The Acute, Short-, and Long-Term Effects of Endurance Exercise on Skeletal Muscle Transcriptome Profiles.

A better understanding of the cellular and molecular mechanisms that are involved in skeletal muscle adaptation to exercise is fundamentally important to take full advantage of the enormous benefits that exercise training offers in disease prevention and therapy. The aim of this study was to elucidate the transcriptional signatures that distinguish the endurance-trained and untrained muscles in young adult males (24 ± 3.5 years). We characterized baseline differences as well as acute exercise-induced transcriptome responses in vastus lateralis biopsy specimens of endurance-trained athletes (ET; n = 8; VO2max, 67.2 ± 8.9 mL/min/kg) and sedentary healthy volunteers (SED; n = 8; VO2max, 40.3 ± 7.6 mL/min/kg) using microarray technology. A second cohort of SED volunteers (SED-T; n = 10) followed an 8-week endurance training program to assess expression changes of selected marker genes in the course of skeletal muscle adaptation. We deciphered differential baseline signatures that reflected major differences in the oxidative and metabolic capacity of the endurance-trained and untrained muscles. SED-T individuals in the training group displayed an up-regulation of nodal regulators of oxidative adaptation after 3 weeks of training and a significant shift toward the ET signature after 8 weeks. Transcriptome changes provoked by 1 h of intense cycling exercise only poorly overlapped with the genes that constituted the differential baseline signature of ETs and SEDs. Overall, acute exercise-induced transcriptional responses were connected to pathways of contractile, oxidative, and inflammatory stress and revealed a complex and highly regulated framework of interwoven signaling cascades to cope with exercise-provoked homeostatic challenges. While temporal transcriptional programs that were activated in SEDs and ETs were quite similar, the quantitative divergence in the acute response transcriptomes implicated divergent kinetics of gene induction and repression following an acute bout of exercise. Together, our results provide an extensive examination of the transcriptional framework that underlies skeletal muscle plasticity.

A 10-step participatory program for developing, implementing, and evaluating physical activity promoting actions in nursing homes in Germany.

BACKGROUND: Since multidimensional barriers challenge nursing homes, a socio-ecological approach is needed for physical activity promotion in this setting. So far, little is known about how such an approach can be transferred into the successful development and implementation of PA-promoting actions together with stakeholders on-site. We aimed to investigate the actions and dimensions of PA-promoting actions and their sustainable implementation. To contribute to closing this gap, we present a 10-step program for co-developing and co-evaluating PA-promoting actions in nursing homes through an integrated counselling approach. METHODS: We used a multiple case study approach that built upon manifold data sources, collected in 7 nursing homes over 3 years between 2021 and 2023. We collected fieldnotes and photologs from 14 future workshops (2 per home); 7 evaluation workshops (1 per home); 36 individual counsellings (2 sessions per resident), as well as 87 implementation protocols (action type and frequency), 11 evaluation questionnaires (changes among resources, cooperations, and collaborations); 7 goal attainment scales and 18 individual activity schedules. In addition, we retrieved and documented progress information at regular intervals by phone or email. RESULTS: With staff, residents, relatives, and volunteers, we co-developed 112 ideas for PA promotion; from which 54 ideas were implemented and integrated into everyday life, differentiated into "activities of daily living," "structured activities," and "activity-friendly environments."; 18 residents in 4 homes participated in individual counselling to develop individual activity schedules. Eighteen actions were rated as "(much) more successful than expected"; 10 "(much) worse than expected," and 23 "as successful as expected." Three actions were not evaluated. DISCUSSION: The participatory integrated counselling approach led to home-specific actions and promoted implementation into everyday life. The number and dimensions of actions implemented largely depended on the mission and vision of the respective home. The lack of staff could partially be compensated for by involving neighbourhoods, volunteers, and community organisations, such as local clubs. CONCLUSION: To effectively promote PA in nursing homes, a tailored approach considering structural conditions, locations, volunteer engagement, and organisational visions is essential. Long-lasting partnerships and low-threshold opportunities prove promising. Future research should delve into structural-level change processes and outcomes in this context.

COVID-19 in Female and Male Athletes: Symptoms, Clinical Findings, Outcome, and Prolonged Exercise Intolerance-A Prospective, Observational, Multicenter Cohort Study (CoSmo-S).

