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Context: Baseline testing is a common strategy for concussion assessment and management. Research continues to evaluate novel measures for potential to improve baseline testing methods. Objectives: The primary objective was to (1) determine the feasibility of including physiological, neuromuscular, and mood measures as part of baseline concussion testing protocol, (2) describe typical values in a varsity athlete sample, and (3) estimate the influence of concussion history on these baseline measures. Design: Prospective observational study. Setting: Ryerson University Athletic Therapy Clinic. Participants: One hundred varsity athletes. Main Outcome Measures: Frequency and domain measures of heart rate variability, blood pressure, grip strength, profile of mood states—short form, and the Sport Concussion Assessment Tool-2. Results: Physiological, neuromuscular performance, and mood measures were feasible at baseline. Participants with a history of 2 or more previous concussions displayed significantly higher diastolic blood pressure. Females reported higher total mood disturbance compared with males. Conclusions: Physiological and neuromuscular performance measures are safe and feasible as baseline concussion assessment outcomes. History of concussion may have an influence on diastolic blood pressure. [ABSTRACT FROM AUTHOR]

A unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays—such as prothrombin time, partial thromboplastin time, and international normalized ratio—have historically been utilized to assess hemostasis and guide treatment following traumatic brain injury. However, these plasma-based assays alone often lack the sensitivity to diagnose and adequately treat coagulopathy associated with traumatic brain injury. Here, we review the whole blood coagulation assays termed viscoelastic tests and their use in traumatic brain injury. Modified viscoelastic tests with platelet function assays have helped elucidate the underlying pathophysiology and guide clinical decisions in a goal-directed fashion. Platelet dysfunction appears to underlie most coagulopathies in this patient population, particularly at the adenosine diphosphate and/or arachidonic acid receptors. Future research will focus not only on the utility of viscoelastic tests in diagnosing coagulopathy in traumatic brain injury, but also on better defining the use of these tests as evidence-based and/or precision-based tools to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Physical activity is an effective lifestyle therapy for patients at risk for, or with, documented cardiovascular disease (CVD). Current screening tools - the Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) - require updating to align with risk/benefit evidence. We provide evidence-based recommendations to identify individuals with CVD at lower risk, intermediate risk, or higher risk of adverse events when participating in physical activity. Forms of exercise and the settings that will appropriately manage the risks are identified. A computer-assisted search of electronic databases, using search terms for CVD and physical activity risks and benefits, was employed. The Appraisal of Guidelines for Research and Evaluation were applied to assess the evidence and assign a strength of evidence rating. A strength rating for the physical activity participation clearance recommendation was assigned on the basis of the evidence. Recommendations for physical activity clearance were made for specific CVD groups. Evidence indicates that those who are medically stable, who are involved with physical activity, and who have adequate physical ability can participate in physical activity of lower to moderate risk. Patients at higher risk can exercise in medically supervised programs. Systematic evaluation of evidence indicates that clinically stable individuals with CVD may participate in physical activity with little risk of adverse events. Therefore, changes in the PAR-Q should be undertaken and a process of assessment and consultation to replace the PARmed-X should be developed. Patients at lower risk may exercise at low to moderate intensities with minimal supervision. Those at intermediate risk should exercise with guidance from a qualified exercise professional. Patients at higher risk should exercise in medically supervised programs. [ABSTRACT FROM AUTHOR]

Increased physical activity (PA) is associated with improved health and quality of life in the general population. A dose-response effect is evident between increasing levels of PA participation and a lower relative risk for cardiovascular disease and all-cause mortality. However, there is also clear evidence that PA acutely increases the risk of an adverse cardiovascular (CV) event and sudden cardiac death (SCD) significantly above levels expected at rest. Adverse CV events during PA may be triggered acutely by the physiological stress of exercise. This investigation will review the available literature describing the CV risks of exercise testing and PA participation in apparently healthy individuals. A systematic review of the literature was performed using electronic databases, including Medline, CINAHL, SPORT discus, EMBASE, Cochrane DSR, ACP Journal Club, and DARE; additional relevant articles were hand-picked and the final grouping was used for the review using the AGREE process to assess the impact and quality of the selected articles. Six hundred and sixteen relevant articles were reviewed with 51 being identified as describing adverse CV events during exercise and PA. Data suggests the risks of fatal and nonfatal events during maximal exercise testing in apparently healthy individuals rarely occur (approximately <0.8 per 10 000 tests or 1 per 10 000 h of testing). The incidence of adverse CV events is extremely low during PA of varying types and intensities, with data limited almost exclusively to fatal CV events, as nonfatal events are rarely reported. However, this risk is reduced by 25%-50% in those individuals who have prior experience with increased levels of PA, particularly vigorous PA. Throughout a wide age range, the risk of SCD and nonfatal events during PA remain extremely low (well below 0.01 per 10 000 participant hours), but both increasing age and PA intensity are associated with greater risk. In most cases of exercise-related SCD, undetected pre-existing disease is present and SCD is typically the first clinical event. The risks of an adverse CV event during exercise testing and PA are rare and are outweighed by the health benefits. Given this risk-benefit relationship, the PAR-Q is an appropriate method to identify those at higher risk across a wide age span and should be used in conjunction with appropriate clinical guidelines for guiding individuals towards graduated PA. There are not adequate data to describe the risks of PA in those individuals considered to be at higher risk but without cardiovascular disease. [ABSTRACT FROM AUTHOR]

Abstract: Few studies have examined the effects of leisure physical activity (PA) participation on bone mass and geometry in postmenopausal women using peripheral quantitative computed tomography (pQCT). The purpose of this study was to determine associations between leisure PA participation and bone mass and geometry at the radius and tibia in a Canadian cohort of healthy postmenopausal women (n =234, mean age 62 years). Leisure PA participation was assessed using the Minnesota Leisure Time Physical Activity Questionnaire and by generating a total activity score (TAS, mean=105, range=0–840). Bone mass and geometry at the distal and midshaft sites of the non-dominant radius and tibia were measured using pQCT. Associations between TAS and bone mass and geometry variables were determined using linear regression models adjusted for clinically relevant confounding variables. TAS was positively and significantly associated with total content, total area, cortical content and cortical area at the midshaft sites of the radius and tibia (p <0.05 for all associations). TAS was also positively and significantly associated with bone bending and torsional strength parameters at the midshaft radius and tibia (p <0.05 for all associations). No associations were observed between TAS and trabecular bone parameters. Leisure PA participation is positively associated with cortical bone mass and geometry as well as bending and torsional strength at weight-bearing and non-weight-bearing bone sites and may have the potential to modify bone strength and influence bone fragility in postmenopausal women. [Copyright &y& Elsevier]

