Differences in lung function, bronchial hyperresponsiveness and respiratory health between elite athletes competing in different sports

The aim of this study was to examine lung function, bronchial hyperresponsiveness (BHR) and exercise-induced respiratory symptoms in elite athletes performing different sports. Norwegian national-team athletes (30 swimmers, 32 cross-country skiers, 16 speed-skaters, 11 rowers/paddlers, 17 handball players and 23 soccer players) completed a validated questionnaire, measured exhaled nitric oxide (FENO), spirometry, methacholine provocation (PD20met) and skin prick test. Three cut-off levels defined BHR; i.e. PD20met ≤2 µmol, ≤4 µmol and ≤8 µmol. Mean forced vital capacity (FVC) was highest in swimmers (Mean z-score[95%CI]  = 1.16 [0.80, 1.51]), and close to or higher than reference values according to the Global Lung Initiative equation, across all sports. Mean forced expiratory volume in 1 s (FEV1) was higher than reference values in swimmers (0.48 [0.13, 0.84]), and ball game athletes (0.69 [0.41, 0.97]). Mean forced expiratory flow between 25 and 75% of FVC (FEF25-75), and/or FEV1/FVC were lower than reference values in all endurance groups. BHR defined by ≤2 and ≤8 µmol methacholine was observed in respectively 50%–87% of swimmers, 25%–47% of cross-country skiers, 20%–53% of speed-skaters, 18%–36% of rowers/paddlers, and 0%–17% of the ball game athletes. Exercise-induced symptoms were common in all groups, most frequent in cross-country skiers (88%), swimmers (83%) and speed-skaters (81%).publishedVersio

Birth weight, cardiometabolic risk factors and effect modification of physical activity in children and adolescents : pooled data from 12 international studies

Objectives: Low and high birth weight is associated with higher levels of cardiometabolic risk factors and adiposity in children and adolescents, and increases the risk of cardiovascular diseases, obesity, and early mortality later in life. Moderate-to-vigorous physical activity (MVPA) is associated with lower cardiometabolic risk factors and may mitigate the detrimental consequences of high or low birth weight. Thus, we examined whether MVPA modified the associations between birth weight and cardiometabolic risk factors in children and adolescents. Methods: We used pooled individual data from 12 cohort- or cross-sectional studies including 9,100 children and adolescents. Birth weight was measured at birth or maternally reported retrospectively. Device-measured physical activity (PA) and cardiometabolic risk factors were measured in childhood or adolescence. We tested for associations between birth weight, MVPA, and cardiometabolic risk factors using multilevel linear regression, including study as a random factor. We tested for interaction between birth weight and MVPA by introducing the interaction term in the models (birth weight x MVPA). Results: Most of the associations between birth weight (kg) and cardiometabolic risk factors were not modified by MVPA (min/day), except between birth weight and waist circumference (cm) in children (p = 0.005) and HDL-cholesterol (mmol/l) in adolescents (p = 0.040). Sensitivity analyses suggested that some of the associations were modified by VPA, i.e., the associations between birth weight and diastolic blood pressure (mmHg) in children (p = 0.009) and LDL- cholesterol (mmol/l) (p = 0.009) and triglycerides (mmol/l) in adolescents (p = 0.028). Conclusion: MVPA appears not to consistently modify the associations between low birth weight and cardiometabolic risk. In contrast, MVPA may mitigate the association between higher birth weight and higher waist circumference in children. MVPA is consistently associated with a lower cardiometabolic risk across the birth weight spectrum. Optimal prenatal growth and subsequent PA are both important in relation to cardiometabolic health in children and adolescents.publishedVersio

Birth weight, cardiometabolic risk factors and effect modification of physical activity in children and adolescents: pooled data from 12 international studies

