Evaluation of Central Fatigue by the Critical Flicker Fusion Threshold in Cyclists

Assessing Critical Flicker Fusion Frequency: Which Confounders? A Narrative Review

The critical flicker fusion frequency (cFFF) refers to the frequency at which a regularly recurring change of light stimuli is perceived as steady. The cFFF threshold is often assessed in clinics to evaluate the temporal characteristics of the visual system, making it a common test for eye diseases. Additionally, it serves as a helpful diagnostic tool for various neurological and internal diseases. In the field of diving/hyperbaric medicine, cFFF has been utilized to determine alertness and cognitive functions. Changes in the cFFF threshold have been linked to the influence of increased respiratory gas partial pressures, although there exist inconsistent results regarding this effect. Moreover, the use of flicker devices has produced mixed outcomes in previous studies. This narrative review aims to explore confounding factors that may affect the accuracy of cFFF threshold measurements, particularly in open-field studies. We identify five broad categories of such factors, including (1) participant characteristics, (2) optical factors, (3) smoking/drug use, (4) environmental aspects, and (5) breathing gases and partial pressures. We also discuss the application of cFFF measurements in the field of diving and hyperbaric medicine. In addition, we provide recommendations for interpreting changes in the cFFF threshold and how they are reported in research studies.

The theory of critical flicker fusion frequency and its application in cataracts

Background

Due to media opacity, it is usually difficult to accurately evaluate the postoperative visual acuity in cataracts patients. As a small and portable tool, the critical flicker fusion frequency (CFF) device reflects the temporal resolution of visual function and has been widely used in clinical research. However, poor understanding of the technique and equipment limitations have restricted its clinical application in China.

Main text

There was a decrease in the CFF value in various ophthalmic diseases, indicating that the CFF is sensitive to detect visual functional changes. A number of studies have shown that the CFF test can accurately distinguish patients with simple cataracts from those with cataracts combined with fundus disease, and, as a visual test, it can more accurately predict postoperative visual acuity without being affected by media opacity. This study comprehensive reviews the basic principles of CFF and its application in ophthalmology, especially in cataracts.

Conclusions

As one of the tools for dynamic visual function detection, the CFF test could help doctors to assess the possible presence of fundus disease in cataracts patients, especially in eyes with dense cataracts, and more precisely provide a reasonable visual prognosis than other available visual tests.

Influence of Two Exercise Programs on Heart Rate Variability, Body Temperature, Central Nervous System Fatigue, and Cortical Arousal after a Heart Attack

Cardiovascular diseases (CVD) are the leading cause of death globally. Cardiac rehabilitation (CR) programs' benefits are overall consensual; however, during exercise, progressive physiological effects have not been studied yet in cardiac patients. Our study aims to analyze physiological parameters of thermography, heart rate variability (HRV), blood pressure, central nervous system (CNS) fatigue, and cortical arousal in heart attack patients (HAP) who belong to CR programs of High-Intensity Interval Training (HIIT) and Moderate-intensity Continuous Training (MICT) compared to healthy participants. In this case control study, two HAP patients (both male, age 35 and 48, respectively) and two healthy people (both male, age 38 and 46, respectively) were randomly assigned in a 1:1:1:1 allocation ratio to one of four groups: cardiac MICT, cardiac HIIT, control MICT, and control HIIT. The HIIT at ≈85-95% of peak heart rate (HR) was followed by a one-minute recovery interval at 40% peakHR, and MICT at ≈70-75% of peakHR. Outcome measurements included thermography, HRV, blood pressure, CNS fatigue, and cortical arousal; The HAP presents more than twice the CNS fatigue in MICT than control participants, but HIIT has almost the same CNS fatigue in HAP and control. In addition, both of the HAP groups presented higher temperatures in the chest. The HIIT protocol showed better physiological responses during exercise, compared to MICT in HAP.

Central and Peripheral Fatigue in Physical Exercise Explained: A Narrative Review

The study of the origin and implications of fatigue in exercise has been widely investigated, but not completely understood given the complex multifactorial mechanisms involved. Then, it is essential to understand the fatigue mechanism to help trainers and physicians to prescribe an adequate training load. The present narrative review aims to analyze the multifactorial factors of fatigue in physical exercise. To reach this aim, a consensus and critical review were performed using both primary sources, such as scientific articles, and secondary ones, such as bibliographic indexes, web pages, and databases. The main search engines were PubMed, SciELO, and Google Scholar. Central and peripheral fatigue are two unison constructs part of the Integrative Governor theory, in which both psychological and physiological drives and requirements are underpinned by homeostatic principles. The relative activity of each one is regulated by dynamic negative feedback activity, as the fundamental general operational controller. Fatigue is conditioned by factors such as gender, affecting men and women differently. Sleep deprivation or psychological disturbances caused, for example, by stress, can affect neural activation patterns, realigning them and slowing down simple mental operations in the context of fatigue. Then, fatigue can have different origins not only related with physiological factors. Therefore, all these prisms must be considered for future approaches from sport and clinical perspectives.

cardiac autonomic control and neural arousal as indexes of fatigue in professional bus drivers

Background

Bus driving is a mentally demanding activity that requires prolonged attention to ensure safety. The aim of the study was to assess mental fatigue caused by driving a public bus and to find a profile of workers at higher risk.

