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McKenna MJ, Renaud JM, Ørtenblad N, Overgaard K. A century of exercise physiology: effects of muscle contraction and exercise on skeletal muscle Na +,K +-ATPase, Na + and K + ions, and on plasma K + concentration-historical developments. Eur J Appl Physiol 2024; 124:681-751. [PMID: 38206444 PMCID: PMC10879387 DOI: 10.1007/s00421-023-05335-9] [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: 02/02/2023] [Accepted: 09/27/2023] [Indexed: 01/12/2024]
Abstract
This historical review traces key discoveries regarding K+ and Na+ ions in skeletal muscle at rest and with exercise, including contents and concentrations, Na+,K+-ATPase (NKA) and exercise effects on plasma [K+] in humans. Following initial measures in 1896 of muscle contents in various species, including humans, electrical stimulation of animal muscle showed K+ loss and gains in Na+, Cl- and H20, then subsequently bidirectional muscle K+ and Na+ fluxes. After NKA discovery in 1957, methods were developed to quantify muscle NKA activity via rates of ATP hydrolysis, Na+/K+ radioisotope fluxes, [3H]-ouabain binding and phosphatase activity. Since then, it became clear that NKA plays a central role in Na+/K+ homeostasis and that NKA content and activity are regulated by muscle contractions and numerous hormones. During intense exercise in humans, muscle intracellular [K+] falls by 21 mM (range - 13 to - 39 mM), interstitial [K+] increases to 12-13 mM, and plasma [K+] rises to 6-8 mM, whilst post-exercise plasma [K+] falls rapidly, reflecting increased muscle NKA activity. Contractions were shown to increase NKA activity in proportion to activation frequency in animal intact muscle preparations. In human muscle, [3H]-ouabain-binding content fully quantifies NKA content, whilst the method mainly detects α2 isoforms in rats. Acute or chronic exercise affects human muscle K+, NKA content, activity, isoforms and phospholemman (FXYD1). Numerous hormones, pharmacological and dietary interventions, altered acid-base or redox states, exercise training and physical inactivity modulate plasma [K+] during exercise. Finally, historical research approaches largely excluded female participants and typically used very small sample sizes.
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Affiliation(s)
- Michael J McKenna
- Institute for Health and Sport, Victoria University, Melbourne, VIC, 8001, Australia.
- College of Physical Education, Southwest University, Chongqing, China.
- College of Sport Science, Zhuhai College of Science and Technology, Zhuhai, China.
| | - Jean-Marc Renaud
- Department of Cellular and Molecular Medicine, Neuromuscular Research Center, University of Ottawa, Ottawa, ON, Canada
| | - Niels Ørtenblad
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kristian Overgaard
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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2
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Renaud JM, Ørtenblad N, McKenna MJ, Overgaard K. Exercise and fatigue: integrating the role of K +, Na + and Cl - in the regulation of sarcolemmal excitability of skeletal muscle. Eur J Appl Physiol 2023; 123:2345-2378. [PMID: 37584745 PMCID: PMC10615939 DOI: 10.1007/s00421-023-05270-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
Perturbations in K+ have long been considered a key factor in skeletal muscle fatigue. However, the exercise-induced changes in K+ intra-to-extracellular gradient is by itself insufficiently large to be a major cause for the force decrease during fatigue unless combined to other ion gradient changes such as for Na+. Whilst several studies described K+-induced force depression at high extracellular [K+] ([K+]e), others reported that small increases in [K+]e induced potentiation during submaximal activation frequencies, a finding that has mostly been ignored. There is evidence for decreased Cl- ClC-1 channel activity at muscle activity onset, which may limit K+-induced force depression, and large increases in ClC-1 channel activity during metabolic stress that may enhance K+ induced force depression. The ATP-sensitive K+ channel (KATP channel) is also activated during metabolic stress to lower sarcolemmal excitability. Taking into account all these findings, we propose a revised concept in which K+ has two physiological roles: (1) K+-induced potentiation and (2) K+-induced force depression. During low-moderate intensity muscle contractions, the K+-induced force depression associated with increased [K+]e is prevented by concomitant decreased ClC-1 channel activity, allowing K+-induced potentiation of sub-maximal tetanic contractions to dominate, thereby optimizing muscle performance. When ATP demand exceeds supply, creating metabolic stress, both KATP and ClC-1 channels are activated. KATP channels contribute to force reductions by lowering sarcolemmal generation of action potentials, whilst ClC-1 channel enhances the force-depressing effects of K+, thereby triggering fatigue. The ultimate function of these changes is to preserve the remaining ATP to prevent damaging ATP depletion.
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Affiliation(s)
- Jean-Marc Renaud
- Faculty of Medicine, Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Rd., Ottawa, ON, K1H 8M5, Canada.
| | - Niels Ørtenblad
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Michael J McKenna
- Institute for Health and Sport, Victoria University, Melbourne, VIC, 8001, Australia
- College of Physical Education, Southwest University, Chongqing, China
- College of Sport Science, Zhuhai College of Science and Technology, Zhuhai, China
| | - Kristian Overgaard
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Van der Stede T, Spaas J, de Jager S, De Brandt J, Hansen C, Stautemas J, Vercammen B, De Baere S, Croubels S, Van Assche CH, Pastor BC, Vandenbosch M, Van Thienen R, Verboven K, Hansen D, Bové T, Lapauw B, Van Praet C, Decaestecker K, Vanaudenaerde B, Eijnde BO, Gliemann L, Hellsten Y, Derave W. Extensive profiling of histidine-containing dipeptides reveals species- and tissue-specific distribution and metabolism in mice, rats, and humans. Acta Physiol (Oxf) 2023; 239:e14020. [PMID: 37485756 DOI: 10.1111/apha.14020] [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: 03/31/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
AIM Histidine-containing dipeptides (HCDs) are pleiotropic homeostatic molecules with potent antioxidative and carbonyl quenching properties linked to various inflammatory, metabolic, and neurological diseases, as well as exercise performance. However, the distribution and metabolism of HCDs across tissues and species are still unclear. METHODS Using a sensitive UHPLC-MS/MS approach and an optimized quantification method, we performed a systematic and extensive profiling of HCDs in the mouse, rat, and human body (in n = 26, n = 25, and n = 19 tissues, respectively). RESULTS Our data show that tissue HCD levels are uniquely produced by carnosine synthase (CARNS1), an enzyme that was preferentially expressed by fast-twitch skeletal muscle fibres and brain oligodendrocytes. Cardiac HCD levels are remarkably low compared to other excitable tissues. Carnosine is unstable in human plasma, but is preferentially transported within red blood cells in humans but not rodents. The low abundant carnosine analogue N-acetylcarnosine is the most stable plasma HCD, and is enriched in human skeletal muscles. Here, N-acetylcarnosine is continuously secreted into the circulation, which is further induced by acute exercise in a myokine-like fashion. CONCLUSION Collectively, we provide a novel basis to unravel tissue-specific, paracrine, and endocrine roles of HCDs in human health and disease.
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Affiliation(s)
- Thibaux Van der Stede
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Jan Spaas
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- University MS Center (UMSC) Hasselt, Pelt, Belgium
- BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Sarah de Jager
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Jana De Brandt
- BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | - Camilla Hansen
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Jan Stautemas
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Bjarne Vercammen
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Siegrid De Baere
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, Ghent, Belgium
| | - Siska Croubels
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, Ghent, Belgium
| | - Charles-Henri Van Assche
- The Maastricht MultiModal Molecular Imaging (M4I) institute, Maastricht University, Maastricht, The Netherlands
| | - Berta Cillero Pastor
- The Maastricht MultiModal Molecular Imaging (M4I) institute, Maastricht University, Maastricht, The Netherlands
| | - Michiel Vandenbosch
- The Maastricht MultiModal Molecular Imaging (M4I) institute, Maastricht University, Maastricht, The Netherlands
| | - Ruud Van Thienen
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Kenneth Verboven
- BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | - Dominique Hansen
- BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital Hasselt, Hasselt, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Charles Van Praet
- Department of Urology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Karel Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Bart Vanaudenaerde
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Bert O Eijnde
- University MS Center (UMSC) Hasselt, Pelt, Belgium
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Division of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Lasse Gliemann
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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Wang J, Rindom E, Groennebaek T, Sieljacks P, Jakobsgaard JE, Farup J, Vissing K, Pedersen TH, de Paoli FV. Six weeks of high-load resistance and low-load blood flow restricted training increase Na/K-ATPase sub-units α2 and β1 equally, but does not alter ClC-1 abundance in untrained human skeletal muscle. J Muscle Res Cell Motil 2023; 44:25-36. [PMID: 37014477 DOI: 10.1007/s10974-023-09644-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/08/2023] [Indexed: 04/05/2023]
Abstract
Contractile function of skeletal muscle relies on the ability of muscle fibers to trigger and propagate action potentials (APs). These electrical signals are created by transmembrane ion transport through ion channels and membrane transporter systems. In this regard, the Cl- ion channel 1 (ClC-1) and the Na+/K--ATPase (NKA) are central for maintaining ion homeostasis across the sarcolemma during intense contractile activity. Therefore, this randomized controlled trial aimed to investigate the changes in ClC-1 and specific NKA subunit isoform expression in response to six weeks (18 training sessions) of high-load resistance exercise (HLRE) and low-load blood flow restricted resistance exercise (BFRRE), respectively. HLRE was conducted as 4 sets of 12 repetitions of knee extensions performed at 70% of 1 repetition maximum (RM), while BFRRE was conducted as 4 sets of knee extensions at 30% of 1RM performed to volitional fatigue. Furthermore, the potential associations between protein expression and contractile performance were investigated. We show that muscle ClC-1 abundance was not affected by either exercise modality, whereas NKA subunit isoforms [Formula: see text]2 and [Formula: see text]1 increased equally by appx. 80-90% with BFRRE (p < 0.05) and 70-80% with HLRE (p < 0.05). No differential impact between exercise modalities was observed. At baseline, ClC-1 protein expression correlated inversely with dynamic knee extensor strength (r=-0.365, p = 0.04), whereas no correlation was observed between NKA subunit content and contractile performance at baseline. However, training-induced changes in NKA [Formula: see text]2 subunit (r = 0.603, p < 0.01) and [Formula: see text]1 subunit (r = 0.453, p < 0.05) correlated with exercise-induced changes in maximal voluntary contraction. These results suggest that the initial adaptation to resistance-based exercise does not involve changes in ClC-1 abundance in untrained skeletal muscle, and that increased content of NKA subunits may facilitate increases in maximal force production.
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Affiliation(s)
- Jakob Wang
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Emil Rindom
- Department of Zoophysiology, Aarhus University, Aarhus, Denmark
| | - Thomas Groennebaek
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Sieljacks
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Jean Farup
- Department of Biomedicine - Physiology, Aarhus University, Ole Worms Allé, Building 1163, Aarhus C, DK-8000, Denmark
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Kristian Vissing
- Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Thomas Holm Pedersen
- Department of Biomedicine - Physiology, Aarhus University, Ole Worms Allé, Building 1163, Aarhus C, DK-8000, Denmark
| | - Frank Vincenzo de Paoli
- Department of Biomedicine - Physiology, Aarhus University, Ole Worms Allé, Building 1163, Aarhus C, DK-8000, Denmark.
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Kino K, Komabayashi T, Hashida A, Kuramoto A. Improving the enzymatic activity of l-amino acid α-ligase for imidazole dipeptide production by site-directed mutagenesis. Biosci Biotechnol Biochem 2023; 87:389-394. [PMID: 36694927 DOI: 10.1093/bbb/zbac213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023]
Abstract
Imidazole dipeptides, histidine-containing dipeptides, including carnosine (β-alanyl-l-histidine), anserine (β-alanyl-3-methyl-l-histidine), and balenine (β-alanyl-1-methyl-l-histidine) in animal muscles have physiological functions, such as significant antioxidant and antifatigue effects. They are obtained by extraction from natural raw materials, including chicken and fish meat. However, using natural raw materials entails stable supply and mass production limitations. l-amino acid α-ligase (Lal) catalyzes the formation of various dipeptides from unprotected l-amino acids by conjugating with adenosine 5'-triphosphate (ATP) hydrolysis reaction. In this study, site-directed mutagenesis of Lal was applied to establish an efficient method for producing imidazole dipeptides by the enzymatic process. We significantly improved the conversion rate from substrate amino acids compared with wild-type Lal.
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Affiliation(s)
- Kuniki Kino
- Department of Applied Chemistry, Faculty of Science and Engineering, Waseda University, 3-4-1 Ohkubo, Shinjuku-ku, Tokyo, Japan
- Research Institute for Science and Engineering, Waseda University, 3-4-1 Ohkubo, Shinjuku-ku, Tokyo, Japan
| | - Takuma Komabayashi
- Department of Applied Chemistry, Faculty of Science and Engineering, Waseda University, 3-4-1 Ohkubo, Shinjuku-ku, Tokyo, Japan
| | - Ayaka Hashida
- Department of Applied Chemistry, Faculty of Science and Engineering, Waseda University, 3-4-1 Ohkubo, Shinjuku-ku, Tokyo, Japan
| | - Ayumu Kuramoto
- Research Institute for Science and Engineering, Waseda University, 3-4-1 Ohkubo, Shinjuku-ku, Tokyo, Japan
- Food Research Institute, Tokai Bussan Co., Ltd., 2391 Kunimoto, Fukuroi, Shizuoka, Japan
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6
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Otani H. Prior heat exposure diminishes upper-body endurance work capacity and maximal arm and leg strength in young men. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:337-345. [PMID: 36449084 DOI: 10.1007/s00484-022-02411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Workers often experience heat exposure before manual labour. This study investigated whether prior heat exposure diminished upper-body endurance work capacity and maximal isokinetic arm and leg strength in young men. Ten male participants completed two trials in a climatic chamber maintained at 25°C with 50% relative humidity. The two trials required them to complete a 30-min pre-exercise water-immersion at either 40°C (HOT) to provoke an approximately 1°C rise in rectal temperature (Tre) or 36°C (CON) to maintain a normal Tre. Pre- and post-immersion and following arm-cranking, isokinetic maximal voluntary contraction (MVC) torque was assessed for the elbow flexors and knee extensors. During arm-cranking, time to exhaustion was measured using arm crank ergometry at 60% peak oxygen uptake. Electromyography was recorded from the elbow flexors and knee extensors to calculate the integrated electromyography. Tre at post-immersion was higher in HOT (Mean ± SD, 38.1 ± 0.3°C) than CON (37.1 ± 0.3°C; P < 0.01). Time to exhaustion was less in HOT (41 ± 13 min) than CON (52 ± 12 min; P < 0.01). Isokinetic MVC torque in the elbow flexors and knee extensors was lower in HOT than CON (both P < 0.05). The integrated electromyography of the elbow flexors and knee extensors were lower in HOT than CON (both P < 0.05). This study indicates that a 1°C rise in Tre by prior heat exposure reduces time to exhaustion during arm-cranking and isokinetic MVC torque of the elbow flexors and knee extensors. Workers should be careful about reductions in upper-body endurance work capacity and maximal arm and leg strength when exposed to heat before manual labour.