Abstract: Objectives: Low and high birth weight is associated with higher levels of cardiometabolic risk factors and adiposity in children and adolescents, and increases the risk of cardiovascular diseases, obesity, and early mortality later in life. Moderate-to-vigorous physical activity (MVPA) is associated with lower cardiometabolic risk factors and may mitigate the detrimental consequences of high or low birth weight. Thus, we examined whether MVPA modified the associations between birth weight and cardiometabolic risk factors in children and adolescents. Methods: We used pooled individual data from 12 cohort- or cross-sectional studies including 9,100 children and adolescents. Birth weight was measured at birth or maternally reported retrospectively. Device-measured physical activity (PA) and cardiometabolic risk factors were measured in childhood or adolescence. We tested for associations between birth weight, MVPA, and cardiometabolic risk factors using multilevel linear regression, including study as a random factor. We tested for interaction between birth weight and MVPA by introducing the interaction term in the models (birth weight x MVPA). Results: Most of the associations between birth weight (kg) and cardiometabolic risk factors were not modified by MVPA (min/day), except between birth weight and waist circumference (cm) in children (p = 0.005) and HDL-cholesterol (mmol/l) in adolescents (p = 0.040). Sensitivity analyses suggested that some of the associations were modified by VPA, i.e., the associations between birth weight and diastolic blood pressure (mmHg) in children (p = 0.009) and LDL- cholesterol (mmol/l) (p = 0.009) and triglycerides (mmol/l) in adolescents (p = 0.028). Conclusion: MVPA appears not to consistently modify the associations between low birth weight and cardiometabolic risk. In contrast, MVPA may mitigate the association between higher birth weight and higher waist circumference in children. MVPA is consistently associated with a lower cardiometabolic risk across the birth weight spectrum. Optimal prenatal growth and subsequent PA are both important in relation to cardiometabolic health in children and adolescents

Pre- and postnatal factors related to cardiometabolic health and adiposity in children and adolescents: Does physical activity matter?

Introduction: Cardiovascular diseases are a leading cause of premature mortality in all regions of the world, and they are highly linked to obesity. Pre- and postnatal factors, including maternal pre-pregnancy body mass index (BMI), birth weight and infant weight gain, have consistently been shown to be associated with higher cardiometabolic risk factors and greater adiposity in children and adolescents. Increased knowledge to establish safe and efficacious prevention strategies in these predisposed groups is thus urgent. An important public health strategy may be physical activity (PA); however, few studies have examined whether pre- and postnatal factors are also associated with or interact with PA in the development of cardiometabolic health and adiposity in children and adolescents. Objectives: The main objectives are 1) to examine whether pre- and postnatal factors (maternal pre-pregnancy BMI, birth weight, infant weight gain and motor development) are associated with PA in children and adolescents and 2) to examine whether PA interacts with pre- and postnatal factors (maternal pre-pregnancy BMI, birth weight and infant weight gain) in the development of cardiometabolic health and adiposity in children and adolescents? Participants and methods: This thesis is based on different study designs and comprises of different participants. The first research question was examined by a systematic review and metaanalysis and data from the Norwegian Mother, Father and Child cohort study (MoBa). The latter (MoBa) is a population-based birth cohort study in which the children are followed up regularly with maternal reported questionnaires and linked to the Medical Birth Registry of Norway (MBRN). For the present analyses 48 672 children were eligible for inclusion. The second research question was examined using data from a sub-cohort of the MoBa, including 445 children with available data on accelerometer-assessed PA. All participants had data on BMI, and 186 provided data on body composition (dual energy X‐ray absorptiometry [DXA]). The subcohort was either examined separately or included in pooled individual data from 12 cohort- or cross-sectional studies including 9 100 children and adolescents. Main results: 1) The systematic review and meta-analysis suggest no linear association between birth weight and later PA in children and adolescents. Three studies examined infant weight gain and later PA; they differ in methodology, and the results are inconsistent. Two studies suggest that earlier motor development is associated with PA and sport participation in children and adolescents. Moreover, analyses indicate that maternal pre-pregnancy BMI and birth weight are non-linearly associated with maternally reported leisure time PA (LTPA) in boys, in which the association was positive below 21kg/m2 and -1 z-score, and slightly inverse above 21kg/m2 and -1 z-score for maternal pre-pregnancy BMI and birth weight for gestational age z-score, respectively. We further observed a weak positive association between infant weight gain and LTPA in boys. We found no associations between maternal pre-pregnancy BMI, birth weight and infant weight gain with LTPA in girls. 2) A higher vigorous PA (VPA) attenuated the association between maternal pre‐pregnancy BMI and BMI in boys, but not in girls. Furthermore, birth weight was unrelated to childhood body composition, and there was no effect modification by PA. Physical activity attenuated the associations between infant weight gain and childhood fat mass and percent fat in boys but not in girls. Most of the associations between birth weight and cardiometabolic risk factors were not modified by moderate-tovigorous PA (MVPA), except between birth weight and waist circumference in children and high-density lipoprotein (HDL) cholesterol in adolescents. Sensitivity analyses suggest that some of the associations were modified by VPA: those between birth weight and diastolic blood pressure in children and between low-density lipoprotein (LDL) cholesterol and triglycerides in adolescents. Conclusion: Pre- and postnatal factors may be non-linearly associated with later PA in boys but not in girls. The strongest influence appears to be at the lower end of the maternal prepregnancy BMI and birth weight continuum, indicating that fetal undernutrition may undesirably impact the PA level in boys. Furthermore, motor development may be inversely associated with PA in children and adolescents. Boys also appears to be more vulnerable to a high maternal prepregnancy BMI and infant weight gain on subsequent fat mass and BMI in childhood, and some of these associations may be modified and attenuated by PA in boys. In addition, PA may, to some degree, attenuate the association between a higher birth weight and abdominal adiposity in children, whereas MVPA does not appear to consistently modify the associations between a lower birth weight and either cardiometabolic risk factors or clustered cardiometabolic risk. Finally, optimal pre- and postnatal environments and subsequent PA are all important in relation to cardiometabolic health and adiposity in children and adolescents

