Effects of a short residential thermal spa program to prevent work-related stress/burnout on stress biomarkers: The thermstress proof of concept study

Objective Work-related stress is a public health issue. Stress has multiple physical and psychological consequences, the most serious of which are increased mortality and cardiovascular morbidity. The ThermStress protocol was designed to offer a short residential thermal spa program for work-related stress prevention that is compatible with a professional context. Methods Participants will be 56 male and female workers aged 18 years or above. All participants will undergo a 6-day residential spa program comprising psychological intervention, physical activity, thermal spa treatment, health education, eating disorder therapy and a follow-up. On six occasions, participants’ heart rate variability, cardiac remodelling and function, electrodermal activity, blood markers, anthropometry and body composition, psychology and quality of life will be measured using questionnaires and bone parameters. Results This study protocol reports the planned and ongoing research for this intervention. Discussion The ThermStress protocol has been approved by an institutional ethics committee (ANSM: 2016 A02082 49). It is expected that this proof of concept study will highlight the effect of a short-term specific residential thermal spa program on the prevention of occupational burnout and work-related stress. The findings will be disseminated at several research conferences and in published articles in peer-reviewed journals. Trial Registration: ClinicalTrials.gov (NCT 03536624, 24/05/2018

Kinetics of left ventricular function and mechanic during the transition from rest to exercise : evaluation in sedentary and endurance trained subjects

Initiée par les travaux des lauréats du prix Nobel Krogh et Hill l’étude de l’adaptation du système cardiorespiratoire lors de la transition du repos à l’exercice représente un champ majeur en physiologie de l’exercice. En début d’effort, la consommation d’oxygène (VO2) doit rapidement s’adapter afin de minimiser le déficit en dioxygène (O2), les perturbations intracellulaires et par conséquent optimiser la performance. Pendant cette phase dite « cardiodynamique » le ventricule gauche (VG) doit rapidement augmenter l’apport en O2 aux muscles actifs. Le volume d’éjection systolique (VES) et les nombreux paramètres qui le conditionnent doivent aussi rapidement s’adapter malgré une réduction très importante de la durée de diastole. Comment le VG parvient-il à relever ce défi dans les premières minutes de l’exercice et comment ces différents paramètres interagissent ? L’objectif de ce travail de thèse est de répondre à ces questions en combinant l’utilisation des dernières avancées de l’échocardiographie en mode « Speckle Tracking » (STE), permettant d’apprécier finement la fonction myocardique régionale grâce à l’évaluation de la mécanique du VG, avec une approche originale caractérisée par des enregistrements à intervalles réguliers proches au cours de répétitions d’épreuves à charges constantes (épreuves dites « rectangulaires »). Une première partie va consister à décrire finement les cinétiques cardiaques chez le sujet jeune actif, alors qu’une deuxième partie s’attachera à évaluer l’impact de l’entraînement aérobie chez des cyclistes de très bon niveau rapportant de nombreuses années de pratique. Les résultats mettent en évidence que la fonction diastolique et ses mécanismes sous-jacents jouent un rôle clé dans l’adaptation du VES à l’exercice. En permettant l’augmentation de la vitesse de remplissage, la pression de remplissage et la relaxation favorisent l’adaptation du VES dans la première minute. L’adaptation de la vitesse de détorsion jusqu’à 120s prolonge l’adaptation de la vitesse de remplissage et permet le maintien du VES au-delà de la première minute. Par ailleurs, nos résultats indiquent que l’entraînement aérobie induit une adaptation du VES plus importante grâce à une amélioration de la vitesse et du débit de remplissage du VG. Ces améliorations sont le résultat d’une adaptation plus rapide et plus importante de la relaxation à la base et d’une adaptation plus importante de la vitesse de détorsion. Ce travail de thèse basé sur l’étude de la mécanique cardiaque à l’exercice d’intensité modérée a permis de montrer le rôle clé de la diastole, et plus particulièrement de la détorsion du VG, dans l’adaptation rapide du VES ainsi que son amélioration chez le sportif aérobie. En perspective, il serait intéressant d’étudier les cinétiques cardiaques à des intensités d’exercice supérieures ou dans des populations qui présentent des intolérances à l'effort.Initiated by the pioneering works of Nobel laureates Krogh and Hill, the study of cardiorespiratory system adaptation from rest to dynamic exercise represents a major field in exercise physiology. Oxygen uptake (VO2) has to abruptly increase in order to optimize exercise performance and tolerance by minimizing oxygen deficit and intracellular perturbations. During this “cardiodynamic” phase the LV has to abruptly increase oxygen delivery to mitochondria of active muscles. The stroke volume (SV) and its underlying mechanisms have to rapidly increase despite an important reduction of LV diastolic time. How do LV mechanics address this challenge at the onset of exercise and how do these different factors interact? Therefore, the aim of the present thesis is to answer to these questions by combining the use of latest advances in speckle tracking echocardiography (STE), which allow accurate assessment of regional myocardial function by the evaluation of LV mechanics, with an original approach based on the repetition of five similar constant work-load exercises, each of them being used to record different parameters. The first part give an accurate description of LV kinetics in young healthy active males whereas the second part focus on the evaluation of endurance training effect in well-trained cyclists. Our result highlight the key role of diastolic function and its underlying mechanisms in SV adaptation to exercise. In the first 60s, LV filling pressure and relaxation promote increase of LV filling velocity and hence SV adaptation. Beyond the first 60s, peak untwisting rate continue to increase until 120s allowing for a further increase of LV filling velocity involving SV maintenance. Furthermore, our results indicate that endurance training involve more important adaptation of SV by the improvement of LV filling velocity and filling rate. These improvement are the result of faster and higher adaptation of relaxation at the base and untwisting rate. This thesis based on the assessment of cardiac mechanic at moderate intensity exercise show the key role of diastole and more specifically LV untwist in the fast adaptation of SV and its improvement with endurance training. It would be interesting to study cardiac kinetics in heavy exercise and in pathological population presenting exercise intolerance

