Association between changes in habitual stepping activity and cognition in older adults

Advancing age is associated with declines in cognitive function. Although physical activity is thought to protect against this decline, it is unclear how a short-term uptake in daily steps or a decline in day-to-day step variability may contribute to cognition among older adults. We tested associations between changes in step counts, day-to-day step variability and executive cognitive functions among older adults taking part in a physical activity intervention. Thirty-seven older adults (33 females; 71.4 ± 6.3 years) completed a 10-week personalized physical activity intervention. Participants wore a Fitbit to measure daily step counts throughout the study. They also completed a computerized Stroop task before and after the intervention. Average step counts and step count variability via average-real-variability (ARV) were determined. Compared to pre-intervention, step counts increased (p < 0.001) and step variability decreased post-intervention (p = 0.04). Models describing the changes in step counts and ARV over the 10-weeks were cubic (both, p < 0.04). Reaction times during the simple (p = 0.002) and switching (p = 0.04) conditions were faster post-intervention. Change in step variability was positively associated with the change in reaction time for the switching condition (β = 0.029, p = 0.002). On average, a reduction in day-to-day step variability was associated with improvements in cognitive flexibility.

Arm cooling selectively impacts sensorimotor control

The benefits of cold have long been recognized in sport and medicine. However, it also brings costs, which have more rarely been investigated, notably in terms of sensorimotor control. We hypothesized that, in addition to peripheral effects, cold slows down the processing of proprioceptive cues, which has an impact on both feedback and feedforward control. We therefore compared the performances of participants whose right arm had been immersed in either cold water (arm temperature: 14°C) or lukewarm water (arm temperature: 34°C). In experiment 1, we administered a Fitts's pointing task and performed a kinematic analysis to determine whether sensorimotor control processes were affected by the cold. Results revealed 1) modifications in late kinematic parameters, suggesting changes in the use of proprioceptive feedback, and 2) modifications in early kinematic parameters, suggesting changes in action representations and/or feedforward processes. To explore our hypothesis further, we ran a second experiment in which no physical movement was involved, and thus no peripheral effects. Participants were administrated a hand laterality task, known to involve implicit motor imagery and assess the internal representation of the hand. They were shown left- and right-hand images randomly displayed in different orientations in the picture plane and had to identify as quickly and as accurately as possible whether each image was of the left hand or the right hand. Results revealed slower responses and more errors when participants had to mentally rotate the cooled hand in the extreme orientation of 160°, further suggesting the impact of cold on action representations.NEW & NOTEWORTHY We investigated how arm cooling modulates sensorimotor representations and sensorimotor control. Arm cooling induced changes in early kinematic parameters of pointing, suggesting an impact on feedforward processes or hand representation. Arm cooling induced changes in late kinematic parameters of pointing, suggesting an impact on feedback processes. Arm cooling also affected performance on a hand laterality task, suggesting that action representations were modified.

Frailty is associated with worse executive function and higher cerebral blood velocity in cognitively healthy older adults: a cross-sectional study

Frailty is characterized by an increased vulnerability to adverse health events. Executive function impairment is an early sign of progression towards cognitive impairments. Whether frailty is associated with executive function and the associated mechanisms are unclear. We test the hypothesis that higher frailty is associated with worse executive function (Trail Making Test) and if aerobic fitness, prefrontal cortex oxygenation (ΔO2Hb), or middle-cerebral artery velocity (MCAv) impact this association. Forty-one (38 females) cognitively health older adults (70.1 ± 6.3 years) completed a Trail task and 6-min walk test. Prefrontal cortex oxygenation was measured during the Trail task (via functional near-infrared spectroscopy) and MCAv in a sub-sample (n=26, via transcranial Doppler). A 35-item frailty index was used. Frailty was independently, non-linearly related to trail B performance (Frailty2: β=1927 [95% CI: 321-3533], p = 0.02), with the model explaining 22% of the variance of trail B time (p = 0.02). Aerobic fitness was an independent predictor of trail B (β=-0.05 [95% CI: -0.10-0.004], p = 0.04), but age and ΔO2Hb were not (both, p > 0.78). Frailty was positively associated with the difference between trails B and A (β=105 [95% CI: 24-186], p = 0.01). Frailty was also associated with a higher peak MCAv (ρ = 0.40, p = 0.04), but lower ΔO2Hb-peakMCAv ratio (ρ = -0.44, p = 0.02). Higher frailty levels are associated to worse Trail times after controlling for age, aerobic fitness, and prefrontal oxygenation. High frailty level may disproportionately predispose older adults to challenges performing executive function tasks that may manifest early as a compensatory higher MCAv despite worse executive function, and indicate a greater risk of progressing to cognitive impairment.

Effects of combined physical and cognitive program performed in socially enriched environment on older people's cognitive abilities and quality of life (StimCoAPS): study protocol for a randomized controlled trial

The number of older people worldwide is constantly increasing. However, ageing is accompanied by a decline in cognitive ability that can affect quality of life. Cognitive, physical and social activities can all slow this decline but social factors and their contribution to the well-being remain under-researched. The aim of this study is to analyse how the practice environment can foster these social relations and thus enhance well-being and to identify the psychological dimensions that are activated by social relations. This study is a 3-year randomised controlled trial designed to assess the effects on participants' cognitive abilities and quality of life of a combined (ie, physical and cognitive) training programme in different social practice environments. A total of 159 older people (≥65 years old) will be recruited and randomly assigned to one of three practice environments: individual practice at home (n=53), group practice in a gymnasium (n=53) and group practice in an enriched environment (n=53). All participants will complete 12-week combined training sessions and will be assessed four times: before the start, in the middle, at the end and 6 months after the end of the programme. They will undergo cognitive function (episodic memory and executive functions), physical capacity (aerobic fitness, muscle strength and dynamic balance) and psychosocial assessments (indicators of psychological well-being, social support, self-esteem, anxiety, depression and achievement goal strategies), as well as semistructured interviews. Statistical analyses will be conducted to assess the effect of the practice environment on the perceived benefits of this programme in terms of cognitive abilities and quality of life, and to determine the role of psychosocial factors in this relationship. This protocol has been approved by an institutional review board (CERSTAPS: IRB00012476-2022-20-01-146). Trials registration number: NCT05721508.

Partial-body cryostimulation does not impact peripheral microvascular responsiveness but reduces muscular metabolic O2 consumption (mV˙O2) at rest

This study aimed to investigate the effect of partial-body cryostimulation (PBC) on microvascular responsiveness and muscular metabolic O2 consumption rate (mV˙O2). Twenty healthy young adults (ten males and ten females) underwent a post-occlusive reactive hyperemia (PORH) test at the flexor digitorum superficialis area before and after a 3-min PBC session and a 3-min control session. Using near-infrared spectroscopy, occlusion and reperfusion slopes were calculated: oxyhemoglobin ([HbO2]) decrease rate ([HbO2] slope 1), deoxyhaemoglobin ([HHb]) increase rate ([HHb] slope 1), [HbO2] increase rate ([HbO2] slope 2), and [HHb] increase rate ([HHb] slope 2. Using HbO2 kinetics during the occlusion, mV˙O2 was also calculated to characterize myocytes' metabolic O2 consumption. HbO2 slope 1 value was lower after PBC than before PBC (-0.15 ± 0.08 vs -0.24 ± 0.11 s-1; respectively; P < 0.05) in male participants only. A lower [HHb] slope 1 was also observed after PBC compared to before PBC (0.18 ± 0.10 vs 0.24 ± 0.16 s-1; P < 0.05) with no interaction for sex categories. mV˙O2 was significantly lower after PBC than before (pre values 14.75 ± 3.94 vs 18.47 ± 5.73 μMO2Hb.s-1; respectively; P < 0.01) with no interaction between sex categories. No changes in the calculated slope 2 were observed. These findings suggest that a single session of PBC reduces the muscular metabolic O2 needs at rest; however, it does not alter the vascular ability to provide O2 to the myocytes.

