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Hamstring strain injuries are common in sport. Supramaximal eccentric or high-intensity isometric contractions are favored in hamstring strain injury prevention. The effect of combining these contraction modes in such prevention programs as a poststretch isometric contraction is unknown. Poststretch isometric contractions incorporate an active stretch and result in greater final isometric force than isometric contractions at comparable joint angles. This study compared torque and muscle activation levels between maximal voluntary isometric contraction and maximal poststretch isometric contractions of the knee flexors. Participants (n = 9) completed baseline maximal voluntary isometric contraction at 150° knee flexion and maximal poststretch isometric contractions at 120° knee flexion actively stretching at 60°/s to 150° knee flexion for final isometric contraction. Torque of the knee flexors and surface electromyography root mean square (sEMGRMS) of biceps femoris long head were simultaneously recorded and compared between baseline and poststretch isometric at 150° knee flexion. Torque was 14% greater in the poststretch isometric condition compared with baseline maximal voluntary isometric contraction (42.45 [20.75] N·m, 14% [22.18%], P RMS of biceps femoris long head (−.03 mV, ±.06, P = .130, d = .93). Poststretch isometric contractions resulted in supramaximal levels of poststretch isometric torque without increased activation of biceps femoris long head.

Background: The aim of the study was to explore the experiences of participants in a short aquatic exercise programme for individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, and to...

Background: Acceptance is a coping strategy associated with chronic pain management, but its effectiveness is unclear for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME).Objecti...

Diet and exercise are associated with the maintenance of physical function, independence and better health-related quality of life in cancer survivors. Adherence to healthy diet and exercise guidelines, however, remains low. The aim of this study was to explore the perceptions of hematological cancer survivors (HCS, ≥50 years) on the role of diet and exercise in navigating daily tasks using a qualitative descriptive research method. Eligible HCS completed an online survey gathering demographic information including physical functioning, exercise frequency, malnutrition and frailty risk. Following a semi-structured telephone interview, thematic analysis was used. Nine HCS (67 ± 2 years) were included in the final analysis, with 55.5% sufficiently active, three at risk of malnutrition and five of frailty. Three primary themes reflected the survivors’ perceptions: (1) beliefs about the impact of diet and exercise on physical and mental wellbeing, (2) the ability to overcome barriers to adhere to healthy diet and exercise behavior, and (3) diet and exercise empowered and gave hope. Participants had a more nuanced understanding of the role of exercise in physical function but lacked insight into the role of a healthy diet. Knowledge, support and instruction were key enablers of diet and exercise behavior, with community connection a unique enabler identified in this group.

Residual force enhancement (rFE) is observed when isometric force following an active stretch is elevated compared to an isometric contraction at corresponding muscle lengths. Acute rFE has been confirmed in vivo in upper and lower limb muscles. However, it is uncertain whether rFE persists using multiple, consecutive contractions as per a training simulation. Using the knee flexors, 10 recreationally active participants (seven males, three females, age 31.00 years &plusmn, 8.43 years) performed baseline isometric contractions at 150&deg, knee flexion (180&deg, representing terminal knee extension) of 50% maximal voluntary activation of semitendinosus. Participants performed post-stretch isometric (PS-ISO) contractions (three sets of 10 repetitions) starting at 90&deg, knee extension with a joint rotation of 60&deg, at 60&deg, &middot, s&minus, 1 at 50% maximal voluntary activation of semitendinosus. Baseline isometric torque and muscle activation were compared to PS-ISO torque and muscle activation across all 30 repetitions. Significant rFE was noted in all repetitions (37.8&ndash, 77.74%), with no difference in torque between repetitions or sets. There was no difference in activation of semitendinosus or biceps femoris long-head between baseline and PS-ISO contractions in all repetitions (ST, baseline ISO = 0.095&ndash, 1.000 &plusmn, 0.036&ndash, 0.039 Mv, PS-ISO = 0.094&ndash, 0.098 &plusmn, 0.033&ndash, 0.038 and BFlh, baseline ISO = 0.068&ndash, 0.075 &plusmn, 0.031&ndash, 0.038 Mv). This is the first investigation to observe rFE during multiple, consecutive submaximal PS-ISO contractions. PS-ISO contractions have the potential to be used as a training stimulus.

A systematic literature search was conducted to review the evidence of residual force enhancement (RFE) in vivo human muscle. The search, adhered to the PRISMA statement, of CINAHL, EBSCO, Embase, MEDLINE, and Scopus (inception—July 2017) was conducted. Full-text English articles that assessed at least 1 measure of RFE in vivo voluntarily contracted human skeletal muscle were selected. The methodologies of included articles were assessed against the Downs and Black checklist. Twenty-four studies were included (N = 424). Pooled Downs and Black scores ranked “fair” ( [2.26]). RFE was observed in all muscles tested. Joint range of motion varied from 15° to 60°. Contraction intensities ranged from 10% to >95% maximum. Although transient force enhancement during the stretch phase may change with angular velocity, RFE in the subsequent isometric phase is independent of velocity. The magnitude of RFE was influenced by smaller stretch amplitudes and greatest at joint angles indicative of longer muscle lengths. Contraction and activation intensity influenced RFE, particularly during the initial isometric contraction phase of a poststretch isometric contraction. RFE resulted in increased torque production, reduced muscular activation, and enhanced torque production when the neuromuscular system is weakened seen in an aged population.

