Effects of 3-day bed rest on physiological responses to graded exercise in athletes and sedentary men

The effect of space travel on human reproductive health: a systematic review

With increasing possibilities of multi-year missions in deep space, colonizing other planets, and space tourism, it is important to investigate the effects of space travel on human reproduction. This study aimed to systematically review and summarize the results of available literature on space travel, microgravity, and space radiation, or Earth-based spaceflight analogues impact on female and male reproductive functions in humans. This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Space Biomedicine Systematic Review methods. The search was performed using three databases: PubMed, Web of Science, and Medline Complete. During the database search, 364 studies were identified. After the study selection process, 16 studies were included in the review. Five studies included female participants, and the findings show an increased risk of thromboembolism in combined oral contraceptive users, decreased decidualization, functional insufficiency of corpus luteum, and decreased progesterone and LH levels related to space travel or its simulation. Male participants were included in 13 studies. In males, reproductive health considerations focused on the decrease in testosterone and sex hormone-binding globulin levels, the ratio of male offspring, sperm motility, sperm vitality, and the increase in sperm DNA fragmentation related to space travel or its simulation. Results of this systematic review highlight the need to focus more on the astronaut's reproductive health in future research, as only 16 studies were found during the literature search, and many more research questions related to reproductive health in astronauts still need to be answered.

Effects of Bed Rest on Physical Performance in Athletes: A Systematic and Narrative Review

BACKGROUND

Athletes can face scenarios in which they are confined to bed rest (e.g., due to injury or illness). Existing research in otherwise healthy individuals indicates that those entering bed rest with the greatest physical performance level might experience the greatest performance decrements, which indirectly suggests that athletes might be more susceptible to the detrimental consequences of bed rest than general populations. Therefore, a comprehensive understanding of the effects of bed rest might help guide the medical care of athletes during and following bed rest.

OBJECTIVE

This systematic and narrative review aimed to (1) establish the evidence for the effects of bed rest on physical performance in athletes; (2) discuss potential countermeasures to offset these negative consequences; and (3) identify the time-course of recovery following bed rest to guide return-to-sport rehabilitation.

METHODS

This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched (SPORTDiscus, Web of Science, Scopus, and MEDLINE/PubMed) in October of 2022, and studies were included if they were peer-reviewed investigations, written in English, and investigated the effects of horizontal bed rest on changes in physical capacities and qualities in athletes (defined as Tier 3-5 participants). The reporting quality of the research was assessed using a modified version of the Downs & Black checklist. Furthermore, findings from studies that involved participants in Tiers 1-2 were presented and synthesized using a narrative approach.

RESULTS

Our systematic review of the literature using a rigorous criterion of 'athletes' revealed zero scientific publications. Nevertheless, as a by-product of our search, seven studies were identified that involved apparently healthy individuals who performed specific exercise training prior to bed rest.

CONCLUSIONS

Based on the limited evidence from studies involving non-athletes who were otherwise healthy prior to bed rest, we generally conclude that (1) bed rest rapidly (within 3 days) decreases upright endurance exercise performance, likely due to a rapid loss in plasma volume; whereas strength is reduced within 5 days, likely due to neural factors as well as muscle atrophy; (2) fluid/salt supplementation may be an effective countermeasure to protect against decrements in endurance performance during bed rest; while a broader array of potentially effective countermeasures exists, the efficacy of these countermeasures for previously exercise-trained individuals requires further study; and (3) athletes likely require at least 2-4 weeks of progressive rehabilitation following bed rest of ≤ 28 days, although the timeline of recovery might need to be extended depending on the underlying reason for bed rest (e.g., injury or illness). Despite these general conclusions from studies involving non-athletes, our primary conclusion is that substantial effort and research is still required to quantify the effects of bed rest on physical performance, identify effective countermeasures, and provide return-to-sport timelines in bona fide athletes.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION

Registration ID: osf.io/d3aew; Date: October 24, 2022.

Reduced athletic performance post-COVID-19 is associated with reduced anaerobic threshold

Detailed characterisation of cardiopulmonary limitations in patients post-COVID-19 is currently limited, particularly in elite athletes. A male elite distance runner in his late 30s experienced chest pain following confirmed COVID-19. He underwent cardiopulmonary exercise testing (CPET) at 5 months postacute illness. Subjective exercise tolerance was reduced compared with normal, he described inability to 'kick' (rapidly accelerate). His CPET was compared with an identical protocol 15 months prior to COVID-19. While supranormal maximal oxygen uptake was maintained (155% of peak predicted V̇O₂) anaerobic threshold (AT), a better predictor of endurance performance, reduced from 84% to 71% predicted peak V̇O₂ maximum. Likewise, fat oxidation at AT reduced by 21%, from 0.35 to 0.28 g/min. Focusing exclusively on V̇O₂ maximum risks missing an impairment of oxidative metabolism. Reduced AT suggests a peripheral disorder of aerobic metabolism. This finding may result from virally mediated mitochondrial dysfunction beyond normal 'deconditioning', associated with impaired fat oxidation.

Sedentary behaviour, but not moderate-to-vigorous physical activity, is associated with respiratory responses to acute psychological stress

BACKGROUND

Acute psychological stress induces respiratory responses, and stress-induced respiratory changes can be used to non-invasively reflect metabolic regulation. Respiratory and cardiovascular responses to stress are both driven by sympathetic mechanisms. Higher volumes of sedentary behaviour and lower volumes of physical activity are associated with elevated sympathetic tone and larger cardiovascular responses to stress. The aim of this study was to test whether these associations translate to measures of respiratory stress reactivity.

METHODS

Daily hours of sedentary behaviour (thigh-mounted activPAL) and moderate-to-vigorous physical activity (MVPA; wrist-mounted ActiGraph) were assessed across seven days. Breath-by-breath respiratory (e.g., breathing frequency [BF], end-tidal carbon dioxide partial pressure [PetCO₂], carbon dioxide output [V̇CO₂] and respiratory exchange ratio [RER]) responses to an 8-min Paced Auditory Serial Addition Test were then measured using a Cortex MetaLyzer3B.