Acute Effects of a Maximal Cardiopulmonary Exercise Test on Cardiac Hemodynamic and Cerebrovascular Response and Their Relationship with Cognitive Performance in Individuals with Type 2 Diabetes

Cardiovascular and cerebrovascular diseases are prevalent in individuals with type 2 diabetes (T2D). Among people with T2D aged over 70 years, up to 45% might have cognitive dysfunction. Cardiorespiratory fitness (V˙O₂max) correlates with cognitive performances in healthy younger and older adults, and individuals with cardiovascular diseases (CVD). The relationship between cognitive performances, V˙O₂max, cardiac output and cerebral oxygenation/perfusion responses during exercise has not been studied in patients with T2D. Studying cardiac hemodynamics and cerebrovascular responses during a maximal cardiopulmonary exercise test (CPET) and during the recovery phase, as well as studying their relationship with cognitive performances could be useful to detect patients at greater risk of future cognitive impairment. Purposes: (1) to compare cerebral oxygenation/perfusion during a CPET and during its post-exercise period (recovery); (2) to compare cognitive performances in patients with T2D to those in healthy controls; and (3) to examine if V˙O₂max, maximal cardiac output and cerebral oxygenation/perfusion are associated with cognitive function in individuals with T2D and healthy controls. Nineteen patients with T2D (61.9 ± 7 years old) and 22 healthy controls (HC) (61.8 ± 10 years old) were evaluated on the following: a CPET test with impedance cardiography and cerebral oxygenation/perfusion using a near-infrared spectroscopy. Prior to the CPET, the cognitive performance assessment was performed, targeting: short-term and working memory, processing speed, executive functions, and long-term verbal memory. Patients with T2D had lower V˙O₂max values compared to HC (34.5 ± 5.6 vs. 46.4 ± 7.6 mL/kg fat free mass/min; p < 0.001). Compared to HC, patients with T2D showed lower maximal cardiac index (6.27 ± 2.09 vs. 8.70 ± 1.09 L/min/m², p < 0.05) and higher values of systemic vascular resistance index (826.21 ± 308.21 vs. 583.35 ± 90.36 Dyn·s/cm⁵·m²) and systolic blood pressure at maximal exercise (204.94 ± 26.21 vs. 183.61 ± 19.09 mmHg, p = 0.005). Cerebral HHb during the 1st and 2nd min of recovery was significantly higher in HC compared to T2D (p < 0.05). Executive functions performance (Z score) was significantly lower in patients with T2D compared to HC (-0.18 ± 0.7 vs. -0.40 ± 0.60, p = 0.016). Processing speed, working and verbal memory performances were similar in both groups. Brain tHb during exercise and recovery (-0.50, -0.68, p < 0.05), and O₂Hb during recovery (-0.68, p < 0.05) only negatively correlated with executive functions performance in patients with T2D (lower tHb values associated with longer response times, indicating a lower performance). In addition to reduced V˙O₂max, cardiac index and elevated vascular resistance, patients with T2D showed reduced cerebral hemoglobin (O₂Hb and HHb) during early recovery (0-2 min) after the CPET, and lower performances in executive functions compared to healthy controls. Cerebrovascular responses to the CPET and during the recovery phase could be a biological marker of cognitive impairment in T2D.

Initiation of the Fixed Combination IDegLira in Patients with Type 2 Diabetes on Prior Injectable Therapy: Insights from the EASY French Real-World Study

INTRODUCTION

Combining basal insulin (BI) with glucagon-like peptide-1 receptor agonist (GLP-1RA) is recognized as a relevant option to optimize glucose control in type 2 diabetes (T2D). The EASY real-world study aimed to evaluate the modalities of initiation and the effectiveness of the insulin Degludec plus Liraglutide (IDegLira) fixed-ratio combination in the French health care system.

METHODS

A retrospective analysis included all patients with T2D and prior injectable therapy (GLP1-RA and/or insulin) who started treatment with IDegLira from September 2016 to December 2017 in 11 French diabetes centers. Baseline characteristics, reasons for IDegLira initiation, and modes of implementation were collected from the medical records. Changes in HbA_1c and body weight were determined in patients with available follow-up data (nearest 6-month visit).

RESULTS

IDegLira was initiated in 629 patients previously treated with GLP-1RA alone (11.6%), insulin alone (31.5% including 16.5% with BI and 14.9% with multiple daily injections [MDI]) or a free combination of GLP-1RA and insulin (56.9% including 44.8% with BI and 12.1% with MDI), associated or not with oral agents. IDegLira starting dose (mean of 29 ± 11 dose steps) most often exceeded the recommended dose, and was significantly correlated with prior BI but not GLP-1RA dosage. At initiation, mean age, body mass index (BMI) and HbA_1c were 60.1 ± 10.2 years, 33.4 ± 6.2 kg/m² and 8.8 ± 1.7%, respectively. In 461 patients with available follow-up (median 178 days), HbA_1c decreased in all subgroups submitted to treatment intensification (- 1.7 ± 1.8% [p < 0.0001], - 1.2 ± 1.8% [p < 0.001] and - 0.8 ± 1.8% [p = 0.0026] in patients with prior GLP-1RA, BI or MDI therapy, respectively) but also in those switching from BI and GLP-1RA free combination (- 0.2 ± 0.9%, p = 0.0419). Significant body weight gain occurred in patients previously treated with GLP-1RA alone (+ 1.5 ± 5.8 kg, p = 0.0572) or combined to BI (+ 1.0 ± 3.1 kg, p < 0.0001) while those on BI (- 1.4 ± 4.6 kg, p = 0.0139) or MDI (- 1.4 ± 5.0 kg, p = 0.0484) experienced weight loss.

CONCLUSIONS

While providing new information on the use of IDegLira in the French healthcare system, these data confirm the effectiveness of this fixed-ratio combination in the management of T2D.