Background and aims Adolescent obesity is an increasing health burden with a growing prevalence in low- and middle-income countries. The aim of this review is to assess and compare current best practice obesity prevention interventions for adolescents in developed nations and in India Methods Medline (PubMed), CINAHL, Scopus and Google Scholar electronic databases from 2000 to 2020 were searched using the key terms obesity, overweight, child and adolescent obesity, child and adolescent overweight, interventions for childhood and adolescent obesity and dietary interventions for adolescents, developed countries, and India. Results Developed nations worldwide have formed and implemented policies and programs at national and local levels to attempt to minimize and manage adolescent obesity. In 2019, scientific and government consultation groups in India have recommended national cross-sectoral structures to action interventions to restrict high-fat food intake, increase physical activity in children and adolescents and to link current research and school-based interventions in a national framework. Conclusions Obesity is a multifactorial problem, and multimodal interventions involving all Indian stakeholders, combined with government policy reform, are urgently needed.

Purpose: There is increasing evidence of immune system dysfunction in chronic fatigue syndrome (CFS), but little is known of the regular exercise effects on immune cell parameters. This pilot study investigated the effects of graded and intermittent exercise on CD4+ lymphocyte subset counts and activation compared with usual care. Methods: Twenty-four CFS patients (50.2 ± 10 yr) were randomized to graded exercise (GE), intermittent exercise (IE), or usual care (UC) groups; 18 sedentary non-CFS participants (50.6 ± 10 yr) were controls (CTL) for blood and immunological comparisons. Outcome measures were pre- and postintervention flow cytometric analyses of circulating lymphocyte subset cell counts; expression of CD3+, CD4+, CD25+, and CD134+; full blood counts; and V˙O2peak. Results: Preintervention, CD3+ cell counts, and expression of CD4+, CD25+, CD134+, and CD4+CD25+CD134+ were significantly lower in GE, IE, and UC compared with CTL (P < 0.05). Total lymphocyte concentration was significantly lower in GE and IE groups compared with CTL. There were significant postintervention increases in i) expression of CD4+ and CD4+CD25+CD134+ for GE and IE, but CD25+ and CD134+ for IE only; ii) circulating counts of CD3+ and CD4+ for GE, and CD3+, CD4+, CD8+, CD3+CD4+CD8+, CD3−CD16+CD56+, CD19+, and CD45+ for IE; iii) neutrophil concentration for GE; and iv) V˙O2peak and elapsed test time for IE and GE, V˙Epeak for IE. Conclusions: Twelve weeks of GE and IE training significantly improved CD4+ lymphocyte activation and aerobic capacity without exacerbating CFS symptoms. IE may be a more effective exercise modality with regard to enhanced CD4+ activation in CFS patients.

Purpose Although evidence is building on the positive effects of physical activity for prostate cancer survivors, less is known about the possible independent effects of sedentary behavior on quality of life and psychological well-being in this population. We determined the extent to which objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary behavior were independently associated with quality of life, anxiety, and depressive symptoms in prostate cancer survivors. Methods An exploratory cross-sectional analysis was undertaken on baseline data from a multicenter, cluster randomized controlled trial on the efficacy of a clinician referral and 12-week exercise program for men who had completed active treatment for prostate cancer. Multiple regression analyses were performed using data from 98 prostate cancer survivors who wore hip-mounted accelerometers (time spent sedentary defined as 1,951 CPM) and completed self-report instruments on their quality of life, anxiety, and depressive symptoms. Results were compared with minimal clinically important differences for the quality of life scales. Results Independent of sedentary behavior, increases in MVPA of between 15 and 33 min/day were associated with clinically important (but not statistically significant) improvements in three quality of life scales (insomnia, diarrhea, and financial difficulties). Independent of MVPA, decreases in sedentary behavior of 119 and 107 min/day were associated with clinically important (but not statistically significant) improvements in physical functioning and role functioning, respectively. Conclusion Within our exploratory study, modest increases in MVPA and more substantive decreases in sedentary behavior were independently associated with clinically important improvements in several quality of life scales. Further research, including prospective studies, is required to understand sedentary behavior across larger and more representative samples (in terms of their physical, psychological, and social functioning and their engagement in physical activity) of prostate cancer survivors. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000609055

Background Ageing is associated with a range of anatomical and physiological changes. Establishing whether a change is part of ‘normal’ ageing or the early signs of disease will affect management strategies. Progressive stiffening of the thoracic spine, decreasing chest wall compliance and declining lung function begin as early as 40 years of age. Administering an intervention such as manual therapy, which has the potential to mitigate age-related changes in the thoracic spine and chest wall, has the potential to improve thoracic compliance and lung function. The aims of this trial are to investigate whether manual therapy can mitigate the effects of age-related changes in lung function and whether there is a difference in effect between different forms of manual therapy. Methods The study design is a randomised controlled trial of 372 people with no history of respiratory disease between the ages of 50 and 65 years. The cohort will be divided into three equal groups. The first group will receive a simple 10-min treadmill walking program (Ex). The second group will receive joint mobilisation (MB) of the thoracic spine and ribs plus the same walking program (MB + Ex). The third group will receive joint manipulation (MT) of the thoracic spine and ribs plus the same walking program (MT + Ex). All interventions will be administered a total of six times over a 3-week period. The primary outcome measure is lung function: forced expiratory volume in the 1st second and forced vital capacity. The secondary outcome measures include chest wall expansion (tape measurements) and quality of life measurements (36-Item Short Form Health Survey). Outcome measurements will be taken by blinded assessors on four occasions over a 9-week period. Adverse event data will be gathered at the beginning of each intervention session. Discussion This randomised controlled trial is designed to investigate whether manual therapy can mitigate the effects of age-related changes in lung function and whether there is a difference in effect between different forms of manual therapy. This is the first fully powered trial designed to test this hypothesis on healthy males and females in this age range. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), 12616001317482. Registered on 20 September 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3257-z) contains supplementary material, which is available to authorized users.

