Muscle atrophy exacerbates disease outcomes and increases mortality, whereas the preservation of skeletal muscle mass and function play pivotal roles in ensuring long-term health and overall quality-of-life. Muscle atrophy represents a significant clinical challenge, involving the continued loss of muscle mass and strength, which frequently accompany the development of numerous types of cancer. Cancer cachexia is a highly prevalent multifactorial syndrome, and although cachexia is one of the main causes of cancer-related deaths, there are still no approved management strategies for the disease. The etiology of this condition is based on the upregulation of systemic inflammation factors and catabolic stimuli, resulting in the inhibition of protein synthesis and enhancement of protein degradation. Numerous necessary cellular processes are disrupted by cachectic pathology, which mediate intracellular signaling pathways resulting in the net loss of muscle and organelles. However, the exact underpinning molecular mechanisms of how these changes are orchestrated are incompletely understood. Much work is still required, but structured exercise has the capacity to counteract numerous detrimental effects linked to cancer cachexia. Primarily through the stimulation of muscle protein synthesis, enhancement of mitochondrial function, and the release of myokines. As a result, muscle mass and strength increase, leading to improved mobility, and quality-of-life. This review summarises existing knowledge of the complex molecular networks that regulate cancer cachexia and exercise, highlighting the molecular interplay between the two for potential therapeutic intervention. Finally, the utility of mass spectrometry-based proteomics is considered as a way of establishing early diagnostic biomarkers of cachectic patients.
Decreased mechanical loading after orthopaedic surgery predisposes patients to develop muscle atrophy. The purpose of this review was to assess whether the evidence supports oral protein supplementation can help decrease postoperative muscle atrophy and/or improve patient outcomes following orthopaedic surgery. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). PubMed (MEDLINE), Embase, Scopus, and Web of Science were searched for randomized controlled trials that assessed protein or amino acid supplementation in patients undergoing orthopaedic surgery. Two investigators independently conducted the search using relevant Boolean operations. Primary outcomes included functional or physiologic measures of muscle atrophy or strength. Fourteen studies including 611 patients (224 males, 387 females) were analyzed. Three studies evaluated protein supplementation after ACL reconstruction (ACLR), 3 after total hip arthroplasty (THA), 5 after total knee arthroplasty (TKA), and 3 after surgical treatment of hip fracture. Protein supplementation showed beneficial effects across all types of surgery. The primary benefit was a decrease in muscle atrophy compared to placebo as measured by muscle cross sectional area. Multiple authors also demonstrated improved functional measures and quicker achievement of rehabilitation benchmarks. Protein supplementation has beneficial effects on mitigating muscle atrophy in the postoperative period following ACLR, THA, TKA, and surgical treatment of hip fracture. These effects often correlate with improved functional measures and quicker achievement of rehabilitation benchmarks. Further research is needed to evaluate long-term effects of protein supplementation and to establish standardized population-specific regimens that maximize treatment efficacy in the postoperative period.
