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Ganse B. Methods to accelerate fracture healing - a narrative review from a clinical perspective. Front Immunol 2024; 15:1384783. [PMID: 38911851 PMCID: PMC11190092 DOI: 10.3389/fimmu.2024.1384783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/14/2024] [Indexed: 06/25/2024] Open
Abstract
Bone regeneration is a complex pathophysiological process determined by molecular, cellular, and biomechanical factors, including immune cells and growth factors. Fracture healing usually takes several weeks to months, during which patients are frequently immobilized and unable to work. As immobilization is associated with negative health and socioeconomic effects, it would be desirable if fracture healing could be accelerated and the healing time shortened. However, interventions for this purpose are not yet part of current clinical treatment guidelines, and there has never been a comprehensive review specifically on this topic. Therefore, this narrative review provides an overview of the available clinical evidence on methods that accelerate fracture healing, with a focus on clinical applicability in healthy patients without bone disease. The most promising methods identified are the application of axial micromovement, electromagnetic stimulation with electromagnetic fields and direct electric currents, as well as the administration of growth factors and parathyroid hormone. Some interventions have been shown to reduce the healing time by up to 20 to 30%, potentially equivalent to several weeks. As a combination of methods could decrease the healing time even further than one method alone, especially if their mechanisms of action differ, clinical studies in human patients are needed to assess the individual and combined effects on healing progress. Studies are also necessary to determine the ideal settings for the interventions, i.e., optimal frequencies, intensities, and exposure times throughout the separate healing phases. More clinical research is also desirable to create an evidence base for clinical guidelines. To make it easier to conduct these investigations, the development of new methods that allow better quantification of fracture-healing progress and speed in human patients is needed.
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Affiliation(s)
- Bergita Ganse
- Innovative Implant Development (Fracture Healing), Clinics and Institutes of Surgery, Saarland University, Homburg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Clinics and Institutes of Surgery, Saarland University, Homburg, Germany
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Frett T, Lecheler L, Arz M, Pustowalow W, Petrat G, Mommsen F, Breuer J, Schmitz MT, Green DA, Jordan J. Acute cardiovascular and muscular response to rowing ergometer exercise in artificial gravity - a pilot trial. NPJ Microgravity 2024; 10:57. [PMID: 38782970 PMCID: PMC11116499 DOI: 10.1038/s41526-024-00402-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
Prolonged immobilization and spaceflight cause cardiovascular and musculoskeletal deconditioning. Combining artificial gravity through short-arm centrifugation with rowing exercise may serve as a countermeasure. We aimed to compare the tolerability, muscle force production, cardiovascular response, and power output of rowing on a short-arm centrifuge and under terrestrial gravity. Twelve rowing athletes (4 women, aged 27.2 ± 7.4 years, height 179 ± 0.1 cm, mass 73.7 ± 9.4 kg) participated in two rowing sessions, spaced at least six weeks apart. One session used a short-arm centrifuge with +0.5 Gz, while the other inclined the rowing ergometer by 26.6° to mimic centrifugal loading. Participants started self-paced rowing at 30 W, increasing by 15 W every three minutes until exhaustion. We measured rowing performance, heart rate, blood pressure, ground reaction forces, leg muscle activation, and blood lactate concentration. Rowing on the centrifuge was well-tolerated without adverse events. No significant differences in heart rate, blood pressure, or blood lactate concentration were observed between conditions. Inclined rowing under artificial gravity resulted in lower power output (-33%, p < 0.001) compared to natural gravity, but produced higher mean and peak ground reaction forces (p < 0.0001) and increased leg muscle activation. Muscle activation and ground reaction forces varied with rotational direction. Rowing in artificial gravity shows promise as a strategy against cardiovascular and muscular deconditioning during long-term spaceflight, but further investigation is required to understand its long-term effects.
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Affiliation(s)
- Timo Frett
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.
| | - Leo Lecheler
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Michael Arz
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Willi Pustowalow
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Guido Petrat
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Florian Mommsen
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Jan Breuer
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Marie-Therese Schmitz
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | - David Andrew Green
- European Space Agency, Cologne, Germany
- King's College London, London, UK
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBRwyle GmbH, Cologne, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
- Chair of Aerospace Medicine, University of Cologne, Cologne, Germany
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3
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Eggelbusch M, Charlton BT, Bosutti A, Ganse B, Giakoumaki I, Grootemaat AE, Hendrickse PW, Jaspers Y, Kemp S, Kerkhoff TJ, Noort W, van Weeghel M, van der Wel NN, Wesseling JR, Frings-Meuthen P, Rittweger J, Mulder ER, Jaspers RT, Degens H, Wüst RCI. The impact of bed rest on human skeletal muscle metabolism. Cell Rep Med 2024; 5:101372. [PMID: 38232697 PMCID: PMC10829795 DOI: 10.1016/j.xcrm.2023.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/19/2023] [Accepted: 12/14/2023] [Indexed: 01/19/2024]
Abstract
Insulin sensitivity and metabolic flexibility decrease in response to bed rest, but the temporal and causal adaptations in human skeletal muscle metabolism are not fully defined. Here, we use an integrative approach to assess human skeletal muscle metabolism during bed rest and provide a multi-system analysis of how skeletal muscle and the circulatory system adapt to short- and long-term bed rest (German Clinical Trials: DRKS00015677). We uncover that intracellular glycogen accumulation after short-term bed rest accompanies a rapid reduction in systemic insulin sensitivity and less GLUT4 localization at the muscle cell membrane, preventing further intracellular glycogen deposition after long-term bed rest. We provide evidence of a temporal link between the accumulation of intracellular triglycerides, lipotoxic ceramides, and sphingomyelins and an altered skeletal muscle mitochondrial structure and function after long-term bed rest. An intracellular nutrient overload therefore represents a crucial determinant for rapid skeletal muscle insulin insensitivity and mitochondrial alterations after prolonged bed rest.