Background/Aims: Dragon boat racing is an increasingly popular sport across the age continuum but there is little research about paddling-related injuries and appropriate rehabilitation exercises. The purpose of this study was to determine whether individualised strength and stretching interventions improved injuries, flexibility and muscular strength in female dragon boat paddlers. Methods: Anthropometry, frequency of injuries, joint flexibility, muscular strength/endurance, and musculoskeletal stiffness/pain were assessed in 22 recreational female dragon boat paddlers before and after 6 months of individualised strengthening and stretching interventions. Pain/stiffness was self-reported using a 0–10 Likert scale. Results: Post-intervention, there were significant improvements (p < 0.05) in systolic and diastolic blood pressure; shoulder and spinal flexion/extension; hip, knee and elbow flexion; hip flexor/extensor and hip abductor isometric strength; straight leg raise and sit and reach test values; and self-reported pain. The frequency of neck, shoulder, back and wrist injuries decreased significantly post-intervention. Conclusions: Targeted exercise interventions reduced the frequency of sport-related injuries to joints and muscle groups most at risk from repetitive loading during paddling. Range of motion, isometric muscle strength and pain in specific regions also improved. The interventions were effective for predominantly older paddlers but may also be applicable to other age groups and levels of ability.

BACKGROUND The purpose of this study was to determine the efficacy of a clinician referral and exercise program in improving exercise levels and quality of life for men with prostate cancer. METHODS This was a multicenter cluster randomized controlled trial in Melbourne, Australia comprising 15 clinicians: 8 clinicians were randomized to refer eligible participants (n = 54) to a 12-week exercise program comprising 2 supervised gym sessions and 1 home-based session per week, and 7 clinicians were randomized to follow usual care (n = 93). The primary outcome was self-reported physical activity; the secondary outcomes were quality of life, anxiety, and symptoms of depression. RESULTS A significant intervention effect was observed for vigorous-intensity exercise (effect size: Cohen's d, 0.46; 95% confidence interval [CI], 0.09-0.82; P = .010) but not for combined moderate and vigorous exercise levels (effect size: d, 0.08; 95% CI, −0.28 to 0.45; P = .48). Significant intervention effects were also observed for meeting exercise guidelines (≥150 min/wk; odds ratio, 3.9; 95% CI, 1.9-7.8; P = .002); positive intervention effects were observed in the intervention group for cognitive functioning (effect size: d, 0.34; 95% CI, −0.02 to 0.70; P = .06) and depression symptoms (effect size: d, −0.35; 95% CI, −0.71 to 0.02; P = .06). Eighty percent of participants reported that the clinician's referral influenced their decision to participate in the exercise program. CONCLUSIONS The clinician referral and 12-week exercise program significantly improved vigorous exercise levels and had a positive impact on mental health outcomes for men living with prostate cancer. Further research is needed to determine the sustainability of the exercise program and its generalizability to other cancer populations. Cancer 2015;121:2646–2654. © 2015 American Cancer Society.

Aims The aims of this study were to determine the effects of four weeks of intermittent exposure to a moderate hypoxia environment (15% oxygen), and compare with the effects of exercise in normoxia or hypoxia, on glucose homeostasis, insulin sensitivity, GLUT4 translocation, insulin receptor phosphorylation, Akt-dependent GSK3 phosphorylation and Akt activity in skeletal muscle of obese mice with type 2 diabetes. Methods C57BL/6J mice that developed type 2 diabetes with a high-fat-diet (55% fat) (fasting blood glucose, FBG = 13.9 ± 0.69 (SD) mmol/L) were randomly allocated into diabetic control (DC), rest in hypoxia (DH), exercise in normoxia (DE), and exercise in hypoxia (DHE) groups (n = 7, each), together with a normal-diet (4% fat) control group (NC, FBG = 9.1 ± 1.11 (SD) mmol/L). The exercise groups ran on a treadmill at intensities of 75–90% VO2max. The interventions were applied one hour per day, six days per week for four weeks. Venous blood samples were analysed for FBG, insulin (FBI) and insulin sensitivity (QUICKI) pre and post the intervention period. The quadriceps muscle samples were collected 72 hours post the last intervention session for analysis of GLUT4 translocation, insulin receptor phosphorylation, Akt expression and phosphorylated GSK3 fusion protein by western blot. Akt activity was determined by the ratio of the phosphorylated GSK3 fusion protein to the total Akt protein. Results The FBG of the DH, DE and DHE groups returned to normal level (FBG = 9.4 ± 1.50, 8.86 ± 0.94 and 9.0 ± 1.13 (SD) mmol/L for DH, DE and DHE respectively, P < 0.05), with improved insulin sensitivity compared to DC (P < 0.05), after the four weeks treatment, while the NC and DC showed no significant changes, as analysed by general linear model with repeated measures. All three interventions resulted in a significant increase of GLUT4 translocation to cell membrane compared to the DC group (P < 0.05). The DE and DH showed a similar level of insulin receptor phosphorylation compared with NC that was significantly lower than the DC (P < 0.05) post intervention. The DH and DHE groups showed a significantly higher Akt activity compared to the DE, DC and NC (P < 0.05) post intervention, as analysed by one-way ANOVA. Conclusions This study produced new evidence that intermittent exposure to mild hypoxia (0.15 FiO2) for four weeks resulted in normalisation of FBG, improvement in whole body insulin sensitivity, and a significant increase of GLUT4 translocation in the skeletal muscle, that were similar to the effects of exercise intervention during the same time period, in mice with diet-induced type 2 diabetes. However, exercise in hypoxia for four weeks did not have additive effects on these responses. The outcomes of the research may contribute to the development of effective, alternative and complementary interventions for management of hyperglycaemia and type 2 diabetes, particularly for individuals with limitations in participation of physical activity.

