Effects of acute modafinil ingestion on exercise time to exhaustion

Effects of Regular Exercise and Intermittent Fasting on Neurotransmitters, Inflammation, Oxidative Stress, and Brain-Derived Neurotrophic Factor in Cortex of Ovariectomized Rats

A collection of metabolic disorders and neurodegenerative diseases linked to oxidative stress and neuroinflammation frequently affect postmenopausal women or estrogen deprivation. Recent research has focused on alternative therapies that can enhance these women's quality of life. This study set out to investigate the effects of physical exercise (EX) and intermittent fasting (IF) on oxidants/antioxidants, inflammatory cytokines, neurotransmitters, and brain-derived neurotrophic factor (BDNF) in the cortex of rats. Additionally, it sought to assess the response to oxidative stress and neuroinflammation in the brains of rats following ovariectomy (OVX) and the potential mechanisms of these interventions. Fifty female rats were divided into one of the following groups 30 days after bilateral OVX: Control, OVX, OVX + EX, OVX + IF, and OVX + EX + IF groups. The rats in the Control and OVX groups continued their normal activities and had unrestricted access to food and water, but the rats in the OVX + EX and OVX + EX + IF groups had a 4-week treadmill training program, and the rats in the OXV + IF and OVX + EX + IF groups fasted for 13 h each day. The rats were killed, the cerebral cortex was taken, tissue homogenates were created, and various parameters were estimated using these homogenates. The results show that ovariectomized rats had decreased levels of neurotransmitters (DA, NE, and SE), acetylcholinesterase, brain GSH (glutathione), SOD (superoxide dismutase), catalase, GPx (glutathione peroxidase), and TAC (total antioxidant capacity), as well as elevated levels of proinflammatory cytokines and mediators (TNF-α, IL-1β, Cox-2). While ovariectomy-induced declines in neurotransmitters, enzymatic and nonenzymatic molecules, neuroinflammation, and oxidative brain damage were considerably mitigated and prevented by treadmill exercise and intermittent fasting, BDNF was significantly increased. These results suggest that ovariectomy can impair rat neuronal function and regular treadmill exercise and intermittent fasting seem to protect against ovariectomy-induced neuronal impairment through the inhibition of oxidative stress and neuroinflammation and increased BDNF levels in the brain cortex. However, combining regular exercise and intermittent fasting did not provide additional benefits compared to either treatment alone.

Dose-dependent subacute cardiovascular effects of modafinil in rats

Modafinil is used for the treatment of various sleep disorders; however, its usage among healthy individuals is also increasing. There are a limited number of cardiovascular side effects, including ischemic T-wave changes, dyspnea, hypertension, and tachycardia in the literature. Our research aimed to investigate the dose-dependent subacute cardiovascular effects of modafinil in rats. Thirty-two rats were randomly and equally assigned to a control group (vehicle-treated for 14 days), a subacute low-dose group (SALD, 10 mg/kg for 14 days), a subacute moderate-dose group (SAMD, 100 mg/kg for 14 days), and a subacute high-dose group (SHD, 600 mg/kg for 14 days). The cardiovascular effects of modafinil were evaluated using hemodynamic, biochemical, electrocardiographic, electrophysiologic, and histopathologic parameters. In terms of hemodynamic parameters, heart rate, and systolic/diastolic/mean blood pressure levels, electrophysiological parameters did not reach statistical significance among the groups (p > 0.05). The incidence of T-wave negativity in SAMD and SAHD groups was 25 and 37.5%, respectively. Moreover, one rat per group was affected by an atrioventricular blockage. Malondialdehyde, superoxide dismutase, catalase, and reduced glutathione levels in the heart and vascular tissues, serum troponin-I, and creatine kinase levels were similar between the modafinil-administered groups and the control group (p > 0.05); this indicates that modafinil activated neither oxidative stress nor antioxidant pathway. Also, there was no difference in histopathological parameters between groups (p > 0.05). Supratherapeutic doses of modafinil may have the potential to cause ischemic cardiac damage and atrioventricular blockage, despite inconsistency with literature findings; however, this does not pertain to hemodynamic changes.

American Medical Society for Sports Medicine Position Statement: Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention-Executive Summary

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practice document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health (MH) issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and MH providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact MH, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific MH disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention: American Medical Society for Sports Medicine Position Statement

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders, and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy (SORT) to grade level of evidence.