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Affiliation(s)
- Moritz Eggelbusch
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Braeden T Charlton
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - Bergita Ganse
- Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK; Clinics and Institutes of Surgery, Saarland University, Homburg, Germany
| | - Ifigenia Giakoumaki
- Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Anita E Grootemaat
- Electron Microscopy Center Amsterdam, Department of Medical Biology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Paul W Hendrickse
- Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK; Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Yorrick Jaspers
- Laboratory Genetic Metabolic Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Stephan Kemp
- Laboratory Genetic Metabolic Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Tom J Kerkhoff
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Wendy Noort
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Michel van Weeghel
- Laboratory Genetic Metabolic Diseases, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Nicole N van der Wel
- Electron Microscopy Center Amsterdam, Department of Medical Biology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Julia R Wesseling
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Department of Pediatrics and Adolescent Medicine, University Hospital Cologne, Cologne, Germany
| | - Edwin R Mulder
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Richard T Jaspers
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Hans Degens
- Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK; Lithuanian Sports University, Kaunas, Lithuania
| | - Rob C I Wüst
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
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Zwart SR, Macias BR, Laurie SS, Ferguson C, Stern C, Suh A, Melin MM, Young M, Bershad E, Smith SM. Optic disc edema during strict 6° head-down tilt bed rest is related to one-carbon metabolism pathway genetics and optic cup volume. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1279831. [PMID: 38983014 PMCID: PMC11182205 DOI: 10.3389/fopht.2023.1279831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/16/2023] [Indexed: 07/11/2024]
Abstract
Some astronauts on International Space Station missions experience neuroophthalmological pathologies as part of spaceflight associated neuro-ocular syndrome (SANS). Strict head-down tilt bed rest (HDTBR) is a spaceflight analog that replicates SANS findings and those who had 3-4 risk alleles (G and C alleles from the methionine synthase reductase [MTRR] A66G and serine hydroxymethyltransferase [SHMT1] C1420T, respectively) as compared to 1-2 risk alleles, had a greater increase in total retinal thickness (TRT). The objective of this study was to identify factors that contribute to the individual variability of the development of SANS in a 60 d HDTBR at the German Aerospace Center's:envihab facility, Cologne Germany. 22 of 24 subjects who participated in the HDTBR study provided blood samples for genetic analysis. Total retinal thickness and optic cup volume were measured before and after bed rest. Subjects with 3-4 versus 0-2 risk alleles had greater ΔTRT during and after bed rest, and the model improved with the addition of baseline optic cup volume. This bed rest study confirms that variants of MTRR and SHMT1 are associated with ocular pathologies. Subjects with more risk alleles had the greatest HDTBR-induced ΔTRT, reaffirming that genetics predispose some individuals to developing SANS. Preflight optic cup volume and genetics better predict ΔTRT than either one alone. Whether nutritional supplements can override the genetic influences on biochemistry, physiology, and pathophysiology remains to be tested. These findings have significant implications for both aerospace and terrestrial medicine.
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Affiliation(s)
- Sara R. Zwart
- Human Health and Performance Directorate, University of Texas Medical Branch (UTMB), Galveston, TX, United States
| | - Brandon R. Macias
- National Aeronautics and Space Administration (NASA), Johnson Space Center, Human Health and Performance Directorate, Houston, TX, United States
| | - Steven S. Laurie
- Human Health and Performance Directorate, KBR, Houston, TX, United States
| | - Connor Ferguson
- Human Health and Performance Directorate, Aegis Corp, Houston, TX, United States
| | - Claudia Stern
- Department of Clinical Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Alex Suh
- Tulane University School of Medicine, New Orleans, LA, United States
| | - M. Mark Melin
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States
| | - Millennia Young
- National Aeronautics and Space Administration (NASA), Johnson Space Center, Human Health and Performance Directorate, Houston, TX, United States
| | - Eric Bershad
- Neurology Department, Baylor College of Medicine, Houston, TX, United States
| | - Scott M. Smith
- National Aeronautics and Space Administration (NASA), Johnson Space Center, Human Health and Performance Directorate, Houston, TX, United States
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5
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Hoenemann JN, Moestl S, van Herwaarden AE, Diedrich A, Mulder E, Frett T, Petrat G, Pustowalow W, Arz M, Heusser K, Lee S, Jordan J, Tank J, Hoffmann F. Effects of daily artificial gravity training on orthostatic tolerance following 60-day strict head-down tilt bedrest. Clin Auton Res 2023; 33:401-410. [PMID: 37347452 PMCID: PMC10439060 DOI: 10.1007/s10286-023-00959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Orthostatic intolerance commonly occurs following immobilization or space flight. We hypothesized that daily artificial gravity training through short-arm centrifugation could help to maintain orthostatic tolerance following head-down tilt bedrest, which is an established terrestrial model for weightlessness. METHODS We studied 24 healthy persons (eight women; age 33.3 ± 9.0 years; BMI 24.3 ± 2.1 kg/m2) who participated in the 60-days head-down tilt bedrest (AGBRESA) study. They were assigned to 30 min/day continuous or 6 × 5 min intermittent short-arm centrifugation with 1Gz at the center of mass or a control group. We performed head-up tilt testing with incremental lower-body negative pressure until presyncope before and after bedrest. We recorded an electrocardiogram, beat-to-beat finger blood pressure, and brachial blood pressure and obtained blood samples from an antecubital venous catheter. Orthostatic tolerance was defined as time to presyncope. We related changes in orthostatic tolerance to changes in plasma volume determined by carbon dioxide rebreathing. RESULTS Compared with baseline measurements, supine and upright heart rate increased in all three groups following head-down tilt bedrest. Compared with baseline measurements, time to presyncope decreased by 323 ± 235 s with continuous centrifugation, by 296 ± 508 s with intermittent centrifugation, and by 801 ± 354 s in the control group (p = 0.0249 between interventions). The change in orthostatic tolerance was not correlated with changes in plasma volume. CONCLUSIONS Daily artificial gravity training on a short-arm centrifuge attenuated the reduction in orthostatic tolerance after 60 days of head-down tilt bedrest.