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Affiliation(s)
- Hidenori Otani
- Faculty of Health Care Sciences, Himeji Dokkyo University, 7-2-1 Kamiono, Himeji, Hyogo, 670-8524, Japan.
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7
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Carnosine synthase deficiency in mice affects protein metabolism in skeletal muscle. Biochem Biophys Res Commun 2022; 612:22-29. [DOI: 10.1016/j.bbrc.2022.04.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
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8
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Gollie JM, Patel SS, Harris-Love MO, Cohen SD, Blackman MR. Fatigability and the Role of Neuromuscular Impairments in Chronic Kidney Disease. Am J Nephrol 2022; 53:253-263. [PMID: 35344954 PMCID: PMC9871956 DOI: 10.1159/000523714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/16/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The combination of neuromuscular impairments plus psychosocial aspects of chronic kidney disease (CKD) may predispose these patients to greater risk for experiencing increased levels of fatigability. There has been extensive clinical and scientific interest in the problem of fatigue in CKD and end-stage kidney disease (ESKD) patients, whereas less attention has been directed to understanding fatigability. Accordingly, the primary purposes of this review are to (1) discuss fatigue and fatigability and their potential interactions in patients with CKD and ESKD, (2) provide evidence for increased fatigability in CKD and ESKD patients, (3) examine how commonly experienced neuromuscular impairments in CKD and ESKD patients may contribute to the severity of performance fatigability, and (4) highlight preliminary evidence on the effects of exercise as a potential clinical treatment for targeting fatigability in this population. SUMMARY Fatigue is broadly defined as a multidimensional construct encompassing a subjective lack of physical and/or mental energy that is perceived by the individual to interfere with usual or desired activities. In contrast, fatigability is conceptualized within the context of physical activity and is quantified as the interactions between reductions in objective measures of performance (i.e., performance fatigability) and perceptual adjustments regulating activity performance (i.e., perceived fatigability). We propose herein a conceptual model to extend current understandings of fatigability by considering the interactions among fatigue, perceived fatigability, and performance fatigability. Neuromuscular impairments reported in patients with CKD and ESKD, including reductions in force capacity, skeletal muscle atrophy, mitochondrial dysfunction, abnormal skeletal muscle excitability, and neurological complications, may each contribute to the greater performance fatigability observed in these patients. KEY MESSAGES Considering the interactions among fatigue, perceived fatigability, and performance fatigability provides a novel conceptual framework to advance the understanding of fatigability in CKD and ESKD patients. Measures of fatigability may provide valuable clinical insights into the overall health status of CKD and ESKD patients. Existing data suggest that CKD and ESKD patients are at greater risk of experiencing increased fatigability, partly due to neuromuscular impairments associated with reduced kidney function. Further investigations are warranted to determine the potential clinical role fatigability measures can play in monitoring the health of CKD and ESKD patients, and in identifying potential treatments targeting fatigability in this patient population.
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Affiliation(s)
- Jared M. Gollie
- Research Service, Washington DC VA Medical Center, Washington, DC, USA;,Department of Health, Human Function and Rehabilitation Sciences, George Washington University, Washington, DC, USA
| | - Samir S. Patel
- Renal Service, Washington DC VA Medical Center, Washington, DC, USA;,Department of Medicine, George Washington University, Washington, DC, USA
| | - Michael O. Harris-Love
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA;,Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Scott D. Cohen
- Renal Service, Washington DC VA Medical Center, Washington, DC, USA;,Department of Medicine, George Washington University, Washington, DC, USA
| | - Marc R. Blackman
- Research Service, Washington DC VA Medical Center, Washington, DC, USA;,Department of Medicine, George Washington University, Washington, DC, USA;,Departments of Medicine and Rehabilitation Medicine, Georgetown University, Washington, DC, USA
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9
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Hostrup M, Cairns SP, Bangsbo J. Muscle Ionic Shifts During Exercise: Implications for Fatigue and Exercise Performance. Compr Physiol 2021; 11:1895-1959. [PMID: 34190344 DOI: 10.1002/cphy.c190024] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Exercise causes major shifts in multiple ions (e.g., K+ , Na+ , H+ , lactate- , Ca2+ , and Cl- ) during muscle activity that contributes to development of muscle fatigue. Sarcolemmal processes can be impaired by the trans-sarcolemmal rundown of ion gradients for K+ , Na+ , and Ca2+ during fatiguing exercise, while changes in gradients for Cl- and Cl- conductance may exert either protective or detrimental effects on fatigue. Myocellular H+ accumulation may also contribute to fatigue development by lowering glycolytic rate and has been shown to act synergistically with inorganic phosphate (Pi) to compromise cross-bridge function. In addition, sarcoplasmic reticulum Ca2+ release function is severely affected by fatiguing exercise. Skeletal muscle has a multitude of ion transport systems that counter exercise-related ionic shifts of which the Na+ /K+ -ATPase is of major importance. Metabolic perturbations occurring during exercise can exacerbate trans-sarcolemmal ionic shifts, in particular for K+ and Cl- , respectively via metabolic regulation of the ATP-sensitive K+ channel (KATP ) and the chloride channel isoform 1 (ClC-1). Ion transport systems are highly adaptable to exercise training resulting in an enhanced ability to counter ionic disturbances to delay fatigue and improve exercise performance. In this article, we discuss (i) the ionic shifts occurring during exercise, (ii) the role of ion transport systems in skeletal muscle for ionic regulation, (iii) how ionic disturbances affect sarcolemmal processes and muscle fatigue, (iv) how metabolic perturbations exacerbate ionic shifts during exercise, and (v) how pharmacological manipulation and exercise training regulate ion transport systems to influence exercise performance in humans. © 2021 American Physiological Society. Compr Physiol 11:1895-1959, 2021.
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Affiliation(s)
- Morten Hostrup
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Simeon Peter Cairns
- SPRINZ, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand.,Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Jens Bangsbo
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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10
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Jukić I, Kolobarić N, Stupin A, Matić A, Kozina N, Mihaljević Z, Mihalj M, Šušnjara P, Stupin M, Ćurić ŽB, Selthofer-Relatić K, Kibel A, Lukinac A, Kolar L, Kralik G, Kralik Z, Széchenyi A, Jozanović M, Galović O, Medvidović-Kosanović M, Drenjančević I. Carnosine, Small but Mighty-Prospect of Use as Functional Ingredient for Functional Food Formulation. Antioxidants (Basel) 2021; 10:1037. [PMID: 34203479 PMCID: PMC8300828 DOI: 10.3390/antiox10071037] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
Carnosine is a dipeptide synthesized in the body from β-alanine and L-histidine. It is found in high concentrations in the brain, muscle, and gastrointestinal tissues of humans and is present in all vertebrates. Carnosine has a number of beneficial antioxidant properties. For example, carnosine scavenges reactive oxygen species (ROS) as well as alpha-beta unsaturated aldehydes created by peroxidation of fatty acid cell membranes during oxidative stress. Carnosine can oppose glycation, and it can chelate divalent metal ions. Carnosine alleviates diabetic nephropathy by protecting podocyte and mesangial cells, and can slow down aging. Its component, the amino acid beta-alanine, is particularly interesting as a dietary supplement for athletes because it increases muscle carnosine, and improves effectiveness of exercise and stimulation and contraction in muscles. Carnosine is widely used among athletes in the form of supplements, but rarely in the population of cardiovascular or diabetic patients. Much less is known, if any, about its potential use in enriched food. In the present review, we aimed to provide recent knowledge on carnosine properties and distribution, its metabolism (synthesis and degradation), and analytical methods for carnosine determination, since one of the difficulties is the measurement of carnosine concentration in human samples. Furthermore, the potential mechanisms of carnosine's biological effects in musculature, metabolism and on immunomodulation are discussed. Finally, this review provides a section on carnosine supplementation in the form of functional food and potential health benefits and up to the present, neglected clinical use of carnosine.
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Affiliation(s)
- Ivana Jukić
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
| | - Nikolina Kolobarić
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
| | - Ana Stupin
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Pathophysiology, Physiology and Immunology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 10E, HR-31000 Osijek, Croatia
| | - Anita Matić
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
| | - Nataša Kozina
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
| | - Zrinka Mihaljević
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
| | - Martina Mihalj
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Dermatology and Venereology, University Hospital Osijek, HR-31000 Osijek, Croatia
| | - Petar Šušnjara
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
| | - Marko Stupin
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department for Cardiovascular Disease, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Željka Breškić Ćurić
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Internal Medicine, General Hospital Vinkovci, Zvonarska 57, HR-32100 Vinkovci, Croatia
| | - Kristina Selthofer-Relatić
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department for Cardiovascular Disease, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Department for Internal Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Aleksandar Kibel
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department for Cardiovascular Disease, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Anamarija Lukinac
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Rheumatology, Clinical Immunology and Allergology, Clinical Hospital Center Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Luka Kolar
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Internal Medicine, Vukovar General Hospital, HR-32000 Vukovar, Croatia
| | - Gordana Kralik
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Nutricin j.d.o.o. Darda, HR-31326 Darda, Croatia
| | - Zlata Kralik
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Animal Production and Biotechnology, Faculty of Agrobiotechnical Sciences, Josip Juraj Strossmayer University of Osijek, Vladimira Preloga 1, HR-31000 Osijek, Croatia
| | - Aleksandar Széchenyi
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Chemistry, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 8/A, HR-31000 Osijek, Croatia
| | - Marija Jozanović
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Chemistry, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 8/A, HR-31000 Osijek, Croatia
| | - Olivera Galović
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Chemistry, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 8/A, HR-31000 Osijek, Croatia
| | - Martina Medvidović-Kosanović
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
- Department of Chemistry, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 8/A, HR-31000 Osijek, Croatia
| | - Ines Drenjančević
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia; (I.J.); (N.K.); (A.S.); (A.M.); (N.K.); (Z.M.); (M.M.); (P.Š.); (M.S.); (A.K.)
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia; (Ž.B.Ć.); (K.S.-R.); (A.L.); (L.K.); (G.K.); (Z.K.); (A.S.); (M.J.); (O.G.); (M.M.-K.)
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11
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Steward CH, Smith R, Stepto NK, Brown M, Ng I, McKenna MJ. A single oral glucose load decreases arterial plasma [K + ] during exercise and recovery. Physiol Rep 2021; 9:e14889. [PMID: 34110701 PMCID: PMC8191174 DOI: 10.14814/phy2.14889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
AIM We investigated whether acute carbohydrate ingestion reduced arterial potassium concentration ([K+ ]) during and after intense exercise and delayed fatigue. METHODS In a randomized, double-blind crossover design, eight males ingested 300 ml water containing 75 g glucose (CHO) or placebo (CON); rested for 60 min, then performed high-intensity intermittent cycling (HIIC) at 130% V ˙ O 2peak , comprising three 45-s exercise bouts (EB), then a fourth EB until fatigue. Radial arterial (a) and antecubital venous (v) blood was sampled at rest, before, during and after HIIC and analyzed for plasma ions and metabolites, with forearm arteriovenous differences (a-v diff) calculated to assess inactive forearm muscle effects. RESULTS Glucose ingestion elevated [glucose]a and [insulin]a above CON (p = .001), being, respectively, ~2- and ~5-fold higher during CHO at 60 min after ingestion (p = .001). Plasma [K+ ]a rose during and declined following each exercise bout in HIIC (p = .001), falling below baseline at 5 min post-exercise (p = .007). Both [K+ ]a and [K+ ]v were lower during CHO (p = .036, p = .001, respectively, treatment main effect). The [K+ ]a-v diff across the forearm widened during exercise (p = .001), returned to baseline during recovery, and was greater in CHO than CON during EB1, EB2 (p = .001) and EB3 (p = .005). Time to fatigue did not differ between trials. CONCLUSION Acute oral glucose ingestion, as used in a glucose tolerance test, induced a small, systemic K+ -lowering effect before, during, and after HIIC, that was detectable in both arterial and venous plasma. This likely reflects insulin-mediated, increased Na+ ,K+ -ATPase induced K+ uptake into non-contracting muscles. However, glucose ingestion did not delay fatigue.
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Affiliation(s)
| | - Robert Smith
- Institute for Health and SportVictoria UniversityMelbourneVICAustralia
- Department of AnaesthesiaWestern HospitalMelbourneVICAustralia
| | - Nigel K. Stepto
- Institute for Health and SportVictoria UniversityMelbourneVICAustralia
| | - Malcolm Brown
- Department of Biochemistry and PharmacologyUniversity of MelbourneMelbourneVICAustralia
| | - Irene Ng
- Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalMelbourneVICAustralia
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12
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Muscle Glycogen Metabolism and High-Intensity Exercise Performance: A Narrative Review. Sports Med 2021; 51:1855-1874. [PMID: 33900579 DOI: 10.1007/s40279-021-01475-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 02/06/2023]
Abstract
Muscle glycogen is the main substrate during high-intensity exercise and large reductions can occur after relatively short durations. Moreover, muscle glycogen is stored heterogeneously and similarly displays a heterogeneous and fiber-type specific depletion pattern with utilization in both fast- and slow-twitch fibers during high-intensity exercise, with a higher degradation rate in the former. Thus, depletion of individual fast- and slow-twitch fibers has been demonstrated despite muscle glycogen at the whole-muscle level only being moderately lowered. In addition, muscle glycogen is stored in specific subcellular compartments, which have been demonstrated to be important for muscle function and should be considered as well as global muscle glycogen availability. In the present review, we discuss the importance of glycogen metabolism for single and intermittent bouts of high-intensity exercise and outline possible underlying mechanisms for a relationship between muscle glycogen and fatigue during these types of exercise. Traditionally this relationship has been attributed to a decreased ATP resynthesis rate due to inadequate substrate availability at the whole-muscle level, but emerging evidence points to a direct coupling between muscle glycogen and steps in the excitation-contraction coupling including altered muscle excitability and calcium kinetics.
