High response rate and improved exercise capacity and quality of life with a new regimen of darbepoetin alfa with or without filgrastim in lower-risk myelodysplastic syndromes: a phase II study by the GFM.

Darbepoetin (DAR), with or without granulocyte colony-stimulating factor (G-CSF), has proved effective in treating anemia in patients with lower-risk myelodysplastic syndrome (MDS), but its effects on quality of life (QoL) and exercise functioning are less well established. In this phase II study (no. NCT00443339), lower-risk MDS patients with anemia and endogenous erythropoietin (EPO) level <500 IU/L received DAR 500 µg once every 2 weeks for 12 weeks, with G-CSF added at week 12 in non-responders. Physical performance was assessed with the 6-min walking test and, for fit patients, maximal oxygen consumption (VO2max). QoL was evaluated using SF-36 and FACT-An tests. In 99 patients, erythroid response rate according to IWG 2006 criteria was 48 and 56 % at 12 and 24 weeks, respectively. Addition of G-CSF rescued 22 % of non-responders. In 48 % of the responders, interval between darbepoetin injections could be increased for maintenance treatment. Serum EPO level was the only independent predictive factor of response at 12 weeks, and its most discriminant cutoff value was 100 IU/L. QoL and VO2max showed improvement over time in responders, compared with non-responders. With a median follow-up of 52 months, median response duration was not reached, and 3-year cumulative incidence of acute myeloid leukemia and overall survival (OS) was 14.5 and 70 %, respectively. Baseline transfusion dependence, International Prognostic Score System (IPSS), and Revised IPSS accurately predicted OS from treatment onset. Tolerance of darbepoetin was good. In conclusion, this regimen of darbepoetin every 2 weeks yielded high response rates and prolonged response duration. Objective improvement in exercise testing and in patient-reported QoL confirms the clinical relevance of anemia correction with erythropoiesis-stimulating agents.

Decreased fat oxidation during exercise in severe obstructive sleep apnoea syndrome.

AIM: To assess whether the severity of obstructive sleep apnoea syndrome (OSAS) is associated with altered fat oxidation (FO) during physical exercise in men with type 2 diabetes (T2DM) and/or the metabolic syndrome (MetS). METHODS: A total of 105 consecutive overweight or/and T2DM male patients were hospitalized for metabolic check-ups including bioimpedancemetry to measure lean body mass (LBM), standardized exercise calorimetry to assess FO, maximum fat oxidation (MFO) and carbohydrate oxidation (CHO), and OSAS screening using respiratory polygraphy. Twenty patients were classified as having severe OSAS, according to the apnoea/hypopnoea index (AHI), with greater than 30 events/h (mean AHI: 45.2±14.3 events/h). They were group-matched for age, BMI, and the presence of T2DM and/or MetS with two other OSAS groups: mild (AHI<15 events/h [n=20]; mean AHI: 8.8±4.5 events/h); and moderate (AHI>15 events/h and<30 events/h [n=20]; mean AHI: 23.7±4.2 events/h). RESULTS: MFO adjusted for LBM was severely decreased in the severe OSAS group (1.6±1.0 mg.min(-1).kgLM(-1)) compared with the moderate (2.5±0.9 mg.min(-1).kgLM(-1); P=0.008) and mild (2.9±0.8 mg.min(-1).kgLM(-1); P=0.003) groups. All exercise-intensity levels (20%, 30%, 40% and 60% of the theoretical maximum aerobic power) showed reduced FO levels between the severe and mild-to-moderate OSAS groups. However, no differences in CHO were seen at any level of exercise between groups. Pearson's correlation analysis showed that AHI and the oxygen desaturation index were negatively associated with MFO corrected for LBM (r=0.41 and r=0.37, respectively; P<0.005). CONCLUSION: OSAS severity is associated with altered FO during exercise.

Validated treatments and therapeutic perspectives regarding physical activities.

Current knowledge on physical activity in regard to sarcopenia is reported in this manuscript. The consequences of inactivity on muscle mass and function are discussed. Impact of resistance training on muscle and mass and function as well as its interaction with other factors associated with sarcopenia such as denervation, hormones modification and protein intake will be discussed.

Is physical activity possible and beneficial for patients with hepatitis C receiving pegylated interferon and ribavirin therapy?

