Physical activity measured by accelerometry among adolescents participating in sports clubs and non-participating peers

AbstractThe purpose of this descriptive cross-sectional study is to describe the amount and intensity of physical activity (PA) measured by accelerometry among adolescents participating in organized sports (SCP) and age-matched non-participating peers (NP). SCPs (332) and NPs (139) wore an accelerometer on the hip for 7 days. PA was reported using the 1 min exponential moving average. The current moderate-to-vigorous physical activity (MVPA) recommendation of at least an average of 60 minutes of MVPA daily was reached by 85% of SCPs and 45% of NPs (p < 0.001). During training days, the MVPA times among SCPs ranged from 153 ± 39 min in males and 109 ± 35 min in females participating in basketball to 113 ± 33 min in males participating in floorball and 83 ± 32 min in females participating in gymnastics. -Sports participation contributes rather strongly to the accumulation of the recommended amount of MVPA. During training days SCPs, except for females participating in gymnastics, accumulated more MVPA than NPs. During non-training days only males participating in cross country skiing and females participating in track and field accumulated more MVPA than NPs.

Total and regional body adiposity increases during menopause-evidence from a follow-up study

For women, menopausal transition is a time of significant hormonal changes, which may contribute to altered body composition and regional adipose tissue accumulation. Excess adiposity, and especially adipose tissue accumulation in the central body region, increases women's risk of cardiovascular and metabolic conditions and affects physical functioning. We investigated the associations between menopausal progression and total and regional body adiposity measured with dual-energy X-ray absorptiometry and computed tomography in two longitudinal cohort studies of women aged 47-55 (n = 230 and 148, mean follow-up times 1.3 ± 0.7 and 3.9 ± 0.2 years, mean baseline BMI 25.5 kg/m² ). We also examined associations between menopausal progression and skeletal muscle fiber characteristics, as well as adipose tissue-derived adipokines. Relative increases of 2%-14% were observed in regional and total body adiposity measures, with a pronounced fat mass increase in the android area (4% and 14% during short- and long-term follow-ups). Muscle fiber oxidative and glycolytic capacities and intracellular adiposity were not affected by menopause, but were differentially correlated with total and regional body adiposity at different menopausal stages. Menopausal progression and regional adipose tissue masses were positively associated with serum adiponectin and leptin, and negatively associated with resistin levels. Higher diet quality and physical activity level were also inversely associated with several body adiposity measures. Therefore, healthy lifestyle habits before and during menopause might delay the onset of severe metabolic conditions in women.

Resting Electrocardiogram and Blood Pressure in Young Athletes and Non-Athletes: A 4-year follow-up

A follow-up data on electrocardiogram (ECG) and blood pressure (BP) changes in adolescent athletes are scarce. We compared ECG and BP between adolescent athletes and non-athletes in a 4-year follow-up. A total of 154 youth sports clubs (SC) in Finland and 100 secondary schools for comparison data participated in this observational follow-up study. Those who maintained or adopted SC participation are referred to as "Always athletes" (n=137), those who never participated in SC as "Never athletes" (n=108) and those who dropped out of SC during the follow-up as "Changers" (n=116). The mean age of the participants was 15.5 (0.6) years in all study groups at baseline. Resting ECG including heart rate, PR interval, QRS duration, QRS axis, QRS amplitude, T axis and QT interval and BP were measured from all participants at baseline and after follow-up. "Always athletes" had lower resting heart rate, more negative T-wave axis and higher QRS amplitude than "Never athletes" at baseline and at 4-years (P < 0.05). "Changers" had lower resting heart rate, more negative T-wave axis and higher QRS amplitude, systolic BP and pulse pressure than "Never athletes" at baseline (P < 0.05). None of the observed differences at baseline, were visible at 4-years (P > 0.05) except the difference in T-wave axis (P = 0.028). The significant group x time interaction between "Changers" and "Never athletes" was found for QRS amplitude (P = 0.017). Adolescent athletes have several training-induced cardiovascular adaptations, which return towards the levels of non-athletes after cessation of regular training. This article is protected by copyright. All rights reserved.

Resting Electrocardiogram and Blood Pressure in Young Endurance and Nonendurance Athletes and Nonathletes

CONTEXT

Much information is available on electrocardiogram (ECG) and blood pressure (BP) changes in senior athletes. However, corresponding data on adolescent athletes are scarce.

OBJECTIVE

To study the differences in resting ECG and BP values among adolescent endurance athletes, nonendurance athletes, and nonathletes.

DESIGN

Cross-sectional study.

SETTING

A total of 154 youth sports clubs in Finland and 100 secondary schools for comparison data.

PATIENTS OR OTHER PARTICIPANTS

We recruited young athletes (n = 410) aged 14 to 16 years in 10 popular sport disciplines, including winter and summer as well as team and individual sports, and categorized them as endurance or nonendurance sports. Comparison data for age-matched, non-sports club participants (n = 164) were collected via secondary schools.

MAIN OUTCOME MEASURE(S)

Resting ECG, including heart rate, PR interval, QRS duration, QRS axis, QRS amplitude, T axis, and QT interval as well as systolic and diastolic BPs.

RESULTS

No differences in any ECG variable of interest were found between the endurance and nonendurance athletes. The PR interval was longer in endurance athletes than in nonathletes (P = .05). The QRS amplitude (P = .03) was higher among nonendurance athletes than among nonathletes. Diastolic BP was lower among endurance (P = .002) and nonendurance (P = .02) athletes than among nonathletes. Endurance athletes (odds ratio [OR] = 2.85; 95% CI = 1.81, 4.50) and nonendurance athletes (OR = 2.19; 95% CI = 1.43, 3.35) were more likely to have sinus bradycardia than were nonathletes. Nonendurance athletes were more likely to have elevated systolic BP than were endurance athletes (OR = 1.70; 95% CI = 1.07, 2.72) and nonathletes (OR = 1.73; 95% CI = 1.04, 2.87).

CONCLUSIONS

Young athletes had similar ECG and BP findings independent of their sports. Physiological adaptations including sinus bradycardia, higher QRS amplitude, and lower diastolic BP, which are commonly seen in adult athletes, were also present in adolescent athletes.

