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Marandure TT, Schwellnus MP, Grant C, Jansen van Rensburg A, Jordaan E, Boer P. Patellofemoral Pain Syndrome Is Associated With Chronic Disease and Allergies in 60 997 Distance Runner Race Entrants: SAFER XXX Study. Clin J Sport Med 2023; 33:603-610. [PMID: 37389463 DOI: 10.1097/jsm.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/22/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Patellofemoral pain syndrome (PFPS) is a common running-related injury. Independent risk factors associated with PFPS have not been described in a large cohort of distance runners. DESIGN Descriptive, cross-sectional study. SETTING 21.1 and 56 km Two Oceans Marathon races (2012-2015). PARTICIPANTS 60 997 race entrants. ASSESSMENT OF RISK FACTORS Participants completed a compulsory prerace medical screening questionnaire (history of PFPS in the past 12 months, n = 362; no injury history, n = 60 635). Selected risk factors associated with a history of PFPS were explored using univariate & multivariate analyses: demographics, training/running variables, history of chronic diseases (composite chronic disease score), and any allergy. MAIN OUTCOME MEASURES Prevalence ratios (PRs, 95% confidence intervals). RESULTS Risk factors associated with PFPS (univariate analysis) were increased years of recreational running (PR = 1.09; P = 0.0107), older age (>50 years), and chronic diseases (PR > 2): gastrointestinal disease (PR = 5.06; P < 0.0001), cardiovascular disease (CVD) (PR = 3.28; P < 0.0001), nervous system/psychiatric disease (PR = 3.04; P < 0.0001), cancer (PR = 2.83; P = 0.0005), risk factors for CVD (PR = 2.42; P < 0.0001), symptoms of CVD (PR = 2.38; P = 0.0397), and respiratory disease (PR = 2.00; P < 0.0001). Independent risk factors (multivariate analysis) associated with PFPS (adjusted for age, sex, and race distance) were a higher chronic disease composite score (PR = 2.68 increased risk for every 2 additional chronic diseases; P < 0.0001) and a history of allergies (PR = 2.33; P < 0.0001). CONCLUSIONS Novel independent risk factors associated with PFPS in distance runners are a history of multiple chronic diseases and a history of allergies. Identification of chronic diseases and allergies should be considered as part of the clinical assessment of a runner presenting with a history of PFPS.
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Affiliation(s)
- Tsungai Tirivashe Marandure
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Pretoria, South Africa
| | - Martin P Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
- Emeritus Professor, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Catharina Grant
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Esmè Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa; and
| | - Pieter Boer
- Department of Human Movement Science, Cape Peninsula University of Technology, Cape Town, South Africa
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Salvucci F, Codella R, Coppola A, Zacchei I, Grassi G, Anti ML, Nitisoara N, Luzi L, Gazzaruso C. Antihistamines improve cardiovascular manifestations and other symptoms of long-COVID attributed to mast cell activation. Front Cardiovasc Med 2023; 10:1202696. [PMID: 37529714 PMCID: PMC10388239 DOI: 10.3389/fcvm.2023.1202696] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Long-COVID is a broadly defined condition and there are no effective therapies. Cardiovascular manifestations of long-COVID include high heart rate, postural tachycardia, and palpitations. Previous studies have suggested that mast cell activation (MCA) may play a role in the pathophysiology of long-COVID, including in the mechanisms of its cardiovascular manifestations. The present study aimed to evaluate the effectiveness of a treatment with blockers of histamine receptors in patients with long-COVID who did not respond to other therapies. Methods In all, 14 patients (F/M = 9/5; 49.5 ± 11.5 years) and 13 controls (F/M = 8/5; 47.3 ± 8.0 years) with long-COVID symptoms attributed to MCA were evaluated. Patients were treated with fexofenadine (180 mg/day) and famotidine (40 mg/day). Fatigue, brain fog, abdominal disorders, and increased heart rate were evaluated in treated and untreated patients at baseline and 20 days later. Results Long-COVID symptoms disappeared completely in 29% of treated patients. There was a significant improvement in each of the considered symptoms (improved or disappeared) in all treated patients, and the improvement grade was significantly greater in treated patients compared to controls. No significant differences in the outcomes were observed in the controls. Conclusions Our data confirm that histamine receptors blockade may be an effective target to successfully treat long-COVID. Our finding supports the underlying role of MCA in the pathophysiology of long-COVID.
