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Background Care home residents are mainly inactive, leading to increased dependency and low mood. Although exercise classes may increase activity, a more sustainable model is to engage staff and residents in increasing routine activity. Objectives The objectives were to develop and preliminarily test strategies to enhance the routine physical activity of care home residents to improve their physical, psychological and social well-being through five overlapping workstreams. Design This trial had a mixed-methods research design to develop and test the feasibility of undertaking an evaluative study consisting of gaining an understanding of the opportunities for and barriers to enhancing physical activity in care homes (workstream 1); testing physical activity assessment instruments (workstream 2); developing an intervention through a process of intervention mapping (workstream 3); refining the provisional intervention in the care home setting and clarifying outcome measurement (workstream 4); and undertaking a cluster randomised feasibility trial of the intervention [introduced via three facilitated workshops at baseline (with physiotherapist input), 2 weeks (with artist input) and 2 months], with embedded process and health economic evaluations (workstream 5). Setting The trial was set in 12 residential care homes differing in size, location, ownership and provision in Yorkshire, UK. Participants The participants were elderly residents, carers, managers and staff of care homes. Intervention The intervention was MoveMore, designed for the whole home, to encourage and support the movement of residents in their daily routines. Main outcome measures The main outcome measures related to the feasibility and acceptability of implementing a full-scale trial in terms of recruitment and retention of care homes and residents, intervention delivery, completion and reporting of baseline data and outcomes (including hours of accelerometer wear, hours of sedentary behaviour and hours and type of physical activity), and safety and cost data (workstream 5). Results Workstream 1 – through a detailed understanding of life in a care home, a needs assessment was produced, and barriers to and facilitators of activity were identified. Key factors included ethos of care; organisation, management and delivery of care; use of space; and the residents’ daily routines. Workstream 2 – 22 (73.3%) out of 30 residents who wore a hip accelerometer had valid data (≥ 8 hours on ≥ 4 days of the week). Workstream 3 – practical mechanisms for increasing physical activity were developed, informed by an advisory group of stakeholders and outputs from workstreams 1 and 2, framed by the process of intervention mapping. Workstream 4 – action groups were convened in four care homes to refine the intervention, leading to further development of implementation strategies. The intervention, MoveMore, is a whole-home intervention involving engagement with a stakeholder group to implement a cyclical process of change to encourage and support the movement of residents in their daily routines. Workstream 5 – 12 care homes and 153 residents were recruited to the cluster randomised feasibility trial. Recruitment in the care homes varied (40–89%). Five care homes were randomised to the intervention and seven were randomised to usual care. Predetermined progression criteria were recruitment of care homes and residents (green); intervention delivery (amber); and data collection and follow-up – 52% of residents provided usable accelerometer data at 9 months (red), > 75% of residents had reported outcomes at 9 months (green, but self-reported resident outcomes were red), 26% loss of residents to follow-up at 9 months [just missing green criterion (no greater than 25%)] and safety concerns (green). Limitations Observations of residents’ movements were not conducted in private spaces. Working with care home residents to identify appropriate outcome measures was challenging. Take-up of the intervention was suboptimal in some sites. It was not possible to make a reliably informed decision on the most appropriate physical activity end point(s) for future use in a definitive trial. Conclusions A whole-home intervention was developed that was owned and delivered by staff and was informed by residents and staff. The feasibility of conducting a cluster randomised controlled trial was successfully tested: the target numbers of care homes and residents were recruited, demonstrating that it is possible to recruit care home residents to a cluster randomised trial, although this process was time-consuming and resource heavy. A large data set was collected, which provided a comprehensive picture of the environment, residents and staff in care homes. Extensive quantitative and qualitative work comprehensively explored a neglected area of health and social care research. Completion of ethnographic work in a range of settings enabled the production of an in-depth picture of life in care homes that will be helpful for other researchers considering organisational change in this setting. Future work The content and delivery of the intervention requires optimisation and the outcome measurement requires further refinement prior to undertaking a full trial evaluation. Consideration could be given to a recommended, simplified, core outcome set, which would facilitate data collection in this population. Trial registration Current Controlled Trials ISRCTN16076575. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grant for Applied Research programme and will be published in full in Programme Grant for Applied Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

Fatiguing expiratory muscle work in otherwise resting humans elicits an increase in sympathetic motor outflow; whether limb blood flow ([Formula: see text]) and leg vascular resistance (LVR) are affected remains unknown. We found that fatiguing expiratory resistive loaded breathing (ERL) did not affect group mean [Formula: see text] or LVR. However, within-breath oscillations in [Formula: see text] may reflect a sympathetically mediated vasoconstriction that was counteracted by transient increases in [Formula: see text] due to the mechanical effects of high intra-abdominal pressure during ERL.

Background Epidemiological studies have indicated an inverse association between citrus fruit consumption and cardiovascular disease (CVD) risk. There is, however, a paucity of data concerning effects of blood orange juice (BOJ) intake on endothelial function and cardiovascular risk biomarkers. Objectives We examined short-term effects of BOJ on endothelial function, blood pressure, lipid profile, and inflammatory markers in healthy participants of European origin who were overweight or obese. Methods In a randomized, controlled, single-blind, crossover trial, 15 men and women (age: 28.7 ± 6.5 y; BMI: 28.3 ± 3.1 kg/m2) consumed BOJ or a sugar-matched control drink (CD) (200 mL twice daily) for 2 wk with a washout period of 1 wk. Endothelial function, measured as flow-mediated dilation (FMD) (primary outcome), and the secondary outcomes blood pressure, anthropometric measures, lipid profile, inflammatory markers, markers of vasodilation and vasoconstriction, and urinary flavanone metabolites were evaluated prior to and at the end of each treatment period following an overnight fast. Changes between treatments over time were assessed using repeated-measures ANOVA. Results The results demonstrate a significant increase in FMD following BOJ consumption (pre: 8.15% ± 2.92%; post: 10.2% ± 3.31%; P = 0.002) compared with CD (pre: 8.11% ± 2.52%; post: 7.77% ± 2.43%; time × treatment interaction: P = 0.001). Concurrent significant increases in urinary hesperetin-3'-glucuronide and hesperetin-7-glucuronide were observed following BOJ supplementation only (time × treatment interaction: P ≤ 0.01). Baseline blood pressure, lipid profile, high-sensitivity C-reactive protein, and endothelin-1 were generally within healthy ranges and unaffected by the intervention. Conclusions A 2-wk consumption of BOJ exerted favorable effects on endothelial function in healthy women and men who were overweight or obese, which is likely mediated by the combined actions of anthocyanin and flavanone metabolites on mechanisms that contribute to enhancing NO bioavailability. This trial was registered at clinicaltrials.gov as NCT03611114.