To explore the reasons for low levels of physical activity in obese/overweight children and adolescents and to propose appropriate strategies to promote their physical activity (PA). This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by searching and analyzing the literature of studies related to physical activity in obese/overweight children and adolescents published between January 2003 and January 2023 in Web of Science, Scopus, and PubMed databases. A total of 31 relevant studies were included for analysis, of which 16 were quantitative and 15 qualitative. According to these studies, the PA of obese/overweight children and adolescents is mainly constrained by negative factors: Individual, interpersonal, and environmental. Among these factors, low levels of individual motivation and psychological sensitivity and vulnerability, lack of family support, negative social feedback, insufficient protection from government policies, and inadequate support from the built environment are the main reasons that constrain their PA. The promotion of PA in obese/overweight children and adolescents, who are subject to more constraints at all levels, requires a system of security that involves the government, the community, the school, and the family to address the problems they encounter and enhance the sustainability of engagement in PA
Chronic neck pain (CNP) is a worldwide health problem with several risk factors. One of the most widely used treatments for managing this condition is therapeutic exercise, which could generate a response called exercise-induced hypoalgesia (EIH). There is no consensus on the best exercise modality to induce hypoalgesia. Therefore, this review aims to analyze and synthesize the state-of-the-art about the hypoalgesic effect of exercise in subjects with CNP. We included articles on EIH and CNP in patients older than 18 years, with pain for more than three months, where the EIH response was measured. Articles that studied CNP associated with comorbidities or measured the response to treatments other than exercise were excluded. The studies reviewed reported variable results. Exercise in healthy subjects has been shown to reduce indicators of pain sensitivity; however, in people with chronic pain, the response is variable. Some investigations reported adverse effects with increased pain intensity and decreased pain sensitivity, others found no clinical response, and some even reported EIH with decreased pain and increased sensitivity. EIH is an identifiable, stimulable, and helpful therapeutic response in people with pain. More research is still needed on subjects with CNP to clarify the protocols and therapeutic variables that facilitate the EIH phenomenon. In addition, it is necessary to deepen the knowledge of the intrinsic and extrinsic factors that influence EIH in people with CNP
This study aimed to identify the reasons for transferring athletes to local medical facilities during the Olympic and Paralympic Games. Data on 567 injuries and other illnesses of athletes treated at the on-site clinics were collected from the Tokyo 2020 Organizing Committee. Of these, 84 athletes who required outpatient care during the Games were registered for this survey. During the Olympic and Paralympic Games, 66 (8.3/1 000) and 18 (7.2/1 000) athletes, respectively, consulted external medical facilities. In the Olympic Games, the reasons for these visits included 48 cases (72.7%) of injuries, 13 (19.7%) cases of illnesses, and 5 (7.6%) cases of heat stroke illness (HSI). Of these patients, 56 (84.9%) were treated as outpatients and 10 (15.1%) were hospitalized, while three of these patients required hospitalization for > 7 days. On the other hand, in the Paralympics Games, there were 7 (38.8%) cases of injuries, 9 (50.0%) other illnesses, 1 (5.6%) case of HSI, and 1 (5.6%) other cases, of which 11 (61.1%) were treated as outpatients and 7 (38.9%) were hospitalized, but none was hospitalized for > 7 days. Injuries accounted for 70% of the total cases at the 2021 Olympic Games, but only three (0.05%) were severe cases that required hospitalization for more than 1 week. In contrast, in the Paralympic Games, other illnesses accounted for approximately half of the total cases. This study provides details on the extent of injuries and other illnesses that were transferred to outside facilities, which has not been documented in previous games