Methods

We evaluated changes of critical flicker fusion (CFF) (index of central arousal) and heart rate variability (HRV) (index of autonomic balance) in a 6-hour driving shift on a real route, in 31 professional bus drivers, and we tested the influence of personal factors such as sleep quality, BMI, and age. Paired t-test was used to test differences of CFF and HRV between both initial and final phase of driving, while multiple linear regression tested the influence of personal variables on the indexes of mental fatigue.

Results

Results showed that CFF significantly decreased after 6 hours of bus driving (41.91 Hz, sd 3.31 vs. 41.15 Hz, sd 3.15; p = 0.041), and heart rate significantly decreased in the final phase of driving, with respect to the initial phase (85 vs. 78 bpm, p = 0.027). Increasing age (beta = -0.729, p = 0.022), risk of obstructive sleep apnea syndrome (beta = -0.530, p = 0.04), and diurnal sleepiness (beta = -0.406, p = 0.017) showed a significant effect on influencing mental fatigue.

Conclusion

Elderly drivers at higher risk of sleep disorders are more prone to mental fatigue, when exposed to driving activity. Monitoring indexes of central arousal and autonomic balance, coupled with the use of structured questionnaires can represent a useful strategy to detect profile of workers at higher risk of mental fatigue in such duty.

The Effect of Studying a Double Degree in the Psychophysiological Stress Response in the Bachelor's Thesis Defense

The aim of this research was to analyze the effect of studying a single or double degree in the psychophysiological stress response and academic performance of university students in their bachelor's thesis defense. We analyzed the autonomic stress response, cortical arousal, subjective distress perception, and the sense of objective and subjective academic fulfilment of 84 single-degree physiotherapy students and 26 double-degree sport sciences and physiotherapy students during their bachelor's thesis defense. The results showed that the bachelor's thesis defense was a stressful event for double-degree students, showing an activation of the sympathetic nervous system and presenting a higher autonomic habituation response for the double degree students compared to the single degree students. We found higher mean grades during the whole degree and higher grades in the written and oral bachelor's thesis academic achievements for single-degree students compared to double-degree students. No significant differences were found between single-degree and double-degree students in subjective distress perception and cortical arousal. No correlation was found between academic performance variables and subjective distress perception, cortical arousal, and autonomic modulation variables. We conclude that the bachelor's thesis defense produces a large anticipatory anxiety response in single-degree physiotherapy students and in double-degree sport sciences and physiotherapy students. Double-degree students showed higher levels of habituation and adaptability to the stressful event, with a better autonomic response. Academic achievements were significantly higher among single-degree students compared to the double-degree group.

Influence of the artificial turf certification on physical performance and muscle damage in football players (QUALTURF PROJECT)

This study aimed to analyse the influence of the FIFA Quality PRO certification of artificial turf pitches on the physical, physiological performance and muscle damage in soccer players. Fifteen healthy male players (21.2 ± 1.4 years; 178.2 ± 4.3 cm; 79.1 ± 8.3 kg) from a university football team were selected to participate in the research. Mechanical properties related to surface-player interaction were assessed on the two surfaces selected for this study. A randomized design was used and the players performed the Ball-sport Endurance and Sprint Test (BEAST90) on the different artificial turf fields. Average time of the 20 m sprints was longer on the FIFA Quality Pro surface than on the non-certified pitch (+ 0.13 s; p < 0.05; CI 95% - 0.01 to 0.27; ES: 0.305). The players' perceived effort was higher in the first (+ 2.64; p < 0.05; CI 95% 0.92 to 4.35; ES: 1.421) and the second half (+ 1.35; p < 0.05; CI 95% - 0.02 to 2.72; ES: 0.637) of the test on the FIFA Quality Pro field. Comparative analysis between surfaces showed no significant differences in the time spent in each of the heart rate zones and higher concentrations of CK (+ 196.58; p > 0.05; CI 95% 66.54 to 326.61; ES: 1.645) were evidenced in the non-certified pitch surface. In response to a simulated match protocol, markers of post-exercise muscle damage may be reduced on accredited artificial turf fields. These insights can provide the opportunity to maximize the efficiency of training sessions and reduce the risk of injury during the season.

