The effects of a graduated aerobic exercise programme on cardiovascular disease risk factors in the NHS workplace: a randomised controlled trial

BACKGROUND: Sufficient levels of physical activity provide cardio-protective benefit. However within developed society sedentary work and inflexible working hours promotes physical inactivity. Consequently to ensure a healthy workforce there is a requirement for exercise strategies adaptable to occupational time constraint. This study examined the effect of a 12 week aerobic exercise training intervention programme implemented during working hours on the cardiovascular profile of a sedentary hospital workforce. METHODS: Twenty healthy, sedentary full-time staff members of the North West London Hospital Trust cytology unit were randomly assigned to an exercise (n = 12; mean +/- SD age 41 +/- 8 years, body mass 69 +/- 12 kg) or control (n = 8; mean +/- SD age 42 +/- 8 years, body mass 69 +/- 12 kg) group. The exercise group was prescribed a progressive aerobic exercise-training programme to be performed 4 times a week for 8 weeks (initial intensity 65% peak oxygen consumption (VO2 peak)) and to be conducted without further advice for another 4 weeks. The control was instructed to maintain their current physical activity level. Oxygen economy at 2 minutes (2minVO2), 4 minutes (4minVO2), VO2 peak, systolic blood pressure (SBP), diastolic blood pressure (DBP), BMI, C-reactive protein (CRP), fasting glucose (GLU) and total cholesterol (TC) were determined in both groups pre-intervention and at 4 week intervals. Both groups completed a weekly Leisure Time Questionnaire to quantify additional exercise load. RESULTS: The exercise group demonstrated an increase from baseline for VO2 peak at week 4 (5.8 +/- 6.3 %) and 8 (5.0 +/- 8.7 %) (P < 0.05). 2minVO2 was reduced from baseline at week 4 (-10.2 +/- 10.3 %), 8 (-16.8 +/- 10.6 %) and 12 (-15.1 +/- 8.7 %), and 4minVO2 at week 8 (-10.7 +/- 7.9 %) and 12 (-6.8 +/- 9.2) (P < 0.05). There was also a reduction from baseline in CRP at week 4 (-0.4 +/- 0.6 mg.L-1) and 8 (-0.9 +/- 0.8 mg.L-1) (P < 0.05). The control group showed no such improvements. CONCLUSION: This is the first objectively monitored RCT to show that moderate exercise can be successfully incorporated into working hours, to significantly improve physical capacity and cardiovascular health

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Supplementation with [beta]-hydroxy-[beta]-methylbutyrate (HMB) and [alpha]-ketoisocaproic acid (KIC) reduces signs and symptoms of exercise-induced muscle damage in man

This study examined the effects of beta-hydroxyl-beta-methylbutyrate (HMB) and alpha-ketoisocaproic acid (KIC) supplementation on signs and symptoms of exercise-induced muscle damage following a single bout of eccentrically biased resistance exercise. Six non-resistance trained male subjects performed an exercise protocol designed to induce muscle damage on two separate occasions, performed on the dominant or non-dominant arm in a counter-balanced crossover design. Subjects were assigned to an HMB/KIC (3 g HMB and 0.3 g alpha-ketoisocaproic acid, daily) or placebo treatment for 14 d prior to exercise in the counter-balanced crossover design. One repetition maximum (1RM), plasma creatine kinase activity (CK), delayed onset muscle soreness (DOMS), limb girth, and range of motion (ROM) were determined pre-exercise, at 1h, 24 h, 48 h, and 72 h post-exercise. DOMS and the percentage changes in 1RM, limb girth, and ROM all changed over the 72 h period (P < 0.05). HMB//IC supplementation attenuated the CK response, the percentage decrement in 1RM, and the percentage increase in limb girth (P < 0.05). In addition, DOMS was reduced at 24 h post-exercise (P < 0.05) in the HMB/KIC treatment. In conclusion, 14 d of HMB and KIC supplementation reduced signs and symptoms of exercise-induced muscle damage in non-resistance trained males following a single bout of eccentrically biased resistance exercise