Background/aims The primary aim of this study was to evaluate the effectiveness of two 30-minute dietary education sessions, within cardiac rehabilitation, as a means to optimise nutrient and energy intakes. A secondary aim was to evaluate patients' habitual physical activity levels. Methods Thirty patients (males: n=24, 61.8±11.2 years; females: n=6, 66.7±8.5 years) attended a 6-week early outpatient cardiac rehabilitation programme in the UK and received two 30-minute dietary education sessions emphasising Mediterranean diet principles. Energy intakes and nutrient intakes were measured through completion of 3-day food diaries in weeks one and six (before and after the dietary education sessions) to assess the impact of these sessions on nutrient intakes. At the same time-points, a sub-group (n=13) of patients had their physical activity levels assessed via accelerometery to assess the impact of the cardiac rehabilitation programme on physical activity. Results Estimated energy requirements at week one (1988±366 kcal d−1) were not matched by actual energy intakes (1785±561 kcal d−1) (P=0.047, d=−0.36). Energy intakes reduced to 1655±470 kcal d−1 at week six (P=0.66, d=−0.33) whereas estimated energy requirements increased as a function of increased activity (cardiac rehabilitation sessions). Nutrient intakes remained suboptimal, while no significant increases were observed in healthy fats and fibre, which are core elements of a Mediterranean diet. Statistically significant increases were not observed in physical activity; however, patients decreased sedentary time by 11±12% in week six compared with week one (P=0.009; d=−0.54). Conclusions The present study findings suggest that two 30-minute dietary education sessions did not positively influence energy intakes and nutrient intakes, while habitual physical activity levels were not significantly increased as a result of the cardiac rehabilitation programme. Future research should explore means of optimising nutrition and habitual physical activity within UK cardiac rehabilitation.

Physical inactivity is common in people with chronic airways disease (pwCAD) and associated with worse clinical outcomes and impaired quality of life. We conducted a systematic review and meta-analysis to characterise and evaluate the effectiveness of interventions promoting step-based physical activity (PA) in pwCAD. We searched for studies that included a form of PA promotion and step-count outcome measure. A random-effects model was used to determine the overall effect size using post-intervention values. 38 studies (n=32 COPD; n=5 asthma; n=1 bronchiectasis; study population: n=3777) were included. Overall, implementing a form of PA promotion resulted in a significant increase in step-count: median (IQR) 705 (183–1210) when compared with usual standard care: −64 (−597–229), standardised mean difference (SMD) 0.24 (95% CI: 0.12–0.36), p

The mechanism(s) of exercise intolerance at V˙O2max remain poorly understood. In health, standard ramp-incremental (RI) exercise is limited by fatigue-induced reductions in maximum voluntary cycling power. Whether neuromuscular fatigue also limits exercise when the RI rate is slow and RI peak power at intolerance is lower than standard RI exercise, is unknown.In twelve healthy participants, maximal voluntary cycling power was measured during a short (~6 s) isokinetic effort at 80 rpm (Piso) at baseline and, using an instantaneous switch from cadence-independent to isokinetic cycling, immediately at the limit of RI exercise with RI rates of 50, 25, and 10 W·min-1 (RI-50, RI-25, and RI-10). Breath-by-breath pulmonary gas exchange was measured throughout.Baseline Piso was not different among RI rates (analysis of variance; P0.05). Tolerable duration increased with decreasing RI rate (RI-50, 411 ± 58 s vs RI-25, 732 ± 93 s vs RI-10, 1531 ± 288 s; P0.05). At intolerance, V˙O2peak was not different among RI rates (analysis of variance; P0.05), but RI peak power decreased with RI rate (RI-50, 361 ± 48 W vs RI-25, 323 ± 39 W vs RI-10, 275 ± 38 W; P0.05). Piso at intolerance was 346 ± 43 W, 353 ± 45 W, and 392 ± 69 W for RI-50, RI-25, and RI-10, respectively (P0.05 for RI-10 vs RI-50 and RI-25). At intolerance, in RI-50 and RI-25, Piso was not different from RI peak power (P0.05), thus there was no "power reserve." In RI-10, Piso was greater than RI peak power at intolerance (P0.001), that is, there was a "power reserve."In RI-50 and RI-25, the absence of a power reserve suggests the neuromuscular fatigue-induced reduction in Piso coincided with V˙O2max and limited the exercise. In RI-10, the power reserve suggests neuromuscular fatigue was insufficient to limit the exercise, and additional mechanisms contributed to intolerance at V˙O2max.

BackgroundSedentary behaviour has been the focus of considerable clinical, policy and research interest due to its detrimental effects on health and wellbeing. This systematic review aims to (1) develop a more precise description of different categories of interventions that aim to reduce sedentary time in adults by identifying specific components that form an intervention; (2) explore the effect of different categories of interventions in reducing time spent sedentary in adults.MethodsTen electronic databases, websites of relevant organisations (e.g. the Sedentary Behaviour Research Network), and relevant reviews were searched. Inclusion criteria: Randomised controlled trials (RCTs), including cluster and randomised cross-over trials, in the adult population (clinical and non-clinical). Any study including a measure of sedentary behaviour was included even if reducing sedentary behaviour was not the primary aim. Exclusion criteria: Interventions delivered in schools, colleges, or workplaces; studies investigating the immediate effects of breaking up sitting time as part of a supervised (usually laboratory-based) intervention. Two review authors conducted data extraction and quality assessment (GRADE approach).ResultsSearches identified 39,223 records, of which 85 studies met the inclusion criteria and were included in the review. Interventions shown to significantly reduce time spent sedentary were those which incorporated the provision of information, education, or support (advice/recommendations), in conjunction with either counselling (mean difference: -52.24 minutes/day; 95% CI: -85.37 to -19.10) or a form of structured/prescribed physical activity (standardised mean difference: -0.15; 95% CI: -0.23 to -0.07). However, this positive effect was not maintained at follow-up. No interventions were shown to break up prolonged sitting.ConclusionsThis review presents a novel way of categorising interventions according to the types of components they comprised. There is evidence that interventions might be effective in reducing time spent sedentary immediately post-intervention. There were limited studies measuring sustained behaviour change.

ObjectivesThis study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables.DesignObservational cohort study.SettingOutpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks.ParticipantsSixty patients (45 male/15 female 33–86 years) were recruited following referral to local outpatient CR.Outcome measuresThe primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours.ResultsThe mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p0.05).ConclusionPatients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.