Pharmacokinetic and pharmacodynamic of the cognitive enhancer modafinil: Relevant clinical and forensic aspects

Modafinil is a nonamphetamine nootropic drug with an increasingly therapeutic interest due to its different sites of action and behavioral effects in comparison to cocaine or amphetamine. A review of modafinil (and of its prodrug adrafinil and its R-enantiomer armodafinil) chemical, pharmacokinetic, pharmacodynamic, toxicological, clinical and forensic aspects was performed, aiming to better understand possible health problems associated to its unconscious and unruled use. Modafinil is a racemate metabolized mainly in the liver into its inactive acid and sulfone metabolites, which undergo primarily renal excretion. Although not fully clarified, major effects seem to be associated to inhibition of dopamine reuptake and modulation of several other neurochemical pathways, namely noradrenergic, serotoninergic, orexinergic, histaminergic, glutamatergic and GABAergic. Due its wake-promoting effects, modafinil is used for the treatment of daily sleepiness associated to narcolepsy, obstructive sleep apnea and shift work sleep disorder. Its psychotropic and cognitive effects are also attractive in several other pathologies and conditions that affect sleep structure, induce fatigue and lethargy, and impair cognitive abilities. Additionally, in health subjects, including students, modafinil is being used off-label to overcome sleepiness, increase concentration and improve cognitive potential. The most common adverse effects associated to modafinil intake are headache, insomnia, anxiety, diarrhea, dry mouth and raise in blood pressure and heart rate. Infrequently, severe dermatologic effects in children, including maculopapular and morbilliform rash, erythema multiforme and Stevens-Johnson Syndrome have been reported. Intoxication and dependence associated to modafinil are uncommon. Further research on effects and health implications of modafinil and its analogs is steel needed to create evidence-based policies.

Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement—Executive Summary

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

Attention-deficit/hyperactivity disorder in elite athletes: a narrative review

Attention-deficit/hyperactivity disorder (ADHD) is a common brain developmental disorder in the general population that may be even more prevalent in elite athletes in certain sports. General population studies of ADHD are extensive and have reported on prevalence, symptoms, therapeutic and adverse effects of treatment and new clinical and research findings. However, few studies have reported on prevalence, symptoms and treatments of ADHD in elite athletes. This narrative review summarises the literature on symptoms, comorbidities, effects of ADHD on performance and management options for elite athletes with ADHD. The prevalence of ADHD in student athletes and elite athletes may be 7%–8%. The symptoms and characteristics of ADHD play a role in athletes’ choice of a sport career and further achieving elite status. Proper management of ADHD in elite athletes is important for safety and performance, and options include pharmacologic and psychosocial treatments.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Exercise Is Medicine, But Does It Interfere With Medicine?

Exercise frequently is prescribed therapeutically, either on its own or combined with drugs. A drug's absorption, distribution, metabolism, and excretion can be affected by the user's anatomy and physiology, which are both changed by the myriad of complex adaptations to acute and chronic exercise. This article reviews the research that suggests exercise may influence a drug's plasma concentration, and thus its efficacy and safety.

Muscle fatigue: general understanding and treatment

Muscle fatigue is a common complaint in clinical practice. In humans, muscle fatigue can be defined as exercise-induced decrease in the ability to produce force. Here, to provide a general understanding and describe potential therapies for muscle fatigue, we summarize studies on muscle fatigue, including topics such as the sequence of events observed during force production, in vivo fatigue-site evaluation techniques, diagnostic markers and non-specific but effective treatments.

Fatigue-related impairments in oculomotor control are prevented by norepinephrine-dopamine reuptake inhibition

Fatigue-induced reductions in saccade velocity have been reported following acute, prolonged exercise. Interestingly, the detrimental impact of fatigue on oculomotor control can be prevented by a moderate dose of caffeine. This effect may be related to central catecholamine upregulation via caffeine's action as an adenosine antagonist. To test this hypothesis, we compared the protective effect of caffeine on oculomotor control post-exercise to that of a norepinephrine-dopamine reuptake inhibitor. Within a placebo-controlled crossover design, 12 cyclists consumed placebo, caffeine or a norepinephrine-dopamine reuptake inhibitor (bupropion) during 180 minutes of stationary cycling. Saccades, smooth pursuit and optokinetic nystagmus were measured using infrared oculography. Exercise fatigue was associated with an 8 ± 11% reduction in the peak velocity of prosaccades, and a 10 ± 11% decrement in antisaccade peak velocity. Optokinetic nystagmus quick phases decreased in velocity by 15 ± 17%. These differences were statistically significant (p < 0.05). Norepinephrine-dopamine reuptake inhibition and caffeine prevented fatigue-related decrements in eye movement velocity. Pursuit eye movements and visual attention were unaffected. These findings show that norepinephrine-dopamine reuptake inhibition protects oculomotor function during exercise fatigue. Caffeine's fatigue-reversing effects on eye movements appear to be mediated, at least in part, via modulation of central catecholamines.

