Claudio L. Battaglini

Exercise and circulating Cortisol levels: The intensity threshold effect

This study examined the influence of exercise intensity upon the cortisol response of the hypothalamic-pituitaryadrenal (HPA) axis. Specifically, we examined exercise at intensities of 40, 60, and 80% maximal oxygen uptake (VO2max) in an attempt to determine the intensity necessary to provoke an increase in circulating cortisol. Twelve active moderately trained men performed 30 min of exercise at intensities of 40, 60, and 80% of their VO2max, as well as a 30-min resting-control session involving no exercise on separate days. Confounding factors such as time of day — circadian rhythms, prior diet — activity patterns, psychological stress, and levels of exercise training were controlled. Cortisol and ACTH were assessed in blood collected immediately before (pre-) and after (post-) each experimental session. Statistical analysis involved repeated measures analysis of variance and Tukey posthoc testing. The percent change in cortisol from pre- to post-sampling at each session was: resting-control, 40, 60, and 80% sessions (mean±SD) =−6.6±3.5%, +5.7±11.0%, +39.9±11.8%, and +83.1±18.5%, respectively. The 60% and 80% intensity magnitude of change was significantly greater than in the other sessions, as well as from one to another. The ACTH responses mirrored those of cortisol, but only the 80% exercise provoked a significant (p<0.05) increase pre- to post-exercise. The calculated changes in plasma volume for the resting-control, 40%, 60%, and 80% sessions were: +2.2±3.0%, −9.9±5.0%, −15.6±3.5%, and −17.2±3.3%, respectively. Collectively, the cortisol findings support the view that moderate to high intensity exercise provokes increases in circulating cortisol levels. These increases seem due to a combination of hemoconcentration and HPA axis stimulus (ACTH). In contrast, low intensity exercise (40%) does not result in significant increases in cortisol levels, but, once corrections for plasma volume reduction occurred and circadian factors were examined, low intensity exercise actually resulted in a reduction in circulating cortisol levels.

Effect of Exercise Training on Peak Oxygen Consumption in Patients with Cancer: A Meta-Analysis

BACKGROUND We conducted a meta-analysis to determine the effects of supervised exercise training on peak oxygen consumption (VO(2peak)) in adults with cancer. METHODS A literature review using Ovid MEDLINE (1950-2010), the Cochrane Central Register of Controlled Trials (1991-2010), AMED (1985-2010), Embase (1988-2010), PubMed (1966-2010), Scopus (1950-2010), and Web of Science (1950-2010) was performed to identify randomized controlled trials examining the effects of supervised exercise training on measurement of VO(2peak) (via gas exchange analysis) in adults with cancer. Studies were selected using predetermined criteria, and two independent reviewers extracted data. Weighted mean differences (WMDs) were calculated using random effect models. RESULTS Six studies evaluated VO(2peak) involving a total of 571 adult cancer patients (exercise, n = 344; usual care control, n = 227). Pooled data indicated that exercise training was associated with a statistically significant increase in VO(2peak) (WMD, 2.90 ml·kg(-1)·min(-1); 95% confidence interval [CI], 1.16-4.64); however, significant heterogeneity was evident in this estimate (I(2), 87%). Usual care (control) was associated with a significant decline in VO(2peak) from baseline to postintervention (WMD, -1.02 ml·kg(-1)·min(-1); 95% CI, -1.46 to -0.58; I(2), 22%). Sensitivity analyses indicated superior improvements in VO(2peak) for studies conducted for a shorter duration (<4 months) and following the completion of adjuvant therapy (p-values < .001). Exercise training was not associated with a higher incidence of adverse events, although safety was not rigorously monitored or reported. CONCLUSIONS Supervised exercise training is associated with significant improvements in VO(2peak) following a diagnosis of early-stage cancer, with minimal adverse events.

Return of Postural Control to Baseline After Anaerobic and Aerobic Exercise Protocols

CONTEXT With regard to sideline concussion testing, the effect of fatigue associated with different types of exercise on postural control is unknown. OBJECTIVE To evaluate the effects of fatigue on postural control in healthy college-aged athletes performing anaerobic and aerobic exercise protocols and to establish an immediate recovery time course from each exercise protocol for postural control measures to return to baseline status. DESIGN Counterbalanced, repeated measures. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-six collegiate athletes (18 males, 18 females; age = 19.00 +/- 1.01 years, height = 172.44 +/- 10.47 cm, mass = 69.72 +/- 12.84 kg). INTERVENTION(S) Participants completed 2 counterbalanced sessions within 7 days. Each session consisted of 1 exercise protocol followed by postexercise measures of postural control taken at 3-, 8-, 13-, and 18-minute time intervals. Baseline measures were established during the first session, before the specified exertion protocol was performed. MAIN OUTCOME MEASURE(S) Balance Error Scoring System (BESS) results, sway velocity, and elliptical sway area. RESULTS We found a decrease in postural control after each exercise protocol for all dependent measures. An interaction was noted between exercise protocol and time for total BESS score (P = .002). For both exercise protocols, all measures of postural control returned to baseline within 13 minutes. CONCLUSIONS Postural control was negatively affected after anaerobic and aerobic exercise protocols as measured by total BESS score, elliptical sway area, and sway velocity. The effect of exertion lasted up to 13 minutes after each exercise was completed. Certified athletic trainers and clinicians should be aware of these effects and their recovery time course when determining an appropriate time to administer sideline assessments of postural control after a suspected mild traumatic brain injury.

