Building physiological reserve in immobilisation: does nutritional supplementation work?

Introduction: Disuse models, such as limb immobilisation, result in profound changes in skeletal muscle morphology and function. Exercise prescription would be the recommended intervention to prevent immobilisation-induced atrophy and declines in maximal voluntary strength. Nutritional supplementation may stand as a viable intervention to combat muscle atrophy with disuse, when exercise is an unpractical therapeutic option. Aims: To (1) investigate the multifactorial effects of short-term upper limb sling immobilisation and (2) determine whether three potential protein-sparing modulators (essential amino acids (EAA), omega-3 (-3) and vitamin D) would attenuate the anticipated deleterious effects of immobilisation. Methods: Measures of muscle and sub-cutaneous adipose thickness (Brightness mode ultrasonography), body composition (dual-energy x-ray absorptiometry), arm girth (anthropometry), isometric and isokinetic elbow torque (dynamometry), co-contraction (electromyography (EMG)), muscle fatigability (dynamometry and EMG), arterial blood flow (Doppler ultrasound) and endocrine profile (enzyme-linked immunosorbent assay and colorimetry), were taken before and after arm immobilisation in a mixed sex population. Supplementation of EAA (n = 9 vs. placebo n = 7) during three weeks of immobilisation, -3 (n = 8) or vitamin D (n = 8) during two weeks of immobilisation (placebo n = 8) and EAA for two weeks pre-immobilisation (n = 5 vs. placebo n = 5). Main findings: Immobilisation resulted in decreases in muscle thickness, arm girth, lean mass, isometric and isokinetic elbow torque, and an increase in sub-cutaneous adipose thickness. Muscle fatigability, resting arterial blood flow, EMG co-contraction and endocrine profile were unchanged. At the current dosage -3 supplementation only attenuated the increase in sub-cutaneous adipose thickness. Despite some trends, neither -3 nor vitamin D supplementation attenuated any other parameters. EAA supplementation during immobilisation impacted positively on the immobilisation-induced changes in the structural and functional characteristic of the remaining muscle. EAA supplementation before immobilisation did not attenuate the immobilisation-induced changes in muscle structure and function. Conclusion: Although EAA supplementation only showed some benefit to muscle size and function with immobilisation, it was confirmed that the sling immobilisation model used in the thesis, is a suitable model for observing the effects of relatively short-term immobilisation. The findings of the thesis are relevant to both sporting (e.g. off-season detraining modulation) as well as clinical (e.g. injury/illness induced short-term immobilisation/bed rest) populations. This relatively short-term sling immobilisation provides a model to be used to assess other supplements and treatments in future studies. The modest effect of supplementation suggests further research into either: a) more at risk populations (e.g. injury or ageing); b) larger doses of these supplements

Proceedings of Patient Reported Outcome Measure’s (PROMs) Conference Oxford 2017: Advances in Patient Reported Outcomes Research

A33-Effects of Out-of-Pocket (OOP) Payments and Financial Distress on Quality of Life (QoL) of People with Parkinson’s (PwP) and their Carer

Investigating the Efficacy of an 18-Week Postpartum Rehabilitation and Physical Development Intervention on Occupational Physical Performance and Musculoskeletal Health in UK Servicewomen: Protocol for an Independent Group Study Design

Background: Postpartum women are at an increased risk of pelvic floor dysfunction, musculoskeletal injury, and poor psychological health and have reduced physical fitness compared to before pregnancy. There is no formal, evidence-based rehabilitation and physical development program for returning UK servicewomen to work following childbirth. Objective: This study aims to examine the efficacy of a rehabilitation and physical development intervention for returning postpartum UK servicewomen to occupational fitness. Methods: Eligible servicewomen will be assigned to a training or control group in a nonrandomized controlled trial 6 weeks after childbirth. Group allocation will be based on the location of standard pregnancy and postpartum care. The control group will receive standard care, with no prescribed intervention. The training group will start an 18-week core and pelvic health rehabilitation program 6 weeks post partum and a 12-week resistance and high-intensity interval training program 12 weeks post partum. All participants will attend 4 testing sessions at 6, 12, 18, and 24 weeks post partum for the assessment of occupational physical performance, pelvic health, psychological well-being, quality of life, and musculoskeletal health outcomes. Occupational physical performance tests will include vertical jump, mid-thigh pull, seated medicine ball throw, and a timed 2-km run. Pelvic health tests will include the Pelvic Organ Prolapse Quantification system, the PERFECT (power, endurance, repetitions, fast, every contraction timed) scheme for pelvic floor strength, musculoskeletal physiotherapy assessment, the Pelvic Floor Distress Inventory–20 questionnaire, and the International Consultation on Incontinence Questionnaire–Vaginal Symptoms. Psychological well-being and quality of life tests will include the World Health Organization Quality of Life questionnaire and the Edinburgh Postnatal Depression Scale. Musculoskeletal health outcomes will include body composition; whole-body areal bone mineral density; tibial volumetric bone mineral density, geometry, and microarchitecture; patella tendon properties; muscle architecture; muscle protein and collagen turnover; and muscle mass and muscle breakdown. Data will be analyzed using linear mixed-effects models, with participants included as random effects, and group and time as fixed effects to assess within- and between-group differences over time. Results: This study received ethical approval in April 2019 and recruitment started in July 2019. The study was paused in March 2020 owing to the COVID-19 pandemic. Recruitment restarted in May 2021. The results are expected in September 2022. Conclusions: This study will inform the best practice for the safe and optimal return of postpartum servicewomen to physically and mentally demanding jobs