The fitness test for correctional officer applicants (FITCO) was constructed a priori to conform to requirements established by the Meiorin Decision of the Supreme Court of Canada. A critical obligation from this decision is to determine whether the FITCO has the potential of adverse impact on any subpopulation of applicants and, if so, whether it is possible to provide accommodation. The FITCO pass rate was 28.6% for 56 women and 72.7% for 22 men, which indicates adverse impact on the female applicants. There was no specific adverse impact on minority applicants. To evaluate training as accommodation for adverse impact, a subgroup of 40 females and 8 males engaged in a 6-week FITCO-specific training program with pre-FITCO and post-FITCO performance evaluations. Over the 6 weeks, the overall FITCO pass rate of the females improved to 82.5%, whereas the pass rate of the males improved to 100%, indicating that the training program removed the adverse impact that the FITCO had on the females. We conclude that although the FITCO is likely to have an adverse impact on female correctional officer applicants, a 6-week FITCO-specific training program can provide the accommodation necessary to overcome the potential adverse impact, and the FITCO meets all the requirements established by the Supreme Court of Canada’s Meiorin Decision. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to develop and validate a fitness test for correctional officer (CO) applicants (FITCO) and to establish associated standards of acceptability. The FITCO incorporated the most important, physically demanding, and frequently occurring tasks of a CO. It consists of (i) a simulated cell search; (ii) an emergency response circuit (ERC), involving a 60-m run while scaling 4 sets of stairs, followed by simulations of an inmate control, wrist restraint, arm retraction, and 40-m mannequin drag; and (iii) a test of aerobic fitness. The validity of the FITCO was established by very high congruence between the oxygen consumption, heart rate, and rating of perceived exertion of incumbent COs while performing the ERC with the same measurements while COs were performing the on-the-job tasks on which the ERC was based. The content validity of the FITCO was confirmed by very high Likert ratings (>6 on a 7-point scale) by both male and female incumbent COs of all ages concerning the importance, relatedness, physical demands, and overall appropriateness of the FITCO for evaluating CO applicants. We conclude that because the forces built into the ERC and the FITCO standards were both derived from the performance of safe and efficient incumbent female COs of all ages, and both the validity and test-retest reliability (intraclass correllation coefficient = 0.977) of the FITCO are very high, the FITCO was properly constructed to meet the requirements of the Supreme Court of Canada’s Meiorin Decision. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to identify the critical tasks encountered by correctional officers (COs) on the job and to conduct a comprehensive assessment and characterization of the physical demands of these tasks. These are the first steps in developing a fitness screening test for COs in compliance with recent legislation. The most important, physically demanding, and frequently occurring tasks were identified using Delphi methodology, focus groups, and questionnaire responses from 190 experienced front-line COs. These tasks were structured into emergency response scenarios for which a physical and physiological characterization was conducted to verify their relative physical demands analysis. Oxygen consumption and the forces exerted by COs were quantified while they were responding and then controlling and restraining inmates. The female COs used less force than the male COs did to control and restrain the same inmates (body control = 46 vs. 60 kg, wrist hold = 32 vs. 49 kg, and arm retraction = 37 vs. 47 kg) and did not exert their maximal strength during their control and restraint activities. The mean oxygen consumption of the female and male COs while performing the on-the-job tasks was similar (39.5 vs. 38.5 mL·kg-1·min-1). We concluded that the essential components of a fitness screening protocol for CO applicants are cell search, expeditious response, body control, arm restraint, inmate relocation, and an assessment of aerobic fitness. The criterion performance standards for completing these tasks in a circuit were set at the job performance level of safe and efficient female COs. [ABSTRACT FROM AUTHOR]

We investigated effects of 6 days of endurance exercise training [cycling at 65% of peak oxygen consumption (VO(2peak)) for 2 h a day on six consecutive days] on vascular function in young males. Measures of VO(2peak), arterial stiffness, calf vascular conductance and heart rate variability were obtained pre- and post-training. Indices of arterial stiffness were obtained by applanation tonometry to determine aortic augmentation index normalized to a heart rate of 75 bpm (AI(x) at 75 bpm), and central and peripheral pulse wave velocity (CPWV, PPWV). Resting and maximal calf vascular conductances were calculated from concurrent measures of blood pressure and calf blood flow using venous occlusion strain-gauge plethysmography. Time and frequency domain measures of heart rate variability were obtained from recording R-R intervals during supine and standing conditions. Both CPWV (5.9 +/- 0.8 vs. 5.4 +/- 0.8 m/s) and PPWV (9.7 +/- 0.8 vs. 8.9 +/- 1.3 m/s) were reduced following the training program. No significant changes were observed in AI(x) at 75 bpm, vascular conductance, heart rate variability or VO(2peak). These data indicate that changes in arterial stiffness independent of changes in heart rate variability or vascular conductance can be achieved in healthy young males following only 6 days of intense endurance exercise. [ABSTRACT FROM AUTHOR]

The objective of these studies was to assess the reproducibility of (i) short-term food intake (FI) and subjective appetite following a glucose preload, (ii) ventilation threshold (VT) and subjective appetite after short-duration exercise, and (iii) body composition assessed by bioelectrical impedance (BIA). On two separate weekend mornings, boys (n = 11; aged 9-14 years) received drinks containing 50 g glucose made up to 250 mL with water 2 h after a standardized breakfast. FI from a pizza meal was measured 30 min later. Subjective appetite was measured before and after the glucose loads and the VT measures. VTs were measured on 2 weekday evenings, 1 week apart. BIA was measured during the FI assessment sessions. Short-term FI after the glucose preload was highly reproducible. Mean energy intake was 925 ± 139 kcal on the first day and 988 ± 147 kcal on the second day (coefficient of repeatability (CR) = 259 kcal; intra-class correlation coefficient (ICC) = 0.96). Moderate reproducibility of the average appetite score was found at 30 min (CR = 24 mm; ICC = 0.82). Subjective appetite was increased similarly by short-duration exercise on both days (CR = 19 mm). Absolute VT was more highly reproducible (CR = 359 mL O2·min-1, ICC = 0.85) than VT expressed on the basis of body weight (CR = 8.0 mL O2·kg-1·min-1, ICC = 0.59). Fat mass (FM) estimated from BIA was highly reproducible (CR = 2.7 kg, ICC = 0.95), but underestimated FM compared with skinfolds. In conclusion, FI and subjective appetite scores in response to glucose preloads, VT, subjective appetite after short-duration exercise, and estimates of FM from BIA are reproducible in boys. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this investigation was twofold: (1) to examine the role of low- to moderate-intensity, short-duration physical activity on subjective appetite and (2) to identify the role of and associations between ventilation threshold (VeT) and energy intake at a pizza lunch 30min after glucose and whey protein drinks in normal weight boys. In 14 boys (age: 12.5±0.4 years) subjective appetite was measured before and after a 12min walking protocol designed to determine physical fitness based on the VeT. On a separate occasion food intake (FI) and subjective appetite were measured in response to sweetened preloads of either a SPLENDA® Sucralose control, glucose or whey protein made up to 250ml with water, given in random order to each boy, 2h after a standardized breakfast. Subjective average appetite and prospective food consumption scores increased after physical activity. VeT was positively associated with FI at a pizza lunch consumed 30min after glucose and whey protein drinks. Glucose and whey protein reduced FI similarly at lunch compared with control. In conclusion, appetite is increased by low- to moderate-intensity, short-duration physical activity and FI following glucose and protein preloads is positively associated with fitness levels in boys. [Copyright &y& Elsevier]

