Effects of exercise interventions on the functional status of acutely hospitalised older adults: A systematic review and meta-analysis

BACKGROUND

Acute hospitalisation can have adverse effects in older adults, notably functional decline. We aimed to summarize evidence on the effects of exercise interventions in acutely hospitalised older adults.

METHODS

Relevant articles were systematically searched (PubMed, Web of Science, Rehabilitation & Sports Medicine Source, and EMBASE) until 19^th March 2020. Randomized controlled trials (RCTs) of in-hospital exercise interventions versus usual care conducted in older adults (>60yrs) hospitalised for an acute medical condition were included. Methodological quality of the studies was assessed with the PEDro scale. Primary outcomes included functional independence and physical performance. Intervention effects were also assessed for other major outcomes (length of hospital stay, incidence of readmission, and mortality). A meta-analysis was conducted when ≥3 studies analysed the same outcome.

RESULTS

Fifteen studies from 12 RCTs (n = 1748) were included. Methodological quality of the studies was overall high. None of the studies reported any adverse event related to the intervention. Exercise interventions improved functional independence at discharge (standardized mean difference [SMD] = 0.64, 95% confidence interval = 0.19-1.08) and 1-3 months post-discharge (SMD = 0.29, 95%CI = 0.13-0.43), as well as physical performance (SMD = 0.57, 95%CI = 0.18-0.95). No between-group differences were found for length of hospital stay or risk of readmission or mortality (all p > 0.05).

CONCLUSIONS

In-hospital supervised exercise interventions seem overall safe and effective for improving - or attenuating the decline of - functional independence and physical performance in acutely hospitalised older adults. The clinical relevance of these findings remains to be confirmed in future research.

Warming Up Before a 20-Minute Endurance Effort: Is It Really Worth It?

PURPOSE

To analyze the effects of different warm-up protocols on endurance-cycling performance from an integrative perspective (by assessing perceptual, neuromuscular, physiological, and metabolic variables).

METHODS

Following a randomized crossover design, 15 male cyclists (35 [9] y; peak oxygen uptake [VO2peak] 66.4 [6.8] mL·kg-1·min-1) performed a 20-minute cycling time trial (TT) preceded by no warm-up, a standard warm-up (10 min at 60% of VO2peak), or a warm-up that was intended to induce potentiation postactivation (PAP warm-up; 5 min at 60% of VO2peak followed by three 10-s all-out sprints). Study outcomes were jumping ability and heart-rate variability (both assessed at baseline and before the TT), TT performance (mean power output), and perceptual (rating of perceived exertion) and physiological (oxygen uptake, muscle oxygenation, heart-rate variability, blood lactate, and thigh skin temperature) responses during and after the TT.

RESULTS

Both standard and PAP warm-up (9.7% [4.7%] and 12.9% [6.5%], respectively, P < .001), but not no warm-up (-0.9% [4.8%], P = .074), increased jumping ability and decreased heart-rate variability (-7.9% [14.2%], P = .027; -20.3% [24.7%], P = .006; and -1.7% [10.5%], P = .366). Participants started the TT (minutes 0-3) at a higher power output and oxygen uptake after PAP warm-up compared with the other 2 protocols (P < .05), but no between-conditions differences were found overall for the remainder of outcomes (P > .05).

CONCLUSIONS

Compared with no warm-up, warming up enhanced jumping performance and sympathetic modulation before the TT, and the inclusion of brief sprints resulted in a higher initial power output during the TT. However, no warm-up benefits were found for overall TT performance or for perceptual or physiological responses during the TT.

Ultraendurance Exercise in a Renal Transplant Recipient: A Case Study

CONTEXT

Exercise improves the commonly impaired physical fitness and cardiovascular health of transplant recipients. However, concerns remain about the safety of strenuous physical exercise in this population.

PURPOSE

To describe the physiological effects of ultraendurance exercise in a renal transplant recipient.

METHODS

After a 25-week training program, a 31-year-old male with stage 3 chronic kidney disease who had undergone 2 kidney transplants participated in a 62-km (5600 m of positive altitude change) trail-running race. Blood and urine analyses were performed at baseline (24 h before the race), 4 days after the race, and at different time points up to 16 weeks postexercise.