Cinétique de la fonction et de la mécanique ventriculaire gauche lors de la transition repos-effort : èvaluation par échocardiographie en mode 2D-strain

Initiated by the pioneering works of Nobel laureates Krogh and Hill, the study of cardiorespiratory system adaptation from rest to dynamic exercise represents a major field in exercise physiology. Oxygen uptake (VO2) has to abruptly increase in order to optimize exercise performance and tolerance by minimizing oxygen deficit and intracellular perturbations. During this “cardiodynamic” phase the LV has to abruptly increase oxygen delivery to mitochondria of active muscles. The stroke volume (SV) and its underlying mechanisms have to rapidly increase despite an important reduction of LV diastolic time. How do LV mechanics address this challenge at the onset of exercise and how do these different factors interact? Therefore, the aim of the present thesis is to answer to these questions by combining the use of latest advances in speckle tracking echocardiography (STE), which allow accurate assessment of regional myocardial function by the evaluation of LV mechanics, with an original approach based on the repetition of five similar constant work-load exercises, each of them being used to record different parameters. The first part give an accurate description of LV kinetics in young healthy active males whereas the second part focus on the evaluation of endurance training effect in well-trained cyclists. Our result highlight the key role of diastolic function and its underlying mechanisms in SV adaptation to exercise. In the first 60s, LV filling pressure and relaxation promote increase of LV filling velocity and hence SV adaptation. Beyond the first 60s, peak untwisting rate continue to increase until 120s allowing for a further increase of LV filling velocity involving SV maintenance. Furthermore, our results indicate that endurance training involve more important adaptation of SV by the improvement of LV filling velocity and filling rate. These improvement are the result of faster and higher adaptation of relaxation at the base and untwisting rate. This thesis based on the assessment of cardiac mechanic at moderate intensity exercise show the key role of diastole and more specifically LV untwist in the fast adaptation of SV and its improvement with endurance training. It would be interesting to study cardiac kinetics in heavy exercise and in pathological population presenting exercise intolerance.Initiée par les travaux des lauréats du prix Nobel Krogh et Hill l’étude de l’adaptation du système cardiorespiratoire lors de la transition du repos à l’exercice représente un champ majeur en physiologie de l’exercice. En début d’effort, la consommation d’oxygène (VO2) doit rapidement s’adapter afin de minimiser le déficit en dioxygène (O2), les perturbations intracellulaires et par conséquent optimiser la performance. Pendant cette phase dite « cardiodynamique » le ventricule gauche (VG) doit rapidement augmenter l’apport en O2 aux muscles actifs. Le volume d’éjection systolique (VES) et les nombreux paramètres qui le conditionnent doivent aussi rapidement s’adapter malgré une réduction très importante de la durée de diastole. Comment le VG parvient-il à relever ce défi dans les premières minutes de l’exercice et comment ces différents paramètres interagissent ? L’objectif de ce travail de thèse est de répondre à ces questions en combinant l’utilisation des dernières avancées de l’échocardiographie en mode « Speckle Tracking » (STE), permettant d’apprécier finement la fonction myocardique régionale grâce à l’évaluation de la mécanique du VG, avec une approche originale caractérisée par des enregistrements à intervalles