BACKGROUND: An infection with SARS-CoV-2 can lead to a variety of symptoms and complications, which can impair athletic activity. OBJECTIVE: We aimed to assess the clinical symptom patterns, diagnostic findings, and the extent of impairment in sport practice in a large cohort of athletes infected with SARS-CoV-2, both initially after infection and at follow-up. Additionally, we investigated whether baseline factors that may contribute to reduced exercise tolerance at follow-up can be identified. METHODS: In this prospective, observational, multicenter study, we recruited German COVID elite-athletes (cEAs, n = 444) and COVID non-elite athletes (cNEAs, n = 481) who tested positive for SARS-CoV-2 by PCR (polymerase chain reaction test). Athletes from the federal squad with no evidence of SARS-CoV-2 infection served as healthy controls (EAcon, n = 501). Questionnaires were used to assess load and duration of infectious symptoms, other complaints, exercise tolerance, and duration of training interruption at baseline and at follow-up 6 months after baseline. Diagnostic tests conducted at baseline included resting and exercise electrocardiogram (ECG), echocardiography, spirometry, and blood analyses. RESULTS: Most acute and infection-related symptoms and other complaints were more prevalent in cNEA than in cEAs. Compared to cEAs, EAcon had a low symptom load. In cNEAs, female athletes had a higher prevalence of complaints such as palpitations, dizziness, chest pain, myalgia, sleeping disturbances, mood swings, and concentration problems compared to male athletes (p < 0.05). Until follow-up, leading symptoms were drop in performance, concentration problems, and dyspnea on exertion. Female athletes had significantly higher prevalence for symptoms until follow-up compared to male. Pathological findings in ECG, echocardiography, and spirometry, attributed to SARS-CoV-2 infection, were rare in infected athletes. Most athletes reported a training interruption between 2 and 4 weeks (cNEAs: 52.9%, cEAs: 52.4%), while more cNEAs (27.1%) compared to cEAs (5.1%) had a training interruption lasting more than 4 weeks (p < 0.001). At follow-up, 13.8% of cNEAs and 9.9% of cEAs (p = 0.24) reported their current exercise tolerance to be under 70% compared to pre-infection state. A persistent loss of exercise tolerance at follow-up was associated with persistent complaints at baseline, female sex, a longer break in training, and age > 38 years. Periodical dichotomization of the data set showed a higher prevalence of infectious symptoms such as cough, sore throat, and coryza in the second phase of the pandemic, while a number of neuropsychiatric symptoms as well as dyspnea on exertion were less frequent in this period. CONCLUSIONS: Compared to recreational athletes, elite athletes seem to be at lower risk of being or remaining symptomatic after SARS-CoV-2 infection. It remains to be determined whether persistent complaints after SARS-CoV-2 infection without evidence of accompanying organ damage may have a negative impact on further health and career in athletes. Identifying risk factors for an extended recovery period such as female sex and ongoing neuropsychological symptoms could help to identify athletes, who may require a more cautious approach to rebuilding their training regimen. TRIAL REGISTRATION NUMBER: DRKS00023717; 06.15.2021-retrospectively registered.

[Sarcopenia, physical activity and sedentary behavior among nursing home residents in Germany]. / Sarkopenie, körperliche Aktivität und sedentäres Verhalten von Pflegeheimbewohnenden in Deutschland.

BACKGROUND: Residents in nursing homes show a high prevalence of the musculoskeletal syndrome sarcopenia and tend not to achieve current physical activity recommendations. OBJECTIVE: The aim of this study is to identify differences in physical activity and sedentary behavior of sarcopenic residents compared with nonsarcopenic and presarcopenic residents. METHODS: Sarcopenia assessment was performed among 63 nursing home residents in Baden-Wuerttemberg (D) using the European Working Group on Sarcopenia in Older People 2 specifications. Structured activity sessions (per week), accelerometer-based physical activity (steps/day), and sedentary behavior (percentual/day) were examined. The group comparisons were determined with Kruskal-Wallis tests and Dunn-Bonferroni post hoc tests. RESULTS: Significant differences were found for number of steps (p = 0.005) and percentual sedentary behavior (p = 0.019). Moreover, steps per day presented significant results in group comparison for no sarcopenia (2824.4 [423-14275]) with probable sarcopenia (1703.9 [118-5663]) and confirmed/severe sarcopenia (1571.2 [240-2392]) (both p = 0.022; |r| = 0.34). Sedentary behavior demonstrated significant differences in groups with no sarcopenia (87.9% [69.1-94.3]) and with probable sarcopenia (91.7% [80.4-9835]) (p = 0.018; |r| = 0.35). CONCLUSION: Nonsarcopenic residents demonstrated a higher number of steps and lower sedentary behavior compared with presarcopenic and sarcopenic residents. Increasing steps, reducing sedentary behavior and promoting activities of daily living can contribute to the prevention and treatment of sarcopenia in the nursing home setting.