RESULTS

Healthy participants (N = 61, mean age ± SD = 25.7 ± 8.9 years) recorded high volumes of sedentary behaviour (9.96 ± 1.48 h/day) and MVPA (1.70 ± 0.71 h/day). In adjusted models (with the inclusion of sedentary behaviour, MVPA, and other a priori selected covariates) hours of daily sedentary behaviour were associated with baseline to stress changes in BF (Β = 0.695, 95% CI = 0.281 - 1.109, p = .014), V_T (Β = -0.042, 95% CI = -0.058 - -0.026, p = .014), PetCO₂ (Β = -0.537, 95% CI = -0.829 - -0.245, p = .014), V̇CO₂ (Β = -0.008, 95% CI = -0.014 - -0.003, p = .030), and RER (Β = -0.013, 95% CI = -0.021 - -0.005, p = .022). Daily hours of MVPA were not linked with respiratory responses to stress.

DISCUSSION

Sedentary behaviour, but not MVPA, is associated with respiratory stress reactivity. Future work should untangle the underlying mechanisms of these findings and explore the consequences for cardiometabolic disease.

The Impact of Training on the Loss of Cardiorespiratory Fitness in Aging Masters Endurance Athletes

Elite masters endurance athletes are considered models of optimal healthy aging due to the maintenance of high cardiorespiratory fitness (CRF) until old age. Whereas a drop in VO₂max in masters athletes has been broadly investigated, the modifying impact of training still remains a matter of debate. Longitudinal observations in masters endurance athletes demonstrated VO₂max declines between -5% and -46% per decade that were closely related to changes in training volume. Here, using regression analyses, we show that 54% and 39% of the variance in observed VO₂max decline in male and female athletes, respectively is explained by changes in training volume. An almost linear VO₂max decrease was observed in studies on young and older athletes, as well as non-athletes, starting a few days after training cessation, with a decline of as much as -20% after 12 weeks. Besides a decline in stroke volume and cardiac output, training cessation was accompanied by considerable reductions in citrate synthase and succinate dehydrogenase activity (reduction in mitochondrial content and oxidative capacity). This reduction could largely be rescued within similar time periods of training (re)uptake. It is evident that training reduction or cessation leads to a considerably accelerated VO₂max drop, as compared to the gradual aging-related VO₂max decline, which can rapidly nullify many of the benefits of preceding long-term training efforts.

Learning From Human Responses to Deconditioning Environments: Improved Understanding of the "Use It or Lose It" Principle

Physical activity, mobility or patterned mobility (i.e., exercise) is intrinsic to the functioning of Homo sapiens, and required for maintenance of health. Thus, systems such as the musculoskeletal and cardiovascular systems appear to require constant reinforcement or conditioning to maintain integrity. Loss of conditioning or development of chronic deconditioning can have multiple consequences. The study of different types of deconditioning and their prevention or reversal can offer a number of clues to the regulation of these systems and point to how deconditioning poses risk for disease development and progression. From the study of deconditioning associated with spaceflight, a condition not predicted by evolution, prolonged bedrest, protracted sedentary behavior, as well as menopause and obesity and their consequences, provide a background to better understand human heterogeneity and how physical fitness may impact the risks for chronic conditions subsequent to the deconditioning. The effectiveness of optimized physical activity and exercise protocols likely depend on the nature of the deconditioning, the sex and genetics of the individual, whether one is addressing prevention of deconditioning-associated disease or disease-associated progression, and whether it is focused on acute or chronic deconditioning associated with different forms of deconditioning. While considerable research effort has gone into preventing deconditioning, the study of the process of deconditioning and its endpoints can provide clues to the regulation of the affected systems and their contributions to human heterogeneity that have been framed by the boundary conditions of Earth during evolution and the "use it or lose it" principle of regulation. Such information regarding heterogeneity that is elaborated by the study of deconditioning environments could enhance the effectiveness of individualized interventions to prevent deconditions or rescue those who have become deconditioned.

Redefining the perioperative stress response: a narrative review

The systemic stress response triggered by surgical trauma is characterised by sterile inflammation preceding metabolic and neuroendocrine dysregulation. However, the relevance of the classically described 'stress response' is now highly questionable in an era where profound physiological deconditioning is common in older, frail surgical patients. Commonly used assessment techniques do not accurately reflect hypothalamic-pituitary-adrenal axis integrity after major surgery. Clinical interpretation of plasma concentrations of cortisol, the prototypical stress hormone, is rarely accurate, because of study heterogeneity, the inherently dynamic characteristics of cortisol production, and assay variability. Before surgery, chronic psychosocial stress and common cardiorespiratory co-morbidities are clinically relevant modifiers of neuroendocrine activation to acute stress/inflammation. The frequent development of multi-morbidity after major surgery further clouds the compartmentalised, discrete model of neuroendocrine activation after initial tissue injury. Starvation, impaired mobility, and sepsis after surgery generate distinct neuroendocrine profiles that challenge the conventional model of neuroendocrine activation. Basic science studies suggest that high circulating levels of cortisol may directly cause organ injury. Conversely, randomised controlled clinical trials investigating glucocorticoid supplementation have delivered contrasting results, with some suggesting a protective effect in the perioperative period. Here, we consider many of the confounding factors that have emerged to challenge the conventional model of the surgical stress response, and suggest that a more nuanced understanding of changes in hypothalamic-pituitary-adrenal axis physiology is warranted to advance perioperative medicine. Re-examining the perioperative stress response presents opportunities for improving outcomes through enhancing the understanding of the neuroendocrine aspects of preparation for and recovery from surgery.

A Physiological Approach to Assessment and Rehabilitation of Acute Concussion in Collegiate and Professional Athletes

Sport-related concussion is an important condition that can affect collegiate and professional athletes. Expert consensus guidelines currently suggest that all athletes who sustain acute concussion be managed with a conservative approach consisting of relative rest and gradual resumption of school and sport activities with active intervention reserved for those with persistent post-concussion symptoms lasting >10-14 days for adults. Unfortunately, these recommendations place little emphasis on the rapid physical deconditioning that occurs in athletes within days of exercise cessation or the pathophysiological processes responsible for acute concussion symptoms that can be successfully targeted by evidence-based rehabilitation strategies. Based on our evolving approach to patients with persistent post-concussion symptoms, we now present an updated physiological approach to the initial medical assessment, rehabilitation, and multi-disciplinary management of collegiate and professional athletes with acute concussion. Utilizing the results of a careful clinical history, comprehensive physical examination and graded aerobic exercise testing, we outline how team physicians, and athletic training staff can partner with multi-disciplinary experts in traumatic brain injury to develop individually tailored rehabilitation programs that target the main physiological causes of acute concussion symptoms (autonomic nervous system dysfunction/exercise intolerance, vestibulo-ocular dysfunction, and cervical spine dysfunction) while maintaining the athlete's physical fitness during the recovery period. Considerations for multi-disciplinary medical clearance of collegiate and professional athletes as well as the application of this approach to non-elite athletes are also discussed.