RESULTS

The participant completed the race in 12 hours 18 minutes. No noticeable side effects were recorded during the whole study period, including the prerace training program. No major urine or blood alterations were observed after ultraendurance exercise, with glomerular filtration rate remaining steady during the study period.

CONCLUSIONS

Ultraendurance exercise induced no adverse physiological effects in a well-trained young renal transplant recipient.

Functional Threshold Power: Relationship With Respiratory Compensation Point and Effects of Various Warm-Up Protocols

PURPOSE

The functional threshold power (FTP), which demarcates the transition from steady state to non-steady-state oxidative metabolism, is usually determined with a 20-minute cycling time trial that follows a standard ∼45-minute warm-up. This study aimed to determine if the standard warm-up inherent to FTP determination is actually necessary and how its modification or removal affects the relationship between FTP and the respiratory compensation point (RCP).

METHODS

A total of 15 male cyclists (age 35 [9] y, maximum oxygen uptake 66.4 [6.8] mL·kg-1·min-1) participated in this randomized, crossover study. Participants performed a ramp test for determination of RCP and maximum oxygen uptake. During subsequent visits, they performed a 20-minute time trial preceded by the "standard" warm-up that is typically performed before an FTP test (S-WU), a 10-minute warm-up at the power output (PO) corresponding to 60% of maximum oxygen uptake (60%-WU), or no warm-up (No-WU). FTP was computed as 95% of the mean PO attained during the time trial.

RESULTS

Although the FTP was correlated with the RCP independently of the warm-up (r = .89, .93, and .86 for No-WU, 60%-WU, and S-WU, respectively; all Ps < .001), the PO at RCP was higher than the FTP in all cases (bias ± 95% limits of agreement = 57 [24], 60 [23], and 57 [32] W for No-WU, 60%-WU, and S-WU, respectively; all Ps < .001 and effect size > 1.70).

CONCLUSIONS

The FTP is highly correlated with the RCP but corresponds to a significantly lower PO, being these results independent of the warm-up performed (or even with no warm-up).

Young athletes' ECG: Incomplete right bundle branch block vs crista supraventricularis pattern

BACKGROUND

Incomplete right bundle branch block (IRBBB) is prevalent among athletes, but its etiology remains to be clearly elucidated and the commonly advocated mechanism, an intraventricular conduction delay, does not explain all cases. In the general population, an apparently similar phenomenon but with different pathophysiology and potential consequences, "crista supraventricularis pattern" (CSP, defined as QRS ≤ 100 ms, S wave <40 ms in I or V6 together with an RSR´ pattern in lead-V1) has been described. Yet, this manifestation has not been studied in athletes. Given that IRBBB can be associated with some serious conditions (including Brugada syndrome, arrhythmogenic cardiomyopathy, or atrial septal defects) the differentiation between IRBB and CSP could enhance the accuracy of the pre-participation screening (PPS). We thus aimed to determine the prevalence of CSP in young athletes.

METHODS

Observational study of standard 12-lead resting ECG in a cohort of children (5-16 years) attending a PPS program (August 2018-May 2019).

RESULTS

6,401 children (mean ± SD age 11.2 ± 2.9 years, 99.2% Caucasian, 93.8% male, 97.2% soccer players) were studied. We found CSP in 850 participants (prevalence = 13.3% [95% confidence interval 12.5-14.1]) whereas 553 (8.6%) had IRBBB. The proportion of athletes showing an S1S2S3 pattern was higher in those with CSP compared with the other QRS morphologies (P < .05).

CONCLUSIONS

CSP might have been overlooked in previous reports of sports PPS for children and misdiagnosed as IRBBB, as the proportion of the former condition was higher. Our findings might add useful information to improve the interpretation of the young athletes' ECG and thus the diagnostic value of PPS.

