Energy balance and macronutrient intake during season trainings: influence on anthropometric and lipid profiles in professional athletes

This study evaluated energetic balance and macronutrient intake at competitive training and transition training and their impact on anthropometric and lipid profiles in sixteen professional male athletes. Dietary data, body composition measurements and lipid profile were obtained at the end of both season trainings. Despite increased carbohydrate supplementation during exercise and higher caloric intake at competitive training (+10%, P =0.01), total daily energy expenditure was higher than caloric intake (79%, P<0.001). These results show negative energy balance at competitive training. However, total daily energy expenditure and caloric intake were similar at transition training (P =0.35). Higher intake of carbohydrate, fat, and protein were observed at competitive training (+13%, P =0.001 for all), although caloric intake was below the requirements during this period. Body mass (+2%, P =0.05), body fat percentage (+56%, P =0.01), fat mass (+57%, P =0.01), and waist and hip circumferences (+10%, P =0.004) were higher at transition training, as well as total and LDL-cholesterols (+14%, P =0.001). Endurance athletes showed negative energy balance at competitive training and maintained similar caloric intake at transition training despite decreased total daily energy expenditure, which might have contributed to changes in anthropometric and lipid profiles. These findings emphasize the importance of nutritional counseling for professional athletes during different season trainings. RESUMO Balanço energético e ingestão de macronutrientes  durante periodos de treinamento: influência nos perfis antropométrico e lipídico em atletas profissionaisEste estudo avaliou o balanço energético e a ingestão de macronutrientes nos treinamentos competitivo e de transição do treinamento e o seu impacto nos perfis antropométrico e lipídico de dezesseis atletas profissionais. Dados da dieta, medidas da composição corporal e perfil lipídico foram obtidos no final de ambos os treinamentos físico. Apesar do aumento da suplementação de carboidrato durante exercício e maior ingestão calórica no treinamento competitivo (+10%, P =0,01), o gasto energético diário total foi maior do que a ingestão calórica (79%, P<0,001), mostrando balanço energético negativo no treinamento competitivo. Entretanto, o gasto energético diário total e ingestão colórica foram similares no treinamento de transição (P =0,35). Maior ingestão de carboidrato, lipídio e proteína foram observados no treinamento competitivo (+13%, P =0,001), embora a ingestão calórica tenha sido abaixo da recomendada. Massa corporal (+2%, P =0,05), percentual de gordura corporal (+56%, P =0,01), massa de gordura (+57%, P =0,01), e circunferências de cintura e quadril (+10%, P =0,004) foram maiores no treinamento de transição, assim como o cholesterol total e LDL-c (+14%, P =0,001). Atletas de resistência apresentaram balanço energético negativo no treinamento competitivo e mantiveram ingestão calórica similar no treinamento de transição, apesar da diminuição do gasto energético, o que provavelmente contribuiu para as mudanças nos perfis antropométrico e lipídico. Esses achados ressaltam a importância do aconselhamento nutricional para atletas nos diferentes períodos do treinamento.Â

The Effects of Resistance Exercise With Blood Flow Restriction on Flow-Mediated Dilation and Arterial Stiffness in Elderly People With Low Gait Speed: Protocol for a Randomized Controlled Trial

Background: During aging, a significant loss of muscle mass, strength, and power is associated with a decline in daily functional capacities. Traditionally, resistance training is prescribed to prevent or reverse the skeletal muscle weakness, but the required training intensity may be too demanding for older people with poor physical performance. Resistance exercise with blood flow moderation (KAATSU training), originally developed in Japan, combines resistance exercise with blood flow restriction. It has been reported that KAATSU training enhances muscle hypertrophy in many populations. However, few studies have evaluated the effects of resistance exercises with blood flow restriction in elderly people and how this affects vascular structure and function. Objective: The aim of this study was to evaluate (1) the acute and chronic effects of resistance exercise with blood flow restriction on vascular health in elderly people with low gait speed and (2) whether low-load resistance training with blood flow restriction elicits similar strength and gait speed gains to those elicited by conventional resistance training without blood flow restriction. Methods: This is an ongoing randomized controlled trial in elderly people with low gait speed. Overall, two study arms of 13 participants each perform resistance exercise with and without blood flow restriction. The 2 groups are as follows: the control group will perform conventional resistance exercise (60% of 1 repetition maximum) and the KAATSU group will perform the low-load resistance exercise with blood flow restriction (20% of 1 repetition maximum) for 12 weeks. Pulse wave velocity, venous occlusion plethysmography, and flow-mediated dilation are used to assess arterial stiffness, muscle blood flow, and endothelial function, respectively. The secondary outcomes are gait speed, strength, and quality of life. All measures will be performed before and after the training program. Results: This research study is in progress. Recruitment has started, and data collection is expected to finish in August 2020. Conclusions: The findings of this study will have important implications for the rehabilitation of elderly people