Fatigue related impairments in oculomotor control are prevented by caffeine

Strenuous exercise can result in an inability of the central nervous system to drive skeletal muscle effectively, a phenomenon known as central fatigue. The impact of central fatigue on the oculomotor system is currently unexplored. Fatigue that originates in the central nervous system may be related to perturbations in the synthesis and metabolism of several neurotransmitters. In this study we examine central fatigue in the oculomotor system after prolonged exercise. The involvement of central neurotransmission was explored by administering caffeine during exercise. Within a double-blind, randomized, repeated measures, crossover design, 11 cyclists consumed a placebo or caffeine solution during 180 min of stationary cycling. Saccadic eye movements were measured using infra-red oculography. Exercise decreased saccade velocity by 8% (placebo trial). This effect was reversed by caffeine, whereby velocity was increased by 11% after exercise. A non-oculomotor perceptual task (global motion processing) was unaffected by exercise. The human oculomotor system is impaired by strenuous exercise of the locomotor system. Caffeine exerts a protective effect on oculomotor control, which could be related to up-regulated central neurotransmission. In addition, cortical processes supporting global motion perception appear to be robust to fatigue.

Non-conscious visual cues related to affect and action alter perception of effort and endurance performance

The psychobiological model of endurance performance proposes that endurance performance is determined by a decision-making process based on perception of effort and potential motivation. Recent research has reported that effort-based decision-making during cognitive tasks can be altered by non-conscious visual cues relating to affect and action. The effects of these non-conscious visual cues on effort and performance during physical tasks are however unknown. We report two experiments investigating the effects of subliminal priming with visual cues related to affect and action on perception of effort and endurance performance. In Experiment 1 thirteen individuals were subliminally primed with happy or sad faces as they cycled to exhaustion in a counterbalanced and randomized crossover design. A paired t-test (happy vs. sad faces) revealed that individuals cycled significantly longer (178 s, p = 0.04) when subliminally primed with happy faces. A 2 × 5 (condition × iso-time) ANOVA also revealed a significant main effect of condition on rating of perceived exertion (RPE) during the time to exhaustion (TTE) test with lower RPE when subjects were subliminally primed with happy faces (p = 0.04). In Experiment 2, a single-subject randomization tests design found that subliminal priming with action words facilitated a significantly longer TTE (399 s, p = 0.04) in comparison to inaction words. Like Experiment 1, this greater TTE was accompanied by a significantly lower RPE (p = 0.03). These experiments are the first to show that subliminal visual cues relating to affect and action can alter perception of effort and endurance performance. Non-conscious visual cues may therefore influence the effort-based decision-making process that is proposed to determine endurance performance. Accordingly, the findings raise notable implications for individuals who may encounter such visual cues during endurance competitions, training, or health related exercise.

Talking yourself out of exhaustion: the effects of self-talk on endurance performance

PURPOSE

The psychobiological model of endurance performance proposes that the perception of effort is the ultimate determinant of endurance performance. Therefore, any physiological or psychological factor affecting the perception of effort will affect endurance performance. Accordingly, this novel study investigated the effects of a frequently used psychological strategy, motivational self-talk (ST), on RPE and endurance performance.

METHODS

In a randomized between-group pretest-posttest design, 24 participants (mean ± SD age = 24.6 ± 7.5 yr, VO2max = 52.3 ± 8.7 mL·kg·min) performed two constant-load (80% peak power output) cycling time-to-exhaustion (TTE) tests, punctuated by a 2-wk ST intervention or a control phase.