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Affiliation(s)
- Fabrizio Salvucci
- Internal Medicine, Clinica Santa Rita del Gruppo Policlinico di Monza, Vercelli, Italy
| | - Roberto Codella
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Adriana Coppola
- Centre for Applied Clinical Research (Ce.R.C.A.), Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Irene Zacchei
- Cardiovascular and Metabolic Department, Ticinello Cardiovascular and Metabolic Centre, Pavia, Italy
| | - Gabriella Grassi
- Cardiovascular and Metabolic Department, Ticinello Cardiovascular and Metabolic Centre, Pavia, Italy
| | - Maria Luisa Anti
- Cardiovascular and Metabolic Department, Ticinello Cardiovascular and Metabolic Centre, Pavia, Italy
| | - Nicolita Nitisoara
- Internal Medicine, Clinica Santa Rita del Gruppo Policlinico di Monza, Vercelli, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy
| | - Carmine Gazzaruso
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Bartra J, Turner PJ, Muñoz-Cano RM. Cofactors in food anaphylaxis in adults. Ann Allergy Asthma Immunol 2023; 130:733-740. [PMID: 36958469 DOI: 10.1016/j.anai.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
Around 25% to 50% of food-induced allergic reactions in adults cause anaphylaxis, and epidemiologic evidence suggests that food is the most common cause of anaphylaxis. Reaction severity is unpredictable, and patients will often experience reactions of variable severity, even to an identical exposure (both dose and allergen). A common explanation for this phenomenon has been the impact of "cofactors"-factors that might contribute to reaction severity independent of the allergen exposure. Cofactors can influence reaction severity in 2 ways: either by reducing the reaction threshold (ie, the dose needed to trigger any symptoms) so that patients have no symptoms in the absence of the cofactor and only react with the cofactor present, or by increasing reaction severity such that individuals have only mild symptoms in the absence of the cofactor, but a more severe reaction when the cofactor is present. Indeed, the same patient may have reactions with different cofactors or even need more than one cofactor to develop a severe reaction. Cofactors reportedly play a role in approximately 30% of anaphylaxis reactions in adults. Exercise, nonsteroidal, anti-inflammatory drugs, alcohol, and sleep deprivation are the most frequent cofactors reported. Routine evaluation of the possible involvement of cofactors is essential in managing patients with food anaphylaxis: in patients with a suggestive history but a negative oral food challenge, cofactors should be taken into account to provide appropriate advice to reduce the risk of future anaphylaxis.