Patterns of physical activity among nursing home residents before and during the Covid 19 pandemic-a systematic observation.

BACKGROUND: The Covid-19 outbreak in spring of 2020 posed an array of challenges for nursing homes, including promoting resident physical activity (PA). Given the diversity of factors affecting resident PA, we explored how activity patterns outside weekly-scheduled structured activities changed during the pandemic and what factors promoted or inhibited PA during the pandemic. METHODS: We conducted systematic direct observations over 823.5 h in eight nursing homes in Southern Germany in 2020 and 2021. RESULTS: In 2020, 84.7% of person observation units were classified as sedentary (average activity level: 1.14 MET). In 2021, the percentage increased to 91.6% of observed person units (average activity level: 1.08 MET) (t = 6.947; p = .000). According to tree classification, influencing factors of PA included mealtime and daytime in 2020 and 2021, as well as presence of men residents only in 2020 and guided low threshold activities in 2021. CONCLUSIONS: Nursing homes constitute highly sedentary places-an issue exacerbated by access restrictions for external activity experts and significant others as well as behavioural restrictions for residents during the Covid-19 pandemic. Staff could not compensate due to existing time restraints and lack of training in PA promotion. Based on our findings, we recommend future studies to develop feasible and resource-low activities to be integrated into the daily routines of nursing homes.

Adipokines as Predictive Biomarkers for Training Adaptation in Subjects with Multimorbidity-A Hypothesis-Generating Study.

BACKGROUND: Physical exercise exerts a positive effect on many chronic conditions, specifically lifestyle-related diseases such as overweight and obesity, type 2 diabetes mellitus (T2DM), cardiovascular conditions and osteoarthritis (OA). As a result of common risk factors, most of these patients present with multiple conditions. Exercise- and disease-related biomarkers, such as adipokines, are emerging tools in training supervision and regulation; however, their significance in subjects with multimorbidities is unknown. SUBJECTS AND METHODS: To address this issue, adipokines leptin, adiponectin and resistin were assessed in a cohort of subjects with multimorbidities (n = 39) presenting with at least two of the abovementioned conditions or relevant risk factors before and after a six-month exercise and lifestyle intervention program ('MultiPill-Exercise'), and correlated with training adaptation, namely changes in relative maximum oxygen uptake (V·O2max). RESULTS: There was a significant negative correlation between baseline leptin concentrations and training effect for relative V·O2max (after three months: rho = -0.54, p = 0.020 *; after six months: rho = -0.45, p = 0.013 *), with baseline leptin explaining 35% of the variance in delta relative V·O2max after three months and 23% after six months. CONCLUSIONS: Leptin might be a suitable surrogate biomarker in the context of exercise-based lifestyle intervention programs in subjects with multimorbidity.

Skeletal Muscle MicroRNA Patterns in Response to a Single Bout of Exercise in Females: Biomarkers for Subsequent Training Adaptation?