RESULTS

A group (ST vs Control) × test (pretest vs posttest) mixed-model ANOVA revealed that ST significantly enhanced TTE test from pretest to posttest (637 ± 210 vs 750 ± 295 s, P < 0.05) with no change in the control group (486 ± 157 vs 474 ± 169 s). Moreover, a group × test × isotime (0%, 50%, and 100%) mixed-model ANOVA revealed a significant interaction for RPE, with follow-up tests showing that motivational self-talk significantly reduced RPE at 50% isotime (7.3 ± 0.6 vs 6.4 ± 0.8, P < 0.05), with no significant difference in the control group (6.9 ± 1.9 vs 7.0 ± 1.7).

CONCLUSIONS

This study is the first to demonstrate that ST significantly reduces RPE and enhances endurance performance. The findings support the psychobiological model of endurance performance and illustrate that psychobiological interventions designed to specifically target favorable changes in the perception of effort are beneficial to endurance performance. Consequently, this psychobiological model offers an important and novel perspective for future research investigations.

Exercise benefits brain function: the monoamine connection

The beneficial effects of exercise on brain function have been demonstrated in animal models and in a growing number of clinical studies on humans. There are multiple mechanisms that account for the brain-enhancing effects of exercise, including neuroinflammation, vascularization, antioxidation, energy adaptation, and regulations on neurotrophic factors and neurotransmitters. Dopamine (DA), noradrenaline (NE), and serotonin (5-HT) are the three major monoamine neurotransmitters that are known to be modulated by exercise. This review focuses on how these three neurotransmitters contribute to exercise affecting brain function and how it can work against neurological disorders.

Fatigue is a Brain-Derived Emotion that Regulates the Exercise Behavior to Ensure the Protection of Whole Body Homeostasis

An influential book written by A. Mosso in the late nineteenth century proposed that fatigue that “at first sight might appear an imperfection of our body, is on the contrary one of its most marvelous perfections. The fatigue increasing more rapidly than the amount of work done saves us from the injury which lesser sensibility would involve for the organism” so that “muscular fatigue also is at bottom an exhaustion of the nervous system.” It has taken more than a century to confirm Mosso’s idea that both the brain and the muscles alter their function during exercise and that fatigue is predominantly an emotion, part of a complex regulation, the goal of which is to protect the body from harm. Mosso’s ideas were supplanted in the English literature by those of A. V. Hill who believed that fatigue was the result of biochemical changes in the exercising limb muscles – “peripheral fatigue” – to which the central nervous system makes no contribution. The past decade has witnessed the growing realization that this brainless model cannot explain exercise performance. This article traces the evolution of our modern understanding of how the CNS regulates exercise specifically to insure that each exercise bout terminates whilst homeostasis is retained in all bodily systems. The brain uses the symptoms of fatigue as key regulators to insure that the exercise is completed before harm develops. These sensations of fatigue are unique to each individual and are illusionary since their generation is largely independent of the real biological state of the athlete at the time they develop. The model predicts that attempts to understand fatigue and to explain superior human athletic performance purely on the basis of the body’s known physiological and metabolic responses to exercise must fail since subconscious and conscious mental decisions made by winners and losers, in both training and competition, are the ultimate determinants of both fatigue and athletic performance.

Practical use and risk of modafinil, a novel waking drug

OBJECTIVES

Modafinil is a waking drug prescribed to narcolepsy patients, but its usage among healthy individuals is increasing to enhance their alertness or to mitigate fatigue. This study was conducted to investigate practical use and toxic effects on neuro-immune interaction of modafinil.

METHODS

This study reviewed the significance of psychoactive drugs, and discussed the benefits and risks of the application of modafinil, which seems to be ideal as an anti-psychotic or anti-fatigue agent.

RESULTS

Modafinil is known to have less or no adverse effects than those found in traditional psychostimulants such as amphetamine, methylphenidate or cocaine. It can be applied as an anti-psychotic or anti-fatigue agent. However, the waking mechanism of modafinil is yet to be fully revealed. Recent studies reported that modafinil may be subject to abuse and addiction. In addition prolonged sleeplessness induces stress responses and impairs immune function.

CONCLUSIONS

Modafinil can be used by anyone, who wishes to work late, stay awake, enhance their cognitive reactions, or brighten their moods. Users may already be under a great level of stress, i.e. cancer patients or soldiers in a battle field. A psychoneuroimmunological approach is thus needed to investigate the multi-functional effects of modafinil.