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13
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Behm DG, Alizadeh S, Hadjizedah Anvar S, Hanlon C, Ramsay E, Mahmoud MMI, Whitten J, Fisher JP, Prieske O, Chaabene H, Granacher U, Steele J. Non-local Muscle Fatigue Effects on Muscle Strength, Power, and Endurance in Healthy Individuals: A Systematic Review with Meta-analysis. Sports Med 2021; 51:1893-1907. [PMID: 33818751 DOI: 10.1007/s40279-021-01456-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The fatigue of a muscle or muscle group can produce global responses to a variety of systems (i.e., cardiovascular, endocrine, and others). There are also reported strength and endurance impairments of non-exercised muscles following the fatigue of another muscle; however, the literature is inconsistent. OBJECTIVE To examine whether non-local muscle fatigue (NLMF) occurs following the performance of a fatiguing bout of exercise of a different muscle(s). DESIGN Systematic review and meta-analysis. SEARCH AND INCLUSION A systematic literature search using a Boolean search strategy was conducted with PubMed, SPORTDiscus, Web of Science, and Google Scholar in April 2020, and was supplemented with additional 'snowballing' searches up to September 2020. To be included in our analysis, studies had to include at least one intentional performance measure (i.e., strength, endurance, or power), which if reduced could be considered evidence of muscle fatigue, and also had to include the implementation of a fatiguing protocol to a location (i.e., limb or limbs) that differed to those for which performance was measured. We excluded studies that measured only mechanistic variables such as electromyographic activity, or spinal/supraspinal excitability. After search and screening, 52 studies were eligible for inclusion including 57 groups of participants (median sample = 11) and a total of 303 participants. RESULTS The main multilevel meta-analysis model including all effects sizes (278 across 50 clusters [median = 4, range = 1 to 18 effects per cluster) revealed a trivial point estimate with high precision for the interval estimate [- 0.02 (95% CIs = - 0.14 to 0.09)], yet with substantial heterogeneity (Q(277) = 642.3, p < 0.01), I2 = 67.4%). Subgroup and meta-regression analyses showed that NLMF effects were not moderated by study design (between vs. within-participant), homologous vs. heterologous effects, upper or lower body effects, participant training status, sex, age, the time of post-fatigue protocol measurement, or the severity of the fatigue protocol. However, there did appear to be an effect of type of outcome measure where both strength [0.11 (95% CIs = 0.01-0.21)] and power outcomes had trivial effects [- 0.01 (95% CIs = - 0.24 to 0.22)], whereas endurance outcomes showed moderate albeit imprecise effects [- 0.54 (95% CIs = - 0.95 to - 0.14)]. CONCLUSIONS Overall, the findings do not support the existence of a general NLMF effect; however, when examining specific types of performance outcomes, there may be an effect specifically upon endurance-based outcomes (i.e., time to task failure). However, there are relatively fewer studies that have examined endurance effects or mechanisms explaining this possible effect, in addition to fewer studies including women or younger and older participants, and considering causal effects of prior training history through the use of longitudinal intervention study designs. Thus, it seems pertinent that future research on NLMF effects should be redirected towards these still relatively unexplored areas.
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Affiliation(s)
- David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Saman Hadjizedah Anvar
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada.,University of Tehran, Tehran, Iran
| | - Courtney Hanlon
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Emma Ramsay
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | - Joseph Whitten
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - James P Fisher
- School of Sport, Health and Social Science, Solent University, Southampton, UK
| | - Olaf Prieske
- Division of Exercise and Movement, University of Applied Sciences for Sport and Management Potsdam, Potsdam, Germany
| | - Helmi Chaabene
- Division of Training and Movement Science, University of Potsdam, Potsdam, Germany
| | - Urs Granacher
- Division of Training and Movement Science, University of Potsdam, Potsdam, Germany
| | - James Steele
- School of Sport, Health and Social Science, Solent University, Southampton, UK.,Ukactive Research Institute, London, UK
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14
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Behm DG, Alizadeh S, Drury B, Granacher U, Moran J. Non-local acute stretching effects on strength performance in healthy young adults. Eur J Appl Physiol 2021; 121:1517-1529. [PMID: 33715049 DOI: 10.1007/s00421-021-04657-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/01/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Static stretching (SS) can impair performance and increase range of motion of a non-exercised or non-stretched muscle, respectively. An underdeveloped research area is the effect of unilateral stretching on non-local force output. OBJECTIVE The objective of this review was to describe the effects of unilateral SS on contralateral, non-stretched, muscle force and identify gaps in the literature. METHODS A systematic literature search following preferred reporting items for systematic review and meta-analyses Protocols guidelines was performed according to prescribed inclusion and exclusion criteria. Weighted means and ranges highlighted the non-local force output response to unilateral stretching. The physiotherapy evidence database scale was used to assess study risk of bias and methodological quality. RESULTS Unilateral stretching protocols from six studies involved 6.3 ± 2 repetitions of 36.3 ± 7.4 s with 19.3 ± 5.7 s recovery between stretches. The mean stretch-induced force deficits exhibited small magnitude effect sizes for both the stretched (-6.7 ± 7.1%, d = -0.35: 0.01 to -1.8) and contralateral, non-stretched, muscles (-4.0 ± 4.9%, d = , 0.22: 0.08 to 1.1). Control measures exhibited trivial deficits. CONCLUSION The limited literature examining non-local effects of prolonged SS revealed that both the stretched and contralateral, non-stretched, limbs of young adults demonstrate small magnitude force deficits. However, the frequency of studies with these effects were similar with three measures demonstrating deficits, and four measures showing trivial changes. These results highlight the possible global (non-local) effects of prolonged SS. Further research should investigate effects of lower intensity stretching, upper versus lower body stretching, different age groups, incorporate full warm-ups, and identify predominant mechanisms among others.
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Affiliation(s)
- David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's,, Newfoundland and Labrador, Canada.
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's,, Newfoundland and Labrador, Canada
| | - Ben Drury
- Department of Applied Sport Sciences, Hartpury University, Gloucester, UK
| | - Urs Granacher
- Division of Training and Movement Science, University of Potsdam, Potsdam, Germany
| | - Jason Moran
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex, UK
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15
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Bertuzzi R, Silva-Cavalcante MD, Couto PG, Azevedo RDA, Coelho DB, Zagatto A, Lima-Silva AE, Millet GY. Prior Upper Body Exercise Impairs 4-km Cycling Time-Trial Performance Without Altering Neuromuscular Function. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2021; 92:52-62. [PMID: 32023177 DOI: 10.1080/02701367.2019.1708844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
Purpose: This study investigated the effects of previous exhaustive upper body exercise on performance and neuromuscular fatigue following a 4-km cycling time-trial (4-km TT). Methods: Eight recreational cyclists performed a 4-km TT with (ARMPRE) or without (CONTR) a previous arm-crank maximal incremental test. In each experimental session, neuromuscular fatigue was evaluated with a series of electrically evoked and maximal voluntary isometric contractions (MVC). Oxygen uptake ( V ˙ O2), heart rate, electromyographic muscle activity (EMGRMS) and rating of perceived exertion (RPE) were also recorded throughout the 4-km TT. Results: The average power output during the 4-km TT was reduced (P = .027) for the ARMPRE (299 ± 59 W) group, compared with CONTR (310 ± 59 W) and overall performance in 4-km TT was impaired (P = .021) in ARMPRE (382 ± 28 s) compared with CONTR (376 ± 27 s). The decrease observed in MVC (P = .033) and potentiated peak twitch force (P = .004) at post-TT were similar between the ARMPRE and CONTR conditions (P = .739 and P = .493, respectively). There was no (P = .619) change in voluntary activation at post-TT between conditions. V ˙ O2, EMGRMS and RPE measured throughout the 4-km TT were not significantly different between the conditions (P = .558, P = .558 and P = .940, respectively). The rate of RPE change relative to power output average and heart rate was higher (P = .030 and P = .013, respectively) in ARMPRE (0.031 ± 0.018 AU/W and 168 ± 8 bpm) than CONTR (0.022 ± 0.010 AU/W and 161 ± 7 bpm). Conclusion: These results suggest that impaired performance in ARMPRE was mostly due to pronounced perception of effort rather than neuromuscular fatigue.
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16
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Lindinger MI, Cairns SP. Regulation of muscle potassium: exercise performance, fatigue and health implications. Eur J Appl Physiol 2021; 121:721-748. [PMID: 33392745 DOI: 10.1007/s00421-020-04546-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/29/2020] [Indexed: 12/30/2022]
Abstract
This review integrates from the single muscle fibre to exercising human the current understanding of the role of skeletal muscle for whole-body potassium (K+) regulation, and specifically the regulation of skeletal muscle [K+]. We describe the K+ transport proteins in skeletal muscle and how they contribute to, or modulate, K+ disturbances during exercise. Muscle and plasma K+ balance are markedly altered during and after high-intensity dynamic exercise (including sports), static contractions and ischaemia, which have implications for skeletal and cardiac muscle contractile performance. Moderate elevations of plasma and interstitial [K+] during exercise have beneficial effects on multiple physiological systems. Severe reductions of the trans-sarcolemmal K+ gradient likely contributes to muscle and whole-body fatigue, i.e. impaired exercise performance. Chronic or acute changes of arterial plasma [K+] (hyperkalaemia or hypokalaemia) have dangerous health implications for cardiac function. The current mechanisms to explain how raised extracellular [K+] impairs cardiac and skeletal muscle function are discussed, along with the latest cell physiology research explaining how calcium, β-adrenergic agonists, insulin or glucose act as clinical treatments for hyperkalaemia to protect the heart and skeletal muscle in vivo. Finally, whether these agents can also modulate K+-induced muscle fatigue are evaluated.
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Affiliation(s)
- Michael I Lindinger
- Research and Development, The Nutraceutical Alliance, Burlington, ON, L7N 2Z9, Canada
| | - Simeon P Cairns
- SPRINZ, School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, 1020, New Zealand.
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, 1020, New Zealand.
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17
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Szczerbinski L, Golonko A, Taylor M, Puchta U, Konopka P, Paszko A, Citko A, Szczerbinski K, Gorska M, Zabielski P, Błachnio-Zabielska A, Larsen S, Kretowski A. Metabolomic Profile of Skeletal Muscle and Its Change Under a Mixed-Mode Exercise Intervention in Progressively Dysglycemic Subjects. Front Endocrinol (Lausanne) 2021; 12:778442. [PMID: 34938272 PMCID: PMC8685540 DOI: 10.3389/fendo.2021.778442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Skeletal muscles play an essential role in whole-body glucose homeostasis. They are a key organ system engaged in the development of insulin resistance, and also a crucial tissue mediating the beneficial metabolic effects of physical activity. However, molecular mechanisms underlying both these processes in skeletal muscle remain unclear. The aim of our study was to compare metabolomic profiles in skeletal muscle of patients at different stages of dysglycemia, from normoglycemia through prediabetes to T2D, and its changes under a mixed-mode (strength and endurance) exercise intervention. We performed targeted metabolomics comprising several major metabolite classes, including amino acids, biogenic amines and lipid subgroups in skeletal muscles of male patients. Dysglycemic groups differed significantly at baseline in lysophosphatidylcholines, phosphatidylcholines, sphingomyelins, glutamine, ornithine, and carnosine. Following the exercise intervention, we detected significant changes in lipids and metabolites related to lipid metabolism, including in ceramides and acylcarnitines. With their larger and more significant change over the intervention and among dysglycemic groups, these findings suggest that lipid species may play a predominant role in both the pathogenesis of type 2 diabetes and its protection by exercise. Simultaneously, we demonstrated that amino acid metabolism, especially glutamate dysregulation, is correlated to the development of insulin resistance and parallels disturbances in lipid metabolites.
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Affiliation(s)
- Lukasz Szczerbinski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
- *Correspondence: Lukasz Szczerbinski,
| | - Aleksandra Golonko
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Mark Taylor
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
- Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, United States
| | - Urszula Puchta
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Paulina Konopka
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Adam Paszko
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Anna Citko
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Karol Szczerbinski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Maria Gorska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Zabielski
- Department of Medical Biology, Medical University of Bialystok, Bialystok, Poland
| | | | - Steen Larsen
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Adam Kretowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
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18
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The Relationship Between Repeated-Sprint Ability, Aerobic Capacity, and Oxygen Uptake Recovery Kinetics in Female Soccer Athletes. J Hum Kinet 2020; 75:115-126. [PMID: 33312300 PMCID: PMC7706679 DOI: 10.2478/hukin-2020-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study investigated the relationship between repeated-sprint ability, aerobic capacity, and oxygen uptake kinetics during the transition between exercise and recovery (off-transient) in female athletes of an intermittent sport modality. Eighteen professional soccer players completed three tests: 1) a maximal incremental exercise test; 2) a constant speed time-to-exhaustion test; and 3) a repeated-sprint ability test consisting of six 40-m sprints with 20 s of passive recovery in-between. Correlations between time-to-exhaustion, repeated-sprint ability, and oxygen uptake kinetics were calculated afterwards. The level of significance was set at p < 0.05. A performance decrement during repeated-sprint ability was found to be related to: 1) time-to-exhaustion (e.g., exercise tolerance; r = -0.773, p < 0.001); 2) oxygen uptake recovery time (r = 0.601, p = 0.008); and 3) oxygen uptake mean response time of recovery (r = 0.722, p < 0.001). Moreover, the best sprint time (r = -0.601, p = 0.008) and the mean sprint time (r = -0.608, p = 0.007) were found to be related to maximal oxygen uptake. Collectively, these results reinforce the relation between oxygen uptake kinetics and the ability to maintain sprint performance in female athletes. These results may contribute to coaches and training staff of female soccer teams to focus on training and improve their athletes’ aerobic capacity and recovery capacity to improve intermittent exercise performance.
