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Rowland SN, O'Donnell E, James LJ, Da Boit M, Fujii N, Arnold JT, Lloyd AB, Eglin CM, Shepherd AI, Bailey SJ. Nitrate ingestion blunts the increase in blood pressure during cool air exposure. A double-blind, placebo-controlled, randomized, crossover trial. J Appl Physiol (1985) 2024. [PMID: 38572540 DOI: 10.1152/japplphysiol.00593.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
Cold exposure increases blood pressure (BP) and salivary flow rate (SFR). Increased cold-induced SFR would be hypothesised to enhance oral nitrate delivery for reduction to nitrite by oral anaerobes and to subsequently elevate plasma [nitrite] and nitric oxide bioavailability. We tested the hypothesis that dietary nitrate supplementation would increase plasma [nitrite] and lower BP to a greater extent in cool compared to normothermic conditions. Twelve males attended the laboratory on four occasions. Baseline measurements were completed at 28°C. Subsequently, participants ingested 140 mL of concentrated nitrate-rich (BR; ~13 mmol nitrate) or nitrate-depleted (PL) beetroot juice. Measurements were repeated over 3 h at either 28°C (Norm) or 20°C (Cool). Mean skin temperature was lowered compared to baseline in PL-Cool and BR-Cool. SFR was greater in BR-Norm, PL-Cool and BR-Cool than PL-Norm. Plasma [nitrite] at 3 h was higher in BR-Cool (592 ± 239 nM) vs. BR-Norm (410 ± 195 nM). Systolic BP (SBP) at 3 h was not different between PL-Norm (117 ± 6 mmHg) and BR-Norm (113 ± 9 mmHg). SBP increased above baseline at 1, 2 and 3 h in PL-Cool but not BR-Cool. These results suggest that BR consumption is more effective at increasing plasma [nitrite] in cool compared to normothermic conditions and blunts the rise in BP following acute cool air exposure, which might have implications for attenuating the increased cardiovascular strain in the cold.
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Affiliation(s)
- Samantha N Rowland
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Emma O'Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Lewis J James
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Mariasole Da Boit
- Health and Life Sciences, School of Allied Health Sciences, De Montfort University, Leicester, United Kingdom
| | - Naoto Fujii
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Josh T Arnold
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Alex B Lloyd
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Clare M Eglin
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Anthony I Shepherd
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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2
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James TJ, Corbett J, Cummings M, Allard S, Shute JK, Belcher H, Mayes H, Gould AAM, Piccolo DD, Tipton M, Perissiou M, Saynor ZL, Shepherd AI. The effect of repeated hot water immersion on insulin sensitivity, heat shock protein 70, and inflammation in individuals with type 2 diabetes mellitus. Am J Physiol Endocrinol Metab 2023; 325:E755-E763. [PMID: 37938179 DOI: 10.1152/ajpendo.00222.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/09/2023]
Abstract
Repeated hot water immersion (HWI) can improve glycemic control in healthy individuals but data are limited for individuals with type 2 diabetes mellitus (T2DM). The present study investigated whether repeated HWI improves insulin sensitivity and inflammatory status and reduces plasma ([extracellular heat shock protein 70]) [eHSP70] and resting metabolic rate (RMR). Fourteen individuals with T2DM participated in this pre- versus postintervention study, with outcome measures assessed in fasted (≥12 h) and postprandial (2-h post-75 g glucose ingestion) states. HWI consisted of 1 h in 40°C water (target rectal temperature 38.5°C-39°C) repeated 8-10 times within a 14-day period. Outcome measures included insulin sensitivity, plasma [glucose], [insulin], [eHSP70], inflammatory markers, RMR, and substrate utilization. The HWI intervention increased fasted insulin sensitivity (QUICKI; P = 0.03) and lowered fasted plasma [insulin] (P = 0.04), but fasting plasma [glucose] (P = 0.83), [eHSP70] (P = 0.08), [IL-6] (P = 0.55), [IL-10] (P = 0.59), postprandial insulin sensitivity (P = 0.19), plasma [glucose] (P = 0.40), and [insulin] (P = 0.47) were not different. RMR was reduced by 6.63% (P < 0.05), although carbohydrate (P = 0.43) and fat oxidation (P = 0.99) rates were unchanged. This study shows that 8-10 HWIs within a 14-day period improved fasting insulin sensitivity and plasma [insulin] in individuals with T2DM, but not when glucose tolerance is challenged. HWI also improves metabolic efficiency (i.e., reduced RMR). Together these results could be clinically important and have implications for metabolic health outcomes and well-being in individuals with T2DM.NEW & NOTEWORTHY This is the first study to investigate repeated HWI to raise deep body temperature on insulin sensitivity, inflammation, eHSP70, and substrate utilization in individuals with T2DM. The principal novel findings were improvements in fasting insulin sensitivity and fasting plasma [insulin] but no change in fasting plasma [glucose], postprandial insulin sensitivity, plasma [insulin], or [glucose]. There was also no change in eHSP70, inflammatory status, or substrate utilization but there were reductions in RMR and oxygen consumption.
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Affiliation(s)
- Thomas J James
- Faculty of Science and Health, Physical Activity, Health and Rehabilitation Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
- Faculty of Science and Health, Extreme Environments Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Jo Corbett
- Faculty of Science and Health, Extreme Environments Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Michael Cummings
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Sharon Allard
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Janis K Shute
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Harvey Belcher
- Faculty of Science and Health, Physical Activity, Health and Rehabilitation Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
- Faculty of Science and Health, Extreme Environments Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Harry Mayes
- Faculty of Science and Health, Extreme Environments Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Alex A M Gould
- Faculty of Science and Health, Extreme Environments Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Daniel D Piccolo
- Faculty of Science and Health, Physical Activity, Health and Rehabilitation Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
- Faculty of Science and Health, Extreme Environments Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Michael Tipton
- Faculty of Science and Health, Extreme Environments Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Maria Perissiou
- Faculty of Science and Health, Physical Activity, Health and Rehabilitation Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Zoe L Saynor
- Faculty of Science and Health, Physical Activity, Health and Rehabilitation Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Anthony I Shepherd
- Faculty of Science and Health, Physical Activity, Health and Rehabilitation Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
- Faculty of Science and Health, Extreme Environments Theme, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
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3
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Corbett J, Tipton MJ, Perissiou M, James T, Young JS, Newman A, Cummings M, Montgomery H, Grocott MPW, Shepherd AI. Effect of different levels of acute hypoxia on subsequent oral glucose tolerance in males with overweight: A balanced cross-over pilot feasibility study. Physiol Rep 2023; 11:e15623. [PMID: 37144546 PMCID: PMC10161207 DOI: 10.14814/phy2.15623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 05/06/2023] Open
Abstract
Previous research has shown that ≤60 min hypoxic exposure improves subsequent glycaemic control, but the optimal level of hypoxia is unknown and data are lacking from individuals with overweight. We undertook a cross-over pilot feasibility study investigating the effect of 60-min prior resting exposure to different inspired oxygen fractions (CON FI O2 = 0.209; HIGH FI O2 = 0.155; VHIGH FI O2 = 0.125) on glycaemic control, insulin sensitivity, and oxidative stress during a subsequent oral glucose tolerance test (OGTT) in males with overweight (mean (SD) BMI = 27.6 (1.3) kg/m2 ; n = 12). Feasibility was defined by exceeding predefined withdrawal criteria for peripheral blood oxygen saturation (SpO2 ), partial pressure of end-tidal oxygen or carbon dioxide and acute mountain sickness (AMS), and dyspnoea symptomology. Hypoxia reduced SpO2 in a stepwise manner (CON = 97(1)%; HIGH = 91(1)%; VHIGH = 81(3)%, p < 0.001), but did not affect peak plasma glucose concentration (CON = 7.5(1.8) mmol∙L-1 ; HIGH = 7.7(1.1) mmol∙L-1 ; VHIGH = 7.7(1.1) mmol∙L-1 ; p = 0.777; η2 = 0.013), plasma glucose area under the curve, insulin sensitivity, or metabolic clearance rate of glucose (p > 0.05). We observed no between-conditions differences in oxidative stress (p > 0.05), but dyspnoea and AMS symptoms increased in VHIGH (p < 0.05), with one participant meeting the withdrawal criteria. Acute HIGH or VHIGH exposure prior to an OGTT does not influence glucose homeostasis in males with overweight, but VHIGH is associated with adverse symptomology and reduced feasibility.
