Reduction of pressure ulcer size with high-voltage pulsed current and high-frequency ultrasound: a randomised trial.

OBJECTIVE: International guidelines recommend the use of ultrasound (US) and electrical stimulation (ES) for treating chronic and recurrent pressure ulcers (PUs). The methodology of these procedures, however, still needs elaboration and confirmation by clinical studies. This parallel-group, randomised, single-blind, prospective, controlled clinical trial was conducted to determine whether by using high-frequency ultrasound (HFUS) and high-voltage monophasic pulsed current (HVMPC), the rate of change in the area of older patients' PUs can be accelerated. METHOD: Patients were randomly assigned to receive either: standard wound care (SWC) involving supportive care and topical treatments; SWC+US (1MHz; 0.5 W/cm2; 20%; 1-3 minutes/cm2); or SWC+ES (HVMPC, 154 µs, 100 pps, 100 V, 250 µC/sec, 50 minutes/day). US and ES were administered once a day, 5 days a week. The primary outcome was change in PU surface area measured against baseline after 6 weeks of treatment with SWC, SWC+US, and SWC+ES. RESULTS: We recruited 77 patients, aged 60-95 years (80% aged over 70 years of age), with 88 Category II, III and IV PUs were enrolled in the study. The percentage reduction in the surface area of PUs at the end of treatment was significantly greater in the SWC+US group (mean ± standard deviation, 77.48±11.59 %; p=0.024) and the SWC+ES group (76.19±32.83%; p=0.030) versus the control group (48.97±53.42%). The SWC+ES group also had a significantly greater proportion of PUs that decreased in area by at least 50% or closed than the control group (p=0.05 and 0.031, respectively). The SWC+US and SWC+ES groups were not statistically significant different regarding treatment results. Clinical side effects were not recorded. CONCLUSION: The results show that HFUS and HVMPC are comparable regarding their effectiveness in reducing the size of PUs in older people. DECLARATION OF INTEREST: The authors have nothing to disclose. All research activities were funded by the Academy of Physical Education, Katowice, Poland.

Anaerobic capacity of amateur mountain bikers during the first half of the competition season.

Sustained aerobic exercise not only affects the rate of force development but also decreases peak power development. The aim of this study was to investigate whether anaerobic power of amateur mountain bikers changes during the first half of the competition season. Eight trained cyclists (mean ± SE: age: 22.0 ±0.5 years; height: 174.6 ± 0.9 cm; weight: 70.7 ± 2.6 kg) were subjected to an ergocycle incremental exercise test and to the Wingate test on two occasions: before, and in the middle of the season. After the incremental exercise test the excess post-exercise oxygen consumption was measured during 5-min recovery. Blood lactate concentration was measured in the 4th min after the Wingate test. Maximum oxygen uptake increased from 60.0 ± 1.5 ml min(-1) kg(-1) at the beginning of the season to 65.2 ± 1.4 ml min(-1) kg(-1) (P < 0.05) in the season. Neither of the mechanical variables of the Wingate test nor excess post-exercise oxygen consumption values were significantly different in these two measurements. However, blood lactate concentration was significantly higher (P < 0.001) in season (11.0 ± 0.5 mM) than before the season (8.6 ± 0.4 mM). It is concluded that: 1) despite the increase of cyclists' maximum oxygen uptake during the competition season their anaerobic power did not change; 2) blood lactate concentration measured at the 4th min after the Wingate test does not properly reflect training-induced changes in energy metabolism.

Fasting increases palmitic acid incorporation into rat hind-limb intramuscular acylglycerols while short-term cold exposure has no effect.

The aim of the study was to investigate the palmitic acid incorporation into intramuscular acylglycerols in perfused hind-limb skeletal muscles of different fibre types in rats either fasted for 48 h or exposed to cold (6 °C) for 12 h. Hind-limb preparations of fasted and cold exposed rats were perfused with buffers containing tritium labelled and cold palmitic acid. Palmitic acid incorporation into intracellular lipid pools in the soleus, plantaris, red and white gastrocnemius and red and white quadriceps was measured. It was found that fasting increased approximately 2-fold palmitic acid incorporation in all muscles examined regardless of the fibre type composition of the muscle. On the other hand, exposure to cold had no effect on the palmitic acid incorporation into intramuscular acylglycerols regardless the muscle fibre type. The increased incorporation of palmitic acid into acylglycerols in fasted animals is in line with data showing that 48 h fasting stimulates the expression of plasma membrane proteins putatively facilitating fatty acid uptake. It appears that although 12 h cold exposure increases the use of fatty acids as energy substrates it does not alter the incorporation of palmitic acid into intramuscular acylglycerols in the perfused rat hind-limb.