Menstrual dysfunction and body weight dissatisfaction among Finnish young athletes and non-athletes

To determine the prevalence of menstrual dysfunction (MD; ie, oligomenorrhea or amenorrhea) and attitudes toward body weight among athletes and non-athletes, we studied a cohort of athletes and non-athletes, in adolescence (14-16 years) and subsequently in young adulthood (18-20 years). We further studied the differences between athletes reporting MD and eumenorrheic athletes at both time periods and identified physical and behavioral characteristics that might predict MD in young adulthood. Data were collected using questionnaires, accelerometers, and a pre-participation screening. In adolescence, the athletes reported current primary amenorrhea more often than the non-athletes (4.7% vs 0%, P = .03). In young adulthood, athletes reported MD more frequently than non-athletes (38.7% vs 5.6%, P < .001). Athletes had less desire than non-athletes to lose weight at both time points, and in adolescence, athletes were more satisfied with their weight. However, about one fifth of the athletes and about 40% of the non-athletes experienced body weight dissatisfaction at both time points. In adolescence, athletes reporting MD had lower BMI than eumenorrheic athletes. In young adulthood, athletes with MD were more physically active than eumenorrheic athletes. The only longitudinal predictor of MD in young adulthood was MD in adolescence. Our findings indicate that MD is relatively frequent among young Finnish athletes. However, athletes appear to have a smaller tendency to experience body weight dissatisfaction than their non-athletic peers. MD seems to track from adolescence to adulthood, suggesting that there is a need to focus on possible causes at the earliest feasible phase of an athlete's career.

Haemoglobin, iron status and lung function of adolescents participating in organised sports in the Finnish Health Promoting Sports Club Study

Objectives

To compare laboratory test results and lung function of adolescent organised sports participants (SP) with non-participants (NP).

Methods

In this cross-sectional study, laboratory tests (haemoglobin, iron status), and flow-volume spirometry were performed on SP youths (199 boys, 203 girls) and their NP peers (62 boys, 114 girls) aged 14–17.

Results

Haemoglobin concentration <120/130 g/L was found in 5.8% of SP and 5.1% NP (OR 1.20, 95% CI 0.54 to 2.68). Ferritin concentration below 15 µg/L was found in 22.7% of both SP and NP girls. Among boys ferritin <30 µg/L was found in 26.5% of SP and 30.2% of NP (OR 0.76, 95% CI 0.40 to 1.47). Among SP iron supplement use was reported by 3.5% of girls and 1.5% of boys. In flow-volume spirometry with bronchodilation test, 7.0% of SP and 6.4% of NP had asthma-like findings (OR 1.17, 95% CI 0.54 to 2.54); those using asthma medication, that is, 9.8% of SP and 5.2% of NP were excluded from the analysis.

Conclusions

Screening for iron deficiency is recommended for symptomatic persons and persons engaging in sports. Lung function testing is recommended for symptomatic persons and persons participating in sports in which asthma is more prevalent.

Sport burnout inventory-Dual career form for student-athletes: Assessing validity and reliability in a Finnish sample of adolescent athletes

BACKGROUND

The pressure of pursuing an athletic career simultaneously with education may set adolescent student-athletes at risk for sport and school burnout. Although the 2 life domains of student-athletes are strongly intertwined, so far, there has not been an instrument for investigating sport burnout parallel to school burnout. The aim of the present study was to introduce a sport burnout measure for adolescents in a dual career context and investigate its validity and reliability by using confirmatory factor analysis.

METHODS

The participants were 391 student-athletes (51% females) who filled in a questionnaire of sport burnout and background variables in the beginning of upper secondary school.

RESULTS

A 3-factor model or a second-order-factor model described the data better and gave better reliability indices than a 1-factor model. The 3 dimensions of sport burnout were shown to be separate, but closely related constructs. Evidence for convergent and discriminant validity was obtained by correlating the 3 sport burnout dimensions with depressive symptoms, self-esteem, and sport task values.

CONCLUSION

The results suggest that Sport Burnout Inventory-Dual Career Form (SpBI-DC) is a valid and reliable instrument for investigating sport burnout among adolescent student-athletes.

Development of School and Sport Burnout in Adolescent Student-Athletes: A Longitudinal Mixed-Methods Study

We investigated the development of school and sport burnout in adolescent student-athletes (N Time 1 = 391, N Time 2 = 373) during their first year in upper secondary school using an embedded mixed-methods design. The questionnaire-based data were analyzed with growth mixture modeling and four burnout profiles were identified among student-athletes. From the found burnout profiles, two were typical for the interviewed subsample of elite athletes (n = 17), that is, burnout risk and non risk profiles. We generated rich descriptions of well-being and ill-being, showing that elite athletes in two burnout profiles differed in their experienced demands and resources related to individual and environmental factors. The results can be used to generate practical tools for burnout detection in student-athletes' educational path.

Acute and overuse injuries among sports club members and non-members: the Finnish Health Promoting Sports Club (FHPSC) study

Background

Physical activity in adolescence is promoted for its multi-dimensional health benefits. However, too intensive sports participation is associated with an increased injury risk. Our aim was to compare the occurrence of acute and overuse injuries in Finnish sports club members and non-members and to report training and competing habits associated with a higher injury risk in sports club members.

Methods

In this cross-sectional survey targeted at 14–16-year-old adolescents, a structured questionnaire was completed by 1077 sports club members and 812 non-members. The main outcome measures were self-reported acute and overuse injuries, their location and type.

Results

At least one acute injury in the past year was reported by 44.0% of sports club members and 19.8% of non-members (P < 0.001). The sex-adjusted odds ratio (OR) for acute injury in sports club members compared to non-members was 3.13 (95% confidence interval (95% CI) 2.54–3.87). Thirty-five percent of sports club members and 17.4% of non-members (P < 0.001) reported at least one overuse injury during the past year. The overuse injury OR for sports club members was 2.61 (95% CI 2.09–3.26). Sports club members who trained 7–14 h per week during training (OR 1.61, 95% CI 1.21–2.12, P = 0.001) or competition season (OR 1.55, 95% CI 1.18–2.06, P = 0.002) were more likely to report an injury compared to members who trained 3–6 h per week. Those sports club members who participated in forty competitions or more compared to 7–19 competitions per year were more likely to report an acute injury (OR 1.55, 95% CI 1.05–2.08, P = 0.028) or for an overuse injury (OR 1.53, 95% CI 1.02–2.30, P = 0.038).