microRNAs (miRs) have been proposed as a promising new class of biomarkers in the context of training adaptation. Using microarray analysis, we studied skeletal muscle miR patterns in sedentary young healthy females (n = 6) before and after a single submaximal bout of endurance exercise ('reference training'). Subsequently, participants were subjected to a structured training program, consisting of six weeks of moderate-intensity continuous endurance training (MICT) and six weeks of high-intensity interval training (HIIT) in randomized order. In vastus lateralis muscle, we found significant downregulation of myomiRs, specifically miR-1, 133a-3p, and -5p, -133b, and -499a-5p. Similarly, exercise-associated miRs-23a-3p, -378a-5p, -128-3p, -21-5p, -107, -27a-3p, -126-3p, and -152-3p were significantly downregulated, whereas miR-23a-5p was upregulated. Furthermore, in an untargeted approach for differential expression in response to acute exercise, we identified n = 35 miRs that were downregulated and n = 20 miRs that were upregulated by factor 4.5 or more. Remarkably, KEGG pathway analysis indicated central involvement of this set of miRs in fatty acid metabolism. To reproduce these data in a larger cohort of all-female subjects (n = 29), qPCR analysis was carried out on n = 15 miRs selected from the microarray, which confirmed their differential expression. Furthermore, the acute response, i.e., the difference between miR concentrations before and after the reference training, was correlated with changes in maximum oxygen uptake (V̇O2max) in response to the training program. Here, we found that miRs-199a-3p and -19b-3p might be suitable acute-response candidates that correlate with individual degrees of training adaptation in females.

Bioelectrical impedance analysis in the BaSAlt cohort-study: the phase angle as an additional parameter for sarcopenia quantification among German nursing home residents?

PURPOSE: Sarcopenia is characterized by the loss of muscle mass, strength, and physical functioning. The bioelectrical impedance analysis (BIA) is a simplify method for the measurement of muscle quantity and quality. But there is a lack of evidence in the interpretation of the muscle quality parameter phase angle (PhA), which was recommended by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). We hypothesize that the PhA shows differences between sarcopenia categorized groups and can be used as an additional parameter for sarcopenia quantification among residents of nursing homes (NH). METHODS: Based on EWGSOP2 specifications, 78 residents from five German NH was categorized into sarcopenia groups. Group comparisons with Kruskal-Wallis tests, Dunn-Bonferroni post-hoc-Tests, and correlations with Spearman coefficients were conducted with the muscle quality parameter PhA. RESULTS: Significant group differences by Kruskal-Wallis test for PhA was detected (H = 8.150, p = 0.017). The Dunn-Bonferroni post-hoc-Test showed significant results by group comparison for "confirmed/ severe sarcopenia" (4.1° [3.1-5.0]) with "no sarcopenia" (4.6° [3.7-11.2]; p =0 .049) and "probable sarcopenia" (4.7° [3.4-13.5]; p = 0.016), respectively. CONCLUSIONS: There is a limitation for differentiation in preliminary stage of sarcopenia among multimorbid NH residents by PhA. Moreover, further research for specific cut-off-values and the individual sarcopenia progression monitoring by PhA are needed. TRIAL REGISTRATION: No. AZ A2.5.4-096_aa (Date of approval: July 2019).

Acute and long-term exercise adaptation of adipose tissue and skeletal muscle in humans: a matched transcriptomics approach after 8-week training-intervention.

BACKGROUND: Exercise exerts many health benefits by directly inducing molecular alterations in physically utilized skeletal muscle. Molecular adaptations of subcutaneous adipose tissue (SCAT) might also contribute to the prevention of metabolic diseases. AIM: To characterize the response of human SCAT based on changes in transcripts and mitochondrial respiration to acute and repeated bouts of exercise in comparison to skeletal muscle. METHODS: Sedentary participants (27 ± 4 yrs) with overweight or obesity underwent 8-week supervised endurance exercise 3×1h/week at 80% VO2peak. Before, 60 min after the first and last exercise bout and 5 days post intervention, biopsies were taken for transcriptomic analyses and high-resolution respirometry (n = 14, 8 female/6 male). RESULTS: In SCAT, we found 37 acutely regulated transcripts (FC > 1.2, FDR < 10%) after the first exercise bout compared to 394, respectively, in skeletal muscle. Regulation of only 5 transcripts overlapped between tissues highlighting their differential response. Upstream and enrichment analyses revealed reduced transcripts of lipid uptake, storage and lipogenesis directly after exercise in SCAT and point to ß-adrenergic regulation as potential major driver. The data also suggest an exercise-induced modulation of the circadian clock in SCAT. Neither term was associated with transcriptomic changes in skeletal muscle. No evidence for beigeing/browning was found in SCAT along with unchanged respiration. CONCLUSIONS: Adipose tissue responds completely distinct from adaptations of skeletal muscle to exercise. The acute and repeated reduction in transcripts of lipid storage and lipogenesis, interconnected with a modulated circadian rhythm, can counteract metabolic syndrome progression toward diabetes.