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Affiliation(s)
- Jo Corbett
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Michael J Tipton
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Maria Perissiou
- Clinical, Health and Rehabilitation Team, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Thomas James
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
- Clinical, Health and Rehabilitation Team, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - John S Young
- National Horizons Centre, Teesside University, Middlesbrough, UK
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Alexander Newman
- National Horizons Centre, Teesside University, Middlesbrough, UK
| | - Michael Cummings
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Hugh Montgomery
- Centre for Sport Exercise and Health, Dept Medicine, University College London, London, UK
| | - Michael P W Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
| | - Anthony I Shepherd
- Clinical, Health and Rehabilitation Team, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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4
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Antoun J, Brown DJ, Jones DJW, Clarkson BG, Shepherd AI, Sangala NC, Lewis RJ, McNarry MA, Mackintosh KA, Mason L, Corbett J, Saynor ZL. Exploring patients' experiences of the impact of dialysis therapies on quality of life and wellbeing. J Ren Care 2023; 49:15-23. [PMID: 35226403 DOI: 10.1111/jorc.12416] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/24/2022] [Accepted: 02/05/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND When people with chronic kidney disease reach kidney failure, renal replacement therapy is usually required to improve symptoms and maintain life. Although in-centre haemodialysis is most commonly used for this purpose, other forms of dialysis are available, including home haemodialysis and peritoneal dialysis. OBJECTIVES We aimed to explore the experiences of adults living with chronic kidney disease who were either approaching the need for dialysis or had reached kidney failure and were receiving a form of dialysis. In particular, we explored how different forms of dialysis affect their quality of life, wellbeing, and physical activity. METHODS Individual semistructured interviews were conducted with 40 adults with kidney failure, comprising four groups (n = 10 each): those receiving in-centre haemodialysis, home haemodialysis or peritoneal dialysis, or predialysis. Interviews were transcribed verbatim, thematically analysed, and then composite vignettes were subsequently developed to present a rich narrative of the collective experiences of each group. FINDINGS Compared with adults who were predialysis, quality of life and wellbeing improved upon initiation of their home haemodialysis or peritoneal dialysis. Conversely, minimal improvement was perceived by those receiving in-centre haemodialysis. Low physical activity was reported across all four groups, although those receiving home haemodialysis and peritoneal dialysis reported a greater desire and ability to be physically active than those in-centre. CONCLUSION These findings highlight that dialysis modalities not requiring regular hospital attendance (i.e., home haemodialysis and peritoneal dialysis) improve independence, quality of life, wellbeing, and can facilitate a more physically active lifestyle.
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Affiliation(s)
- Joe Antoun
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Daniel J Brown
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Daniel J W Jones
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Beth G Clarkson
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Anthony I Shepherd
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Nicholas C Sangala
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Robert J Lewis
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Laura Mason
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Jo Corbett
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Zoe L Saynor
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
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5
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Eglin CM, Wright J, Shepherd AI, Massey H, Hollis S, Towse J, Young JS, Maley MJ, Bailey SJ, Wilkinson C, Montgomery H, Tipton MJ. Plasma biomarkers of endothelial function, inflammation and oxidative stress in individuals with non-freezing cold injury. Exp Physiol 2023; 108:448-464. [PMID: 36808666 PMCID: PMC10988512 DOI: 10.1113/ep090722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/03/2023] [Indexed: 02/22/2023]
Abstract
NEW FINDINGS What is the central question of this study? Are biomarkers of endothelial function, oxidative stress and inflammation altered by non-freezing cold injury (NFCI)? What is the main finding and its importance? Baseline plasma [interleukin-10] and [syndecan-1] were elevated in individuals with NFCI and cold-exposed control participants. Increased [endothelin-1] following thermal challenges might explain, in part, the increased pain/discomfort experienced with NFCI. Mild to moderate chronic NFCI does not appear to be associated with either oxidative stress or a pro-inflammatory state. Baseline [interleukin-10] and [syndecan-1] and post-heating [endothelin-1] are the most promising candidates for diagnosis of NFCI. ABSTRACT Plasma biomarkers of inflammation, oxidative stress, endothelial function and damage were examined in 16 individuals with chronic NFCI (NFCI) and matched control participants with (COLD, n = 17) or without (CON, n = 14) previous cold exposure. Venous blood samples were collected at baseline to assess plasma biomarkers of endothelial function (nitrate, nitrite and endothelin-1), inflammation [interleukin-6 (IL-6), interleukin-10 (IL-10), tumour necrosis factor alpha and E-selectin], oxidative stress [protein carbonyl, 4-hydroxy-2-nonenal (4-HNE), superoxide dismutase and nitrotyrosine) and endothelial damage [von Willebrand factor, syndecan-1 and tissue type plasminogen activator (TTPA)]. Immediately after whole-body heating and separately, foot cooling, blood samples were taken for measurement of plasma [nitrate], [nitrite], [endothelin-1], [IL-6], [4-HNE] and [TTPA]. At baseline, [IL-10] and [syndecan-1] were increased in NFCI (P < 0.001 and P = 0.015, respectively) and COLD (P = 0.033 and P = 0.030, respectively) compared with CON participants. The [4-HNE] was elevated in CON compared with both NFCI (P = 0.002) and COLD (P < 0.001). [Endothelin-1] was elevated in NFCI compared with COLD (P < 0.001) post-heating. The [4-HNE] was lower in NFCI compared with CON post-heating (P = 0.032) and lower than both COLD (P = 0.02) and CON (P = 0.015) post-cooling. No between-group differences were seen for the other biomarkers. Mild to moderate chronic NFCI does not appear to be associated with a pro-inflammatory state or oxidative stress. Baseline [IL-10] and [syndecan-1] and post-heating [endothelin-1] are the most promising candidates for diagnosing NFCI, but it is likely that a combination of tests will be required.
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Affiliation(s)
- Clare M. Eglin
- Extreme Environments LaboratorySchool of SportHealth and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - Jennifer Wright
- Extreme Environments LaboratorySchool of SportHealth and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - Anthony I. Shepherd
- Extreme Environments LaboratorySchool of SportHealth and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - Heather Massey
- Extreme Environments LaboratorySchool of SportHealth and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - Sarah Hollis
- Regional Occupational Health Team (ROHT) CatterickCatterick GarrisonUK
| | - Jonathan Towse
- School of Pharmacy and Biomedical SciencesUniversity of PortsmouthPortsmouthUK
| | - John S. Young
- National Horizons CentreTeesside UniversityMiddlesbroughUK
| | - Matthew J. Maley
- Environmental Ergonomics Research CentreLoughborough School of Design and Creative ArtsLoughborough UniversityLoughboroughUK
| | - Stephen J. Bailey
- National Centre for Sport and Exercise MedicineSchool of SportExercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Chris Wilkinson
- School of Pharmacy and Biomedical SciencesUniversity of PortsmouthPortsmouthUK
| | | | - Michael J. Tipton
- Extreme Environments LaboratorySchool of SportHealth and Exercise ScienceUniversity of PortsmouthPortsmouthUK
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6
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Causer AJ, Shute JK, Cummings MH, Shepherd AI, Wallbanks SR, Pulsford RM, Bright V, Connett G, Saynor ZL. Elexacaftor-Tezacaftor-Ivacaftor improves exercise capacity in adolescents with cystic fibrosis. Pediatr Pulmonol 2022; 57:2652-2658. [PMID: 35851858 PMCID: PMC9795914 DOI: 10.1002/ppul.26078] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2022] [Accepted: 06/25/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Elexacaftor/Tezacaftor/Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) modulator with the potential to improve exercise capacity. This case series of three adolescents with CF aimed to investigate whether 6 weeks treatment with Elexacaftor/Tezacaftor/Ivacaftor could improve exercise capacity in CFTR modulator naive adolescents with CF. METHODS Three adolescents (14.0 ± 1.4 years) with CF (FEV1 % predicted: 62.5 ± 17.1; F508del/F508del genotype) completed an exhaustive maximal cardiopulmonary exercise test on a cycle ergometer to determine peak oxygen uptake ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>̇</mml:mo></mml:mover> </mml:mrow> <mml:annotation>$\dot{{\rm{V}}}$</mml:annotation></mml:semantics> </mml:math> O2peak ) and measure changes in gas exchange and ventilation during exercise at 6 weeks. We also analyzed wrist-worn device-based physical activity (PA) data in two of the three cases. Validated acceleration thresholds were used to quantify time spent in each PA intensity category. RESULTS Clinically meaningful improvements in <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>̇</mml:mo></mml:mover> </mml:mrow> <mml:annotation>$\dot{{\rm{V}}}$</mml:annotation></mml:semantics> </mml:math> O2peak were observed in all three cases (+17.6%, +52.4%, and +32.9%, respectively), with improvements greatest in those with more severe lung disease and lower fitness at baseline. Although lung function increased in all cases, inconsistent changes in markers of ventilatory and peripheral muscle efficiency likely suggest different mechanisms of improvement in this case group of adolescents with CF. Device-based analysis of PA was variable, with one case increasing and one case decreasing. CONCLUSION In this case series, we have observed, for the first time, improvements in exercise capacity following 6 weeks of treatment with Elexacaftor/Tezacaftor/Ivacaftor. Improvements were greatest in the presence of more severe CF lung disease and lower aerobic fitness at baseline. The mechanism(s) responsible for these changes warrant further investigation in larger trials.