Conclusions

Both acute and overuse injuries are common among youth sports club members, and the number increases along with increasing amounts of training and competitions. More effective injury prevention is needed both for adolescents engaging in sports club activities and for other adolescents.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2417-3) contains supplementary material, which is available to authorized users.

Musculoskeletal examination in young athletes and non-athletes: the Finnish Health Promoting Sports Club (FHPSC) study

Objectives

To determine the inter-rater repeatability of a musculoskeletal examination and to compare findings between adolescent athletes and non-athletes in Finland.

Methods

In this cross-sectional study, a musculoskeletal examination assessing posture, mobility and movement control was carried out by a sports and exercise medicine physician on 399 athletes aged 14–17 years and 177 non-athletes. Within 2 weeks another sports and exercise medicine physician repeated the examination for 41 adolescents to test the inter-rater repeatability.

Results

In total, 10 of the 11 tests performed had at least moderate inter-rater reliability (κ ≥0.4 or percentage agreement >80%). Athletes more often than non-athletes had one shoulder protruded (8.0% vs 4.0%, OR 2.81, 95% CI 1.16 to 6.81). Forty-six per cent of athletes had good knee control in the two-legged vertical drop jump test compared with 32% of non-athletes (OR 1.99, 95% CI 1.29 to 3.06). Athletes had better core muscle control with 86.3% being able to remain in the correct plank position for 30 s compared with 68.6% of non-athletes (OR 2.70, 95% CI 1.67 to 4.36). In the deep squat test, good lumbar spine control was maintained only by 35.8% of athletes and 38.4% of non-athletes.

Conclusion

A basic musculoskeletal examination is sufficiently reliable to be performed by trained physicians as a part of a periodic health evaluation. Shortfalls in mobility, posture and movement control are common in both athletes and non-athletes. These deficits could have been caused by sedentary behaviour, monotonous training, or both.

Low level activity thresholds for changes in NMR biomarkers and genes in high risk subjects for Type 2 Diabetes

Our objectives were to determine if there are quantitative associations between amounts and intensities of physical activities (PA) on NMR biomarkers and changes in skeletal muscle gene expressions in subjects with high risk for type 2 diabetes (T2D) performing a 3-month PA intervention. We found that PA was associated with beneficial biomarker changes in a factor containing several VLDL and HDL subclasses and lipids in principal component analysis (P = <0.01). Division of PA into quartiles demonstrated significant changes in NMR biomarkers in the 2nd - 4th quartiles compared to the 1st quartile representing PA of less than 2850 daily steps (P = 0.0036). Mediation analysis of PA-related reductions in lipoproteins showed that the effects of PA was 4-15 times greater than those of body weight or fat mass reductions. In a subset study in highly active subjects' gene expressions of oxidative fiber markers, Apo D, and G0/G1 Switch Gene 2, controlling insulin signaling and glucose metabolism were significantly increased. Slow walking at speeds of 2-3 km/h exceeding 2895 steps/day attenuated several circulating lipoprotein lipids. The effects were mediated rather by PA than body weight or fat loss. Thus, lower thresholds for PA may exist for long term prevention of cardio-metabolic diseases in sedentary overweight subjects.

Dietary acid load and renal function have varying effects on blood acid-base status and exercise performance across age and sex

Diet composition influences acid-base status of the body. This may become more relevant as renal functional capacity declines with aging. We examined the effects of low (LD) versus high dietary acid load (HD) on blood acid-base status and exercise performance. Participants included 22 adolescents, 33 young adults (YA), and 33 elderly (EL), who followed a 7-day LD and HD in a randomized order. At the end of both diet periods the subjects performed a cycle ergometer test (3 × 10 min at 35%, 55%, 75%, and (except EL) until exhaustion at 100% of maximal oxygen uptake). At the beginning of and after the diet periods, blood samples were collected at rest and after all workloads. Oxygen uptake, respiratory exchange ratio (RER), and heart rate (HR) were monitored during cycling. In YA and EL, bicarbonate (HCO₃^-) and base excess (BE) decreased over the HD period, and HCO₃^-, BE, and pH were lower at rest after HD compared with LD. In YA and EL women, HCO₃^- and BE were lower at submaximal workloads after HD compared with LD. In YA women, the maximal workload was 19% shorter and maximal oxygen uptake, RER, and HR were lower after HD compared with LD. Our data uniquely suggests that better renal function is associated with higher availability of bases, which may diminish exercise-induced acidosis and improve maximal aerobic performance. Differences in glomerular filtration rate between the subject groups likely explains the larger effects of dietary acid load in the elderly compared with younger subjects and in women compared with men.

Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial

OBJECTIVE

To study the efficacy of aquatic resistance training on biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis (OA).

DESIGN

Eighty seven volunteer postmenopausal women, aged 60-68 years, with mild knee OA (Kellgren-Lawrence grades I/II and knee pain) were recruited and randomly assigned to an intervention (n = 43) and control (n = 44) group. The intervention group participated in 48 supervised aquatic resistance training sessions over 16 weeks while the control group maintained usual level of physical activity. The biochemical composition of the medial and lateral tibiofemoral cartilage was estimated using single-slice transverse relaxation time (T2) mapping and delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC index). Secondary outcomes were cardiorespiratory fitness, isometric knee extension and flexion force and knee injury and OA outcome (KOOS) questionnaire.

RESULTS

After 4-months aquatic training, there was a significant decrease in both T2 -1.2 ms (95% confidence interval (CI): -2.3 to -0.1, P = 0.021) and dGEMRIC index -23 ms (-43 to -3, P = 0.016) in the training group compared to controls in the full thickness posterior region of interest (ROI) of the medial femoral cartilage. Cardiorespiratory fitness significantly improved in the intervention group by 9.8% (P = 0.010).

CONCLUSIONS

Our results suggest that, in postmenopausal women with mild knee OA, the integrity of the collagen-interstitial water environment (T2) of the tibiofemoral cartilage may be responsive to low shear and compressive forces during aquatic resistance training. More research is required to understand the exact nature of acute responses in dGEMRIC index to this type of loading. Further, aquatic resistance training improves cardiorespiratory fitness.

TRIAL REGISTRATION NUMBER

ISRCTN65346593.

Low back and neck and shoulder pain in members and non-members of adolescents' sports clubs: the Finnish Health Promoting Sports Club (FHPSC) study

BACKGROUND

The objective of this study was to investigate the prevalence of self-reported low back pain (LBP) and neck and shoulder pain (NSP), and the related factors in members and non-members of adolescents' sports clubs.