The Impact of Nationality on the Psychophysiological Stress Response and Academic Fulfilment in the Final Degree Dissertation

The aims of this study were: i. to analyze the effect of nationality on the psychophysiological stress response of physiotherapy last year students in their final degree dissertations; and ii. to analyze the relationship between the stress response and academic results according to nationality. We evaluated the autonomic stress response, cortical arousal, distress subjective perception, and objective and subjective academic fulfilment in Spanish, Italian, and French physiotherapy students during their final degree dissertation. Results showed a large anticipatory anxiety response before the dissertation in the three student groups. Only the Spanish group showed an increased tendency in the habituation process, reducing the psychophysiological stress response during the dissertation, while the Italian and French groups maintained a large sympathetic activation until the end of the dissertation. Cortical arousal and subjective perception of distress were similar in the three nationalities. In addition, no correlation between academic fulfilment and autonomic modulation was found. We concluded that there was no nationality effect in the psychophysiological stress response of physiotherapy last year students in their final degree dissertation, all of them showing a large anticipatory anxiety response.

Impact of Weekly Physical Activity on Stress Response: An Experimental Study

The aim of this research is focused on analyzing the alteration of the psychophysiological and cognitive response to an objective computerized stress test (Determination Test - DT-, Vienna test System^®), when the behavioral response is controlled. The sample used was sports science students (N = 22), with a mean age of 22.82 (M_age = 22.82; SD_years = 3.67; M_{PhysicalActivity hours/Week} = 7.77; SD_hours/_week = 3.32) A quasi-experimental design was used in which the response of each participant to the DT test was evaluated. The variable “number of hours of physical activity per week” and the variable “level of behavioral response to stress” were controlled. Before and after this test, the following parameters were measured: activation and central fatigue (Critical Flicker Fusion Threshold (CFF Critical flicker fusion ascending and Critical flicker fusion descending; DC potential), and perceived exertion (Central Rating of Perceived Exertion and Peripheral Rating of Perceived Exertion). Significant differences were found in all of the measures indicated. The usefulness of this protocol and the measures used to analyze the stress response capacity of the study subjects are discussed.

Psychophysiological respond in a swimming ultra-endurance event

BACKGROUND

Ultra-endurance events under critical environmental conditions represent unique stress, resulting in acute marked adaptations to the cardiovascular, respiratory, metabolic and neuromuscular systems of the organism. In line with this, no studies in swimming events were found thus far.

METHODS

This research aimed to analyze the psychophysiological response of swimmers in an ultra-endurance swimming event. Changes in the rate of perceived exertion, blood lactate concentration, 1000m swimming time and cortical arousal were measured in 19 male volunteer swimmers (28.0±5.6 years; 175.0±7.9 cm; 70.1±7.8 kg) in 3 moments during a 24h swimming event.

RESULTS

We found a significant increase in lactate concentration after series 1, decreasing the values in series 2 and series 3. Cortical arousal decreased significantly in series 3 respect the basal sample. Rate of perceived exertion significantly increased in the swimming ultra-endurance event and 1000m swimming time was maintained during the series analyzed.

CONCLUSIONS

An ultra-endurance swimming event produced an increase in blood lactate concentration and rated of perceived exertion and a decrease in cortical arousal, not affecting average swimming velocity along the event.

The effect of final dissertation defense language, native vs. non-native, in the psychophysiological stress response of university students

The objective of this study was to analyze the effect of final dissertation defense language in the autonomic stress response and cortical arousal of Physiotherapy students. We analysed in 110 students divided in 2 groups: native language (83) and non-native language (27), the autonomic stress response in four different moments of the dissertation defense; the cortical arousal and subjective perception of distress before and after the dissertation; and academic performance perception of students and the real performance obtained. Results showed a high sympathetic modulation at the beginning of the evaluation, which was maintained until the end of the evaluation in both groups. In addition, no decrease in cortical activity was found, possibly due to the short time of exposure to the stressful event. The final dissertation defense of Physiotherapy students produces an anticipatory anxiety response and a maintained high sympathetic nervous system activation during the defense, not negatively affecting cortical arousal, regardless of defending in native or non-native language.

Autonomic and cortical response of soldiers in different combat scenarios

INTRODUCTION

The study of chronic and acute responses when exposed to extreme, aggressive and stressful environments, such as in combat environments, is becoming increasingly popular as such information leads to better optimisation of soldiers' physical and psychological performance, as well as mission effectiveness and efficiency. Due to internal complexity, uncertainty and variability of real combat scenarios, a specific approach to all possible types of military combat scenarios is necessary.

METHODS

Modifications in the autonomic modulation and cortical arousal before and after asymmetrical, symmetrical and close quarter combat simulations were analysed in 31 male professional veteran soldiers (age: 34.5±4.2 years) with between seven and 18 years of experience in their respective units, as well as experience in international missions in current conflict areas such as Lebanon, Afghanistan, Bosnia, Kosovo and Iraq.

RESULTS

The three combat situations produced a non-significant decrease in cortical arousal after combat simulations, presenting a trivial effect size in symmetrical and close quarter combat situations and a small effect size in asymmetrical situations. HR increased significantly in the three combat situations, and close quarter combat produced the highest sympathetic modulation of the three situations analysed.

CONCLUSION

Symmetrical, asymmetrical and close quarter combat situations produced an increase in sympathetic modulation, being highest in the close quarter combat situation, where actions are performed at a close distance and in closed spaces.