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Affiliation(s)
- Adam J Causer
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis K Shute
- School of Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Michael H Cummings
- Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Portsmouth, UK
| | - Anthony I Shepherd
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Samuel R Wallbanks
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Richard M Pulsford
- Sport and Health Sciences, College of Life and Environmental Science, University of Exeter, Exeter, UK
| | - Victoria Bright
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gary Connett
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,National Institute for Health Research, Southampton Biomedical Research Centre, Southampton Children's Hospital, Southampton, UK
| | - Zoe L Saynor
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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7
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Antoun J, Brown DJ, Clarkson BG, Shepherd AI, Sangala NC, Lewis RJ, McNarry MA, Mackintosh KA, Corbett J, Saynor ZL. Experiences of adults living with a kidney transplant-Effects on physical activity, physical function, and quality of life: A descriptive phenomenological study. J Ren Care 2022. [PMID: 36250752 DOI: 10.1111/jorc.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although kidney transplantation is the best treatment for kidney failure, scarce research has examined its effects on physical activity, physical function and quality of life. OBJECTIVES To investigate the experiences of a group of adults living with advanced kidney disease focusing on quality of life, physical activity and function and to see how findings differ in a group of kidney transplant recipients. APPROACH Individual semi-structured interviews were conducted with adults with advanced kidney disease (n = 10; 70.5 ± 8.9 years) and adults who had received a kidney transplant (n = 10; 50.7 ± 11.5 years; transplant age: 42.7 ± 20.9 months). Interviews were transcribed verbatim, thematically analysed and composite vignettes developed. FINDINGS Individuals with advanced kidney disease described a sense of loss and alteration to their life plans. Kidney transplant recipients reported increased freedom, independence and a return to near normality, with improved quality of life, physical activity and function compared with their pre-transplant lives. However, transplant recipients also described living with anxiety about the health of their transplant and fear it may fail. CONCLUSION Whilst adults living with advanced kidney disease often experience a reduced quality of life, physical activity and function, kidney transplantation can help facilitate a return to pre-disease levels of physical activity, physical function and quality of life. However, transplant recipients also reported living with anxiety around their new kidney failing. This study demonstrates the variability in the lived experiences of adults living with advanced kidney disease or a kidney transplant and highlights the need for patient-centred care.
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Affiliation(s)
- Joe Antoun
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Daniel J Brown
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Beth G Clarkson
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Anthony I Shepherd
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Nicholas C Sangala
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Robert J Lewis
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Melitta A McNarry
- Department of Sport and Exercise Sciences, Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Swansea, UK
| | - Kelly A Mackintosh
- Department of Sport and Exercise Sciences, Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Swansea, UK
| | - Jo Corbett
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK.,Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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Saynor ZL, Shepherd AI. Exercise Is Medicine, but Does Not Need To Be Prescribed by a Physician: Time to Recognize the Role and Expertise of the Clinical Exercise Professional. PRiMER 2022; 6:4. [PMID: 35481237 PMCID: PMC9037243 DOI: 10.22454/primer.2022.950894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Anthony I Shepherd
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
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Causer AJ, Khalaf M, Klein Rot E, Brand K, Smith J, Bailey SJ, Cummings MH, Shepherd AI, Saynor ZL, Shute JK. CFTR limits F-actin formation and promotes morphological alignment with flow in human lung microvascular endothelial cells. Physiol Rep 2021; 9:e15128. [PMID: 34851051 PMCID: PMC8634629 DOI: 10.14814/phy2.15128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022] Open
Abstract
Micro- and macrovascular endothelial dysfunction in response to shear stress has been observed in cystic fibrosis (CF), and has been associated with inflammation and oxidative stress. We tested the hypothesis that the cystic fibrosis transmembrane conductance regulator (CFTR) regulates endothelial actin cytoskeleton dynamics and cellular alignment in response to flow. Human lung microvascular endothelial cells (HLMVEC) were cultured with either the CFTR inhibitor GlyH-101 (20 µM) or CFTRinh-172 (20 µM), tumor necrosis factor (TNF)-α (10 ng/ml) or a vehicle control (0.1% dimethyl sulfoxide) during 24 and 48 h of exposure to shear stress (11.1 dynes/cm2 ) or under static control conditions. Cellular morphology and filamentous actin (F-actin) were assessed using immunocytochemistry. [Nitrite] and endothelin-1 ([ET-1]) were determined in cell culture supernatant by ozone-based chemiluminescence and ELISA, respectively. Treatment of HLMVECs with both CFTR inhibitors prevented alignment of HLMVEC in the direction of flow after 24 and 48 h of shear stress, compared to vehicle control (both p < 0.05). Treatment with TNF-α significantly increased total F-actin after 24 h versus control (p < 0.05), an effect that was independent of shear stress. GlyH-101 significantly increased F-actin after 24 h of shear stress versus control (p < 0.05), with a significant (p < 0.05) reduction in cortical F-actin under both static and flow conditions. Shear stress decreased [ET-1] after 24 h (p < 0.05) and increased [nitrite] after 48 h (p < 0.05), but neither [nitrite] nor [ET-1] was affected by GlyH-101 (p > 0.05). CFTR appears to limit cytosolic actin polymerization, while maintaining a cortical rim actin distribution that is important for maintaining barrier integrity and promoting alignment with flow, without effects on endothelial nitrite or ET-1 production.