Validity, Reliability, and Sensitivity to Exercise-Induced Fatigue of a Customer-Friendly Device for the Measurement of the Brain's Direct Current Potential

Valenzuela, PL, Sánchez-Martínez, G, Torrontegi, E, Vázquez-Carrión, J, Montalvo, Z, and Kara, O. Validity, reliability, and sensitivity to exercise-induced fatigue of a customer-friendly device for the measurement of the brain's direct current potential. J Strength Cond Res XX(X): 000-000, 2020-This study aimed to determine the validity, reliability, and sensitivity to exercise-induced fatigue of the brain's direct current (DC) potential measured with a commercially available and customer-friendly electroencephalography (EEG) device and Omegawave (OW). The study was composed of 3 different experiments as follows: (a) we compared the DC potential values obtained simultaneously in 31 subjects with both OW and a research-quality EEG system; (b) 3 consecutive DC potential measurements with OW were taken at rest on the same day in 25 subjects for reliability analyses; and (c) sensitivity to fatigue was assessed in 9 elite badminton players through the measurement of the DC potential with OW-as well as other fatigue-related measures (e.g., Hooper's index, heart rate variability, jump ability, and simple and complex reaction times)-24 hours after both a day of rest and of strenuous exercise, which were performed in a crossover and randomized design. The DC potential measured with OW was reliable (intraclass correlation coefficient = 0.97) and significantly correlated to that of EEG (r = 0.55, p = 0.001), although significant differences were observed between systems (p < 0.001). Compared with the rest day, strenuous exercise resulted in an impaired Hooper's index (p = 0.010) and jump ability (p = 0.008), longer simple (p = 0.038) and complex reaction times (p = 0.011), and a trend toward sympathetic dominance (standard deviation of normal to normal R-R intervals, p = 0.042; root mean square of differences between consecutive R-R intervals, p = 0.068). In turn, no significant differences were found between sessions for the DC potential (p = 0.173). In summary, the DC potential measured with OW was reliable and modestly correlated to that measured with EEG, but no differences were observed in response to the delayed fatigue (after 24 hours) elicited by strenuous exercise in elite athletes.

Concurrent Exercise Interventions in Breast Cancer Survivors with Cancer-related Fatigue

This study compared the effects of two supervised concurrent training interventions in breast cancer survivors with cancer-related fatigue at baseline. Twenty-three female breast cancer survivors (50±8 years) were randomized to a high- (n=13) or a moderate-intensity (n=10) training program. Both interventions lasted 16 weeks and included the same resistance exercises, but the aerobic component was supervised and more intense in the former (i.e., rating of perceived exertion of 7-8 vs. 6 on a 1-10 scale for the high and moderate-intensity intervention, respectively). The primary endpoint was fatigue perception. Endpoints were assessed at baseline and after 16 weeks. The p-value for statistical significance was set at 0.004 after Bonferroni correction for multiple comparisons. The high-intensity training program increased lower-limb muscle strength significantly (p=0.002) and tended to improve fatigue perception (p=0.006), waist circumference (p=0.013), neutrophil-to-lymphocyte ratio (p=0.028) and some quality of life items (p=0.011). Although the moderate-intensity training program did not provide such benefits in general (i.e., higher p-values for pre vs post-intervention comparisons), no significant differences were found between interventions (all p>0.004). Further research is needed to elucidate if the benefits provided by high-intensity concurrent training are superior to those elicited by moderate-intensity training in breast cancer survivors.

Reference power values for the jump squat exercise in elite athletes: A multicenter study

The present study aimed to provide reference values for lower-limb muscle power assessed during the incremental jump squat (JS) test in elite athletes (i.e., professional athletes competing at international level). We pooled data from all JS tests performed by elite athletes of different sports in two high-performance centres between 2015 and 2019, and computed reference values (i.e., terciles) for mean power (MP), mean propulsive power (MPP), and peak power (PP). Reference values were obtained from 684 elite athletes (458 male and 226 female) of 16 different sports (boxing, judo, karate, fencing, taekwondo, wrestling, basketball, soccer, futsal, handball, rugby union, badminton, tennis, long distance running, triathlon, and sprinting). Significant differences (p < 0.001) were found between male and female athletes for MP (7.47 ± 1.93 and 6.15 ± 1.68 W·Kg^-1, respectively), MPP (10.50 ± 2.75 and 8.63 ± 2.43 W·Kg^-1), and PP (23.64 ± 6.12 and 19.35 ± 5.49 W·Kg^-1). However, the velocity at which these power measures was attained seemed to be independent of sex (~0.95, 1.00 and 2.00 m·s^-1 for mean, mean propulsive, and peak velocity, respectively) and homogeneous across different sport disciplines (coefficient of variation <10%). These data can be used to classify athletes' power capabilities, and the optimum velocity ranges provided here could be useful for training purposes.