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Affiliation(s)
- Joan Bartra
- Department of Allergy, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETIC ARADyAL, RICORs REI, Barcelona, Spain
| | - Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Rosa M Muñoz-Cano
- Department of Allergy, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETIC ARADyAL, RICORs REI, Barcelona, Spain
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4
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Acute impact of aerobic exercise on local cutaneous thermal hyperaemia. Microvasc Res 2023; 146:104457. [PMID: 36423711 DOI: 10.1016/j.mvr.2022.104457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
Little is known about the acute changes in cutaneous microvascular function that occur in response to exercise, the accumulation of which may provide the basis for beneficial chronic cutaneous vascular adaptations. Therefore, we examined the effects of acute exercise on cutaneous thermal hyperaemia. Twelve healthy, recreationally active participants (11 male, 1 female) performed 30-minute cycling at 50 % (low-intensity exercise, LOW) or 75 % (high-intensity exercise, HIGH) maximum heart rate. Laser Doppler flowmetry (LDF) and rapid local skin heating were used to quantify cutaneous thermal hyperaemia before (PRE), immediately following (IMM) and 1-h (1HR) after exercise. Baseline, axon reflex peak, axon reflex nadir, plateau, maximum skin blood flow responses to rapid local heating (42 °C for 30-min followed by 44 °C for 15-min) at each stage were assessed and indexed as cutaneous vascular conductance [CVC = flux / mean arterial blood pressure (MAP), PU·mm Hg-1], and expressed as a percentage of maximum (%CVCmax). Exercise increased heart rate (HR), MAP and skin blood flow (all P < 0.001), and to a greater extent during HIGH (all P < 0.001). The axon reflex peak and nadir were increased immediately and 1-h after exercise (all comparisons P < 0.01 vs. PRE), which did not differ between intensities (peak: P = 0.34, axon reflex nadir: P = 0.91). The endothelium-dependent plateau response was slightly elevated after exercise (P = 0.06), with no effect of intensity (P = 0.58) nor any interaction effect (P = 0.55). CONCLUSION: Exercise increases cutaneous microvascular axonal responses to local heating for up to 1-h, suggesting an augmented sensory afferent function post-exercise. Acute exercise may only modestly affect endothelial function in cutaneous microcirculation.
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du Toit F, Schwellnus M, Jordaan E, Swanevelder S, Wood P. Factors associated with patellofemoral pain in recreational road cyclists: A cross-sectional study in 59953 cyclists - SAFER XXXIII. Phys Ther Sport 2023; 59:136-143. [PMID: 36535111 DOI: 10.1016/j.ptsp.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Patellofemoral pain (PFP) is a common cycling-related injury, and independent factors need to be identified to enable effective injury prevention strategies. We aim to determine factors associated with PFP in cyclists entering mass community-based events. DESIGN Cross-sectional study. SETTING 2016-2020 Cape Town Cycle Tour. PARTICIPANTS Consenting race entrants. MAIN OUTCOME MEASURES 62758 consenting race entrants completed a pre-race medical questionnaire, and 323 reported PFP. Selected factors associated with PFP (demographics, cycling experience and training, chronic disease history) were explored using multivariate analyses. RESULTS Prevalence ratio (PR) of PFP was similar for sex and age groups. Independent factors associated with PFP (adjusted for sex and age) were history of chronic disease [Composite Chronic Disease Score (0-10)(PR = 2.0, p < 0.0001) and any allergies (PR = 2.0, p < 0.0001)]. CONCLUSION A history of chronic diseases and allergies is associated with PFP in cyclists. Practical clinical recommendations are: 1) that prevention programs for PFP be considered when cycling is prescribed as a physical activity intervention for patients with chronic disease, and 2) that older cyclists presenting with PFP be assessed for the presence of risk factors or existing chronic disease.
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Affiliation(s)
- François du Toit
- Division of Biokinetics and Sports Science, Department of Physiology, Faculty of Health Sciences, University of Pretoria, South Africa; Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa; International Olympic Committee (IOC) Research Centre, South Africa.
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, South Africa; Statistics and Population Studies Department, University of the Western Cape, South Africa
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, South Africa
| | - Paola Wood
- Division of Biokinetics and Sports Science, Department of Physiology, Faculty of Health Sciences, University of Pretoria, South Africa; Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, South Africa
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6
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Arida RM. Physical Exercise as a Strategy to Reduce Seizure Susceptibility. PHARMACORESISTANCE IN EPILEPSY 2023:453-477. [DOI: 10.1007/978-3-031-36526-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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7
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MacCannell AD, Roberts LD. Metabokines in the regulation of systemic energy metabolism. Curr Opin Pharmacol 2022; 67:102286. [PMID: 36137304 DOI: 10.1016/j.coph.2022.102286] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
Metabolism consists of life-sustaining chemical reactions involving metabolites. Historically, metabolites were defined as the intermediates or end products of metabolism and considered to be passive participants changed by metabolic processes. However, recent research has redefined how we view metabolism. There is emerging evidence of metabolites which function to mediate cellular signalling and interorgan crosstalk, regulating local metabolism and systemic physiology. These bioactive metabolite signals have been termed metabokines. Metabokines regulate diverse energy metabolism pathways across multiple tissues, including fatty acid β-oxidation, mitochondrial oxidative phosphorylation, lipolysis, glycolysis and gluconeogenesis. There is increasing impetus to uncover novel metabokine signalling axes to better understand how these may be perturbed in metabolic diseases and determine their utility as therapeutic targets.