Background: The one leg hop for distance is one of the most commonly employed functional tests utilized in the evaluation of the ACL deficient and reconstructed patient. While the reliability of the hop test scores has been well established, validity studies have revealed low sensitivity rates in detecting functional limitations using the hop index (the ratio or percentage of limb performance). However, the impact of the inherent limitations associated with the hop index have not been investigated to date. One specific limitation relates to the impact of the differences in the underlying hop distance scores. Therefore, this pilot study set out to determine: 1) the impact that between limb differences in hop distance has on the sensitivity of the hop index in detecting functional limitations and; 2) whether a logarithmic transformation of the underlying hop distance scores improves the sensitivity of the hop index. Methods: A cross sectional design involving the evaluation of one leg hop for distance performance in a consecutive sample of 10 ACL deficient males with an isolated ACL tear awaiting reconstructive surgery and nine gender, age-matched controls. Results: In the ACL deficient, the hop index was associated with the distance hopped on the noninjured limb (r = -0.66, p = 0.04) but not on the injured limb. Transformation (logarithmic) of the hop distance scores and re-calculation of the hop index using the transformed scores increased the sensitivity of the hop index in the detection of functional limitations from 20 to 60% and 50 to 70% using the normal limb symmetry reference norms of ⩾ 85% and 90% respectively. Conclusion: The distance hopped on the non-injured limb is a critical factor in detecting functional limitations using the hop index in patients with an ACL deficient knee. Logarithmic transformation of the hop distance scores minimizes the effect of the arithmetic differences between limbs however; the sensitivity of the hop index in detecting abnormal limb symmetry remains low. [ABSTRACT FROM AUTHOR]

Growth hormone (GH) treatment reverses the muscle loss allegedly responsible for diminished aerobic capacity and increased fatigue in patients with HIV-associated wasting. This study examined whether submaximal measures of physical performance can be used as objective measures of the functional impact of GH treatment-induced anabolism. We randomized 27 HIV-positive men [mean (SD) age, 43.9 (7.2) yr; body mass, 71.9 (10.4) kg; BMI, 23.1 (2.8) kg/m²] with unintentional weight loss despite antiretroviral therapy to receive GH (6 mg) or placebo in a double-blinded, placebo-controlled, cross-over trial with a 3-mo washout. Lean body mass (LBM), maximum oxygen uptake (VO2 peak), ventilatory threshold (VeT), 6-min walk test (6MWT) distance and work, profile of mood states (POMS) fatigue and vigor scores, and Nottingham health profile (NHP) energy and physical mobility scores were measured. LBM significantly increased after 3 mo of GH treatment vs. placebo (means ± SE, 3.7 ± 0.6 vs. 0.3 ± 0.4 kg; P < 0.001). VeT significantly improved (17.6 ± 3.7 vs. -5.9 ± 2.5%; P < 0.001), but VO2 peak did not change significantly. 6MWT distance improved (24.9 ± 9.7 vs. 19.9 ± 11.6 m; P > 0.05) and 6MWT work increased significantly more after 3 mo of GH treatment (33.3 ± 8.8 vs. 16.5 ± 7.5 kJ; P < 0.05). POMS scores of fatigue and vigor and the NHP score of energy improved, yet the changes were not statistically significant. GH treatment improved VeT linearly to the increase in LBM (r =0.43, P = 0.037) and 6MWT work (r = 0.51, P = 0.008), and the increase in 6MWT work correlated with increase in LBM (r = 0.45, P = 0.024). Improvement in 6MWT work above the median (27.3 kJ) showed a decrease in fatigue (r = -0.62, P = 0.024). We concluded that GH treatment-induced LBM gains in HIV-associated wasting were functionally relevant, as determined by effort-independent submaximal measures of cardiopulmonary exercise testing. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Determine if gender differences in osteoarthritis relate to cytokine and growth factor levels. Methods: Cross-sectional comparison of serum and synovial concentrations of cytokines (IL-1αβ, TNF-α, IL-6), growth factors (IGF-I, TGF-β, IRAP), physical performance and perceived function in total knee arthroplasty candidates (TKAC) (n =17) and healthy controls (n =21) was done. Results: Serum IGF-I values were reduced in female (TKAC 137.6±7.2; Controls 160.2±26.2) but not male TKAC (TKAC 182.6±18.4; Controls 184.0±18.4) (p &#60;0.05).). Serum and synovial levels of cytokines and growth factors did not differ significantly by group or gender. Physical performance testing (SPW, TUG) revealed significant group and gender differences (p =0.001) with women demonstrating greater functional impairment. Discussion: A systemic, not local component to OA pathophysiology may exist for female TKAC. Male TKAC were less impaired, and their IGF-I levels differ little from Control values. [Copyright &y& Elsevier]

Background: The maximal rate of oxygen consumption (VO2max) is an important measure in exercise science as it is an indicator of cardiorespiratory fitness. Individual studies have identified central and peripheral adaptions to interval training that may underlie improvements in VO2max, but there is no compilation of results. Objective: We aimed to systematically review the adaptive responses to high-intensity interval training (HIIT) and sprint interval training (SIT) on the central and peripheral factors influencing VO2max in healthy individuals. Data Sources: SPORTDiscus and MEDLINE (up to and including 13 June, 2020) were explored to conduct the literature search. Study Selection: Reviewed studies met the following criteria: (1) were in the English language; (2) prospective in nature; (3) included at least three interval sessions or were at least 1 week in duration; (4) contained HIIT or SIT; (5) involved participants between the ages of 18 and 65 years; and (6) included at least one of the following central (blood volume, plasma volume, hemoglobin mass, left ventricular mass, maximal stroke volume, maximal cardiac output) or peripheral factors (capillary density, maximal citrate synthase activity, mitochondrial respiration associated with VO2max). Results: Thirty-two studies (369 participants, 49 were female) were included in the quantitative analyses, consisting of both HIIT (n = 18) and SIT (n = 17) interventions. There were only statistically significant changes in hematological measures (plasma volume) following HIIT. There was a significant increase in left ventricular mass following HIIT (7.4%, p < 0.001) and SIT (5.3%, p = 0.007) in inactive individuals, though the change following SIT may be misleading. There was only a significant increase in maximal stroke volume (14.1%, p = 0.015) and maximal cardiac output (12.6%, p = 0.002) following HIIT. In addition to central factors, there was a significant increase in capillary density (13.8%, p < 0.001) following SIT in active individuals. With respect to maximal citrate synthase activity, there were improvements following HIIT (20.8%, p < 0.001) and SIT (15.7%, p < 0.001, I2 = 97%) in active individuals. The results for mitochondrial respiration suggested that there was no statistically significant improvement following HIIT (5.0%, p = 0.585). Conclusions: Improvements in the central and peripheral factors influencing VO2max were dependent on the interval type. Only HIIT led to a statistically significant improvement in cardiac function. Both HIIT and SIT increased maximal citrate synthase activity, while changes in other peripheral measures (capillary density, mitochondrial respiration) only occurred with SIT. [ABSTRACT FROM AUTHOR]