Physiological Predictors of Competition Performance in CrossFit Athletes

The aim of this study was to determine the physiological variables that predict competition performance during a CrossFit competition. Fifteen male amateur CrossFit athletes (age, 35 ± 9 years; CrossFit experience, 40 ± 27 months) performed a series of laboratory-based tests (incremental load test for deep full squat and bench press; squat, countermovement and drop jump tests; and incremental running and Wingate tests) that were studied as potential predictors of CrossFit performance. Thereafter, they performed the five Workouts of the Day (WODs) corresponding to the CrossFit Games Open 2019, and we assessed the relationship between the laboratory-based markers and CrossFit performance with regression analyses. Overall CrossFit performance (i.e., final ranking considering the sum of all WODs, as assessed by number of repetitions, time spent in exercises or weight lifted) was significantly related to jump ability, mean and peak power output during the Wingate test, relative maximum strength for the deep full squat and the bench press, and maximum oxygen uptake (VO2max) and speed during the incremental test (all p < 0.05, r = 0.58-0.75). However, the relationship between CrossFit Performance and most laboratory markers varied depending on the analyzed WOD. Multiple linear regression analysis indicated that measures of lower-body muscle power (particularly jump ability) and VO2max explained together most of the variance (R2 = 81%, p < 0.001) in overall CrossFit performance. CrossFit performance is therefore associated with different power-, strength-, and aerobic-related markers.

Interindividual Variation in Cardiorespiratory Fitness: A Candidate Gene Study in Han Chinese People

Cardiorespiratory fitness, as assessed through peak oxygen uptake (VO2peak), is a powerful health indicator. We aimed to evaluate the influence of several candidate causal genetic variants on VO2peak level in untrained Han Chinese people. A total of 1009 participants (566 women; age [mean ± SD] 40 ± 14 years, VO2peak 29.9 ± 7.1 mL/kg/min) performed a maximal incremental cycling test for VO2peak determination. Genomic DNA was extracted from peripheral whole blood, and genotyping analysis was performed on 125 gene variants. Using age, sex, and body mass as covariates, and setting a stringent threshold p-value of 0.0004, only one single nucleotide polymorphism (SNP), located in the gene encoding angiotensin-converting enzyme (rs4295), was associated with VO2peak (β = 0.87; p < 2.9 × 10-4). Stepwise multiple regression analysis identified a panel of three SNPs (rs4295 = 1.1%, angiotensin II receptor type 1 rs275652 = 0.6%, and myostatin rs7570532 = 0.5%) that together accounted for 2.2% (p = 0.0007) of the interindividual variance in VO2peak. Participants carrying six 'favorable' alleles had a higher VO2peak (32.3 ± 8.1 mL/kg/min) than those carrying only one favorable allele (24.6 ± 5.2 mL/kg/min, p < 0.0001). In summary, VO2peak at the pre-trained state is partly influenced by several polymorphic variations in candidate genes, but they represent a minor portion of the variance.

Effectiveness of Hip Arthroscopy on Treatment of Femoroacetabular Impingement Syndrome: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To appraise the highest available evidence provided by randomized controlled trials (RCTs) on the effectiveness of hip arthroscopy versus physical therapy in patients with femoroacetabular impingement syndrome (FAIS).