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Affiliation(s)
- J-N Hoenemann
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology, and Intensive Care, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Moestl
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - A E van Herwaarden
- Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - A Diedrich
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN, USA
| | - E Mulder
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - T Frett
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - G Petrat
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - W Pustowalow
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - M Arz
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - K Heusser
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - S Lee
- NASA JSC KBR Wyle, Houston, TX, USA
| | - J Jordan
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Head of Aerospace Medicine, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
| | - J Tank
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany.
| | - F Hoffmann
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology, and Intensive Care, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Jagtap S, Kumar A, Mahale B, Dixit J, Kalange AE, Kanawade R, Gangal S, Vidyasagar P. Response of cardiac pulse parameters in humans at various inclinations via 360° rotating platform for simulated microgravity perspective. NPJ Microgravity 2023; 9:54. [PMID: 37463938 DOI: 10.1038/s41526-023-00301-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/02/2023] [Indexed: 07/20/2023] Open
Abstract
On the Earth, the human body is designed and adapted to function under uniform gravitational acceleration. However, exposure to microgravity or weightlessness as experienced by astronauts in space causes significant alterations in the functioning of the human cardiovascular system. Due to limitations in using real microgravity platforms, researchers opted for various ground-based microgravity analogs including head-down tilt (HDT) at fixed inclination. However, in the present study, an investigation of response of various cardiac parameters and their circulatory adaptation in 18 healthy male subjects was undertaken by using an indigenously developed 360° rotating platform. Cardiac pulse was recorded from 0° to 360° in steps of 30° inclination using piezoelectric pulse sensor (MLT1010) and associated cardiac parameters were analyzed. The results showed significant changes in the pulse shape while an interesting oscillating pattern was observed in associated cardiac parameters when rotated from 0° to 360°. The response of cardiac parameters became normal after returning to supine posture indicating the ability of the cardiovascular system to reversibly adapt to the postural changes. The observed changes in cardiac parameters at an inclination of 270°, in particular, were found to be comparable with spaceflight studies. Based on the obtained results and the proposed extended version of fluid redistribution mechanism, we herewith hypothesize that the rotation of a subject to head down tilt inclination (270°) along with other inclinations could represent a better microgravity analog for understanding the cumulative cardiac response of astronauts in space, particularly for short duration space missions.
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Affiliation(s)
- Sagar Jagtap
- Department of Physics, Haribhai V. Desai College, Pune, MS, 411002, India.
| | - Ajay Kumar
- Physical and Materials Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, MS, 411008, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
| | - Bhoopesh Mahale
- Department of Electronics, Savitribai Phule Pune University, Pune, MS, 411007, India
| | - Jyotsana Dixit
- Department of Microbiology, Savitribai Phule Pune University, Pune, MS, 411007, India
| | - Ashok E Kalange
- Department of Physics, Tuljaram Chaturchand College, Baramati, Dist., Pune, 413102, MS, India
| | - Rajesh Kanawade
- Physical and Materials Chemistry Division, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune, MS, 411008, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Shashikala Gangal
- Department of Electronics, Savitribai Phule Pune University, Pune, MS, 411007, India
| | - Pandit Vidyasagar
- Department of Physics, Savitribai Phule Pune University, Pune, MS, 411007, India.
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Rabineau J, Issertine M, Hoffmann F, Gerlach D, Caiani EG, Haut B, van de Borne P, Tank J, Migeotte PF. Cardiovascular deconditioning and impact of artificial gravity during 60-day head-down bed rest—Insights from 4D flow cardiac MRI. Front Physiol 2022; 13:944587. [PMID: 36277205 PMCID: PMC9586290 DOI: 10.3389/fphys.2022.944587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
Microgravity has deleterious effects on the cardiovascular system. We evaluated some parameters of blood flow and vascular stiffness during 60 days of simulated microgravity in head-down tilt (HDT) bed rest. We also tested the hypothesis that daily exposure to 30 min of artificial gravity (1 g) would mitigate these adaptations. 24 healthy subjects (8 women) were evenly distributed in three groups: continuous artificial gravity, intermittent artificial gravity, or control. 4D flow cardiac MRI was acquired in horizontal position before (−9 days), during (5, 21, and 56 days), and after (+4 days) the HDT period. The false discovery rate was set at 0.05. The results are presented as median (first quartile; third quartile). No group or group × time differences were observed so the groups were combined. At the end of the HDT phase, we reported a decrease in the stroke volume allocated to the lower body (−30% [−35%; −22%]) and the upper body (−20% [−30%; +11%]), but in different proportions, reflected by an increased share of blood flow towards the upper body. The aortic pulse wave velocity increased (+16% [+9%; +25%]), and so did other markers of arterial stiffness (CAVI; CAVI0). In males, the time-averaged wall shear stress decreased (−13% [−17%; −5%]) and the relative residence time increased (+14% [+5%; +21%]), while these changes were not observed among females. Most of these parameters tended to or returned to baseline after 4 days of recovery. The effects of the artificial gravity countermeasure were not visible. We recommend increasing the load factor, the time of exposure, or combining it with physical exercise. The changes in blood flow confirmed the different adaptations occurring in the upper and lower body, with a larger share of blood volume dedicated to the upper body during (simulated) microgravity. The aorta appeared stiffer during the HDT phase, however all the changes remained subclinical and probably the sole consequence of reversible functional changes caused by reduced blood flow. Interestingly, some wall shear stress markers were more stable in females than in males. No permanent cardiovascular adaptations following 60 days of HDT bed rest were observed.
