The influence of caffeine expectancies on sport, exercise and cognitive performance

Caffeine (CAF) is widely consumed across sport and exercise for its reputed ergogenic properties, including central nervous stimulation and enhanced muscular force development. However, expectancy and the related psychological permutations that are associated with oral CAF ingestion are generally not considered in most experimental designs and these could be important in understanding if/how CAF elicits an ergogenic effect. The present paper reviews 17 intervention studies across sport, exercise, and cognitive performance. All explore CAF expectancies, in conjunction with/without CAF pharmacology. Thirteen out of 17 studies indicated expectancy effects of varying magnitudes across a range of exercise tasks and cognitive skills inclusive off but not limited to; endurance capacity, weightlifting performance, simple reaction time and memory. Factors, such as motivation, belief, and habitual CAF consumption habits influenced the response. In many instances, these effects were comparable to CAF pharmacology. Given these findings and the lack of consistency in the experimental design, future research acknowledging factors, such as habitual CAF consumption habits, habituated expectations, and the importance of subjective post-hoc analysis will help to advance knowledge within this area.N/

The Influence of Caffeine Expectancies on Simulated Soccer Performance in Recreational Individuals

Caffeine (CAF) has been reported to improve various facets associated with successful soccer play, including gross motor skill performance, endurance capacity and cognition. These benefits are primarily attributed to pharmacological mechanisms. However, evidence assessing CAF’s overall effects on soccer performance are sparse with no studies accounting for CAF’s potential psychological impact. Therefore, the aim of this study was to assess CAF’s psychological vs. pharmacological influence on various facets of simulated soccer performance. Utilising a double-dissociation design, eight male recreational soccer players (age: 22 ± 5 years, body mass: 78 ± 16 kg, height: 178 ± 6 cm) consumed CAF (3 mg/kg/body mass) or placebo (PLA) capsules, 60 min prior to performing the Loughborough Intermittent Shuttle Test (LIST) interspersed with a collection of ratings of perceived exertion (RPE), blood glucose and lactate, heart rate and performing the Loughborough Soccer Passing Test (LSPT). Whole-body dynamic reaction time (DRT) was assessed pre- and post- LIST, and endurance capacity (TLIM) post, time-matched LIST. Statistical analysis was performed using IBM SPSS (v24) whilst subjective perceptions were explored using template analysis. Mean TLIM was greatest (p < 0.001) for synergism (given CAF/told CAF) (672 ± 132 s) vs. placebo (given PLA/told PLA) (533 ± 79 s). However, when isolated, TLIM was greater (p = 0.012) for CAF psychology (given PLA/told CAF) (623 ± 117 s) vs. pharmacology (given CAF/told PLA) (578 ± 99 s), potentially, via reduced RPE. Although DRT performance was greater (p = 0.024) post-ingestion (+5 hits) and post-exercise (+7 hits) for pharmacology vs. placebo, psychology and synergism appeared to improve LSPT performance vs. pharmacology. Interestingly, positive perceptions during psychology inhibited LSPT and DRT performance via potential CAF over-reliance, with the opposite occurring following negative perceptions. The benefits associated with CAF expectancies may better suit tasks that entail lesser cognitive-/skill-specific attributes but greater gross motor function and this is likely due to reduced RPE. In isolation, these effects appear greater vs. CAF pharmacology. However, an additive benefit may be observed after combining expectancy with CAF pharmacology (i.e., synergism).N/

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

A Prospective Study of Risk Factors for Symptomatic Urinary Tract Infection in Young Women

An estimated 7 million episodes of acute cystitis occur annually in the United States, 1 and the annual costs of caring for these infections in young women are thought to exceed $1 billion. 2 Thus, improved means of preventing acute cystitis could lead to important reductions in both morbidity and health care costs. Factors that may influence the risk of urinary tract infection include recent sexual intercourse, 3 – 7 use of a diaphragm with spermicide, 4 – 9 delayed postcoital micturition, 4 , 7 , 10 , 11 and the ABO-blood-group nonsecretor phenotype. 12 – 14 However, these factors have been identified primarily in small case–control studies reporting widely varying risk . .