METHODS

This cross-sectional study was based on surveys of 14-16-year-olds as a part of the Finnish Health Promoting Sports Club (FHPSC) Study. The surveys on self-reported health behaviours, injuries, and musculoskeletal health were conducted among sports club members (n = 962) and non-members (n = 675). Binary logistic regression analysis was applied to study the associations between dependent variables of LBP and NSP, and the independent factors.

RESULTS

The prevalence of LBP during the preceding 3 months was 35.0 % in girls and 24.5 % in boys (p < 0.05 for sex difference). The prevalence of NSP was 55.9 % in girls and 27.3 % in boys (p < 0.001 for sex difference). Being a sports club member increased the odds for LBP in boys (odds ratio [OR] 2.35, 95 % CI 1.48-3.72). On the other hand, sports club participation was associated with lower odds of frequent NSP in girls (OR 0.52, 95 % CI 0.33-0.82). No associations were found between other leisure-time physical activity and LBP or NSP. Higher screen time (computer games, TV/DVD, phone, Internet) during leisure-time increased the odds of NSP in boys and LBP in boys and girls.

CONCLUSIONS

In this study, self-reported LBP and NSP were already relatively common among adolescents. Girls have a higher risk for reporting LBP and NSP. Measures that are more effective in the prevention of LBP in male sports club members are needed. Excessive screen time is weakly associated with LBP and NSP, which should be taken into account in health promotion among adolescents.

Effects of Exercise on Patellar Cartilage in Women with Mild Knee Osteoarthritis

PURPOSE

This study aims to investigate the effects of exercise on patellar cartilage using T2 relaxation time mapping of magnetic resonance imaging in postmenopausal women with mild patellofemoral joint osteoarthritis (OA).

METHODS

Eighty postmenopausal women (mean age, 58 (SD, 4.2) yr) with mild knee OA were randomized to either a supervised progressive impact exercise program three times a week for 12 months (n = 40) or a nonintervention control group (n = 40). Biochemical properties of cartilage were estimated using T2 relaxation time mapping, a parameter sensitive to collagen integrity, collagen orientation, and tissue hydration. Leg muscle strength and power, aerobic capacity, and self-rated assessment with the Knee Injury and Osteoarthritis Outcome Score were also measured.

RESULTS

After intervention, full-thickness patellar cartilage T2 values had medium-size effect (d = 0.59; 95% confidence interval, 0.16 to 0.97; P = 0.018); the change difference was 7% greater in the exercise group compared with the control group. In the deep half of tissue, the significant exercise effect size was medium (d = 0.56; 95% confidence interval, 0.13 to 0.99; P = 0.013); the change difference was 8% greater in the exercise group compared with controls. Furthermore, significant medium-size T2 effects were found in the total lateral segment, lateral deep, and lateral superficial zones in favor of the exercise group. Extension force was 11% greater (d = 0.63, P = 0.006) and maximal aerobic capacity was 4% greater (d = 0.55, P = 0.028) in the exercise group than in controls. No changes in Knee Injury and Osteoarthritis Outcome Score emerged between the groups.

CONCLUSIONS

Progressively implemented high-impact and intensive exercise creates enough stimuli and exerts favorable effects on patellar cartilage quality and physical function in postmenopausal women with mild knee OA.

What Makes a 97-Year-Old Man Cycle 5,000 km a Year?

Background: The nature versus nurture debate is one of the oldest issues in the study of longevity, health and successful aging. Objective: We present a 97-year-old man (I.K.) as an example of the effects of habitual exercise on the aging process. Methods: Extensive assessments included medical examinations, interviews, musculoskeletal structure, performance characteristics, cognitive function and gut microbiota composition. Results: I.K. suffers from iatrogenic hypogonadism, prostate cancer, hypothyroidism and a history of deep popliteal thrombosis. Notwithstanding, he cycles up to 5,000 km a year and participates in competitive sports. His musculoskeletal properties, athletic performance, cognitive function and gut microbiota are outstanding. Some traits even exceed those seen in middle-aged men. Conclusions: His long-term physically and intellectually active lifestyles combined with extensive social interactions have most likely contributed to his exercise capacity, despite his medical history.

PGC-1 isoforms and their target genes are expressed differently in human skeletal muscle following resistance and endurance exercise

The primary aim of the present study was to investigate the acute gene expression responses of PGC-1 isoforms and PGC-1α target genes related to mitochondrial biogenesis (cytochrome C), angiogenesis (VEGF-A), and muscle hypertrophy (myostatin), after a resistance or endurance exercise bout. In addition, the study aimed to elucidate whether the expression changes of studied transcripts were linked to phosphorylation of AMPK and MAPK p38. Nineteen physically active men were divided into resistance exercise (RE, n = 11) and endurance exercise (EE, n = 8) groups. RE group performed leg press exercise (10 × 10 RM, 50 min) and EE walked on a treadmill (∼80% HR_max, 50 min). Muscle biopsies were obtained from the vastus lateralis muscle before, 30 min, and 180 min after exercise. EE and RE significantly increased the gene expression of alternative promoter originated PGC-1α exon 1b- and 1bxs’-derived isoforms, whereas the proximal promoter originated exon 1a-derived transcripts were less inducible and were upregulated only after EE. Truncated PGC-1α transcripts were upregulated both after EE and RE. Neither RE nor EE affected the expression of PGC-1β. EE upregulated the expression of cytochrome C and VEGF-A, whereas RE upregulated VEGF-A and downregulated myostatin. Both EE and RE increased the levels of p-AMPK and p-MAPK p38, but these changes were not linked to the gene expression responses of PGC-1 isoforms. The present study comprehensively assayed PGC-1 transcripts in human skeletal muscle and showed exercise mode-specific responses thus improving the understanding of early signaling events in exercise-induced muscle adaptations.

Health promotion activities of sports clubs and coaches, and health and health behaviours in youth participating in sports clubs: the Health Promoting Sports Club study

Introduction

Sports clubs form a potential setting for health promotion, but the research is limited. The aim of the Health Promoting Sports Club (HPSC) study was to elucidate the current health promotion activities of youth sports clubs and coaches, and to investigate the health behaviours and health status of youth participating in sports clubs compared to non-participants.