Acute Cognitive and Physical Rest May Not Improve Concussion Recovery Time

OBJECTIVE

To evaluate the effectiveness of an acute period of cognitive and physical rest on concussion.

PARTICIPANTS

Fifty consecutive patients with a diagnosis of concussions.

DESIGN

Participants were evaluated before (n = 25) and after (n = 25) a policy change that incorporated cognitive and physical rest. Patients in the rest group were withheld from activities, including classes, for the remainder of the injury day and the following day, whereas patients in the no-rest group were not provided any postinjury accommodations.

MAIN MEASURES

Patients were evaluated on a graded symptom checklist, Balance Error Scoring System, Standard Assessment of Concussion, and computerized neuropsychological tests. The number of days until each test achieved baseline values was compared between groups with independent-samples t test.

RESULTS

The no-rest group achieved asymptomatic status sooner than the rest group (5.2 ± 2.9 days and 3.9 ± 1.9 days, respectively; P = .047). There were no differences between groups for time to baseline values on the Balance Error Scoring System, Standard Assessment of Concussion, computerized neuropsychological tests, or time to clinical recovery.

CONCLUSION

A prescribed day of cognitive and physical rest was not effective in reducing postconcussion recovery time. These results agree with a previous study and suggest that light activity postconcussion may not be deleterious to the concussion recovery process.

The Prevalence of Overfat Adults and Children in the US

The overfat condition is defined as excess body fat sufficient to impair health. The problem exists in most overweight and obese individuals and can also occur in those who are normal-weight and non-obese, often due to excess abdominal fat. Despite previous indications that the prevalence overweight and obesity is leveling, these conditions are currently at their highest levels in US history. Our review estimated the number of overfat Americans at 91% for adults and 69% for children. The primary purpose of this review was to build upon previous estimations of overfat prevalence in developed countries by using new data from the Centers for Disease Control and Prevention to estimate the overfat prevalence in American adults (≥20 years) and children (2-19 years), and to expand the definition of overfat as excess body fat associated with at least one additional risk factor of impaired cardiometabolic or physical health. The secondary goals are to highlight the role of dietary sugar as a primary cause of the overfat pandemic and mention new data showing the increased prevalence of exercise that parallels the rising prevalence of overfat to further emphasize the secondary role exercise may play in fat loss. Current public health guidelines to address the overfat pandemic may require more emphasis on reducing the consumption of refined carbohydrates, including added sugars.

Effects of strict prolonged bed rest on cardiorespiratory fitness: systematic review and meta-analysis

The aim of this systematic review and meta-analysis [International Prospective Register of Systematic Reviews (PROSPERO) CRD42017055619] was to assess the effects of strict prolonged bed rest (without countermeasures) on maximal oxygen uptake (V̇o2max) and to explore sources of variation therein. Since 1949, 80 studies with a total of 949 participants (>90% men) have been published with data on strict bed rest and V̇o2max. The studies were conducted mainly in young participants [median age (interquartile range) 24.5 (22.4–34.0) yr]. The duration of bed rest ranged from 1 to 90 days. V̇o2max declined linearly across bed rest duration. No statistical difference in the decline among studies reporting V̇o2max as l/min (−0.3% per day) compared with studies reporting V̇o2max normalized to body weight (ml·kg−1·min−1; −0.43% per day) was observed. Although both total body weight and lean body mass declined in response to bed rest, we did not see any associations with the decline in V̇o2max. However, 15–26% of the variation in the decline in V̇o2max was explained by the pre-bed-rest V̇o2max levels, independent of the duration of bed rest (i.e., higher pre-bed-rest V̇o2max levels were associated with larger declines in V̇o2max). Furthermore, the systematic review revealed a gap in the knowledge about the cardiovascular response to extreme physical inactivity, particularly in older subjects and women of any age group. In addition to its relevance to spaceflight, this lack of data has significant translational implications because younger women sometimes undergo prolonged periods of bed rest associated with the complications of pregnancy and the incidence of hospitalization including prolonged periods of bed rest increases with age.

NEW & NOTEWORTHY Large interindividual responses of maximal oxygen uptake (V̇o2max) to aerobic exercise training exist. However, less is known about the variability in the response of V̇o2max to prolonged bed rest. This systematic review and meta-analysis showed that pre-bed-rest V̇o2max values were inversely associated with the change in V̇o2max independent of the duration of bed rest. Moreover, we identified a large knowledge gap about the causes of decline in V̇o2max, particularly in postmenopausal women, which may have clinical implications.

Prolonged Activity Restriction After Concussion: Are We Worsening Outcomes?

The current treatment of concussion or mild traumatic brain injury (mTBI) is primarily based on expert consensus. Most clinical practice guidelines advise cognitive and physical rest after injury including withdrawal from normal life activities such as school attendance, sports participation, and technology use until symptoms resolve. Some individuals who sustain an mTBI experience persistent physical, cognitive, and mental health problems. Activity restriction itself may contribute to protracted recovery and other complications. Williamson's Activity Restriction Model of Depression, formulated more than 20 years ago, is central to this hypothesis. We review research evidence for potential harms of prolonged activity restriction and report an mTBI case as an example of how an "activity restriction cascade" can unfold. According to this model, psychological consequences of removal from validating life activities, combined with physical deconditioning, contribute to the development and persistence of postconcussive symptoms after mTBI in some youth. A modification to mTBI guidelines that emphasizes prompt reengagement in life activities as tolerated is encouraged.