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Affiliation(s)
- Jeremy Rabineau
- LPHYS, Département de Cardiologie, Université Libre de Bruxelles, Brussels, Belgium
- TIPs, École Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
- *Correspondence: Jeremy Rabineau,
| | - Margot Issertine
- LPHYS, Département de Cardiologie, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabian Hoffmann
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Darius Gerlach
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Enrico G. Caiani
- Electronic, Information and Biomedical Engineering Department, Politecnico di Milano, Milan, Italy
| | - Benoit Haut
- TIPs, École Polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
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Marcos-Lorenzo D, Frett T, Gil-Martinez A, Speer M, Swanenburg J, Green DA. Effect of trunk exercise upon lumbar IVD height and vertebral compliance when performed supine with 1 g at the CoM compared to upright in 1 g. BMC Sports Sci Med Rehabil 2022; 14:177. [PMID: 36207739 PMCID: PMC9540696 DOI: 10.1186/s13102-022-00575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022]
Abstract
Background Spinal unloading in microgravity is associated with stature increments, back pain, intervertebral disc (IVD) swelling and impaired spinal kinematics. The aim of this study was to determine the effect of lateral stabilization, trunk rotation and isometric abdominal exercise upon lumbar IVD height, and both passive and active vertebral compliance when performed supine on a short-arm human centrifuge (SAHC)—a candidate microgravity countermeasure—with 1 g at the CoM, compared to that generated with equivalent upright exercise in 1 g. Methods 12 (8 male) healthy subjects (33.8 ± 7 years, 178.4 ± 8.2 cm, 72.1 ± 9.6 kg) gave written informed consent. Subjects performed three sets of upper body trunk exercises either when standing upright (UPRIGHT), or when being spun on the SAHC. Lumbar IVD height and vertebral compliance (active and passive) were evaluated prior to SAHC (PRE SAHC) and following the first SAHC (POST SPIN 1) and second Spin (POST SPIN 2), in addition to before (PRE UPRIGHT), and after upright trunk exercises (POST UPRIGHT). Results No significant effect upon IVD height (L2–S1) when performed UPRIGHT or on the SAHC was observed. Trunk muscle exercise induced significant (p < 0.05) reduction of active thoracic vertebral compliance when performed on the SAHC, but not UPRIGHT. However, no effect was observed in the cervical, lumbar or across the entire vertebral column. On passive or active vertebral compliance. Conclusion This study, the first of its kind demonstrates that trunk exercise were feasible and tolerable. Whilst trunk muscle exercise appears to have minor effect upon IVD height, it may be a candidate approach to mitigate—particularly active—vertebral stability on Earth, and in μg via concurrent SAHC. However, significant variability suggests larger studies including optimization of trunk exercise and SAHC prescription with MRI are warranted. Trial Registration North Rhine ethical committee (Number: 6000223393) and registered on 29/09/2020 in the German Clinical Trials Register (DRKS00021750).
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Affiliation(s)
- D Marcos-Lorenzo
- School of Medicine of Autonomous, University of Madrid, 28029, Madrid, Spain
| | - T Frett
- Department of Aerospace Physiology, Institute for Aerospace Medicine, German Aerospace Center E.V. (DLR), 51147, Cologne, Germany
| | - A Gil-Martinez
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023, Madrid, Spain
| | - M Speer
- Space Medicine Team, European Astronaut Centre, European Space Agency, Linder Höhe, 51147, Cologne, Germany
| | - J Swanenburg
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, UZH Space Hub Space Life Sciences, University of Zurich, Lengghalde 5, 8008, Zurich, Switzerland. .,University of Zurich, Zurich, Switzerland.
| | - D A Green
- Space Medicine Team, European Astronaut Centre, European Space Agency, Linder Höhe, 51147, Cologne, Germany.,Centre of Human and Applied Physiological Sciences, King's College London, London, SE1 1UL, UK.,KBRwyle GmbH, Albin Köbis Straße 4, 51147, Cologne, Germany
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9
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Robin A, Wang L, Custaud MA, Liu J, Yuan M, Li Z, Lloret JC, Liu S, Dai X, Zhang J, Lv K, Li W, Gauquelin-Koch G, Wang H, Li K, Li X, Qu L, Navasiolava N, Li Y. Running vs. resistance exercise to counteract deconditioning induced by 90-day head-down bedrest. Front Physiol 2022; 13:902983. [PMID: 36117704 PMCID: PMC9473647 DOI: 10.3389/fphys.2022.902983] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Spaceflight is associated with enhanced inactivity, resulting in muscular and cardiovascular deconditioning. Although physical exercise is commonly used as a countermeasure, separate applications of running and resistive exercise modalities have never been directly compared during long-term bedrest. This study aimed to compare the effectiveness of two exercise countermeasure programs, running and resistance training, applied separately, for counteracting cardiovascular deconditioning induced by 90-day head-down bedrest (HDBR). Maximal oxygen uptake (V˙O2max), orthostatic tolerance, continuous ECG and blood pressure (BP), body composition, and leg circumferences were measured in the control group (CON: n = 8), running exercise group (RUN: n = 7), and resistive exercise group (RES: n = 7). After HDBR, the decrease in V˙O2max was prevented by RUN countermeasure and limited by RES countermeasure (−26% in CON p < 0.05, −15% in RES p < 0.05, and −4% in RUN ns). Subjects demonstrated surprisingly modest orthostatic tolerance decrease for different groups, including controls. Lean mass loss was limited by RES and RUN protocols (−10% in CON vs. −5% to 6% in RES and RUN). Both countermeasures prevented the loss in thigh circumference (−7% in CON p < 0.05, −2% in RES ns, and −0.6% in RUN ns) and limited loss in calf circumference (−10% in CON vs. −7% in RES vs. −5% in RUN). Day–night variations in systolic BP were preserved during HDBR. Decrease in V˙O2max positively correlated with decrease in thigh (r = 0.54 and p = 0.009) and calf (r = 0.52 and p = 0.012) circumferences. During this 90-day strict HDBR, running exercise successfully preserved V˙O2max, and resistance exercise limited its decline. Both countermeasures limited loss in global lean mass and leg circumferences. The V˙O2max reduction seems to be conditioned more by muscular than by cardiovascular parameters.