FLUID INGESTION STRATEGIES OF COMPETITIVE CYCLISTS DURING 40 KM TIME TRIAL COMPETITION

Dear Editor-in- ChiefLoss of fluid during prolonged exercise has been purported to be a cause of fatigue (Below et al., 1995; Walsh et al., 1994, for example). A plethora of information regarding 'optimal' fluid replacement strategies exists; perhaps the most prominent of these in the public domain is the position stand on exercise and fluid replacement published by the American College of Sports Medicine (ACSM). It recommends that one should ingest fluid early and continually at regular intervals in an attempt to replace the volume of fluid lost through sweating or consume as much as can be tolerated (Covertino et al., 1996). Drinking practices associated with different types of endurance activity are not well documented and it may be possible that the guidelines based on empirical data derived from laboratory conditions lack the necessary ecological validity for performance in the field. To our knowledge, there are no data on fluid intake or body mass losses during high-intensity cycling time trials (TT) outside of laboratory conditions; although a pilot study questionnaire used by El-Sayed et al., 1997 revealed that the volume ingested in pre-race preparation over a similar TT race distance (46 km) ranged between 0.125-0.5 L. Therefore the aim of this investigation was to elucidate the fluid ingestion strategies of competitive cyclists during pre-race preparation and 40 km TT competition and the resultant body mass loss.Seventy-two competitive male cyclists ranging from Elite Category to Category 4 cyclists (according to British Cycling classification) volunteered to participated in this investigation from two separate 40 km TT (n = 21 and n = 51, respectively). Mean (±SD) body mass, height and age for all participants were 73.4 ± 7.5 kg, 1.77 ± 0.06 m, and 47 ± 13 years. All procedures were approved by the University's Research Ethics Committee and subjects completed informed consent prior to the start of the investigation.Both events were held on 'out and back' courses. Environmental conditions were dry, 19ºC and 48% relative humidity during TT1. During TT2 riding conditions were wet in places, the temperature was 16ºC and the relative humidity was 64%. After voiding, cyclists' body mass was measured along with the bottle that each participant was to use during the TT. The fluid volume consumed was recorded post-warm-up and 5 min post-TT; body mass was also recorded 5 min post-TT. Fluid replacement was calculated as the volume of fluid ingested during the warm-up and TT expressed as a percentage of the total loss in body mass. Spearman Rho correlation analysis was used to determine the relationship between fluid replacement and average TT speed. Independent samples t-tests were used to determine differences between mean TT speed, ingested fluid volume and body mass loss.The mean speed for both TT were 39.27 ± 2.59 km·h-1 (range: 46.02 - 33.18 km·h-1). The mean speed for the individual TT1 and TT2 was 40.46 ± 2.89 and 38.78 ± 2.31 km·h-1, respectively. Despite the moderate conditions and exercise duration of ~60 min, the mean body mass loss was 1.5 ± 0.5 kg (1.8 ± 0.6% body mass). Body mass losses for TT1 and TT2 were 1.8 ± 0.5 kg (2.1 ± 0.7% body mass) and 1.4 ± 0.4 kg (1.7 ± 0.5% body mass), respectively. Approximately 60% (n=43) of riders consumed a pre-TT bolus of 0.343 ± 0.236 L. The remaining 29 athletes did not drink at any time during the pre-TT preparation or during the TT and no athletes chose to drink during the race. There was a significant, but nonetheless poor relationship between mean TT speed and fluid intake (r = 0.28, p = 0.018), but no significance between TT speed and percentage body mass loss (r = 0.17, p = 0.16). There was a significant difference between mean TT speeds (p = 0.011) and percentage body mass loss (p = 0.004), but not fluid intake (p = 0.37). Table 1 provides a summary of the volume and composition of the fluid ingested during the warm-up as well as the fluid replacement values. It is notable that the range for fluid replacement was between 2.8% and 61.5% of total body mass loss; mean (20.4 ± 12.0%).This study has identified fluid replacement strategies and body mass losses sustained by competitive 40 km TT cyclists from field data. Recently, there has been an increased awareness of excessive hydration during endurance exercise (Noakes and Speedy, 2006). From our observations, the fluid volume ingested was similar to the recommended pre- competition volume of 0.005 L·kg-1 body mass (Burke et al., 1996), however, many cyclists do not meet the guidelines presented by the ACSM during exercise (Convertino et al., 1996). Many riders chose to ingest fluid during the warm-up period; however very few drank during the TT. It is important to point out that these data are limited to cycling TT in moderate conditions. Further research is warranted to determine the effects of different environmental conditions on actual TT performance outside the laboratory, to enable appropriate fluid replacement strategies to be devise