Background/Aims: Limb load asymmetry (LLA) is common in clinical conditions related to the lower limbs such as degenerative joint disease, soft tissue injuries, joint replacements, amputations and stroke. However, the measurement of LLA is limited in clinical practice as the equipment used is expensive and not readily available in most health care settings. The digital weighing scale is proposed as an inexpensive alternative method of measuring LLA and the objective of this study was to investigate the reliability and accuracy of a digital weighing scale relative to the Nintendo Wii in measuring limb load asymmetry during static standing. Methods: Twenty-four participants (12 participants with knee osteoarthritis (OA) and 12 healthy participants) were recruited through convenient sampling from a public university teaching hospital. The participants were required to perform a quiet standing task during the measurement of LLA. The measurements were taken over three trials during both eyes-open (EO) and eyes-closed (EC) resting conditions. LLA was measured in kilograms and computed with a symmetry index. Intra-class correlation coefficient (ICC) (3, 1) analysis, standard error of measurement and coefficient of variation were performed to assess reliability. The Bland-Altman plot was used to test the degree of agreement between digital weighing scales and the Nintendo Wii. Results: The digital weighing scale showed an excellent reliability of 0.983 and 0.988 in EC and EO conditions, respectively. The Bland-Altman plot showed good agreement between digital weighing scales and the Nintendo Wii in measuring LLA. Conclusions: The digital weighing scale is a reliable tool to measure LLA and has excellent potential to be used in clinical settings.

Background/Purpose: Physical deconditioning and impaired balance and gait are common barriers to exercise in frail older adults. This case report describes the efficacy of Nintendo Wii Fit exercises in improving functional capacity, exercise tolerance, strength and balance in an elderly woman with CREST syndrome and multiple chronic conditions. Case description: A sedentary 77-year-old woman with: scleroderma (CREST syndrome) and secondary Sjögren's syndrome; pulmonary hypertension; coronary artery disease; interstitial lung disease; and tremor. The patient could ambulate with a cane and had a high risk of falling. Methods: The participant completed three 30-minute sessions of Wii Fit exercises per week for 12 weeks. The exercises included step aerobics, marching and interactive games to develop balance, weight transfer and upper and lower body strength. Results: Substantial improvements were seen in the following: 6-minute walk test (6MWT) (100%); Timed Up and Go (TUG) (5.3%); 30-second sit to stand (25%); hand grip strength (right 21%; left 8.6%); ankle plantarflexion (right 16.7%; left 33.3%) and dorsiflexion (right 125%; left 88.9%), Tinetti Balance and Gait Assessment (balance score 35.5%; falls efficacy scale score 21.4%); resting systolic blood pressure (5.1%); and oxygen saturation (3.3%). The average movement of centre of pressure decreased post-intervention, but average velocity increased. Conclusions: Specific Wii Fit games may improve health, exercise capacity, mobility, balance and fall risk in older adults affected with CREST and associated severe cardiopulmonary symptoms.

Whey protein and leucine ingestion following exercise increases muscle protein synthesis and could influence neutrophil function during recovery from prolonged intense exercise. We examined the effects of whey protein and leucine ingestion post-exercise on neutrophil function and immunomodulators during a period of intense cycling. In a randomized double-blind crossover, 12 male cyclists ingested protein/leucine/carbohydrate/fat (LEUPRO 20/7.5/89/22 g h(-1), respectively) or isocaloric carbohydrate/fat control (CON 119/22 g h(-1)) beverages for 1-3 h post-exercise during 6 days of high-intensity training. Blood was taken pre- and post-exercise on days 1, 2, 4 and 6 for phorbol myristate acetate (PMA)-stimulated neutrophil superoxide (O2 (-)) production, immune cell counts, amino acid and lipid metabolism via metabolomics, hormones (cortisol, testosterone) and cytokines (interleukin-6, interleukin-10). During recovery on day 1, LEUPRO ingestion increased mean concentrations of plasma amino acids (glycine, arginine, glutamine, leucine) and myristic acid metabolites (acylcarnitines C14, myristoylcarnitine; and C14:1-OH, hydroxymyristoleylcarnitine) with neutrophil priming capacity, and reduced neutrophil O2 production (15-17 mmol O2 (-) cell(-1) ± 90 % confidence limits 20 mmol O2 (-) cell(-1)). On day 2, LEUPRO increased pre-exercise plasma volume (6.6 ± 3.8 %) but haematological effects were trivial. LEUPRO supplementation did not substantially alter neutrophil elastase, testosterone, or cytokine concentrations. By day 6, however, LEUPRO reduced pre-exercise cortisol 21 % (±15 %) and acylcarnitine C16 (palmitoylcarnitine) during exercise, and increased post-exercise neutrophil O2 (-) (33 ± 20 mmol O2 (-) cell(-1)), relative to control. Altered plasma amino acid and acylcarnitine concentrations with protein-leucine feeding might partly explain the acute post-exercise reduction in neutrophil function and increased exercise-stimulated neutrophil oxidative burst on day 6, which could impact neutrophil-dependent processes during recovery from intense training.