Methods and analysis

The study design employs cross-sectional multilevel and multimethod research with aspirations to a prospective cohort study in the next phase. The setting-based variables at sports clubs and coaching levels, and health behaviour variables at the individual level, are investigated using surveys; and total levels of physical activity are assessed using objective accelerometer measurements. Health status variables will be measured by preparticipation screening. The health promotion activity of sports clubs (n=154) is evaluated by club officials (n=313) and coaches (n=281). Coaches and young athletes aged 14–16 (n=759) years evaluate the coaches’ health promotion activity. The survey of the adolescents’ health behaviours consist of two data sets—the first is on their health behaviours and the second is on musculoskeletal complaints and injuries. Data are collected via sports clubs (759 participants) and schools 1650 (665 participants and 983 non-participants). 591 (418 athletes and 173 non-athletes) youth, have already participated in preparticipation screening. Screening consists of detailed personal medical history, electrocardiography, flow-volume spirometry, basic laboratory analyses and health status screening, including posture, muscle balance, and static and dynamic postural control tests, conducted by sports and exercise medicine specialists.

Ethics and dissemination

The HPSC study is carried out conforming with the declaration of Helsinki. Ethical approval was received from the Ethics Committee of Health Care District of Central Finland. The HPSC study is close-to-practice, which generates foundations for development work within youth sports clubs.

Effect of diet composition on acid-base balance in adolescents, young adults and elderly at rest and during exercise

BACKGROUND

Diets rich in animal protein and cereal grains and deficient in vegetables and fruits may cause low-grade metabolic acidosis, which may impact exercise and health. We hypothesized that (1) a normal-protein diet with high amount of vegetables and fruits (HV) induces more alkaline acid-base balance compared with a high-protein diet with no vegetables and fruits (HP) and (2) diet composition has a greater impact on acid-base balance in the elderly (ELD).

SUBJECTS/METHODS

In all, 12-15 (adolescents (ADO)), 25-35 (young adults (YAD)) and 60-75 (ELD)-year-old male and female subjects (n=88) followed a 7-day HV and a 7-day HP in a randomized order and at the end performed incremental cycle ergometer tests. We investigated the effect of diet composition and age on capillary (c-pH) and urine pH (u-pH), strong ion difference (SID), partial pressure of carbon dioxide (pCO2) and total concentration of weak acids (Atot). Linear regression analysis was used to examine the contribution of SID, pCO2 and Atot to c-pH.

RESULTS

In YAD and ELD, c-pH (P⩽0.038) and u-pH (P<0.001) were higher at rest after HV compared with HP. During cycling, c-pH was higher (P⩽0.034) after HV compared with HP at submaximal workloads in YAD and at 75% of VO2max (maximal oxygen consumption) in ELD. The contribution of SID, pCO2 and Atot to c-pH varied widely. Gender effects or changes in acid-base balance of ADO were not detected.

CONCLUSIONS

A high intake of vegetables and fruits increases blood and u-pH in YAD and ELD. ELD compared with younger persons may be more sensitive for the diet-induced acid-base changes.

Motor unit discharge rate in dynamic movements of the aging soleus

Aging is related to a variety of changes at the muscular level. It seems that the age-related changes in motor unit activation are muscle- and intensity dependent. The purpose of this study was to examine the motor unit discharge rate (MUDR) in both isometric and dynamic contractions of the aging soleus muscle. Eight elderly males participated in the study. The subjects performed isometric and dynamic plantar flexions while seated in an ankle dynamometer. The force levels studied were 10, 20, 40, 60, 80 and 100% of the isometric (ISO) maximal voluntary contractions (MVC) in ISO and 10, 20 and 40% in concentric (CON) and eccentric (ECC) contractions. Soleus intramuscular EMG was recorded with bipolar fine-wire electrodes and decomposed to individual trains of motor unit discharges. In ISO the MUDR increased with each force level from 40 to 100% MVC. In dynamic contractions the descriptive analysis showed a higher MUDR in CON compared to ISO or ECC. The difficulties of recording single motor units in dynamic contractions, especially in the elderly is discussed.

Effects of high-impact training on bone and articular cartilage: 12-month randomized controlled quantitative MRI study

Osteoarthritis and osteoporosis often coexist in postmenopausal women. The simultaneous effect of bone-favorable high-impact training on these diseases is not well understood and is a topic of controversy. We evaluated the effects of high-impact exercise on bone mineral content (BMC) and the estimated biochemical composition of knee cartilage in postmenopausal women with mild knee osteoarthritis. Eighty women aged 50 to 66 years with mild knee osteoarthritis were randomly assigned to undergo supervised progressive exercise three times a week for 12 months (n = 40) or to a nonintervention control group (n = 40). BMC of the femoral neck, trochanter, and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA). The biochemical composition of cartilage was estimated using delayed gadolinium-enhanced magnetic resonance imaging (MRI) cartilage (dGEMRIC), sensitive to cartilage glycosaminoglycan content, and transverse relaxation time (T2) mapping that is sensitive to the properties of the collagen network. In addition, we evaluated clinically important symptoms and physical performance-related risk factors of falling: cardiorespiratory fitness, dynamic balance, maximal isometric knee extension and flexion forces, and leg power. Thirty-six trainees and 40 controls completed the study. The mean gain in femoral neck BMC in the exercise group was 0.6% (95% CI, -0.2% to 1.4%) and the mean loss in the control group was -1.2% (95% CI, -2.1% to -0.4%). The change in baseline, body mass, and adjusted body mass change in BMC between the groups was significant (p = 0.005), whereas no changes occurred in the biochemical composition of the cartilage, as investigated by MRI. Balance, muscle force, and cardiorespiratory fitness improved significantly more (3% to 11%) in the exercise group than in the control group. Progressively implemented high-impact training, which increased bone mass, did not affect the biochemical composition of cartilage and may be feasible in the prevention of osteoporosis and physical performance-related risk factors of falling in postmenopausal women.

Body composition in 18- to 88-year-old adults--comparison of multifrequency bioimpedance and dual-energy X-ray absorptiometry

OBJECTIVE

This study compared bioimpedance analysis (BIA) in the assessment of body composition with dual-energy X-ray absorptiometry (DXA) in 18- to 88-year-old adults.

DESIGN AND METHODS

Body composition of 882 adults was estimated by eight-polar BIA and DXA. In addition, estimates of lean mass, fat mass, and percentage of fat were investigated across a range of age and leisure time physical activity (LTPA) groups.