No association between maternal exercise during pregnancy and the child’s weight status at age 7 years: The MoBa study

Introduction: Maternal lifestyle during pregnancy may affect the development of overweight and obesity in the child. We examined whether maternal exercise during pregnancy is associated with offspring overweight and obesity in childhood. A secondary aim was to examine whether the association is affected by the child's physical activity level. Materials and methods: This study is based on data from the Norwegian Mother, Father and Child Cohort Study (MoBa), including 44 352 pregnancies and children (n = 32 304 in week 17 and n = 32 419 in week 30 in the final adjusted model). Maternal exercise during pregnancy was self-reported in gestational weeks 17 and 30. We conducted linear and logistic regression separately for girls and boys, and outcomes were the child's body mass index (BMI) and weight status (overweight/obese) at age 7 years. We further examined the additive joint association between maternal exercise during pregnancy and the child's leisure time physical activity on weight status at age 7 years. Results: In total, 12.4% of the children were classified as overweight or obese, and 1.7% as obese. The results suggest no association between maternal exercise in both gestational weeks 17 and 30 and the weight status of the child at age 7 years. The association between maternal exercise and the child's weight status at age 7 years appears not to be affected by the child's physical activity level. Conclusion: Maternal exercise level during pregnancy does not appear to be associated with the child's BMI or odds of being overweight or obese in childhood

No association between maternal exercise during pregnancy and the child’s weight status at age 7 years: The MoBa study

Introduction: Maternal lifestyle during pregnancy may affect the development of overweight and obesity in the child. We examined whether maternal exercise during pregnancy is associated with offspring overweight and obesity in childhood. A secondary aim was to examine whether the association is affected by the child's physical activity level. Materials and methods: This study is based on data from the Norwegian Mother, Father and Child Cohort Study (MoBa), including 44 352 pregnancies and children (n = 32 304 in week 17 and n = 32 419 in week 30 in the final adjusted model). Maternal exercise during pregnancy was self-reported in gestational weeks 17 and 30. We conducted linear and logistic regression separately for girls and boys, and outcomes were the child's body mass index (BMI) and weight status (overweight/obese) at age 7 years. We further examined the additive joint association between maternal exercise during pregnancy and the child's leisure time physical activity on weight status at age 7 years. Results: In total, 12.4% of the children were classified as overweight or obese, and 1.7% as obese. The results suggest no association between maternal exercise in both gestational weeks 17 and 30 and the weight status of the child at age 7 years. The association between maternal exercise and the child's weight status at age 7 years appears not to be affected by the child's physical activity level. Conclusion: Maternal exercise level during pregnancy does not appear to be associated with the child's BMI or odds of being overweight or obese in childhood

Differences in lung function, bronchial hyperresponsiveness and respiratory health between elite athletes competing in different sports