Health-related quality of life in Brazilian community-dwelling and institutionalized elderly: Comparison between genders

Objective: To compare the health-related quality of life (HRQL) indicators between institutionalized and community-dwelling elderly men and women. Method: This was a cross-sectional study with a sample of 496 elderly men and women, surveyed by researchers at a private hospital that attends institutionalized and community-dwelling elderly. HRQL (World Health Organization Quality of Life), daily living activities (Katz questionnaire), and instrumental daily living activities (Lawton questionnaire), mini-mental state examination, handgrip strength test, and function capacity (timed up and go test) were obtained. Results: Institutionalized men presented higher scores in physical and psychological domains of HRQL compared to elderly men living alone (p<0.05). Among women, the scores in all domains (physical, psychological, relationship, and environment) were similar between institutionalized and community-dwelling individuals. Conclusion: Institutionalized elderly men reported better scores in physical and psychological domains of HRQL compared to their community-dwelling pairs, while both institutionalized and community-dwelling elderly women presented similar HRQL

Peak expiratory flow mediates the relationship between handgrip strength and timed up and go performance in elderly women, but not men

OBJECTIVE: The aim of the present study was to verify if there is sex difference in the associations among handgrip strength, peak expiratory flow (PEF) and timed up and go (TUG) test results. METHODS: The sample included 288 consecutive elderly men (n=93) and women (n=195). Functional capacity was measured using the TUG test, and muscle strength was measured based on handgrip. Moreover, as a measure of current health status, PEF was evaluated. Linear regression procedures were performed to analyze the relationships between handgrip and both PEF and TUG test results, with adjustment for confounders, and to identify the possible mediating role of PEF in the association between handgrip strength and TUG test results. RESULTS: In men, handgrip strength was associated with both PEF and TUG performance (

Energy balance and macronutrient intake during season trainings: influence on anthropometric and lipid profiles in professional athletes

This study evaluated energetic balance and macronutrient intake at competitive training and transition training and their impact on anthropometric and lipid profiles in sixteen professional male athletes. Dietary data, body composition measurements and lipid profile were obtained at the end of both season trainings. Despite increased carbohydrate supplementation during exercise and higher caloric intake at competitive training (+10%, P =0.01), total daily energy expenditure was higher than caloric intake (79%, P<0.001). These results show negative energy balance at competitive training. However, total daily energy expenditure and caloric intake were similar at transition training (P =0.35). Higher intake of carbohydrate, fat, and protein were observed at competitive training (+13%, P =0.001 for all), although caloric intake was below the requirements during this period. Body mass (+2%, P =0.05), body fat percentage (+56%, P =0.01), fat mass (+57%, P =0.01), and waist and hip circumferences (+10%, P =0.004) were higher at transition training, as well as total and LDL-cholesterols (+14%, P =0.001). Endurance athletes showed negative energy balance at competitive training and maintained similar caloric intake at transition training despite decreased total daily energy expenditure, which might have contributed to changes in anthropometric and lipid profiles. These findings emphasize the importance of nutritional counseling for professional athletes during different season trainings. RESUMO Balanço energético e ingestão de macronutrientes  durante periodos de treinamento: influência nos perfis antropométrico e lipídico em atletas profissionaisEste estudo avaliou o balanço energético e a ingestão de macronutrientes nos treinamentos competitivo e de transição do treinamento e o seu impacto nos perfis antropométrico e lipídico de dezesseis atletas profissionais. Dados da dieta, medidas da composição corporal e perfil lipídico foram obtidos no final de ambos os treinamentos físico. Apesar do aumento da suplementação de carboidrato durante exercício e maior ingestão calórica no treinamento competitivo (+10%, P =0,01), o gasto energético diário total foi maior do que a ingestão calórica (79%, P<0,001), mostrando balanço energético negativo no treinamento competitivo. Entretanto, o gasto energético diário total e ingestão colórica foram similares no treinamento de transição (P =0,35). Maior ingestão de carboidrato, lipídio e proteína foram observados no treinamento competitivo (+13%, P =0,001), embora a ingestão calórica tenha sido abaixo da recomendada. Massa corporal (+2%, P =0,05), percentual de gordura corporal (+56%, P =0,01), massa de gordura (+57%, P =0,01), e circunferências de cintura e quadril (+10%, P =0,004) foram maiores no treinamento de transição, assim como o cholesterol total e LDL-c (+14%, P =0,001). Atletas de resistência apresentaram balanço energético negativo no treinamento competitivo e mantiveram ingestão calórica similar no treinamento de transição, apesar da diminuição do gasto energético, o que provavelmente contribuiu para as mudanças nos perfis antropométrico e lipídico. Esses achados ressaltam a importância do aconselhamento nutricional para atletas nos diferentes períodos do treinamento.