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Affiliation(s)
- Amanda Dv MacCannell
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Lee D Roberts
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK.
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8
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Mohammadi‐Pilehdarboni H, Rasouli M. Histamine H1‐ and H2‐receptors participate to provide metabolic energy differently. Fundam Clin Pharmacol 2022; 36:1031-1037. [DOI: 10.1111/fcp.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/21/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Hanieh Mohammadi‐Pilehdarboni
- Immunogenetic Research Center, Department of Clinical Biochemistry and Genetics, Faculty of Medicine Mazandaran University of Medical Sciences Sari Mazandaran Iran
| | - Mehdi Rasouli
- Immunogenetic Research Center, Department of Clinical Biochemistry and Genetics, Faculty of Medicine Mazandaran University of Medical Sciences Sari Mazandaran Iran
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Hebisz P, Jastrzębska AD, Hebisz R. Real Assessment of Maximum Oxygen Uptake as a Verification After an Incremental Test Versus Without a Test. Front Physiol 2021; 12:739745. [PMID: 34777008 PMCID: PMC8581565 DOI: 10.3389/fphys.2021.739745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
The study was conducted to compare peak oxygen uptake (VO2peak) measured with the incremental graded test (GXT) (VO2peak) and two tests to verify maximum oxygen uptake, performed 15 min after the incremental test (VO2peak1) and on a separate day (VO2peak2). The aim was to determine which of the verification tests is more accurate and, more generally, to validate the VO2max obtained in the incremental graded test on cycle ergometer. The study involved 23 participants with varying levels of physical activity. Analysis of variance showed no statistically significant differences for repeated measurements (F = 2.28, p = 0.118, η2 = 0.12). Bland–Altman analysis revealed a small bias of the VO2peak1 results compared to the VO2peak (0.4 ml⋅min–1⋅kg–1) and VO2peak2 results compared to the VO2peak (−0.76 ml⋅min–1⋅kg–1). In isolated cases, it was observed that VO2peak1 and VO2peak2 differed by more than 5% from VO2peak. Considering the above, it can be stated that among young people, there are no statistically significant differences between the values of VO2peak measured in the following tests. However, in individual cases, the need to verify the maximum oxygen uptake is stated, but performing a second verification test on a separate day has no additional benefit.
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Affiliation(s)
- Paulina Hebisz
- Department of Physiology and Biochemistry, University School of Physical Education in Wrocław, Wrocław, Poland
| | | | - Rafał Hebisz
- Department of Physiology and Biochemistry, University School of Physical Education in Wrocław, Wrocław, Poland
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Characterizing Marathon-Induced Metabolic Changes Using 1H-NMR Metabolomics. Metabolites 2021; 11:metabo11100656. [PMID: 34677371 PMCID: PMC8541139 DOI: 10.3390/metabo11100656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Although physical activity is a health-promoting, popular global pastime, regular engagement in strenuous exercises, such as long-distance endurance running races, has been associated with a variety of detrimental physiological and immunological health effects. The resulting altered physiological state has previously been associated with fluctuations in various key metabolite concentrations; however, limited literature exists pertaining to the global/holistic metabolic changes that are induced by such. This investigation subsequently aims at elucidating the metabolic changes induced by a marathon by employing an untargeted proton nuclear magnetic resonance (1H-NMR) spectrometry metabolomics approach. A principal component analysis (PCA) plot revealed a natural differentiation between pre- and post-marathon metabolic profiles of the 30-athlete cohort, where 17 metabolite fluctuations were deemed to be statistically significant. These included reduced concentrations of various amino acids (AA) along with elevated concentrations of ketone bodies, glycolysis, tricarboxylic acid (TCA) cycle, and AA catabolism intermediates. Moreover, elevated concentrations of creatinine and creatine in the post-marathon group supports previous findings of marathon-induced muscle damage. Collectively, the results of this investigation characterize the strenuous metabolic load induced by a marathon and the consequential regulation of main energy-producing pathways to accommodate this, and a better description of the cause of the physiological changes seen after the completion of a marathon.