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Affiliation(s)
- Adam J. Causer
- Department for HealthUniversity of BathBathUK
- School of Pharmacy and Biomedical SciencesUniversity of PortsmouthPortsmouthUK
- School of Sport, Health and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - Maha Khalaf
- School of Pharmacy and Biomedical SciencesUniversity of PortsmouthPortsmouthUK
| | - Emily Klein Rot
- School of Pharmacy and Biomedical SciencesUniversity of PortsmouthPortsmouthUK
- School of Life Science, Engineering & DesignSaxion UniversityEnschedeThe Netherlands
| | - Kimberly Brand
- School of Pharmacy and Biomedical SciencesUniversity of PortsmouthPortsmouthUK
- School of Life Science, Engineering & DesignSaxion UniversityEnschedeThe Netherlands
| | - James Smith
- School of Pharmacy and Biomedical SciencesUniversity of PortsmouthPortsmouthUK
| | - Stephen J. Bailey
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Michael H. Cummings
- Department of Diabetes and EndocrinologyQueen Alexandra HospitalPortsmouthUK
| | - Anthony I. Shepherd
- School of Sport, Health and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - Zoe L. Saynor
- School of Sport, Health and Exercise ScienceUniversity of PortsmouthPortsmouthUK
| | - Janis K. Shute
- School of Pharmacy and Biomedical SciencesUniversity of PortsmouthPortsmouthUK
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10
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Shannon OM, Easton C, Shepherd AI, Siervo M, Bailey SJ, Clifford T. Dietary nitrate and population health: a narrative review of the translational potential of existing laboratory studies. BMC Sports Sci Med Rehabil 2021; 13:65. [PMID: 34099037 PMCID: PMC8186051 DOI: 10.1186/s13102-021-00292-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dietary inorganic nitrate (NO3-) is a polyatomic ion, which is present in large quantities in green leafy vegetables and beetroot, and has attracted considerable attention in recent years as a potential health-promoting dietary compound. Numerous small, well-controlled laboratory studies have reported beneficial health effects of inorganic NO3- consumption on blood pressure, endothelial function, cerebrovascular blood flow, cognitive function, and exercise performance. Translating the findings from small laboratory studies into 'real-world' applications requires careful consideration. MAIN BODY This article provides a brief overview of the existing empirical evidence basis for the purported health-promoting effects of dietary NO3- consumption. Key areas for future research are then proposed to evaluate whether promising findings observed in small animal and human laboratory studies can effectively translate into clinically relevant improvements in population health. These proposals include: 1) conducting large-scale, longer duration trials with hard clinical endpoints (e.g. cardiovascular disease incidence); 2) exploring the feasibility and acceptability of different strategies to facilitate a prolonged increase in dietary NO3- intake; 3) exploitation of existing cohort studies to explore associations between NO3- intake and health outcomes, a research approach allowing larger samples sizes and longer duration follow up than is feasible in randomised controlled trials; 4) identifying factors which might account for individual differences in the response to inorganic NO3- (e.g. sex, genetics, habitual diet) and could assist with targeted/personalised nutritional interventions; 5) exploring the influence of oral health and medication on the therapeutic potential of NO3- supplementation; and 6) examining potential risk of adverse events with long term high- NO3- diets. CONCLUSION The salutary effects of dietary NO3- are well established in small, well-controlled laboratory studies. Much less is known about the feasibility and efficacy of long-term dietary NO3- enrichment for promoting health, and the factors which might explain the variable responsiveness to dietary NO3- supplementation between individuals. Future research focussing on the translation of laboratory data will provide valuable insight into the potential applications of dietary NO3- supplementation to improve population health.
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Affiliation(s)
- Oliver M Shannon
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Easton
- Institute for Clinical Exercise and Health Science, University of the West of Scotland, Blantyre, Scotland, UK
| | - Anthony I Shepherd
- School of Sport, Health & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Mario Siervo
- School of Life Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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11
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James TJ, Corbett J, Cummings M, Allard S, Young JS, Towse J, Carey-Jones K, Eglin C, Hopkins B, Morgan C, Tipton M, Saynor ZL, Shepherd AI. Timing of acute passive heating on glucose tolerance and blood pressure in people with type 2 diabetes: a randomized, balanced crossover, control trial. J Appl Physiol (1985) 2021; 130:1093-1105. [PMID: 33411640 DOI: 10.1152/japplphysiol.00747.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is characterized by chronic hyperglycemia and progressive insulin resistance, leading to macro and microvascular dysfunction. Passive heating has potential to improve glucose homeostasis and act as an exercise mimetic. We assessed the effect of acute passive heating before or during an oral glucose tolerance test (OGTT) in people with T2DM. Twelve people with T2DM were randomly assigned to the following three conditions: 1) 3-h OGTT (control), 2) 1-h passive heating (40°C water) 30 min before an OGTT (HOT-OGTT), and 3) 1-h passive heating (40°C water) 30 min after commencing an OGTT (OGTT-HOT). Blood glucose concentration, insulin sensitivity, extracellular heat shock protein 70 (eHSP70), total energy expenditure (TEE), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded. Passive heating did not alter blood glucose concentration [control: 1,677 (386) arbitrary units (AU), HOT-OGTT: 1,797 (340) AU, and OGTT-HOT: 1,662 (364) AU, P = 0.28], insulin sensitivity (P = 0.15), or SBP (P = 0.18) but did increase eHSP70 concentration in both heating conditions [control: 203.48 (110.81) pg·mL-1; HOT-OGTT: 402.47 (79.02) pg·mL-1; and OGTT-HOT: 310.00 (60.53) pg·mL-1, P < 0.001], increased TEE (via fat oxidation) in the OGTT-HOT condition [control: 263 (33) kcal, HOT-OGTT: 278 (40) kcal, and OGTT-HOT: 304 (38) kcal, P = 0.001], increased HR in both heating conditions (P < 0.001), and reduced DBP in the OGTT-HOT condition (P < 0.01). Passive heating in close proximity to a glucose challenge does not alter glucose tolerance but does increase eHSP70 concentration and TEE and reduce blood pressure in people with T2DM.NEW & NOTEWORTHY This is the first study to investigate the timing of acute passive heating on glucose tolerance and extracellular heat shock protein 70 concentration ([eHSP70]) in people with type 2 diabetes. The principal novel findings from this study were that both passive heating conditions: 1) did not reduce the area under the curve or peak blood glucose concentration, 2) elevated heart rate, and 3) increased [eHSP70], which was blunted by glucose ingestion, while passive heating following glucose ingestion, 4) increased total energy expenditure, and 5) reduced diastolic blood pressure.
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Affiliation(s)
- Thomas J James
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom.,Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Jo Corbett
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Michael Cummings
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Sharon Allard
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - John S Young
- School of Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Jonathan Towse
- School of Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Kathryn Carey-Jones
- School of Biological Sciences, Faculty of Science and Health, University of Portsmouth, United Kingdom.,Oaks Healthcare, Cowplain Family Practice, Waterlooville, United Kingdom
| | - Clare Eglin
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Billy Hopkins
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Connor Morgan
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Michael Tipton
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - Zoe L Saynor
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom.,Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Anthony I Shepherd
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom.,Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
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12
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Antoun J, Brown DJ, Jones DJW, Sangala NC, Lewis RJ, Shepherd AI, McNarry MA, Mackintosh KA, Mason L, Corbett J, Saynor ZL. Understanding the Impact of Initial COVID-19 Restrictions on Physical Activity, Wellbeing and Quality of Life in Shielding Adults with End-Stage Renal Disease in the United Kingdom Dialysing at Home versus In-Centre and Their Experiences with Telemedicine. Int J Environ Res Public Health 2021; 18:3144. [PMID: 33803708 PMCID: PMC8002886 DOI: 10.3390/ijerph18063144] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022]
Abstract
Early in the coronavirus-2019 (COVID-19) containment strategy, people with end-stage renal disease (ESRD) were identified as extremely clinically vulnerable and subsequently asked to 'shield' at home where possible. The aim of this study was to investigate how these restrictions and the transition to an increased reliance on telemedicine within clinical care of people living with kidney disease impacted the physical activity (PA), wellbeing and quality of life (QoL) of adults dialysing at home (HHD) or receiving in-centre haemodialysis (ICHD) in the UK. Individual semistructured telephone interviews were conducted with adults receiving HHD (n = 10) or ICHD (n = 10), were transcribed verbatim and, subsequently, thematically analysed. As result of the COVID-19 restrictions, PA, wellbeing and QoL of people with ESRD were found to have been hindered. However, widespread support for the continued use of telemedicine was strongly advocated and promoted independence and satisfaction in patient care. These findings highlight the need for more proactive care of people with ESRD if asked to shield again, as well as increased awareness of safe and appropriate PA resources to help with home-based PA and emotional wellbeing.
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Affiliation(s)
- Joe Antoun
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO1 2UP, UK; (J.A.); (D.J.B.); (A.I.S.); (J.C.)
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK; (N.C.S.); (R.J.L.)
| | - Daniel J. Brown
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO1 2UP, UK; (J.A.); (D.J.B.); (A.I.S.); (J.C.)
| | - Daniel J. W. Jones
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AH, UK;
| | - Nicholas C. Sangala
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK; (N.C.S.); (R.J.L.)
| | - Robert J. Lewis
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK; (N.C.S.); (R.J.L.)
| | - Anthony I. Shepherd
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO1 2UP, UK; (J.A.); (D.J.B.); (A.I.S.); (J.C.)