Influence of ribose on adenine salvage after intense muscle contractions.

The influence of ribose supplementation on skeletal muscle adenine salvage rates during recovery from intense contractions and subsequent muscle performance was evaluated using an adult rat perfused hindquarter preparation. Three minutes of tetanic contractions (60 tetani/min) decreased ATP content in the calf muscles by approximately 50% and produced an equimolar increase in IMP. Effective recovery of muscle ATP 1 h after contractions was due to reamination of IMP via the purine nucleotide cycle and was complete in the red gastrocnemius but incomplete in the white gastrocnemius muscle section. Adenine salvage rates in recovering muscle averaged 45 +/- 4, 49 +/- 5, and 30 +/- 3 nmol. h(-1). g(-1) for plantaris, red gastrocnemius, and white gastrocnemius muscle, respectively, which were not different from values in corresponding nonstimulated muscle sections. Adenine salvage rates increased five- to sevenfold by perfusion with approximately 4 mM ribose (212 +/- 17, 192 +/- 9, and 215 +/- 14 nmol. h(-1). g(-1) in resting muscle sections, respectively). These high rates were sustained in recovering muscle, except for a small (approximately 20%) but significant (P < 0.001) decrease in the white gastrocnemius muscle. Ribose supplementation did not affect subsequent muscle force production after 60 min of recovery. These data indicate that adenine salvage rates were essentially unaltered during recovery from intense contractions.

Effect of sustained adrenergic receptors stimulation and blockade on lactate threshold in rats.

BACKGROUND: This study examined the hypothesis that prolonged (12 hrs) stimulation of adrenergic receptors by adrenaline and their blockade by regitine (alpha-blockade) or propranolol (beta-blockade) affect lactate thresh-old (T(LA)) and exercise tolerance in rats. METHODS: Twenty-four untrained male Wistar rats performed a multistage running test on a treadmill with an intensity increased from 13 m/min to the maximum speed. After a control exercise test the animals were devided into three groups implanted s.c. with: 1) adrenaline; 2) propranolol and 3) regitine tablets. Twelve hours after the tablet implantation the exercise was repeated. Both before the exercise test and at the end of each 2-min loads blood lactate [LA] was measured to evaluate T(LA). RESULTS: Prolonged adrenaline excess resulted in reduced maximal running speed and shifted T(LA) towards lower exercise intensities than in the control test. Both alpha- and beta-adrenergic blockade reduced the work load at which T(LA) occurred, without changing the maximum running speed and maximal blood LA concentration. Blood [LA] at the lactate threshold ([LA] at T(LA)) was significantly higher in hyperadrenalinemic than in control rats, whilst under beta-blockade it was lowered in comparison with control values. Alpha-adrenergic blockade had no effect on [LA] at T(LA), but at the higher exercise intensities blood [LA] exceeded the respective control values. CONCLUSIONS: The present study demonstrated that prolonged excess of adrenaline reduces the maximum power output and T(LA). The former effect seems to be a result of simultaneous stimulation of both types of adrenergic receptors.

The effect of low-carbohydrate diet on the pattern of hormonal changes during incremental, graded exercise in young men.

The purpose of this study was to discover whether severe dietary carbohydrate (CHO) restriction modifies the relationship between exercise intensity and hormonal responses to exercise. Changes in the plasma adrenaline (A), noradrenaline (NA), growth hormone (hGH), testosterone (T), and blood lactate (LA) during an incremental exercise performed until volitional exhaustion were determined in 8 physically active volunteers after 3 days on low CHO (< 5% of energy content; L-CHO) and isocaloric mixed (M) diets. Following L-CHO diet, the basal plasma A, NA, and hGH concentrations were increased, whilst T and LA levels were decreased. During exercise all the hormones increased exponentially, with thresholds close to that of LA. Neither the magnitude nor the pattern of the hormonal changes were affected by L-CHO diet except the NA threshold, which was lowered. Blood LA response to exercise was diminished and LA threshold was shifted towards higher loads by L-CHO diet. It is concluded that restriction of CHO intake (a) does not affect the pattern of changes in plasma A, hGH, and T concentrations during graded exercise but lowers NA threshold, indicating increased sensitivity of the sympathetic nervous system to exercise stimulus; (b) alters the basal and exercise levels of circulating hormones, which may have an impact on the balance between anabolic and catabolic processes and subsequently influence the effectiveness of training.