BACKGROUND: Cardiovascular magnetic resonance (CMR) image acquisition techniques during exercise typically requires either transient cessation of exercise or complex post-processing, potentially compromising clinical utility. We evaluated the feasibility and reproducibility of a navigated image acquisition method for ventricular volumes assessment during continuous physical exercise. METHODS: Ten healthy volunteers underwent supine cycle ergometer (Lode) exercise CMR on two separate occasions using a free-breathing, multi-shot, navigated, balanced steady-state free precession cine pulse sequence. Images were acquired at 3-stages, baseline and during steady-state exercise at 55% and 75% maximal heart rate (HR(max)), based on a prior supine cardiopulmonary exercise test. Intra-and inter-observer variability and inter-scan reproducibility were derived. Clinical feasibility was tested in a separate cohort of patients with severe mitral regurgitation (n=6). RESULTS: End-diastolic volume (EDV) of both LV and RV decreased during exercise at 55% and 75% HR(max), although a reduction in RVEDV index was only observed at 75% HR(max). Ejection fractions (EF) for both ventricles were significantly higher at 75% HR(max) compared to their respective baselines (LVEF 68%±3% vs. 58%±5%, P=0.001; RVEF 66%±4% vs. 58%±7%, P=0.02). Intra-observer and inter-observer reproducibility of LV parameters was excellent at all 3-stages. Although measurements of RVESV were more variable during exercise, the reproducibility of both RVEF and RV cardiac index was excellent (CV

Background The role of omega-3 polyunsaturated fatty acids (n-3PUFA), and the potential impact of n-3PUFA supplementation, in the treatment and management of type 1 diabetes (T1D) remains unclear and controversial. Therefore, this study aimed to examine the efficacy of daily high-dose-bolus n-3PUFA supplementation on vascular health, glycaemic control, and metabolic parameters in subjects with T1D. Methods Twenty-seven adults with T1D were recruited to a 6-month randomised, double-blind, placebo-controlled trial. Subjects received either 3.3 g/day of encapsulated n-3PUFA or encapsulated 3.0 g/day corn oil placebo (PLA) for 6-months, with follow-up at 9-months after 3-month washout. Erythrocyte fatty acid composition was determined via gas chromatography. Endpoints included inflammation-associated endothelial biomarkers (vascular cell adhesion molecule-1 [VCAM-1], intercellular adhesion molecule-1 [ICAM-1], E-selectin, P-selectin, pentraxin-3, vascular endothelial growth factor [VEGF]), and their mediator tumor necrosis factor alpha [TNFα] analysed via immunoassay, vascular structure (carotid intima-media thickness [CIMT]) and function (brachial artery flow mediated dilation [FMD]) determined via ultrasound technique, blood pressure, glycosylated haemoglobin (HbA1c), fasting plasma glucose (FPG), and postprandial metabolism. Results Twenty subjects completed the trial in full. In the n-3PUFA group, the mean ± SD baseline n-3PUFA index of 4.93 ± 0.94% increased to 7.67 ± 1.86% (P P P P > 0.05). Conclusions This study indicates that daily high-dose-bolus of n-3PUFA supplementation for 6-months does not improve vascular health, glucose homeostasis, or metabolic parameters in subjects with T1D. The findings from this preliminary RCT do not support the use of therapeutic n-3PUFA supplementation in the treatment and management of T1D and its associated complications. Trial Registration ISRCTN, ISRCTN40811115. Registered 27 June 2017, http://www.isrctn.com/ISRCTN40811115.

Over the last 10 years, evidence has emerged that too much sedentary time (e.g. time spent sitting down) has adverse effects on health, including an increased risk of cardiovascular disease incidence and mortality. A considerable amount of media attention has been given to the topic. The current UK activity guidelines recommend that all adults should minimize the amount of time spent being sedentary for extended periods. How best to minimize sedentary behavior is a focus of ongoing research. Understanding the impact of sedentary behaviors on the health of people with stroke is vital as they are some of the most sedentary individuals in society. Implementing strategies to encourage regular, short breaks in sedentary behaviors has potential to improve health outcomes after stroke. Intervention work already conducted with adults and older adults suggests that sedentary behaviors can be changed. A research priority is to explore the determinants of sedentary behavior in people with stroke and to develop tailored interventions.

Endothelial cell phenotype and endothelial function are regulated by hemodynamic forces, particularly wall shear stress (WSS). During a single bout of exercise, the specific exercise protocol can affect in-exercise WSS patterns and, consequently, endothelial function. MicroRNAs might provide a biomarker of in-exercise WSS pattern to indicate whether a specific exercise bout will have a positive effect on endothelial function. We evaluated the effect of acute interval (IT) and continuous (CON) in-exercise WSS patterns upon postexercise endothelial function and circulating microRNA (miR)-21 expression. Methods and results: 13 participants performed CON and 3 different IT exercise protocols matched for duration and intensity on separate days. Oxygen uptake, heart rate, and brachial artery blood flow were recorded throughout the exercise. Brachial artery flow-mediated dilation (FMD) was performed pre-exercise and 15 min postexercise. Plasma samples were acquired pre-exercise and 6 h postexercise to determine miR-21 expression. In-exercise shear rate (SR) patterns (a surrogate of WSS) differed according to the CON or IT work-rate profile. In-exercise anterograde SR was greater in CON than IT exercise ( P < 0.05), but retrograde SR was equivalent between exercise protocols ( P > 0.05). Oscillatory shear index was higher during IT versus CON exercise ( P < 0.05). Postexercise FMD increased (pre: 7.08% ± 2.95%, post: 10.54% ± 4.24%, P < 0.05), whereas miR-21 expression was unchanged (pre: 12.0% ± 20.7% cel-miR-39, post: 11.1 ± 19.3% cel-miR-39, P > 0.05) with no effect of exercise protocol ( P > 0.05). Conclusions: CON and IT exercise induced different SR patterns but equivalent improvements in acute endothelial function. The absence of change in miR-21 expression suggests that miR-21 is not a suitable biomarker of exercise-induced SR. NEW & NOTEWORTHY Interval exercise has the potential to negatively impact vascular adaptations because of repeated oscillations in vascular shear. To our knowledge, we are the first to continuously assess exercise-induced shear throughout different acute exercise protocols and examine its relationship with acute endothelial function and a circulating biomarker of shear (miR-21). These experiments provide clear data indicating enhancement of the acute vascular response from differing interval exercise protocols, with the study also providing detailed vascular and shear responses for future reference.