Deletion of ARNT/HIF1β in pancreatic beta cells does not impair glucose homeostasis in mice, but is associated with defective glucose sensing ex vivo

AIMS/HYPOTHESIS

It has been suggested that the transcription factor ARNT/HIF1β is critical for maintaining in vivo glucose homeostasis and pancreatic beta cell glucose-stimulated insulin secretion (GSIS). Our goal was to gain more insights into the metabolic defects seen after the loss of ARNT/HIF1β in beta cells.

METHODS

The in vivo and in vitro consequences of the loss of ARNT/HIF1β were investigated in beta cell specific Arnt/Hif1β knockout mice (β-Arnt (fl/fl/Cre) mice).

RESULTS

The only in vivo defects found in β-Arnt (fl/fl/Cre) mice were significant increases in the respiratory exchange ratio and in vivo carbohydrate oxidation, and a decrease in lipid oxidation. The mitochondrial oxygen consumption rate was unaltered in mouse β-Arnt (fl/fl/Cre) islets upon glucose stimulation. β-Arnt (fl/fl/Cre) islets had an impairment in the glucose-stimulated increase in Ca(2+) signalling and a reduced insulin secretory response to glucose in the presence of KCl and diazoxide. The glucose-stimulated increase in the NADPH/NADP(+) ratio was reduced in β-Arnt (fl/fl/Cre) islets. The reduced GSIS and NADPH/NADP(+) levels in β-Arnt (fl/fl/Cre) islets could be rescued by treatment with membrane-permeable tricarboxylic acid intermediates. Small interfering (si)RNA mediated knockdown of ARNT/HIF1β in human islets also inhibited GSIS. These results suggest that the regulation of GSIS by the KATP channel-dependent and -independent pathways is affected by the loss of ARNT/HIF1β in islets.

CONCLUSIONS/INTERPRETATION

This study provides three new insights into the role of ARNT/HIF1β in beta cells: (1) ARNT/HIF1β deletion in mice impairs GSIS ex vivo; (2) β-Arnt (fl/fl/Cre) mice have an increased respiratory exchange ratio; and (3) ARNT/HIF1β is required for GSIS in human islets.

Breaking up of prolonged sitting over three days sustains, but does not enhance, lowering of postprandial plasma glucose and insulin in overweight and obese adults

To compare the cumulative (3-day) effect of prolonged sitting on metabolic responses during a mixed meal tolerance test (MTT), with sitting that is regularly interrupted with brief bouts of light-intensity walking. Overweight/obese adults (n=19) were recruited for a randomized, 3-day, outpatient, cross-over trial involving: (1) 7-h days of uninterrupted sitting (SIT); and (2) 7-h days of sitting with light-intensity activity breaks [BREAKS; 2-min of treadmill walking (3.2 km/h) every 20 min (total: 17 breaks/day)]. On days 1 and 3, participants underwent a MTT (75 g of carbohydrate, 50 g of fat) and the incremental area under the curve (iAUC) was calculated from hourly blood samples. Generalized estimating equation (GEE) models were adjusted for gender, body mass index (BMI), energy intake, treatment order and pre-prandial values to determine effects of time, condition and time × condition. The glucose iAUC was 1.3 ± 0.5 and 1.5 ± 0.5 mmol·h·l(-1) (mean differences ± S.E.M.) higher in SIT compared with BREAKS on days 1 and 3 respectively (condition effect: P=0.001), with no effect of time (P=0.48) or time × condition (P=0.8). The insulin iAUC was also higher on both days in SIT (day 1: ∆151 ± 73, day 3: ∆91 ± 73 pmol·h·l(-1), P=0.01), with no effect of time (P=0.52) or time × condition (P=0.71). There was no between-treatment difference in triglycerides (triacylglycerols) iAUC. There were significant between-condition effects but no temporal change in metabolic responses to MTT, indicating that breaking up of sitting over 3 days sustains, but does not enhance, the lowering of postprandial glucose and insulin.

Maximal oxygen consumption in healthy humans: theories and facts

This article reviews the concept of maximal oxygen consumption ([Formula: see text]) from the perspective of multifactorial models of [Formula: see text] limitation. First, I discuss procedural aspects of [Formula: see text] measurement: the implications of ramp protocols are analysed within the theoretical work of Morton. Then I analyse the descriptive physiology of [Formula: see text], evidencing the path that led to the view of monofactorial cardiovascular or muscular [Formula: see text] limitation. Multifactorial models, generated by the theoretical work of di Prampero and Wagner around the oxygen conductance equation, represented a radical change of perspective. These models are presented in detail and criticized with respect to the ensuing experimental work. A synthesis between them is proposed, demonstrating how much these models coincide and converge on the same conclusions. Finally, I discuss the cases of hypoxia and bed rest, the former as an example of the pervasive effects of the shape of the oxygen equilibrium curve, the latter as a neat example of adaptive changes concerning the entire respiratory system. The conclusion is that the concept of cardiovascular [Formula: see text] limitation is reinforced by multifactorial models, since cardiovascular oxygen transport provides most of the [Formula: see text] limitation, at least in normoxia. However, the same models show that the role of peripheral resistances is significant and cannot be neglected. The role of peripheral factors is greater the smaller is the active muscle mass. In hypoxia, the intervention of lung resistances as limiting factors restricts the role played by cardiovascular and peripheral factors.

The independent associations of sedentary behaviour and physical activity on cardiorespiratory fitness

BACKGROUND

During childhood and adolescence, both physical activity (PA) and sedentary behaviour seem to influence cardiorespiratory fitness (CRF); however, the combined association of PA and sedentary behaviour remains to be understood. We analysed the combined association of objectively measured sedentary behaviour and moderate-to-vigorous intensity PA (MVPA) on CRF in Portuguese children and adolescents.

METHODS

The sample comprised 2506 Portuguese healthy children and adolescents aged 10-18 years, from a cross-sectional school-based study (2008). PA and sedentary behaviour were assessed with accelerometry. Participants were classified as meeting current PA guidelines for youth versus not meeting, and as low versus high sedentary (according to the median value of sedentary time/day by age and gender), and then grouped as follows: Low active-high sedentary; low active-low sedentary; high active-high sedentary; high active-low sedentary. CRF was assessed with the FITNESSGRAM 20 m shuttle-run test. Binary logistic regression models were constructed to verify the relationship between high CRF and the combined influence of MVPA/sedentary behaviour, adjusting for age, gender, body mass index and accelerometer wear time.