Barriers to enrollment in pulmonary rehabilitation in a private hospital in Brazil: a physician survey study

Introduction: Pulmonary rehabilitation (PR) plays a key role in the management of chronic lung diseases, but it remains largely underused worldwide. The aim of this study was to assess clinicians’ knowledge about PR and to identify the barriers they encounter when referring patients with medical insurance to PR in a private hospital in Brazil. Methodology: This was a survey-based cross-sectional study conducted in 2019 at a reference hospital in São Paulo, Brazil. Eligible participants were physicians registered with the following specialties: Internal Medicine, Geriatrics, Cardiology, Pulmonology or Thoracic Surgery. Results: We collected 72 responses. While 99% of participants recognized COPD as a potential indication for PR, interstitial lung disease, bronchiectasis and pulmonary hypertension were less often recognized (75%). Most participants (67%) incorrectly associated PR with lung function improvement, while 28% of cardiologists and 35% of internists/geriatricians failed to recognize benefits on mood disorders. Notably, 18% of participants recommended PR only to patients on supplemental oxygen and 14% prescribed only home physiotherapy, patterns more commonly seen among non-respiratory physicians. The 3 most perceived barriers to referral and adherence were health insurance coverage (79%), transportation to the PR center (63%) and lack of social support (29%). Conclusions: Financial, logistic and social constraints pose challenges to PR enrollment even for patients with premium healthcare insurance plans. Moreover, physician knowledge gaps may be an additional barrier to PR referral and uptake. Providing continued medical education, incorporating automatic reminders in electronic medical records and using telerehabilitation tools may improve PR referral, adherence and ultimately patient care

Comparison of Electrocardiographic Criteria for Identifying Left Ventricular Hypertrophy in Athletes from Different Sports Modalities

OBJECTIVES: In athletes, isolated electrocardiogram high voltage criteria are widely used to evaluate left ventricular hypertrophy, but positive findings are thought to represent normal electrocardiogram alterations. However, which electrocardiogram criterion can best detect left ventricular hypertrophy in athletes of various sport modalities remains unknown. METHODS: Five electrocardiogram criteria used to detect left ventricular hypertrophy were tested in 180 male athletes grouped according to their sport modality: 67% low-static and high-dynamic components and 33% high-static and high-dynamic components of exercise. The following echocardiogram parameters are the gold standard for diagnosing left ventricular hypertrophy: left ventricular mass index ≥134 g.m-2, relative wall thickness ≥0.42 mm, left ventricular diastolic diameter index ≥32 mm.m-2, septum wall thickness ≥13 mm, and posterior wall thickness ≥13 mm. Results for the various criteria were compared using the kappa coefficient. Significance was established at p<0.05. RESULTS: Fifty athletes (28%) presented with left ventricular hypertrophy according to electrocardiogram findings, with the following sensitivities and specificities, respectively: 38-53% and 79-83% (Perugia), 22-40% and 89-91% (Cornell), 24-29% and 90% (Romhilt-Estes), 68-87% and 20-23% (Sokolow-Lyon), and 0% and 99% (Gubner). The Perugia and Cornell criteria had higher negative predictive values for the low-static and high-dynamic subgroup. Kappa coefficients were higher for Romhilt-Estes, Cornell and Perugia criteria than for Sokolow-Lyon and Gubner criteria. CONCLUSION: All five evaluated criteria are inadequate for detecting left ventricular hypertrophy, but the Perugia, Cornell and Romhilt-Estes criteria are useful for excluding its presence. The Perugia and Cornell criteria were more effective at excluding left ventricular hypertrophy in athletes involved in a sport modality with low-static and high-dynamic component predominance