Mathematical models may provide a method of describing and predicting the effect of training on performance. The current models attempt to describe the effects of single or multiple bouts of exercise on the performance of a specific task on a given day. These models suggest that any training session increases fitness and provokes a fatigue response. Various methods of quantifying the training stimulus (training impulse, absolute work, psychophysiological rating) and physical performance (criterion scale, arbitrary units) are employed in these models. The models are empirical descriptions and do not use current knowledge regarding the specificity of training adaptations. Tests of these models with published data indicate discrepancies between the predicted and measured time course of physiological adaptations, and between the predicted and measured performance responses to training. The relationship between these models and the underlying physiology requires clarification. New functional models that incorporate specificity of training and known physiology are required to enhance our ability to guide athletic training, rehabilitation and research. [ABSTRACT FROM AUTHOR]

Summary objective Fatigue is a prominent symptom among patients with GH excess and acromegaly. Identifying the physiological basis of such complaints and obtaining objective measures to quantify their severity remains an ongoing challenge. We investigated whether submaximal measures of aerobic performance can be used to assess GH excess-associated fatigue objectively. design and patients To investigate this possibility we examined the relation between physical function and physical capacity in 12 patients with active acromegaly and persistent fatigue before and after 3 and 6 months of treatment with the long-acting somatostatin analogue octreotide (LAR® ). measurements Heart rate (HR) and rating of perceived exertion (RPE using Borg’s 10-point scale) were measured during a 160-metre self-paced walk test (SPW). Maximum oxygen uptake (VO2max ) and ventilation threshold (VeT: a measure of work rate when breathlessness develops) were measured during a progressive treadmill test to fatigue or symptom-limited maximum. The Profile Of Mood States questionnaire (POMS) was used to quantify subjective feelings of fatigue and vigour. Morning fasting levels of GH and IGF-I were measured using immunoassay of serum samples. results SPW speed at a fast pace of 1·69 ± 0·18 m/s was achieved with higher than normal HR (112 ± 15/min; normal = 102) and RPE (2·4 ± 1·2). Similar to GH-deficient adults, VO2max (22·6 ± 6·4 ml.kg-1 .min-1 ; normal ~30 ml.kg-1 .min-1 ) and VeT (13·1 ± 2·9 ml.kg-1 .min-1 ; predicted normal ~16 ml.kg-1 (min-1 ) were low. However, VeT occurred at a normal fraction of VO2max (VeT/VO2max = 0·58). VeT was significantly increased and plasma IGF-I levels reduced following 3 and 6 months of octreotide LAR® treatment. Reduction... [ABSTRACT FROM AUTHOR]

Purpose and Methods: To compare the effects of a set of 12–30 min, maximal effort, constant load cycle bouts (HICT) to 12 short work: shorter rest (10 s: 5 s) interval sessions (INT) of similar duration and effort, performed on alternate days over 4 weeks, on performance and V̇O2 l.min−1. INT sessions consisted of repeated cycles of 10 s work followed by 5 s of recovery for 30 min. Fourteen male athletes (83 kg ± 6, 24year ± 2) were randomly assigned to HICT (n = 7) or INT (n = 7) training. Pre- and post-power output (PO), V̇O2 and V̇O2peak, during 60s, 3 min, and ramp (RAMP) tests were collected Results: Between group comparisons showed increased mean PO, pre- to post-INT training (p =.026) over the last min of the 3-min test whereas PO post-HICT training declined. INT showed greater training effects on the 60 s test than HCIT (INT 506 ± 45 to 535 ± 55 W; p =.002, Cd =.57; HCIT 513 ± 78 to 548 ± 83 W; p =.02, Cd = 27). RAMP peak PO and V̇O2peak increased within both groups (INT 341 ± 63 to 370 ± 48 W, p =.002, Cd = 0.52; HICT 332 ± 45 to 353 ± 44 W, p =.006, Cd =.53; 3.73 ± 0.68 to 4.06 ± 0.63 L·min−1, p =.001, Cd =.50; 3.75 ± 0.62 to 4.09 ± 0.52 L·min−1, p =.002, Cd =.59). Conclusion(s): These results show that utilizing this novel short work: shorter rest (10 s: 5 s) interval training paradigm will elicit better performances in moderate duration performances compared to continuous training of the same duration, effort, and frequency. [ABSTRACT FROM AUTHOR]

Background: Two forms of interval training commonly discussed in the literature are high-intensity interval training (HIIT) and sprint interval training (SIT). HIIT consists of repeated bouts of exercise that occur at a power output or velocity between the second ventilatory threshold and maximal oxygen consumption (VO2max). SIT is performed at a power output or velocity above those associated with VO2max. Objective: The primary objective of this study is to systematically review published randomized and pair-matched trials to determine which mode of interval training, HIIT versus SIT, leads to a greater improvement in TT performance in active and trained individuals. The second objective of this review is to perform a subgroup analysis to determine if there is a distinction between HIIT programs that differ in work-bout duration. Data Sources: SPORTDiscus (1800–present) and Medline with Full Text (1946–present) were used to conduct a systematic literature search. Study Selection: Studies were selected for the review if they met the following criteria: (1) individuals (males and females) who were considered at least moderately trained (~ 3-h per week of activity) as specified by the authors of the included studies; (2) between the ages of 18 and 45 years; (3) randomized or pair-matched trials that included a HIIT and a SIT group; (4) provided detailed information about the interval training program; (5) were at least 2 weeks in duration; (6) included a TT test that required participants to complete a set distance. Results: A total of 6 articles met the inclusion criteria for the subjective and objective analysis. The pooled analysis was based on a random-effects model. There was no difference in the change in TT performance when comparing all HIIT versus SIT (0.9%; 90% CI − 1.2–1.9%, p = 0.18). However, subgroup analysis based on duration of work interval indicated a 2% greater improvement in TT performance following long-HIIT (≥ 4 min) when compared to SIT. There was no difference in change in VO2max/peak oxygen consumption (VO2peak) between groups. There was a moderate effect (ES = 0.70) in favor of HIIT over SIT in maximal aerobic power (MAP) or maximal aerobic velocity (MAV). Conclusion: The results of the meta-analysis indicate that long-HIIT may be the optimal form of interval training to augment TT performance. Additional research that directly compares HIIT exercise differing in work-bout duration would strengthen these results and provide further insight into the mechanisms behind the observed benefits of long-HIIT. [ABSTRACT FROM AUTHOR]