Effect of simultaneous exercise and cognitive training on executive functions, baroreflex sensitivity, and pre-frontal cortex oxygenation in healthy older adults: a pilot study

Aging is characterized by cognitive decline affecting daily functioning. To manage this socio-economic challenge, several non-pharmacological methods such as physical, cognitive, and combined training are proposed. Although there is an important interest in this subject, the literature is still heterogeneous. The superiority of simultaneous training compared to passive control and physical training alone seems clear but very few studies compared simultaneous training to cognitive training alone. The aim of this pilot study was to investigate the effect of simultaneous exercise and cognitive training on several cognitive domains in healthy older adults, in comparison with either training alone. Thirty-five healthy older adults were randomized into one of three experimental groups: exercise training, cognitive training, and simultaneous exercise and cognitive training. The protocol involved two 30-min sessions per week for 24 weeks. Cognitive performance in several domains, pre-frontal cortex oxygenation, and baroreflex sensitivity were assessed before and after the intervention. All groups improved executive performance, including flexibility or working memory. We found a group by time interaction for inhibition cost (F_(2,28) = 6.44; p < 0.01) and baroreflex sensitivity during controlled breathing (F_(2,25) = 4.22; p = 0.01), the magnitude of improvement of each variable being associated (r = -0.39; p = 0.03). We also found a decrease in left and right pre-frontal cortex oxygenation in all groups during the trail making test B. A simultaneous exercise and cognitive training are more efficient than either training alone to improve executive function and baroreflex sensitivity. The results of this study may have important clinical repercussions by allowing to optimize the interventions designed to maintain the physical and cognitive health of older adults.

Semaglutide for treatment of obesity in hemodialysis patients waiting for a kidney transplant: new hope?

Obesity limits the access to kidney transplantation and increases the risk of complications and mortality posttransplantation. Usual noninvasive measures, including lifestyle changes and dietary education, do not provide long-term and consistent body weight reduction. In many cases, only bariatric surgery allows patients to significantly reduce body weight. We here report two cases of obese hemodialysis (HD) patients who were successfully treated with off-labeled semaglutide, a glucagon-like peptide receptor agonist (GLP-1RA). The first patient had a body mass index (BMI) of 45.7 kg/m² despite a history of partial gastrectomy. The second patient had a history of type 2 diabetes mellitus and a BMI of 36.5 kg/m². Both patients started semaglutide at the maximal subcutaneous dose of 1 mg/week, which was clinically well tolerated. During the 9-month follow-up, body weight loss ranged from 6.5 to 9.0 kg, ∼1 kg/month. GLP-1RAs, such as semaglutide or liraglutide, could be a novel pharmacological alternative to bariatric surgeries for these HD patients.

Effects of Cardiorespiratory Fitness on Cerebral Oxygenation in Healthy Adults: A Systematic Review

Introduction

Exercise is known to improve cognitive functioning and the cardiorespiratory hypothesis suggests that this is due to the relationship between cardiorespiratory fitness (CRF) level and cerebral oxygenation. The purpose of this systematic review is to consolidate findings from functional near-infrared spectroscopy (fNIRS) studies that examined the effect of CRF level on cerebral oxygenation during exercise and cognitive tasks.

Methods

Medline, Embase, SPORTDiscus, and Web of Science were systematically searched. Studies categorizing CRF level using direct or estimated measures of V̇O_2max and studies measuring cerebral oxygenation using oxyhemoglobin ([HbO₂]) and deoxyhemoglobin ([HHb]) were included. Healthy young, middle-aged, and older adults were included whereas patient populations and people with neurological disorders were excluded.

Results

Following PRISMA guidelines, 14 studies were retained following abstract and full-text screening. Cycle ergometer or treadmill tests were used as direct measures of CRF, and one study provided an estimated value using a questionnaire. Seven studies examined the effects of CRF on cerebral oxygenation during exercise and the remaining seven evaluated it during cognitive tasks. Increased [HbO₂] in the prefrontal cortex (PFC) was observed during cognitive tasks in higher compared to lower fit individuals. Only one study demonstrated increased [HHb] in the higher fit group. Exercise at submaximal intensities revealed increased [HbO₂] in the PFC in higher compared to lower fit groups. Greater PFC [HHb] was also observed in long- vs. short-term trained males but not in females. Primary motor cortex (M1) activation did not differ between groups during a static handgrip test but [HHb] increased beyond maximal intensity in a lower compared to higher fit group.

Conclusion

Consistent with the cardiorespiratory hypothesis, higher fit young, middle-aged, and older adults demonstrated increased cerebral oxygenation compared to lower fit groups. Future research should implement randomized controlled trials to evaluate the effectiveness of interventions that improve CRF and cerebral oxygenation longitudinally.

Cardiorespiratory fitness and prefrontal cortex oxygenation during Stroop task in older males

AIM

The aim of the current study was to assess whether executive function and prefrontal oxygenation are dependent on fitness level and age in older adults.

METHODS

Twenty-four healthy males aged between 55 and 69 years old were recruited for this study. They were stratified by age, leading to the creation of two groups: 55-60 years old and 61-69 years old. A median split based on CRF created higher- and lower-fit categories of participants. Cerebral oxygenation was assessed using functional near-infrared spectroscopy (fNIRS) during a computerized Stroop task. Accuracy (% of correct responses) and reaction times (ms) were used as behavioural indicators of cognitive performances. Changes in oxygenated (∆[HbO2]) and deoxygenated (∆[HHb]) hemoglobin were measured to capture neural changes. Repeated measures ANOVAs (CRF × Age × Stroop conditions) were performed to test the null hypothesis of an absence of interaction between CRF, Age and executive performance.

RESULTS

We also found an interaction between CRF and age on reaction times (p = .001), in which higher fitness levels were related to faster reaction times in the 61-69 year olds but not in the 55-60 year olds. Regarding ΔHHb, the ANOVA revealed a main effect of CRF in the right PFC (p = .04), in which higher-fit participants had a greater Δ[HHb] than the lower-fit (d = 1.5). We also found fitness by age interaction for Δ[HHb] in the right PFC (p = .04).

CONCLUSION

Our results support the positive association of CRF on cerebral oxygenation and Stroop performance in healthy older males. They indicated that high-fit individuals performed better in the 61-69 year olds group, but not in the 55-60 years old group. We also observed a greater PFC oxygenation change (as measured by Δ[HHb]) in the high-fit individuals.

Cryostimulation for Post-exercise Recovery in Athletes: A Consensus and Position Paper

Recovery after exercise is a crucial key in preventing muscle injuries and in speeding up the processes to return to homeostasis level. There are several ways of developing a recovery strategy with the use of different kinds of traditional and up-to-date techniques. The use of cold has traditionally been used after physical exercise for recovery purposes. In recent years, the use of whole-body cryotherapy/cryostimulation (WBC; an extreme cold stimulation lasting 1-4 min and given in a cold room at a temperature comprised from -60 to -195°C) has been tremendously increased for such purposes. However, there are controversies about the benefits that the use of this technique may provide. Therefore, the main objectives of this paper are to describe what is whole body cryotherapy/cryostimulation, review and debate the benefits that its use may provide, present practical considerations and applications, and emphasize the need of customization depending on the context, the purpose, and the subject's characteristics. This review is written by international experts from the working group on WBC from the International Institute of Refrigeration.

Does branched-chain amino acid supplementation improve pulmonary rehabilitation effect in COPD?