Attention deficit hyperactivity disorder and the athlete: an American Medical Society for Sports Medicine position statement

Attention deficit hyperactivity disorder (ADHD) is an important issue for the physician taking care of athletes since ADHD is common in the athletic population, and comorbid issues affect athletes of all ages. The health care provider taking care of athletes should be familiar with making the diagnosis of ADHD, the management of ADHD, and how treatment medications impact exercise and performance. In this statement, the term "Team Physician" is used in reference to all healthcare providers that take care of athletes. These providers should understand the side effects of medications, regulatory issues regarding stimulant medications, and indications for additional testing. This position statement is not intended to be a comprehensive review of ADHD, but rather a directed review of the core issues related to the athlete with ADHD.

Is it time to retire the A.V. Hill Model?: A rebuttal to the article by Professor Roy Shephard

Recent publications by Emeritus Professor Roy Shephard propose that a "small group of investigators who have argued repeatedly (over the past 13 years) for a 'Central Governor'," should now either "Put up or shut up." Failing this, their 'hypothesis' should be 'consigned to the bottom draw for future reference'; but Professor Shephard's arguments are contradictory. Thus, in different sections of his article, Professor Shephard explains: why there is no need for a brain to regulate exercise performance; why there is no proof that the brain regulates exercise performance; and why the brain's proven role in the regulation of exercise performance is already so well established that additional comment and research is unnecessary. Hence, "The higher centres of an endurance athlete … call forth an initial effort … at a level where a minimal accumulation of lactate in the peripheral muscles is sensed." Furthermore, "a variety of standard texts have illustrated the many mutually redundant feedback loops (to the nervous system) that limit exercise." Yet, the figure from Professor Shephard's 1982 textbook does not contain any links between the nervous system, "many mutually redundant feedback loops" and skeletal muscle. This disproves his contradictory claims that although there is neither any need for, nor any proof of, any role of the brain in the regulation of exercise performance, the physiological mechanisms for this (non-existent) control were already well established in 1982. In contrast, the Central Governor Model (CGM) developed by our "small group … in a single laboratory" after 1998, provides a simple and unique explanation of how 'redundant feedback loops' can assist in the regulation of exercise behaviour. In this rebuttal to his article, I identify (i) the numerous contradictions included in Professor Shephard's argument; (ii) the real meaning of the facts that he presents; (iii) the importance of the evidence that he ignores; and (iv) the different philosophies of how science should be conducted according to either the Kuhnian or the Popperian philosophies of scientific discovery. My conclusion is that the dominance of an authoritarian Kuhnian philosophy, which refuses to admit genuine error or "the need to alter one's course of belief or action," explains why there is little appetite in the exercise sciences for the acceptance of genuinely novel ideas such as the CGM. Furthermore, to advance the case for the CGM, I now include evidence from more than 30 studies, which, in my opinion, can only be interpreted according to a model of exercise regulation where the CNS, acting in an anticipatory manner, regulates the exercise behaviour by altering skeletal muscle recruitment, specifically to ensure that homeostasis is maintained during exercise. Since few, if any, of those studies can be explained by the 'brainless' A.V. Hill Cardiovascular Model on which Professor Shephard bases his arguments, I argue that it is now the appropriate time to retire that model. Perhaps this will bring to an end the charade that holds either (i) that the brain plays no part in the regulation of exercise performance; or, conversely, (ii) that the role of the brain is already so well defined that further research by other scientists is unnecessary. However, this cannot occur in a discipline that is dominated by an authoritarian Kuhnian philosophy.

Central fatigue and neurotransmitters, can thermoregulation be manipulated?

Fatigue is a complex phenomenon that can be evoked by peripheral and central factors. Although it is obvious that fatigue has peripheral causes such as glycogen depletion and cardiovascular strain, recent literature also focuses on the central origin of fatigue. It is clear that different brain neurotransmitters--such as serotonin, dopamine and noradrenaline--are implicated in the occurrence of fatigue, but manipulation of these neurotransmitters produced no conclusive results on performance in normal ambient temperature. Exercise in the heat not only adds an extra challenge to the cardiorespiratory system, but also to the brain. This provides a useful tool to investigate the association between exercise-induced hyperthermia and central fatigue. This review focuses on the effects of pharmacological manipulations on performance and thermoregulation in different ambient temperatures. Dopaminergic reuptake inhibition appears to counteract hyperthermia-induced fatigue in 30 °C, while noradrenergic neurotransmission shows negative effects on performance in both normal and high temperature, and serotonergic manipulations did not lead to significant changes in performance. It is, however, unlikely that one neurotransmitter system is responsible for the delay or onset of fatigue. Further research is required to determine the exact mechanisms of fatigue in different environmental conditions.