METHODS

Four databases (Medline, Embase, Web of Science, and Scopus) were systematically searched until October 1, 2019. Eligible studies were RCTs in which patients with FAIS underwent hip arthroscopy or physical therapy. The study outcome was the International Hip Outcome Tool, 33 Items (iHOT-33) score, a measure of hip pain, function, and quality of life, assessed at baseline and at the follow-up closer to 12 months after randomization. The pooled mean difference in iHOT-33 scores within and between the treatment arms was computed using a random effects model. The minimum clinically important difference in the iHOT-33 scores was set at 10 points.

RESULTS

Three RCTs evaluating iHOT-33 scores between 6 and 8 months after the interventions were included. Significant increases in iHOT-33 scores were observed from baseline to follow-up for both hip arthroscopy (22.3 points [95% confidence interval (95% CI) 17.3-27.4]) and physical therapy (13.0 points [95% CI 9.5-16.4]). Hip arthroscopy demonstrated significantly higher iHOT-33 scores at follow-up compared with physical therapy (10.9 points [95% CI 4.7-17.0]).

CONCLUSION

Both hip arthroscopy and physical therapy resulted in statistically and clinically significant short-term improvements in hip pain, function, and quality of life in patients with FAIS. Hip arthroscopy was statistically superior to physical therapy in improving the outcome at follow-up even if improvement may not be detected by patients.

Intradialytic neuromuscular electrical stimulation improves functional capacity and muscle strength in people receiving haemodialysis: a systematic review

QUESTIONS

Does neuromuscular electrical stimulation (NMES) applied during haemodialysis sessions improve functional capacity in people with end-stage renal disease? Does NMES used in this way also improve muscle strength, muscle mass/architecture, psychological outcomes, cardiovascular outcomes and biochemical variables? Does it have any adverse effects?

DESIGN

Systematic review of randomised controlled trials with meta-analysis. PubMed, Web of Science, Scopus and SPORTDiscus were searched from inception to 15 October 2019.

PARTICIPANTS

Patients receiving haemodialysis for end-stage renal disease.

INTERVENTION

NMES administered during haemodialysis sessions versus control.

OUTCOMES MEASURES

Functional capacity, muscle strength, muscle mass, psychological outcomes, cardiovascular outcomes, biochemical variables and adverse events.

DATA ANALYSIS

Data were meta-analysed where possible and results were expressed as the pooled mean difference between groups with a 95% confidence interval.

RESULTS

Eight studies (221 patients) were included in the analysis. Overall, the methodological quality of the studies was fair to good. NMES improved functional capacity as assessed by the 6-minute walk distance test (MD 31 m, 95% CI 13 to 49) and peak workload attained in incremental exercise (MD 12.5 W, 95% CI 3.2 to 21.9). NMES increased knee extensor muscle strength (MD 3.5 kg, 95% CI 2.3 to 4.7) and handgrip strength (MD 2.4 kg, 95% CI 0.4 to 4.4). Muscle mass/architecture was not substantially affected. NMES was estimated to be beneficial for several domains of quality of life in several studies, although most of these estimates were imprecise. No benefits were found for cardiovascular outcomes. The available data did not establish any clear effects on cardiovascular outcomes or biochemical variables (dialysis efficiency, urea and creatinine). No major NMES-related adverse events were observed.

CONCLUSIONS

NMES is safe, practical and effective for improving functional capacity and muscle strength in haemodialysis patients. Further research is needed to confirm the clinical relevance of these findings.

REGISTRATION

PROSPERO CRD42018107323.

A Path Toward Precision Medicine for Neuroinflammatory Mechanisms in Alzheimer's Disease