Interval training (IT) may induce physiological adaptations superior to those achieved with conventional moderate-intensity continuous training (MCT) in patients with coronary artery disease (CAD). Our objectives were (1) to systematically review studies which have prescribed IT in CAD, (2) to summarize the findings of this research including the safety and physiological benefits of IT, and (3) to identify areas for further investigation. A systematic review of the literature using computerized databases was performed. The search yielded two controlled trials and five randomized controlled trials (RCTs) enrolling 213 participants. IT prescribed in isolation or in combination with resistance training was shown to induce significant and clinically important physiological adaptations in cardiac patients. IT was also shown to improve cardiorespiratory fitness (e.g. VO(2max), VO(2AT)), endothelial function, left ventricle morphology and function (e.g. ejection fraction) to a significantly greater extent when compared with conventional MCT. No adverse cardiac or other life-threatening events occurred secondary to exercise participation in these studies. However, these findings must be interpreted with caution, as methodological limitations were present in all trials reviewed. In conclusion, robustly designed RCTs with thorough and standardized reporting are required to determine the risk and benefits of IT in the broader cardiac patient population. Further research is required to determine optimal IT protocols for the use in cardiac rehabilitation programmes, potentially contributing to novel exercise prescription guidelines for this patient population.

Objective In this study, the effects of vibration therapy (VT) on delayed-onset muscle soreness (DOMS) and associated inflammatory markers after downhill running were determined. Methods 29 male recreational runners (33 (8) years; Vo 2 peak 57 (6) ml kg −1 min −1 ) completed a 40-min downhill run and were randomly allocated to a VT group or Control group. For 5 days post-run, the VT group underwent once-daily sessions of VT on the upper and lower legs. DOMS was assessed pre-run and for 5 days post-run by visual analogue scale. Immune cell subsets and plasma inflammatory markers were assessed pre-run, post-run, 24 and 120 h post-run by full differential cell count, and by ELISA and enzyme immunoassay, respectively. Data were analysed as per cent change from pre-run (ANOVA) and the magnitude of the treatment effect (Cohen9s effect size statistics). Results VT significantly reduced calf pain 96 h post-run (−50% (40%), 90% confidence limits) and gluteal pain 96 h (−50% (40%)) and 120 h post-run (−30% (30%)); decreased interleukin 6 (IL6) 24 h (−46% (31%)) and 120 h post-run (−65% (30%)); substantially decreased histamine 24 h (−40% (50%)) and 120 h post-run (−37% (48%)); substantially increased neutrophils (8.6% (8.1%)) and significantly decreased lymphocytes (−17% (12%)) 24 h post-run. There were no clear substantial effects of VT on other leukocyte subsets and inflammatory markers. Conclusion VT reduces muscle soreness and IL6. It may stimulate lymphocyte and neutrophil responses and may be a useful modality in treating muscle inflammation.

The ingestion of solutions containing carbohydrates with different intestinal transport mechanisms (e.g., fructose and glucose) produce greater carbohydrate and water absorption compared with single-carbohydrate solutions. However, the fructose-ingestion rate that results in the most efficient use of exogenous carbohydrate when glucose is ingested below absorption-oxidation saturation rates is unknown. Ten cyclists rode 2 h at 50% of peak power then performed 10 maximal sprints while ingesting solutions containing 13C-maltodextrin at 0.6 g/min combined with 14C-fructose at 0.0 (No-Fructose), 0.3 (Low-Fructose), 0.5 (Medium-Fructose), or 0.7 (High-Fructose) g/min, giving fructose:maltodextrin ratios of 0.5, 0. 8, and 1.2. Mean (percent coefficient of variation) exogenous-fructose oxidation rates during the 2-h rides were 0.18 ( 19 ), 0.27 ( 27 ), 0.36 ( 27 ) g/min in Low-Fructose, Medium-Fructose, and High-Fructose, respectively, with oxidation efficiencies (=oxidation/ingestion rate) of 62–52%. Exogenous-glucose oxidation was highest in Medium-Fructose at 0.57 ( 28 ) g/min (98% efficiency) compared with 0.54 ( 28 ), 0.48 ( 29 ), and 0.49 ( 19 ) in Low-Fructose, High-Fructose, No-Fructose, respectively; relative to No-Fructose, only the substantial 16% increase (95% confidence limits ±16%) in Medium-Fructose was clear. Total exogenous-carbohydrate oxidation was highest in Medium-Fructose at 0.84 ( 26 ) g/min. Although the effect of fructose quantity on overall sprint power was unclear, the metabolic responses were associated with lower perceptions of muscle tiredness and physical exertion, and attenuated fatigue (power slope) in the Medium-Fructose and High-Fructose conditions. With the present solutions, low-medium fructose-ingestion rates produced the most efficient use of exogenous carbohydrate, but fatigue and the perception of exercise stress and nausea are reduced with moderate-high fructose doses.

