can lead to AD in men.

Changes in inflammation markers after a 10-week high-intensity combined strength and endurance training block in women: The effect of hormonal contraceptive use.

OBJECTIVES: The influence of hormonal contraceptives (HC) on inflammation and body composition after high-intensity combined strength and endurance training was investigated. DESIGN: Active healthy women formed two training groups: HC users (HCU, n = 9) and those who had never used HC (NHC, n = 9). Training included two strength training sessions and two high-intensity interval training sessions per week for 10 weeks. METHODS: Before (PRE) and after (POST) the training intervention, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1beta (IL-1ß) concentrations were measured. Dual-energy X-ray absorptiometry was used to estimate fat mass (FM), abdominal fat mass (aFM), and lean mass (LM). RESULTS: Circulating concentrations of hs-CRP decreased significantly in the NHC from pre to post with -0.46 mg l-1 (95% CI: -0.78, -0.14, p = 0.009, ES = 0.434), whereas a significant increase was observed in HCU from pre to post with 0.89 mg l-1 (95% CI: 1.66, 0.12, p = 0.048, ES = 1.988) with a significant between-group difference (p = 0.015). In addition, hs-CRP concentration was significantly higher in HCU than in NHC after training (p = 0.036) at post. Lean mass increased significantly more in NHC than in HCU (p = 0.049). CONCLUSIONS: High-intensity combined strength and endurance training can modify inflammation and body composition of women. The present study showed that inflammation, in terms of hs-CRP was higher post training in HCU than NHC, which may be associated with smaller gains in lean mass in response to training.

Effects of Recovery Mode during High Intensity Interval Training on Glucoregulatory Hormones and Glucose Metabolism in Response to Maximal Exercise.

Catecholamines [adrenaline (A) and noradrenaline (NA)] are known to stimulate glucose metabolism at rest and in response to maximal exercise. However, training and recovery mode can alter theses hormones. Thus our study aims to examine the effects of recovery mode during High-intensity Interval Training (HIIT) on glucoregulatory hormone responses to maximal exercise in young adults. Twenty-four male enrolled in this randomized study, assigned to: control group (eg, n=6), and two HIIT groups: intermittent exercise (30 s run/30 s recovery) with active (arg, n=9) or passive (prg, n=9) recovery, arg and prg performed HIIT 3 times weekly for 7 weeks. Before and after HIIT, participants undergo a Maximal Graded Test (MGT). Plasma catecholamines, glucose, insulin, growth hormone (Gh) and cortisol were determined at rest, at the end of MGT, after 10 and 30 min of recovery. After training V02max and Maximal Aerobic Velocity (MAV) increased significantly (p<0.05) in arg. After HIIT and in response to MGT plasma glucose increase significantly (p=0.008) lesser in arg compared to prg whereas insulin concentrations were similar. The glucose/insulin ratio was significantly lower at MGT end (p=0.033) only in arg after training. After HIIT, in response to MGT, plasma A, NA, cortisol and Gh concentrations were significantly higher only in arg (p<0.05). HIIT using active recovery is beneficial for aerobic fitness, plasma glucose and glucoregulatory hormones better than HIIT with passive recovery. These findings suggest that HIIT with active recovery may improve some metabolic and hormonal parameters in young adults.

Correction to: Estrogen and muscle stiffness have a negative relationship in females.

In the original publication the name of the fourth reviewer was incorrectly published.

Impact of physical activity and exercise on male reproductive potential: a new assessment questionnaire.

Male athletes in general are subjected to the same causes of infertility as the general population, but sports practice itself may be possibly an additional infertility factor or, at least an aggravating factor for a previously existing fertility condition; on the contrary, being physically active has been hypothesized to favor hormonal and seminological processes and could be beneficial for fertility. In this relationship, the different inherent parameters of physical activity-exercise (training volume, intensity, objective, organization and frequency) are of paramount importance. Therefore, this review discusses both the negative and positive impact of physical exercise on the male reproductive potential. Clear knowledge is lacking on this topic as incongruences exist due to the fact that studies lack standardization in assessment tools or research protocols. So that future studies can reveal more information regarding exercising male fertility, we introduce a unique questionnaire developed with the intent to help standardize future studies on male fertility and exercise.

Exercise, adipokines and pediatric obesity: a meta-analysis of randomized controlled trials.

BACKGROUND/OBJECTIVE: Adipokines are involved in the etiology of diabetes, insulin resistance, and the development of atherosclerosis and other latent-onset complications. The objective of this meta-analysis was to determine the effectiveness of exercise interventions on adipokines in pediatric obesity. SUBJECTS/METHODS: A computerized search was made using three databases. The analysis was restricted to studies that examined the effect of exercise interventions on adipokines (adiponectin, leptin, resistin and visfatin) in pediatric obesity (6-18 years old). Fourteen randomized controlled trials (347 youths) were included. Weighted mean difference (WMD) and 95% confidence intervals were calculated. RESULTS: Exercise was associated with a significant increase in adiponectin (WMD=0.882 µg ml-1, 95% CI, 0.271-1.493) but did not alter leptin and resistin level. Likewise, exercise intensity and change in body fat; as well as total exercise program duration, duration of the sessions, and change in body fat all significantly influenced the effect of exercise on adiponectin and leptin, respectively. CONCLUSIONS: Exercise seems to increase adiponectin levels in childhood obesity. Our results also suggested that exercise on its own, without the concomitant presence of changes in body composition levels, does not affect leptin levels.

Adrenal Hormone and Metabolic Biomarker Responses to 30 min of Intermittent Cycling Exercise in Breast Cancer Survivors.

The aim of this study was to explore the effect of one bout of aerobic exercise on epinephrine, norepinephrine, cortisol, glucose, lactate, and free fatty acid (FFA) responses in breast cancer survivors and healthy controls. 9 female breast cancer survivors and 9 women without a history of cancer completed 30 min of cycle ergometry exercise at 60% of VO2peak. Blood samples were taken pre-exercise, immediately post-exercise, and 2 h post-exercise from which plasma concentrations of study variables were measured. Immediately and 2 h post-exercise, increases were observed in epinephrine (control group only) norepinephrine (both groups), lactate (both groups), and FFA (both groups immediately post-exercise; breast cancer survivor group only at 2 h post-exercise) (p<0.05). Cortisol decreased immediately and 2 h post-exercise in the control group while glucose decreased immediately post-exercise in the breast cancer survivor group (p<0.05). In conclusion, breast cancer survivors appeared to display attenuated epinephrine, cortisol, and lactate responses while displaying larger magnitude changes in glucose and FFA responses compared to controls. These preliminary findings may have implications for the regulation of metabolism during exercise in breast cancer survivors.