Neuroinflammation commences decades before Alzheimer's disease (AD) clinical onset and represents one of the earliest pathomechanistic alterations throughout the AD continuum. Large-scale genome-wide association studies point out several genetic variants—TREM2, CD33, PILRA, CR1, MS4A, CLU, ABCA7, EPHA1, and HLA-DRB5-HLA-DRB1—potentially linked to neuroinflammation. Most of these genes are involved in proinflammatory intracellular signaling, cytokines/interleukins/cell turnover, synaptic activity, lipid metabolism, and vesicle trafficking. Proteomic studies indicate that a plethora of interconnected aberrant molecular pathways, set off and perpetuated by TNF-α, TGF-β, IL-1β, and the receptor protein TREM2, are involved in neuroinflammation. Microglia and astrocytes are key cellular drivers and regulators of neuroinflammation. Under physiological conditions, they are important for neurotransmission and synaptic homeostasis. In AD, there is a turning point throughout its pathophysiological evolution where glial cells sustain an overexpressed inflammatory response that synergizes with amyloid-β and tau accumulation, and drives synaptotoxicity and neurodegeneration in a self-reinforcing manner. Despite a strong therapeutic rationale, previous clinical trials investigating compounds with anti-inflammatory properties, including non-steroidal anti-inflammatory drugs (NSAIDs), did not achieve primary efficacy endpoints. It is conceivable that study design issues, including the lack of diagnostic accuracy and biomarkers for target population identification and proof of mechanism, may partially explain the negative outcomes. However, a recent meta-analysis indicates a potential biological effect of NSAIDs. In this regard, candidate fluid biomarkers of neuroinflammation are under analytical/clinical validation, i.e., TREM2, IL-1β, MCP-1, IL-6, TNF-α receptor complexes, TGF-β, and YKL-40. PET radio-ligands are investigated to accomplish in vivo and longitudinal regional exploration of neuroinflammation. Biomarkers tracking different molecular pathways (body fluid matrixes) along with brain neuroinflammatory endophenotypes (neuroimaging markers), can untangle temporal–spatial dynamics between neuroinflammation and other AD pathophysiological mechanisms. Robust biomarker–drug codevelopment pipelines are expected to enrich large-scale clinical trials testing new-generation compounds active, directly or indirectly, on neuroinflammatory targets and displaying putative disease-modifying effects: novel NSAIDs, AL002 (anti-TREM2 antibody), anti-Aβ protofibrils (BAN2401), and AL003 (anti-CD33 antibody). As a next step, taking advantage of breakthrough and multimodal techniques coupled with a systems biology approach is the path to pursue for developing individualized therapeutic strategies targeting neuroinflammation under the framework of precision medicine.

Obesity-associated poor muscle quality: prevalence and association with age, sex, and body mass index

BACKGROUND

Muscle quality (i.e., the expression of muscle function per unit of muscle mass) has been proposed as a clinically-relevant measure to detect individuals at risk of functional incapacity. Individuals with obesity might be at an increased risk of having poor muscle quality. Thus, we aimed to analyze the prevalence of poor muscle quality in obese individuals, to determine associated variables, and to provide normative values for this population.

METHODS

203 individuals with obesity (103 women, age: 18-75 years, body mass index (BMI): 35-64 kg·m^- 2) participated in this cross-sectional study. Their muscle strength (handgrip dynamometry), muscle power (sit-to-stand test) and muscle mass (bioelectrical impedance analysis) were measured, and muscle quality (strength/power to muscle mass ratio) was compared with reference values obtained in young healthy individuals. Muscle quality was individually categorized as normal, low or poor based on specific muscle strength and power (i.e., strength and power per unit of muscle mass, respectively). Sex and age-specific normative values of specific muscle strength and power were computed for the whole cohort.

RESULTS

Age and being a woman were inversely associated with specific muscle strength, with age being also inversely associated with specific muscle power. A small proportion of participants (6%) presented with an impaired (i.e., low/poor) specific muscle power while most of them (96%) had impaired specific muscle strength. Eventually, 84% of the participants were deemed to have poor muscle quality. Being a woman (odds ratio [OR]: 18.09, 95% confidence intervals [CI]: 4.07-80.38), age (OR: 1.06, 95%CI: 1.03-1.10) and BMI (OR: 1.22, 95%CI: 1.07-1.38) were independently associated with a higher risk of poor muscle quality in adjusted analyses.

CONCLUSIONS

These findings show a high prevalence of poor muscle quality among individuals with obesity, with age, sex and BMI being independent predictors.