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Van der Stede T, Blancquaert L, Stassen F, Everaert I, Van Thienen R, Vervaet C, Gliemann L, Hellsten Y, Derave W. Histamine H 1 and H 2 receptors are essential transducers of the integrative exercise training response in humans. SCIENCE ADVANCES 2021; 7:7/16/eabf2856. [PMID: 33853781 PMCID: PMC8046361 DOI: 10.1126/sciadv.abf2856] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/25/2021] [Indexed: 05/12/2023]
Abstract
Exercise training is a powerful strategy to prevent and combat cardiovascular and metabolic diseases, although the integrative nature of the training-induced adaptations is not completely understood. We show that chronic blockade of histamine H1/H2 receptors led to marked impairments of microvascular and mitochondrial adaptations to interval training in humans. Consequently, functional adaptations in exercise capacity, whole-body glycemic control, and vascular function were blunted. Furthermore, the sustained elevation of muscle perfusion after acute interval exercise was severely reduced when H1/H2 receptors were pharmaceutically blocked. Our work suggests that histamine H1/H2 receptors are important transducers of the integrative exercise training response in humans, potentially related to regulation of optimal post-exercise muscle perfusion. These findings add to our understanding of how skeletal muscle and the cardiovascular system adapt to exercise training, knowledge that will help us further unravel and develop the exercise-is-medicine concept.
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Affiliation(s)
- Thibaux Van der Stede
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen 2100, Denmark
| | - Laura Blancquaert
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium
| | - Flore Stassen
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium
| | - Inge Everaert
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium
| | - Ruud Van Thienen
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium
| | - Chris Vervaet
- Laboratory of Pharmaceutical Technology, Department of Pharmaceutics, Ghent University, Ghent 9000, Belgium
| | - Lasse Gliemann
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen 2100, Denmark
| | - Ylva Hellsten
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen 2100, Denmark
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium.
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Histamine, mast cell tryptase and post-exercise hypotension in healthy and collapsed marathon runners. Eur J Appl Physiol 2021; 121:1451-1459. [PMID: 33629149 PMCID: PMC8373737 DOI: 10.1007/s00421-021-04645-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/14/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE Heat stress exacerbates post-exercise hypotension (PEH) and cardiovascular disturbances from elevated body temperature may contribute to exertion-related incapacity. Mast cell degranulation and muscle mass are possible modifiers, though these hypotheses lack practical evidence. This study had three aims: (1) to characterise pre-post-responses in histamine and mast cell tryptase (MCT), (2) to investigate relationships between whole body muscle mass (WBMM) and changes in blood pressure post-marathon, (3) to identify any differences in incapacitated runners. METHODS 24 recreational runners were recruited and successfully completed the 2019 Brighton Marathon (COMPLETION). WBMM was measured at baseline. A further eight participants were recruited from incapacitated runners (COLLAPSE). Histamine, MCT, blood pressure, heart rate, body temperature and echocardiographic measures were taken before and after exercise (COMPLETION) and upon incapacitation (COLLAPSE). RESULTS In completion, MCT increased by nearly 50% from baseline (p = 0.0049), whereas histamine and body temperature did not vary (p > 0.946). Systolic (SBP), diastolic (DBP) and mean (MAP) arterial blood pressures and systemic vascular resistance (SVR) declined (p < 0.019). WBMM negatively correlated with Δ SBP (r = - 0.43, p = 0.046). For collapse versus completion, there were significant elevations in MCT (1.77 ± 0.25 μg/L vs 1.18 ± 0.43 μg/L, p = 0.001) and body temperature (39.8 ± 1.3 °C vs 36.2 ± 0.8 °C, p < 0.0001) with a non-significant rise in histamine (9.6 ± 17.9 μg/L vs 13.7 ± 33.9 μg/L, p = 0.107) and significantly lower MAP, DBP and SVR (p < 0.033). CONCLUSION These data support the hypothesis that mast cell degranulation is a vasodilatory mechanism underlying PEH and exercise associated collapse. The magnitude of PEH is inversely proportional to the muscle mass and enhanced by concomitant body heating.