BACKGROUND

Muscle wasting is frequent in chronic obstructive lung disease (COPD) and associated with low branched-chain amino acids (BCAA). We hypothesized that BCAA supplementation could potentiate the effect of a pulmonary rehabilitation program (PRP) by inducing muscular change.

MATERIALS AND METHODS

Sixty COPD patients (GOLD 2-3) were involved in an ambulatory 4-week PRP either with BCAA oral daily supplementation or placebo daily supplementation in a randomized double-blind design. Maximal exercise test including quadriceps oxygenation measurements, functional exercise test, muscle strength, lung function tests, body composition, dyspnea and quality of life were assessed before and after PRP.

RESULTS

Fifty-four patients (64.9 ± 8.3 years) completed the protocol. In both groups, maximal exercise capacity, functional and muscle performances, quality of life and dyspnea were improved after 4-week PRP (p ≤ 0.01). Changes in muscle oxygenation during the maximal exercise and recovery period were not modified after 4-week PRP in BCAA group. Contrarily, in the placebo group the muscle oxygenation kinetic of recovery was slowed down after PRP.

CONCLUSION

This study demonstrated that a 4-week PRP with BCAA supplementation is not more beneficial than PRP alone for patients. A longer duration of supplementation or a more precise targeting of patients would need to be investigated to validate an effect on muscle recovery and to demonstrate other beneficial effects.

Use of dipeptidyl peptidase-4 inhibitors and prognosis of COVID-19 in hospitalized patients with type 2 diabetes: A propensity score analysis from the CORONADO study

AIM

To investigate the association between routine use of dipeptidyl peptidase-4 (DPP-4) inhibitors and the severity of coronavirus disease 2019 (COVID-19) infection in patient with type 2 diabetes in a large multicentric study.

MATERIALS AND METHODS

This study was a secondary analysis of the CORONADO study on 2449 patients with type 2 diabetes (T2D) hospitalized for COVID-19 in 68 French centres. The composite primary endpoint combined tracheal intubation for mechanical ventilation and death within 7 days of admission. Stabilized weights were computed for patients based on propensity score (DPP-4 inhibitors users vs. non-users) and were used in multivariable logistic regression models to estimate the average treatment effect in the treated as inverse probability of treatment weighting (IPTW).

RESULTS

Five hundred and ninety-six participants were under DPP-4 inhibitors before admission to hospital (24.3%). The primary outcome occurred at similar rates in users and non-users of DPP-4 inhibitors (27.7% vs. 28.6%; p = .68). In propensity analysis, the IPTW-adjusted models showed no significant association between the use of DPP-4 inhibitors and the primary outcome by Day 7 (OR [95% CI]: 0.95 [0.77-1.17]) or Day 28 (OR [95% CI]: 0.96 [0.78-1.17]). Similar neutral findings were found between use of DPP-4 inhibitors and the risk of tracheal intubation and death.

CONCLUSIONS

These data support the safety of DPP-4 inhibitors for diabetes management during the COVID-19 pandemic and they should not be discontinued.

Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

AIMS/HYPOTHESIS

This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19).

METHODS

The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days.

RESULTS

We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m². Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors.

CONCLUSIONS/INTERPRETATION

In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT04324736.

Asymptomatic left ventricular dysfunction in patients with type 2 diabetes free of cardiovascular disease and its relationship with clinical characteristics: The DIACAR cohort study

AIMS

To assess the prevalence, type and clinical factors associated with left ventricular (LV) dysfunction in patients with type 2 diabetes mellitus (T2DM) by performing a comprehensive echocardiographic Doppler assessment including speckle tracking.

METHODS

Two hundred T2DM patients without overt cardiovascular disease were prospectively enrolled in a single-centre cohort study between 2018 and 2019.

RESULTS

Left ventricular mass was increased in 24 patients (12%) and relative wall thickness (h/r) was increased in 46 patients (23%). Left atrial (LA) enlargement was observed in 27 patients (13.6%) and global longitudinal strain (GLS) was reduced in 38 patients (20.3%). In univariate analysis, LV hypertrophy (LVH) or increased h/r were associated with age, renal function, hypertension and B-type natriuretic peptide (BNP) plasma level. LA dilation was associated with age, history of hypertension, diabetes duration and complications, insulin treatment, BNP level and renal function. GLS was associated with body mass index (BMI) and, in a borderline manner, with diabetes duration. In multivariate analysis, hypertension was associated with LVH and with h/r and a borderline relationship was observed for female gender (LVH), age and insulin treatment (h/r). Age, hypertension and, in a borderline manner, insulin treatment were associated with LA dilation. BMI and shorter diabetes duration were associated with reduced GLS.

CONCLUSION

A high prevalence of asymptomatic cardiac dysfunction/structural abnormalities was observed in patients with T2DM without overt cardiac disease and was associated with either age, diabetes duration or treatment and with comorbidities including hypertension and obesity. Whether these preclinical abnormalities are associated with poor outcomes warrants further study.

Severe Graves' disease-associated orbitopathy: A rare case of frontal bone hemangioma

Graves' orbitopathy might be severe, requiring treatment with high-dose glucocorticoids. A lytic bone lesion, malignant lesions, and diseases resulting from bone remodeling processes (eg, Paget's disease) must be excluded by markers and imagery. Outcomes of high-dose glucocorticoids and thyrotoxicosis must be screened and prevented.

1H-NMR-Based Analysis for Exploring Knee Synovial Fluid Metabolite Changes after Local Cryotherapy in Knee Arthritis Patients

Rehabilitation using cryotherapy has widely been used in inflammatory diseases to relieve pain and decrease the disease activity. The aim of this study was to explore the metabolite changes in inflammatory knee-joint synovial fluids following local cryotherapy treatment (ice or cold CO2). We used proton nuclear magnetic resonance (1H NMR) spectroscopy to assess the metabolite patterns in synovial fluid (SF) in patients with knee arthritis (n = 46) before (D0) and after (D1, 24 h later) two applications of local cryotherapy. Spectra from aqueous samples and organic extracts were obtained with an 11.75 Tesla spectrometer. The metabolite concentrations within the SF were compared between D1 and D0 using multiple comparisons with the application of a false discovery rate (FDR) adjusted at 10% for each metabolite. A total of 32 metabolites/chemical structures were identified including amino acids, organic acids, fatty acids or sugars. Pyruvate, alanine, citrate, threonine was significantly higher at D1 vs D0 (p < 0.05). Tyrosine concentration significantly decreases after cryotherapy application (p < 0.001). We did not observe any effect of gender and cooling technique on metabolite concentrations between D0 and D1 (p > 0.05). The present study provides new insight into a short-term effect of cold stimulus in synovial fluid from patients with knee arthritis. Our observations suggest that the increased level of metabolites involved in energy metabolism may explain the underlying molecular pathways that mediate the antioxidant and anti-inflammatory capacities of cryotherapy.