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19
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Palucci Vieira LH, Arins FB, Guglielmo LGA, de Lucas RD, Carminatti LJ, Santiago PRP. Game Running Performance and Fitness in Women’s Futsal. Int J Sports Med 2020; 42:74-81. [DOI: 10.1055/a-1202-1496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe study aimed to verify possible associations between game-play running
performance and outcomes derived from fitness (running) tests in female futsal
players. Sixteen women professional elite futsal players from a 1st
division league team (19.2±2 years-old, 4.3±2.1 years of
experience) participated. Firstly, a graded incremental treadmill test was
adopted to determine maximal oxygen uptake (VO2max). Following
72 h of laboratory protocol, players were asked to perform a
repeated-sprint test on a court (8×40 m with two 180°
change-of-directions). Twenty-four hours after, players participated in a
one-off friendly game (two 20-min half-times). A computerized automatic image
recognition software (DVIDEOW; 30 Hz) allowed to determine game running
performance variables. Fatigue index and best time in the court test and
VO2max and its attached speed derived from laboratory-based test
showed significant moderate-to-moderately high correlations
(r=− 0.59–0.76; p<0.05) with some game
running performance outputs, notably related to high-intensity running. In
conclusion, the present study provided initial evidence on associations between
two fitness tests and one-off game running performance in female futsal.
Information derived from the work potentially help conditioning professionals
working with female futsal athletes gain awareness about some properties of
common testing tools.
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Affiliation(s)
- Luiz Henrique Palucci Vieira
- Faculty of Sciences, UNESP, Bauru, Brazil
- School of Physical Education and Sport of Ribeirão Preto,
University of São Paulo (USP), Ribeirão Preto,
Brazil
| | - Francimara Budal Arins
- Physical Effort Laboratory, Sports Center, Federal University of Santa
Catarina, Florianópolis, Brazil
| | | | - Ricardo Dantas de Lucas
- Physical Effort Laboratory, Sports Center, Federal University of Santa
Catarina, Florianópolis, Brazil
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20
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Greenhouse-Tucknott A, Wrightson JG, Raynsford M, Harrison NA, Dekerle J. Interactions between perceptions of fatigue, effort, and affect decrease knee extensor endurance performance following upper body motor activity, independent of changes in neuromuscular function. Psychophysiology 2020; 57:e13602. [PMID: 32578885 DOI: 10.1111/psyp.13602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022]
Abstract
Prior exercise has previously been shown to impair subsequent endurance performance in non-activated muscles. Declines in the neuromuscular function and altered perceptual/affective responses offer possible mechanisms through which endurance performance may be limited in these remote muscle groups. We thus conducted two experiments to better understand these performance-limiting mechanisms. In the first experiment, we examined the effect of prior handgrip exercise on the behavioral, perceptual, and affective responses to a sustained, sub-maximal contraction of the knee extensors. In the second experiment, transcranial magnetic stimulation was used to assess the neuromuscular function of the knee extensors before and after the handgrip exercise. The results of the first experiment demonstrated prior handgrip exercise increased the perceptions of effort and reduced affective valence during the subsequent knee extensor endurance exercise. Both effort and affect were associated with endurance performance. Subjective ratings of fatigue were also increased by the preceding handgrip exercise but were not directly related to knee extensor endurance performance. However, perceptions of fatigue were correlated with heightened effort perception and reduced affect during the knee extensor contraction. In the second experiment, prior handgrip exercise did not significantly alter the neuromuscular function of the knee extensors. The findings of the present study indicate that motor performance in the lower limbs following demanding exercise in the upper body appears to be regulated by complex, cognitive-emotional interactions, which may emerge independent of altered neuromuscular function. Subjective fatigue states are implicated in the control of perceptual and affective processes responsible for the regulation of endurance performance.
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Affiliation(s)
| | - J G Wrightson
- Fatigue and Exercise Laboratory, University of Brighton, Brighton, UK.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Raynsford
- Fatigue and Exercise Laboratory, University of Brighton, Brighton, UK
| | - N A Harrison
- Immunopsychiatry Research Group, Cardiff University, Cardiff, UK.,Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - J Dekerle
- Fatigue and Exercise Laboratory, University of Brighton, Brighton, UK
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21
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Everaert I, He J, Hanssens M, Stautemas J, Bakker K, Albrecht T, Zhang S, Van der Stede T, Vanhove K, Hoetker D, Howsam M, Tessier FJ, Yard B, Baba SP, Baelde HJ, Derave W. Carnosinase-1 overexpression, but not aerobic exercise training, affects the development of diabetic nephropathy in BTBR ob/ob mice. Am J Physiol Renal Physiol 2020; 318:F1030-F1040. [PMID: 32150446 DOI: 10.1152/ajprenal.00329.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Manipulation of circulating histidine-containing dipeptides (HCD) has been shown to affect the development of diabetes and early-stage diabetic nephropathy (DN). The aim of the present study was to investigate whether such interventions, which potentially alter levels of circulating HCD, also affect the development of advanced-stage DN. Two interventions, aerobic exercise training and overexpression of the human carnosinase-1 (hCN1) enzyme, were tested. BTBR ob/ob mice were either subjected to aerobic exercise training (20 wk) or genetically manipulated to overexpress hCN1, and different diabetes- and DN-related markers were compared with control ob/ob and healthy (wild-type) mice. An acute exercise study was performed to elucidate the effect of obesity, acute running, and hCN1 overexpression on plasma HCD levels. Chronic aerobic exercise training did not affect the development of diabetes or DN, but hCN1 overexpression accelerated hyperlipidemia and aggravated the development of albuminuria, mesangial matrix expansion, and glomerular hypertrophy of ob/ob mice. In line, plasma, kidney, and muscle HCD were markedly lower in ob/ob versus wild-type mice, and plasma and kidney HCD in particular were lower in ob/ob hCN1 versus ob/ob mice but were unaffected by aerobic exercise. In conclusion, advanced glomerular damage is accelerated in mice overexpressing the hCN1 enzyme but not protected by chronic exercise training. Interestingly, we showed, for the first time, that the development of DN is closely linked to renal HCD availability. Further research will have to elucidate whether the stimulation of renal HCD levels can be a therapeutic strategy to reduce the risk for developing DN.
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Affiliation(s)
- Inge Everaert
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Junling He
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maxime Hanssens
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Jan Stautemas
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Kim Bakker
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas Albrecht
- Fifth Medical Department, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Shiqi Zhang
- Fifth Medical Department, Universitätsklinikum Mannheim, Mannheim, Germany
| | | | - Kenneth Vanhove
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - David Hoetker
- Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky
| | - Michael Howsam
- Inserm, CHU Lille, Pasteur Institute of Lille, University of Lille, Lille, France
| | - Frédéric J Tessier
- Inserm, CHU Lille, Pasteur Institute of Lille, University of Lille, Lille, France
| | - Benito Yard
- Fifth Medical Department, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Shahid P Baba
- Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky
| | - Hans J Baelde
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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22
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Aboodarda SJ, Iannetta D, Emami N, Varesco G, Murias JM, Millet GY. Effects of pre-induced fatigue vs. concurrent pain on exercise tolerance, neuromuscular performance and corticospinal responses of locomotor muscles. J Physiol 2020; 598:285-302. [PMID: 31826296 DOI: 10.1113/jp278943] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS Fatigue and muscle pain induced in a remote muscle group has been shown to alter neuromuscular performance in exercising muscles. Inhibitory neural feedback associated with activation of mechano- and metabo-sensitive muscle afferents has been implicated in this phenomenon. The present study aimed to quantify and compare the effects of pre-induced fatigue and concurrent rising pain (evoked by muscle ischaemia) on the contralateral leg exercise capacity, neuromuscular performance, and corticomotor excitability and inhibition of knee extensor muscles. Pre-induced fatigue in one leg had a greater detrimental effect than the concurrent rising pain on the contralateral limb cycling capacity. Furthermore, pre-induced fatigue, but not concurrent rising pain, reduced corticospinal inhibition recorded from tested contralateral muscles. Regardless of the origin or mechanisms modulating sensory afferents during single-leg cycling exercise (i.e. pre-induced fatigue vs. concurrent rising pain), the limit of exercise tolerance remained the same and exercise was terminated upon achievement of a sensory tolerance limit. ABSTRACT Individuals often need to maintain voluntary contractions during high intensity exercise in the presence of fatigue and pain. This investigation examined the effects of pre-induced fatigue and concurrent rising pain (evoked by muscle ischaemia) in one leg on motor fatigability and corticospinal excitability/inhibition of the contralateral limb. Twelve healthy males undertook four experimental protocols including unilateral cycling to task failure at 80% of peak power output with: (i) the right-leg (RL); (ii) the left-leg (LL); (iii) RL immediately preceded by LL protocol (FAT-RL); and (iv) RL when blood flow was occluded in the contralateral (left) leg (PAIN-RL). Participants performed maximal and submaximal 5 s right-leg knee extensions during which transcranial magnetic and femoral nerve electrical stimuli were delivered to elicit motor-evoked and compound muscle action potentials, respectively. The pre-induced fatigue reduced the right leg cycling time-to-task failure (mean ± SD; 332 ± 137 s) to a greater extent than concurrent pain (460 ± 158 s), compared to RL (580 ± 226 s) (P < 0.001). The maximum voluntary contraction force declined less following FAT-RL (P < 0.019) and PAIN-RL (P < 0.032) compared to RL. Voluntary activation declined and the corticospinal excitability recorded from knee extensors increased similarly after the three conditions (P < 0.05). However, the pre-induced fatigue, but not concurrent pain, reduced corticospinal inhibition compared to RL (P < 0.05). These findings suggest that regardless of the origin and/or mechanisms modulating sensory afferent feedback during single-leg cycling (e.g. pre-induced fatigue vs. concurrent rising pain), the limit of exercise tolerance remains the same, suggesting that exercise will be terminated upon achievement of sensory tolerance limit.
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Affiliation(s)
| | - Danilo Iannetta
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Nader Emami
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Guillaume Y Millet
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Jean Monnet University, Saint-Etienne, France
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23
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Pedersen KK, Cheng AJ, Westerblad H, Olesen JH, Overgaard K. Moderately elevated extracellular [K+] potentiates submaximal force and power in skeletal muscle via increased [Ca2+]i during contractions. Am J Physiol Cell Physiol 2019; 317:C900-C909. [DOI: 10.1152/ajpcell.00104.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The extracellular K+ concentration ([K+]o) increases during physical exercise. We here studied whether moderately elevated [K+]o may increase force and power output during contractions at in vivo-like subtetanic frequencies and whether such potentiation was associated with increased cytosolic free Ca2+ concentration ([Ca2+]i) during contractions. Isolated whole soleus and extensor digitorum longus (EDL) rat muscles were incubated at different levels of [K+]o, and isometric and dynamic contractility were tested at various stimulation frequencies. Furthermore, [Ca2+]i at rest and during contraction was measured along with isometric force in single mouse flexor digitorum brevis (FDB) fibers exposed to elevated [K+]o. Elevating [K+]o from 4 mM up to 8 mM (soleus) and 11 mM (EDL) increased isometric force at subtetanic frequencies, 2–15 Hz in soleus and up to 50 Hz in EDL, while inhibition was seen at tetanic frequency in both muscle types. Elevating [K+]o also increased peak power of dynamic subtetanic contractions, with potentiation being more pronounced in EDL than in soleus muscles. The force-potentiating effect of elevated [K+]o was transient in FDB single fibers, reaching peak after ~4 and 2.5 min in 9 and 11 mM [K+]o, respectively. At the time of peak potentiation, force and [Ca2+]i during 15-Hz contractions were significantly increased, whereas force was slightly decreased and [Ca2+]i unchanged during 50-Hz contractions. Moderate elevation of [K+]o can transiently potentiate force and power during contractions at subtetanic frequencies, which can be explained by a higher [Ca2+]i during contractions.
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Affiliation(s)
- Katja K. Pedersen
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - Arthur J. Cheng
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Westerblad
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas H. Olesen
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - Kristian Overgaard
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
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24
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Pedersen KK, Nielsen OB, Overgaard K. Contractile benefits of doublet-initiated low-frequency stimulation in rat extensor digitorum longus muscle exposed to high extracellular [K +] or fatiguing contractions. Am J Physiol Cell Physiol 2019; 317:C39-C47. [PMID: 30969780 DOI: 10.1152/ajpcell.00519.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
During dynamic contractions, high-frequency muscle activation is needed to achieve optimal power. This must be balanced against an increased excitation-induced accumulation of extracellular K+, which can reduce excitability and ultimately may prevent adequate responses to high-frequency activation. Mean activation frequencies in vivo are often low (subtetanic), but activation patterns contain bursts of high (supratetanic) frequencies known as doublets, which enhance dynamic contraction in rested muscles at normal extracellular K+ concentration ([K+]o). Here, we examine how dynamic contractions in fast-twitch fibers stimulated by high frequency/doublets are affected during exposure to 11 mM [K+]o and during fatigue. Dynamic contractions were elicited by electrical stimulation in isolated rat extensor digitorum longus muscles incubated at 4 or 11 mM K+. When stimulation frequency was maintained constant, an increase from 150 to 300 Hz enhanced maximal power (Pmax), maximal velocity (Vmax), and rate of force development (RFD) at 4 mM K+ but only Vmax at 11 mM K+. With the use of subtetanic frequency trains (50 Hz) with or without an initiating doublet (300 Hz), the addition of a doublet increased maximal force, Pmax, Vmax, and RFD at both 4 and 11 mM K+. Furthermore, a work-matched fatiguing protocol was performed comparing a doublet-initiated subtetanic train (DT) of 60 Hz with a constant-frequency train (CFT) of 71 Hz during 100 dynamic contractions. We found that DT produced higher power, velocity, and RFD than CFT throughout the fatiguing protocol. The results indicate that doublets enhance dynamic contraction in fast-twitch muscles stimulated at subtetanic frequency during both normal and fatiguing conditions.