réguliers proches au cours de répétitions d’épreuves à charges constantes (épreuves dites « rectangulaires »). Une première partie va consister à décrire finement les cinétiques cardiaques chez le sujet jeune actif, alors qu’une deuxième partie s’attachera à évaluer l’impact de l’entraînement aérobie chez des cyclistes de très bon niveau rapportant de nombreuses années de pratique. Les résultats mettent en évidence que la fonction diastolique et ses mécanismes sous-jacents jouent un rôle clé dans l’adaptation du VES à l’exercice. En permettant l’augmentation de la vitesse de remplissage, la pression de remplissage et la relaxation favorisent l’adaptation du VES dans la première minute. L’adaptation de la vitesse de détorsion jusqu’à 120s prolonge l’adaptation de la vitesse de remplissage et permet le maintien du VES au-delà de la première minute. Par ailleurs, nos résultats indiquent que l’entraînement aérobie induit une adaptation du VES plus importante grâce à une amélioration de la vitesse et du débit de remplissage du VG. Ces améliorations sont le résultat d’une adaptation plus rapide et plus importante de la relaxation à la base et d’une adaptation plus importante de la vitesse de détorsion. Ce travail de thèse basé sur l’étude de la mécanique cardiaque à l’exercice d’intensité modérée a permis de montrer le rôle clé de la diastole, et plus particulièrement de la détorsion du VG, dans l’adaptation rapide du VES ainsi que son amélioration chez le sportif aérobie. En perspective, il serait intéressant d’étudier les cinétiques cardiaques à des intensités d’exercice supérieures ou dans des populations qui présentent des intolérances à l'effort

Kinetics of Left Ventricular Mechanics during Transition from Rest to Exercise

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Left ventricular dyssynchrony and post-systolic shortening in young bodybuilders using anabolic-androgenic steroids

International audienceBackground: Left ventricular (LV) remodeling, characterized by increased LV hypertrophy and depressed function, is observed in strength-trained athletes who use anabolic-androgenic steroids (AAS). Previous studies reported an increase in cardiac fibrosis in these athletes, which could promote intraventricular dyssynchrony. In this context, this study evaluated LV dyssynchrony in strength-trained athletes using AA; hypothesizing that the use of AAS leads to an increase in LV dyssynchrony with an increase in post-systolic shortening.Methods: Forty-four participants (aged 20-40 years) were divided into three age-matched groups: strength-trained athletes using AAS (users, n=14) and those who were not (non-users, n=15), and healthy sedentary men (controls, n=15),. After completing a survey, each participant was assessed with 2D-strain echocardiography. Left ventricular dyssynchrony was quantified using the standard deviation of the time to peak for longitudinal strains (SD), the longitudinal strain delay index (LSDI) and the segmental post-systolic index (PSI).Results: Users exhibited a greater LV mass index and higher systolic and diastolic functions than both controls and non-users. The decrease in LV strains in users was predominantly observed at the interventricular segments. The SD, LSDI and PSI, calculated on the basal inferoseptal, basal anteroseptal and basal inferolateral segments, were higher in users.Conclusion: The results strongly support that the specific LV remodeling observed in young AAS users was associated with an increase in LV dyssynchrony. The correlations with ejection fraction suggested that wasted energy, due to post-systolic shortenings, contributed in part to the decrease in LV function in strength-trained athletes using AAS