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Affiliation(s)
- Adrien Robin
- Univ Angers, CHU Angers, CRC, INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, Angers, France
| | - Linjie Wang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Marc-Antoine Custaud
- Univ Angers, CHU Angers, CRC, INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, Angers, France
| | - Jiexin Liu
- Beijing Tiantan Hospital, Medical Capital University, Beijing, China
| | - Min Yuan
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Zhili Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | | | - Shujuan Liu
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Xiaoqian Dai
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Jianfeng Zhang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Ke Lv
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Wenjiong Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | | | - Huijuan Wang
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Kai Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Xiaotao Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Lina Qu
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Nastassia Navasiolava
- Univ Angers, CHU Angers, CRC, INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, Angers, France
- *Correspondence: Nastassia Navasiolava, ; Yinghui Li,
| | - Yinghui Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
- *Correspondence: Nastassia Navasiolava, ; Yinghui Li,
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10
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Horeau M, Ropert M, Mulder E, Tank J, Frings-Meuthen P, Armbrecht G, Loréal O, Derbré F. Iron Metabolism Regulation in Females and Males Exposed to Simulated Microgravity: results from the Randomized Trial AGBRESA. Am J Clin Nutr 2022; 116:1430-1440. [PMID: 36026525 DOI: 10.1093/ajcn/nqac205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/23/2022] [Accepted: 08/14/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iron metabolism imbalance could contribute to physical deconditioning experienced by astronauts due to its essential role in energy metabolism, cellular respiration, and oxygen transport. OBJECTIVES In this clinical exploratory study, we wanted to determine whether artificial gravity (AG) training modulated iron metabolism, red blood cell indices, and body lean mass in male and female healthy participants exposed to head-down tilt (HDT) bed rest, the reference ground-based model of microgravity. METHODS We recruited 8 female and 16 male healthy participants who were all exposed to HDT bed rest for 60 days. In addition, they were assigned to three experimental groups (n = 8/each): controls, continuous AG training in a short-arm centrifuge (1×30 min/day), and intermittent AG training (6 × 5 min/day). RESULTS The iron metabolism responses to simulated microgravity of AG training groups do not significantly differ from the responses of controls. Independently from AG, we found that both serum iron (+31.3%, P = 0.027) and transferrin saturation levels (+28.4%, P = 0.009) increased in males after 6 days of HDT bed rest, as well as serum hepcidin levels (+36.9% P = 0.005). The increase of transferrin saturation levels persisted after 57 days of HDT bed rest (+13.5%, P = 0.026), suggesting that long-term exposure to microgravity sustainably increases serum iron availability in males, and consequently the risk of iron excess or misdistribution. In females, 6 and 57 days of HDT bed rest did not significantly change serum iron, transferrin saturation, and hepcidin levels. CONCLUSIONS The data from this exploratory study suggest that 1) AG training does not influence the iron metabolism responses to microgravity; 2) iron metabolism parameters, especially iron availability for cells, are significantly increased in males, but not in females, exposed to long-term simulated microgravity. Due to the small sample size of females, we nevertheless must be cautious before concluding that iron metabolism could differently respond to microgravity in females. Clinical trial registry number: DRKS00015677.
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Affiliation(s)
- Mathieu Horeau
- Laboratory "Movement Sport and Health Sciences" EA7470, University of Rennes/ENS Rennes, France.,INSERM, University of Rennes, INRAE, UMR 1241, AEM2 platform, Nutrition Metabolisms and Cancer (NuMeCan) institute, Rennes, France
| | - Martine Ropert
- INSERM, University of Rennes, INRAE, UMR 1241, AEM2 platform, Nutrition Metabolisms and Cancer (NuMeCan) institute, Rennes, France.,Department of Biochemistry, CHU Rennes, France
| | - Edwin Mulder
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Gabriele Armbrecht
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Radiology, Berlin, Germany
| | - Olivier Loréal
- INSERM, University of Rennes, INRAE, UMR 1241, AEM2 platform, Nutrition Metabolisms and Cancer (NuMeCan) institute, Rennes, France
| | - Frédéric Derbré
- Laboratory "Movement Sport and Health Sciences" EA7470, University of Rennes/ENS Rennes, France
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11
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Frett T, Lecheler L, Speer M, Marcos D, Pesta D, Tegtbur U, Schmitz MT, Jordan J, Green DA. Comparison of trunk muscle exercises in supine position during short arm centrifugation with 1 g at centre of mass and upright in 1 g. Front Physiol 2022; 13:955312. [PMID: 36060705 PMCID: PMC9428406 DOI: 10.3389/fphys.2022.955312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Abstract
Spaceflight is associated with reduced antigravitational muscle activity, which results in trunk muscle atrophy and may contribute to post-flight postural and spinal instability. Exercise in artificial gravity (AG) performed via short-arm human centrifugation (SAHC) is a promising multi-organ countermeasure, especially to mitigate microgravity-induced postural muscle atrophy. Here, we compared trunk muscular activity (mm. rectus abdominis, ext. obliques and multifidi), cardiovascular response and tolerability of trunk muscle exercises performed during centrifugation with 1 g at individual center of mass on a SAHC against standard upright exercising. We recorded heart rate, blood pressure, surface trunk muscle activity, motion sickness and rating of perceived exertion (BORG) of 12 participants (8 male/4 female, 34 ± 7 years, 178.4 ± 8.2 cm, 72.1 ± 9.6 kg). Heart rate was significantly increased (p < 0.001) during exercises without differences in conditions. Systolic blood pressure was higher (p < 0.001) during centrifugation with a delayed rise during exercises in upright condition. Diastolic blood pressure was lower in upright (p = 0.018) compared to counter-clockwise but not to clockwise centrifugation. Target muscle activation were comparable between conditions, although activity of multifidi was lower (clockwise: p = 0.003, counter-clockwise: p < 0.001) and rectus abdominis were higher (clockwise: p = 0.0023, counter-clockwise: < 0.001) during centrifugation in one exercise type. No sessions were terminated, BORG scoring reflected a relevant training intensity and no significant increase in motion sickness was reported during centrifugation. Thus, exercising trunk muscles during centrifugation generates comparable targeted muscular and heart rate response and appears to be well tolerated. Differences in blood pressure were relatively minor and not indicative of haemodynamic challenge. SAHC-based muscle training is a candidate to reduce microgravity-induced inter-vertebral disc pathology and trunk muscle atrophy. However, further optimization is required prior to performance of a training study for individuals with trunk muscle atrophy/dysfunction.