The reliability of electromechanical delay and torque during isometric and concentric isokinetic contractions

The purpose of this investigation was to examine the intra-subject reliability of electromechanical delay (EMD) and torque of the dominant and non-dominant elbow flexors during isometric and isokinetic muscle contractions repeated over five consecutive days. Eleven volunteers that were unfamiliar with isokinetic dynamometry participated in this study and were asked to attend the laboratory on five consecutive days. An isokinetic dynamometer was used to exercise the elbow flexors under isometric, slow (60 degrees s(-1)) and fast (210 degrees s(-1)) isokinetic conditions; surface electromyography was recorded from the belly of biceps brachii and the signal was synchronised with the dynamometer to determine EMD. Intra-subject reliability for all measures was good (CV range, 3.1-6.5%) with no discernable difference between the dominant and non-dominant arms during isometric and isokinetic conditions. In addition, there was little difference in EMD and torque variability between the dominant and non-dominant arms which may have applications for clinicians and future research design when monitoring and investigating human muscle function. These data provide researchers and clinicians with an indication of the magnitude of change that is required to elucidate the presence of a meaningful change to muscle function in the elbow flexors

Compression garments and recovery from exercise-induced muscle damage: a meta-analysis

The purpose of the study was to determine the effects of compression garments on recovery following damaging exercise. A systematic review and meta-analysis was conducted using studies that evaluated the efficacy of compression garments on measures of delayed onset muscle soreness (DOMS), muscular strength, muscular power and creatine kinase (CK). Studies were extracted from a literature search of online databases. Data were extracted from 12 studies, where variables were measured at baseline and at 24 or 48 or 72 h postexercise. Analysis of pooled data indicated that the use of compression garments had a moderate effect in reducing the severity of DOMS (Hedges' g=0.403, 95% CI 0.236 to 0.569, p<0.001), muscle strength (Hedges' g=0.462, 95% CI 0.221 to 0.703, p<0.001), muscle power (Hedges' g=0.487, 95% CI 0.267 to 0.707, p<0.001) and CK (Hedges' g=0.439, 95% CI 0.171 to 0.706, p<0.001). These results indicate that compression garments are effective in enhancing recovery from muscle damage

The effect of custom-fitted compression garments worn overnight for recovery from Judo training in elite athletes

This study investigated the effects of custom-fitted compression garments (CG) worn during recovery over a multi-day training camp in elite judo players (judoka). A single blind, placebo-controlled study was carried out in 11 elite judoka, using a two-way crossover design. Two three-day training camps were completed in CG and placebo conditions in a random order. Changes in performance and physiological markers were compared between conditions. Judoka were assessed before training for (maximal) isometric knee extension and grip strength, countermovement jump performance and bench-press velocity, alongside soreness, limb circumferences, plasma creatine kinase activity (CK) and perceived bruising. Measurements were repeated after 12 h, 36 h and 43 h of training, whereupon judoka rated the effectiveness of each intervention. Knee extension and bench-press performance demonstrated significant familiarization (p 0.05). Grip strength declined throughout training (p 0.05). Compression conferred no statistically significant impact upon recovery markers in elite judoka throughout training. Muscle damage responses were inconsistent in this population. Individual athletes would be advised to monitor habitually-used performance measures while using CG to ascertain whether perceptual benefits translate into enhanced recovery