RESULTS

Compared to DXA, larger lean masses (mean difference 2.9 and 1.6 kg) and smaller fat masses (3.1 and 2.6 kg) were estimated by BIA in both women and men, respectively. Differences between the methods' mean values were evident in all age and LTPA groups, except in the oldest men (over 70 years). Age, waist circumference, grip strength, and LTPA explained 21% or less of the variance observed in the differences between methods.

CONCLUSIONS

Compared to DXA, BIA provided systematically different body composition estimates throughout the adult age span with considerable amount of intraindividual variation. The differences between estimates may be related to the BIAs' algorithm or body geometry or composition of the population used in this study. Knowledge about the methodological limitations and device comparability is essential for researchers, clinicians, and persons working in rehabilitation and sport centers.

Effects of a progressive aquatic resistance exercise program on the biochemical composition and morphology of cartilage in women with mild knee osteoarthritis: protocol for a randomised controlled trial

BACKGROUND

Symptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs. There is a need to investigate and develop effective interventions to minimise the impact of and even prevent the progression of osteoarthritis. Aquatic exercise has been shown to be effective at reducing the impact of osteoarthritis. The purpose of this article is to describe the rationale, design and intervention of a study investigating the effect of an aquatic resistance exercise intervention on cartilage in postmenopausal women with mild knee osteoarthritis.

METHODS

A minimum of 80 volunteers who meet the inclusion criteria will be recruited from the local population through newspaper advertisements. Following initial assessment volunteers will be randomised into two groups. The intervention group will participate in a progressive aquatic resistance exercise program of 1-hour duration 3 times a week for four months. The control group will be asked to maintain normal care during this period. Primary outcome measure for this study is the biochemical composition of knee cartilage measured using quantitative magnetic resonance imaging; T2 relaxation time and delayed gadolinium-enhanced magnetic resonance imaging techniques. In addition, knee cartilage morphology as regional cartilage thickness will be studied. Secondary outcomes include measures of body composition and bone traits using dual energy x-ray absorptiometry and peripheral quantitative computed tomography, pain, function using questionnaires and physical performance tests and quality of life. Measurements will be performed at baseline, after the 4-month intervention period and at one year follow up.

DISCUSSION

This randomised controlled trial will investigate the effect a progressive aquatic resistance exercise program has on the biochemical composition of cartilage in post-menopausal women with mild knee osteoarthritis. This is the first study to investigate what impact aquatic exercise has on human articular cartilage. In addition it will investigate the effect aquatic exercise has on physical function, pain, bone and body composition and quality of life. The results of this study will help optimise the prescription of aquatic exercise to persons with mild knee osteoarthritis.

TRIAL REGISTRATION

ISRCTN65346593.

Motor unit firing behaviour of soleus muscle in isometric and dynamic contractions

INTRODUCTION

Understanding the detailed control of human locomotion and balance can be improved, when individual motor units can be isolated and their firing rates followed in natural movement of large, fuctionally important muscles. For this reason the present study investigated the motor unit discharge rate (MUDR) in isometric and dynamic contractions of the soleus muscle.

METHODS

Eleven males performed isometric (10-100% MVC) and dynamic (10-40% MVC) plantar flexions. Intramuscular EMG was measured from Soleus with bipolar wire-electrodes and decomposed with custom built "Daisy" software.

RESULTS

The Soleus MUDR was significantly higher in concentric compared to isometric or eccentric contractions at all submaximal force levels (P<0.05). In isometric contractions MUDR increased up to 100% MVC.

CONCLUSION

Motor unit discharge properties of a large plantarflexor can be measured in dynamic and maximal contractions. For a given torque output, MUDR is dependent upon contraction type, as set by the major mechanical differences between concentric and eccentric actions.

Heavy resistance exercise training and skeletal muscle androgen receptor expression in younger and older men

Effects of heavy resistance exercise on serum testosterone and skeletal muscle androgen receptor (AR) concentrations were examined before and after a 21-week resistance training period. Seven healthy untrained young adult men (YT) and ten controls (YC) as well as ten older men (OT) and eight controls (OC) volunteered as subjects. Heavy resistance exercise bouts (5 × 10 RM leg presses) were performed before and after the training period. Muscle biopsies were obtained before and 1h and 48 h after the resistance exercise bouts from m.vastus lateralis (VL) to determine cross-sectional area of muscle fibers (fCSA) and AR mRNA expression and protein concentrations. No changes were observed in YC and OC while resistance training led to significant increases in maximal strength of leg extensors (1 RM), fCSA and lean body mass in YT and OT. Acute increases occurred in serum testosterone concentrations due to resistance exercises but basal testosterone remained unaltered. Mean AR mRNA expression and protein concentration remained unchanged after heavy resistance exercise bouts compared to pre-values. The individual pre- to post-training changes in resting (pre-exercise) AR protein concentration correlated with the changes in fCSA and lean body mass in the combined group of YT and OT. Similarly, it correlated with the changes in 1 RM in YT. Although mean AR expression did not changed due to the resistance exercise training, the present findings suggest that the individual changes of AR protein concentration in skeletal muscle following resistance training may have an impact on training-induced muscular adaptations in both younger and older men.

Seventy-year-old habitual volleyball players have larger tibial cross-sectional area and may be differentiated from their age-matched peers by the osteogenic index in dynamic performance

The osteogenicity of a given exercise may be estimated by calculating an osteogenic index (OI) consisting of magnitude and rate of strain. Volleyball involves repetitive jumping and requires high power output and thus may be expected to be beneficial to bone and performance. The purpose of the present study was to examine if habitual volleyball playing is reflected in OI. Ten elderly habitual volleyball players [age 69.9 (SD 4.4) years] and ten matched controls volunteered [age 69.7 (4.2) years] as subjects. Distal tibia (d), tibial mid-shaft (50) and femoral neck (FN) bone characteristics were measured using pQCT and DXA. To estimate skeletal rigidity, cross-sectional area (ToA(50)), and compressive (BSI(d)) and bending strength indices (SSImax(50)) were calculated. Maximal performance was assessed with eccentric ankle plantar flexion, isometric leg press and countermovement jump (CMJ). A fast Fourier transform (FFT) was calculated from the acceleration of the center of mass during the CMJ. Maximal acceleration (MAG) and mean magnitude frequency (MMF) were selected to represent the constituents of OI. OI was calculated as the sum of the products of magnitudes and corresponding frequencies. Volleyball players had 7% larger ToA(50) and 37% higher power in CMJ, 15% higher MAG and 36% higher OI (P <or= 0.047) than the matched controls. No difference was observed in leg press, plantar flexion or the MMF (P >or= 0.646). In conclusion, habitual volleyball players may be differentiated from their matched peers by their dynamic jumping performance, and the differences are reflected in the magnitude but not rate of loading.