The Acute Cytokine Response to 30-Minute Exercise Bouts Before and After 8-Week Endurance Training in Individuals With Obesity.

CONTEXT: One acute bout of exercise leads to a rapid increase in the systemic cytokine concentration. Regular exercise might alter the cytokine response, in particular in beforehand untrained and obese individuals. OBJECTIVE: Using a proximity extension assay, we studied the effects of acute exercise as well as endurance training on a panel of 92 cytokines related to inflammation. METHODS: A total of 22 individuals (30 ± 9 years; peak oxygen uptake [VO2peak] 25.2 ± 4.2 mL/[kg × min]; body mass index [BMI] 31.7 ± 4.4) participated in an 8-week endurance exercise intervention. Blood samples were collected before and immediately after 30 minutes' ergometer exercise at 80% VO2peak. RESULTS: Before and after the training intervention, 40 and 37 cytokines, respectively, were acutely increased more than 1.2-fold (Benjamini-Hochberg [BH]-adjusted P < .05). The exercise intervention did not change the acute increase in cytokines nor the resting cytokine levels, whereas fitness was improved and adiposity reduced. The increase in fitness led to a slight increase in power output when exercising at the same heart rate, which might explain the comparable increase in cytokines before and after the intervention. The largest acute increase was found for OSM, TGFA, CXCL1 and 5, and TNFSF14 (≥ 1.9-fold, BH-adjusted P < .001). The transcript levels of these proteins in whole blood were also elevated, particularly in the trained state. Only the acute increase in IL6 (1.3-fold) was related to the increase in lactate, confirming the lactate-driven secretion of IL6. CONCLUSION: Our comprehensive proteomics approach detected several underexplored serum exerkines with up to now less understood function in the adaptation to exercise.

Comparison of Habitual and Maximal Gait Speed and their Impact on Sarcopenia Quantification in German Nursing Home Residents.

Objectives: Sarcopenia is characterized by loss of muscle strength and muscle mass. The EWGSOP2 specifications include physical functioning determination for quantification of the sarcopenia severity. However, there is a lack in the use of habitual and maximal gait speed and their influence on sarcopenia quantification. We hypothesize differences in sarcopenia quantification using habitual and maximal gait speed. Methods: Sixty-six residents from five nursing homes were examined. Habitual and maximal gait speed were measured by 4-meter-walking-Test. McNemar-Test and χ2-test were used to identify quantification differences. Effect sizes of both gait speeds were calculated with Spearman's rank-correlation-coefficient. Results: Significant difference was identified for twenty-two residents in physical functioning classification by McNemar-Test (p<.001). χ2-Test identified a significant frequency distribution for sarcopenia categories between both gait speeds (χ2 (df2)=11.215, p=.004; Cramer's V=.412). Significant correlations (p<.05) were only shown for maximal gait speed in variables falls in the last three months (|rs|=.326), Barthel-Index (|rs|=.415), and SARC-F (|rs|=.335). Conclusions: The use of habitual and maximal gait speed has a significant impact on sarcopenia quantification in nursing home residents. An adapted standardization in the EWGSOP2 specifications should follow.

miRNAs as markers for the development of individualized training regimens: A pilot study.

Small, non-coding RNAs (microRNAs) have been shown to regulate gene expression in response to exercise in various tissues and organs, thus possibly coordinating their adaptive response. Thus, it is likely that differential microRNA expression might be one of the factors that are responsible for different training responses of different individuals. Consequently, determining microRNA patterns might be a promising approach toward the development of individualized training strategies. However, little is known on (1) microRNA patterns and their regulation by different exercise regimens and (2) possible correlations between these patterns and individual training adaptation. Here, we present microarray data on skeletal muscle microRNA patterns in six young, female subjects before and after six weeks of either moderate-intensity continuous or high-intensity interval training on a bicycle ergometer. Our data show that n = 36 different microRNA species were regulated more than twofold in this cohort (n = 28 upregulated and n = 8 downregulated). In addition, we correlated baseline microRNA patterns with individual changes in VO2 max and identified some specific microRNAs that might be promising candidates for further testing and evaluation in the future, which might eventually lead to the establishment of microRNA marker panels that will allow individual recommendations for specific exercise regimens.