This randomized controlled trial investigated the efficacy of short-term resistance training (RT) on cardiac autonomic modulation and peripheral hemodynamic parameters in hypertensive older women. Twenty-five hypertensive older women who were insufficiently active (64.7 ± 4.7 years) participated in this study. Subjects were randomly allocated to a 10-week RT program (2 d·wk in the first 5 weeks; 3 d·wk in the last 5 weeks) or a nonexercise control group. Linear reverse periodization was used for the RT program. Cardiac autonomic modulation, mean blood pressure (MBP), peripheral vascular resistance (PVR), and resting heart rate (RHR) were measured before and after 10 weeks. The RT group reduced cardiac sympathetic modulation (0V%; B = -6.6; 95% confidence interval [CI]: -12.9 to -0.2; p = 0.045; Cohen's d = 0.88) and showed a trend for increased parasympathetic modulation (2V%; B = 12.5; 95% CI: 0-25; p = 0.050; Cohen's d = 0.87) compared with the control group. The RT group reduced MBP (B = -8.5 mm Hg; 95% CI: -13.6 to -3.4; p = 0.001; Cohen's d = 1.27), PVR (B = -14.1 units; 95% CI: -19.9 to -8.4; p < 0.001; Cohen's d = 1.86), and RHR (B = -8.8 b·min; 95% CI: -14.3 to -3.3; p = 0.002; Cohen's d = 1.20) compared with the control group. In the RT group, the changes in 2V% patterns and low-frequency components showed a correlation with changes in MBP (r = -0.60; p = 0.032) and RHR (r = 0.75; p = 0.0003). In conclusion, 10 weeks of RT improved cardiac autonomic modulation and reduced MBP and PVR in hypertensive older women. These results reinforce the importance of RT for this population. [ABSTRACT FROM AUTHOR]

Introduction: The effectiveness of self-guided Internet-based lifestyle counseling (e-counseling) varies, depending on treatment protocol. Two dominant procedures in e-counseling are expert- and user-driven. The influence of these procedures on hypertension management remains unclear. The objective was to assess whether blood pressure improved with expert-driven or user-driven e-counseling over control intervention in patients with hypertension over a 4-month period.Study Design: This study used a three-parallel group, double-blind randomized controlled design.Setting/participants: In Toronto, Canada, 128 participants (aged 35-74 years) with hypertension were recruited. Participants were recruited using online and poster advertisements. Data collection took place between June 2012 and June 2014. Data were analyzed from October 2014 to December 2016.Intervention: Controls received a weekly e-mail newsletter regarding hypertension management. The expert-driven group was prescribed a weekly exercise and diet plan (e.g., increase 1,000 steps/day this week). The user-driven group received weekly e-mail, which allowed participants to choose their intervention goals (e.g., [1] feel more confident to change my lifestyle, or [2] self-help tips for exercise or a heart healthy diet).Main Outcome Measures: Primary outcome was systolic blood pressure measured at baseline and 4-month follow-up. Secondary outcomes included cholesterol, 10-year Framingham cardiovascular risk, daily steps, and dietary habits.Results: Expert-driven groups showed a greater systolic blood pressure decrease than controls at follow-up (expert-driven versus control: -7.5 mmHg, 95% CI= -12.5, -2.6, p=0.01). Systolic blood pressure reduction did not significantly differ between user- and expert-driven. Expert-driven compared with controls also showed a significant improvement in pulse pressure, cholesterol, and Framingham risk score. The expert-driven intervention was significantly more effective than both user-driven and control groups in increasing daily steps and fruit intake.Conclusions: It may be advisable to incorporate an expert-driven e-counseling protocol in order to accommodate participants with greater motivation to change their lifestyle behaviors, but more studies are needed.Trial Registration: This study is registered at www.clinicaltrials.gov NCT03111836. [ABSTRACT FROM AUTHOR]

Regarding the first point, the authors referred to our review of the use of VHAs in COVID-19 and our use of the term "coagulopathy" to define the universally observed proclivity of these patients to not only present with clotting anomalies but also to simultaneously hemorrhage. In our manuscript on page 13, we specifically state that these patients can "clot and bleed at the same time" thus agreeing with Bareille et al.'s characterization of the singular nature of the "disordered hemostasis" in COVID-19 patients. The "one size fits all" methodology of awaiting large RCTs to confirm the validity of VHAs would have deprived the medical community of the rapid advances that have occurred during the pandemic and that led to the early approval of VHAs by the FDA for use in guiding the anticoagulation of COVID-19 patients [[11], [38], [54], [56]]. During the peak two years of the COVID-19 pandemic, our group and others relied heavily on adjunctive VHAs to guide the anticoagulation of patients who had a COVID-associated coagulopathy or "disordered homeostasis", as Barielle et al. would prefer to call this unique hemostatic derangement. [Extracted from the article]

The purpose of this study was to clarify if Ratings of Perceived Exertion (RPE) and self-selected exercise intensity are sensitive not only to alterations in the absolute level of arterial saturation (SPO2) but also the rate of change in SPO2. Twelve healthy participants (31.6 ± 3.9 y, 175.5 ± 7.7 cm, 73.3 ± 10.3 kg, 51 ± 7 mL·kg-1·min-1 ) exercised four times on a cycle ergometer, freely adjusting power output (PO) to maintain RPE at 5 on Borg’s 10-point scale with no external feedback to indicate their exercise intensity. The fraction of inspired oxygen (FIO2) was reduced during three of those trials such that SPO2 decreased during exercise from starting values (>98%) to 70%. These trials were differentiated by the time over which the desaturation occurred: 3.9 ± 1.4 min, -8.7 ± 4.2%•min-1 (FAST), 11.0 ± 3.7 min, -2.8 ± 1.3%•min-1 (MED), and 19.5 ± 5.8 min, -1.5 ± 0.8%•min-1 (SLOW) (P < 0.001). Compared to stable PO throughout the control condition (no SPO2 manipulation), PO significantly decreased across the experimental conditions (FAST = 2.8 ± 2.1 W•% SPO2-1; MED = 2.5 ± 1.8 W•% SPO2-1; SLOW = 1.8 ± 1.6 W•% SPO2-1; P < 0.001). The rates of decline in PO during FAST and MED were similar, with both greater than SLOW. Our results confirm that decreases in absolute SPO2 impair exercise performance and that a faster rate of oxygen desaturation magnifies that impairment. [ABSTRACT FROM AUTHOR]