Bone rigidity to neuromuscular performance ratio in young and elderly men

Given the adaptation of bone to prevalent loading, bone loss should follow, but lag behind, the decline in physical performance during aging. Furthermore, bone responsiveness to load-induced strains is believed to decrease with aging. However, the relationship between bone and lean body ( approximately muscle) mass appears to remain rather constant throughout adulthood. The purpose of this study was to examine the association between age and bone to neuromuscular performance ratio. Young (N=20, age 24 SD+/-2 years, body mass 77+/-11 kg, height 178+/-6 cm) and elderly (N=25, 72+/-4 years, 75+/-9 kg, 172+/-5 cm) men served as subjects. Bone structural traits were measured at the right distal tibia and tibial mid-shaft with peripheral quantitative computed tomography (pQCT). Maximal section modulus (Z(max50)), total area (ToA(d)), cortical area (CoA(50)), total density (ToD(d)) and cortical density (CoD(50)) were determined from the pQCT images. Neuromuscular performance was measured by recording vertical ground reaction force (GRF) in maximal bilateral hopping. Load-induced strains were estimated by calculating appropriate indices for compressive and tensile loading that took into account both the bone structure and apparent biomechanics of the given bone site. Young subjects had significantly higher maximal GRF compared to older men (4260+/-800 N vs. 3080+/-600 N, P<0.001). They also had smaller ToA(d) (1100+/-170 mm(2) vs. 1200+/-100 mm(2), P=0.028) while their ToD(d) was higher (370+/-46 g/cm(3) vs. 330+/-22 g/cm(3), P=0.002). The Z(max50) did not differ significantly between young (1660+/-320 mm(3)) and elderly men (1750+/-320 mm(3)) (P=0.224). Compressive (0.484+/-0.102 vs. 0.399+/-0.078, P=0.016) and tensile (0.107+/-0.016 vs. 0.071+/-0.018, P<0.001) strain indices were significantly higher in the younger group. In conclusion, the difference in bone to loading ratio at the tibial mid-shaft is bigger than expected from the delay in bone adaptation alone. Potential candidates to explain this phenomenon include a decrease in mechanosensitivity with aging, inability of maximal physical performance to adequately represent the bone loading environment, or the need to maintain constant safety factors to functional strains.

Resistance exercise with whey protein ingestion affects mTOR signaling pathway and myostatin in men

Signaling pathways sense local and systemic signals and regulate muscle hypertrophy. The effects of whey protein ingestion on acute and long-term signaling responses of resistance exercise are not well known. Previously untrained young men were randomized into protein ( n = 9), placebo ( n = 9), and control ( n = 11) groups. Vastus lateralis (VL) muscle biopsies were taken before and 1 h and 48 h after a leg press of 5 × 10 repetitions [resistance exercise (RE)] and after 21 wk (2 times per week) of resistance training (RT). Protein (15 g of whey) or nonenergetic placebo was ingested before and after a single RE bout and each RE workout throughout the RT. The protein group increased its body mass and VL muscle thickness (measured by ultrasonography) already at week 10.5 ( P < 0.05). At week 21, the protein and placebo groups had similarly increased their myofiber size. No changes were observed in the nonexercised controls. However, the phosphorylation of p70S6K and ribosomal protein S6 (rpS6) were increased at 1 h post-RE measured by Western blotting, the former being the greatest with protein ingestion. Mammalian target of rapamycin (mTOR) phosphorylation was increased after the RE bout and RT only in the protein group, whereas the protein ingestion prevented the post-RE decrease in phosphorylated eukaryotic initiation factor 4E binding protein 1 (p-4E-BP1). Akt phosphorylation decreased after RT, whereas no change was observed in phosphorylated eukaryotic elongation factor 2. A post-RE decrease in muscle myostatin protein occurred only in the placebo group. The results indicate that resistance exercise rapidly increases mTOR signaling and may decrease myostatin protein expression in muscle and that whey protein increases and prolongs the mTOR signaling response.

Androgen receptors and testosterone in men--effects of protein ingestion, resistance exercise and fiber type

The purpose of this study was to examine the impact of protein ingestion on circulating testosterone and muscle androgen receptor (AR) as well as on insulin-like growth factor-I (MGF and IGF-IEa) responses to a resistance exercise (RE) bout in (57-72 year) men. Protein (15 g whey) (n=9) or placebo (n=9) was consumed before and after a RE bout (5 sets of 10 repetition maximums), and vastus lateralis muscle biopsies were taken pre, 1 and 48 h post-RE. The protein ingestion blunted the RE-induced increase in serum free and total testosterone while the RE bout significantly increased muscle AR mRNA levels in older men (P<0.05). However, protein ingestion did not significantly affect AR mRNA or protein expression, or MGF and IGF-IEa mRNA expression at 1 and 48 h post-RE. Immunohistochemical staining of muscle cross-sections was done with antibodies specific to AR and MyHC I and II and showed that there seems to be within or near the type-I muscle fibers a greater staining of ARs than within or near the type-II fibres. In conclusion, the protein ingestion hinders RE-induced increase in serum testosterone in older men but may not significantly affect muscle AR, MGF or IGF-IEa gene expression. Furthermore, the present study shows that even older men are able to increase muscle AR mRNA expression in response to a RE bout.