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Affiliation(s)
| | - Ole Bækgaard Nielsen
- Department of Public Health, Aarhus University , Aarhus , Denmark.,Department of Biomedicine, Aarhus University , Aarhus , Denmark
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25
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Fels J, Kusche-Vihrog K. Endothelial Nanomechanics in the Context of Endothelial (Dys)function and Inflammation. Antioxid Redox Signal 2019; 30:945-959. [PMID: 29433330 PMCID: PMC6354603 DOI: 10.1089/ars.2017.7327] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022]
Abstract
SIGNIFICANCE Stiffness of endothelial cells is closely linked to the function of the vasculature as it regulates the release of vasoactive substances such as nitric oxide (NO) and reactive oxygen species. The outer layer of endothelial cells, consisting of the glycocalyx above and the cortical zone beneath the plasma membrane, is a vulnerable compartment able to adapt its nanomechanical properties to any changes of forces exerted by the adjacent blood stream. Sustained stiffening of this layer contributes to the development of endothelial dysfunction and vascular pathologies. Recent Advances: The development of specific techniques to quantify the mechanical properties of cells enables the detailed investigation of the mechanistic link between structure and function of cells. CRITICAL ISSUES Challenging the mechanical stiffness of cells, for instance, by inflammatory mediators can lead to the development of endothelial dysfunction. Prevention of sustained stiffening of the outer layer of endothelial cells in turn improves endothelial function. FUTURE DIRECTIONS The mechanical properties of cells can be used as critical marker and test system for the proper function of the vascular system. Pharmacological substances, which are able to improve endothelial nanomechanics and function, could take a new importance in the prevention and treatment of vascular diseases. Thus, detailed knowledge acquisition about the structure/function relationship of endothelial cells and the underlying signaling pathways should be promoted.
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Affiliation(s)
- Johannes Fels
- Institute of Cell Dynamics and Imaging, University of Münster, Münster, Germany
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26
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Christiansen D. Molecular stressors underlying exercise training-induced improvements in K + regulation during exercise and Na + ,K + -ATPase adaptation in human skeletal muscle. Acta Physiol (Oxf) 2019; 225:e13196. [PMID: 30288889 DOI: 10.1111/apha.13196] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/12/2018] [Accepted: 09/28/2018] [Indexed: 12/28/2022]
Abstract
Despite substantial progress made towards a better understanding of the importance of skeletal muscle K+ regulation for human physical function and its association with several disease states (eg type-II diabetes and hypertension), the molecular basis underpinning adaptations in K+ regulation to various stimuli, including exercise training, remains inadequately explored in humans. In this review, the molecular mechanisms essential for enhancing skeletal muscle K+ regulation and its key determinants, including Na+ ,K+ -ATPase function and expression, by exercise training are examined. Special attention is paid to the following molecular stressors and signaling proteins: oxygenation, redox balance, hypoxia, reactive oxygen species, antioxidant function, Na+ ,K+ , and Ca2+ concentrations, anaerobic ATP turnover, AMPK, lactate, and mRNA expression. On this basis, an update on the effects of different types of exercise training on K+ regulation in humans is provided, focusing on recent discoveries about the muscle fibre-type-dependent regulation of Na+ ,K+ -ATPase-isoform expression. Furthermore, with special emphasis on blood-flow-restricted exercise as an exemplary model to modulate the key molecular mechanisms identified, it is discussed how training interventions may be designed to maximize improvements in K+ regulation in humans. The novel insights gained from this review may help us to better understand how exercise training and other strategies, such as pharmacological interventions, may be best designed to enhance K+ regulation and thus the physical function in humans.
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Affiliation(s)
- Danny Christiansen
- Department of Nutrition, Exercise and Sports (NEXS) University of Copenhagen Copenhagen Denmark
- Institute for Health and Sport (IHES) Victoria University Melbourne Victoria Australia
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27
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Topical application of L-carnosine to skeletal muscle excites the sympathetic nerve innervating the contralateral skeletal muscle in rats. Amino Acids 2018; 51:39-48. [PMID: 29926197 DOI: 10.1007/s00726-018-2597-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
We previously obtained evidence suggesting that physical exercise increases the release of L-carnosine (CAR) from muscles and that CAR affects autonomic neurotransmission and physiological phenomena in rats. It has also been reported that exercise elicits an increase in activity of the sympathetic nerve innervating the skeletal muscle. Therefore, in this study, we investigated the effect of CAR application, onto the surface of the right femoral muscle, on activity of the sympathetic nerve innervating the left femoral muscle, in urethane-anesthetized rats. Topical application of 10 pg (44.2 fmol) of CAR increased either skeletal muscle sympathetic nerve activity (skeletal muscle-SNA) or skeletal muscle blood flow (skeletal muscle-BF) of the contralateral skeletal muscle. Furthermore, thioperamide, a histamine H3-antagonist, inhibited the increase in skeletal muscle-SNA, and butoxamine, a β2-antagonist, abolished the increase in skeletal muscle-BF caused by topical application of CAR. The present results suggest that CAR released from muscles during physical exercise might affect skeletal muscle-SNA and skeletal muscle-BF on the opposite side of the body via a CAR evoked effect in muscles.
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28
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Terwoord JD, Hearon CM, Luckasen GJ, Richards JC, Joyner MJ, Dinenno FA. Elevated extracellular potassium prior to muscle contraction reduces onset and steady-state exercise hyperemia in humans. J Appl Physiol (1985) 2018; 125:615-623. [PMID: 29722620 DOI: 10.1152/japplphysiol.00183.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The increase in interstitial potassium (K+) during muscle contractions is thought to be a vasodilatory signal that contributes to exercise hyperemia. To determine the role of extracellular K+ in exercise hyperemia, we perfused skeletal muscle with K+ before contractions, such that the effect of any endogenously-released K+ would be minimized. We tested the hypothesis that local, intra-arterial infusion of potassium chloride (KCl) at rest would impair vasodilation in response to subsequent rhythmic handgrip exercise in humans. In 11 young adults, we determined forearm blood flow (FBF) (Doppler ultrasound) and forearm vascular conductance (FVC) (FBF/mean arterial pressure) during 4 min of rhythmic handgrip exercise at 10% of maximal voluntary contraction during 1) control conditions, 2) infusion of KCl before the initiation of exercise, and 3) infusion of sodium nitroprusside (SNP) as a control vasodilator. Infusion of KCl or SNP elevated resting FVC similarly before the onset of exercise (control: 39 ± 6 vs. KCl: 81 ± 12 and SNP: 82 ± 13 ml·min-1·100 mmHg-1; both P < 0.05 vs. control). Infusion of KCl at rest diminished the hyperemic (ΔFBF) and vasodilatory (ΔFVC) response to subsequent exercise by 22 ± 5% and 30 ± 5%, respectively (both P < 0.05 vs. control), whereas SNP did not affect the change in FBF ( P = 0.74 vs. control) or FVC ( P = 0.61 vs. control) from rest to steady-state exercise. These findings implicate the K+ ion as an essential vasodilator substance contributing to exercise hyperemia in humans. NEW & NOTEWORTHY Our findings support a significant and obligatory role for potassium signaling in the local vasodilatory and hyperemic response to exercise in humans.
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Affiliation(s)
- Janée D Terwoord
- Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, Colorado State University , Fort Collins, Colorado
| | - Christopher M Hearon
- Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, Colorado State University , Fort Collins, Colorado.,Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Gary J Luckasen
- Medical Center of the Rockies Foundation, University of Colorado Health, Loveland, Colorado
| | - Jennifer C Richards
- Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, Colorado State University , Fort Collins, Colorado
| | - Michael J Joyner
- Department of Anesthesiology, Mayo Clinic , Rochester, Minnesota
| | - Frank A Dinenno
- Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, Colorado State University , Fort Collins, Colorado
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Bowtell JL, Mohr M, Fulford J, Jackman SR, Ermidis G, Krustrup P, Mileva KN. Improved Exercise Tolerance with Caffeine Is Associated with Modulation of both Peripheral and Central Neural Processes in Human Participants. Front Nutr 2018; 5:6. [PMID: 29484298 PMCID: PMC5816050 DOI: 10.3389/fnut.2018.00006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 01/17/2018] [Indexed: 12/24/2022] Open
Abstract
Background Caffeine has been shown to enhance exercise performance and capacity. The mechanisms remain unclear but are suggested to relate to adenosine receptor antagonism, resulting in increased central motor drive, reduced perception of effort, and altered peripheral processes such as enhanced calcium handling and extracellular potassium regulation. Our aims were to investigate how caffeine (i) affects knee extensor PCr kinetics and pH during repeated sets of single-leg knee extensor exercise to task failure and (ii) modulates the interplay between central and peripheral neural processes. We hypothesized that the caffeine-induced extension of exercise capacity during repeated sets of exercise would occur despite greater disturbance of the muscle milieu due to enhanced peripheral and corticospinal excitatory output, central motor drive, and muscle contractility. Methods Nine healthy active young men performed five sets of intense single-leg knee extensor exercise to task failure on four separate occasions: for two visits (6 mg·kg-1 caffeine vs placebo), quadriceps 31P-magnetic resonance spectroscopy scans were performed to quantify phosphocreatine kinetics and pH, and for the remaining two visits (6 mg·kg-1 caffeine vs placebo), femoral nerve electrical and transcranial magnetic stimulation of the quadriceps cortical motor area were applied pre- and post exercise. Results The total exercise time was 17.9 ± 6.0% longer in the caffeine (1,225 ± 86 s) than in the placebo trial (1,049 ± 73 s, p = 0.016), and muscle phosphocreatine concentration and pH (p < 0.05) were significantly lower in the latter sets of exercise after caffeine ingestion. Voluntary activation (VA) (peripheral, p = 0.007; but not supraspinal, p = 0.074), motor-evoked potential (MEP) amplitude (p = 0.007), and contractility (contraction time, p = 0.009; and relaxation rate, p = 0.003) were significantly higher after caffeine consumption, but at task failure MEP amplitude and VA were not different from placebo. Caffeine prevented the reduction in M-wave amplitude that occurred at task failure (p = 0.039). Conclusion Caffeine supplementation improved high-intensity exercise tolerance despite greater-end exercise knee extensor phosphocreatine depletion and H+ accumulation. Caffeine-induced increases in central motor drive and corticospinal excitability were attenuated at task failure. This may have been induced by the afferent feedback of the greater disturbance of the muscle milieu, resulting in a stronger inhibitory input to the spinal and supraspinal motor neurons. However, causality needs to be established through further experiments.
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Affiliation(s)
- Joanna L Bowtell
- Sport and Health Sciences, College of Life and Environmental Sciences, Exeter University, Exeter, United Kingdom
| | - Magni Mohr
- Sport and Health Sciences, College of Life and Environmental Sciences, Exeter University, Exeter, United Kingdom.,Centre of Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands.,Centre of Health and Human Performance, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Jonathan Fulford
- Exeter NIHR Clinical Research Facility, Medical School, University of Exeter, Exeter, United Kingdom
| | - Sarah R Jackman
- Sport and Health Sciences, College of Life and Environmental Sciences, Exeter University, Exeter, United Kingdom
| | - Georgios Ermidis
- Sport and Health Sciences, College of Life and Environmental Sciences, Exeter University, Exeter, United Kingdom.,Department of Exercise and Wellness, Parthenope University of Naples, Naples, Italy.,Department of Sports Science and Clinical Biomechanics, Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark
| | - Peter Krustrup
- Sport and Health Sciences, College of Life and Environmental Sciences, Exeter University, Exeter, United Kingdom.,Department of Sports Science and Clinical Biomechanics, Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark
| | - Katya N Mileva
- Sport and Exercise Science Research Centre, School of Applied Science, London South Bank University, London, United Kingdom
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Christensen PM, Shirai Y, Ritz C, Nordsborg NB. Caffeine and Bicarbonate for Speed. A Meta-Analysis of Legal Supplements Potential for Improving Intense Endurance Exercise Performance. Front Physiol 2017; 8:240. [PMID: 28536531 PMCID: PMC5422435 DOI: 10.3389/fphys.2017.00240] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/05/2017] [Indexed: 12/13/2022] Open
Abstract
A 1% change in average speed is enough to affect medal rankings in intense Olympic endurance events lasting ~45 s to 8 min which for example includes 100 m swimming and 400 m running (~1 min), 1,500 m running and 4000 m track cycling (~4 min) and 2,000 m rowing (~6-8 min). To maximize the likelihood of winning, athletes utilizes legal supplements with or without scientifically documented beneficial effects on performance. Therefore, a continued systematic evidence based evaluation of the possible ergogenic effects is of high importance. A meta-analysis was conducted with a strict focus on closed-end performance tests in humans in the time domain from 45 s to 8 min. These test include time-trials or total work done in a given time. This selection criterion results in a high relevance for athletic performance. Only peer-reviewed placebo controlled studies were included. The often applied and potentially ergogenic supplements beta-alanine, bicarbonate, caffeine and nitrate were selected for analysis. Following a systematic search in Pubmed and SportsDiscuss combined with evaluation of cross references a total of 7 (beta-alanine), 25 (bicarbonate), 9 (caffeine), and 5 (nitrate) studies was included in the meta-analysis. For each study, performance was converted to an average speed (km/h) from which an effect size (ES; Cohens d with 95% confidence intervals) was calculated. A small effect and significant performance improvement relative to placebo was observed for caffeine (ES: 0.41 [0.15–0.68], P = 0.002) and bicarbonate (ES: 0.40 [0.27–0.54], P < 0.001). Trivial and non-significant effects on performance was observed for nitrate (ES: 0.19 [−0.03–0.40], P = 0.09) and beta-alanine (ES: 0.17 [−0.12–0.46], P = 0.24). Thus, caffeine's and bicarbonate's ergogenic effect is clearly documented for intense endurance performance. Importantly, for all supplements an individualized approach may improve the ergogenic effect on performance.