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13
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Muñoz-Cano R, San Bartolome C, Casas-Saucedo R, Araujo G, Gelis S, Ruano-Zaragoza M, Roca-Ferrer J, Palomares F, Martin M, Bartra J, Pascal M. Immune-Mediated Mechanisms in Cofactor-Dependent Food Allergy and Anaphylaxis: Effect of Cofactors in Basophils and Mast Cells. Front Immunol 2021; 11:623071. [PMID: 33679712 PMCID: PMC7925840 DOI: 10.3389/fimmu.2020.623071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022] Open
Abstract
Cofactors may explain why in some cases food ingestion leads to anaphylaxis while in others elicits a milder reaction or tolerance. With cofactors, reactions become more severe and/or have a lower allergen threshold. Cofactors are present in up to 58% of food anaphylaxis (FAn). Exercise, NSAIDs, and alcohol are the most frequently described, although the underlying mechanisms are poorly known. Several hypotheses have suggested the influence of these cofactors on basophils and mast cells (MCs). Exercise has been suggested to enhance MC activation by increasing plasma osmolarity, redistributing blood flow, and activating adenosine and eicosanoid metabolism. NSAIDs’ cofactor effect has been related with cyclooxygenase inhibition and therefore, prostaglandin E2 (PGE2) production. Indeed, overexpression of adenosine receptor 3 (A3) gene has been described in NSAID-dependent FAn; A3 activation potentiates FcϵRI-induced MC degranulation. Finally, alcohol has been related with an increase of histamine levels by inhibition of diamino oxidase (DAO) and also with and increase of extracellular adenosine by inhibition of its uptake. However, most of these mechanisms have limited evidence, and further studies are urgently needed. In conclusion, the study of the immune-related mechanisms involved in food allergic reactions enhanced by cofactors is of the utmost interest. This knowledge will help to design both tailored treatments and prophylactic strategies that, nowadays, are non-existent.
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Affiliation(s)
- Rosa Muñoz-Cano
- Allergy Section, Pneumology Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Barcelona, Spain.,Asma, Reacciones Adversas y Alergia (ARADyAL), Instituto de Salud Carlos III, Madrid, Spain.,Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Clara San Bartolome
- Asma, Reacciones Adversas y Alergia (ARADyAL), Instituto de Salud Carlos III, Madrid, Spain.,Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain.,Immunology Department, Centre de Diagnostic Biomedic (CDB), Hospital Clínic, Barcelona, Spain
| | - Rocío Casas-Saucedo
- Allergy Section, Pneumology Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Barcelona, Spain.,Asma, Reacciones Adversas y Alergia (ARADyAL), Instituto de Salud Carlos III, Madrid, Spain.,Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain
| | - Giovanna Araujo
- Allergy Section, Pneumology Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Barcelona, Spain.,Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain
| | - Sonia Gelis
- Allergy Section, Pneumology Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Barcelona, Spain.,Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain
| | - Maria Ruano-Zaragoza
- Allergy Section, Pneumology Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Barcelona, Spain.,Asma, Reacciones Adversas y Alergia (ARADyAL), Instituto de Salud Carlos III, Madrid, Spain.,Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain
| | - Jordi Roca-Ferrer
- Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Francis Palomares
- Asma, Reacciones Adversas y Alergia (ARADyAL), Instituto de Salud Carlos III, Madrid, Spain.,Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Margarita Martin
- Asma, Reacciones Adversas y Alergia (ARADyAL), Instituto de Salud Carlos III, Madrid, Spain.,Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain.,Biochemistry Unit, University of Barcelona Faculty of Medicine and Health Sciences, Barcelona, Spain
| | - Joan Bartra
- Allergy Section, Pneumology Department, Institut Clinic Respiratori (ICR), Hospital Clinic, Barcelona, Spain.,Asma, Reacciones Adversas y Alergia (ARADyAL), Instituto de Salud Carlos III, Madrid, Spain.,Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Asma, Reacciones Adversas y Alergia (ARADyAL), Instituto de Salud Carlos III, Madrid, Spain.,Immunoalergia Respiratoria y Experimental - Institut d'Investigacions Biomediques August Pi i Sunyer (IRCE-IDIBAPS), Barcelona, Spain.,Immunology Department, Centre de Diagnostic Biomedic (CDB), Hospital Clínic, Barcelona, Spain