Individual Responsiveness to Physical Exercise Intervention in Acutely Hospitalized Older Adults

We analyzed inter-individual variability in response to exercise among acutely hospitalized oldest-old adults. In this ancillary analysis of a randomized controlled trial, 268 patients (mean age 88 years) were assigned to a control (n = 125, usual care) or intervention group (n = 143, supervised exercise, i.e., walking and rising from a chair [1-3 sessions/day]). Intervention group patients were categorized as responders, non-responders, or adverse responders (improved, no change, or impaired function in activities of daily living [ADL, Katz index] from hospital admission to discharge, respectively). We analyzed the association between responsiveness to exercise and variables assessed at baseline (2 weeks pre-admission), admission, during hospitalization, at discharge, and during a subsequent 3-month follow-up. An impaired ADL function and worse nutritional status at admission were associated to a greater responsiveness, whereas a better ADL function at admission, longer hospitalization and lower comorbidity index were associated with a poorer response (p < 0.05). Adverse responders had worse outcomes at discharge and during the follow-up (e.g., impaired physical performance and greater fall number) (p < 0.05). Although exercise intervention helps to prevent ADL function decline in hospitalized oldest-old people, a number of them-particularly those with a better functional/health status at admission and longer hospitalization-are at higher risk of being adverse responders, which can have negative short/middle-term consequences.

Acute Ketone Supplementation and Exercise Performance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE

To determine the acute effects of ketone supplementation on exercise performance (primary outcome) and physiological and perceptual responses to exercise (secondary outcomes).

METHODS

A systematic search was conducted in PubMed, Web of Science, and SPORTDiscus (since inception to July 21, 2019) to find randomized controlled trials assessing the effects of acute ketone supplementation compared with a drink containing no ketones (ie, control intervention). The standardized mean difference (Hedges g) between interventions and 95% confidence interval (CI) were computed using a random-effects model.

RESULTS

Thirteen studies met all inclusion criteria. No significant differences were observed between interventions for overall exercise performance (Hedges g = -0.05; 95% CI, -0.30 to 0.20; P = .68). Subanalyses revealed no differences between interventions when analyzing endurance time-trial performance (g = -0.04; 95% CI, -0.35 to 0.28; P = .82) or when assessing the separate effects of supplements containing ketone esters (g = -0.07; 95% CI, -0.38 to 0.24; P = .66) or salts (g = -0.02; 95% CI, -0.45 to 0.41; P = .93). All studies reported increases in plasma ketone concentration after acute ketone supplementation, but no consistent effects were reported on the metabolic (plasma lactate and glucose levels), respiratory (respiratory exchange ratio, oxygen uptake, and ventilatory rate), cardiovascular (heart rate), or perceptual responses to exercise (rating of perceived exertion).

CONCLUSIONS

The present findings suggest that ketone supplementation exerts no clear influence on exercise performance (from sprints to events lasting up to ∼50 min) or metabolic, respiratory, cardiovascular, or perceptual responses to exercise. More research is needed to elucidate if this strategy could provide ergogenic effects on other exercise types (eg, ultraendurance exercise).

Successful aging: insights from proteome analyses of healthy centenarians

Healthy aging depends on a complex gene-environment network that is ultimately reflected in the expression of different proteins. We aimed to perform a comparative analysis of the plasma proteome of healthy centenarians (n=9, 5 women, age range 100–103 years) with a notably preserved ambulatory capacity (as a paradigm of ‘successful’ aging), and control individuals who died from a major age-related disease before the expected life expectancy (n=9, 5 women, age range: 67–81 years), and while having impaired ambulatory capacity (as a paradigm of ‘unsuccessful’ aging). We found that the expression of 49 proteins and 86 pathways differed between the two groups. Overall, healthy centenarians presented with distinct expression of proteins/pathways that reflect a healthy immune function, including a lower pro-inflammatory status (less ‘inflammaging’ and autoimmunity) and a preserved humoral immune response (increased B cell-mediated immune response). Compared with controls, healthy centenarians also presented with a higher expression of proteins involved in angiogenesis and related to enhanced intercellular junctions, as well as a lower expression of proteins involved in cardiovascular abnormalities. The identification of these proteins/pathways might provide new insights into the biological mechanisms underlying the paradigm of healthy aging.