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Affiliation(s)
- Timo Frett
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
- *Correspondence: Timo Frett,
| | - Leopold Lecheler
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
| | | | | | - Dominik Pesta
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
- Center for Endocrinology, Diabetes and Preventive Medicine (CEDP), University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Uwe Tegtbur
- Hannover Medical School, Institutes of Sports Medicine, Hannover, Germany
| | - Marie-Therese Schmitz
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
- Informatics and Epidemiology, Institute of Medical Biometry, Medical Faculty, University of Bonn, Bonn, Germany
| | - Jens Jordan
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
- Chair of Aerospace Medicine, University of Cologne, Cologne, Germany
| | - David Andrew Green
- European Space Agency, Cologne, Germany
- King’s College London, London, United Kingdom
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBRwyle GmbH, Cologne, Germany
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12
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Mechanical deconditioning of the heart due to long-term bed rest as observed on seismocardiogram morphology. NPJ Microgravity 2022; 8:25. [PMID: 35821029 PMCID: PMC9276739 DOI: 10.1038/s41526-022-00206-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/13/2022] [Indexed: 11/26/2022] Open
Abstract
During head-down tilt bed rest (HDT) the cardiovascular system is subject to headward fluid shifts. The fluid shift phenomenon is analogous to weightlessness experienced during spaceflight microgravity. The purpose of this study was to investigate the effect of prolonged 60-day bed rest on the mechanical performance of the heart using the morphology of seismocardiography (SCG). Three-lead electrocardiogram (ECG), SCG and blood pressure recordings were collected simultaneously from 20 males in a 60-day HDT study (MEDES, Toulouse, France). The study was divided into two campaigns of ten participants. The first commenced in January, and the second in September. Signals were recorded in the supine position during the baseline data collection (BDC) before bed rest, during 6° HDT bed rest and during recovery (R), post-bed rest. Using SCG and blood pressure at the finger, the following were determined: Pulse Transit Time (PTT); and left-ventricular ejection time (LVET). SCG morphology was analyzed using functional data analysis (FDA). The coefficients of the model were estimated over 20 cycles of SCG recordings of BDC12 and HDT52. SCG fiducial morphology AO (aortic valve opening) and AC (aortic valve closing) amplitudes showed significant decrease between BDC12 and HDT52 (p < 0.03). PTT and LVET were also found to decrease through HDT bed rest (p < 0.01). Furthermore, PTT and LVET magnitude of response to bed rest was found to be different between campaigns (p < 0.001) possibly due to seasonal effects on of the cardiovascular system. Correlations between FDA and cardiac timing intervals PTT and LVET using SCG suggests decreases in mechanical strength of the heart and increased arterial stiffness due to fluid shifts associated with the prolonged bed rest.
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13
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Möstl S, Hoffmann F, Hönemann JN, Alvero-Cruz JR, Rittweger J, Tank J, Jordan J. Utility of estimated pulse wave velocity for assessing vascular stiffness: comparison of methods. eLife 2022; 11:73428. [PMID: 35502896 PMCID: PMC9094741 DOI: 10.7554/elife.73428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 05/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Pulse wave velocity independently predicts cardiovascular risk. Easy to use single cuff oscillometric methods are utilized in clinical practice to estimate pulse wave velocity. We applied the approach in master athletes to assess possible beneficial effects of lifelong exercise on vascular health. Furthermore, we compared single cuff measurements with a two-cuff method in another cohort. Methods: We obtained single cuff upper arm oscillometric measurements thrice in 129 master athletes aged 35 to 86 years and estimated pulse wave velocity using the ArcSolver algorithm. We applied the same method in 24 healthy persons aged 24 to 55 years participating in a head down tilt bedrest study. In the latter group, we also obtained direct pulse wave velocity measurements using a thigh cuff. Results: Estimated pulse velocity very highly correlated with age (R2 = 0.90) in master athletes. Estimated pulse wave velocity values were located on the same regression line like values obtained in participants of the head down tilt bed rest study. The modest correlation between estimated and measured PWV (r2 0.40; p<0.05) was attenuated after adjusting for age; the mean difference between pulse wave velocity measurements was 1 m/s. Conclusion: Estimated pulse wave velocity mainly reflects the entered age rather than true vascular properties and, therefore, failed detecting beneficial effects of life long exercise. Funding: The AGBRESA-Study was funded by the German Aerospace Center (DLR), the European Space Agency (ESA, contract number 4000113871/15/NL/PG) and the National Aeronautics and Space Administration (NASA, contract number 80JSC018P0078). FH received funding by the DLR and the German Federal Ministry of Economy and Technology, BMWi (50WB1816). SM, JT and JJ were supported by the Austrian Federal Ministry for Climate Action, Environment, Energy, Mobility, Innovation and Technology, BMK (SPACE4ALL Project, FFG No. 866761).
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Affiliation(s)
- Stefan Möstl
- Department of Cardiovascular Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Fabian Hoffmann
- Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | | | - Jose Ramon Alvero-Cruz
- Department of Human Physiology and Physical Sports Education, University of Málaga, Málaga, Spain
| | - Jörn Rittweger
- Department of Cardiovascular Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Jens Tank
- Department of Cardiovascular Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Jens Jordan
- Department of Cardiovascular Aerospace Medicine, German Aerospace Center, Cologne, Germany
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14
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Jordan J, Limper U, Tank J. Cardiovascular autonomic nervous system responses and orthostatic intolerance in astronauts and their relevance in daily medicine. Neurol Sci 2022; 43:3039-3051. [PMID: 35194757 PMCID: PMC9018660 DOI: 10.1007/s10072-022-05963-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/17/2022] [Indexed: 11/12/2022]
Abstract
Background The harsh environmental conditions during space travel, particularly weightlessness, impose a major burden on the human body including the cardiovascular system. Given its importance in adjusting the cardiovascular system to environmental challenges, the autonomic nervous system has been in the focus of scientists and clinicians involved in human space flight. This review provides an overview on human autonomic research under real and simulated space conditions with a focus on orthostatic intolerance. Methods The authors conducted a targeted literature search using Pubmed. Results Overall, 120 articles were identified and included in the review. Conclusions Postflight orthostatic intolerance is commonly observed in astronauts and could pose major risks when landing on another celestial body. The phenomenon likely results from changes in volume status and adaptation of the autonomic nervous system to weightlessness. Over the years, various non-pharmacological and pharmacological countermeasures have been investigated. In addition to enabling safe human space flight, this research may have implications for patients with disorders affecting cardiovascular autonomic control on Earth.