The effect of a low-carbohydrate diet on performance, hormonal and metabolic responses to a 30-s bout of supramaximal exercise.

The aim of this study was to find out whether a low-carbohydrate diet (L-CHO) affects: (1) the capacity for all-out anaerobic exercise, and (2) hormonal and metabolic responses to this type of exercise. To this purpose, eight healthy subjects underwent a 30-s bicycle Wingate test preceded by either 3 days of a controlled mixed diet (130 kJ/kg of body mass daily, 50% carbohydrate, 30% fat, 20% protein) or 3 days of an isoenergetic L-CHO diet (up to 5% carbohydrate, 50% fat, 45% protein) in a randomized order. Before and during 1 h after the exercise venous blood samples were taken for measurement of blood lactate (LA), beta-hydroxybutyrate (beta-HB), glucose, adrenaline (A), noradrenaline (NA) and insulin levels. Oxygen consumption (VO2) was also determined. It was found that the L-CHO diet diminished the mean power output during the 30-s exercise bout [533 (7) W vs 581 (7) W, P < 0.05] without changing the maximal power attained during the first or second 5-s interval of the exercise. In comparison with the data obtained after the consumption of a mixed diet, after the consumption of a L-CHO diet resting plasma concentrations of beta-HB [2.38 (0.18) vs 0.23 (0.01) mmol x l(-1), P < 0.001] and NA [4.81 (0.68) vs 2.2 (0.31) nmol x l(-1), P < 0.05] were higher, while glucose [4.6 (0.1) vs 5.7 (0.2) mmol x l(-1), P < 0.05] and insulin concentrations [11.9 (0.9) vs 21.8 (1.8) mU x l(-1)] were lower. The 1-h post-exercise excess of VO2 [9.1 (0.25) vs 10.6 (0.25) 1, P < 0.05], and blood LA measured 3 min after the exercise [9.5 (0.4) vs 10.6 (0.5) mmol x l(-1), P < 0.05] were lower following the L-CHO treatment, whilst plasma NA and A concentrations reached higher values [2.24 (0.40) vs 1.21 (0.13) nmol x l(-1) and 14.30 (1.41) vs 8.20 (1.31) nmol x l(-1), P < 0.01, respectively]. In subjects on the L-CHO diet, the plasma beta-HB concentration decreased quickly after exercise, attaining approximately 30% of the pre-exercise value within 60 min, while insulin and glucose levels were elevated. The main conclusions of this study are: (1) a L-CHO diet is detrimental to anaerobic work capacity, possibly because of a reduced muscle glycogen store and decreased rate of glycolysis; (2) reduced carbohydrate intake for 3 days enhances activity of the sympathoadrenal system at rest and after exercise.

Influence of thyroid hormones on exercise tolerance and lactate threshold in rats.

Effects of thyroid hormone deficit, and triiodothyronine (T3) treatment on exercise performance, blood lactate (LA) concentrations and LA threshold (TLA) were studied in trained and untrained rats. Fourteen rats were thyroidectomized and then treated with propylthiouracil for 30 days (THY + PTU group). Fourteen sham operated rats served as controls. In each group there were 7 sedentary and 7 endurance-trained animals. Six weeks after thyroidectomy or sham operation the rats were subjected to a multistage running test with speed increasing from 13 m/min at 10 degrees treadmill inclination till maximum. Blood samples for LA were taken from the rats' tail after each 3-min exercise stage. During 3 days following this test rats from all groups were injected (i.p.) with 75 micrograms/100 g of triiodothyronine (T3), and 24 hrs afterwards the second exercise test was performed. In THY + PTU rats maximal running speed (RSmax) and the speed at which TLA occurred were markedly decreased in comparison with control group. The level of LA at the maximal speed (LAmax) and that corresponding to TLA were higher in THY + PTU rats than in controls. T3 injection to control animals diminished their RSmax and TLA, whereas in THY + PTU rats it increased RSmax and shifted TLA to a higher speed. Both in THY + PTU and control animals T3 elevated LAmax and the threshold LA concentration. Endurance training in control and THY + PTU animals markedly enhanced RSmax and TLA. This was accompanied by increases in LAmax and concentration of LA at TLA only in control group. After T3 injection to control trained rats RSmax and TLA were diminished, whereas in THY + PTU trained group RSmax was unchanged and TLA was elevated. Maximal blood LA increased only in THY + PTU trained rats whilst the threshold blood LA was elevated in both groups. It is concluded, that both the T3 deficiency and its excess reduce maximal exercise performance and shift TLA to lower workloads. Enduarance training or administration of T3 to hypothyroid rats markedly improve their exercise performance and elevate TLA, however, T3 treatment markedly increases maximal and submaximal LA levels.