The great majority of patients with chronic viral hepatitis C are treated with pegylated interferon-ribavirin therapy. The aim of this study was to demonstrate that these patients were able to have some form of physical exercise, and that this activity can lead to an improvement in their quality-of-life. Twelve volunteer patients with hepatitis C, who were either sedentary or had become sedentary and who had been treated by combination therapy for the past few weeks, were recruited at hepatology clinics in the Midi-Pyrénées region of France early in 2006. All patients attended a sports medicine consultation for an initial evaluation: maximal aerobic power and maximal oxygen consumption tests, maximum heart rate (MHR), search for contraindications for participation in the proposed program of physical exercise. The patients were given a heart rate monitor so they could measure their heart rate during physical exercise and check that they exercised under safe conditions and remained within the so-called "endurance" zone. The patients came to a sports facility daily for 5 days for the exercise program. The activities were divided into four sessions each day: an individual physical exercise selected by the patient, team physical exercise, recreational physical exercise, lectures on the different types of hepatitis and their treatment, on nutrition and on sports medicine assessments. Data on hepatitis, results of the cardiorespiratory examination and personal history and record of past physical activity were collected for each patient. Quality-of-life (SF36) was assessed at enrollment in the study and one month after the training sessions. At the initial sports medicine consultation, all patients reached their MHR and were found capable of participating in the proposed physical exercise program. One enrolled patient was excluded from the analysis because of the presence of sinusitis on arrival. Seven men and four women, mean age of 46 years completed the full course of the study protocol. All participated in the three types of proposed physical activity with no problem. The score of the general perception item of the SF36 questionnaire increased from 63 on day 0 to 71 at one month (p=0.07). In conclusion, patients with hepatitis C receiving pegylated interferon plus ribavirin may safely participate in a program of suitably supervised physical exercise. Taking part in physical exercise leads to clear changes in the way patients perceive their bodies and its capacities. Participating in sports activities could improve self-confidence and lead to far-reaching changes in the way patients perceive their disease and the constraints of treatment.

Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives.

Sarcopenia is a loss of muscle protein mass and loss of muscle function. It occurs with increasing age, being a major component in the development of frailty. Current knowledge on its assessment, etiology, pathogenesis, consequences and future perspectives are reported in the present review. On-going and future clinical trials on sarcopenia may radically change our preventive and therapeutic approaches of mobility disability in older people.

Nutritional intake and recreational physical activity in healthy elderly women living in the community.

PURPOSE: Recreational physical activity, which increases energy expenditure, may help to maintain proper food intake. To compare the nutritional intake of inactive, active and very active healthy elderly women. METHODS: Eighty-two women were recruited in the community. Participants had to be > or = 65 years and in good health (< or = 2 drugs, < or = 1 major illness, < or = 1 surgical operation, no disability in basic or instrumental activities of daily living and no cognitive impairment). We compared food intakes between the 26 inactive (age 73.9 +/- 7.7 y, BMI 24.3 +/- 3.2 kg/m2), the 29 active (age 71.5 +/- 5.6 y, BMI 23.2 +/- 3.5 kg/m2) and the 27 very active (age 70.9 +/- 4.8 y, BMI 24.3 +/- 3.2 kg/m2) healthy women. The nutritional intake was evaluated by a three-day food record. Macronutrient, mineral and vitamin content were derived from tables. Self-reported type, duration and frequency of recreational physical activities during the last month were converted into energy expenditures. RESULTS: Despite high levels of energy intake (mean 1743.9 kcal/d), mean intakes of calcium, vitamin B1, E and folic acid were lower than Recommended Dietary Allowances (-26.2%, -12%, -50.8%, -2.4% respectively) in the whole sample. There were no significant differences of energy intake and quantities of nutrients between the groups except for calcium intake which was significantly higher in inactive women (p=0.04). CONCLUSION: Active healthy elderly women do not have a better nutritional profile than their inactive peers.

Aerobic training improves exercise-induced lipolysis in SCAT and lipid utilization in overweight men.