Functional Status Is Associated With Prefrontal Cortex Activation in Gait in Subacute Stroke Patients: A Functional Near-Infrared Spectroscopy Study

Increasing cerebral oxygenation, more precisely the overactivation of the prefrontal cortex (PFC), reflects cortical control of gait in stroke disease. Studies about the relationship between brain activation and the functional status in stroke patients remain scarce. The aim of this study was to compare brain activation, gait parameters, and cognitive performances in single and dual tasks according to the functional status in subacute stroke patients. Twenty-one subacute stroke patients were divided in two groups according to Barthel Index ("low Barthel" and "high Barthel") and randomly performed ordered walking, cognitive task (n-back task), and dual tasks (walking + n-back task). We assessed gait performances (speed, variability) using an electronic walkway system and cerebral oxygenation (ΔO₂Hb) by functional near-infrared spectroscopy. Patients with better functional status (high Barthel) showed a lower PFC activation (ΔO₂Hb) and better gait parameters in single and dual tasks compared to low-Barthel patients, who exhibited decreased gait performances despite a higher PFC activation, especially in the unaffected side (P < 0.001). PFC overactivation in less functional subacute stroke patients may be due to the loss of stepping automaticity. Our results underline the interest of proposing rehabilitation programs focused on walking, especially for patients with low functional capacity.

High-Intensity Interval Training Improves Cognitive Flexibility in Older Adults

Introduction: Regular aerobic exercise is associated with better executive function in older adults. It is unclear if high-intensity-interval-training (HIIT) elicits moderate-intensity continuous training (MICT) or resistance training (RT). We hypothesized that HIIT would augment executive function more than MICT and RT. Methods: Sixty-nine older adults (age: 68 ± 7 years) performed six weeks (three days/week) of HIIT (2 × 20 min bouts alternating between 15 s intervals at 100% of peak power output (PPO) and passive recovery (0% PPO); n = 24), MICT (34 min at 60% PPO; n = 19), or whole-body RT (eight exercise superior improvements in executive function of older adults than moderate-intensity-continuous-training, 2 × 10 repetitions; n = 26). Cardiorespiratory fitness (i.e., V˙O2max) and executive function were assessed before and after each intervention via a progressive maximal cycle ergometer protocol and the Stroop Task, respectively. Results: The V˙O2max findings revealed a significant group by time interaction (p = 0.001) in which all groups improved following training, but HIIT and MICT improved more than RT. From pre- to post-training, no interaction in the naming condition of the Stroop Task was observed (p > 0.10). However, interaction from pre- to post-training by group was observed, and only the HIIT group exhibited a faster reaction time (from 1250 ± 50 to 1100 ± 50 ms; p < 0.001) in switching (cognitive flexibility). Conclusion: Despite similar improvements in cardiorespiratory fitness, HIIT, but not MICT nor RT, enhanced cognitive flexibility in older adults. Exercise programs should consider using HIIT protocols in an effort to combat cognitive decline in older adults.

Cooling During Exercise May Induce Benefits Linked to Improved Brain Perfusion

The aim of this study was to evaluate the impact of using a cooling vest during physical exercise (per-cooling) in humid and temperate conditions (≈22°C, ≈80% relative humidity) on perceptual and physiological responses (tissue oxygenation and heart rate). 20 physically active men performed twice a 30-min cycling exercise at 70% of their theoretical maximum heart rate while using an activated (experimental condition) and a deactivated (control condition) cooling system in a randomized crossover study. Heart rate and tissue (cerebral and muscular) oxygenation were continuously measured during exercise and recovery, and skin temperature was measured every 10 min. Perception of temperature, humidity and comfort were assessed at the end of the recovery period. Results showed a decrease in trunk skin temperature (p<0.05), a faster heart rate recovery and an increase in the concentration of total hemoglobin at the brain level (p<0.05) compared with control condition. Moreover, an improved subjective rating of thermal sensations, wetness and comfort compared to control values (p<0.05) was noted. In conclusion, wearing a cooling vest during submaximal exercise improves perceptual and physiological responses in humid temperate conditions, which may be due to a better blood perfusion at the brain level and a better parasympathetic reactivation.

Evaluative Threat Increases Effort Expenditure in a Cycling Exercise: An Exploratory Study

Research shows that negative or threatening emotional stimuli can foster movement velocity and force. However, less is known about how evaluative threat may influence movement parameters in endurance exercise. Based on social self-preservation theory, the authors predicted that evaluative threat would facilitate effort expenditure in physical exercise. In an exploratory study, 27 young men completed a bogus intelligence test and received either low-intelligence-quotient feedback (evaluative threat) or no feedback (control). Next, they were asked to pedal on a stationary bicycle for 30 min at a constant cadence. After 10 min (calibration period), the cadence display was hidden. Findings show that participants under evaluative threat increased cadence more than control participants during the subsequent 20-min critical period. These findings underline the potential importance of unrelated evaluative threat on physical performance.

Nutrition for Master Athletes: Is There a Need for Specific Recommendations?

Master athletes are often considered exemplars of successful aging, thanks to their capacity to maintain a high sports performance during their entire life. A high training capacity, regular participation in sporting competitions, and delayed alterations in body composition and physiological capacities have been listed among the main factors contributing to impressive master athletes' performances. However, there is a paucity of data on the metabolism and dietary habits of master athletes, and the question of whether they need to adapt their nutrition to the aging process remains open. Herein, the authors presented a contemporary overview of the metabolic challenges associated with aging, including the risk of low energy availability, anabolic resistance, and periods of metabolic crisis due to forced immobilization. After assembling scientific evidence to show that master athletes must adapt their dietary intake, the authors proposed a summary of nutritional recommendations for master athletes and suggested the next stage of research.

The use of whole-body cryotherapy: time- and dose-response investigation on circulating blood catecholamines and heart rate variability

Purpose

A predominance of parasympathetic drive is observed following cold exposure. Such modulation of the autonomic nervous system (ANS) is associated with faster post-exercise recovery. Within this context, whole-body cryotherapy (WBC) has been spreading in sport medicine, though the optimal temperature and frequency are unclear. The aim of this study was to examine the effects of different cryotherapy conditions on the sympathovagal balance.

Methods

Forty healthy males were randomly assigned into five different groups (− 110 °C, − 60 °C, − 10 °C, control temperature [≃ 24 °C]) and undertook 5 WBC sessions over 5 consecutive days. Cardiac autonomic activity was assessed through heart rate variability (HRV) using power density of high frequency (HF), root-mean square difference of successive R–R intervals (RMSSD) and sympathovagal balance (LF/HF). Systemic sympathetic activity was assessed via circulating blood catecholamines.

Results

Mean weekly RMSSD (pre: 48 ± 22 ms, post: 68 ± 29 ms) and HF (pre: 607 ± 692 ms², post: 1271 ± 1180 ms²) increased (p < 0.05) from pre to post WBC, only in the − 110 °C condition. A rise in plasma norepinephrine was found after the first − 110 °C WBC session only (pre: 173 ± 98, post: 352 ± 231 ng L⁻¹, p < 0.01); whereas, it was not significant after the 5th session (pre: 161 ± 120, post: 293 ± 245 ng L⁻¹, p = 0.15).

Conclusion

These results suggest that one − 110 °C WBC exposure is required to stimulate the ANS. After five daily exposures, a lower autonomic response was recorded compared to day one, therefore suggesting the development of physiological habituation to WBC.