Most working-dog breeding programs have a substantial interest in using behavioral assessments of their young dogs to predict their subsequent success. Different methods of measuring behavior may capture different aspects of behavior yet working-dog programs typically use only a single measurement method. Thus, the primary aim of this study was to test whether two different measurement methods (ratings or codings) would differ in their predictive validity with respect to working-dog selection outcomes. Rating methods require observers to intuitively aggregate their observations into a single rating and in doing so may reduce error variance in measurement, resulting in improved validity. Coding methods on the other hand do not demand so much judgment on the part of the observer so may be less influenced by observer biases. Here we analyzed the two methods with respect to their ability to predict selection for training in a sample of odor-detection dogs bred at the U.S. Transportation Security Administration Canine Breeding and Development Center. Behaviors observed in two standardized tests ( search & retrieve and environment ) at four different time points across the first year of life were measured using nine ratings and 23 codings. Data reduction techniques identified two underlying dimensions in ratings (environmental stability and hunt drive) and nine in codings (confidence, anxiety, exploration, excitability, search performance, dominant possession, independent possession, energy management, and search aptitude). There were no differences in predictive validity between the two methods; both ratings and codings correctly classified a high percentage of dogs that were/were not selected for training at 12 months of age (84.6–88.5%). In the search & retrieve test, codings and ratings appeared to be measuring the same construct. In the environment test the only significant coding predictor of training selection (confidence) was strongly related to the single rating predictor (environmental stability). Rating methods tended to capture behavior that was more consistent, while coding methods tended to capture behavior that was more situation-specific. Our mixed-models approach also allowed us to discriminate between average behavior (between-individual variation) and behavioral change through time (within-individual variation); such findings emphasize different aspects of development that may need to be monitored during rearing. Our results suggest that, in some cases, the use of ratings versus codings may be inconsequential from the standpoint of predicting which dogs get selected for training. Virtually all research on animal behavior assesses behavior via coding or rating methods; further work is needed to verify these results. [ABSTRACT FROM AUTHOR]

Background: The risk of developing cardiovascular disease is directly correlated to one's resting blood pressure (BP), age, and biological sex. Resting BP can be reduced using handgrip exercise training, but the impact of age and sex on the effectiveness of training is not well documented. Methods/design: A systematic search of the literature will be conducted for all experimental studies (including randomized controlled trials and prospective experiments) that report the influence of isometric handgrip exercise training on resting systolic blood pressure. The databases Medline, Embase, Cochrane Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTDiscus, Web of Science, Allied and Complementary Medicine (AMED), PubMed, and Scopus will be searched until 1 December 2015. Screening of potential articles, data abstraction, and quality appraisal will be completed in duplicate independently. When necessary, corresponding authors will be contacted in order to facilitate the separation of pooled data into age and sex categories. Methodological quality will be determined using the Quality Assessment Framework developed by the Cochrane Collaboration and the Newcastle-Ottawa Quality Assessment Scale as appropriate. Any discrepancies will be resolved by a third author. Findings will be presented in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Discussion: This systematic review will determine the overall effectiveness of handgrip exercise training in improving resting blood pressure. A novel, focused assessment will contrast effectiveness of handgrip training based on the age (younger 18-54 years, older >55 years) and the sex (men, women) of study participants. This information is essential to consolidate before moving forward with the development and implementation of handgrip exercise training programmes which are designed to best meet the needs of particular cohorts. [ABSTRACT FROM AUTHOR]

Background: Interval training has become an essential component of endurance training programs because it can facilitate a substantial improvement in endurance sport performance. Two forms of interval training that are commonly used to improve endurance sport performance are high-intensity interval training (HIIT) and sprint interval training (SIT). Despite extensive research, there is no consensus concerning the optimal method to manipulate the interval training programming variables to maximize endurance performance for differing individuals. Objective: The objective of this manuscript was to perform a systematic review and meta-analysis of interval training studies to determine the influence that individual characteristics and training variables have on time-trial (TT) performance. Data Sources: SPORTDiscus and Medline with Full Text were explored to conduct a systematic literature search. Study Selection: The following criteria were used to select studies appropriate for the review: 1. the studies were prospective in nature; 2. included individuals between the ages of 18 and 65 years; 3. included an interval training (HIIT or SIT) program at least 2 weeks in duration; 4. included a TT test that required participants to complete a set distance; 5. and programmed HIIT by power or velocity. Results: Twenty-nine studies met the inclusion criteria for the quantitative analysis with a total of 67 separate groups. The participants included males (n = 400) and females (n = 91) with a mean group age of 25 (range 19–45) years and mean V O 2 max of 52 (range 32–70) mL·kg−1·min−1. The training status of the participants comprised of inactive (n = 75), active (n = 146) and trained (n = 258) individuals. Training status played a significant role in improvements in TT performance with trained individuals only seeing improvements of approximately 2% whereas individuals of lower training status demonstrated improvements as high as 6%. The change in TT performance with HIIT depended on the duration but not the intensity of the interval work-bout. There was a dose–response relationship with the number of HIIT sessions, training weeks and total work with changes in TT performance. However, the dose–response was not present with SIT. Conclusion: Optimization of interval training programs to produce TT performance improvements should be done according to training status. Our analysis suggests that increasing interval training dose beyond minimal requirements may not augment the training response. In addition, optimal dosing differs between high intensity and sprint interval programs. [ABSTRACT FROM AUTHOR]

The article examines the difference between the single and multiple sets aerobic training (AT) and resistance training (RT) in coronary disease. A total of 72 subjects were randomized to AT for five days a week or combined AT for three days a week with either one set or three sets of RT performed twice a week. Before and after 29 weeks of training, the researchers measured the subjects' VO2peak ventilatory anaerobic threshold (VAT), strength and endurance, body composition, and adherence. The results of the study suggest that RT and AT combination gives greater improvements in cardiovascular endpoints of exercise performance, skeletal muscle function, and body composition.

The purpose of this study was to determine potential adverse cardiac effects of chronic endurance training by comparing sympathovagal modulation via heart rate variability (HRV) and heart rate recovery (HRR) in middle-aged endurance athletes (EA) and physically active individuals (PA) following maximal exercise. Thirty-six (age, 53 ± 5 years) EA and 19 (age, 56 ± 5 years) PA were recruited to complete a 2-week exercise diary and graded exercise to exhaustion. Time domain and power spectral HRV analyses were completed on recorded R-R intervals. EA had a greater HRR slope following exercise (95% confidence interval, 0.0134–0.0138 vs. 0.0101–0.0104 beats/s; p < 0.001). While EA had greater HRR at 1–5 min after exercise (all p < 0.01), PA and EA did not differ when expressed as a percentage of baseline heart rate (130 ± 19 vs. 139 ± 19; p = 0.2). Root mean square of successive differences in R-R intervals (rest and immediately after exercise) were elevated in EA (p < 0.05). Low-frequency (LF) and high-frequency (HF) spectral components were nonsignificantly elevated after exercise (p = 0.045–0.147) in EA while LF/HF was not different (p = 0.529–0.986). This data suggests greater HRR in EA may arise in part due to a lower resting HR. While nonsignificant elevations in HF and LF in EA produces a LF/HF similar to PA, absolute spectral component modulation differed. These observations require further exploration. Novelty Acute effects of exercise on HRV in EA compared with a relevant control group, PA, are unknown. EA had greater HRR and nonsignificant elevations in LF and HF compared with PA, yet LF/HF was not different. Future work should explore the implications of this observation. [ABSTRACT FROM AUTHOR]

Compares individuals with total knee arthroplasty (TKA) to those with no diagnosed knee disease, examining the physical impairment and functional limitations. Information on the candidates used in the investigation; Evaluation of the surgical success of TKA; Methodology and findings of the study.