RESULTS

Participants classified as high active/low sedentary (OR=1.81; 95% CI 1.21 to 2.69), as well as those classified as low active/low sedentary (OR=1.27; 95% CI 1.01 to 1.61) were more likely to be fit, compared with those from the low-active/high-sedentary group.

CONCLUSION

MVPA and sedentary behaviour may act independently in their relation with CRF, and that MVPA levels may not overcome the deleterious influence of high-sedentary time in maximising CRF.

Long-duration space flight and bed rest effects on testosterone and other steroids

CONTEXT

Limited data suggest that testosterone is decreased during space flight, which could contribute to bone and muscle loss.

OBJECTIVE

The main objective was to assess testosterone and hormone status in long- and short-duration space flight and bed rest environments and to determine relationships with other physiological systems, including bone and muscle.

DESIGN

Blood and urine samples were collected before, during, and after long-duration space flight. Samples were also collected before and after 12- to 14-d missions and from participants in 30- to 90-d bed rest studies.

SETTING

Space flight studies were conducted on the International Space Station and before and after Space Shuttle missions. Bed rest studies were conducted in a clinical research center setting. Data from Skylab missions are also presented.

PARTICIPANTS

All of the participants were male, and they included 15 long-duration and nine short-duration mission crew members and 30 bed rest subjects.

MAIN OUTCOME MEASURES

Serum total, free, and bioavailable testosterone were measured along with serum and urinary cortisol, serum dehydroepiandrosterone, dehydroepiandrosterone sulfate, and SHBG.

RESULTS

Total, free, and bioavailable testosterone was not changed during long-duration space flight but were decreased (P < 0.01) on landing day after these flights and after short-duration space flight. There were no changes in other hormones measured. Testosterone concentrations dropped before and soon after bed rest, but bed rest itself had no effect on testosterone.

CONCLUSIONS

There was no evidence for decrements in testosterone during long-duration space flight or bed rest.

Cardiovascular determinants of maximal oxygen consumption in upright and supine posture at the end of prolonged bed rest in humans

We tested the hypothesis that, after bed rest, maximal oxygen consumption ( VO₂max ) decreases more upright than supine, because of adequate cardiovascular response supine, but not upright. On 9 subjects, we determined VO₂max and maximal cardiac output (Q ) upright and supine, before and after (reambulation day upright, the following day supine) 35-day bed rest, by classical steady state protocol. Oxygen consumption, heart rate (f(H)) and stroke volume (Q(st)) were measured by a metabolic cart, electrocardiography and Modelflow from pulse pressure profiles, respectively. We computed Q as f(H) times Q(st), and systemic oxygen flow ( QaO₂) as Q. times arterial oxygen concentration, obtained after haemoglobin and arterial oxygen saturation measurements. Before bed rest, all parameters at maximal exercise were similar upright and supine. After bed rest, VO₂max was lower (p<0.05) than before, both upright (-38.6%) and supine (-17.0%), being 30.8% higher supine than upright. Maximal Q(st) decreased upright (-44.3%), but not supine (+3.7%), being 98.9% higher supine than upright. Maximal Q decreased upright (-45.1%), but not supine (+9.0%), being higher supine than upright (+98.4%). Maximal QaO₂ decreased upright (-37.8%), but not supine (+14.8%), being higher (+74.8%) upright than supine. After bed rest, the cardiovascular response (i) did not affect VO₂max supine, (ii) partially explained the VO₂max decrease upright, and (iii) caused the VO₂max differences between postures. We speculate that impaired peripheral oxygen transfer and/or utilisation may explain the VO₂max decrease supine and the fraction of VO₂max decrease upright unexplained by cardiovascular responses.

LBNP exercise protects aerobic capacity and sprint speed of female twins during 30 days of bed rest

We have shown previously that treadmill exercise within lower body negative pressure (LBNPex) maintains upright exercise capacity (peak oxygen consumption, Vo(2peak)) in men after 5, 15, and 30 days of bed rest (BR). We hypothesized that LBNPex protects treadmill Vo(2peak) and sprint speed in women during a 30-day BR. Seven sets of female monozygous twins volunteered to participate. Within each twin set, one was randomly assigned to a control group (Con) and performed no countermeasures, and the other was assigned to an exercise group (Ex) and performed a 40-min interval (40-80% pre-BR Vo(2peak)) LBNPex (51 +/- 5 mmHg) protocol, plus 5 min of static LBNP, 6 days per week. Before and immediately after BR, subjects completed a 30.5-m sprint test and an upright graded treadmill test to volitional fatigue. These results in women were compared with previously reported reductions in Vo(2peak) and sprint speed in male twins after BR. In women, sprint speed (-8 +/- 2%) and Vo(2peak) (-6 +/- 2%) were not different after BR in the Ex group. In contrast, both sprint speed (-24 +/- 5%) and Vo(2peak) (-16 +/- 3%) were significantly less after BR in the Con group. The effect of BR on sprint speed and Vo(2peak) after BR was not different between women and men. We conclude that treadmill exercise within LBNP protects against BR-induced reductions in Vo(2peak) and sprint speed in women and should prove effective during long-duration spaceflight.

COPD as a lung disease with systemic consequences--clinical impact, mechanisms, and potential for early intervention

The natural course of chronic obstructive pulmonary disease (COPD) is complicated by the development of systemic consequences and co-morbidities. These may be major features in the clinical presentation of COPD, prompting increasing interest. Systemic consequences may be defined as non-pulmonary manifestations of COPD with an immediate cause-and-effect relationship, whereas co-morbidities are diseases associated with COPD. The major systemic consequences/co-morbidities now recognized are: deconditioning, exercise intolerance, skeletal muscle dysfunction, osteoporosis, metabolic impact, anxiety and depression, cardiovascular disease, and mortality. The mechanisms by which these develop are unclear. Probably many factors are involved. Two appear of paramount importance: systemic inflammation, which presents in some patients with stable disease and virtually all patients during exacerbations, and inactivity, which may be a key link to most COPD-related co-morbidities. Further studies are required to determine the role of inflammatory cells/mediators involved in systemic inflammatory processes in causing co-morbidities; the link between activity and co-morbidities; and how COPD therapy may affect activity. Both key mechanisms appear to be influenced significantly by COPD exacerbations. Importantly, although the prevalence of systemic consequences increases with increasing severity of airflow obstruction, both systemic consequences and co-morbidities are already present in the Global Initiative for Chronic Obstructive Lung Disease Stage II. This supports the concept of early intervention in chronic obstructive pulmonary disease. Although at present early intervention studies in COPD are lacking, circumstantial evidence suggests that current treatments may influence events leading to the systemic consequences and co-morbidities, and thus may affect the clinical manifestations of the disease.