Different Endurance Exercise Modalities, Different Affective Response: A Within-Subject Study.

Affect experienced during an exercise session is supposed to predict future exercise behavior. However, empirical evidence reveals high variability in affective response to different exercise modalities. Thus, the purpose of the present study was to compare acute affective response and its variation during three different endurance exercise modalities: (a) moderate-intensity continuous exercise (MICE), (b) vigorous-intensity continuous exercise (VICE), and (c) high-intensity interval exercise (HIIE). Using the dual-mode theory as a theoretical framework, cognitive and interoceptive factors were considered as potential predictors of in-task affective response. In a within-subject design, 40 insufficiently active healthy participants (aged from 20 to 40 years) attended three sessions per exercise modality on a cycle ergometer. Affective valence (measured by the Feeling Scale), two cognitive factors (perceived competence and awareness of interoceptive cues), and one interoceptive factor (heart rate) were assessed before, during, and after each exercise session. Mixed models with three levels (subject, exercise session, and time point) revealed more positive affective valence during MICE compared with VICE (p < 0.001) and HIIE (p < 0.01), while there was no significant difference between the latter two. Levene's test results showed the highest variability of in-task affective valence during VICE (ps < 0.01). Regarding the course across the session, MICE was associated with a constant slight increase in affective valence from pre- to post-exercise (p < 0.05), whereas VICE and HIIE caused a decline in pleasure, followed by an affective rebound immediately after exercise termination (ps < 0.01). The highest importance of cognitive and interoceptive factors for in-task affective valence was observed in VICE (ps < 0.05). The current findings provide support for the tenets of the dual-mode theory, however, indicating that there may be differences in the affect-intensity relationship between continuous and interval exercise. In conclusion, the study results concerning previously insufficiently active individuals extend the knowledge of how exercise can positively shape affective well-being depending on exercise modality and psychophysiological influences. This knowledge enables public health practitioners to design more individualized activity recommendations, thereby improving the subjective experience of exercise.

Does Becoming Fit Mean Feeling (f)it? A Comparison of Physiological and Experiential Fitness Data From the iReAct Study.

Regular exercise fosters fitness-enhancing benefits. We assume that exercise interventions become successful and sustainable if physiological benefits of exercise are also subjectively perceivable. The goal of this study was to examine how young inactive adults physiologically respond to an exercise intervention and how those responses are subjectively experienced. Furthermore, we aimed to assess whether the sequence of two distinct endurance-based exercise modes has an impact on physiological and subjectively experienced physical fitness. Thirty-one young inactive adults were assessed for this substudy of the larger iReAct study. Participants were randomly assigned to a high-intensity interval training (HIIT) or a moderate-intensity continuous training (MICT) group for 6 weeks and subsequently switched groups for a second training period. Physiological fitness data was collected at baseline, follow-up I, and follow-up II using a graded cardiopulmonary exercise test. Subjectively reconstructed (i.e., retrospective constructions) experiences relating to physical fitness were assessed at follow-up II using a biographical mapping method. A repeated-measures one-way ANOVA on each training group was performed to see whether physiological and subjectively experienced fitness differed across training periods. The rate of change between all variables was calculated for the first and the second training period in order to compare the agreement between physiological and subjective fitness improvements. Participants increased their fitness across the intervention period both physiologically and subjectively. However, the rate of change depended on the sequence of the two training modes. While VO2max increased significantly in both training periods in the MICT-HIIT sequence, a significant increase in VO2max in the HIIT-MICT sequence was only observed in the HIIT period. Participants similarly perceived those increases subjectively in their exercise-related physical fitness, although they experienced a significant decrease in the second period of the HIIT-MICT sequence. For subjectively perceived physical fitness relating to everyday activities, significant increases were only observed for the first period of the MICT-HIIT sequence. Young inactive adults can improve both their physiological and their subjectively perceived fitness through regular exercise. However, exercise modes and their sequence can make a substantial difference regarding measured and perceived physical fitness. Additionally, despite a favorable tendency toward HIIT over MICT, inter- and intra-individual variability, particularly in the subjective experiences of fitness, reiterates the necessity of individualized approaches to exercise.