Our previous study showed that interleukin-6 (IL-6) is associated with suppression of appetite after high-intensity exercise (HIEX), but an independent role in food intake (FI) was not defined. We hypothesized that IL-6 suppresses appetite and FI, independently of appetite hormones, after HIEX in normal-weight (NW) boys. We investigated the effect of HIEX, with and without the inflammation inhibitor ibuprofen (IBU), on IL-6, other biomarkers of inflammation and appetite, FI, and ratings of appetite in NW boys. Fifteen NW boys (aged 13–18 years) were randomly assigned in a crossover design to 4 sessions: (i) water and rest, (ii) IBU and rest, (iii) water and HIEX, and (iv) IBU and HIEX. HIEX consisted of three 10-min bouts of exercise at 75% of maximal oxygen uptake with 90 s of active rest between bouts. IBU (300 mg) was given as a liquid suspension. FI, ratings of appetite, and plasma biomarkers of appetite, inflammation, stress, and glucose control were measured. FI was not affected by HIEX or IBU. Appetite increased over time (p = 0.002) but was lower after HIEX (p < 0.001) and not affected by IBU. HIEX, but not IBU, resulted in higher levels of IL-6 (p < 0.001) and cortisol (p < 0.001) and lower active ghrelin (p < 0.001). IL-6 correlated with active ghrelin (r = 0.37; p = 0.036) and cortisol (r = 0.26; p = 0.049). An independent role for IL-6 in appetite suppression was not supported. However, IL-6 was correlated with active ghrelin and cortisol, thus potentially mediating appetite via these interactions. [ABSTRACT FROM AUTHOR]

Background: The risk of developing cardiovascular disease can be directly correlated to one's resting blood pressure (BP), age, and biological sex. Resting BP may be successfully reduced using handgrip exercise training, although the impact of age and sex on training effectiveness has yet to be systematically evaluated. The objective of this systematic review is to determine this impact of age and sex on handgrip-induced changes to resting BP. Methods: Data sources included MEDLINE, Embase, Cochrane Reviews, CINAHL, SPORTDiscus, Web of Science, AMED, PubMed, and Scopus through May 2018. Eligibility criteria were those with prospective handgrip exercise training of ≥ 4 weeks with reported impact on resting systolic BP (SBP). Screening of articles, data extraction, and quality appraisal were completed in duplicate. When necessary, the corresponding authors were contacted to provide segregated data based on age (younger, 18–54 years; aged, > 55 years) and sex (men, women) categories. SBP was primarily explored with numerous secondary outcomes of interest summarized as a narrative synthesis. Results: After screening 1789 articles, 26 full texts were reviewed. Eight studies reported data in a way that facilitated age and sex comparisons of primary outcomes, while 7 of 18 studies reporting pooled data (men and women) provided segregated results. Research spans 1992–2018 and represents 466 participants; at least 43.1% of whom are women. Although weighted mean differences reveal that handgrip training-induced SBP reductions are similar when merely comparing sexes (women; − 5.6 mmHg, men; − 4.4 mmHg) or ages (younger; − 5.7 mmHg, aged; − 4.4 mmHg), when the impact of sex and age is simultaneously evaluated, aged women experience the largest reduction in SBP (− 6.5 mmHg). Many factors were explored for their impact on resting BP reductions and have been summarized in the corresponding narrative synthesis. Conclusions: Handgrip exercise is an effective modality for resting BP reduction resulting in clinically significant reductions for men and women of all ages. Systematic review registration: PROSPERO CRD42015019792 [ABSTRACT FROM AUTHOR]

Puberty is a period of development that alters energy intake patterns. However, few studies have examined appetite and food intake (FI) regulation during development of puberty in children and adolescents. Therefore, the objective was to measure the effect of pubertal status on FI and subjective appetite after pre-meal glucose and whey protein drinks in 9- to 14-year-old boys and girls. In a within-subject, randomized, repeated-measures design, children (21 pre-early pubertal, 15 mid-late pubertal) received equally sweetened drinks containing Sucralose (control), glucose, or whey protein (0.75 g/kg body weight) in 250 mL of water 2 h after a standardized breakfast on 6 separate mornings. Ad libitum FI was measured either 30 or 60 min later and appetite was measured over time. In pre-early and mid-late pubertal boys and girls there was no effect of sex on total FI (kcal). Glucose and whey protein drinks reduced calorie intake similarly at 30 min. But at 60 min, whey protein reduced FI ( p < 0.001) compared with control and glucose in pre-early pubertal children, but not in mid-late pubertal children. However, sex was a factor ( p = 0.041) when FI was expressed per kilogram body weight. Pubertal status did not affect FI/kilogram body weight in boys, but it was 32% lower in mid-late pubertal girls than at pre-early puberty ( p = 0.010). Appetite was associated with FI in mid-late pubertal children only. In conclusion, pubertal development affects appetite and FI regulation in children. [ABSTRACT FROM AUTHOR]

Coagulopathy after severe traumatic brain injury (TBI) has been extensively reported. Clinical studies have identified a strong relationship between diminished platelet-rich thrombus formation, responsiveness to adenosine diphosphate agonism, and severity of TBI. The mechanisms that lead to platelet dysfunction in the acute response to TBI are poorly understood. The development of a rodent model of TBI that mimics the coagulopathy observed clinically has recently been reported. Using immunohistochemical techniques and thromboelastography platelet mapping, the current study demonstrated that the expression of coagulation (tissue factor and fibrin) and platelet activation (P-selectin) markers in the injured brain paralleled the alteration in systemic platelet responsiveness to the agonists, adenosine diphosphate and arachodonic acid. Results of this study demonstrate that local procoagulant changes in the injured brain have profound effects on systemic platelet function. [ABSTRACT FROM AUTHOR]

Viscoelastic hemostatic assay (VHAs) are whole blood point-of-care tests that have become an essential method for assaying hemostatic competence in liver transplantation, cardiac surgery, and most recently, trauma surgery involving hemorrhagic shock. It has taken more than three-quarters of a century of research and clinical application for this technology to become mainstream in these three clinical areas. Within the last decade, the cup and pin legacy devices, such as thromboelastography (TEG® 5000) and rotational thromboelastometry (ROTEM® delta), have been supplanted not only by cartridge systems (TEG® 6S and ROTEM® sigma), but also by more portable point-of-care bedside testing iterations of these legacy devices (e.g., Sonoclot®, Quantra®, and ClotPro®). Here, the legacy and new generation VHAs are compared on the basis of their unique hemostatic parameters that define contributions of coagulation factors, fibrinogen/fibrin, platelets, and clot lysis as related to the lifespan of a clot. In conclusion, we offer a brief discussion on the meteoric adoption of VHAs across the medical and surgical specialties to address COVID-19-associated coagulopathy. [ABSTRACT FROM AUTHOR]

Gunshot-related trauma varies in frequency around the world; however, every trauma center should be prepared for and capable of dealing with patients who have sustained gunshot injuries. While the appropriate medical and surgical treatment of gunshot injuries is the goal of the trauma center, many gunshot cases involve situations that have various criminal and/or other forensic concerns. As such, healthcare providers in trauma centers need to be aware of important evidence issues related to gunshot injuries. This paper provides basic information and guidelines for healthcare providers regarding the appropriate identification, documentation, collection, and preservation of forensic evidence in gunshot injury cases. [ABSTRACT FROM AUTHOR]