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Affiliation(s)
- Peter M Christensen
- Section of Integrated Physiology, Department of Nutrition, Exercise and Sports, University of CopenhagenCopenhagen, Denmark.,Team DanmarkCopenhagen, Denmark
| | - Yusuke Shirai
- Section of Integrated Physiology, Department of Nutrition, Exercise and Sports, University of CopenhagenCopenhagen, Denmark
| | - Christian Ritz
- Section of Integrated Physiology, Department of Nutrition, Exercise and Sports, University of CopenhagenCopenhagen, Denmark
| | - Nikolai B Nordsborg
- Section of Integrated Physiology, Department of Nutrition, Exercise and Sports, University of CopenhagenCopenhagen, Denmark
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31
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Pageaux B, Lepers R. Fatigue Induced by Physical and Mental Exertion Increases Perception of Effort and Impairs Subsequent Endurance Performance. Front Physiol 2016; 7:587. [PMID: 27965592 PMCID: PMC5126404 DOI: 10.3389/fphys.2016.00587] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/14/2016] [Indexed: 12/27/2022] Open
Abstract
Endurance performance involves the prolonged maintenance of constant or self-regulated power/velocity or torque/force. While the impact of numerous determinants of endurance performance has been previously reviewed, the impact of fatigue on subsequent endurance performance still needs to be documented. This review aims to present the impact of fatigue induced by physical or mental exertion on subsequent endurance performance. For the purpose of this review, endurance performance refers to performance during whole-body or single-joint endurance exercise soliciting mainly the aerobic energy system. First, the impact of physical and mental exertion on force production capacity is presented, with specific emphasize on the fact that solely physical exertion and not mental exertion induces a decrease in force production capacity of the working muscles. Then, the negative impact of fatigue induced by physical exertion and mental exertion on subsequent endurance performance is highlighted based on experimental data. Perception of effort being identified as the variable altered by both prior physical exertion and mental exertion, future studies should investigate the underlying mechanisms increasing perception of effort overtime and in presence of fatigue during endurance exercise. Perception of effort should be considered not only as marker of exercise intensity, but also as a factor limiting endurance performance. Therefore, using a psychophysiological approach to explain the regulation of endurance performance would allow a better understanding of the interaction between physiological and psychological phenomena known to impact endurance performance.
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Affiliation(s)
- Benjamin Pageaux
- CAPS UMR1093, Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bourgogne-Franche Comté Dijon, France
| | - Romuald Lepers
- CAPS UMR1093, Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bourgogne-Franche Comté Dijon, France
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32
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Hostrup M, Bangsbo J. Limitations in intense exercise performance of athletes - effect of speed endurance training on ion handling and fatigue development. J Physiol 2016; 595:2897-2913. [PMID: 27673449 DOI: 10.1113/jp273218] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/21/2016] [Indexed: 01/10/2023] Open
Abstract
Mechanisms underlying fatigue development and limitations for performance during intense exercise have been intensively studied during the past couple of decades. Fatigue development may involve several interacting factors and depends on type of exercise undertaken and training level of the individual. Intense exercise (½-6 min) causes major ionic perturbations (Ca2+ , Cl- , H+ , K+ , lactate- and Na+ ) that may reduce sarcolemmal excitability, Ca2+ release and force production of skeletal muscle. Maintenance of ion homeostasis is thus essential to sustain force production and power output during intense exercise. Regular speed endurance training (SET), i.e. exercise performed at intensities above that corresponding to maximum oxygen consumption (V̇O2, max ), enhances intense exercise performance. However, most of the studies that have provided mechanistic insight into the beneficial effects of SET have been conducted in untrained and recreationally active individuals, making extrapolation towards athletes' performance difficult. Nevertheless, recent studies indicate that only a few weeks of SET enhances intense exercise performance in highly trained individuals. In these studies, the enhanced performance was not associated with changes in V̇O2, max and muscle oxidative capacity, but rather with adaptations in muscle ion handling, including lowered interstitial concentrations of K+ during and in recovery from intense exercise, improved lactate- -H+ transport and H+ regulation, and enhanced Ca2+ release function. The purpose of this Topical Review is to provide an overview of the effect of SET and to discuss potential mechanisms underlying enhancements in performance induced by SET in already well-trained individuals with special emphasis on ion handling in skeletal muscle.
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Affiliation(s)
- Morten Hostrup
- Section of Integrated Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.,Department of Respiratory Research, Bispebjerg University Hospital, Denmark
| | - Jens Bangsbo
- Section of Integrated Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
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Hureau TJ, Romer LM, Amann M. The 'sensory tolerance limit': A hypothetical construct determining exercise performance? Eur J Sport Sci 2016; 18:13-24. [PMID: 27821022 DOI: 10.1080/17461391.2016.1252428] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Neuromuscular fatigue compromises exercise performance and is determined by central and peripheral mechanisms. Interactions between the two components of fatigue can occur via neural pathways, including feedback and feedforward processes. This brief review discusses the influence of feedback and feedforward mechanisms on exercise limitation. In terms of feedback mechanisms, particular attention is given to group III/IV sensory neurons which link limb muscle with the central nervous system. Central corollary discharge, a copy of the neural drive from the brain to the working muscles, provides a signal from the motor system to sensory systems and is considered a feedforward mechanism that might influence fatigue and consequently exercise performance. We highlight findings from studies supporting the existence of a 'critical threshold of peripheral fatigue', a previously proposed hypothesis based on the idea that a negative feedback loop operates to protect the exercising limb muscle from severe threats to homeostasis during whole-body exercise. While the threshold theory remains to be disproven within a given task, it is not generalisable across different exercise modalities. The 'sensory tolerance limit', a more theoretical concept, may address this issue and explain exercise tolerance in more global terms and across exercise modalities. The 'sensory tolerance limit' can be viewed as a negative feedback loop which accounts for the sum of all feedback (locomotor muscles, respiratory muscles, organs, and muscles not directly involved in exercise) and feedforward signals processed within the central nervous system with the purpose of regulating the intensity of exercise to ensure that voluntary activity remains tolerable.
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Affiliation(s)
- Thomas J Hureau
- a Department of Medicine , University of Utah , Salt Lake City , UT , USA
| | - Lee M Romer
- b Centre for Human Performance, Exercise and Rehabilitation, Department of Life Sciences , Brunel University London , UK
| | - Markus Amann
- a Department of Medicine , University of Utah , Salt Lake City , UT , USA
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Pirkmajer S, Chibalin AV. Na,K-ATPase regulation in skeletal muscle. Am J Physiol Endocrinol Metab 2016; 311:E1-E31. [PMID: 27166285 DOI: 10.1152/ajpendo.00539.2015] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/02/2016] [Indexed: 12/17/2022]
Abstract
Skeletal muscle contains one of the largest and the most dynamic pools of Na,K-ATPase (NKA) in the body. Under resting conditions, NKA in skeletal muscle operates at only a fraction of maximal pumping capacity, but it can be markedly activated when demands for ion transport increase, such as during exercise or following food intake. Given the size, capacity, and dynamic range of the NKA pool in skeletal muscle, its tight regulation is essential to maintain whole body homeostasis as well as muscle function. To reconcile functional needs of systemic homeostasis with those of skeletal muscle, NKA is regulated in a coordinated manner by extrinsic stimuli, such as hormones and nerve-derived factors, as well as by local stimuli arising in skeletal muscle fibers, such as contractions and muscle energy status. These stimuli regulate NKA acutely by controlling its enzymatic activity and/or its distribution between the plasma membrane and the intracellular storage compartment. They also regulate NKA chronically by controlling NKA gene expression, thus determining total NKA content in skeletal muscle and its maximal pumping capacity. This review focuses on molecular mechanisms that underlie regulation of NKA in skeletal muscle by major extrinsic and local stimuli. Special emphasis is given to stimuli and mechanisms linking regulation of NKA and energy metabolism in skeletal muscle, such as insulin and the energy-sensing AMP-activated protein kinase. Finally, the recently uncovered roles for glutathionylation, nitric oxide, and extracellular K(+) in the regulation of NKA in skeletal muscle are highlighted.
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Affiliation(s)
- Sergej Pirkmajer
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; and
| | - Alexander V Chibalin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Pigłowska M, Kostka T, Drygas W, Jegier A, Leszczyńska J, Bill-Bielecka M, Kwaśniewska M. Body composition, nutritional status, and endothelial function in physically active men without metabolic syndrome--a 25 year cohort study. Lipids Health Dis 2016; 15:84. [PMID: 27117476 PMCID: PMC4847354 DOI: 10.1186/s12944-016-0249-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/14/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this analysis was to investigate the relationship between body composition, metabolic parameters and endothelial function among physically active healthy middle-aged and older men. METHODS Out of 101 asymptomatic men prospectively tracked for traditional cardiovascular risk factors (mean observation period 25.1 years), 55 metabolically healthy individuals who maintained stable leisure time physical activity (LTPA) level throughout the observation and agreed to participate in the body composition assessment were recruited (mean age 60.3 ± 9.9 years). Body composition and raw bioelectrical parameters were measured with bioelectrical impedance analysis (BIA). Microvascular endothelial function was evaluated by means of the reactive hyperemia index (RHI) using Endo-PAT2000 system. RESULTS Strong correlations were observed between lifetime physical activity (PA), aerobic fitness and most of analyzed body composition parameters. The strongest inverse correlation was found for fat mass (p < 0.01) while positive relationship for fat-free mass (p < 0.01), total body water (p < 0.05 for current aerobic capacity and p < 0.01 for historical PA), body cell mass (p < 0.001), muscle mass (p < 0.001), calcium and potassium (p < 0.01 and p < 0.001 for current aerobic capacity and p < 0.001 and p < 0.01 for historical PA, respectively) and glycogen mass (p < 0.001). Among metabolic parameters, HDL cholesterol (HDL-C) and uric acid were significantly associated with most body composition indicators. Regarding endothelial function, a negative correlation was found for RHI and body mass (p < 0.05) while positive relationship for RHI and body cell mass (p < 0.05), calcium (p < 0.05) and potassium mass (p < 0.05). Impaired endothelial function was observed among 8 subjects. Among bioelectrical parameters, impedance (Z) and resistance (R) normalized for subjects' height were negatively related with body mass, body mass index (BMI) and waist circumference (p < 0.001); while reactance (Xc) normalized for patients' height was negatively related with body mass (p < 0.05). The mean phase angle value was relatively high (8.83 ± 1.22) what reflects a good level of cellularity and cell function. Phase angle was positively related with body mass and BMI (p < 0.05). CONCLUSIONS Both fat mass and muscle mass components are important predictors of metabolic profile. Maintaining regular high PA level and metabolically healthy status through young and middle adulthood may have beneficial influence on body composition parameters and may prevent age-related decrease of fat-free mass and endothelial dysfunction.
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Affiliation(s)
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Lodz, Poland
| | - Wojciech Drygas
- Department of Preventive Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752, Lodz, Poland
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | - Anna Jegier
- Department of Sports Medicine, Medical University of Lodz, 92-213, Lodz, Poland
| | - Joanna Leszczyńska
- Department of Sports Medicine, Medical University of Lodz, 92-213, Lodz, Poland
| | | | - Magdalena Kwaśniewska
- Department of Preventive Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752, Lodz, Poland.
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Krustrup P, Bradley PS, Christensen JF, Castagna C, Jackman S, Connolly L, Randers MB, Mohr M, Bangsbo J. The Yo-Yo IE2 test: physiological response for untrained men versus trained soccer players. Med Sci Sports Exerc 2016; 47:100-8. [PMID: 24824774 DOI: 10.1249/mss.0000000000000377] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to examine the physical capacity and physiological response to the Yo-Yo Intermittent Endurance level 2 test (IE2) for untrained individuals (UTR) and trained male soccer players (TR) and to investigate the determinants of intense intermittent exercise performance. METHODS Thirty-four healthy UTR males and 15 age-matched TR performed a maximal incremental treadmill test and a Yo-Yo IE2 test. Muscle biopsies and blood samples were obtained, and heart rate (HR) was measured before, during, and after tests. RESULTS UTR had a 67% lower (P < 0.01) Yo-Yo IE2 performance (665 ± 271 vs 2027 ± 298 m; effect size (ES), 4.8), 34% lower V˙O2max (P < 0.01), and 19% lower resting muscle glycogen (P < 0.05) than those of TR. Blood lactate concentration and HR during the first 560 m of the Yo-Yo IE2 test were higher (P < 0.01) in UTR than those in TR (560 m, 7.4 ± 2.8 vs 2.4 ± 0.8 mM; ES, 1.7-2.8; 188 ± 11 vs 173 ± 8 bpm; ES, 0.9-1.5), with no differences at exhaustion. Time >95% HRmax was lower (P < 0.01) in UTR than that in TR (1.0 ± 1.1 vs 6.3 ± 2.9 min; ES, 3.1). Mean rates of muscle creatine phosphate utilization (16.5 ± 9.5 vs 4.3 ± 2.7 mmol·kg d.w·min), muscle lactate accumulation (16.8 ± 9.1 vs 4.2 ± 2.9 mmol·kg d.w.·min), and glycogen breakdown (29.6 ± 14.2 vs 7.7 ± 5.4 mmol·kg d.w.·min) were fourfold higher (P < 0.01; ES, 1.4-1.7) in UTR than those in TR. For UTR, correlations (P < 0.01) were observed between Yo-Yo IE2 performance and V˙O2max (r = 0.77), incremental treadmill test performance (r = 0.79), and muscle citrate synthase activity (r = 0.57) but not for TR (r = -0.12 to 0.50; P > 0.05). CONCLUSIONS The Yo-Yo IE2 test was shown to possess high construct validity by showing large differences in performance, HR, and anaerobic metabolism between UTR and TR. In addition, V˙O2max seemed to be important for intermittent exercise performance in UTR but not for TR.