Understanding the factors that influence adherence to exercise programs is necessary to develop effective interventions for people with cancer. We examined the predictors of adherence to a supervised exercise program for participants in the ENGAGE study – a cluster randomized controlled trial that assessed the efficacy of a clinician‐referred 12‐week exercise program among men treated for prostate cancer. Demographic, clinical, behavioral, and psychosocial data from 52 participants in the intervention group were collected at baseline through self‐report and medical records. Adherence to the supervised exercise program was assessed through objective attendance records. Adherence to the supervised exercise program was 80.3%. In the univariate analyses, cancer‐specific quality of life subscales (role functioning r = 0.37, P = 0.01; sexual activity r = 0.26, P = 0.06; fatigue r = −0.26, P = 0.06, and hormonal symptoms r = −0.31, P = 0.03) and education (d = −0.60, P = 0.011) were associated with adherence. In the subsequent multivariate analysis, role functioning (B = 0.309, P = 0.019) and hormonal symptoms (B = −0.483, P = 0.054) independently predicted adherence. Men who experienced more severe hormonal symptoms had lower levels of adherence to the exercise program. Those who experienced more positive perceptions of their ability to perform daily tasks and leisure activities had higher levels of adherence to the exercise program. Hormonal symptoms and role functioning need to be considered when conducting exercise programs for men who have been treated for prostate cancer.

Background: Chronic Fatigue Syndrome is a complex condition with no clear aetiology. There are inconsistent reports of abnormal red cell indices and variations in some immune cell subsets in CFS patients. Aim: Toexaminehaemato logical and immunological indices and the frequency of irregularities. Methods: Full blood counts and immune cell subsets of 24 Chronic Fatigue Syndrome individuals and 18 healthy, sedentary controls were analysed by cell sorter and flow cytometer. The frequencies of abnormal blood count and immunological indices, and health conditions in both groups were also recorded. Results: Total lymphocyte concentration was below-normal in 33.3% of CFS participants, with mean values significantly lower than the non-CFS group. CFS participants also had a lower CD3+CD4+ lymphocyte count (p < 0.05). Compared to non-CFS, the CFS group had significantly higher frequencies of above-normal red cell distribution width (RDW), above-normal erythrocyte mean cell volume (MCV), previous/current iron deficiency, cardiac symptoms, recurring sore throats and headaches, poor sleep, joint and back pain. Conclusion: Significantly higher frequencies of abnormal RDW, MCV and lymphocyte concentrations in CFS participants may be associated with iron deficiency and immune cell dysfunction.

Background Chronic Fatigue Syndrome is a debilitating disorder with an unknown aetiology but suspected multifactorial origins. Common “triggers” include severe viral infections and emotional stress. Recent studies have also found evidence of immune dysfunction and elevated inflammatory cytokines in CFS patients, but there has been considerable variation in the outcome measures and magnitude of these studies. Currently, there is no cure for CFS but treatments include rest, specialist medical care, cognitive behavioural therapy, and graded (self-paced) exercise. To date, several studies have examined the efficacy of graded exercise with or without Cognitive Behavioural Therapy, with some success for patients. However, improvements in functional capacity have not necessarily correlated with improvements in immune function, fatigue or other symptoms. This 12-week pilot trial compares graded and intermittent exercise to normal care, measuring physiological outcomes, fatigue levels, immune function and wellness. Methods/design 90 patients aged between 16 to 60 years, who meet the diagnostic criteria for CFS and have been diagnosed by their medical practitioner, will be randomly recruited into groups consisting of Intermittent exercise, Graded exercise and usual care (Control). The outcomes will be measured pre-study (Week 0) and post-study (Week 13). Primary outcomes are VO2peak, anaerobic threshold, peak power, levels of fatigue, immune cell (CD3+CD4+, CD3+CD8+, CD19+, CD 16+CD56+) concentrations and activation. Secondary outcomes include onset of secondary CFS symptoms (e.g. fever, swollen lymph nodes), wellness, mood and sleep patterns. Primary analysis will be based on intention to treat using logistic regression models to compare treatments. Quantitative data will be analysed using repeated measures ANOVA with a linear model, and Cohen’s effect size. Qualitative data such as participants’ responses (e.g. changes in mood and other reactions) following the exercise modalities will be read and sections demarcated. A code will be applied to each segment. A prevalence of codes will be considered thematically. Discussion The results of the trial will provide information about the efficacy of intermittent and graded exercise compared to usual care (rest and lifestyle recommendations), contributing to the evidence for best-practice CFS management. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12612001241820.