Biomechanical effects of immobilization and rehabilitation on the skeletal muscle of trained and sedentary rats

Because of the scarcity of information about the comparison of training to sedentarism beforehand immobilization and rehabilitation through muscle mechanical properties, the present work investigates this theme. Seventy rats were divided into 7 groups: 1-control (C); 2-trained (T); 3-sedentary (S); 4-trained and immobilized (TI); 5-sedentary and immobilized (SI); 6-trained, immobilized and rehabilitated (TIR); 7-sedentary, immobilized and rehabilitated (SIR).

INTERVENTIONS

Swimming training; Sedentarism (reduced size cages); Cast immobilization (pelvic limb) and water rehabilitation. Load at the limit of proportionality (LLP), maximum limit load (MLL) and stiffness (St) were the mechanical properties determined after a mechanical test of traction of the gastrocnemius. The training improved all mechanical properties when compared to sedentarism. After immobilization, LLP and MLL were reduced in TI and SI. However, there was no difference in St between C and TI. Additionally, TI showed improved MLL when compared to SI. The comparison of TI and TIR showed significant melioration in all properties after remobilization. SIR showed an improvement only in MLL when compared to SI. Significant melioration in LLP and St was observed in TIR compared to SIR. We demonstrated that the training before immobilization and rehabilitation had a positive effect on the muscle mechanical behavior compared to sedentarism. This analysis is of fundamental importance because it helps characterize the muscle tissue under different functional demands.

The Respiratory Exchange Ratio is Associated with Fitness Indicators Both in Trained and Untrained Men: A Possible Application for People with Reduced Exercise Tolerance

Background:

The respiratory exchange ratio (RER) indirectly shows the muscle’s oxidative capacity to get energy. Sedentarism, exercise and physically active lifestyles modify it. For that reason, this study evaluates the associations between RER during sub-maximum exercise and other well established fitness indicators (body fat, maximum heart rate, maximum O₂ uptake, workload, and lactate threshold), in physically active trained and untrained men.

Methods:

The RER, O₂ uptake and blood lactate were measured in eight endurance trained and eight untrained men (age, 22.9 ± 4.5 vs. 21.9 ± 2.8 years; body mass, 67.1 ± 5.4 vs. 72.2 ± 7.7 kg; body fat, 10.6 ± 2.4% vs. 16.6 ± 3.8% and maximum O₂ uptake, 68.9 ± 6.3 vs. 51.6 ± 5.8 ml•kg⁻¹•min⁻¹), during maximum exercise test and during three different sub-maximum exercises at fixed workload: below, within or above the lactate threshold.

Results:

Endurance trained men presented higher O₂ uptake, lower blood lactate concentrations and lower RER values than those in untrained men at the three similar relative workloads. Even though with these differences in RER, a strong association (p < 0.05) of RER during sub-maximum exercise with the other well established fitness indicators was observed, and both maximum O₂ uptake and lactate threshold determined more than 57% of its variance (p < 0.05).

Conclusions:

These data demonstrate that RER measurement under sub-maximum exercise conditions was well correlated with other established physical fitness indicators, despite training condition. Furthermore, the results suggest that RER could help obtain an easy approach of fitness status under low exercise intensity and could be utilized in subjects with reduced exercise tolerance.

Estimated functional capacity predicts mortality in older adults

OBJECTIVES

To examine associations between functional capacity estimated from cardiorespiratory fitness (CRF) and mortality risks in adults aged 60 and older.

DESIGN

Prospective study, averaging 13.6 years follow-up.

SETTING

Preventive medical clinic.

PARTICIPANTS

Four thousand sixty adults who completed preventive medical examinations between 1971 and 2001; 24.7% women, mean age+/-standard deviation 64.6+/-4.9, body mass index (BMI) 25.9+/-3.8 kg/m2.

MEASUREMENTS

CRF was quantified as metabolic equivalents (METs) achieved during maximal treadmill exercise. The lowest 20% of the age- and sex-specific MET distribution was defined as having low CRF, the middle 40% moderate CRF, and the upper 40% high CRF. Cox regression was used to estimate death rates (per 1,000 person-years), hazard ratios (HRs), and their 95% confidence intervals (CIs).

RESULTS

Nine hundred eighty-nine deaths occurred during follow-up. Death rates adjusted for age, sex, and examination year were 30.9, 18.3, and 13.4 for all causes (P<.001); 15.9, 8.6, and 5.4 for cardiovascular disease (CVD) (P<.001); and 6.1, 4.9, and 4.2 for cancer (P=.04) for subjects with low, moderate, and high CRF, respectively. After adjusting for smoking, abnormal electrocardiograms at rest or while exercising, percentage of age-predicted maximal heart rate achieved during exercise testing, baseline medical conditions, BMI, hypercholesterolemia, and family CVD and cancer history, subjects with high CRF had notably lower mortality risk than those with low CRF from all causes (HR=0.59, 95% CI=0.47-0.74) and from CVD (HR=0.57, 95% CI=0.41-0.80).

CONCLUSION

CRF is an important independent predictor of death in older adults. The results add to the existing evidence that promoting physical activity in older adults provides substantial health benefits, even in the oldest old.