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14
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Abstract
Athletes of various skill levels commonly use many different types of medications, often at rates higher than the general population. Common medication classes used in athletes include analgesics such as nonsteroidal anti-inflammatory drugs and acetaminophen, inhalers for asthma and exercise-induced bronchoconstriction, antihypertensives, antibiotics, and insulin. Prescribers must be aware of the unique considerations for each of these medications when using them in patients participating in physical activity. The safety, efficacy, impact on athletic performance, and regulatory restrictions of the most common medications used in athletes are discussed in this article.
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Affiliation(s)
- Benjamin Ferry
- Trident/MUSC Family Medicine Residency Program, Department of Family Medicine, Medical University of South Carolina, 9228 Medical Plaza Drive, Charleston, SC 29406, USA
| | - Alexei DeCastro
- Department of Family Medicine, Medical University of South Carolina, College of Medicine, 9228 Medical Plaza Drive, Charleston, SC 29406, USA
| | - Scott Bragg
- Department of Family Medicine, College of Medicine, College of Pharmacy, Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina, 280 Calhoun Street MSC 140, Charleston, SC 29425, USA.
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15
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Kucher AN. Association of Polymorphic Variants of Key Histamine Metabolism Genes and Histamine Receptor Genes with Multifactorial Diseases. RUSS J GENET+ 2019. [DOI: 10.1134/s102279541907010x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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16
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Romero SA, Minson CT, Halliwill JR. The cardiovascular system after exercise. J Appl Physiol (1985) 2017; 122:925-932. [PMID: 28153943 DOI: 10.1152/japplphysiol.00802.2016] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 11/22/2022] Open
Abstract
Recovery from exercise refers to the time period between the end of a bout of exercise and the subsequent return to a resting or recovered state. It also refers to specific physiological processes or states occurring after exercise that are distinct from the physiology of either the exercising or the resting states. In this context, recovery of the cardiovascular system after exercise occurs across a period of minutes to hours, during which many characteristics of the system, even how it is controlled, change over time. Some of these changes may be necessary for long-term adaptation to exercise training, yet some can lead to cardiovascular instability during recovery. Furthermore, some of these changes may provide insight into when the cardiovascular system has recovered from prior training and is physiologically ready for additional training stress. This review focuses on the most consistently observed hemodynamic adjustments and the underlying causes that drive cardiovascular recovery and will highlight how they differ following resistance and aerobic exercise. Primary emphasis will be placed on the hypotensive effect of aerobic and resistance exercise and associated mechanisms that have clinical relevance, but if left unchecked, can progress to symptomatic hypotension and syncope. Finally, we focus on the practical application of this information to strategies to maximize the benefits of cardiovascular recovery, or minimize the vulnerabilities of this state. We will explore appropriate field measures, and discuss to what extent these can guide an athlete's training.
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Affiliation(s)
- Steven A Romero
- University of Texas Southwestern Medical Center, Dallas, Texas.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas; and
| | | | - John R Halliwill
- Department of Human Physiology, University of Oregon, Eugene, Oregon
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