Cerebral Oxygenation Reserve: The Relationship Between Physical Activity Level and the Cognitive Load During a Stroop Task in Healthy Young Males

Introduction: Many studies have reported that regular physical activity is positively associated with cognitive performance and more selectively with executive functions. However, some studies reported that the association of physical activity on executive performance in younger adults was not as clearly established when compared to studies with older adults. Among the many physiological mechanisms that may influence cognitive functioning, prefrontal (PFC) oxygenation seems to play a major role. The aim of the current study was to assess whether executive function and prefrontal oxygenation are dependent on physical activity levels (active versus inactive) in healthy young males. Methods: Fifty-six healthy young males (22.1 ± 2.4 years) were classified as active (n = 26) or inactive (n = 30) according to the recommendations made by the World Health Organization (WHO) and using the Global Physical Activity Questionnaire (GPAQ). Bilateral PFC oxygenation was assessed using functional near-infrared spectroscopy (fNIRS) during a computerized Stroop task (which included naming, inhibition, and switching conditions). Accuracy (% of correct responses) and reaction times (ms) were used as behavioural indicators of cognitive performances. Changes in oxygenated (∆HbO₂) and deoxygenated (∆HHb) hemoglobin were measured to capture neural changes. Several two-way repeated measures ANOVAs (Physical activity level x Stroop conditions) were performed to test the null hypothesis of an absence of interaction between physical activity level and executive performance in prefrontal oxygenation. Results: The analysis revealed an interaction between physical activity level and Stroop conditions on reaction time (p = 0.04; ES = 0.7) in which physical activity level had a moderate effect on reaction time in the switching condition (p = 0.02; ES = 0.8) but not in naming and inhibition conditions. At the neural level, a significant interaction between physical activity level and prefrontal oxygenation was found. Physical activity level had a large effect on ΔHbO₂ in the switching condition in the right PFC (p = 0.04; ES = 0.8) and left PFC (p = 0.02; ES = 0.96), but not in other conditions. A large physical activity level effect was also found on ΔHHb in the inhibition condition in the right PFC (p < 0.01; ES = 0.9), but not in the left PFC or other conditions. Conclusion: The results of this cross-sectional study indicate that active young males performed better in executive tasks than their inactive counterparts and had a larger change in oxygenation in the PFC during these most complex conditions.

Per-Cooling (Using Cooling Systems during Physical Exercise) Enhances Physical and Cognitive Performances in Hot Environments. A Narrative Review

There are many important sport events that are organized in environments with a very hot ambient temperature (Summer Olympics, FIFA World Cup, Tour de France, etc.) and in hot locations (e.g., Qatar). Additionally, in the context of global warming and heat wave periods, athletes are often subjected to hot ambient temperatures. It is known that exercising in the heat induces disturbances that may provoke premature fatigue and negatively affects overall performance in both endurance and high intensity exercises. Deterioration in several cognitive functions may also occur, and individuals may be at risk for heat illnesses. To train, perform, work and recover and in a safe and effective way, cooling strategies have been proposed and have been routinely applied before, during and after exercise. However, there is a limited understanding of the influences of per-cooling on performance, and it is the subject of the present review. This work examines the influences of per-cooling of different areas of the body on performance in terms of intense short-term exercises ("anaerobic" exercises), endurance exercises ("aerobic" exercises), and cognitive functioning and provides detailed strategies that can be applied when individuals train and/or perform in high ambient temperatures.

Cardiorespiratory fitness, blood pressure, and cerebral oxygenation during a dual-task in healthy young males

This study aimed to evaluate the effects of cardiorespiratory fitness (CRF) and mean arterial pressure (MAP) on the prefrontal cortex (PFC) oxygenation and dual-task performance in healthy young males. Changes in the concentration of oxygenated (ΔHbO₂) and deoxygenated hemoglobin (ΔHHb) in the right and left PFC were examined during a cognitive auditory 2-back task. Cognitive performance (2-back task's accuracy) and walking motor performances were measured in single-tasks (single motor and single cognitive) and dual-task (2-back task + walking). Thirty-six young males were ranked according to their V˙O₂peak. The second tertile was excluded to generate two groups of different CRF (high fit group: n = 12 and V˙O₂peak = 56.0 ± 6.7 ml kg^-1 min^-1; low-fit group: n = 12 and V˙O₂peak = 36.7 ± 4.1 ml kg^-1 min^-1). The CRF groups were further split into two subgroups according to 24-h MAP (higher-MAP, lower-MAP). Two-way ANOVA (CRF x n-back conditions) revealed a significant interaction between the CRF and cognitive task condition on 2-back accuracy (p =  .007) and a main effect of CRF on ⊗HHb in the right and left PFC (p < .05). These results suggest that in healthy young males: 1) for CRF, only low-fit individuals demonstrate dual-task costs in accuracy (Dual < Single), and 2) that in comparison to the low-fit group, the high fit-group demonstrated greater changes in PFC oxygenation in ΔHHb, but not ΔHbO₂.

The effects of cardiorespiratory fitness on executive function and prefrontal oxygenation in older adults

Reviews on cardiovascular fitness and cognition in older adults suggest that a higher level of cardiorespiratory fitness may protect the brain against the effects of aging. Although studies reveal positive effects of cardiorespiratory fitness on executive function, more research is needed to clarify the underlying mechanisms of these effects in older adults. The aim of the current study was to assess the association between cardiorespiratory fitness level, cerebral oxygenation, and cognitive performance in older adults (OAs). Seventy-four OAs (68 ± 6.3 years) gave their written, informed consent to participate in the study. Complete data was collected from 66 participants. All participants underwent a cycle ergometer maximal continuous graded exercise test in order to assess their peak power output (PPO) and a neuropsychological paper and pencil tests (Trail Making Test A and B) while changes in left prefrontal cortex oxygenation were measured with functional near-infrared spectroscopy (fNIRS). The results reveal increased cardiorespiratory fitness was associated with decreased response time (i.e., better performance) on the Trail Making Test (B) (standardized β = - 0.42, p < 0.05). Cerebral oxygenation in higher fit older adults mediated the relationship with improved executive functioning (standardized β = - 0.08, p < 0.05). Specifically, in older adults with higher cardiorespiratory fitness (based on a median split), cerebral oxygenation was related to executive functioning but no such relationship existed in lower fit adults.

Impact of Carbohydrate Ingestion on Cognitive Flexibility and Cerebral Oxygenation during High-Intensity Intermittent Exercise: A Comparison between Maple Products and Usual Carbohydrate Solutions

BACKGROUND

The aim of this study was to compare the effects of carbohydrate (CHO) drinks (6% per volume) sweetened with maple (syrup or sap) to a commercial sports drink, glucose, and a control solution (water) on cognitive flexibility during high-intensity intermittent exercise.

METHODS

Eighty-five active men completed six 3-min bouts at 95% of their maximal aerobic power on a stationary bike, with 3 min of passive rest between efforts. Subjects were randomly allocated to an ingestion condition. Following each exercise bout, subjects ingested 166 mL of the experimental solution, drinking a total of 1 L of the same solution throughout the experimentation. Cognitive flexibility was measured using reaction time and accuracy on the Stroop task. The cognitive task was performed a total of 10 times, including 15 and 30 min post-exercise. Glycemia and cerebral oxygenation were also measured at each time point. Statistical analyses were performed using a two-way ANOVA (Condition × Time) with repeated measures.