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Affiliation(s)
- Peter Krustrup
- 1Department of Nutrition, Exercise and Sports, Copenhagen Centre for Team Sport and Health, University of Copenhagen, Copenhagen, DENMARK; 2Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UNITED KINGDOM; 3Department of Sport and Exercise Sciences, University of Sunderland, Sunderland, UNITED KINGDOM; 4Carnegie School of Sport, Leeds Metropolitan University, Leeds, UNITED KINGDOM; 5University Hospitals Centre for Health Research, Copenhagen University Hospital, DENMARK; 6Italian Football Referees Association, Rome, ITALY; 7Football Training and Biomechanics Laboratory, Italian Football Federation, Technical Department, Coverciano, Florence, ITALY; 8Faculty of Natural and Health Sciences, University of the Faroe Islands, FAROE ISLANDS; and 9Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, SWEDEN
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Lamb IR, Murrant CL. Potassium inhibits nitric oxide and adenosine arteriolar vasodilatation via K(IR) and Na(+)/K(+) ATPase: implications for redundancy in active hyperaemia. J Physiol 2015; 593:5111-26. [PMID: 26426256 DOI: 10.1113/jp270613] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 09/18/2015] [Indexed: 11/08/2022] Open
Abstract
Redundancy, in active hyperaemia, where one vasodilator can compensate for another if the first is missing, would require that one vasodilator inhibits the effects of another; therefore, if the first vasodilator is inhibited, its inhibitory influence on the second vasodilator is removed and the second vasodilator exerts a greater vasodilatory effect. We aimed to determine whether vasodilators relevant to skeletal muscle contraction [potassium chloride (KCl), adenosine (ADO) and nitric oxide] inhibit one another and, in addition, to investigate the mechanisms for this interaction. We used the hamster cremaster muscle and intravital microscopy to directly visualize 2A arterioles when exposed to a range of concentrations of one vasodilator [10(-8) to 10(-5) M S-nitroso-N-acetyl penicillamine (SNAP), 10(-8) to 10(-5) M ADO, 10 and 20 mM KCl] in the absence and then in the presence of a second vasodilator (10(-7) M ADO, 10(-7) M SNAP, 10 mM KCl). We found that KCl significantly attenuated SNAP-induced vasodilatations by ∼65.8% and vasodilatations induced by 10(-8) to 10(-6) M ADO by ∼72.8%. Furthermore, we observed that inhibition of KCl vasodilatation, by antagonizing either Na(+)/K(+) ATPase using ouabain or inward rectifying potassium channels using barium chloride, could restore the SNAP-induced vasodilatation by up to ∼53.9% and 30.6%, respectively, and also restore the ADO-induced vasodilatations by up to ∼107% and 76.7%, respectively. Our data show that vasodilators relevant to muscle contraction can interact in a way that alters the effectiveness of other vasodilators. These data suggest that active hyperaemia may be the result of complex interactions between multiple vasodilators via a redundant control paradigm.
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Affiliation(s)
- Iain R Lamb
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Coral L Murrant
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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Ciccone AB, Brown LE, Coburn JW, Galpin AJ. Effects of traditional vs. alternating whole-body strength training on squat performance. J Strength Cond Res 2015; 28:2569-77. [PMID: 24942175 DOI: 10.1519/jsc.0000000000000586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traditional strength training with 80% of 1 repetition maximum (1RM) uses 2- to 5-minute rest periods between sets. These long rest periods minimize decreases in volume and intensity but result in long workouts. Performing upper-body exercises during lower-body rest intervals may decrease workout duration but may affect workout performance. Therefore, the purpose of this study was to compare the effects of traditional vs. alternating whole-body strength training on squat performance. Twenty male (24 ± 2 years) volunteers performed 2 workouts. The traditional set (TS) workout consisted of 4 sets of squats (SQ) at 80% of 1RM on a force plate with 3-minute rest between sets. The alternating set (AS) workout also consisted of 4 sets of SQ at 80% of 1RM but with bench press, and bench pull exercises performed between squat sets 1, 2 and 3 with between-exercise rest of 50 seconds, resulting in approximately 3-minute rest between squat sets. Sets 1-3 were performed for 4 repetitions, whereas set 4 was performed to concentric failure. Total number of completed repetitions of the fourth squat set to failure was recorded. Peak ground reaction force (GRF), peak power (PP), and average power (AP) of every squat repetition were recorded and averaged for each set. There was no significant interaction for GRF, PP, or AP. However, volume-equated AP was greater during the TS condition (989 ± 183) than the AS condition (937 ± 176). During the fourth squat set, the TS condition resulted in more repetitions to failure (7.5 ± 2.2) than the AS condition (6.5 ± 2.2). Therefore, individuals who aim to optimize squat AP should refrain from performing more than 3 ASs per exercise. Likewise, those who aim to maximize squat repetitions to failure should refrain from performing upper-body multijoint exercises during squat rest intervals.
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Affiliation(s)
- Anthony B Ciccone
- Center for Sport Performance, Department of Kinesiology, California State University, Fullerton, California
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Halperin I, Chapman DW, Behm DG. Non-local muscle fatigue: effects and possible mechanisms. Eur J Appl Physiol 2015; 115:2031-48. [DOI: 10.1007/s00421-015-3249-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/20/2015] [Indexed: 12/11/2022]
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Johnson MA, Sharpe GR, Williams NC, Hannah R. Locomotor muscle fatigue is not critically regulated after prior upper body exercise. J Appl Physiol (1985) 2015; 119:840-50. [PMID: 26272315 DOI: 10.1152/japplphysiol.00072.2015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 08/06/2015] [Indexed: 01/10/2023] Open
Abstract
This study examined the effects of prior upper body exercise on subsequent high-intensity cycling exercise tolerance and associated changes in neuromuscular function and perceptual responses. Eight men performed three fixed work-rate (85% peak power) cycling tests: 1) to the limit of tolerance (CYC); 2) to the limit of tolerance after prior high-intensity arm-cranking exercise (ARM-CYC); and 3) without prior exercise and for an equal duration as ARM-CYC (ISOTIME). Peripheral fatigue was assessed via changes in potentiated quadriceps twitch force during supramaximal electrical femoral nerve stimulation. Voluntary activation was assessed using twitch interpolation during maximal voluntary contractions. Cycling time during ARM-CYC and ISOTIME (4.33 ± 1.10 min) was 38% shorter than during CYC (7.46 ± 2.79 min) (P < 0.001). Twitch force decreased more after CYC (-38 ± 13%) than ARM-CYC (-26 ± 10%) (P = 0.004) and ISOTIME (-24 ± 10%) (P = 0.003). Voluntary activation was 94 ± 5% at rest and decreased after CYC (89 ± 9%, P = 0.012) and ARM-CYC (91 ± 8%, P = 0.047). Rating of perceived exertion for limb discomfort increased more quickly during cycling in ARM-CYC [1.83 ± 0.46 arbitrary units (AU)/min] than CYC (1.10 ± 0.38 AU/min, P = 0.003) and ISOTIME (1.05 ± 0.43 AU/min, P = 0.002), and this was correlated with the reduced cycling time in ARM-CYC (r = -0.72, P = 0.045). In conclusion, cycling exercise tolerance after prior upper body exercise is potentially mediated by central fatigue and intolerable levels of sensory perception rather than a critical peripheral fatigue limit.
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Affiliation(s)
- M A Johnson
- Sport, Health and Performance Enhancement (SHAPE) Research Group, Department of Sports Science, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - G R Sharpe
- Sport, Health and Performance Enhancement (SHAPE) Research Group, Department of Sports Science, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - N C Williams
- Sport, Health and Performance Enhancement (SHAPE) Research Group, Department of Sports Science, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - R Hannah
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
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Krustrup P, Ermidis G, Mohr M. Sodium bicarbonate intake improves high-intensity intermittent exercise performance in trained young men. J Int Soc Sports Nutr 2015; 12:25. [PMID: 26097440 PMCID: PMC4475610 DOI: 10.1186/s12970-015-0087-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/22/2015] [Indexed: 11/19/2022] Open
Abstract
Background Sodium bicarbonate intake has been shown to improve exercise tolerance, but the effects on high-intensity intermittent exercise are less clear. Thus, the aim of the present study was to determine the effect of sodium bicarbonate intake on Yo-Yo intermittent recovery test level 2 performance in trained young men. Method Thirteen men aged 23 ± 1 year (height: 180 ± 2 cm, weight: 78 ± 3 kg; VO2max: 61.3 ± 3.3 mlO2 · kg−1 · min−1; means ± SEM) performed the Yo-Yo intermittent recovery test level 2 (Yo-Yo IR2) on two separate occasions in randomized order with (SBC) and without (CON) prior intake of sodium bicarbonate (0.4 g · kg−1 body weight). Heart rate and rating of perceived exertion (RPE) were measured during the test and venous blood samples were taken frequently. Results Yo-Yo IR2 performance was 14 % higher (P = 0.04) in SBC than in CON (735 ± 61 vs 646 ± 46 m, respectively). Blood pH and bicarbonate were similar between trials at baseline, but higher (P = 0.003) immediately prior to the Yo-Yo IR2 test in SBC than in CON (7.44 ± 0.01 vs 7.32 ± 0.01 and 33.7 ± 3.2 vs 27.3 ± 0.6 mmol · l−1, respectively). Blood lactate was 0.9 ± 0.1 and 0.8 ± 0.1 mmol · l−1 at baseline and increased to 11.3 ± 1.4 and 9.4 ± 0.8 mmol · l−1 at exhaustion in SBC and CON, respectively, being higher (P = 0.03) in SBC. Additionally, peak blood lactate was higher (P = 0.02) in SBC than in CON (11.7 ± 1.2 vs 10.2 ± 0.7 mmol · l−1). Blood glucose, plasma K+ and Na+ were not different between trials. Peak heart rate reached at exhaustion was 197 ± 3 and 195 ± 3 bpm in SBC and CON, respectively, with no difference between conditions. RPE was 7 % lower (P = 0.003) in SBC than in CON after 440 m, but similar at exhaustion (19.3 ± 0.2 and 19.5 ± 0.2). Conclusion In conclusion, high-intensity intermittent exercise performance is improved by prior intake of sodium bicarbonate in trained young men, with concomitant elevations in blood alkalosis and peak blood lactate levels, as well as lowered rating of perceived exertion.
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Affiliation(s)
- Peter Krustrup
- Department of Nutrition, Exercise and Sports, Section of Human Physiology, Copenhagen Centre for Team Sport and Health, University of Copenhagen, Copenhagen, Denmark ; Sport and Health Sciences, College of Life and Environmental Sciences, St. Luke's Campus, University of Exeter, Exeter, UK
| | | | - Magni Mohr
- Faculty of Natural and Health Sciences, University of the Faroe Islands, Jónas Broncks gøta 25. 3rd floor, Tórshavn, Faroe Islands ; Department of Food and Nutrition, and Sport Science, Center of Health and Human Performance, University of Gothenburg, Gothenburg, Sweden
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Clausen T. Excitation of skeletal muscle is a self-limiting process, due to run-down of Na+, K+ gradients, recoverable by stimulation of the Na+, K+ pumps. Physiol Rep 2015; 3:3/4/e12373. [PMID: 25862098 PMCID: PMC4425977 DOI: 10.14814/phy2.12373] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The general working hypothesis of this study was that muscle fatigue and force recovery depend on passive and active fluxes of Na+ and K+. This is tested by examining the time-course of excitation-induced fluxes of Na+ and K+ during 5–300 sec of 10–60 Hz continuous electrical stimulation in rat extensor digitorum longus (EDL) muscles in vitro and in vivo using 22Na and flame photometric determination of Na+ and K+. 60 sec of 60 Hz stimulation rapidly increases 22Na influx, during the initial phase (0–15 sec) by 0.53 μmol(sec)−1(g wet wt.)−1, sixfold faster than in the later phase (15–60 sec). These values agree with flame photometric measurements of Na+ content. The progressive reduction in the rate of excitation-induced Na+ uptake is likely to reflect gradual loss of excitability due to accumulation of K+ in the extracellular space and t-tubules leading to depolarization. This is in keeping with the concomitant progressive loss of contractile force previously demonstrated. During electrical stimulation rat muscles rapidly reach high rates of active Na+, K+-transport (in EDL muscles a sevenfold increase and in soleus muscles a 22-fold increase), allowing efficient and selective compensation for the large excitation-induced passive Na+, K+-fluxes demonstrated over the latest decades. The excitation-induced changes in passive fluxes of Na+ and K+ are both clearly larger than previously observed. The excitation-induced reduction in [Na+]o contributes considerably to the inhibitory effect of elevated [K+]o. In conclusion, excitation-induced passive and active Na+ and K+ fluxes are important causes of muscle fatigue and force recovery, respectively.
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Affiliation(s)
- Torben Clausen
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
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Ergogenic effects of caffeine and sodium bicarbonate supplementation on intermittent exercise performance preceded by intense arm cranking exercise. J Int Soc Sports Nutr 2015; 12:13. [PMID: 25750597 PMCID: PMC4351945 DOI: 10.1186/s12970-015-0075-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caffeine and sodium bicarbonate ingestion have been suggested to improve high-intensity intermittent exercise, but it is unclear if these ergogenic substances affect performance under provoked metabolic acidification. To study the effects of caffeine and sodium bicarbonate on intense intermittent exercise performance and metabolic markers under exercise-induced acidification, intense arm-cranking exercise was performed prior to intense intermittent running after intake of placebo, caffeine and sodium bicarbonate. METHODS Male team-sports athletes (n = 12) ingested sodium bicarbonate (NaHCO3; 0.4 g.kg(-1) b.w.), caffeine (CAF; 6 mg.kg(-1) b.w.) or placebo (PLA) on three different occasions. Thereafter, participants engaged in intense arm exercise prior to the Yo-Yo intermittent recovery test level-2 (Yo-Yo IR2). Heart rate, blood lactate and glucose as well as rating of perceived exertion (RPE) were determined during the protocol. RESULTS CAF and NaHCO3 elicited a 14 and 23% improvement (P < 0.05), respectively, in Yo-Yo IR2 performance, post arm exercise compared to PLA. The NaHCO3 trial displayed higher [blood lactate] (P < 0.05) compared to CAF and PLA (10.5 ± 1.9 vs. 8.8 ± 1.7 and 7.7 ± 2.0 mmol.L(-1), respectively) after the Yo-Yo IR2. At exhaustion CAF demonstrated higher (P < 0.05) [blood glucose] compared to PLA and NaHCO3 (5.5 ± 0.7 vs. 4.2 ± 0.9 vs. 4.1 ± 0.9 mmol.L(-1), respectively). RPE was lower (P < 0.05) during the Yo-Yo IR2 test in the NaHCO3 trial in comparison to CAF and PLA, while no difference in heart rate was observed between trials. CONCLUSIONS Caffeine and sodium bicarbonate administration improved Yo-Yo IR2 performance and lowered perceived exertion after intense arm cranking exercise, with greater overall effects of sodium bicarbonate intake.