Effect of low-carbohydrate-ketogenic diet on metabolic and hormonal responses to graded exercise in men.

Maximal oxygen uptake (VO2 max) and lactate threshold (LT) were measured during graded, incremental exercise in 8 healthy, untrained volunteers (aged 22 +/- 0.9 yrs) following 3 days on a control, mixed diet, or a ketogenic (50% fat, 45% protein and 5% carbohydrates) diet of equal energy content. Before and after exercise tests acid base balance, plasma beta-hydroxybutyrate (beta-HB), free fatty acid (FFA), and some hormone concentrations were determined. In comparison with the normal diet, the ketogenic diet resulted in: an increased VO2 max, decreased respiratory exchange ratio an a shift of LT towards higher exercise loads. Blood LA concentrations were lower before, during and after exercise. Post exercise blood pH, as well as pre-and post exercise base excess and bicarbonates were reduced. Resting beta-HB concentration was elevated to approx. 2.0 mM, and FFA to approx. 1.0 mM. During a 1 h recovery period beta-HB decreased to 0.85 mM (p < 0.01) after the ketogenic diet, while plasma FFA did not change after exercise under either conditions. Both the pre-and post-exercise levels of adrenaline, noradrenaline, and cortisol were enhanced, whilst plasma insulin concentration was decreased on the ketogenic diet. It is concluded that the short-term ketogenic diet does not impair aerobic exercise capacity, as indicated by elevated VO2 max and LT. This may be due to increased utilization of beta-HB and FFA when carbohydrate stores are diminished. Stimulation of the sympatho-adrenal system, and cortisol secretion with reduced plasma insulin concentration seem to be of importance for preservation of working capacity.

Effect of sustained hyperadrenalinemia on exercise performance and lactate threshold in rats.

The effect of prolonged elevation of blood adrenaline concentration (sustained up to 60 h) on exercise performance and lactate threshold (TLA) was investigated in 24 rats on the basis of a incremental, multistage treadmill exercise test, performed before and after subcutaneous implantation of retard adrenaline tablets (15 mg), which release adrenaline at a constant rate of approx. 1.6 micrograms min-1. Blood samples for lactate (LA) determinations were taken from the rats' tails after each exercise stage. The results obtained indicate that hyperadrenalinemia within the physiologic range, sustained for 6 or 12 h, decreases exercise performance, measured as the maximal speed of running, increases blood LA concentration during submaximal and maximal exercise, and shifts TLA toward lower exercise intensities than in control or sham-operated rats. When adrenaline excess was maintained for 60 h the maximal running speed was still reduced, and exercise blood LA was even higher than during earlier stages of hyperadrenalinemia, but TLA returned to control values. In the rat, a moderate excess of circulating adrenaline, sustained up to 60 h, reduces maximal exercise performance, and causes marked elevations in submaximal and maximal blood lactate concentration. However, this is accompanied by lowering of TLA only in the early stages of hyperadrenalinemia (6 and 12 h), which suggests that shifts of TLA may occur independently of absolute levels of blood lactate during graded exercise.

Anaerobic threshold in rats.

1. The aim of this study was to find out whether the anaerobic threshold (AT) can be estimated in rats running at increasing speed and if so what is the reproducibility of the measurements. 2. Lactate (LA) concentrations in blood taken from 11 rats were determined during a discontinued, multistage treadmill exercise test repeated four times in each animal. 3. It was found that blood LA changes vs speed have an exponential pattern with a distinct, rapid rise at the speed above 25 m/min which corresponds to blood LA of approx. 4 mmol/l. 4. The variation coefficient of the speed at which AT occurred in individual animals ranged between 10 and 20%. 5. These results offer a potential application of AT determination in the animal studies concerning mechanisms controlling exercise metabolism.