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK; (N.C.S.); (R.J.L.)
| | - Melitta A. McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), School of Sport and Exercise Sciences, Swansea University, Swansea SA2 8PP, UK; (M.A.M.); (K.A.M.); (L.M.)
| | - Kelly A. Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), School of Sport and Exercise Sciences, Swansea University, Swansea SA2 8PP, UK; (M.A.M.); (K.A.M.); (L.M.)
| | - Laura Mason
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), School of Sport and Exercise Sciences, Swansea University, Swansea SA2 8PP, UK; (M.A.M.); (K.A.M.); (L.M.)
| | - Jo Corbett
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO1 2UP, UK; (J.A.); (D.J.B.); (A.I.S.); (J.C.)
| | - Zoe L. Saynor
- School of Sport, Health and Exercise Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth PO1 2UP, UK; (J.A.); (D.J.B.); (A.I.S.); (J.C.)
- Academic Department of Renal Medicine, Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK; (N.C.S.); (R.J.L.)
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13
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Causer AJ, Shute JK, Cummings MH, Shepherd AI, Wallbanks SR, Allenby MI, Arregui-Fresneda I, Bright V, Carroll MP, Connett G, Daniels T, Meredith T, Saynor ZL. The implications of dysglycaemia on aerobic exercise and ventilatory function in cystic fibrosis. J Cyst Fibros 2020; 19:427-433. [DOI: 10.1016/j.jcf.2019.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/23/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022]
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14
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Causer AJ, Shute JK, Cummings MH, Shepherd AI, Gruet M, Costello JT, Bailey S, Lindley M, Pearson C, Connett G, Allenby MI, Carroll MP, Daniels T, Saynor ZL. Circulating biomarkers of antioxidant status and oxidative stress in people with cystic fibrosis: A systematic review and meta-analysis. Redox Biol 2020; 32:101436. [PMID: 32044291 PMCID: PMC7264436 DOI: 10.1016/j.redox.2020.101436] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 02/03/2023] Open
Abstract
Introduction Oxidative stress may play an important role in the pathophysiology of cystic fibrosis (CF). This review aimed to quantify CF-related redox imbalances. Methods Systematic searches of the Medline, CINAHL, CENTRAL and PsycINFO databases were conducted. Mean content of blood biomarkers from people with clinically-stable CF and non-CF controls were used to calculate the standardized mean difference (SMD) and 95% confidence intervals (95% CI). Results Forty-nine studies were eligible for this review including a total of 1792 people with CF and 1675 controls. Meta-analysis revealed that protein carbonyls (SMD: 1.13, 95% CI: 0.48 to 1.77), total F2-isoprostane 8-iso-prostaglandin F2α (SMD: 0.64, 95% CI: 0.23 to 1.05) and malondialdehyde (SMD: 1.34, 95% CI: 0.30 to 2.39) were significantly higher, and vitamins A (SMD: −0.66, 95% CI -1.14 to −0.17) and E (SMD: −0.74, 95% CI: −1.28 to −0.20), β-carotene (SMD: −1.80, 95% CI: −2.92 to −0.67), lutein (SMD: −1.52, 95% CI: −1.83 to −1.20) and albumin (SMD: −0.98, 95% CI: −1.68 to −0.27) were significantly lower in the plasma or serum of people with CF versus controls. Conclusions This systematic review and meta-analysis found good evidence for reduced antioxidant capacity and elevated oxidative stress in people with clinically-stable CF. Blood biomarkers of oxidative stress were elevated in stable CF vs non-CF controls. Lipid peroxidation was positively correlated with age and immune cell count in CF. Antioxidants vitamins A & E, β-carotene, lutein and albumin were lower in stable CF. Antioxidants were positively correlated with body mass index and lung function in CF.
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Affiliation(s)
- Adam J Causer
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK; Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis K Shute
- School of Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Michael H Cummings
- Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Portsmouth, UK
| | - Anthony I Shepherd
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Mathieu Gruet
- Laboratory of Impact of Physical Activity on Health (IAPS), UR n°201723207F, University of Toulon, France
| | - Joseph T Costello
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Stephen Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Martin Lindley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Clare Pearson
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gary Connett
- National Institute for Health Research, Southampton Biomedical Research Centre, Southampton Children's Hospital, Southampton, UK
| | - Mark I Allenby
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary P Carroll
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Thomas Daniels
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zoe L Saynor
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK; Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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15
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Norris M, Poltawski L, Calitri R, Shepherd AI, Dean SG. Hope and despair: a qualitative exploration of the experiences and impact of trial processes in a rehabilitation trial. Trials 2019; 20:525. [PMID: 31443735 PMCID: PMC6708169 DOI: 10.1186/s13063-019-3633-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Unanticipated responses by research participants can influence randomised controlled trials (RCTs) in multiple ways, many of which are poorly understood. This study used qualitative interviews as part of an embedded process evaluation to explore the impact participants may have on the study, but also unintended impacts the study may have on them. AIM The aim of the study was to explore participants' experiences and the impact of trial involvement in a pilot RCT in order to inform the designing and delivery of a definitive RCT. METHODS In-depth interviews with 20 participants (10 in the intervention and 10 in the control group) enrolled in a stroke rehabilitation pilot trial. A modified framework approach was used to analyse transcripts. RESULTS Participation in the study was motivated partly by a desperation to receive further rehabilitation after discharge. Responses to allocation to the control group included an increased commitment to self-treatment, and negative psychological consequences were also described. Accounts of participants in both control and intervention groups challenge the presumption that they were neutral, or in equipoise, regarding group allocation prior to consenting to randomisation. CONCLUSIONS Considering and exploring participant and participation effects, particularly in the control group, highlights numerous issues in the interpretation of trial studies, as well as the in ethics of RCTs more generally. While suggestions for a definitive trial design are given, further research is required to investigate the significant implications these findings may have for trial design, monitoring and funding. TRIAL REGISTRATION ClinicalTrials.gov, NCT02429180 . Registered on 29 April/2015.
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Affiliation(s)
- Meriel Norris
- College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
| | | | - Raff Calitri
- University of Exeter Medical School, Exeter, EX1 2LU UK
| | - Anthony I. Shepherd
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, PO1 2ER UK
| | - Sarah G. Dean
- University of Exeter Medical School, Exeter, EX1 2LU UK
| | - on behalf of the ReTrain Team
- College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH UK
- University of Exeter Medical School, Exeter, EX1 2LU UK
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, PO1 2ER UK
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16
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Shepherd AI, Costello JT, Bailey SJ, Bishop N, Wadley AJ, Young-Min S, Gilchrist M, Mayes H, White D, Gorczynski P, Saynor ZL, Massey H, Eglin CM. "Beet" the cold: beetroot juice supplementation improves peripheral blood flow, endothelial function, and anti-inflammatory status in individuals with Raynaud's phenomenon. J Appl Physiol (1985) 2019; 127:1478-1490. [PMID: 31343948 DOI: 10.1152/japplphysiol.00292.2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Raynaud's phenomenon (RP) is characterized by recurrent transient peripheral vasospasm and lower nitric oxide (NO) bioavailability in the cold. We investigated the effect of nitrate-rich beetroot juice (BJ) supplementation on 1) NO-mediated vasodilation, 2) cutaneous vascular conductance (CVC) and skin temperature (Tsk) following local cooling, and 3) systemic anti-inflammatory status. Following baseline testing, 23 individuals with RP attended four times, in a double-blind, randomized crossover design, following acute and chronic (14 days) BJ and nitrate-depleted beetroot juice (NDBJ) supplementation. Peripheral Tsk and CVC were measured during and after mild hand and foot cooling, and during transdermal delivery of acetylcholine and sodium nitroprusside. Markers of anti-inflammatory status were also measured. Plasma nitrite concentration ([nitrite]) was increased in the BJ conditions (P < 0.001). Compared with the baseline visit, thumb CVC was greater following chronic-BJ (Δ2.0 flux/mmHg, P = 0.02) and chronic-NDBJ (Δ1.45 flux/mmHg, P = 0.01) supplementation; however, no changes in Tsk were observed (P > 0.05). Plasma [interleukin-10] was greater, pan endothelin and systolic and diastolic blood pressure (BP) were reduced, and forearm endothelial function was improved, by both BJ and NDBJ supplementation (P < 0.05). Acute and chronic BJ and NDBJ supplementation improved anti-inflammatory status, endothelial function and blood pressure (BP). CVC following cooling increased post chronic-BJ and chronic-NDBJ supplementation, but no effect on Tsk was observed. The key findings are that beetroot supplementation improves thumb blood flow, improves endothelial function and anti-inflammatory status, and reduces BP in people with Raynaud's.NEW & NOTEWORTHY This is the first study to examine the effect of dietary nitrate supplementation in individuals with Raynaud's phenomenon. The principal novel findings from this study were that both beetroot juice and nitrate-depleted beetroot juice 1) increased blood flow in the thumb following a cold challenge; 2) enhanced endothelium-dependent and -independent vasodilation in the forearm; 3) reduced systolic and diastolic blood pressure, and pan-endothelin concentration; and 4) improved inflammatory status in comparison to baseline.