Background: Impaired vascular health is prevalent in type 1 diabetes (T1D); however, it remains unknown whether different insulin treatment regimens mediate indices of vascular structure or function. Methods: Sixteen individuals with T1D receiving either multiple daily injection therapy (MDI; n=8; age: 32±13years; BMI:26.0±5.9kg.m2; HbA1c:53.7±11.2mmol/mol [7.1±3.2%]) or continuous subcutaneous insulin infusion (CSII; n=8; age:35±18years; BMI:26.3±4.6kg.m2; HbA1c: 58.6±9.7mmol/mol [7.5±3.0%]) and ten matched controls (CON; age:31±13years; BMI: 24.3±2.9kg.m2) consumed two high fat (HF) meals at 4-hour intervals. Carotid artery intima-media thickness (CIMT) and flow mediated dilation (FMD) was assessed at baseline, with further FMD assessment at 3-hours following the ingestion of each meal using high resolution B-mode ultrasound. Bolus insulin dose was standardized using the carbohydrate-counting method. Results: CIMT was significantly higher in individuals with T1D compared to controls (p=0.039); treatment stratification within T1D revealed MDI mediated this effect (MDI vs. CON: p=0.049; CSII vs. CON: p=0.112). FMD remained unchanged following the first meal (p=0.204) but was significantly impaired following the second meal (p= Conclusions: Our findings indicate that patients treated with MDI therapy have higher CIMT (a structural marker of subclinical atherosclerosis) compared to controls but not CSII therapy. FMD was impaired following a second HF meal irrespective of a diabetes status. Considering the pre-existing heightened cardiovascular disease risk in T1D therapeutic strategies to reduce postprandial risk warrants further research. Disclosure L.L. O'Mahoney: None. A. Stavropoulos: None. K. Birch: None. R. Ajjan: Consultant; Self; Abbott. Research Support; Self; Abbott, LifeScan, Inc. O.J. Price: None. M. Campbell: None.

Background Randomized controlled trials (RCTs) suggest that supplementation with omega-3 polyunsaturated fatty acids (n-3PUFAs) may favourably modify cardiometabolic biomarkers in type 2 diabetes (T2DM). Previous meta-analyses are limited by insufficient sample sizes and omission of meta-regression techniques, and a large number of RCTs have subsequently been published since the last comprehensive meta-analysis. Updated information regarding the impact of dosage, duration or an interaction between these two factors is therefore warranted. The objective was to comprehensively assess the effect of n-3PUFAs supplementation on cardiometabolic biomarkers including lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control, in people with T2DM, and identify whether treatment dosage, duration or an interaction thereof modify these effects. Methods Databases including PubMed and MEDLINE were searched until 13th July 2017 for RCTs investigating the effect of n-3PUFAs supplementation on lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control. Data were pooled using random-effects meta-analysis and presented as standardised mean difference (Hedges g) with 95% confidence intervals (95% CI). Meta-regression analysis was performed to investigate the effects of duration of supplementation and total dosage of n-3PUFAs as moderator variables where appropriate. Results A total of 45 RCTs were identified, involving 2674 people with T2DM. n-3PUFAs supplementation was associated with significant reductions in LDL [ES: − 0.10, (95% CI − 0.17, − 0.03); p = 0.007], VLDL (ES: − 0.26 (− 0.51, − 0.01); p = 0.044], triglycerides (ES: − 0.39 (− 0.55, − 0.24; p ≤ 0.001] and HbA1c (ES: − 0.27 (− 0.48, − 0.06); p = 0.010]. Moreover, n-3PUFAs supplementation was associated with reduction in plasma levels of TNF-α [ES: − 0.59 (− 1.17, − 0.01); p = 0.045] and IL-6 (ES: − 1.67 (− 3.14, − 0.20); p = 0.026]. All other lipid markers, indices of glycaemic control, inflammatory parameters, and blood pressure remained unchanged (p > 0.05). Conclusions n-3PUFAs supplementation produces favourable hypolipidemic effects, a reduction in pro-inflammatory cytokine levels and improvement in glycaemia. Neither duration nor dosage appear to explain the observed heterogeneity in response to n-3PUFAs. Trial registration This trial was registered at http://www.crd.york.ac.uk as CRD42016050802

Background CMR image acquisition techniques during exercise typically require transient cessation of exercise or complex post-processing analysis, potentially compromising its clinical utility. We evaluated the feasibility and reproducibility of a novel image acquisition Method for the assessment of biventricular physiological response during continuous physical exercise. Methods 10 healthy volunteers (80% men, age 25±2 years) underwent supine cycle ergometer (Lode) induced exercise CMR (Philips 1.5T Ingenia) on two separate occasions using a free-breathing, multi-shot, navigated, balanced steady-state free precession cine pulse sequence. Individual target heart rates (HR) for both moderate and high-intensity exercise were prescribed based on a prior supine cardiopulmonary exercise test (CPET). The scan protocol included a short axis ventricular volume stack and a 40 phase 4-chamber cine. Images were acquired at baseline, and during steady-state moderate and high-intensity exercise (55% and 75% maximal heart rate, respectively). Data were analysed by two independent observers and left and right ventricular (LV, RV) indices calculated. Results End-diastolic volume (EDV) of both LV and RV decreased during moderate and high-intensity exercise, although the reduction in indexed RVEDV (RVEDVi) was only observed during maximal exercise (table 1). Similarly, a significant reduction in end-systolic volumes (ESV) was seen in both ventricles, whilst the reduction in indexed LVESV (LVESVi) was only evident during high-intensity exercise. Ejection fraction (EF) increased from rest to moderate and high intensity exercise in the LV (LVEF 58±5% vs 61±8% vs 68±3%, respectively; p Intra-observer reproducibility of LV parameters was excellent at all three stages (Table 2), although measurements of RVESV were more variable. The reproducibility of both RVEF and RV cardiac indexes was however excellent. Similarly, inter-observer reproducibility of LV volumes, EF and cardiac indexes was excellent. Inter-scan LV and RV ejection fraction were highly reproducible at all 3 stages; RVESVi reproducibility was suboptimal. Conclusion This exercise CMR protocol using a novel free-breathing, multi-shot, navigated imaging Method allows simultaneous assessment of the left and right ventricular response to continuous exercise. Intra and inter-observer reproducibility were excellent. Clinical feasibility and utility now needs to be established.

Background:Physical activity is important for maintaining independence and quality of life in older people living in care homes. Little is known about patterns of physical activity or sedentary behavior in this population.Methods:Thirty-three care home residents (82.6 ± 9.2 years) wore an ActiGraph GTX3 accelerometer for seven days, which provided minutes of sedentary behavior and low, light, and moderate-to-vigorous physical activity. Participants undertook the Mini-Mental State Examination and care staff reported activities of daily living (Barthel index) and functional ambulation classification (FAC) for each participant.Results:Participants spent on average 79% of their day sedentary, 14% in low, 6% in light, and 1% in moderate-to-vigorous physical activity. Activity levels did not significantly differ between days or hours of the day (P > .05).Conclusion:Levels of physical activity were very low and time being sedentary was high. This study can inform physical activity and sedentary behavior interventions for care homes’ residents.