The aim of this study was to examine lung function, bronchial hyperresponsiveness (BHR) and exercise-induced respiratory symptoms in elite athletes performing different sports. Norwegian national-team athletes (30 swimmers, 32 cross-country skiers, 16 speed-skaters, 11 rowers/paddlers, 17 handball players and 23 soccer players) completed a validated questionnaire, measured exhaled nitric oxide (FENO), spirometry, methacholine provocation (PD20met) and skin prick test. Three cut-off levels defined BHR; i.e. PD20met ≤2 μmol, ≤4 μmol and ≤8 μmol. Mean forced vital capacity (FVC) was highest in swimmers (Mean z-score[95%CI] = 1.16 [0.80, 1.51]), and close to or higher than reference values according to the Global Lung Initiative equation, across all sports. Mean forced expiratory volume in 1 s (FEV1) was higher than reference values in swimmers (0.48 [0.13, 0.84]), and ball game athletes (0.69 [0.41, 0.97]). Mean forced expiratory flow between 25 and 75% of FVC (FEF25-75), and/or FEV1/FVC were lower than reference values in all endurance groups. BHR defined by ≤2 and ≤8 μmol methacholine was observed in respectively 50%–87% of swimmers, 25%–47% of cross-country skiers, 20%–53% of speedskaters, 18%–36% of rowers/paddlers, and 0%–17% of the ball game athletes. Exercise-induced symptoms were common in all groups, most frequent in cross-country skiers (88%), swimmers (83%) and speed-skaters (81%)

Early life risk factors for childhood obesity - Does physical activity modify the associations?: The MoBa cohort study

Objectives: High maternal pre‐pregnancy body mass index (BMI), high birth weight, and rapid infant weight gain are associated with increased risk of childhood obesity. We examined whether moderate‐to‐vigorous physical activity (MVPA) or vigorous physical activity (VPA) in 9‐ to 12‐year‐olds modified the associations between these early life risk factors and subsequent body composition and BMI. Methods: We used data from a sub‐cohort of the Norwegian Mother and Child Cohort Study (MoBa), including 445 children with available data on accelerometer assessed physical activity (PA). All participants had data on BMI, 186 of them provided data on body composition (dual energy X‐ray absorptiometry (DXA)). We used multiple regression analyses to examine the modifying effect of PA by including interaction terms. Results: Maternal pre‐pregnancy BMI and infant weight gain were more strongly related to childhood body composition in boys than in girls. Higher VPA attenuated the association between maternal pre‐pregnancy BMI and BMI in boys (low VPA: B = 0.32, 95% CI = 0.22, 0.41; high VPA B = 0.22, 95% CI = 0.12, 0.31). Birth weight was unrelated to childhood body composition, and there was no effect modification by PA. PA attenuated the associations between infant weight gain and childhood fat mass (low MVPA: B = 2.32, 95% CI = 0.48, 4.17; high MVPA: B = 1.00, 95% CI = 0.10, 1.90) and percent fat (low MVPA: B = 3.35, 95% CI = 0.56, 6.14; high MVPA: B = 1.41, 95% CI = −0.06, 2.87) in boys, but not girls. Conclusion: Findings from this study suggest that MVPA and VPA may attenuate the increased risk of an unfavorable body composition and BMI due to high maternal pre‐pregnancy BMI and rapid infant weight gain in boys, but not in girls

Early life risk factors for childhood obesity—Does physical activity modify the associations? The MoBa cohort study

Objectives: High maternal pre‐pregnancy body mass index (BMI), high birth weight, and rapid infant weight gain are associated with increased risk of childhood obesity. We examined whether moderate‐to‐vigorous physical activity (MVPA) or vigorous physical activity (VPA) in 9‐ to 12‐year‐olds modified the associations between these early life risk factors and subsequent body composition and BMI. Methods: We used data from a sub‐cohort of the Norwegian Mother and Child Cohort Study (MoBa), including 445 children with available data on accelerometer assessed physical activity (PA). All participants had data on BMI, 186 of them provided data on body composition (dual energy X‐ray absorptiometry (DXA)). We used multiple regression analyses to examine the modifying effect of PA by including interaction terms. Results: Maternal pre‐pregnancy BMI and infant weight gain were more strongly related to childhood body composition in boys than in girls. Higher VPA attenuated the association between maternal pre‐pregnancy BMI and BMI in boys (low VPA: B = 0.32, 95% CI = 0.22, 0.41; high VPA B = 0.22, 95% CI = 0.12, 0.31). Birth weight was unrelated to childhood body composition, and there was no effect modification by PA. PA attenuated the associations between infant weight gain and childhood fat mass (low MVPA: B = 2.32, 95% CI = 0.48, 4.17; high MVPA: B = 1.00, 95% CI = 0.10, 1.90) and percent fat (low MVPA: B = 3.35, 95% CI = 0.56, 6.14; high MVPA: B = 1.41, 95% CI = −0.06, 2.87) in boys, but not girls. Conclusion: Findings from this study suggest that MVPA and VPA may attenuate the increased risk of an unfavorable body composition and BMI due to high maternal pre‐pregnancy BMI and rapid infant weight gain in boys, but not in girls