Responders and non-responders to aerobic exercise training: beyond the evaluation of V˙O2max.

The evaluation of the maximal oxygen uptake ( V˙O2max ) following exercise training is the classical assessment of training effectiveness. Research has lacked in investigating whether individuals that do not respond to the training intervention ( V˙O2max ), also do not improve in other health-related parameters. We aimed to investigate the cardiovascular and metabolic adaptations (i.e., performance, body composition, blood pressure, vascular function, fasting blood markers, and resting cardiac function and morphology) to exercise training among participants who showed different levels of V˙O2max responsiveness. Healthy sedentary participants engaged in a 6-week exercise training program, three times a week. Our results showed that responders had a greater increase in peak power output, second lactate threshold, and microvascular responsiveness, whereas non-responders had a greater increase in cycling efficiency. No statistical differences were observed in body composition, blood pressure, fasting blood parameters, and resting cardiac adaptations. In conclusion, our study showed, for the first time, that in addition to the differences in the V˙O2max , a greater increase in microvascular responsiveness in responders compared to non-responders was observed. Additionally, responders and non-responders did not show differences in the adaptations on metabolic parameters. There is an increasing need for personalized training prescription, depending on the target clinical outcome.

Exercise and sports after COVID-19-Guidance from a clinical perspective.

SARS-CoV-2 infection has emerged as not only a pulmonary but also potentially multi-organ disease, which may cause long-term structural damage of different organ systems including the lung, heart, vasculature, brain, liver, kidney, or intestine. As a result, the current SARS-CoV-2/COVID-19 pandemic will eventually yield substantially increased numbers of chronically diseased patients worldwide, particularly suffering from pulmonary fibrosis, post-myocarditis, chronic heart failure, or chronic kidney disease. Exercise recommendations for rehabilitation are complex in these patients and should follow current guidelines including standards for pre-exercise medical examinations and individually tailored exercise prescription. It is of utmost importance to start exercise training at an early stage after COVID-19 infection, but at the same time paying attention to the physical barriers to ensure safe return to exercise. For exercise recommendations beyond rehabilitation programs particularly for leisure time and elite athletes, more precise advice is required including assessment of sports eligibility and specific return-to-sports exercise programs. Because of the current uncertainty of long-term course of SARS-CoV-2 infection or COVID disease, long-term follow-up seems to be necessary.

Prevalence of pathological FFRCT values without coronary artery stenosis in an asymptomatic marathon runner cohort.

OBJECTIVES: To evaluate computed tomography fractional flow reserve (FFRCT) values in distal parts of the coronaries in an asymptomatic cohort of marathon runners without any coronary stenosis for potentially false-positive values. METHODS: Ninety-eight asymptomatic male marathon runners (age 53 ± 7 years) were enrolled in a prospective monocentric study and underwent coronary computed tomography angiography (CCTA). CCTA data were analyzed for visual coronary artery stenosis. FFRCT was evaluated in 59 participants without coronary artery stenosis in proximal, mid, and distal coronary sections using an on-site software prototype. RESULTS: In participants without coronary artery stenosis, abnormal FFRCT values ≤ 0.8 in distal segments were found in 22 participants (37%); in 19 participants in the LAD; in 5 participants in the LCX; and in 4 participants in the RCA. Vessel diameters in participants with FFRCT values > 0.80 compared to ≤ 0.80 were 1.6 ± 0.3 mm versus 1.5 ± 0.3 mm for distal LAD (p = 0.025), 1.8 ± 0.3 mm versus 1.6 ± 0.5 mm for distal LCX (p = 0.183), and 2.0 ± 0.4 mm versus 1.5 ± 0.2 mm for distal RCA (p < 0.001). CONCLUSIONS: Abnormal FFRCT values of ≤ 0.8 frequently occurred in distal coronary segments in subjects without any anatomical coronary artery stenosis. This effect is only to some degree explainable by small distal vessel diameters. Therefore, the validity of hemodynamic relevance evaluation using FFRCT in distal coronary artery segment stenosis is reduced. KEY POINTS: • Abnormal FFRCT values (≤ 0.8) occurred in over a third of the subjects in the distal LAD despite the absence of coronary artery stenosis.. • Therefore, the validity of hemodynamic relevance evaluation in distal coronary artery segment stenosis is reduced. • Decision-making based on abnormal FFRCT values in distal vessel sections should be performed with caution and only in combination with visual assessment of the grade of stenosis..