RESULTS

The ingestion of maple products and the commercial sports drink led to a lesser increase in glycemia than glucose ingestion. CHO ingestion, when compared to water, induced a slight reduction in reaction times on the cognitive task, especially in the switching trials. CHO ingestion had no impact on cerebral oxygenation.

CONCLUSIONS

This study shows that CHO ingestion, regardless of its type, tends to improve cognitive performance throughout exercise, especially during difficult cognitive tasks.

Prefrontal Cortex Activation During Dual Task With Increasing Cognitive Load in Subacute Stroke Patients: A Pilot Study

Stroke patients often exhibit difficulties performing a cognitive task while walking, defined as a dual task (DT). Their prefrontal cortex (PFC) activity is higher in DT than in single task (ST). The effects of an increasing load on PFC activity during DT in subacute stroke patients remains unexplored. Our objective was to assess the effects of N-back tasks (low/high load) on cerebral activity, gait parameters, and cognitive performances. Eleven subacute stroke patients (days post-stroke 45.8 ± 31.6) participated in this pilot study (71.4 ± 10 years, BMI 26.7 ± 4.8 kg.m^-2, Barthel index 81.8 ± 11.0). Patients completed a ST_walk, and 4 conditions with 1-back (low load) and 2-back (high load): ST_low, ST_high, DT_low, and DT_high. Overground walking was performed at a comfortable pace and -N-back conditions were carried out verbally. Both gait (speed, stride variability) and cognitive (rate of correct answers) performances were recorded. Changes in PFC oxyhemoglobin (ΔO₂Hb) and deoxyhemoglobin (ΔHHb) were measured by functional near infrared spectroscopy (fNIRS). Results showed an increase of ΔO₂Hb while walking, which was not augmented by cognitive loads in DT. Walking speed was reduced by low and high cognitive loads in DT compared to ST_walk (P < 0.05), but was not different between DT_low and DT_high. Cognitive performances were negatively impacted by both walking (P < 0.05) and cognitive load (between "low" and "high," P < 0.001). These data highlight a "ceiling" effect in ΔO₂Hb levels while walking, leaving no available resources for simultaneous cognitive tasks, during the early recovery period following stroke. In these patients, cognitive, but not motor, performances declined with a higher cognitive load.

Cerebral and Muscle Oxygenation during Repeated Shuttle Run Sprints with Hypoventilation

Ten highly-trained Jiu-Jitsu fighters performed 2 repeated-sprint sessions, each including 2 sets of 8 x ~6 s back-and-forth running sprints on a tatami. One session was carried out with normal breathing (RSN) and the other with voluntary hypoventilation at low lung volume (RSH-VHL). Prefrontal and vastus lateralis muscle oxyhemoglobin ([O₂Hb]) and deoxyhemoglobin ([HHb]) were monitored by near-infrared spectroscopy. Arterial oxygen saturation (SpO₂), heart rate (HR), gas exchange and maximal blood lactate concentration ([La]_max) were also assessed. SpO₂ was significantly lower in RSH-VHL than in RSN whereas there was no difference in HR. Muscle oxygenation was not different between conditions during the entire exercise. On the other hand, in RSH-VHL, cerebral oxygenation was significantly lower than in RSN (-6.1±5.4 vs-1.5±6.6 µm). Oxygen uptake was also higher during the recovery periods whereas [La]_max tended to be lower in RSH-VHL. The time of the sprints was not different between conditions. This study shows that repeated shuttle-run sprints with VHL has a limited impact on muscle deoxygenation but induces a greater fall in cerebral oxygenation compared with normal breathing conditions. Despite this phenomenon, performance is not impaired, probably because of a higher oxygen uptake during the recovery periods following sprints.

3-min whole body cryotherapy/cryostimulation after training in the evening improves sleep quality in physically active men

Exercise training during evening may disturb sleep patterns and hinder recovery process. The present study aimed to examine the effect of whole body cryotherapy (WBC) exposure after training in the evening on sleep quality and night heart rate variability (HRV). A total of 22 physically active men were randomized to undergo either WBC (3-min at -40°C, wind speed of 2.3 m s^-1) or passive recovery (control) following an evening training consisting of 25 min of continuous running at 65% of the maximal aerobic speed (MAS) followed by intermittent running at 85% of the MAS. Each night following the training, the number of movements and HRV during sleeping time were recorded. The next morning, subjective sleep quality and perceived pain were assessed using Spiegel questionnaire and a visual analogue scale, respectively. The number of movements during the night following WBC was significantly reduced (p < 0.05) compared with the control condition. Subjective sleep quality following WBC was significantly better than the control group (p < 0.05). During the estimated slow-wave sleep (SWS), the high frequency power (HF) was higher in the WBC group than the control group (p < 0.05), and the low frequency power (LF) and the LF/HF ratio were lower than the control group (p < 0.05). Pain was significantly reduced following WBC compared to the control (p < 0.01). In conclusion, the use of 3-min WBC after training in the evening improves subjective and objective sleep quality in physically active subjects, which may be due to greater pain relief and improved parasympathetic nervous activity during the SWS period.

Higher cardiovascular fitness level is associated to better cognitive dual-task performance in Master Athletes: Mediation by cardiac autonomic control

INTRODUCTION/PURPOSE

This study compared cognitive performances and cardiac autonomic measures of higher fit and lower fit middle-aged and older highly active adults. The working hypotheses were that higher fit (master athletes) would show cognitive benefits in executive control conditions due to a high level of fitness compared to lower fit people and that this effect would be mediated by better cardiac autonomic adaptations in athletes.

METHODS

We recruited 39 highly active middle aged and older adults from Master Athletes' organizations. All participants performed a Rockport walking test and a computerized dual-task. Cardiac autonomic control was assessed with a measure of heart rate variability. Based on the V̇O_2max estimated by the Rockport test, a median split was performed to assess the influence of fitness level on cognitive performance and the link with heart rate variability. Those with the highest fitness level were considered Master Athletes.

RESULTS

Master Athletes showed better dual-task performances than lower fit individuals. A positive relationship between the V̇O_2max and dual-task performances was also observed. Master Athletes demonstrated a lower resting HR and higher RR interval than lower fit individuals, and this index was specifically related to the executive conditions of the dual task.

CONCLUSION

Our results highlight the role of fitness level on executive function in highly active middle aged and older adults and suggest that the better performances observed in highly fit individuals is mediated by cardiac autonomic control.