Sudarshan Kriya Yoga Breathing and a Meditation Program for Burnout Among Physicians A Randomized Clinical Trial

Importance Physicians are exposed to high stress and strain that results in burnout, which affects them, their families, their patients, and the entire health care system; thus, there is an urgent need to develop methods to increase the resiliency of physicians. Sudarshan Kriya Yoga (SKY) is a comprehensive yoga breathing and meditation-based program that is a potential approach to mitigate physician burnout. Objective To determine whether SKY can reduce psychological distress and improve wellness in physicians. Design, Setting, and Participants This randomized clinical trial assessed the potential efficacy of SKY compared with a stress management education (SME) training as control. This study was conducted online from November 11, 2021, to March 14, 2022, and included physicians from Turkey, Germany, and Dubai. Both the SKY and the SME control groups received 1.5 hours of training for 3 consecutive days via a group video conference call. Participants were physicians willing to do some form of relaxation exercise everyday for 2 months. Exclusion criteria included presence of major illness and maintaining a regular mind-body program practice. Statistical analysis took place from March to November 2023. InterventionsParticipants were randomly assigned 1:1 into 2 groups-the SKY group or the SME (control) group-using a computer algorithm. After the 3-day instruction period, the participants in the SKY group practiced for approximately 30 minutes per day on their own and participated in a weekly 1-hour, group-based online follow-up practice. After the 3-day instruction period, participants in the SME group reviewed and applied the notes from stress management education training at their initiative and had a weekly 1-hour group-based online follow-up session. Main Outcomes and Measures The primary outcomes were stress and depression (measured by the 42-item Depression, Anxiety, and Stress Scale [DASS-42]) and insomnia measured by the Regensburg Insomnia Scale (RIS) with primary end point at 8 weeks. Secondary outcomes included anxiety (DASS-42); optimism (Life Orientation Test-Revised [LOT-R]); professional fulfillment, work exhaustion, interpersonal disengagement, and overall burnout (Professional Fulfillment Index [PFI]); and self-reported professional errors (Self-Reported Professional Error Questionnaire). Results This study included 129 participants (SME, 63 participants [48.9%]; SKY, 66 participants [51.1%]; 115 females [89.2%]; 14 males [10.8%]; mean [SD] age, 46.2 [9.0] years). Compared with the SME control group, participants in the SKY group had significantly decreased stress on the DASS-42 at posttraining (difference, -6.8 points; 95% CI, -9.6 to -4.1 points; P = .006) and at postintervention (difference, -6.0 points; 95% CI, -8.8 to -3.3 points; P = .03), significantly decreased depression at posttraining (difference, -5.7 points; 95% CI, -8.6 to -2.8 points; P < .001) and postintervention (difference, -5.4 points; 95% CI, -8.3 to -2.5 points; P < .001), and significantly decreased anxiety at postintervention. In addition, there was a significant decrease in insomnia from baseline to postintervention in the SKY group (difference, -0.3 points; 95% CI, -2.3 to 1.7 points; P = .01). The SKY group also showed significantly increased professional fulfillment as well as significant decreases in work exhaustion, interpersonal disengagement, and burnout. There was no effect on self-reported medical errors.Conclusions and Relevance In this randomized clinical trial, physicians who regularly practiced SKY throughout a 2-month period experienced improvements in wellness and decreased burnout. These data suggest that SKY may be an effective, practical, and safe strategy to increase wellness and mitigate burnout in physicians.Peer reviewe