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Affiliation(s)
- Anthony I Shepherd
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Joseph T Costello
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Stephen J Bailey
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, United Kingdom
| | - Nicolette Bishop
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, United Kingdom.,University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, United Kingdom
| | - Alex J Wadley
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, United Kingdom.,University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, United Kingdom
| | - Steven Young-Min
- Rheumatology Department, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Mark Gilchrist
- University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom
| | - Harry Mayes
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Danny White
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Paul Gorczynski
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Zoe L Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Heather Massey
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Clare M Eglin
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
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17
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Causer AJ, Shute JK, Cummings MH, Shepherd AI, Bright V, Connett G, Allenby MI, Carroll MP, Daniels T, Saynor ZL. Reply to Askew and Green. J Appl Physiol (1985) 2019; 126:512. [PMID: 30799675 DOI: 10.1152/japplphysiol.00939.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Adam J Causer
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom.,Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
| | - Janis K Shute
- School of Pharmacy and Biomedical Sciences, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom
| | - Michael H Cummings
- Department of Diabetes and Endocrinology, Queen Alexandra Hospital , Portsmouth , United Kingdom
| | - Anthony I Shepherd
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom
| | - Victoria Bright
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
| | - Gary Connett
- National Institute for Health Research, Southampton Biomedical Research Centre, Southampton Children's Hospital , Southampton , United Kingdom
| | - Mark I Allenby
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
| | - Mary P Carroll
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
| | - Thomas Daniels
- Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
| | - Zoe L Saynor
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom.,Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
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18
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Causer AJ, Shute JK, Cummings MH, Shepherd AI, Bright V, Connett G, Allenby MI, Carroll MP, Daniels T, Saynor ZL. Reply to Cooper. J Appl Physiol (1985) 2019; 126:265. [PMID: 30694712 DOI: 10.1152/japplphysiol.00839.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Adam J Causer
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom.,Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Janis K Shute
- School of Pharmacy and Biomedical Sciences, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom
| | - Michael H Cummings
- Department of Diabetes and Endocrinology, Queen Alexandra Hospital , Portsmouth , United Kingdom
| | - Anthony I Shepherd
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom
| | - Victoria Bright
- Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Gary Connett
- National Institute for Health Research, Southampton Biomedical Research Centre, Southampton Children's Hospital , United Kingdom
| | - Mark I Allenby
- Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Mary P Carroll
- Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Thomas Daniels
- Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Zoe L Saynor
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom.,Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
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19
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Causer AJ, Shute JK, Cummings MH, Shepherd AI, Bright V, Connett G, Allenby MI, Carroll MP, Daniels T, Saynor ZL. Cardiopulmonary exercise testing with supramaximal verification produces a safe and valid assessment of V̇o 2max in people with cystic fibrosis: a retrospective analysis. J Appl Physiol (1985) 2018; 125:1277-1283. [PMID: 30346240 DOI: 10.1152/japplphysiol.00454.2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The validity and safety of using supramaximal verification (Smax) to confirm a maximal effort during cardiopulmonary exercise testing (CPET) in people with cystic fibrosis (CF) and/or those with severe disease has been questioned. Therefore, this study aimed to investigate these concerns in children, adolescents, and adults with mild-to-severe CF lung disease. Retrospective analysis of 17 pediatric and 28 adult participants with CF [age range: 9.2-62.9 y; forced expiratory volume in 1 s: 66.7% (range: 29.9%-102.3%); 30 men] who completed a routine ramp-incremental cycling test to determine peak oxygen uptake (V̇o2peak) was studied. Maximal oxygen uptake (V̇o2max) was subsequently confirmed by Smax at 110% of peak power output. All participants satisfied the criteria to verify a maximal effort during CPET. However, Smax-V̇o2peak exceeded ramp-V̇o2peak in 3/14 (21.4%) of pediatric and 6/28 (21.4%) adult exercise tests. A valid measurement of V̇o2max was attained in 85.7% of pediatric and 96.4% of adult exercise tests, as Smax-V̇o2peak did not exceed ramp-V̇o2peak by >9%. Adults ( n = 9) experienced a ≥5% reduction in arterial O2 saturation during CPET, 4 during both the ramp and Smax, 3 during only the ramp, and 2 during only Smax. Smax did not significantly worsen perceived breathing effort, chest tightness, throat narrowing, or exertion compared with ramp-incremental testing. Given the clinical importance of aerobic fitness in people with CF, incorporating Smax is recommended to provide a safe and valid measure of V̇o2max in children, adolescents, and adults who span the spectrum of CF disease severity. NEW & NOTEWORTHY Incorporating supramaximal verification into cardiopulmonary exercise testing protocols did not increase the frequency of adverse events or perceived discomfort versus a single-phase incremental exercise test in people with mild-to-severe cystic fibrosis. Furthermore, a valid measure of maximal oxygen uptake (V̇o2max) was obtained from 85.7% of pediatric and 96.4% of adult exercise tests, whereas peak oxygen uptake underestimated aerobic fitness in comparison with V̇o2max in 21.4% of cases (by up to 24.4%).
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Affiliation(s)
- Adam J Causer
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom.,Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust , Southampton , United Kingdom
| | - Janis K Shute
- School of Pharmacy and Biomedical Sciences, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom
| | - Michael H Cummings
- Department of Diabetes and Endocrinology, Queen Alexandra Hospital , Portsmouth , United Kingdom
| | - Anthony I Shepherd
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom
| | - Victoria Bright
- Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust , Southampton , United Kingdom
| | - Gary Connett
- National Institute for Health Research, Southampton Biomedical Research Centre, Southampton Children's Hospital , United Kingdom
| | - Mark I Allenby
- Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust , Southampton , United Kingdom
| | - Mary P Carroll
- Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust , Southampton , United Kingdom
| | - Thomas Daniels
- Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust , Southampton , United Kingdom
| | - Zoe L Saynor
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom.,Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust , Southampton , United Kingdom
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20
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Norris M, Poltawski L, Calitri R, Shepherd AI, Dean SG. Acceptability and experience of a functional training programme (ReTrain) in community-dwelling stroke survivors in South West England: a qualitative study. BMJ Open 2018; 8:e022175. [PMID: 30049699 PMCID: PMC6067351 DOI: 10.1136/bmjopen-2018-022175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/18/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
Rehabilitation Training (ReTrain) is a group-based approach to functional training post stroke. ReTrain has recently been evaluated through a pilot randomised controlled trial. OBJECTIVE This article reports on the acceptability of the intervention as described by trial participants. DESIGN A qualitative approach was undertaken. Of the 45 participants recruited into the trial, 23 were randomised to receive ReTrain. Following a sampling strategy, 10 participants undertook 1:1 semistructured audio-recorded interviews. Transcripts were analysed following a modified Framework Approach. RESULTS Six themes were developed including exploration of: the physical and psychological impacts of training,the perceived mechanisms of change, the interaction of the group and approach of the trainer. A further theme considered the reported longer term impact of participation. Overall, the results indicated the acceptability of the intervention, but also key areas for potential modification in the definitive trial. These include a need to consider potential impact on both physical and psychological function, careful consideration of dosing and fatigue and the interpersonal factors that facilitate appropriate level of delivery, the trainer to participant ratio, and enhancing features that support continuation of activity postintervention. CONCLUSION Overall, this study supports the acceptability of ReTrain and the development of a definitive trial evaluation of this intervention to full. TRIAL REGISTRATION NUMBER NCT02429180.