An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis

Introduction: The aim of the present work was to perform a meta-analysis evaluating the impact of recovery techniques on delayed onset muscle soreness (DOMS), perceived fatigue, muscle damage, and inflammatory markers after physical exercise. Method: Three databases including PubMed, Embase, and Web-of-Science were searched using the following terms: ("recovery" or "active recovery" or "cooling" or "massage" or "compression garment" or "electrostimulation" or "stretching" or "immersion" or "cryotherapy") and ("DOMS" or "perceived fatigue" or "CK" or "CRP" or "IL-6") and ("after exercise" or "post-exercise") for randomized controlled trials, crossover trials, and repeated-measure studies. Overall, 99 studies were included. Results: Active recovery, massage, compression garments, immersion, contrast water therapy, and cryotherapy induced a small to large decrease (-2.26 < g < -0.40) in the magnitude of DOMS, while there was no change for the other methods. Massage was found to be the most powerful technique for recovering from DOMS and fatigue. In terms of muscle damage and inflammatory markers, we observed an overall moderate decrease in creatine kinase [SMD (95% CI) = -0.37 (-0.58 to -0.16), I2 = 40.15%] and overall small decreases in interleukin-6 [SMD (95% CI) = -0.36 (-0.60 to -0.12), I2 = 0%] and C-reactive protein [SMD (95% CI) = -0.38 (-0.59 to-0.14), I2 = 39%]. The most powerful techniques for reducing inflammation were massage and cold exposure. Conclusion: Massage seems to be the most effective method for reducing DOMS and perceived fatigue. Perceived fatigue can be effectively managed using compression techniques, such as compression garments, massage, or water immersion.

Cardiovascular and cerebral hemodynamics during exercise and recovery in obese individuals as a function of their fitness status

The aim of this study was to compare cardiovascular hemodynamics and cerebral oxygenation/perfusion (COP) during and after maximal incremental exercise in obese individuals according to their aerobic fitness versus age‐matched healthy controls (AMHC). Fifty‐four middle–aged obese (OB) and 16 AMHC were recruited. Maximal cardiopulmonary function (gas exchange analysis), cardiac hemodynamics (impedance cardiography), and left frontal COP (near‐infrared spectroscopy: NIRS) were measured continuously during a maximal incremental ergocycle test. During recovery, reoxygenation/perfusion rate (ROPR: oxyhemoglobin: ΔO₂Hb, deoxyhemoglobin: ΔHHb and total hemoglobin: ΔtHb; with NIRS) was also measured. Obese participants (OB, n = 54) were divided into two groups according to the median V˙O2 peak: the low‐fit obese (LF‐OB, n = 27) and the high‐fit obese (HF‐OB, n = 27). During exercise, end tidal pressure of CO₂ (PETCO₂), and COP (ΔO₂Hb, ΔHHb and ΔtHb) did not differ between groups (OB, LF‐OB, HF‐OB, AMHC). During recovery, PETCO₂ and ROPR (ΔO₂Hb, ΔHHb and ΔtHb) were similar between the groups (OB, LF‐OB, HF‐OB, AMHC). During exercise and recovery, cardiac index was lower (P < 0.05) in LF‐OB versus the other two groups (HF‐OB, AMHC). As well, systolic blood pressure was higher during exercise in the OB, LF‐OB and HF‐OB groups versus AMHC (P < 0.05). When compared to AMHC, obese individuals (OB, LF‐OB, HF‐OB) have a similar cerebral vasoreactivity by CO₂ and cerebral hemodynamics during exercise and recovery, but a higher systolic blood pressure during exercise. Higher fitness in obese subjects (HF‐OB) seems to preserve their cardiopulmonary and cardiac function during exercise and recovery.

Cognitive function in patients with stable coronary heart disease: Related cerebrovascular and cardiovascular responses

Chronic exercise has been shown to prevent or slow age-related decline in cognitive functions in otherwise healthy, asymptomatic individuals. We sought to assess cognitive function in a stable coronary heart disease (CHD) sample and its relationship to cerebral oxygenation-perfusion, cardiac hemodynamic responses, and V˙O2 peak compared to age-matched and young healthy control subjects. Twenty-two young healthy controls (YHC), 20 age-matched old healthy controls (OHC) and 25 patients with stable CHD were recruited. Cognitive function assessment included short term—working memory, perceptual abilities, processing speed, cognitive inhibition and flexibility and long-term verbal memory. Maximal cardiopulmonary function (gas exchange analysis), cardiac hemodynamic (impedance cardiography) and left frontal cerebral oxygenation-perfusion (near-infra red spectroscopy) were measured during and after a maximal incremental ergocycle test. Compared to OHC and CHD, YHC had higher V˙O2 peak, maximal cardiac index (CI max), cerebral oxygenation-perfusion (ΔO₂ Hb, ΔtHb: exercise and recovery) and cognitive function (for all items) (P<0.05). Compared to OHC, CHD patients had lower V˙O2 peak, CI max, cerebral oxygenation-perfusion (during recovery) and short term—working memory, processing speed, cognitive inhibition and flexibility and long-term verbal memory (P<0.05). V˙O2 peak and CI max were related to exercise cerebral oxygenation-perfusion and cognitive function (P<0.005). Cerebral oxygenation-perfusion (exercise) was related to cognitive function (P<0.005). Stable CHD patients have a worse cognitive function, a similar cerebral oxygenation/perfusion during exercise but reduced one during recovery vs. their aged-matched healthy counterparts. In the all sample, cognitive functions correlated with V˙O2 peak, CI max and cerebral oxygenation-perfusion.

Comparable Cerebral Oxygenation Patterns in Younger and Older Adults during Dual-Task Walking with Increasing Load

The neuroimaging literature on dual-task gait clearly demonstrates increased prefrontal cortex (PFC) involvement when performing a cognitive task while walking. However, findings from direct comparisons of the cerebral oxygenation patterns of younger (YA) and older (OA) adults during dual-task walking are mixed and it is unclear how YA and OA respond to increasing cognitive load (difficulty) while walking. This functional near infra-red (fNIRS) study examined cerebral oxygenation of YA and OA during self-paced dual-task treadmill walking at two different levels of cognitive load (auditory n-back). Changes in accuracy (%) as well as oxygenated (HbO) and deoxygenated (HbR) hemoglobin were examined. For the HbO and HbR measures, eight regions of interest (ROIs) were assessed: the anterior and posterior dorsolateral and ventrolateral PFC (aDLPFC, pDLPFC, aVLPFC, pVLPFC) in each hemisphere. Nineteen YA (M = 21.83 years) and 14 OA (M = 66.85 years) walked at a self-selected pace while performing auditory 1-back and 2-back tasks. Walking alone (single motor: SM) and performing the cognitive tasks alone (single cognitive: SC) were compared to dual-task walking (DT = SM + SC). In the behavioural data, participants were more accurate in the lowest level of load (1-back) compared to the highest (2-back; p < 0.001). YA were more accurate than OA overall (p = 0.009), and particularly in the 2-back task (p = 0.048). In the fNIRS data, both younger and older adults had task effects (SM < DT) in specific ROIs for ΔHbO (three YA, one OA) and ΔHbR (seven YA, eight OA). After controlling for walk speed differences, direct comparisons between YA and OA did not reveal significant age differences, but did reveal a difficulty effect in HbO in the left aDLPFC (p = 0.028) and significant task effects (SM < DT) in HbR for six of the eight ROIs. Findings suggest that YA and OA respond similarly to manipulations of cognitive load when walking on a treadmill at a self-selected pace.