Individual cardiovascular responsiveness to work-matched exercise within the moderate- and severe-intensity domains.

PURPOSE: We investigated the cardiovascular individual response to 6 weeks (3×/week) of work-matched within the severe-intensity domain (high-intensity interval training, HIIT) or moderate-intensity domain (moderate-intensity continuous training, MICT). In addition, we analyzed the cardiovascular factors at baseline underlying the response variability. METHODS: 42 healthy sedentary participants were randomly assigned to HIIT or MICT. We applied the region of practical equivalence-method for identifying the levels of responders to the maximal oxygen uptake (V̇O2max) response. For investigating the influence of cardiovascular markers, we trained a Bayesian machine learning model on cardiovascular markers. RESULTS: Despite that HIIT and MICT induced significant increases in V̇O2max, HIIT had greater improvements than MICT (p < 0.001). Greater variability was observed in MICT, with approximately 50% classified as "non-responder" and "undecided". 20 "responders", one "undecided" and no "non-responders" were observed in HIIT. The variability in the ∆V̇O2max was associated with initial cardiorespiratory fitness, arterial stiffness, and left-ventricular (LV) mass and LV end-diastolic diameter in HIIT; whereas, microvascular responsiveness and right-ventricular (RV) excursion velocity showed a significant association in MICT. CONCLUSION: Our findings highlight the critical influence of exercise-intensity domains and biological variability on the individual V̇O2max response. The incidence of "non-responders" in MICT was one third of the group; whereas, no "non-responders" were observed in HIIT. The incidence of "responders" was 11 out of 21 participants in MICT, and 20 out of 21 participants in HIIT. The response in HIIT showed associations with baseline fitness, arterial stiffness, and LV-morphology; whereas, it was associated with RV systolic function in MICT.

Effectiveness of HIIE versus MICT in Improving Cardiometabolic Risk Factors in Health and Disease: A Meta-analysis.

PURPOSE: We aimed to investigate differences between high-intensity interval exercise (HIIE, including high-intensity interval training and sprint interval training) and moderate-intensity continuous training (MICT) on physical fitness, body composition, blood pressure, blood lipids, insulin and glucose metabolism, inflammation, and endothelial function. METHODS: Differences between HIIE and MICT were summarized using a random-effects meta-analysis on the effect size (Cohen's d). A meta-regression was conducted using the following subgroups: population, age, training duration, men ratio, exercise type, baseline values (clinical relevant ranges), and type of HIIE. Studies were included if at least one of the following outcomes were reported: maximal oxygen uptake (V˙O2max), flow-mediated dilation (FMD), body mass index (BMI), body mass, percent body fat, systolic and diastolic blood pressure, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, total cholesterol, C-reactive protein (CRP), fasting glucose and insulin, glycated hemoglobin (HbA1c), and insulin resistance (HOMA-IR). A total of 55 studies were included. RESULTS: Overall, HIIE was superior to MICT in improving V˙O2max (d = 0.40, P < 0.001) and FMD (d = 0.54, P < 0.05). Oppositely, MICT was superior to HIIE in improving HbA1c (d = -0.27, P < 0.05). No differences were observed in BMI (d = -0.02), body mass (d = -0.05), percent body fat (d = 0.04), systolic blood pressure (d = -0.04), diastolic blood pressure (d = 0.03), HDL (d = -0.05), LDL (d = 0.08), triglycerides (d = 0.03), total cholesterol (d = 0.14), CRP (d = -0.11), fasting insulin (d = 0.02), fasting glucose (d = 0.02), and HOMA-IR (d = -0.04). Moderator analyses indicated that the difference between HIIE and MICT was affected by different subgroups. CONCLUSION: Overall, HIIE showed to be more effective in improving cardiovascular health and cardiorespiratory fitness, whereas MICT was superior in improving long-term glucose metabolism. In the process of personalized training counseling, health-enhancing effects of exercise training may be improved by considering the individual risk profiles.