A single bout of exercise with high mechanical loading induces the expression of Cyr61/CCN1 and CTGF/CCN2 in human skeletal muscle

High mechanical loading was hypothesized to induce the expression of angiogenic and/or lymphangiogenic extracellular matrix (ECM) proteins in skeletal muscle. Eight men performed a strenuous exercise protocol, which consisted of 100 unilateral maximal drop jumps followed by submaximal jumping until exhaustion. Muscle biopsies were taken 30 min and 48 h postexercise from the vastus lateralis muscle and analyzed for the following parameters: mRNA and protein expression of ECM-associated CCN proteins [cysteine-rich angiogenic protein 61 (Cyr61)/CCN1, connective tissue growth factor (CTGF)/CCN2], and mRNA expression of vascular endothelial growth factors (VEGFs) and hypoxia-inducible factor-1α. The mRNA expression of Cyr61 and CTGF increased 30 min after the exercise (14- and 2.5-fold, respectively; P < 0.001). Cyr61 remained elevated 48 h postexercise (threefold; P < 0.05). The mRNA levels of VEGF-A, VEGF-B, VEGF-C, VEGF-D, or hypoxia-inducible factor-1α did not change significantly at either 30 min or 48 h postexercise; however, the variation between subjects increased markedly in VEGF-A and VEGF-B mRNA. Cyr61 protein levels were higher at both 30 min and 48 h after the exercise compared with the control ( P < 0.05). Cyr61 and CTGF proteins were localized to muscle fibers and the surrounding ECM by immunohistochemistry. Fast fibers stained more intensively than slow fibers. In conclusion, mechanical loading induces rapid expression of CCN proteins in human skeletal muscle. This may be one of the early mechanisms involved in skeletal muscle remodeling after exercise, since Cyr61 and CTGF regulate the expression of genes involved in angiogenesis and ECM remodeling.

Postexercise Myostatin and Activin IIb mRNA Levels

PURPOSE

Muscle hypertrophy is likely to result from the cumulative effects of repeated bouts of resistance exercise (RE) on postexercise molecular responses. Therefore, we determined muscle growth- and regeneration-related mRNA expression in response to a single RE bout both before and after a strength-training (ST) period. By means of this novel longitudinal setting, we examined whether postexercise gene expression at the transcriptional level is different in the trained and untrained state.

METHODS

Eleven untrained healthy older men and 11 controls (age 62.3 +/- 6.3 yr) volunteered as subjects. Muscle biopsies from the vastus lateralis muscle were taken at rest and 1 and 48 h after five sets of 10-repetition leg press RE both before and after 21 wk of supervised ST.

RESULTS

Myostatin and myogenin mRNA expression, determined by real-time RT-PCR, increased (P < 0.05) after ST. Conversely, the single RE bout decreased myostatin mRNA after ST, with the decrease showing a negative correlation (r = -0.65, P < 0.05) with the long-term increase in myostatin during ST. Furthermore, RE before ST increased myogenin mRNA (P < 0.05) and tended to increase after ST (P = 0.08). Myostatin receptor activin IIb mRNA levels were decreased at 1 h after RE in the pre-ST condition (P = 0.05) and also tended to decrease in the post-ST condition (P = 0.07). RE-induced downregulation in myostatin mRNA correlated with the ST-induced increase in total body muscle mass (r = -0.82, P = 0.002).

CONCLUSIONS

A single bout of RE in older men can downregulate the expression of myostatin receptor activin IIb mRNA. ST influences the response of myostatin to RE, as short-term RE-induced downregulation of myostatin was observed only after ST. The results also indicate that RE-induced alterations in myostatin mRNA expression may have a role in ST-induced muscle hypertrophy.

Effects of exhaustive stretch-shortening cycle exercise on muscle blood flow during exercise

AIM

The influence of exhaustive stretch-shortening cycle exercise (SSC) on skeletal muscle blood flow (BF) during exercise is currently unknown.

METHODS

Quadriceps femoris (QF) BF was measured in eight healthy men using positron emission tomography before and 3 days after exhaustive SSC exercise. The SSC protocol consisted of maximal and submaximal drop jumps with one leg. Needle biopsies of the vastus lateralis muscles were taken immediately and 2 days after SSC for muscle endothelial nitric oxide synthase (eNOS) and interleukin-1-beta (IL-1beta) mRNA level determinations.

RESULTS

All subjects reported subjective muscle soreness after SSC (P < 0.001), which was well in line with a decrease in maximal isometric contraction force (MVC) and increase in serum creatine kinase activity (CK) (P = 0.018). After SSC muscle BF was 25% higher in entire QF (P = 0.043) and in its deep and superficial muscle regions, whereas oxygen uptake remained unchanged (P = 0.893). Muscle biopsies revealed increased IL-1beta (30 min: 152 +/- 75%, P = 0.012 and 2 days: 108 +/- 203%, P = 0.036) but decreased or unchanged eNOS (30 min; -21 +/- 57%, P = 0.050 and 2 days: +101 +/- 204%, P = 0.779) mRNA levels after SSC.

CONCLUSION

It was concluded that fatiguing SSC exercise induces increased muscle BF during exercise, which is likely to be associated with pro-inflammatory processes in the exercised muscle.

Protein ingestion prior to strength exercise affects blood hormones and metabolism

PURPOSE

The effects of protein consumption before strength training session on blood hormones, energy metabolites, RER, and excess postexercise oxygen consumption (EPOC) were examined.

METHODS

Ten resistance-trained young men consumed either a 25 g of whey and caseinate proteins (PROT) or a noncaloric placebo (P) in a liquid form 30 min before a heavy strength training session (STS) in a crossover design separated by at least 7 d. STS lasted 50 min and included 5 x 1 RM squats, 3 x 10 RM squats and 4 x 10 RM leg presses with 2-, 3-, and 2-min recoveries, respectively. A protein-carbohydrate supplement was consumed after STS in both trials. Venous blood samples were collected before, during, and after STS and oxygen consumption before and after STS.

RESULTS

Serum growth hormone (GH), testosterone, and free fatty acids (FFA) were significantly (P < or = 0.05) higher in P compared with PROT 5 min after an STS. The calculated area under curve (AUC) of the serum insulin response during an STS was significantly (P < 0.001) higher in PROT compared with P. The EPOC value from 90 to 120 min after an STS was significantly greater in the PROT condition compared with P (P = 0.01), and PROT treatment had a significantly higher RER 2 h postexercise (P = 0.04). The AUC of serum FFA during STS correlated significantly and negatively with RER 10-30 min after STS (r = -0.53, P = 0.02).

CONCLUSIONS

Consuming 25 g of whey and caseinate proteins 30 min before an STS significantly decreases serum GH, testosterone, and FFA levels, and increases serum insulin during an STS. Furthermore, the pre-STS protein increased EPOC and RER significantly during 2-h recovery after STS.