Características cardíacas e metabólicas de corredores de longa distância do ambulatório de cardiologia do esporte e exercício, de um hospital terciário Cardiac and metabolic characteristics in long distance runners of sport and exercise cardiology outpatient facility of a tertiary hospital

OBJETIVO: Caracterizar parâmetros cardíacos, eletrocardiográficos e funcionais, e respostas cardiopulmonares ao exercício em corredores de longa distância brasileiros, acompanhados no Ambulatório de Cardiologia do Esporte e Exercício de um hospital terciário. MÉTODOS: De uma população inicial de 443 atletas, de ambos os sexos, de diferentes modalidades esportivas, foram avaliados 162 (37%) corredores de longa distância, do sexo masculino, com idade variando entre quatorze e 67 anos. Registros eletrocardiográficos (doze derivações) e ecocardiográficos (modos mono e bidimensional) foram realizados em repouso. Respostas cardiopulmonares foram avaliadas durante teste em esteira rolante, com protocolo em rampa. RESULTADOS: Alterações metabólicas e doenças cardiovasculares foram diagnosticadas em 17% e 9% dos corredores, respectivamente. Bradicardia sinusal e hipertrofia ventricular esquerda foram verificadas em 62% e 33% dos corredores, respectivamente. Alterações estruturais, como cavidade ventricular > 55mm, espessura relativa de parede > 0,44 e índice de massa ventricular > 134g/m2 foram encontradas em 15%, 11% e 7% dos corredores, respectivamente. Fração de ejeção < 55% foi observada em 4% dos corredores. O consumo de oxigênio pico (VO2pico) diminuiu a partir de 41 anos, embora o limiar anaeróbio relativo ao VO2pico tenha se mantido inalterado com a idade. CONCLUSÃO: Bradicardia de repouso e hipertrofia ventricular esquerda são as adaptações cardiovasculares mais freqüentes em corredores de longa distância brasileiros acompanhados no Ambulatório de Cardiologia do Esporte e Exercício. Apesar da diminuição do VO2pico a partir de 41 anos, há manutenção do consumo de oxigênio relativo no limiar anaeróbio nesses corredores.<br>OBJECTIVE: To characterize electrocardiographic and functional cardiac parameters and cardiopulmonary responses to exercise in long-distance Brazilian runners monitored at the Sport and Exercise Cardiology Outpatient Facility of a tertiary care hospital. METHODS: Of an initial population of 443 male and female athletes of different sport modalities, we assessed 162 (37%) long-distance male runners, aged from 14 to 67. Electrocardiographic (12 leads) and echocardiographic (M-mode and two-dimensional) parameters were recorded at rest. Cardiopulmonary responses were evaluated on a treadmill with a ramp protocol. RESULTS: Metabolic alterations and cardiovascular diseases were diagnosed in 17% and 9% of the runners, respectively. Sinus bradycardia and left ventricular hypertrophy were observed in 62% and 33% of the runners, respectively. Structural alterations such as ventricular cavity > 55mm, relative wall thickness > 0.44, and ventricular mass index > 134g/m2 were found in 15%, 11% and 7% of the runners, respectively. Ejection fraction < 55% was observed in 4% of the runners. Peak oxygen uptake (VO2peak) decreased as of the age of 41, although the anaerobic threshold relative to the VO2peak remained unchanged with age. CONCLUSION: Resting bradycardia and left ventricular hypertrophy are the most frequent cardiovascular adaptations in Brazilian long distance runners monitored by the Sport and Exercise Cardiology Outpatient Facility. Although VO2peak decreases after the age of 41, the relative oxygen uptake at the anaerobic threshold of these runners remained unchanged