Poor cardiorespiratory fitness may mediate vascular impairments at rest and following an acute bout of exercise in young healthy individuals. This study aimed to compare flow mediated dilation (FMD) and vascular augmentation index (AIx75) between young adults with low, moderate, and high levels of cardiorespiratory fitness before and after an acute bout of aerobic exercise. Forty-three participants (22 men; 21 women) between 18 and 29 years of age completed the study. Participants were classified into low, moderate, and high health-related cardiorespiratory fitness groups according to age- and sex-based relative maximal oxygen consumption (˙VV˙O2 max) percentile rankings. FMD was performed using Doppler ultrasound and AIx75 was performed using pulse wave analysis at baseline and 60-min after a 30-min bout of treadmill running at 70% ˙VV˙O2 max. A significant interaction (p = 0.047; ηp2 = 0.142) was observed, with the moderate fitness group exhibiting a higher FMD post-exercise compared with baseline ([6.7% ± 3.1%] vs. [8.5% ± 2.8%], p = 0.028; d = 0.598). We found a significant main effect of group for AIx75 (p = 0.023; ηp2 = 0.168), with the high fitness group exhibiting lower AIx75 compared to low fitness group ([-10% ± 10%] vs. [2% ± 10%], respectively, p = 0.019; g = 1.07). This was eliminated after covarying for body fat percentage (p = 0.489). Our findings suggest that resting FMD and AIx75 responses are not significantly influenced by cardiorespiratory fitness, but FMD recovery responses to exercise may be enhanced in individuals with moderate cardiorespiratory fitness levels
Oxygen uptake (˙V𝑉˙ O2) was measured during a non-exhaustive high-intensity intermittent cross-exercise (HIICE) protocol consisting of four alternating bouts of 20 s running (R) and three bouts of bicycle exercise (BE) at ∼160% and ∼170% maximal oxygen uptake (˙V𝑉˙ O2max), respectively, with 10 s between-bout rests (sequence R-BE-R-BE-R-BE-R). The ˙V𝑉˙ O2 during the last BE ([52.2 ± 5.0] mL·kg-1·min-1) was significantly higher than the ˙V𝑉˙ O2max of the BE ([48.0 ± 5.4] mL·kg-1·min-1, n = 30) and similar to that of running. For clarifying the underlying mechanisms, a corresponding HIICE-protocol with BE and arm cranking ergometer exercise (AC) was used (sequence AC-AC-BE-AC-BE-AC-AC-BE). In some experiments, thigh blood flow was occluded by a cuff around the upper thigh. Without occlusion, the ˙V𝑉˙ O2 during the AC ([39.2 ± 7.1] mL·kg-1·min-1 [6th bout]) was significantly higher than the ˙V𝑉˙ O2max of AC ([30.2 ± 4.4] mL·kg-1·min-1, n = 7). With occlusion, the corresponding ˙V𝑉˙ O2 ([29.8 ± 3.9] mL·kg-1·min-1) was reduced to that of the ˙V𝑉˙ O2max of AC and significantly less than the ˙V𝑉˙ O2 without occlusion. These findings suggest that during the last bouts of HIICE may exceed the of the specific exercise, probably because it is a summation of the ˙V𝑉˙ O2 for the ongoing exercise plus excess post-oxygen consumption (EPOC) produced by the previous exercise with a higher ˙V𝑉˙ O2max
Little is known about the prevalent nationalities among the best-placed athletes participating in “Ironman Hawaii.” Moreover, the age at which athletes achieve their best performances remains unclear. The present study aimed to compare the prevalent nationalities among the athletes, their respective placement among the top five, and the performance difference between the different age groups in ‘Ironman Hawaii’ from 2003 to 2019. A total of 30 354 amateur triathletes were selected from the Obsessed Triathlete (OBSTRI) website. A “TOP 5” division filter was applied for further analysis, resulting in 1 851 athletes being included in this study. Among the male runners, Americans participated the most in Ironman events (39%), followed by Germans (10%). Among female runners, Americans participated the most (54%), followed by Australian runners (8%). Male Americans also featured most among the top five (30%), followed by Germans (16%). Female Americans were the most prevalent among the top five (47%), followed by Australian Americans (10%). There were no significant performance differences (p > 0.05) between the 25-29 and 40-44 age groups for either sex. The 45-49 age group presented significantly worse performance than the 35-39 age group for both sexes (p < 0.001). North Americans were the most performant and frequent participants in “Ironman Hawaii.” The expected performance decline due to aging was observed after 45 years in both sexes