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Affiliation(s)
| | | | | | - Anthony I Shepherd
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
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21
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Shepherd AI, Pulsford R, Poltawski L, Forster A, Taylor RS, Spencer A, Hollands L, James M, Allison R, Norris M, Calitri R, Dean SG. Physical activity, sleep, and fatigue in community dwelling Stroke Survivors. Sci Rep 2018; 8:7900. [PMID: 29785009 PMCID: PMC5962574 DOI: 10.1038/s41598-018-26279-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/30/2018] [Indexed: 11/09/2022] Open
Abstract
Stroke can lead to physiological and psychological impairments and impact individuals' physical activity (PA), fatigue and sleep patterns. We analysed wrist-worn accelerometry data and the Fatigue Assessment Scale from 41 stroke survivors following a physical rehabilitation programme, to examine relationships between PA levels, fatigue and sleep. Validated acceleration thresholds were used to quantify time spent in each PA intensity/sleep category. Stroke survivors performed less moderate to vigorous PA (MVPA) in 10 minute bouts than the National Stroke guidelines recommend. Regression analysis revealed associations at baseline between light PA and fatigue (p = 0.02) and MVPA and sleep efficiency (p = 0.04). Light PA was positively associated with fatigue at 6 months (p = 0.03), whilst sleep efficiency and fatigue were associated at 9 months (p = 0.02). No other effects were shown at baseline, 6 or 9 months. The magnitude of these associations were small and are unlikely to be clinically meaningful. Larger trials need to examine the efficacy and utility of accelerometry to assess PA and sleep in stroke survivors.
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Affiliation(s)
- Anthony I Shepherd
- University of Portsmouth, Sport and Exercise Science, Portsmouth, PO1 2ER, UK.
| | - Richard Pulsford
- University of Exeter, Sport and Health Sciences, Exeter, EX1 2LU, UK
| | - Leon Poltawski
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Anne Forster
- Academic Unit of Elderly Care, University of Leeds, Leeds, LS2 9LJ, UK
| | - Rod S Taylor
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Anne Spencer
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Laura Hollands
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Martin James
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK.,Royal Devon & Exeter Hospital, Exeter, EX2 5DW, UK
| | - Rhoda Allison
- Torbay and Southern Devon Health and Care Trust, Torquay, TQ2 7TD, UK
| | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, London, Uxbridge, UB8 3PH, UK
| | - Raff Calitri
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
| | - Sarah G Dean
- University of Exeter Medical School & PenCLAHRC, Exeter, EX1 2LU, UK
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22
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Dean SG, Poltawski L, Forster A, Taylor RS, Spencer A, James M, Allison R, Stevens S, Norris M, Shepherd AI, Landa P, Pulsford RM, Hollands L, Calitri R. Community-based rehabilitation training after stroke: results of a pilot randomised controlled trial (ReTrain) investigating acceptability and feasibility. BMJ Open 2018; 8:e018409. [PMID: 29449290 PMCID: PMC5829775 DOI: 10.1136/bmjopen-2017-018409] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/20/2017] [Accepted: 09/29/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To assess acceptability and feasibility of trial processes and the Rehabilitation Training (ReTrain) intervention including an assessment of intervention fidelity. DESIGN A two-group, assessor-blinded, randomised controlled trial with parallel mixed methods process and economic evaluations. SETTING Community settings across two sites in Devon. PARTICIPANTS Eligible participants were: 18 years old or over, with a diagnosis of stroke and with self-reported mobility issues, no contraindications to physical activity, discharged from National Health Service or any other formal rehabilitation programme at least 1 month before, willing to be randomised to either control or ReTrain and attend the training venue, possessing cognitive capacity and communication ability sufficient to participate. Participants were individually randomised (1:1) via a computer-generated randomisation sequence minimised for time since stroke and level of functional disability. Only outcome assessors independent of the research team were blinded to group allocation. INTERVENTIONS ReTrain comprised (1) an introductory one-to-one session; (2) ten, twice-weekly group classes with up to two trainers and eight clients; (3) a closing one-to-one session, followed by three drop-in sessions over the subsequent 3 months. Participants received a bespoke home-based training programme. All participants received treatment as usual. The control group received an exercise after stroke advice booklet. OUTCOME MEASURES Candidate primary outcomes included functional mobility and physical activity. RESULTS Forty-five participants were randomised (ReTrain=23; Control=22); data were available from 40 participants at 6 months of follow-up (ReTrain=21; Control=19) and 41 at 9 months of follow-up (ReTrain=21; Control=20). We demonstrated ability to recruit and retain participants. Participants were not burdened by the requirements of the study. We were able to calculate sample estimates for candidate primary outcomes and test procedures for process and health economic evaluations. CONCLUSIONS All objectives were fulfilled and indicated that a definitive trial of ReTrain is feasible and acceptable. TRIAL REGISTRATION NUMBER NCT02429180; Results.
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Affiliation(s)
| | | | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | | | | | - Martin James
- University of Exeter Medical School, Exeter, UK
- Royal Devon and Exeter NHS Foundation Trust
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Rhoda Allison
- Torbay and Southern Devon NHS Foundation Trust, Torquay, UK
| | | | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Anthony I Shepherd
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Paolo Landa
- University of Exeter Medical School, Exeter, UK
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Eglin CM, Costello JT, Bailey SJ, Gilchrist M, Massey H, Shepherd AI. Effects of dietary nitrate supplementation on the response to extremity cooling and endothelial function in individuals with cold sensitivity. A double blind, placebo controlled, crossover, randomised control trial. Nitric Oxide 2017; 70:76-85. [PMID: 28941934 DOI: 10.1016/j.niox.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 01/09/2023]
Abstract
Individuals with cold sensitivity have low peripheral skin blood flow and skin temperature possibly due to reduced nitric oxide (NO•) bioavailability. Beetroot has a high concentration of inorganic nitrate and may increase NO-mediated vasodilation. Using a placebo-controlled, double blind, randomised, crossover design, this study tested the hypotheses that acute beetroot supplementation would increase the rate of cutaneous rewarming following a local cold challenge and augment endothelium-dependent vasodilation in cold sensitive individuals. Thirteen cold sensitive participants completed foot and hand cooling (separately, in 15 °C water for 2 min) with spontaneous rewarming in 30 °C air whilst skin temperature and cutaneous vascular conductance (CVC) were measured (Baseline). On two further separate visits, participants consumed 140 ml of either concentrated beetroot juice (nitrate supplementation) or nitrate-depleted beetroot juice (Placebo) 90 min before resting seated blood pressure was measured. Endothelial function was assessed by measuring CVC at the forearm, finger and foot during iontophoresis of 1% w/v acetylcholine followed by foot and hand cooling as for Baseline. Plasma nitrite concentrations significantly increased in nitrate supplementation compared to Placebo and Baseline (502 ± 246 nmol L-1; 73 ± 45 nmol L-1; 74 ± 49 nmol L-1 respectively; n = 11; P < 0.001). Resting blood pressure and the response to foot and hand cooling did not differ between conditions (all P > 0.05). Nitrate supplementation did not alter endothelial function in the forearm, finger or foot (all P > 0.05) compared to Placebo. Despite a physiologically meaningful rise in plasma nitrite concentrations, acute nitrate supplementation does not alter extremity rewarming, endothelial function or blood pressure in individuals with cold sensitivity.