Introduction Exercise can help to negate the increased cardiovascular disease risk observed in women after the menopausal transition. This study sought to determine whether interval or continuous exercise has differential effects on endothelial function and circulating angiogenic cell (CAC) number and function in postmenopausal women. Methods Fifteen healthy postmenopausal women completed a 30 min acute moderate-intensity continuous (CON) and interval exercise (MOD-INT) session on a cycle ergometer on separate days. Nine participants completed a further single 30 min acute heavy-intensity interval (HEAVY-INT) exercise session. Brachial artery flow-mediated dilation (FMD) was assessed pre-exercise and 15 min post-exercise session. CAC number and colony-forming capacity in vitro were assessed post exercise and compared with resting levels. Results FMD and CAC number did not change post exercise regardless of exercise type (p>0.05). However, the number (mean±SD) of colony-forming units (CFUs) increased from visit 1 (12±10 CFUs/well) to post MOD-INT (32±30 CFUs/well) and post HEAVY-INT (38±23 CFUs/well) but not post CON (13±14 CFUs/well). Conclusion A single session of interval exercise is more effective than a continuous exercise session for increasing the intercellular communication of CACs, regardless of exercise intensity. The enhanced ability of CACs to form colonies may reflect an increased number and/or function of angiogenic T-cells. The repeated exertions to higher work rates during interval exercise may explain this response. Repeated exercise sessions might be required to improve FMD in postmenopausal women.

Scaling left ventricular (LV) mass and other cardiac dimensions to account for individual body size is important. The traditional method of simple ratio scaling using, for example, body surface area (BSA) assumes a linear and proportional relationship and accurate measurement of both LV mass and BSA. These assumptions can be questioned; hence, we examined the appropriateness of methods and different indices using highly accurate magnetic resonance imaging scans. Cardiac and whole-body scans were performed in 172 young, healthy, male subjects (age range, 17-28 years) to assess LV mass, volume, linear dimensions, lean body mass and fat mass. Height, body mass and BSA were determined anthropometrically. Relationships were examined for linearity and closeness of fit using log-log least-squares linear regression to determine the slope exponent b (where 1.0 indicates linearity). The relationship between LV mass and lean body mass (b=.90+/-.15; r(2)=.66) was linear and geometrically consistent. This was also the case for LV end-diastolic volume (b=.70), although the confidence intervals were broader (+/-0.32) and the r(2) (.31) smaller. The relationships between LV mass, volume and other variables were generally not linear or geometrically consistent. LV linear dimensions did not demonstrate any linear relationships, and in particular, those with BSA were extremely poor (r(2)=.02-.09). In summary, the traditional scaling of LV measurements to BSA does not remove the influence of body size and other techniques should be considered. Lean body mass was the most appropriate variable for simple indexing of LV mass. No body size variable had a linear and proportional relationship with LV linear dimensions, and the use of simple ratio scaling for these is seriously questioned.

The World Health Organization and a number of national bodies recommend adults undertake at least 150 min/week of moderate intensity physical activity, or 75 min/week of vigorous intensity physical activity. However, a large proportion of the population do not achieve these targets. Lack of time is often cited as a primary barrier,1 and many researchers have suggested that high-intensity interval training (HIIT), with interval durations from 10 s to 4 min and intensities ranging from 85% maximal heart rate (HRmax) to ‘all out’ efforts, may provide a time-efficient solution to improve public health.2 A wealth of evidence has demonstrated that HIIT can elicit a range of health benefits such as improved cardiorespiratory fitness, insulin sensitivity and vascular function, with these benefits being of at least a similar magnitude to those seen with standard moderate intensity physical activity interventions.3 ,4 These data are clear and convincing. However, they largely emanate from …

Traditional continuous aerobic exercise training attenuates age-related increases of arterial stiffness, however, training studies have not determined whether metabolic stress impacts these favourable effects. Twenty untrained healthy participants (n = 11 heavy metabolic stress interval training, n = 9 moderate metabolic stress interval training) completed 6 weeks of moderate or heavy intensity interval training matched for total work and exercise duration. Carotid artery stiffness, blood pressure contour analysis, and linear and non-linear heart rate variability were assessed before and following training. Overall, carotid arterial stiffness was reduced (p 0.05). This study demonstrates the effectiveness of interval training at improving arterial stiffness and autonomic function, however, the metabolic stress was not a mediator of this effect. In addition, these changes were also independent of improvements in aerobic capacity, which were only induced by training that involved a high metabolic stress.

Aims: To determine the intraobserver reproducibility of peak and temporal values for myocardial strain (ɛ) and strain rate (SR) using a speckle tracking technique in the left ventricle (LV), right ventricle (RV), and left atrium (LA). Methods and Results: Myocardial speckle tracking echocardiograms of the LV, RV, and LA were obtained on 20 healthy adults to provide indices of longitudinal, radial, circumferential ɛ, and SR as well as LV rotation and twist. Each participant had two separate acquisitions approximately 30 minutes apart. No systematic bias was present in ɛ data. LV ɛ across all planes provided “good” to “very good” intraclass correlation coefficient (ICC) values (0.714–0.807), however radial ɛ was inferior in terms of coefficients of variation (CoV) (19%). SR data were more variable than ɛ with LV radial SR performing least favorably. RV and LA ɛ demonstrated excellent reproducibility (ICCs of 0.834, 0.959, and CoVs of 7% and 6%, respectively). RV and LA SR were again more variable but generally acceptable ICC > 0.6 and CoV < 15%. Peak basal and apical rotation demonstrated quite high variability while derived torsion had low variability and excellent agreement (ICC = 0.940, CoV = 10%). Time-to-peak values demonstrated acceptable agreement with the exception of systolic SR from all chambers. Conclusion: Good reproducibility was obtained for peak ɛ indices although radial ɛ performs less favorably. Intraobserver variation of peak ɛ appears superior to values obtained for peak SR. Time-to-peak values demonstrate very good intraobserver reproducibility across all planes of contraction with exception of (time-to-peak) systolic strain rate (SRS).