Healthy movement behaviours are associated with various physical and mental wellbeing; however, little is known about such associations in low- and middle-income countries. The aim of this study was to examine adherence to 24-hour (h) movement guidelines and their relationship with depressive symptoms in adolescents. Data were from 312 Bangladeshi adolescents aged 13-17 years (42% female). Meeting the guidelines was defined as: energy expenditure for physical activity (PA) ≥ 1 680 Metabolic Equivalent of Task (MET)-min/week, ≤ 2 h/day of recreational screen time (ST), and 8-10 h/night of sleep. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) with a score of 10 or more indicating high depressive symptoms. Percentage of adolescents meeting the three recommendations was 2.2%, with 17.6% meeting two, and 31.2% meeting one recommendation. Generalized estimating equations showed that odds of having high depressive symptoms was a third (odds ratio [OR] = 0.35, 95% confidence interval [CI], 0.19-0.57) for meeting the PA guidelines, and about a half (OR = 0.47, 95%CI, 0.18-0.87) for meeting the sleep guidelines. Odds of depressive symptoms reduced significantly for meeting PA and sleep (OR = 0.20, 95%CI, 0.09-0.59), or PA and ST (OR = 0.24, 95%CI, 0.08-0.55) guidelines. About half of the adolescents did not meet any recommendations, which underscores the need for public health campaigns to promote adherence to the movement guidelines in this pediatric population. Further longitudinal research with larger sample size is recommended to explore the inter-relationships of these behaviours and their impact on health and wellbeing outcomes of adolescents in Bangladesh
Physical activity and exercise (PAE) improve quality of life and reduce the effects of chronic diseases. Primary care physicians (PCPs) play an important role to encourage PAE in patients. We aim to assess PCPs' current PAE consultation practices and their enablers/barriers in daily clinical practice. We had 64 PCPs (age [35.3 ± 4.7] y, 47 women) that completed self-administered questionnaires on PAE consultation practices, training, and confidence levels. PCPs (n = 42) also completed the International Physical Activity Questionnaire-Short Form to assess their physical activity (PA) levels. We conducted correlation, one-way analysis of variance and a linear regression to assess the associations between enablers, barriers and PA levels to PAE consultation practices. On average, PCPs consulted on PAE in 49.7% of their daily clinical appointments. Majority of PCPs (70%) strongly agreed that more PAE knowledge were needed to increase consultation practices. Top three barriers related (p < 0.001) to practices were lack of PAE education (r = 0.47), patients’ preference of pharmaceutical interventions (r = 0.45) and lack of continuing education in PAE for PCPs (r = 0.37). Physically active PCPs (health-enhancing PA levels, n = 6) gave significantly more daily consultations in PAE, 73.2% ± 21.9%, compared to inactive PCPs (n = 13), 37.4% ± 22.8% (p = 0.013). In our regression output, PCPs who had higher PA levels consulted more on PAE daily (R2 = 0.38, p < 0.001) while controlling for age. Conclusion, PCPs require more knowledge on PAE and need be physically active themselves to increase PAE consultation for patients in their daily practice. Medical education should consider including more PA and exercise topics that may benefit both physicians and their patients
A 23-year-old professional distance runner with several years of exertional calf pain was diagnosed with a unique mixed type III and functional popliteal artery entrapment syndrome (PAES). Surgical reduction of the obstructing tissue allowed her to return to professional running. This case highlights the importance of including PAES in the differential for chronic intermittent lower extremity claudication and outlines the work-up required to diagnose this vascular obstruction in younger athletes.
The purpose of this manuscript was to present the evidence for why cells do not produce metabolic acids. In addition, evidence that opposes common viewpoints and arguments used to support the cellular production of lactic acid (HLa) or liver keto-acids have been provided. Organic chemistry reveals that many molecules involved in cellular energy catabolism contain functional groups classified as acids. The two main acidic functional groups of these molecules susceptible to ∼H+ release are the carboxyl and phosphoryl structures, though the biochemistry and organic chemistry of molecules having these structures reveal they are produced in a non-acidic ionic (negatively charged) structure, thereby preventing pH dependent ∼H+ release. Added evidence from the industrial production of HLa further reveals that lactate (La-) is produced followed by an acidification step that converts La- to HLa due to pH dependent ∼H+ association. Interestingly, there is a plentiful list of other molecules that are classified as acids and compared to HLa have similar values for their H+ dissociation constant (pKd). For many metabolic conditions, the cumulative turnover of these molecules is far higher than for La-. The collective evidence documents the non-empirical basis for the construct of the cellular production of HLa, or any other metabolic acid. Keywords. Metabolic biochemistry. Acidosis. Carboxyl. Phosphoryl. Metabolic acid. Dissociation. Association. pH.