There is substantial evidence of immune system dysfunction in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) but little is understood of exercise training effects on lymphocyte function in this illness. This study investigated whether graded and intermittent exercise improved CD8 + lymphocyte activation and natural killer cell degranulation markers compared to no exercise. Twenty‐four chronic fatigue syndrome (CFS) patients (50.2 ± 10 year) were randomized to graded exercise (GE), intermittent exercise (IE) or usual care (UC) groups; a control group (CTL) of 18 matched sedentary non‐CFS/ME participants were included for immunological variable comparisons. Main outcome measures were pre‐ and postintervention expression of CD3 + CD8 + CD38 + and CD3 − CD16 + 56 + CD107a + (LAMP‐1) CD107b + (LAMP‐2) and aerobic exercise capacity. The postintervention percentage of NK cells expressing LAMP‐1 and ‐2 was significantly higher in IE compared to UC, and higher in GE compared to UC and CTL. LAMP‐1 and LAMP‐2 expression (absolute numbers and percent positive) increased significantly pre‐to‐postintervention for both GE and IE. Preintervention, the absolute number of CD8 + CD38 + cells was significantly lower in CTL compared to UC and IE. There were no significant pre‐ to postintervention changes in CD8 + CD38 + expression for any group. Aerobic exercise capacity was significantly improved by GE and IE. Twelve weeks of GE and IE increased the expression of NK cell activation and degranulation markers, suggesting enhanced immunosurveillance. Low‐intensity exercise may also reduce CD8 + CD38 + expression, a marker of inflammation. Both GE and IE improved exercise capacity without worsening CFS/ME symptoms, and more robust trials of these exercise modalities are warranted.

NELSON, A. R., S. M. PHILLIPS, T. STELLINGWERFF, S. REZZI, S. J. BRUCE, I. BRETON, A. THORIMBERT, P. A. GUY, J. CLARKE, S. BROADBENT, and D. S. ROWLANDS. A Protein–Leucine Supplement Increases Branched-Chain Amino Acid and Nitrogen Turnover But Not Performance. Med. Sci. Sports Exerc., Vol. 44, No. 1, pp. 57–68, 2012. Purpose: This study aimed to determine the effect of postexercise protein–leucine coingestion with CHO–lipid on subsequent high-intensity endurance performance and to investigate candidate mechanisms using stable isotope methods and metabolomics. Methods: In this double-blind, randomized, crossover study, 12 male cyclists ingested a leucine/protein/CHO/fat supplement (LEUPRO 7.5/20/89/22 gIh j1 , respectively) or isocaloric CHO/fat control (119/22 gIh j1 ) 1–3 h after exercise during a 6-d training block (intense intervals, recovery, repeated-sprint performance rides). Daily protein intake was clamped at 1.9 gIkg j1 Id j1 (LEUPRO) and 1.5 gIkg j1 Id j1 (control). Stable isotope infusions (1- 13 C-leucine and 6,6- 2 H2-glucose), mass spectrometry–based metabolomics, and nitrogen balance methods were used to determine the effects of LEUPRO on whole-body branched-chain amino acid (BCAA) and glucose metabolism and protein turnover. Results: After exercise, LEUPRO increased BCAA levels in plasma (2.6-fold; 90% confidence limits = /1.1) and urine (2.8-fold; /1.2) and increased products of BCAA metabolism plasma acylcarnitine C5 (3.0-fold; /0.9) and urinary leucine (3.6-fold; /1.3) and A-aminoisobutyrate (3.4-fold; /1.4), indicating that ingesting E10 g leucine per hour during recovery exceeds the capacity to metabolize BCAA. Furthermore, LEUPRO increased leucine oxidation (5.6-fold; /1.1) and nonoxidative disposal (4.8-fold; /1.1) and left leucine balance positive relative to control. With the exception of day 1 (LEUPRO = 17 T 20 mg NIkg j1 , control = j90 T 44 mg NIkg j1 ), subsequent (days 2–5) nitrogen balance was positive for both conditions (LEUPRO = 130 T 110 mg NIkg j1 , control = 111 T 86 mg NIkg j1 ). Compared with control feeding, LEUPRO lowered the serum creatine kinase concentration by 21%–25% (90% confidence limits = T14%), but the effect on sprint power was trivial (day 4 = 0.4% T 1.0%, day 6 = j0.3% T 1.0%). Conclusions: Postexercise protein–leucine supplementation saturates BCAA metabolism and attenuates tissue damage, but effects on subsequent intense endurance performance may be inconsequential under conditions of positive daily nitrogen balance.

We investigated whether 12 months of chronic endurance training would affect haematology, CD4(+) lymphocyte transferrin receptor (CD71) expression, CD4(+) intracellular iron and the incidence of upper respiratory tract illnesses (URTI) in Ironman triathletes compared with untrained men. Resting venous blood samples were taken from 15 Ironman triathletes (TR 30 ± 5 year) and 12 untrained men (UT 30 ± 6 year) every 4 weeks for 12 months. Erythrocyte, leukocyte and platelet concentration, haematocrit, haemoglobin (Hb) and mean corpuscular haemoglobin (MCHC) were measured with a full blood count. CD4(+) lymphocytes were analysed for changes in transferrin receptor (CD71) expression (CD4(+)CD71(+)), and intracellular iron (Fe(3+)), by flow cytometry. The TR group had significantly lower Hb, MCHC, and platelets for 10, 9 and 11 months, respectively; lower CD4(+)CD71(+) (3 months) and Fe(3+) (1 month), respectively; higher CD4(+)CD71(+) (1 month); a higher lymphocyte count for 4 months. There were no between-group differences in other variables. In both groups haematology and lymphocytes increased during spring, early summer and winter and decreased during late summer/late winter, with an inverse relationship between CD4(+)CD71(+) and Fe(3+). The TR group reported significantly fewer URTI than the UT. Low Hb and MCHC suggest an iron deficiency which may affect triathlete performance. Monthly changes in lymphocytes, CD4(+)CD71(+) and Fe(3+) suggested that spring, summer and late autumn are associated with CD4(+) proliferation. There may be seasonal relationships between haematology and lymphocyte function, independent of endurance training, possibly affecting performance but not the incidence of URTI.