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Johnson MA, Mills DE, Brown PI, Sharpe GR. Prior upper body exercise reduces cycling work capacity but not critical power. Med Sci Sports Exerc 2015; 46:802-8. [PMID: 24042306 DOI: 10.1249/mss.0000000000000159] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study examined whether metabolite accumulation, induced by prior upper body exercise, affected the power-duration relationship for leg cycle ergometry. METHODS Seven males performed, to the limit of tolerance and both without (L) and with (AL) prior severe-intensity arm-cranking exercise, an incremental cycling test and four constant power cycling tests to determine the parameters of the power-duration relationship: critical power (CP) and W'. RESULTS At the onset of cycling exercise plasma lactate (L vs AL: 1.2 ± 0.1 vs 11.6 ± 2.9 mEq · L) and hydrogen ion (40.4 ± 1.3 vs 53.1 ± 4.3 nEq · L), concentrations were higher during AL compared with L, whereas the strong ion difference (37.8 ± 1.8 vs 32.4 ± 2.0 mEq · L) and bicarbonate concentration (25.7 ± 0.7 vs 18.3 ± 1.9 mEq · L) were lower during AL compared with L (P < 0.01). During incremental exercise, maximum cycling power (358 ± 15 vs 332 ± 21 W) and peak oxygen uptake (VO2peak) (4.31 ± 0.36 vs 3.71 ± 0.44 L · min) were lower during AL compared with L (P < 0.05). The rate of increase in plasma potassium concentration during constant power cycling was greater during AL compared with L (0.09 ± 0.08 vs 0.14 ± 0.13 mEq · L · min) (P < 0.05), and exercise duration was 35 ± 15% shorter (P < 0.01). CP was not different between L and AL (267 ± 19 vs 264 ± 20 W), whereas W' was lower in AL (17.3 ± 5.7 vs 11.8 ± 4.2 kJ) (P < 0.01). CONCLUSION The reduced W' after prior upper body exercise indicates that the magnitude of W' is partly dependent on metabolite accumulation.
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Affiliation(s)
- Michael A Johnson
- 1Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, UNITED KINGDOM; and 2Department of Sport and Exercise, Derby University, UNITED KINGDOM
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45
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Nordsborg NB, Robach P, Boushel R, Calbet JAL, Lundby C. Erythropoietin does not reduce plasma lactate, H+, and K+during intense exercise. Scand J Med Sci Sports 2014; 25:e566-75. [DOI: 10.1111/sms.12374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- N. B. Nordsborg
- Department of Nutrition, Exercise and Sport (NEXS); University of Copenhagen; Copenhagen Denmark
| | - P. Robach
- Site de l'Ecole Nationale de Ski et d'Alpinisme; Ecole Nationale des Sports de Montagne; Chamonix France
| | - R. Boushel
- Åstrand Laboratory; The Swedish School of Sport and Health Sciences; Stockholm Sweden
| | - J. A. L. Calbet
- Department of Physical Education; University of Las Palmas de Gran Canaria; Las Palmas Spain
| | - C. Lundby
- Institute of Physiology and Center for Integrative Human Physiology; University of Zürich; Zurich Switzerland
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Warm-up strategy and high-intensity endurance performance in trained cyclists. Int J Sports Physiol Perform 2014; 10:353-60. [PMID: 25229657 DOI: 10.1123/ijspp.2014-0228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the influence of warm-up exercise intensity and subsequent recovery on intense endurance performance, selected blood variables, and the oxygen-uptake (VO2) response. METHODS Twelve highly trained male cyclists (VO2max 72.4 ± 8.0 mL · min-1 · kg-1, incremental-test peak power output (iPPO) 432 ± 31 W; mean ± SD) performed 3 warm-up strategies lasting 20 min before a 4-min maximal-performance test (PT). Strategies consisted of moderate-intensity exercise (50%iPPO) followed by 6 min of recovery (MOD6) or progressive high-intensity exercise (10-100%iPPO and 2 × 20-s sprints) followed by recovery for 6 min (HI6) or 20 min (HI20). RESULTS Before PT venous pH was lower (P < .001) in HI6 (7.27 ± 0.05) than in HI20 (7.34 ± 0.04) and MOD6 (7.35 ± 0.03). At the same time, differences (P < .001) existed for venous lactate in HI6 (8.2 ± 2.0 mmol/L), HI20 (5.1 ± 1.7 mmol/L), and MOD6 (1.4 ± 0.4 mmol/L), as well as for venous bicarbonate in HI6 (19.3 ± 2.6 mmol/L), HI20 (22.6 ± 2.3 mmol/L), and MOD6 (26.0 ± 1.4 mmol/L). Mean power in PT in HI6 (402 ± 38 W) tended to be lower (P = .11) than in HI20 (409 ± 34 W) and was lower (P = .007) than in MOD6 (416 ± 32 W). Total VO2 (15-120 s in PT) was higher in HI6 (8.18 ± 0.86 L) than in HI20 (7.85 ± 0.82 L, P = .008) and MOD6 (7.90 ± 0.74 L, P = .012). CONCLUSIONS Warm-up exercise including race-pace and sprint intervals combined with short recovery can reduce subsequent performance in a 4-min maximal test in highly trained cyclists. Thus, a reduced time at high exercise intensity, a reduced intensity in the warm-up, or an extension of the recovery period after an intense warm-up is advocated.
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Halperin I, Copithorne D, Behm DG. Unilateral isometric muscle fatigue decreases force production and activation of contralateral knee extensors but not elbow flexors. Appl Physiol Nutr Metab 2014; 39:1338-44. [PMID: 25291403 DOI: 10.1139/apnm-2014-0109] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Nonlocal muscle fatigue occurs when fatiguing 1 muscle alters performance of another rested muscle. The purpose of the study was to investigate if fatiguing 2 separate muscles would affect the same rested muscle, and if fatiguing the same muscle would affect 2 separate muscles. Twenty-one trained males participated in 2 studies (n = 11; n = 10). Subjects performed 2 pre-test maximum voluntary contractions (MVCs) with the nondominant knee extensors. Thereafter they performed two 100-s MVCs with their dominant knee extensors, elbow flexors, or rested. Between and after the sets, a single MVC with the nondominant rested knee extensors was performed. Subsequently, 12 nondominant knee extensors repeated MVCs were completed. Force, quadriceps voluntary activation (VA), and electromyography (EMG) were measured. The same protocol was employed in study 2 except the nondominant elbow-flexors were tested. Study 1: Compared with control conditions, a significant decrease in nondominant knee extensors force, EMG, and VA was found under both fatiguing conditions (P ≤ 0.05; effect size (ES) = 0.91-1.15; 2%-8%). Additionally, decrements in all variables were found from the first post-intervention MVC to the last (P ≤ 0.05; ES = 0.82-2.40; 9%-20%). Study 2: No differences were found between conditions for all variables (P ≥ 0.33; ES ≤ 0.2; ≤3.0%). However, all variables decreased from the first post-intervention MVC to the last (P ≤ 0.05; ES = 0.4-3.0; 7.2%-19.7%). Whereas the rested knee extensors demonstrated nonlocal effects regardless of the muscle being fatigued, the elbow-flexors remained unaffected. This suggests that nonlocal effects are muscle specific, which may hold functional implications for training and performance.
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Affiliation(s)
- Israel Halperin
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL A1C 5S7, Canada
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Oberleithner H. Sodium selective erythrocyte glycocalyx and salt sensitivity in man. Pflugers Arch 2014; 467:1319-25. [PMID: 25027385 PMCID: PMC4435639 DOI: 10.1007/s00424-014-1577-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 01/04/2023]
Abstract
Negatively charged surfaces of erythrocytes (RBC) reflect properties of the endothelial glycocalyx. Plasma electrolytes counteract these charges and thus control the repulsive forces between RBC and endothelium. Although Na+ is supposed to exert a rather high affinity to the RBC surface, a direct comparison between Na+ and K+ in counteracting the RBC surface has been never made. Therefore, we measured Na+/K+ selectivity of the RBC surface in 20 healthy volunteers applying the previously published salt blood test (SBT). It turned out that the Na+/K+ selectivity ratio of the RBC glycocalyx is on average 6.1 ± 0.39 (ranging from 3 to 9 in different individuals). Considering standard plasma Na+ and K+ concentrations, binding probability of Na+/K+ at the RBC surface is about 180:1. The SBT reveals that plasma K+ counteracts only about 7 % of the negative charges in the RBC glycocalyx. As an in vivo proof of principle, a volunteer’s blood was continuously tested over 6 months while applying a glycocalyx protective polyphenol-rich natural compound (hawthorn extract). It turned out that RBC Na+ sensitivity (the inverse of Na+ buffer capacity) decreased significantly by about 25 % while Na+/K+ selectivity of the RBC glycocalyx declined only slightly by about 8 %. Taken together, (i) plasma Na+ selectively buffers the negative charges of the RBC glycocalyx, (ii) the contribution of K+ in counteracting these negative surface charges is small, and (iii) natural polyphenols applied in vivo increase RBC surface negativity. In conclusion, low plasma Na+ is supposed to favor frictionless RBC-slipping through blood vessels.
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Affiliation(s)
- Hans Oberleithner
- Institute of Physiology II, University of Münster, Robert-Koch-Str. 27b, 48149, Münster, Germany,
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Goodman CA, Bennie JA, Leikis MJ, McKenna MJ. Unaccustomed eccentric contractions impair plasma K+ regulation in the absence of changes in muscle Na+,K+-ATPase content. PLoS One 2014; 9:e101039. [PMID: 24959836 PMCID: PMC4069193 DOI: 10.1371/journal.pone.0101039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 06/02/2014] [Indexed: 12/31/2022] Open
Abstract
The Na+,K+-ATPase (NKA) plays a fundamental role in the regulation of skeletal muscle membrane Na+ and K+ gradients, excitability and fatigue during repeated intense contractions. Many studies have investigated the effects of acute concentric exercise on K+ regulation and skeletal muscle NKA, but almost nothing is known about the effects of repeated eccentric contractions. We therefore investigated the effects of unaccustomed maximal eccentric knee extensor contractions on K+ regulation during exercise, peak knee extensor muscle torque, and vastus lateralis muscle NKA content and 3-O-MFPase activity. Torque measurements, muscle biopsies, and venous blood samples were taken before, during and up to 7 days following the contractions in six healthy adults. Eccentric contractions reduced peak isometric muscle torque immediately post-exercise by 26±11% and serum creatine kinase concentration peaked 24 h post-exercise at 339±90 IU/L. During eccentric contractions, plasma [K+] rose during Set 1 and remained elevated at ∼4.9 mM during sets 4–10; this was despite a decline in work output by Set 4, which fell by 18.9% at set 10. The rise in plasma [K+].work−1 ratio was elevated over Set 2 from Set 4– Set 10. Eccentric contractions had no effect on muscle NKA content or maximal in-vitro 3-O-MFPase activity immediately post- or up to 7 d post-exercise. The sustained elevation in plasma [K+] despite a decrease in work performed by the knee extensor muscles suggests an impairment in K+ regulation during maximal eccentric contractions, possibly due to increased plasma membrane permeability or to excitation-contraction uncoupling.
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Affiliation(s)
- Craig A. Goodman
- Institute of Sport, Exercise and Active Living (ISEAL), Muscle, Ions and Exercise Group, Victoria University, Melbourne, Victoria, Australia
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jason A. Bennie
- Institute of Sport, Exercise and Active Living (ISEAL), Muscle, Ions and Exercise Group, Victoria University, Melbourne, Victoria, Australia
| | - Murray J. Leikis
- Institute of Sport, Exercise and Active Living (ISEAL), Muscle, Ions and Exercise Group, Victoria University, Melbourne, Victoria, Australia
- Department of Nephrology, Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J. McKenna
- Institute of Sport, Exercise and Active Living (ISEAL), Muscle, Ions and Exercise Group, Victoria University, Melbourne, Victoria, Australia
- * E-mail:
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Kempton T, Sirotic AC, Coutts AJ. An integrated analysis of match-related fatigue in professional rugby league. J Sports Sci 2014; 33:39-47. [PMID: 24857235 DOI: 10.1080/02640414.2014.921832] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined the changes in external outputs, including metabolic power variables, and internal response whilst considering contextual factors on physical performance variables during rugby league match play. Physical performance (total distance, high-speed running and high-power distances, average metabolic power), heart-rate (percentage heart-rate peak and training impulse), collisions (attacking and defensive) and contextual (time in attack, time in defence, time out of play) data were collected from 18 rugby league players during 38 games throughout two National Rugby League seasons. Physical variables were highest in the first 10-min period of each half (P < 0.001). Heart-rate indices peaked in the second 10-min period and were lower during second half periods (P < 0.001). Few differences existed in collisions and contextual factors across 10-min periods. Physical variables were highest during the first 5-min period compared to the final (P < 0.001). There was no difference in heart-rate response, attacking collisions or contextual factors between these periods. Following the peak 5-min period in the match, there were reductions in physical, heart-rate, defensive collisions and contextual factors (P < 0.001). The data show temporal changes in physical performance, heart-rate response and collisions during rugby league match play, although these are affected by contextual factors.
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Affiliation(s)
- Thomas Kempton
- a Faculty of Health , University of Technology , Sydney , Australia
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