Angina at Low heart rate And Risk of imminent Myocardial infarction (the ALARM study): a prospective, observational proof-of-concept study

BACKGROUND: Myocardial infarction (MI) is often preceded by unstable angina. Helping patients identify the onset of unstable angina rather than MI may result in earlier treatment and improve outcomes. Unstable angina is angina occurring at a lower-than-usual workload. Since heart rate (HR) is correlated with degree of exertion, we hypothesised that angina occurring at low HR is a warning signal for unstable angina and MI. METHODS: In this prospective study, 111 patients with acute coronary syndrome (ACS) or prognostically significant coronary disease were recruited. Each patient’s HR was measured using a portable electrocardiogram (ECG) recorder after regular class III exercise on the Canadian Cardiovascular Society Angina Grading Scale and the cumulative moving average and three-sigma (standard deviation) range were calculated for each new measurement. The HR was subsequently measured at the beginning of angina; a HR lower than the preceding three-sigma ranges for class III or anginal HR was regarded as a ‘warning signal’. The proportion of warning signals associated with ACS occurring in the following 2 weeks was compared with that for non-warning signals. RESULTS: Nine cases of ACS occurred in eight patients. Two cases were preceded by warning signals; a signal marked the onset of ACS in a third patient, and four patients failed to make anginal ECG recordings. There were 591 documented episodes of angina during the study and ECGs were available for 383 (64.8 %) of these of which 55 were warning signals. Of these warning signals, 4 occurred in the 2 weeks preceding ACS, compared with 4 of 328 non-warning signals (odds ratio, 6.4; 95 % confidence interval, 1.5–26.2; p = 0.01; positive predictive value, 7.3 %; negative predictive value, 98.8 %). CONCLUSIONS: Low HR angina may identify unstable angina and serve as an early warning for MI. In addition, angina that does not occur at a low heart rate indicates that ACS is very unlikely

Is there an acute exercise-induced physiological/biochemical threshold which triggers increased speed of cognitive functioning? A meta-analytic investigation

Purpose: The purpose of this study was to examine, using meta-analytic measures, the evidence regarding the optimal exercise intensity at which improvements in speed of cognitive function are triggered. Specifically, it was hypothesized that the catecholamine, lactate, and ventilatory thresholds is the point at which significant improvements in speed of cognitive function are observed. Methods: We compared mean effect sizes for threshold studies and for those studies where exercise intensity was classed as moderate (40%–79% VO2max or equivalent) but in which the thresholds were not measured. Results: Random effects meta-analysis showed significant, moderate, mean effect sizes for studies at the threshold (g = 0.58, Z = 2.98, p < 0.003) and for those during moderate intensity exercise but in which the threshold was not measured (g = 0.54, Z = 5.01, p < 0.001). There was no significant difference between mean effect sizes, which suggests that the thresholds are unlikely to represent a trigger point. Conclusion: Moderate intensity exercise, even below the thresholds, can induce improved speed of cognition, possibly due to a combination of increased peripheral catecholamine concentrations inducing vagal/nucleus tractus solitarii pathway activation and central increases due to perceptions of stress

Rock drumming enhances motor and psychosocial skills of children with emotional and behavioral difficulties

Drumming may have therapeutic and learning benefits but there exists little causal evidence regarding the benefits for children with emotional and behavioural difficulties (EBD) such as Autistic Spectrum Disorder. Six EBD pupils (EBD Drum) and 6 peers (Peer Drum) were given 2, 30 minute rock drumming lessons per week, over 5 weeks. Six matched individuals received no drumming instruction (3=EBD Control; 3=Peer Control). An exploratory, mixed-methods analysis was used to explore quantitative changes in skills and qualitative perspectives of the teaching staff. All pupils were tested two times (pretest and posttest) on drumming ability and Motor skills (Movement Assessment Battery for Children, version 2). Teacher’s rating of social behaviour (Strength and Difficulties Questionnaire; SDQ) was tested two times (pretest and retention).Significant differences in total SDQ difficulties between the four groups (χ2(3) = 8.210, p = 0.042) and the hyperactivity subscale (χ2(3) = 10.641, p = 0.014) were observed. The EBD Drum group had greater reductions in total difficulties compared to the Peer Drum (p = 0.009) group and specifically greater reductions in hyperactivity compared to Peer Drum (p = 0.046) and the EBD Control (p = 0.006) group. In follow-up interviews, staff spoke positively about changes in pupil’s attitudes towards learning and social confidence. The positive changes to social and behavioural skills reported in this pilot study are similar to those recorded for other music modalities