Effect of a Simple Exercise Program on Hospitalization-Associated Disability in Older Patients: A Randomized Controlled Trial

OBJECTIVE

Hospitalization-associated disability [HAD, ie, the loss of ability to perform ≥1 basic activities of daily living (ADLs) independently at discharge] is a frequent condition among older patients. The present study assessed whether a simple inpatient exercise program decreases HAD incidence in acutely hospitalized very old patients.

DESIGN

In this randomized controlled trial (Activity in Geriatric Acute Care) participants were assigned to a control or intervention group and were assessed at baseline, admission, discharge, and 3 months thereafter.

SETTING AND PARTICIPANTS

In total, 268 patients (mean age 88 years, range 75-102) admitted to an acute care for older patients unit of a public hospital were randomized to a control (n = 125) or intervention (exercise) group (n = 143).

METHODS

Both groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total duration of ∼20 minutes/day). We measured ADL function (Katz index) and incident HAD at discharge and after 3 months (primary outcome) and Short Physical Performance Battery, ambulatory capacity, number of falls, rehospitalization, and death during a 3-month follow-up (secondary outcomes).

RESULTS

Median duration of hospitalization was 7 days (interquartile range 4 days). The intervention group had a lower risk of HAD with reference to both baseline [odds ratio (OR) 0.36; 95% confidence interval (CI) 0.17-0.76, P = .007] and admission (OR 0.29; 95% CI 0.10-0.89, P = .030). A trend toward an improved ADL function at discharge vs admission was found in the intervention group compared with controls (OR 0.32; 95% CI ‒0.04 to 0.68; P = .083). No between-group differences were noted for the other endpoints (all P > .05).

CONCLUSION AND IMPLICATIONS

A simple inpatient exercise program decreases risk of HAD in acutely hospitalized, very old patients.

Exercise Interventions and Cardiovascular Health in Childhood Cancer: A Meta-analysis

This study analyzed the effects of physical exercise interventions on cardiovascular endpoints in childhood cancer survivors. Relevant articles were systematically searched in PubMed, CINAHL, and Web of Science databases (since inception to 11th September 2019). We performed a meta-analysis (random effects) to determine the mean difference (expressed together with 95% confidence intervals) between pre- and post-intervention values for those cardiovascular endpoints reported in more than three studies. Twenty-seven studies (of which 16 were controlled studies) comprising 697 participants were included. Only three studies reported adverse events related to exercise interventions. Exercise resulted in an increased performance on the 6-minute walk distance test (mean difference=111 m, 95% confidence interval=39–183, p=0.003) and a non-significant trend (mean difference=1.97 ml∙kg−1∙min−1, 95% confidence interval=−0.12–4.06, p=0.065) for improvement in peak oxygen uptake. Furthermore, left ventricular ejection fraction was preserved after exercise interventions (mean difference=0.29%, 95% confidence interval=−1.41–1.99, p=0.738). In summary, exercise interventions might exert a cardioprotective effect in childhood cancer survivors by improving – or attenuating the decline of – physical capacity and cardiovascular function. Further studies, particularly randomized controlled trials, are needed to confirm these benefits.

Potential of video games for the promotion of neuroadaptation to multifocal intraocular lenses: a narrative review

Multifocal intraocular lenses (IOLs) are currently usually implanted for the treatment of cataracts because they have been proved to be superior to monofocal IOLs with respect to spectacle independence. In turn, they are associated with a higher prevalence of dysphotopsia symptoms that is one of the most common causes of patient dissatisfaction. Neuroadaptation seems to play a major role in the optimal adaptation to multifocal IOLs. In this context, the development of strategies that facilitate the neuroadaptation process to multifocality might be an effective strategy to reduce patients' dissatisfaction. Video games have been proved to be effective for the improvement of visual acuity and for the promotion of neuroplasticity in elderly subjects and other populations with cortical-related visual impairment. This narrative review highlights the physiological potential of video games as a perceptual strategy to improve visual acuity and promote neuroplasticity in patients using multifocal IOLs, although research is still needed to confirm these benefits in this specific population, with only one comparative study to this date providing evidence of them.