Resposta divergente da testosterona e do cortisol séricos em atletas masculinos após uma corrida de maratona

O exercício físico altera a homeostase, pois requer rápida mobilização de fontes metabólicas. Neste estudo, analisamos a resposta dos níveis séricos de testosterona (T) e cortisol (C) e das enzimas de desgaste muscular CK, CKMB e LDH, em 20 atletas masculinos sadios (25 a 40 anos), participantes de uma maratona (42,2 km). Coletas de sangue venoso foram feitas em 3 períodos: (i) pela manhã, 48 h antes da maratona (controle), (ii) logo após o término da corrida (final) e (iii) na manhã seguinte, 20 h após a realização da prova (recuperação). Ao final, T estava significantemente mais baixa (de 673 para 303 ng/dl) e C mais elevado (de 20,3 para 42,5 µg/dl) que no período controle. Na recuperação, ambos praticamente retornaram aos níveis basais. CK, CKMB e LDH estavam significantemente mais elevadas ao final da corrida e mais ainda na recuperação (exceto a CKMB), caracterizando o desgaste muscular. Enquanto CK e LDH apresentaram significante correlação negativa com a T (-0,412 e -0,546, respectivamente), CKMB correlacionou-se positivamente com o C (0,4521). Concluímos que a correlação inversa entre T e C, e o comportamento das enzimas CK, CKMB e LDH, permite comprovar que uma corrida de maratona causa intenso stress físico, provocando desequilíbrio hormonal e lesão celular severa.

Factors determining the time course of $${\dot{V}}\hbox{O}_{2\max}$$ decay during bedrest: implications for $${\dot{V}}\hbox{O}_{2\max}$$ limitation

The aim of this study was to characterize the time course of maximal oxygen consumption VO2(max) changes during bedrests longer than 30 days, on the hypothesis that the decrease in VO2(max) tends to asymptote. On a total of 26 subjects who participated in one of three bedrest campaigns without countermeasures, lasting 14, 42 and 90 days, respectively, VO2(max) maximal cardiac output (Qmax) and maximal systemic O2 delivery (QaO2max) were measured. After all periods of HDT, VO2max, Qmax, and QaO2max were significantly lower than before. The VO2max decreased less than qmax after the two shortest bedrests, but its per cent decay was about 10% larger than that of Qmax after 90-day bedrest. The VO2max decrease after 90-day bedrest was larger than after 42- and 14-day bedrests, where it was similar. The Qmax and QaO2max declines after 90-day bedrest was equal to those after 14- and 42-day bedrest. The average daily rates of the VO2max, Qmax, and QaO2max decay during bedrest were less if the bedrest duration were longer, with the exception of that of VO2max in the longest bedrest. The asymptotic VO2max decay demonstrates the possibility that humans could keep working effectively even after an extremely long time in microgravity. Two components in the VO2max decrease were identified, which we postulate were related to cardiovascular deconditioning and to impairment of peripheral gas exchanges due to a possible muscle function deterioration.

Depressive mood symptoms and fatigue after exercise withdrawal: the potential role of decreased fitness

OBJECTIVE

Depressive symptomatology is more prevalent among sedentary than physically active individuals. The present prospective study examines whether withdrawal of regular aerobic activity provokes depressive mood symptoms and fatigue, and to what extent reductions in fitness levels contribute to the development of these symptoms.

METHODS

Forty participants (mean age of 31.3 +/- 7.5 years, 55% women) who exercised regularly (> or = 30 minutes aerobic exercise > or = 3 times/week) were randomized to aerobic exercise withdrawal (n = 20) or to continue regular exercise (n = 20) for 2 weeks. Protocol adherence was documented using ambulatory actigraphy. Negative mood was measured with the Profile of Mood States (POMS), depressive symptoms with the Beck Depression Inventory-II (somatic and cognitive-affective components), and fatigue with the Multidimensional Fatigue Inventory (MFI). Fitness levels were documented by cycle ergometry testing.

RESULTS

Fatigue and somatic depressive symptoms emerged after 1 week of exercise withdrawal (p = .05) and subsequently predicted the development of cognitive-affective depressive symptoms at 2 weeks (beta = 0.62; p = .046). Exercise withdrawal also resulted in increased negative mood (POMS; p < or = .01), and this increase was correlated with decreases in fitness level (r = -0.36, p = .03). Decreased fitness was related to increased POMS fatigue (p = .003) when statistically adjusting for baseline fitness levels and group condition.

CONCLUSION

Depressed mood and fatigue are commonly observed in individuals deprived of usual exercise activities, and the increase in fatigue may be partially mediated by reduced fitness levels. These findings may explain mood changes in response to short-term exercise withdrawal such as injuries and recovery from medical procedures that do not require full bedrest.

Differences in the postexercise threshold for cutaneous active vasodilation between men and women

The purpose of this study was to evaluate the possible differences in the postexercise cutaneous vasodilatory response between men and women. Fourteen subjects (7 men and 7 women) of similar age, body composition, and fitness status remained seated resting for 15 min or cycled for 15 min at 70% of peak oxygen consumption followed by 15 min of seated recovery. Subjects then donned a liquid-conditioned suit. Mean skin temperature was clamped at ∼34°C for 15 min. Mean skin temperature was then increased at a rate of 4.3 ± 0.8°C/h while local skin temperature was clamped at 34°C. Skin blood flow was measured continuously at two forearm skin sites, one with (UT) and without (BT) (treated with bretylium tosylate) intact α-adrenergic vasoconstrictor activity. The exercise threshold for cutaneous vasodilation in women (37.51 ± 0.08°C and 37.58 ± 0.04°C for UT and BT, respectively) was greater than that measured in men (37.33 ± 0.06°C and 37.35 ± 0.06°C for UT and BT, respectively) ( P < 0.05). Core temperatures were similar to baseline before the start of whole body warming for all conditions. Postexercise heart rate (HR) for the men (77 ± 4 beats/min) and women (87 ± 6 beats/min) were elevated above baseline (61 ± 3 and 68 ± 4 beats/min for men and women, respectively), whereas mean arterial pressure (MAP) for the men (84 ± 3 mmHg) and women (79 ± 3 mmHg) was reduced from baseline (93 ± 3 and 93 ± 4 mmHg for men and women, respectively) ( P < 0.05). A greater increase in HR and a greater decrease in the MAP postexercise were noted in women ( P < 0.05). No differences in core temperature, HR, and MAP were measured in the no-exercise trial. The postexercise threshold for cutaneous vasodilation measured at the UT and BT sites for men (37.15 ± 0.03°C and 37.16 ± 0.04°C, respectively) and women (37.36 ± 0.05°C and 37.42 ± 0.03°C, respectively) were elevated above no exercise (36.94 ± 0.07°C and 36.97 ± 0.05°C for men and 36.99 ± 0.09°C and 37.03 ± 0.11°C for women for the UT and BT sites, respectively) ( P < 0.05). A difference in the magnitude of the thresholds was measured between women and men ( P < 0.05). We conclude that women have a greater postexercise onset threshold for cutaneous vasodilation than do men and that the primary mechanism influencing the difference between men and women in postexercise skin blood flow is likely the result of an altered active vasodilatory response and not an increase in adrenergic vasoconstrictor tone.