Does acute exercise affect the performance of whole-body, psychomotor skills in an inverted-U fashion?:a meta-analytic investigation

The primary purpose of this study was to examine, using meta-analytical measures, whether research into the performance of whole-body, psychomotor tasks following moderate and heavy exercise demonstrates an inverted-U effect. A secondary purpose was to compare the effects of acute exercise on tasks requiring static maintenance of posture versus dynamic, ballistic skills. Moderate intensity exercise was determined as being between 40% and 79% maximum power output (ẆMAX) or equivalent, while ≥ 80% ẆMAX was considered to be heavy. There was a significant difference (Zdiff = 4.29, p = 0.001, R2 = 0.42) between the mean effect size for moderate intensity exercise (g = 0.15) and that for heavy exercise size (g = − 0.86). These data suggest a catastrophe effect during heavy exercise. Mean effect size for static tasks (g = − 1.24) was significantly different (Zdiff = 3.24, p = 0.001, R2 = 0.90) to those for dynamic/ballistic tasks (g = − 0.30). The result for the static versus dynamic tasks moderating variables point to perception being more of an issue than peripheral fatigue for maintenance of static posture. The difference between this result and those found in meta-analyses examining the effects of acute exercise on cognition shows that, when perception and action are combined, the complexity of the interaction induces different effects to when cognition is detached from motor performance

Creatine supplementation research fails to support the theoretical basis for an effect on cognition: Evidence from a systematic review

Creatine supplementation has been put forward as a possible aid to cognition, particularly for vegans, vegetarians, the elderly, sleep deprived and hypoxic individuals. However, previous narrative reviews have only provided limited support for these claims. This is despite the fact that research has shown that creatine supplementation can induce increased brain concentrations of creatine, albeit to a limited extent. We carried out a systematic review to examine the current state of affairs. The review supported claims that creatine supplementation can increases brain creatine content but also demonstrated somewhat equivocal results for effects on cognition. It does, however, provide evidence to suggest that more research is required with stressed populations, as supplementation does appear to significantly affect brain content. Issues with research design, especially supplementation regimens, need to be addressed. Future research must include measurements of creatine brain content

Injuries in youth football and the relationship to player maturation: an analysis of time-loss injuries during four seasons in an English elite male football academy

A better insight into injuries in elite youth football may inform prevention strategies. The purpose of this prospective cohort study was to investigate the frequency, incidence and pattern of time-loss injuries in an elite male football academy, exploring injuries in relation to age and maturation status. Across four consecutive playing seasons, playing exposure and injuries to all academy players (U’9 to U’21) were recorded by club medical staff. Maturation status at the time of injury was also calculated for players competing in U’13 to U’16 aged squads. Time-loss injury occurrence and maturation status at time of injury were the main outcome measures. A total of 603 time-loss injuries were recorded, from 190 different players. Playing exposure was 229,317 hours resulting in an overall injury rate of 2.4 p/1000h, ranging from 0.7 p/1000h (U’11) to 4.8 p/1000h (u’21). Most injuries were traumatic in mechanism (73%). The most common injury location was the thigh (23%) and the most common injury type was muscle injury (29%) combining to provide the most common injury diagnosis; thigh muscle injury (17%). In U’13-U’16 players, a higher number of injuries to early-maturing players were observed in U’13-U’14 players, whilst more injuries to U’15-U’16 players occurred when classed as ‘on-time’ in maturity status. Maturation status did not statistically relate to injury pattern, however knee bone (not-fracture) injuries peaked in U’13 players whilst hip/groin muscle injuries peaked in U’15 players