Anabolic Steroids Use Is Associated with Impairments in Atrial and Ventricular Cardiac Structure and Performance in Athletes

International audiencePurpose: Despite potential severe cardiac side effects, anabolic androgenic steroids (AAS) are increasingly used by strength athletes. However, previous echocardiographic studies focused on the left ventricular strains (LV) but did not assess LV twist and untwist mechanics. Moreover, LA function has been often neglected, and its stiffness, an important determinant of LA reservoir function, has never been challenged. The aim of this study was to investigate the effects of anabolic androgenic steroids (AAS) on left atrial (LA) and left ventricular (LV) morphologies and functions in strength athletes.Methods: 50 subjects including 20 strength-trained young athletes aged 32.0 ± 8.5 years with a mean duration of AAS use of 4.7 ± 1.8 years (Users), 15 athletes with no history of AAS use (Non-Users) and 15 sedentary controls underwent STE to assess LA and LV morphology and function.Results: Users showed higher LA reservoir dysfunction than Non-Users (33.7 ± 10.9 vs 44.9 ± 9.9 % respectively, p = 0.004) and higher LA stiffness (0.13 ± 0.05 vs 0.19 ± 0.08 A.U. respectively, p = 0.02), higher LV mass index and lower global and regional LV diastolic and systolic dysfunction (global longitudinal strain: -15.5 ± 3.2 vs -18.9 ± 1.8 % respectively, p = 0.003), with a drop of LV twist-untwist mechanics (untwisting velocity: 61.5 ± 20.2 vs 73.7 ± 16.1 deg.s-1 respectively, p = 0.04). There were significant correlations between LV mass and LV apical rotation (p = 0.003, r = 0.44) and diastolic longitudinal strain rate (p = 0.015, r = 0.33).Conclusion: Our results showing significant LA and LV remodeling and dysfunctions in young AAS using athletes are alarming. Screening echocardiography based on STE parameters for early diagnosis, as well as a stronger awareness in athletes and in physicians are warranted in this context

Stress management in obesity during a thermal spa residential programme (ObesiStress): protocol for a randomised controlled trial study

International audienceIntroduction Stress and obesity are two public health issues. The relationship between obesity and stress is biological through the actions of stress on the major hormones that regulate appetite (leptin and ghrelin). Many spa resorts in France specialise in the treatment of obesity, but no thermal spa currently proposes a specific programme to manage stress in obesity. The ObesiStress protocol has been designed to offer a new residential stress management programme. This thermal spa treatment of obesity implements stress management strategies as suggested by international recommendations.Methods and analysis 140 overweight or obese participants with a Body Mass Index of >25 kg/m(2) and aged over 18 years will be recruited. Participants will be randomised into two groups: a control group of usual practice (restrictive diet, physical activity and thermal spa treatment) and an intervention group with stress management in addition to the usual practice. In the present protocol, parameters will be measured on five occasions (at inclusion, at the beginning of the spa (day 0), at the end of the spa (day 21), and at 6 and 12 months). The study will assess the participants' heart rate variability, cardiac remodelling and function, electrodermal activity, blood markers, anthropometric profile, body composition, psychology and quality of life via the use of questionnaires and bone parameters.Ethics and dissemination The ObesiStress protocol complies with the ethics guidelines for Clinical Research and has been approved by the ethics committee (CPP Sud-Est VI, Clermont-Ferrand - ANSM: 2016-A01774-47). This study aimed to highlight the efficacy of a 21-day thermal spa residential programme of stress management in obesity through objective measurements of well-being and cardiovascular morbidity. Results will be disseminated during several research conferences and articles published in peer-reviewed journals