Moderate-intensity endurance exercise training improves vascular endothelial vasomotor function; however, the impact of high-intensity exercise training has been equivocal. Thus, the effect of the physiological stress of the exercise remains poorly understood. Furthermore, enhanced vascular repair mediated by circulating progenitor cells may also be improved. To address whether the physiological stress of exercise training is an important factor contributing to these adaptations, 20 healthy participants trained for 6 weeks. Training involved either moderate (MSIT; n= 9) or heavy metabolic stress (HSIT; n= 11) interval exercise training programmes matched for total work and duration of exercise. Before and after training, flow-mediated dilatation, low-flow-mediated constriction and total vessel reactivity were measured at the brachial artery using Doppler ultrasound. Circulating progenitor cells (CD34+, CD133+ and CD309/KDR+) were measured by flow cytometry (means ± SD). Relative (MSIT pre- 5.5 ± 3.4 versus post-training 6.6 ± 2.5%; HSIT pre- 6.6 ± 4.1 versus post-training 7.0 ± 3.4%, P= 0.33) and normalized (P= 0.16) flow-mediated dilatation did not increase with either training programme. However, low-flow-mediated constriction was greater after training in both groups (MSIT pre- −0.5 ± 3.2 versus post-training −1.9 ± 3.1%; HSIT pre- −1.0 ± 1.7 versus post-training −2.9 ± 3.0%, P= 0.04) and contributed to greater total vessel reactivity (MSIT pre- 7.4 ± 3.3 versus post-training 10.1 ± 3.7%; HSIT pre- 10.9 ± 5.9 versus post-training 12.7 ± 6.2%, P= 0.01). Peak reactive hyperaemia and the area under the shear rate curve were not different between groups, either before or after training. Although circulating progenitor cell numbers increased following heavy-intensity interval exercise training, variability was great amongst participants [MSIT pre- 16 ± 18 versus post-training 14 ± 12 cells (ml whole blood)−1; HSIT pre- 8 ± 6 versus post-training 19 ± 23 cells (ml whole blood)−1, P= 0.50]. Overall, vasoconstrictor function may be augmented by moderate- and heavy-intensity interval exercise training in young adults. However, circulating progenitor cell numbers were not increased, suggesting that these cells are not likely to be upregulated as a result of training.

Introduction It is well established that endurance exercise results in cardiac adaptation including eccentric hypertrophy of the left ventricle which can complicate the differential diagnosis of the athletic heart from some cardiac pathologies that may pre-dispose to sudden cardiac death. The impact of physiological conditioning on RV structure and function, and a similar diagnostic challenge with arrhythmogenic right ventricular cardiomyopathy (ARVC), has received less attention. A recent guideline paper from the American Society of Echocardiography (ASE) has provided a range for normal RV dimensions and functional deformation. These guidelines suggest the RV inflow (RVI) should be 36 mm or 21 mm/m 2 is a major criterion for the diagnosis of ARVC and furthermore longitudinal RV deformation has been shown to be impaired in these patients. In view of this, the aims of this study are twofold: To provide a range of absolute values for RV dimensions in 102 endurance athletes as well as providing a range of data indexed for body surface area (BSA). To provide normal athlete data for indices of RV strain (ɛ) and strain rate (SR). Methods and Results One hundred and two (102) endurance athletes (86 males and 16 females) with a broad age range (mean ± SD age (range)=36 ± 11 (21–71) years) volunteered and were consecutively enrolled in the study. All subjects were either endurance runners or cyclists and were scanned at peak condition. Echocardiography provided measurements of RVI, RV length, RVOT and RV diastolic area (RVDarea). A 2D strain technique was utilised to provide indices of RVɛ and systolic and diastolic SR. The values for RVI ranged from 30 to 55 mm with 57% of the population having values greater than the normal range. Proximal RVOT ranged from 26 to 49 mm with 40% of the population above the normal range. 28% of the population had RVOT values greater than the proposed “major criteria” for ARVC. RV length ranged from 70 to 110 mm and RVDarea from 13 to 38 cm 2 with values falling above ASE cut-offs in 69% and 59% of the population, respectively. When indexed (ratio scaling) for BSA proximal RVOT ranged from 13 to 25 mm/m 2 with 6% of the population meeting the major criteria for ARVC. Peak RVɛ ranged from −18 to −41% and peak RV SRS′ from −0.75 to −2.65 l/s, consistent with normal ranges proposed by the ASE. RV diastolic deformation indices displayed marked individual variability with a dominant SRE′ (mean ± SD=2.0±0.61 l/s) and smaller SRA′ (1.25±0.56 l/s). Conclusion RV dimensions in endurance athletes are higher than those proposed as “normal” and likewise may be consistent with the criteria for ARVC. Despite this enlargement, RV function in endurance athletes is preserved and therefore the role of RV strain imaging may provide additional diagnostic value in differentiating physiological from pathological adaptation.

The mechanism for slow pulmonary O2uptake (V̇o2) kinetics in patients with chronic heart failure (CHF) is unclear but may be due to limitations in the intramuscular control of O2utilization or O2delivery. Recent evidence of a transient overshoot in microvascular deoxygenation supports the latter. Prior (or warm-up) exercise can increase O2delivery in healthy individuals. We therefore aimed to determine whether prior exercise could increase muscle oxygenation and speed V̇o2kinetics during exercise in CHF. Fifteen men with CHF (New York Heart Association I–III) due to left ventricular systolic dysfunction performed two 6-min moderate-intensity exercise transitions ( bouts 1 and 2, separated by 6 min of rest) from rest to 90% of lactate threshold on a cycle ergometer. V̇o2was measured using a turbine and a mass spectrometer, and muscle tissue oxygenation index (TOI) was determined by near-infrared spectroscopy. Prior exercise increased resting TOI by 5.3 ± 2.4% ( P = 0.001), attenuated the deoxygenation overshoot (−3.9 ± 3.6 vs. −2.0 ± 1.4%, P = 0.011), and speeded the V̇o2time constant (τV̇o2; 49 ± 19 vs. 41 ± 16 s, P = 0.003). Resting TOI was correlated to τV̇o2before ( R2= 0.51, P = 0.014) and after ( R2= 0.36, P = 0.051) warm-up exercise. However, the mean response time of TOI was speeded between bouts in half of the patients (26 ± 8 vs. 20 ± 8 s) and slowed in the remainder (32 ± 11 vs. 44 ± 16 s), the latter group having worse New York Heart Association scores ( P = 0.042) and slower V̇o2kinetics ( P = 0.001). These data indicate that prior moderate-intensity exercise improves muscle oxygenation and speeds V̇o2kinetics in CHF. The most severely limited patients, however, appear to have an intramuscular pathology that limits V̇o2kinetics during moderate exercise.