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Affiliation(s)
- Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center DLR, Linder Hoehe, 51147, Cologne, Germany. .,Aerospace Medicine, Medical Faculty, University of Cologne, Cologne, Germany.
| | - Ulrich Limper
- Institute of Aerospace Medicine, German Aerospace Center DLR, Linder Hoehe, 51147, Cologne, Germany.,Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, Cologne, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center DLR, Linder Hoehe, 51147, Cologne, Germany
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15
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Jirak P, Mirna M, Rezar R, Motloch LJ, Lichtenauer M, Jordan J, Binneboessel S, Tank J, Limper U, Jung C. How spaceflight challenges human cardiovascular health. Eur J Prev Cardiol 2022; 29:1399-1411. [PMID: 35148376 DOI: 10.1093/eurjpc/zwac029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/08/2022] [Accepted: 02/06/2022] [Indexed: 11/14/2022]
Abstract
The harsh environmental conditions in space, particularly weightlessness and radiation exposure, can negatively affect cardiovascular function and structure. In the future, preventive cardiology will be crucial in enabling safe space travel. Indeed, future space missions destined to the Moon and from there to Mars will create new challenges to cardiovascular health while limiting medical management. Moreover, commercial spaceflight evolves rapidly such that older persons with cardiovascular risk factors will be exposed to space conditions. This review provides an overview on studies conducted in space and in terrestrial models, particularly head-down bedrest studies. These studies showed that weightlessness elicits a fluid shift towards the head, which likely predisposes to the spaceflight-associated neuro-ocular syndrome, neck vein thrombosis, and orthostatic intolerance after return to Earth. Moreover, cardiovascular unloading produces cardiopulmonary deconditioning which may be associated with cardiac atrophy. In addition to limiting physical performance, the mechanism further worsens orthostatic tolerance after return to Earth. Finally, space conditions may directly affect vascular health, however, the clinical relevance of these findings in terms of morbidity and mortality is unknown. Targeted preventive measures, which are referred to as countermeasures in aerospace medicine, and technologies to identify vascular risks early on will be required to maintain cardiovascular performance and health during future space missions.
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Affiliation(s)
- Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Moritz Mirna
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Richard Rezar
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas J Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Michael Lichtenauer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.,Medical Faculty, University of Cologne, Germany
| | - Stephan Binneboessel
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Ulrich Limper
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.,Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Germany
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16
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De Gioannis R, Ewald AC, Gerlach DA, Heusser K, Hoffmann F, Frings-Meuthen P, Heer M, Tank J, Jordan J. Effects of short-term hypercaloric nutrition on orthostatic tolerance in healthy individuals: a randomized controlled crossover study. Clin Auton Res 2022; 32:423-430. [PMID: 36195683 PMCID: PMC9719449 DOI: 10.1007/s10286-022-00900-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/21/2022] [Indexed: 01/31/2023]
Abstract
Reduced-caloric intake lowers blood pressure through sympathetic inhibition, and worsens orthostatic tolerance within days. Conversely, hypercaloric nutrition augments sympathetic activity and blood pressure. Because dietary interventions could be applied in patients with syncope, we tested the hypothesis that short-term hypercaloric dieting improves orthostatic tolerance. In a randomized crossover trial, 20 healthy individuals (7 women, 26.7 ± 8 years, 22.6 ± 2 kg/m2) followed a 4-day hypercaloric (25% increase of energy intake by fat) or normocaloric nutritional plan, with a washout period of at least 23 days between interventions. We then performed head-up tilt table testing with incremental lower body negative pressure while recording beat-by-beat blood pressure and heart rate. The primary endpoint was orthostatic tolerance defined as time to presyncope. Time to presyncope during combined head-up tilt and lower body negative pressure did not differ between hypercaloric and normocaloric dieting (median 23.19 versus 23.04 min, ratio of median 1.01, 95% CI of ratio 0.5-1.9). Heart rate, blood pressure, heart rate variability, and blood pressure variability in the supine position and during orthostatic testing did not differ between interventions. We conclude that 4 days of moderate hypercaloric nutrition does not significantly improve orthostatic tolerance in healthy individuals. Nevertheless, given the important interaction between energy balance and cardiovascular autonomic control in the brain, caloric intake deserves more attention as a potential contributor and treatment target for orthostatic intolerance.
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Affiliation(s)
- Riccardo De Gioannis
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
- Faculty of Medicine, Department III for Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ann C Ewald
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Darius A Gerlach
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Karsten Heusser
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Fabian Hoffmann
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
- Faculty of Medicine, Department III for Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Petra Frings-Meuthen
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Martina Heer
- IU International University of Applied Sciences, Erfurt, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe, 51147, Cologne, Germany.
- Chair of Aerospace Medicine, University of Cologne, Cologne, Germany.