Time to move beyond a brainless exercise physiology: the evidence for complex regulation of human exercise performance

In 1923, Nobel Laureate A.V. Hill proposed that maximal exercise performance is limited by the development of anaerobiosis in the exercising skeletal muscles. Variants of this theory have dominated teaching in the exercise sciences ever since, but 90 years later there is little biological evidence to support Hill’s belief, and much that disproves it. The cardinal weakness of the Hill model is that it allows no role for the brain in the regulation of exercise performance. As a result, it is unable to explain at least 6 common phenomena, including (i) differential pacing strategies for different exercise durations; (ii) the end spurt; (iii) the presence of fatigue even though homeostasis is maintained; (iv) fewer than 100% of the muscle fibers have been recruited in the exercising limbs; (v) the evidence that a range of interventions that act exclusively on the brain can modify exercise performance; and (vi) the finding that the rating of perceived exertion is a function of the relative exercise duration rather than the exercise intensity. Here I argue that the central governor model (CGM) is better able to explain these phenomena. In the CGM, exercise is seen as a behaviour that is regulated by complex systems in the central nervous system specifically to ensure that exercise terminates before there is a catastrophic biological failure. The complexity of this regulation cannot be appreciated if the body is studied as a collection of disconnected components, as is the usual approach in the modern exercise sciences.

Alterations in central fatigue by pharmacological manipulations of neurotransmitters in normal and high ambient temperature

The scientific evidence is reviewed for the involvement of the brain monoamines serotonin, dopamine and noradrenaline (norepinephrine) in the onset of fatigue, in both normal and high ambient temperatures. The main focus is the pharmacological manipulations used to explore the central fatigue hypothesis. The original central fatigue hypothesis emphasizes that an exercise-induced increase in serotonin is responsible for the development of fatigue. However, several pharmacological studies attempted and failed to alter exercise capacity through changes in serotonergic neurotransmission in humans, indicating that the role of serotonin is often overrated. Recent studies, investigating the inhibition of the reuptake of both dopamine and noradrenaline, were capable of detecting changes in performance, specifically when ambient temperature was high. Dopamine and noradrenaline are prominent in innervated areas of the hypothalamus, therefore changes in the catecholaminergic concentrations may also be expected to be involved with the regulation of body core temperature during exercise in the heat. Evidence from different studies suggests that it is very unlikely that one neurotransmitter system is responsible for the appearance of central fatigue. The exact mechanism of fatigue is not known; presumably a complex interplay between both peripheral and central factors induces fatigue. Central fatigue will be determined by the collaboration of the different neurotransmitter systems, with the most important role possibly being for the catecholamines dopamine and noradrenaline.

Effect of caffeine on the neuromuscular system--potential as an ergogenic aid

The ergogenic effect of caffeine on endurance exercise performance is multifactorial; however, there is evidence for an effect on both the central nervous system and the excitation-contraction coupling of skeletal muscle. The increase in exercise performance seen following intracerebroventrical caffeine injection in rats provides strong evidence for a central ergogenic effect. The central ergogenic effect is not likely related to the ability of caffeine to promote wakefulness, but could be due to an increase in the pain and effort perception threshold. There is no evidence that caffeine alters peripheral nerve conduction velocity or neuromuscular transmission, and 1 study showed that motor unit synchronization was not altered by caffeine. Studies have also shown that caffeine can have a direct effect on skeletal muscle that could be ergogenic. For example, patients with high cervical spinal cord lesions showed improvements in stimulated contractile force during cycling, in spite of the fact that they have no peripheral pain input and no sympathetic nervous system response. Two studies have found a potentiation of force production during submaximal stimulation intensities, and 1 found that the M-wave amplitude was not altered by caffeine. Together, these studies suggest that caffeine can enhance contractile force during submaximal contractions by potentiating calcium release from the ryanodine receptor, not by altering sarcoplasmic excitability. Furthermore, the potentiation of force during submaximal electrical stimulation is identical in habitual and nonhabitual caffeine consumers. In summary, the ergogenic effects of caffeine during endurance activity are mediated partly by enhanced contractile force and partly by a reduction in perceived exertion, possibly though a blunting of effort and (or) pain.