Stroke volume and systolic time intervals: beat-to-beat comparison between echocardiography and ambulatory impedance cardiography in supine and tilted positions

The aim of the study was to compare stroke volume (SV), ejection time (ET) and pre-ejection period (PEP) measurements obtained using a central haemodynamics ambulatory monitoring device based on impedance cardiography (ICG), in supine and tilted positions (60 degrees), with pulsed Doppler echocardiography as a non-invasive reference method. The Holter-type ICG device was used for off-line, beat-to-beat, automatic determination of SV, ET and PEP. ICG data were compared with those obtained simultaneously using pulsed Doppler echocardiography in the ascending aorta from a suprasternal projection, 1 min before and 10 min after tilting. The tests were performed in 13 young, healthy subjects (six men and seven women, aged 23-33 years). Linear regression between the measured values obtained for all subjects was described by the following formulas: SVicg= 13.9 + 0.813 x SVecho (r = 0.857, SEE = 9.03, n = 496), ETicg = 16.8 + 0.987 x ETecho (r = 0.841, SEE=21.3, n = 496), PEPicg= 22.8 + 0.890 x PEPecho (r = 0.727, SEE = 14.6, n = 496). The data showed that ambulatory impedance cardiography gives useful absolute values of SV and systolic time intervals measured in supine and tilted positions.

Repeated stress-induced stimulation of catecholamine response is not followed by altered immune cell redistribution

Stress response is considered an important factor in the modulation of immune function. Neuroendocrine hormones, including catecholamines, affect the process of immune cell redistribution, important for cell-mediated immunity. This longitudinal investigation was aimed at evaluating the effect of repeated stress-induced elevation of catecholamines on immune cell redistribution and expression of adhesive molecules. We assessed the responses of epinephrine (EPI), norepinephrine (NE), cortisol, changes in lymphocytes subpopulations, and percentages of CD11a+, CD11b+, and CD62L+ lymphocytes to a 20-min treadmill exercise of an intensity equal to 80% of the individual's Vo(2)max. The exercise was performed before and after 6 weeks of endurance training consisting of a 1-h run 4 times a week (ET) and after 5 days of bed rest (HDBR) in 10 healthy males. We did not observe any significant changes in the basal levels of EPI, NE, and cortisol in the plasma, nor in the immune parameters after ET and HDBR. The exercise test led to a significant (P <.001) elevation of EPI and NE levels after both ET and HDBR, a significant elevation (P <.01) of cortisol after HDBR, an increase in the absolute numbers of leukocytes, granulocytes, monocytes, CD3+, CD4+, CD8+, CD16+, CD19+ lymphocytes, percentage of CD11a+ and CD11b+ lymphocytes, and to a decrease of CD62L1 before, after ET, and after HDBR. We found comparable changes in all measured immune parameters after ET and HDBR. In conclusion, repeated stress-induced elevation of EPI and NE was not associated with an alteration in immune cell redistribution found in response to the single bout of exercise.

Effects of endurance training on endocrine response to physical exercise after 5 days of bed rest in healthy male subjects

The study was designed to evaluate how a bout of endurance training (ET) influences the endocrine response after head-down bed rest (HDBR). Eleven healthy males completed the study, which consisted of a 6-wk ET followed by 5 days of -6 degrees head-down HDBR. Treadmill exercise at 80% of pretraining maximal aerobic capacity (VO(2max)) was performed before and after ET as well as after HDBR. ET increased VO(2max) by 13%. The response of norepinephrine was attenuated after ET and exaggerated after HDBR (P < 0.001). The differences in epinephrine responses were not statistically significant. The responses of cortisol and plasma renin activity (PRA) were unchanged after ET and were enhanced after HDBR (P < 0.001). The response of growth hormone after HDBR was reduced (P < 0.05). Only the change in cortisol response was associated with the increment of VO(2max) after ET (r = 0.68, P < 0.01). Endurance training failed to completely prevent changes in endocrine responses seen after HDBR. Improvement of physical fitness was associated with an enhancement of the cortisol response to exercise following the period of bed rest.

Exercise capacity and body composition as predictors of mortality among men with diabetes

OBJECTIVE

To quantify the relation of fitness to mortality among men with diabetes, adjusted for BMI and within levels of BMI.

RESEARCH DESIGN AND METHODS

In this observational cohort study, we calculated all-cause death rates in men with diabetes across quartiles of fitness and BMI categories. Study participants were 2,196 men with diabetes (average age 49.3 years, SD 9.5) who underwent a medical examination, including a maximal exercise test, during 1970 to 1995, with mortality follow-up to 31 December 1996.

RESULTS

We identified 275 deaths during 32,161 person-years of observation. Risk of all-cause mortality was inversely related to fitness. For example, in the fully adjusted model, the risk of mortality was 4.5 (2.6-7.6), 2.8 (1.6-4.7), and 1.6 (0.93-2.76) for the first, second, and third fitness quartiles, respectively, with the fourth quartile (highest fitness level) as the referent (P for trend <0.0001). There was no significant trend across BMI categories for mortality after adjustment for fitness. Similar results were found when the fitness-mortality relation was examined within levels of body composition. In normal-weight men with diabetes, the relative risks of mortality were 6.6 (2.8-15.0), 3.2 (1.4-7.0), and 2.2 (1.1-4.6) for the first, second, and third quartiles of fitness, respectively, as compared with the fourth quartile (P for trend <0.0001). We found similar results in the overweight and obese weight categories.

CONCLUSIONS

There was a steep inverse gradient between fitness and mortality in this cohort of men with documented diabetes, and this association was independent of BMI.