The aim of this study was to investigate whether endurance training improves lipid mobilization and oxidation in overweight subjects. Eleven young men (25.6 +/- 1.4 yr and body mass index 27.7 +/- 0.2) performed a 4-mo training program consisting of practicing aerobic exercise 5 days/wk. Before and after the training period, lipid oxidation was explored during a 60-min exercise at 50% of peak O2 consumption by use of indirect calorimetry. Lipid mobilization and antilipolytic alpha2-adrenoceptor effect were also studied using the microdialysis method in abdominal subcutaneous adipose tissue (SCAT). After training, plasma nonesterified fatty acid (NEFA) levels, at rest and during exercise, were significantly lower than before (P < 0.001). Lipolysis in SCAT was significantly higher after than before training. An antilipolytic alpha2-adrenoceptor effect in SCAT was underlined during exercise before training and disappeared after. The respiratory exchange ratio was lower after training, i.e., the percentage of lipid oxidation was higher only at rest. The amount of lipid oxidized was higher after training, at rest, and during exercise. Although exercise power was higher after training, the relative intensity was equivalent, as suggested by a similar increase in plasma catecholamine concentrations before and after training. In conclusion, 4-mo training in overweight men improved lipid mobilization through a decrease of antilipolytic alpha2-adrenoceptor effect in SCAT and lipid oxidation during moderate exercise. Training induced a decrease of blood NEFA, predicting better prevention of obesity.

[Sport practice and cannabis consumption in a representative sample of French high school adolescents]. / Pratique sportive et usage de cannabis d'un échantillon représentatif des élèves de Midi-Pyrénées.

PURPOSE: - To assess the association between cannabis consumption and sport practice. METHODS: We randomised a representative sample of 1,506 girls and 1,420 boys from the third to the last year of school in the French Midi-Pyrénées region, excluding classes reserved for children practising high level sport. Information was collected by self-answer questionnaire. RESULTS: More than 90% of boys and 70% of girls declared they practised sport outside physical education at school (athletic students). Among boys, sport practice mainly concerned activities in clubs or competitions (respectively 66% and 60%, against 35% and 27% among girls; p<0.001). Twenty-eight percents of boys and 19% of girls declared they had consumed cannabis (at least occasionnally, during or outside sport). Among athletic students, such potential consumption concerned 28.6% of boys and 19.6% of girls (p<0.001). Moreover, 1.2% of athletic students (n=7) declared they had already consumed cannabis during the practice sport with clubs or competitions. Among boys, this potential consumption increased with age, was lower among non-athletic students and the most athletic students, but was highest among those practising an individual "X-treme" sport (50% in this group versus 26% among athletes practising collective or non- "X-treme" sport; p<0.001). Potential cannabis consumption was also highest among athletes who declared they practiced sport for seeking emotions, who did not practise sport for health benefits but who considered that sport could involve taking risks. CONCLUSION: It seems more important to consider how sport is practised rather than its intensity when assessing the association between sport and cannabis consumption. Indeed, sport appears to be more favourable for cannabis consumption when associated with ideas of emotion and risk and when practised outside of an organisation.

Feasibility [corrected] of regular physical exercise for patients with moderate to severe Alzheimer disease.

BACKGROUND: Physical activity delays loss of autonomy in the elderly. In patients with Alzheimer disease (AD), physical activity could be a useful strategy in therapeutic management by delaying loss of functional independence and the usual complications of the disease. OBJECTIVE: To determine, using standardized tools, the effects on autonomy (ADL, IADL), cognitive function (MMS), nutritional status (MNA), behavioral problems (NPI) and risk of falls (Tinetti test) of a physical exercise program in patients with AD. DESIGN: Twenty-three subjects (13 men and 10 women, aged 71-92 years, mean 78 years) with AD (mean MMS 16, range 1-23) carried out for a mean of 7 weeks (5-12 weeks) a program of endurance exercise (walking, exercise bicycle) adapted to their individual capacities. Standardized gerontological evaluation was performed before and after the study. RESULTS: No significant change in autonomy (ADL, IADL) was observed. There was an improvement in the MNA (p<0.001) and the MMS (p<0.001). Risk of falls (p<0.01) and behavioral problems (p<0.05) decreased. These results were obtained without increasing family workload. CONCLUSION: We suggest that physical activity is a therapeutic option which can reduce nutritional and behavioral complications and risk of falls in subjects with AD.

[Asthma drugs and doping]. / Médicaments de l'asthme et dopage.

Some drugs regularly used in the treatment of asthma (beta-agonists and corticosteroids) are registered on the list of drugs forbidden in sport, because they have a doping action. To avoid penalizing asthmatic sportsmen, some beta-agonists (Salbutamol, Salmeterol, Terbutaline) and corticosteroids are allowed only in inhaled form, with written notification from the prescribing physician, a pneumologist or the team doctor. Considering the increase of doping with increasing involvement of physicians, good and up to date notions about the current rules of prescription in asthmatic sportsmen are needed.