Aims: Two-dimensional (2D) strain imaging from speckle tracking is a Doppler independent technique allowing assessment of left ventricular (LV) strain (ɛ); systolic strain rate (SRs’) and early diastolic strain rate (SRe’) in the radial and circumferential planes. We set out to investigate whether (i) these parameters facilitated assessment of dyssynchronous contraction and (ii) these measures could predict response to cardiac resynchronization therapy (CRT). Methods and Results: Forty-one patients with severe, symptomatic heart failure on optimal medical therapy were recruited. Thirty-two healthy subjects were used as controls. Time to peak ɛ, SRs’, and SRe’ of 6 LV segments were measured in the parasternal short axis prior to and 6 weeks post CRT implantation. Time delays between segments were then calculated and ANOVA assessed for prediction of response, classified as reduction in LV end systolic volume of >15%. 2D strain demonstrated significantly more dyssynchronous contraction in the heart failure population at baseline compared to healthy controls. Significant reduction in dyssynchrony was seen in ɛ and SRs’ following CRT, largely confined to those with evidence of remodeling. The time delay between peak circumferential SRs’ of opposing walls was the best predictor of reverse remodeling. Conclusion: 2D strain imaging appears to be a useful measure to predict response to CRT. The time to peak circumferential SR is a new predictor of response. (Echocardiography 2011;28:76-84)

There is growing evidence to support the suggestion that prolonged strenuous exercise has a negative impact on left and right ventricular function during recovery. The main body of evidence covers a 20-year time window with many studies using transthoracic echocardiography to quantify cardiac function. Although studies have addressed different exercise modes and durations most work has been "field" based. During this time period echocardiographic instrumentation and techniques have evolved significantly and their application in the assessment of prolonged exercise has developed in tandem. The primary objective of this article is to provide reflective insight into the phenomenon of "exercise induced cardiac fatigue" by critically evaluating available literature in different competitive field studies or lab-based settings. We achieve this objective by introducing the empirical evidence in relation to echocardiographic modalities employed in developmental order including standard 2D, Doppler, tissue Doppler derived myocardial velocity and strain and myocardial speckle tracking echocardiography and by looking at different modes and duration of exercise. The insights provided by data based on each technique are critically reviewed, contradictory findings are explored and the potential for further work is identified. Furthermore the clinical implications and proposed mechanisms of "exercise-induced cardiac fatigue" are also explored.

Objective— Circulating progenitor cells (CPC) have emerged as potential mediators of vascular repair. In experimental models, CPC mobilization is critically dependent on nitric oxide (NO). South Asian ethnicity is associated with reduced CPC. We assessed CPC mobilization in response to exercise in Asian men and examined the role of NO in CPC mobilization per se. Methods and Results— In 15 healthy, white European men and 15 matched South Asian men, CPC mobilization was assessed during moderate-intensity exercise. Brachial artery flow-mediated vasodilatation was used to assess NO bioavailability. To determine the role of NO in CPC mobilization, identical exercise studies were performed during intravenous separate infusions of saline, the NO synthase inhibitor l -NMMA, and norepinephrine. Flow-mediated vasodilatation (5.8%±0.4% vs 7.9%±0.5%; P =0.002) and CPC mobilization (CD34 + /KDR + 53.2% vs 85.4%; P =0.001; CD133 + /CD34 + /KDR + 48.4% vs 73.9%; P =0.05; and CD34 + /CD45 − 49.3% vs 78.4; P =0.006) was blunted in the South Asian group. CPC mobilization correlated with flow-mediated vasodilatation and l -NMMA significantly reduced exercise-induced CPC mobilization (CD34 + /KDR + −3.3% vs 68.4%; CD133 + /CD34 + /KDR + 0.7% vs 71.4%; and CD34 + /CD45 − −30.5% vs 77.8%; all P Conclusion— In humans, NO is critical for CPC mobilization in response to exercise. Reduced NO bioavailability may contribute to imbalance between vascular damage and repair mechanisms in South Asian men.

Aims This study examined the relationships between myocardial strain (epsilon) and strain rate (SR) data, derived from both two-dimensional (2D) speckle tracking and tissue Doppler imaging (TDI), and indices of left ventricular (LV) morphology to assess size-(in)dependence of these functional parameters. Methods and results 2D speckle tracking and TDI echocardiograms were performed in 79 healthy adult male volunteers (age range: 22-76 years). 2D speckle tracking allowed the determination of myocardial epsilon and peak systolic and early diastolic SR in radial, circumferential, and longitudinal planes, whereas TDI provided longitudinal epsilon only. Mean circumferential and radial epsilon and SR were calculated from data collected at six basal myocardial regions, whereas mean longitudinal epsilon and SR derived from both 2D speckle tracking and TDI were calculated from the basal septum and basal lateral walls. Standard 2D echocardiography allowed the assessment of LV morphology including LV length, LV end-diastolic volume, LV end-diastolic diameter, mean wall thickness, and LV mass. The association of myocardial epsilon and SR data with relevant LV morphology indices was determined by adoption of the general, non-linear allometric model (y= ax(b)). The b exponent +/- 95% confidence intervals were reported. The relationships between the measures of LV morphology and myocardial epsilon and SR were highly variable and generally weak. Only two relationships displayed at least a moderate effect size (r > or = 0.30): (i) 2D circumferential peak systolic SR and LV end-diastolic dimension (b = -0.92; -1.35 to 0.5, r = 0.44) and (ii) TDI longitudinal peak systolic SR and LV length (b = -1.39; -2.11 to -0.66, r = 0.41). Conclusion The empirical relationships derived in this cohort do not support the need to scale myocardial epsilon and SR derived from 2D speckle or TDI for any index of LV morphology.

This study investigated the contribution of muscle architecture to the differences in the torque-velocity and power-velocity relationships between older (OM n = 9, aged 69-82 years) and younger men (YM n = 15, aged 19-35 years). Plantarflexors' (PF) maximal isometric and concentric torques were recorded at 0.87, 1.75, 2.62, 3.49 and 4.36 rad s(-1). Physiological cross-sectional area (PCSA) was calculated as the ratio of muscle volume (determined by magnetic resonance imaging) to muscle fascicle length (Lf, measured by ultrasonography). GM PCSA and Lf of the OM were, respectively, 14.3% (P < 0.05) and 19.3% (P < 0.05) smaller than of the YM. In the OM, GM maximum isometric torque and maximum contraction velocity (Vmax), estimated from Hill's equation were, respectively, 48.5 and 38.2% lower (P < 0.001) than in the YM. At all contraction velocities, the OM produced less torque than the YM (46.3% of YM at 0.87 rad s(-1) to 14.7% at 4.36 rad s(-1), P < 0.001). Peak power (PP) of the OM was 80% lower than that of the YM and normalisation of PP to muscle volume only reduced this difference by 10%. Normalisation of torque to PCSA reduced, but did not eliminate, differences in torque between YM and OM (9.6%) and differences in torque/PCSA increased with contraction velocity (P < 0.05). After normalisation of velocity to Lf, the difference in Vmax between the OM and the YM was reduced to 15.9%. Thus, although muscle architecture contributes significantly to the differences in the torque- and power-velocity properties of OM and YM, other contractile factors, intrinsic to the muscle, seem to play a role. It is noteworthy that the deficit in PP between OM and YM is far greater than that of muscle torque, even after normalisation of PP to muscle volume. This finding likely plays an important role in the loss of mobility in old age.