Acute coagulopathy is a serious complication of traumatic brain injury (TBI) and is of uncertain etiology because of the complex nature of TBI. However, recent work has shown a correlation between mortality and abnormal hemostasis resulting from early platelet dysfunction. The aim of the current study was to develop and characterize a rodent model of TBI that mimics the human coagulopathic condition so that mechanisms of the early acute coagulopathy in TBI can be more readily assessed. Studies utilizing a highly reproducible constrained blunt-force brain injury in rats demonstrate a strong correlation with important postinjury pathological changes that are observed in human TBI patients, namely, diminished platelet responses to agonists, especially adenosine diphosphate (ADP), and subarachnoid bleeding. Additionally, administration of a direct thrombin inhibitor, preinjury, recovers platelet functionality to ADP stimulation, indicating a direct role for excess thrombin production in TBI-induced early platelet dysfunction. [ABSTRACT FROM AUTHOR]

Modern approaches to resuscitation seek to bring patient interventions as close as possible to the initial trauma. In recent decades, fresh or cold-stored whole blood has gained widespread support in multiple settings as the best first agent in resuscitation after massive blood loss. However, whole blood is not a panacea, and while current guidelines promote continued resuscitation with fixed ratios of blood products, the debate about the optimal resuscitation strategy—especially in austere or challenging environments—is by no means settled. In this narrative review, we give a brief history of military resuscitation and how whole blood became the mainstay of initial resuscitation. We then outline the principles of viscoelastic hemostatic assays as well as their adoption for providing goal-directed blood-component therapy in trauma centers. After summarizing the nascent research on the strengths and limitations of viscoelastic platforms in challenging environmental conditions, we conclude with our vision of how these platforms can be deployed in far-forward combat and austere civilian environments to maximize survival. [ABSTRACT FROM AUTHOR]

The article discusses research which was conducted to correlate the magnitude of blood pressure (BP) decrease after acute exercise to the magnitude of BP reduction after chronic exercise and to examine the correlates of BP reduction after acute and chronic exercise in prehypertensive subjects. Researchers evaluated 17 prehypertensive males and females between the ages of 45 and 60. They found that BP was significantly reduced after acute and chronic exercise and that the magnitude of the acute BP lowering with exercise may predict the extent of BP lowering after chronic training interventions in prehypertensive individuals.

The effect of short duration exercise (EXR) on food intake (FI) and energy balance (EB) is not well understood in either normal weight (NW) or overweight (OW) and obese (OB) 9-14 years old children. Our purpose was to describe the effects of activity and a glucose drink on short term FI, appetite, and EB in NW, OW, and OB boys. Each boy received in random order either a noncaloric Sucralose sweetened control or glucose (1.0 g·kg-1 body weight) drink 5 min after either exercise (EXR) or sedentary (SED) activity. Boys exercised for 15 min at their ventilation threshold ( VT) in experiment 1 or at 25% above their VT in experiment 2. FI was measured at an ad libitum pizza meal 30 min after drink consumption. FI was lower after the glucose drink ( p < 0.001) but not affected by activity, even though EXR increased appetite ( p < 0.001). OW/OB boys ate more total food than NW boys ( p = 0.020). EB over the duration of the experiments was reduced by EXR in OW/OB boys ( p = 0.013) but not in NW boys in either experiment ( p > 0.05). We conclude that intake regulation in OW/OB boys in response to a glucose drink is similar to NW boys, but it may be less responsive to activity. [ABSTRACT FROM AUTHOR]

This study compared the oxygen uptake (VO(2)) and muscle deoxygenation (∆HHb) of two intermittent protocols to responses during continuous constant load cycle exercise in males (24 year ± 2, n = 7). Subjects performed three protocols: (1) 10 s work/5 s active recovery (R), R at 20 W (INT1): (2) 10 s work/5 s R, R at moderate intensity (INT2); and (3) continuous exercise (CONT), all for 10 min, on separate days. The work rate of CONT and the 10 s work of INT1 and INT2 were set within the heavy intensity domain. VO(2) and ∆HHb data were filtered and averaged to 5 s bins. Average VO(2) (80-420 s) was highest during CONT (3.77 L/min), lower in INT2 (3.04 L/min), and lowest during INT1 (2.81 L/min), all (p < 0.05). Average ∆HHb (80-420 s) was higher during CONT (p < 0.05) than both INT exercise protocols (CONT; 25.7 ± 0.9 a.u. INT1; 16.4 ± 0.8 a.u., and INT2; 15.8 ± 0.8 a.u.). The repeated changes in metabolic rate elicited oscillations in ΔHHb in both intermittent protocols, whereas oscillations in VO(2) were only observed during INT1. The greater ΔHHb during CONT suggests a reduction in oxygen delivery compared to oxygen consumption relative to INT. The higher VO(2) for INT 2 versus INT 1 and similar ΔHHb during INT suggests an increase in oxygen delivery during INT 2. Thus the different demands of INT1, INT2, and CONT protocols elicited differing physiological responses to a similar heavy intensity power output. These intermittent exercise models seem to elicit an elevated O(2) delivery condition compared to CONT. [ABSTRACT FROM AUTHOR]

Equicaloric bouts of interval (IE: 5 × 2:2 min at 85% and 40% maximal oxygen uptake) and steady state (SS: 21 min at 60% maximal oxygen uptake) exercise were performed by 13 older prehypertensive males on separate days, at equivalent times of day, to assess the influence of exercise mode on postexercise hypotension (PEH). Exercise conditions were compared with a control session. Cardiovascular measures were collected for 30 min prior to, and 60 min following exercise. PEH, as measured by mean postexercise systolic blood pressure (SBP) decrease (IE: -4 ± 6 mm Hg; SS: -3 ± 4 mm Hg; control: 4 ± 4 mm Hg), area under the SBP curve (IE: -240 ± 353 mm Hg·min; SS: -192 ± 244 mm Hg·min), and minimum SBP achieved (IE: -15 ± 7 mm Hg; SS: -13 ± 7 mm Hg), was equivalent after both conditions. Stroke volume was significantly reduced (IE: -14.6 ± 16.0 mL; SS: -10.1 ± 14.2 mL, control -1.7 ± 2.2 mL) and heart rate was significantly elevated (IE: 13 ± 8 beats·min-1; SS: 7.9 ± 8 beats·min-1; control: -2 ± 3 beats·min-1) postexercise after both conditions. Cardiac output and total peripheral resistance were nonsignificantly decreased and increased postexercise, respectively. Baroreflex sensitivity (BRS) was reduced following IE (p < 0.05) and heart rate variability (HRV) parameters were reduced after both conditions, with IE eliciting larger and longer reductions in some indices. The results from the current study indicate that older prehypertensive adults experience similar PEH following equicaloric bouts of IE and SS exercise despite larger alterations in HRV and BRS elicited by IE. [ABSTRACT FROM AUTHOR]