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17
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Orter S, Möstl S, Bachler M, Hoffmann F, Mayer CC, Kaniusas E, Reisinger M, Wassertheurer S, Tank J, Jordan J, Hametner B. A comparison between left ventricular ejection time measurement methods during physiological changes induced by simulated microgravity. Exp Physiol 2021; 107:213-221. [PMID: 34921742 PMCID: PMC9303723 DOI: 10.1113/ep090103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/08/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? There are two aims of this study. First, we validated easy-to-use oscillometric LVET against the classical echocardiographic LVET. Second, we investigated the progression of LVETI, PEPI, QS2I and PEP/LVET ratio during 60 days HDT. What is the main finding and its importance? LVETosci and LVETecho showed good agreement in effect direction. Thus, LVETosci might be a useful measure to evaluate cardiovascular responses during space flight. Moreover, the approach may have utility for individual follow up of patients with altered ejection times. Furthermore, significant effects of 60 days HDT were captured by measurements of LVETI, PEPI, QS2I and PEP/LVET ratio. ABSTRACT Easy to detect systolic time intervals may be used as parameters reflecting cardiovascular deconditioning. We compared left ventricular ejection time (LVET) measured via ultrasound doppler on the left ventricular outflow tract with oscillometric measured LVET measured at the brachialis. Furthermore, we assessed the progression of left ventricular ejection time index (LVETI), pre-ejection period index (PEPI) the Weissler index (PEP/LVET) and the total electromechanical systole index (QS2I) during prolonged strict head-down tilt bedrest including 16 male and 8 female subjects. Simultaneous oscillometric and echocardiographic LVET measurements show significant correlation (r = 0.53 with p = .0084 before bedrest and r = 0.73 with p < .05 at the last day of bedrest). The shortening of LVET during head-down tilt bedrest measured with both approaches is highly concordant in their effect direction with a concordance rate of 0.96. Our results furthermore report a significant decrease of LVETI (p < .0001) and QS2I (p = .0992) as well as a prolongation of PEPI (p = .0049) and PEP/LVET (p = .0003) during head down tilt bedrest over 60 days. 4 days after bedrest LVETI fully recovers to its baseline value. Because of the relationship between shortening of LVETI and heart failure progression, the easy-to-use oscillometric method might be not only a useful measure to evaluate the cardiovascular system during space flights, butcould also be of high value in a clinical setting. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stefan Orter
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria.,Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
| | - Stefan Möstl
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Martin Bachler
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Fabian Hoffmann
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Christopher C Mayer
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Eugenijus Kaniusas
- Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
| | - Michaela Reisinger
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Bernhard Hametner
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
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18
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Möstl S, Orter S, Hoffmann F, Bachler M, Hametner B, Wassertheurer S, Rabineau J, Mulder E, Johannes B, Jordan J, Tank J. Limited Effect of 60-Days Strict Head Down Tilt Bed Rest on Vascular Aging. Front Physiol 2021; 12:685473. [PMID: 34122149 PMCID: PMC8194311 DOI: 10.3389/fphys.2021.685473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cardiovascular risk may be increased in astronauts after long term space flights based on biomarkers indicating premature vascular aging. We tested the hypothesis that 60 days of strict 6° head down tilt bed rest (HDTBR), an established space analog, promotes vascular stiffening and that artificial gravity training ameliorates the response. Methods We studied 24 healthy participants (8 women, 24–55 years, BMI = 24.3 ± 2.1 kg/m2) before and at the end of 60 days HDTBR. 16 subjects were assigned to daily artificial gravity. We applied echocardiography to measure stroke volume and isovolumetric contraction time (ICT), calculated aortic compliance (stroke volume/aortic pulse pressure), and assessed aortic distensibility by MRI. Furthermore, we measured brachial-femoral pulse wave velocity (bfPWV) and pulse wave arrival times (PAT) in different vascular beds by blood pressure cuffs and photoplethysmography. We corrected PAT for ICT (cPAT). Results In the pooled sample, diastolic blood pressure (+8 ± 7 mmHg, p < 0.001), heart rate (+7 ± 9 bpm, p = 0.002) and ICT (+8 ± 13 ms, p = 0.036) increased during HDTBR. Stroke volume decreased by 14 ± 15 ml (p = 0.001). bfPWV, aortic compliance, aortic distensibility and all cPAT remained unchanged. Aortic area tended to increase (p = 0.05). None of the parameters showed significant interaction between HDTBR and artificial gravity training. Conclusion 60 days HDTBR, while producing cardiovascular deconditioning and cephalad fluid shifts akin to weightlessness, did not worsen vascular stiffness. Artificial gravity training did not modulate the response.
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Affiliation(s)
- Stefan Möstl
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Stefan Orter
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Fabian Hoffmann
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Martin Bachler
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Bernhard Hametner
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Jérémy Rabineau
- Laboratory of Physics and Physiology, University of Brussels, Brussels, Belgium
| | - Edwin Mulder
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Bernd Johannes
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Jens Jordan
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Chair of Aerospace Medicine, University Hospital Cologne, Cologne, Germany
| | - Jens Tank
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
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19
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Hoffmann F, Moestl S, Wooten SV, Stray-Gundersen S, Tomczak CR, Tank J, Tanaka H, Rittweger J, Chilibeck PD. Left Ventricular Dimensions and Diastolic Function Are Different in Throwers, Endurance Athletes, and Sprinters From the World Masters Athletics Championships. Front Physiol 2021; 12:643764. [PMID: 33790804 PMCID: PMC8005638 DOI: 10.3389/fphys.2021.643764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/12/2021] [Indexed: 11/27/2022] Open
Abstract
There is controversy whether a lifetime of heavy resistance training, providing pressure-overload, is harmful for left ventricular function. We compared left ventricular dimensions and function in elite Masters athletes involved in throwing events (requiring strength; n = 21, seven females, 60 ± 14 years) to those involved in endurance events (n = 65, 25 females, 59 ± 10 years) and sprinting (n = 68, 21 females, 57 ± 13 years) at the 2018 World Masters Athletic Championships. Left ventricular dimensions and function were assessed with B-mode ultrasound and Doppler. The ratio of left ventricular early diastolic peak filling velocity to peak velocity during atrial contraction (E/A) across the mitral valve and the ratio of E to velocity of the E-wave (E’) across the lateral and septal mitral annulus (E/E’) were used as indexes of left ventricular diastolic function. Intra-ventricular septal wall thickness was greater in throwers compared to sprinters (11.9 ± 2.2 vs. 10.3 ± 2.3 mm; p = 0.01). Left ventricular end diastolic diameter/body surface area was higher in endurance athletes and sprinters vs. throwers (25.2 ± 3.0, 24.3 ± 3.1, and 22.0 ± 3.1 mm/m2, respectively, p < 0.01). The E/A was higher in endurance athletes and sprinters vs. throwers (1.35 ± 0.40, 1.37 ± 0.43, and 1.05 ± 0.41, respectively; p < 0.01). The E/E’ was lower in endurance athletes and sprinters vs. throwers (6.9 ± 1.8, 6.6 ± 1.9, and 8.1 ± 1.9, respectively, p < 0.05). Compared to age-matched historical controls (n > 1,000; E/A = 1.06; E/E’ = 7.5), left ventricular diastolic function was not different in throwers, but superior in endurance athletes and sprinters (p < 0.01). Masters throwers have altered left ventricular dimensions and function vs. other athletes, but a lifetime of heavy resistance training does not appear to alter left ventricular function compared to age-matched controls.
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Affiliation(s)
- Fabian Hoffmann
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Cardiology, University Hospital, Cologne, Germany
| | - Stefan Moestl
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Savannah V Wooten
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Sten Stray-Gundersen
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Corey R Tomczak
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jens Tank
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Jörn Rittweger
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Pediatrics and Adolescent Medicine, University Hospital, Cologne, Germany
| | - Philip D Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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