Sarcopenia and muscle weakness are well-known consequences of aging. The aim of the present study was to ascertain whether a decrease in fascicle force (Ff) could be accounted for entirely by muscle atrophy. In vivo physiological cross-sectional area (PCSA) and specific force (Ff/PCSA) of the lateral head of the gastrocnemius (GL) muscle were assessed in a group of elderly men [EM, aged 73.8 yr (SD 3.5), height 173.4 cm (SD 4.4), weight 78.4 kg (SD 8.3); means (SD)] and for comparison in a group of young men [YM, aged 25.3 yr (SD 4.4), height 176.4 cm (SD 7.7), weight 79.1 kg (SD 11.9)]. GL muscle volume (Vol) and Achilles tendon moment arm length were evaluated using magnetic resonance imaging. Pennation angle and fiber fascicle length (Lf) were measured using B-mode ultrasonography during isometric maximum voluntary contraction of the plantar flexors. PCSA was estimated as Vol/Lf. GL Ff was calculated by dividing Achilles tendon force by the cosine of θ, during the interpolation of a supramaximal doublet, and accounting for antagonist activation level (assessed using EMG), Achilles tendon moment arm length, and the relative PCSA of the GL within the plantar flexor group. Voluntary activation of the plantar flexors was lower in the EM than in the YM (86 vs. 98%, respectively, P < 0.05). Compared with the YM, plantar flexor maximal voluntary contraction torque and Ff of the EM were lower by 47 and 40%, respectively ( P < 0.01). Both Vol and PCSA were smaller in the EM by 28% ( P < 0.01) and 16% ( P < 0.05), respectively. Also, pennation angle was 12% smaller in the EM, whereas there was no significant difference in Lf between the YM and EM. After accounting for differences in agonists and antagonists activation, the Ff/PCSA of the EM was 30% lower than that of the YM ( P < 0.01). These findings demonstrate that the loss of muscle strength with aging may be explained not only by a reduction in voluntary drive to the muscle, but mostly by a decrease in intrinsic muscle force. This phenomenon may possibly be due to a reduction in single-fiber specific tension.

The aim of the present study was to examine the pattern of cardiovascular recovery from exercise in 15 women (age, 20.3 +/- 1.4 years; body mass, 61.5 +/- 4.3 kg) across two phases of oral contraceptive (OC) use: 21 days of consumption and 7 days of withdrawal. Cardiovascular recovery was measured in the supine position for 60 min following 30 min of exercise at 60% maximal rate of oxygen consumption (VO2,max). Central and peripheral haemodynamics were assessed during consumption and withdrawal of the OC pill using occlusion plethysmography, Doppler flowmetry and echocardiography. Significant hypotension occurred following exercise (P0.05), returning to baseline values after 60 min. The peak hypotension occurred 5 min into recovery. Cardiac output and heart rate were elevated for 60 min following exercise (P0.05), whilst stroke volume remained at baseline values. Heart rate was greater throughout recovery during consumption compared to withdrawal (P0.05); however, although there was a trend for greater responses during consumption, phase of OC use did not affect the other central cardiovascular variables (P0.05). Post-exercise blood flow parameters were not significantly affected by exercise or OC phase; however, calf blood flow was greater, and resistance to flow lower during consumption (P0.05). The pattern of post-exercise fluctuations in cardiovascular parameters may differ from those seen in men, whilst oestrogen variation may influence research findings.

Introduction: The improvement of vascular health in the exercising limb can be attained by sprint interval training (SIT). However, the effects on systemic vascular function and on circulating angiogenic cells (CACs) which may contribute to endothelial repair have not been investigated. Additionally, a comparison between SIT and sprint continuous training (SCT) which is less time committing has not been made. Methods: 12 women (22±2 yrs) completed 12 sessions of either SIT (n = 6) or work-matched SCT (n = 6) on 3 days/week. Pre and post-training assessments included brachial artery endothelial function and peripheral blood analysis for CAC number (CD34+/CD34+CD45dim). CAC function was measured by migration and adhesion assays. Cardio-respiratory fitness, carotid arterial stiffness and carotid-radial and brachial-foot pulse wave velocity (PWV) were also evaluated. Results: CD34+ CACs increased following training in both groups but CD34+CD45dim did not (Pre CD34+: 40±21/105 leukocytes, Post CD34+: 56±24/105 leukocytes, main time effect p0.05). Discussion: SCT involving little time commitment is comparable to SIT in increasing CD34+ cell number and [Formula: see text]. An increased mobilisation of CD34+ CACs suggests that sprint training may be an effective method to enhance vascular repair.

The aim of this study was to determine the effect of sitting and standing postures on the repeatability of a stadiometer designed to detect small variations in spinal length. Two groups of ten healthy subjects, with no previous or known history of back problems, participated in this study. One group was measured in the standing posture, while the other group was measured in a sitting posture. All subjects gave informed consent to participate in this study. Subjects had a set of landmarks defining the spinal contour marked on their backs and then stood in the stadiometer for three series of ten measurements to be performed. At the end of each measurement, the subjects were requested to move away from and then be repositioned in the stadiometer. Subjects improved the repeatability across the measurement series. At the end of the second measurement series, all subjects presented mean standard deviations of 0.43 +/- 0.08 mm (range 0.30-0.50 mm) in the standing posture. In the sitting posture, deviations of less than 0.05 mm were obtained only at the end of the third measurement series (0.48 +/- 0.08 mm; range 0.34-0.62 mm), suggesting that this posture required three measurement series before repeatable measurements could be assured rather than two in the standing posture.

High intensity exercise can lead to physiological and psychological adaptations that are detrimental to the athlete. These adaptations reflect the ‘overtraining syndrome’ (OTS) and can usually be identified via a persistent decrease in physical performance. In the female athlete the symptoms of OT are often exacerbated by the occurrence of athletic amenorrhea, or the loss of menstruation. The present review aims to identify the signs of the OTS, present tools for its diagnosis, and to establish the links between OT and athletic amenorrhea. Perhaps of greatest importance the review also discusses the prevention of overtraining with emphasis upon the long-term health problems the female athlete may encounter through OT and amenorrhea.

Cyclic variations in physiological and endocrinolgical baselines are known to be consistent with the eumenorrheic (healthy) menstrual cycle. The aim of this study was to examine the interaction of these variations with the physiological responses to repeated lifting. Sixteen females visited the laboratory in each of five phases of their menstrual cycle. During each visit, subjects performed a repetitive lifting task, lifting a weighted box, from knee to shoulder height, at six repetitions per minute for 10 min. Oxygen consumption, minute ventilation, heart rate (HR), and perceived exertion were monitored throughout the task. The variation in physiological and subjective responses to lifting with menstrual cycle phase did not reach statistical significance (p > .05). However, the HR response to lifting was elevated by approximately 10 beats min−1 in the postovulatory phases of the cycle (effect size > 0.61). Although the impact of the menstrual cycle upon lifting performance is minimal, alterations in HR must be taken into account in determining new international standards for manual handling. Key words: lifting, maximal oxygen consumption, subjective response, effect size