Central fatigue: the serotonin hypothesis and beyond

The original central fatigue hypothesis suggested that an exercise-induced increase in extracellular serotonin concentrations in several brain regions contributed to the development of fatigue during prolonged exercise. Serotonin has been linked to fatigue because of its well known effects on sleep, lethargy and drowsiness and loss of motivation. Several nutritional and pharmacological studies have attempted to manipulate central serotonergic activity during exercise, but this work has yet to provide robust evidence for a significant role of serotonin in the fatigue process. However, it is important to note that brain function is not determined by a single neurotransmitter system and the interaction between brain serotonin and dopamine during prolonged exercise has also been explored as having a regulative role in the development of fatigue. This revised central fatigue hypothesis suggests that an increase in central ratio of serotonin to dopamine is associated with feelings of tiredness and lethargy, accelerating the onset of fatigue, whereas a low ratio favours improved performance through the maintenance of motivation and arousal. Convincing evidence for a role of dopamine in the development of fatigue comes from work investigating the physiological responses to amphetamine use, but other strategies to manipulate central catecholamines have yet to influence exercise capacity during exercise in temperate conditions. Recent findings have, however, provided support for a significant role of dopamine and noradrenaline (norepinephrine) in performance during exercise in the heat. As serotonergic and catecholaminergic projections innervate areas of the hypothalamus, the thermoregulatory centre, a change in the activity of these neurons may be expected to contribute to the control of body temperature whilst at rest and during exercise. Fatigue during prolonged exercise clearly is influenced by a complex interaction between peripheral and central factors.

Modafinil-induced modulation of working memory and plasma corticosterone in chronically-stressed mice

The original aims of our study were to investigate the dose-effect relationship of modafinil administration on working memory performance, in parallel with the measurement of plasma corticosterone in chronically-stressed mice, as compared to control mice. Memory performance was evaluated by spontaneous alternation in a T-maze. Vehicle or modafinil (8, 16 or 32 mg/kg) were administered after or without chronic stress (immobilization and exposure to light) for 15 min/day over a period of consecutive 14 days. Immediately after behavioral testing, blood was sampled to measure plasma corticosterone levels. Under non-stress conditions, corticosterone significantly increased with 16 and 32 mg/kg modafinil administration. Interestingly, optimal working memory performance was revealed at the 16 mg/kg dose. Moreover, no correlation was evidenced between working memory performance and plasma corticosterone level in modafinil-treated animals. Under stress conditions, corticosterone level was lowered at 8 mg/kg and remained unchanged at 16 and 32 mg/kg modafinil. An optimal working memory performance was evidenced at 8 mg/kg, which indicated a decrease in the efficiency threshold of modafinil under stress. Furthermore, an inverse correlation emerged between working memory performance and corticosterone level. Our study evidenced for the first time the interaction between stress and memory, in the emotional modulation of working memory performance, as a function of the administered dose of modafinil.

Effects of caffeine ingestion on rating of perceived exertion during and after exercise: a meta-analysis

The purpose of this study was to use the meta-analytic approach to examine the effects of caffeine ingestion on ratings of perceived exertion (RPE). Twenty-one studies with 109 effect sizes (ESs) met the inclusion criteria. Coding incorporated RPE scores obtained both during constant load exercise (n=89) and upon termination of exhausting exercise (n=20). In addition, when reported, the exercise performance ES was also computed (n=16). In comparison to placebo, caffeine reduced RPE during exercise by 5.6% (95% CI (confidence interval), -4.5% to -6.7%), with an equivalent RPE ES of -0.47 (95% CI, -0.35 to -0.59). These values were significantly greater (P<0.05) than RPE obtained at the end of exercise (RPE % change, 0.01%; 95% CI, -1.9 to 2.0%; RPE ES, 0.00, 95% CI, -0.17 to 0.17). In addition, caffeine improved exercise performance by 11.2% (95% CI; 4.6-17.8%). Regression analysis revealed that RPE obtained during exercise could account for approximately 29% of the variance in the improvement in exercise performance. The results demonstrate that caffeine reduces RPE during exercise and this may partly explain the subsequent ergogenic effects of caffeine on performance.