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Affiliation(s)
- Clare M Eglin
- Department of Sport and Exercise Science, University of Portsmouth, UK
| | - Joseph T Costello
- Department of Sport and Exercise Science, University of Portsmouth, UK
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Mark Gilchrist
- University of Exeter Medical School, NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - Heather Massey
- Department of Sport and Exercise Science, University of Portsmouth, UK
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24
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Dean SG, Poltawski L, Forster A, Taylor RS, Spencer A, James M, Allison R, Stevens S, Norris M, Shepherd AI, Calitri R. Community-based Rehabilitation Training after stroke: protocol of a pilot randomised controlled trial (ReTrain). BMJ Open 2016; 6:e012375. [PMID: 27697876 PMCID: PMC5073546 DOI: 10.1136/bmjopen-2016-012375] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The Rehabilitation Training (ReTrain) intervention aims to improve functional mobility, adherence to poststroke exercise guidelines and quality of life for people after stroke. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost-effectiveness of ReTrain, which is based on Action for Rehabilitation from Neurological Injury (ARNI). The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design. METHODS AND ANALYSIS A 2-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed-methods process evaluation and economic evaluation. 48 participants discharged from clinical rehabilitation despite residual physical disability will be individually randomised 1:1 to ReTrain (25 sessions) or control (exercise advice booklet). Outcome assessment at baseline, 6 and 9 months include Rivermead Mobility Index; Timed Up and Go Test; modified Patient-Specific Functional Scale; 7-day accelerometry; Stroke Self-efficacy Questionnaire, exercise diary, Fatigue Assessment Scale, exercise beliefs and self-efficacy questionnaires, SF-12, EQ-5D-5L, Stroke Quality of Life, Carer Burden Index and Service Receipt Inventory. Feasibility, acceptability and process outcomes include recruitment and retention rates; with measurement burden and trial experiences being explored in qualitative interviews (20 participants, 3 intervention providers). Analyses include descriptive statistics, with 95% CI where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis. ETHICS AND DISSEMINATION National Health Service (NHS) National Research Ethics Service approval granted in April 2015; recruitment started in June. Preliminary studies suggested low risk of serious adverse events; however (minor) falls, transitory muscle soreness and high levels of postexercise fatigue are expected. Outputs include pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised Trainer and Intervention Delivery manuals for multicentre replication of ReTrain; presentations at conferences, public involvement events; internationally recognised peer-reviewed journal publications, open access sources and media releases. TRIAL REGISTRATION NUMBER NCT02429180; Pre-results.
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Affiliation(s)
- Sarah G Dean
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Leon Poltawski
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Anne Forster
- ResearchAcademic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Rod S Taylor
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Anne Spencer
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Martin James
- University of Exeter Medical School & PenCLAHRC, Exeter, UK Royal Devon & Exeter Hospital, Exeter, UK
| | - Rhoda Allison
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | | | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, Middlesex, UK
| | - Anthony I Shepherd
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Raff Calitri
- University of Exeter Medical School & PenCLAHRC, Exeter, UK
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25
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Shepherd AI, Wilkerson DP, Fulford J, Winyard PG, Benjamin N, Shore AC, Gilchrist M. Effect of nitrate supplementation on hepatic blood flow and glucose homeostasis: a double-blind, placebo-controlled, randomized control trial. Am J Physiol Gastrointest Liver Physiol 2016; 311:G356-64. [PMID: 27418682 PMCID: PMC5076007 DOI: 10.1152/ajpgi.00203.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/11/2016] [Indexed: 01/31/2023]
Abstract
Nitric oxide alters gastric blood flow, improves vascular function, and mediates glucose uptake within the intestines and skeletal muscle. Dietary nitrate, acting as a source of nitric oxide, appears to be a potential low-cost therapy that may help maintain glucose homeostasis. In a randomized, double-blind, placebo-controlled crossover study, 31 young and older adult participants had a standardized breakfast, supplemented with either nitrate-rich beetroot juice (11.91 mmol nitrate) or nitrate-depleted beetroot juice as placebo (0.01 mmol nitrate). MRI was used to assess apparent diffusion coefficient (ADC), portal vein flux, and velocity. Plasma glucose, incretin, and C-peptide concentrations and blood pressure were assessed. Outcome variables were measured at baseline and hourly for 3 h. Compared with a placebo, beetroot juice resulted in a significant elevation in plasma nitrate and plasma nitrite concentration. No differences were seen for the young or older adult cohorts between placebo and beetroot juice for ADC, or portal vein flux. There was an interaction effect in the young adults between visits for portal vein velocity. Nitrate supplementation did not reduce plasma glucose, active GLP-1, total GLP-1, or plasma C-peptide concentrations for the young or older adult cohorts. Despite a significant elevation in plasma nitrite concentration following an acute dose of (11.91 mmol) nitrate, there was no effect on hepatic blood flow, plasma glucose, C-peptide, or incretin concentration in healthy adults.
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Affiliation(s)
- Anthony I. Shepherd
- 1College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Devon, United Kingdom; ,2University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom; ,4Department of Sport and Exercise Science, Portsmouth, United Kingdom
| | - Daryl P. Wilkerson
- 1College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Devon, United Kingdom;
| | - Jon Fulford
- 2University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom;
| | - Paul G. Winyard
- 2University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom;
| | - Nigel Benjamin
- 2University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom; ,3Torbay Hospital, Heart and Lung Unit, Torquay, Devon, United Kingdom; and
| | - Angela C. Shore
- 2University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom;
| | - Mark Gilchrist
- 2University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom;
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26
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Shepherd AI, Gilchrist M, Winyard PG, Jones AM, Hallmann E, Kazimierczak R, Rembialkowska E, Benjamin N, Shore AC, Wilkerson DP. Effects of dietary nitrate supplementation on the oxygen cost of exercise and walking performance in individuals with type 2 diabetes: a randomized, double-blind, placebo-controlled crossover trial. Free Radic Biol Med 2015; 86:200-8. [PMID: 25998421 DOI: 10.1016/j.freeradbiomed.2015.05.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/20/2015] [Accepted: 05/11/2015] [Indexed: 12/16/2022]
Abstract
Dietary nitrate supplementation has been shown to reduce the oxygen (O2) cost of exercise and enhance exercise tolerance in healthy individuals. This study assessed whether similar effects could be observed in individuals with type 2 diabetes (T2DM). In a randomized, double-blind, placebo-controlled crossover study, 48 participants with T2DM supplemented their diet for 4 days with either nitrate-rich beetroot juice (70ml/day, 6.43mmol nitrate/day) or nitrate-depleted beetroot juice as placebo (70ml/day, 0.07mmol nitrate/day). After each intervention period, resting plasma nitrate and nitrite concentrations were measured subsequent to participants completing moderate-paced walking. Pulmonary gas exchange was measured to assess the O2 cost of walking. After a rest period, participants performed the 6-min walk test (6MWT). Relative to placebo, beetroot juice resulted in a significant increase in plasma nitrate (placebo, 57±66 vs beetroot, 319±110µM; P < 0.001) and plasma nitrite concentration (placebo, 680±256 vs beetroot, 1065±607nM; P < 0.001). There were no differences between placebo juice and beetroot juice for the O2 cost of walking (946±221 vs 939±223ml/min, respectively; P = 0.59) and distance covered in the 6MWT (550±83 vs 554±90m, respectively; P = 0.17). Nitrate supplementation did not affect the O2 cost of moderate-paced walking or improve performance in the 6MWT. These findings indicate that dietary nitrate supplementation does not modulate the response to exercise in individuals with T2DM.
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Affiliation(s)
- Anthony I Shepherd
- College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter EX1 2LU, Devon, UK; University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - Mark Gilchrist
- University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - Paul G Winyard
- University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - Andrew M Jones
- College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter EX1 2LU, Devon, UK
| | | | | | | | - Nigel Benjamin
- University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - Angela C Shore
- University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - Daryl P Wilkerson
- College of Life and Environmental Sciences, Sport and Health Sciences, University of Exeter, Exeter EX1 2LU, Devon, UK.
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Shepherd AI, Wilkerson DP, Dobson L, Kelly J, Winyard PG, Jones AM, Benjamin N, Shore AC, Gilchrist M. The effect of dietary nitrate supplementation on the oxygen cost of cycling, walking performance and resting blood pressure in individuals with chronic obstructive pulmonary disease: A double blind placebo controlled, randomised control trial. Nitric Oxide 2015; 48:31-7. [DOI: 10.1016/j.niox.2015.01.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
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