The purpose of the present study was to determine whether 12 months of moderate intensity cycling would increase the expression of IL-2 (CD25+) receptors in T helper (CD4+) lymphocytes in men and women aged 65-75 years. Fourteen men and 10 women completed 52 weeks of moderate intensity cycling (60% VO2peak). Subjects trained (TR) three times per week for 45 min per session. Eight age-matched untrained (UT) male and eight UT female subjects acted as controls. Resting blood samples were taken from TR and UT subjects every 4 weeks. Leukocyte concentration was measured using a full blood count. PHA-stimulated CD4+ lymphocytes were analysed for changes in the expression of CD25+, by flow cytometry. Training significantly increased VO2peak (l min(-1), ml kg(-1) min(-1)) in male (+14.3, +16%) and female (+16.7, +27.8%) groups. The TR male group showed a significantly lower percentage of CD4+CD25+ than the male UT in January but the TR male percentage was significantly higher than the UT male group during February, March, April, May, June, September B and December. The female TR group showed a significantly higher percentage CD4+CD25+ than the female UT only during July. There were also significant sequential monthly changes in the percentage of CD4+CD25+ for male and female UT and TR groups. Significant increases in the percentage of CD4+CD25+ in the male TR group suggest training-enhanced lymphocyte mitogenic responsiveness. Moderate intensity long-term training may increase the recruitment of active memory CD4+CD25+ in men rather than women.

The purpose of the present study was to determine whether 12 months of endurance training reduced [Ca2+]i in T helper (CD4+) lymphocytes in trained (TR) men compared to untrained (UT). Fourteen trained (Ironman triathletes) and nine untrained (sedentary) men volunteered for the study. The TR group averaged 12 km of swimming, 300 km of cycling and 60 km of running per week during the year. Resting blood samples were taken from TR (VO(2peak) 64 +/- 2 ml kg(-1) min(-1)) and UT (VO(2peak) 42 +/- 2 ml kg(-1) min(-1)) subjects every 4 weeks for 52 weeks (October 1, 1999-October 1, 2000). Leukocyte concentration was measured using a full blood count. Unstimulated CD4+ lymphocytes were separated and analysed for changes in free ([Ca2+]i) and total ([Ca2+]t) calcium using flow cytometry. There were no significant differences in leukocyte concentration between UT and TR groups. There were significant differences between TR and UT in [Ca2+]i (October B and November), and [Ca2+]t (January and March). There were also significant sequential monthly changes in both [Ca2+]i and [Ca2+]t for TR and UT groups during the study. Significant increases in [Ca2+]i and [Ca2+]t during summer (January and March) for both TR and UT groups suggest an increase in intracellular signalling during hot weather. [Ca2+]i and [Ca2+]t were significantly lower in TR lymphocytes during November and March, suggesting that endurance training during warmer months may decrease [Ca2+]i through altered intracellular signalling, possibly to maintain lymphocyte function during heat stress.

for paper in - Medicine & Science in Sports & Exercise, volume 43(5) Suppl 1, May 2011, p. 136

Regular exercise is thought to maintain or improve the adaptive immune (lymphocyte) response but there is little data on the long-term exercise effects on CD4+ activation in young and older individuals. PURPOSE: To investigate if 12 months of aerobic/endurance training would enhance CD4+ activation via increased CD25 receptor expression and density in trained older and young men compared to sedentary controls. METHODS: We compared young (30±5 yr) trained (TRY, n = 14) and sedentary (UTY, n = 12) men to older (69±5 yr) trained (TRO, n = 14) and sedentary (UTO, n = 10) men for 12 months. Older men cycled for three 50 min sessions per week (60-70% VO2peak) while the TRY group completed daily endurance training (90-120 min per day, 60-80% VO2peak). Venous blood was analysed every month for resting lymphocyte count and CD4+CD25+ expression and density by flow cytometry. Results were analysed by repeated measures two-way ANOVA (time vs group) with Bonferroni post hoc test (between-group and between-month), with p

Background Despite evidence that physical activity improves the health and well-being of prostate cancer survivors, many men do not engage in sufficient levels of activity. The primary aim of this study (ENGAGE) is to determine the efficacy of a referral and physical activity program among survivors of prostate cancer, in terms of increasing participation in physical activity. Secondary aims are to determine the effects of the physical activity program on psychological well-being, quality of life and objective physical functioning. The influence of individual and environmental mediators on participation in physical activity will also be determined. Methods/Design This study is a cluster randomised controlled trial. Clinicians of prostate cancer survivors will be randomised into either the intervention or control condition. Clinicians in the intervention condition will refer eligible patients (n = 110) to participate in an exercise program, comprising 12 weeks of supervised exercise sessions and unsupervised physical activity. Clinicians allocated to the control condition will provide usual care to eligible patients (n = 110), which does not involve the recommendation of the physical activity program. Participants will be assessed at baseline, 12 weeks, 6 months, and 12 months on physical activity, quality of life, anxiety, depression, self-efficacy, outcome expectations, goals, and socio-structural factors. Discussion The findings of this study have implications for clinicians and patients with different cancer types or other chronic health conditions. It will contribute to our understanding on the potential impact of clinicians promoting physical activity to patients and the long term health benefits of participating in physical activity programs. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000609055 Deakin University Human Research Ethics Approval 2011-085