The National Football League Combine: Performance Differences Between Drafted and Nondrafted Players Entering the 2004 and 2005 Drafts

The purpose of this study was to examine performance differences between drafted and nondrafted athletes (N = 321) during the 2004 and 2005 National Football League (NFL) Combines. We categorized players into one of 3 groups: Skill, Big skill, and Linemen. Skill players (SP) consisted of wide receivers, cornerbacks, free safeties, strong safeties, and running backs. Big skill players (BSP) included fullbacks, linebackers, tight ends, and defensive ends. Linemen (LM) consisted of centers, offensive guards, offensive tackles, and defensive tackles. We analyzed player height and mass, as well as performance on the following combine drills: 40-yard dash, 225-lb bench press test, vertical jump, broad jump, pro-agility shuttle, and the 3-cone drill. Student t-tests compared performance on each of these measures between drafted and nondrafted players. Statistical significance was found between drafted and nondrafted SP for the 40-yard dash (P < 0.001), vertical jump (P = 0.003), pro-agility shuttle (P < 0.001), and 3-cone drill (P < 0.001). Drafted and nondrafted BSP performed differently on the 40-yard dash (P = 0.002) and 3-cone drill (P = 0.005). Finally, drafted LM performed significantly better than nondrafted LM on the 40-yard dash (P = 0.016), 225-lb bench press (P = 0.003), and 3-cone drill (P = 0.005). Certified strength and conditioning specialists will be able to utilize the significant findings to help better prepare athletes as they ready themselves for the NFL Combine.

The effects of an individualized exercise intervention on body composition in breast cancer patients undergoing treatment

CONTEXT AND OBJECTIVE Changes in metabolism have been reported in the majority of patients undergoing cancer treatment, and these are usually characterized by progressive change in body composition. The effects of aerobic exercise programs to combat the cancer and cancer treatment-related side effects, which include the negative changes in body composition, have been extensively reported in the literature. However, few resistance exercise intervention studies have hypothesized that breast cancer patients might benefit from this type of exercise. The purpose of this study was to determine whether exercise protocols that emphasize resistance training would change body composition and strength in breast cancer patients undergoing treatment. DESIGN AND SETTING Randomized controlled trial, at the Campus Recreation Center and Rocky Mountain Cancer Rehabilitation Institute of the University of Northern Colorado, and the North Colorado Medical Center. METHODS Twenty inactive breast cancer patients were randomly assigned to a 21-week exercise group (n = 10) or a control group (n = 10). The exercise group trained at low to moderate intensity for 60 minutes on two days/week. The primary outcome measurements included body composition (skinfold method) and muscle strength (one repetition maximum). RESULTS Significant differences in lean body mass, body fat and strength (p = 0.004, p = 0.004, p = 0.025, respectively) were observed between the groups at the end of the study. CONCLUSION The results suggest that exercise emphasizing resistance training promotes positive changes in body composition and strength in breast cancer patients undergoing treatment.

Twenty-five years of research on the effects of exercise training in breast cancer survivors: A systematic review of the literature

AIM To investigate the role of exercise training the past 25 years on major physiological-psychological outcomes studied thus far in this patient population. METHODS PubMed, MedlinePlus, the Cochrane Library, Web of Science, SportDiscus, Embase, Scorpus, and Google Scholar were searched from September to November 2013 to identify exercise training studies that used objective measurements of fitness and/or patient reported outcomes assessed pre and post-exercise training with statistical analyses performed in at least one of the following outcome measurements: Cardiorespiratory function, body composition, muscular strength, fatigue, depression, and overall quality of life. Five reviewers independently identified the studies that met the criteria for the review and discrepancies were resolved by consensus among all authors. RESULTS Fifty-one studies were included in this review with 5 from the period between 1989-1999, 11 from 2000-2006, and 35 from 2007-2013. The evolution of study designs changed from aerobic only exercise training interventions (1989-1999), to a combination of aerobic and resistance training (2000-2006), to studies including an arm of resistance training or examining the effects of resistance training as the main mode of exercise (2007-2013). Overall, the benefits of exercise showed improvements in cardiorespiratory function, body composition, strength, and patient reported outcomes including fatigue, depression, and quality of life. CONCLUSION Exercise training appears to be safe for most breast cancer patients and improvements in physiological, psychological, and functional parameters can be attained with regular participation in moderate intensity exercise.

Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants

IntroductionDeficits after breast cancer treatment have been examined by comparing the surgically affected upper extremity to the unaffected extremity. It is not possible to know precisely if anti-cancer treatment such as radiation and chemotherapy had any effect on the unaffected arm. The purpose of this study was to compare ROM, strength, and shoulder function between breast cancer survivors and healthy, matched controls.MethodsShoulder pain and function was assessed using the Disabilities of the Arm Shoulder Hand (DASH) and the Pennsylvania Shoulder Score (PSS). Active and passive range of motion (ROM) for shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, internal rotation (IR) at 90° of abduction were measured on the affected side using a digital inclinometer. Strength was measured using a hand held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, internal rotation, ER, scaption, and horizontal adduction.ResultsSignificant differences were found between the two groups for the DASH (p < 0.001) and PSS (p < 0.001), active flexion (p < 0.001), 90° ER (p = 0.020), extension (p = 0.004) and passive flexion (p < 0.001) and 90° ER (p = 0.012). All 7 of the shoulder girdle strength measures were significantly different between groups for abduction and upward rotation (p = 0.006), depression and adduction (p = 0.001), flexion (p < 0.001), ER (p = 0.004), IR (p = 0.001), scaption (p < 0.001), and adduction (p < 0.001).Discussion/ConclusionsThese results provide preliminary evidence to suggest clinicians focus on these particular ROM, strength, and shoulder function measures when treating a breast cancer survivors.Implications for Cancer SurvivorsShoulder ROM, strength, and function are important to assess in BCS.

Comparing short-term complex and compound training programs on vertical jump height and power output

The purpose of this study was to determine whether there were differences in vertical jump height and lower body power production gains between complex and compound training programs. A secondary purpose was to determine whether differences in gains were observed at a faster rate between complex and compound training programs. Thirty-one college-aged club volleyball players (11 men and 20 women) were assigned into either a complex training group or a compound training group based on gender and pre-training performance measures. Both groups trained twice per week for 4 weeks. Work was equated between the 2 groups. Complex training alternated between resistance and plyometric exercises on each training day; whereas, compound training consisted of resistance training on one day and plyometric training on the other. Our analyses showed significant improvements in vertical jump height in both training groups after only 3 weeks of training (P < 0.0001); vertical jump height increased by approximately 5% and 9% in the complex and compound training groups, respectively. However, neither group improved significantly better than the other, nor did either group experience faster gains in vertical leap or power output. The results of this study suggest that performing a minimum of 3 weeks of either complex or compound training is effective for improving vertical jump height and power output; thus, coaches should choose the program which best suits their training schedules.

The Effects of an Exercise Program in Leukemia Patients

Purpose. To examine the feasibility of administering an in-hospital exercise program to acute leukemia patients undergoing chemotherapy. A secondary purpose explored the impact of exercise on selected physiological, psychological, and inflammatory markers. Methods. Ten patients, aged 18 to 50 years, diagnosed with acute leukemia or newly relapsed were assessed for body weight, height, body composition (skinfolds), cardiorespiratory endurance (total minutes on bicycle ergometer at 60% heart rate reserve), dynamic muscular endurance (Rocky Mountain Cancer Rehabilitation Institute protocol), fatigue (Revised Piper Fatigue Scale), depression (Center for Epidemiologic Studies Depression scale, National Institute of Mental Health questionnaire), and quality of life (Functional Assessment of Cancer Therapy—General) at baseline (within 3 days of diagnosis) and at the end of induction phase of treatment. Blood draws were taken at baseline, midpoint, and at the end of induction for analyses of inflammatory markers (Linco Luminex assay). Combined aerobic and strength training exercises were administered 3 times per week, twice daily, for 30 minutes. Paired-samples t-tests were used for the analyses of physiological and psychological parameters. One-way repeated measures analysis of variance was used for the analyses of inflammatory markers. Results. Significant improvements in cardiorespiratory endurance (P = .009, baseline 8.9 ± 8.8 minutes, postexercise intervention 17 ± 14.3 minutes) with significant reductions in total fatigue scores (P = .009, baseline 4.6 ± 1.7, postexercise intervention 1.8 ± 1.6) and depression scores (P = .023, baseline 19 ± 11.5, postexercise intervention 12 ± 8.2) were observed. Marginally significant decrease in interleukin-6 (IL-6; P = .059) with no significant changes in IL-10 (P = .223) or interferon-γ (P = .882) were observed. Conclusion. Administration of exercise to acute leukemia patients undergoing treatment is feasible. The exercise protocol used increased cardiovascular endurance, reduced fatigue and depression scores, and maintained quality of life. Although no significant change in inflammation was observed, a trend demonstrating a reduction in IL-6 and an increase in IL-10 warrants further investigation.

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Hematopoietic cell transplantation (HCT) is a life-saving treatment for patients with high-risk hematological malignancies. Prognostic measures to determine fitness for HCT are needed to inform decision-making and interventions. VO2peak is obtained by measuring gas exchange during cycle ergometry and has not been studied as a prognostic factor in HCT. Thirty-two autologous and allogeneic HCT patients underwent VO2peak and 6 Minute Walk (6MW) testing before HCT, and provided weekly symptom and health-related quality of life (HRQOL) assessments before HCT and concluding at Day 100. Twenty-nine patients completed pre-HCT testing. Pre-HCT VO2peak was positively correlated with pre-HCT 6MW (r=0.65, P<0.001) and negatively correlated with number of chemotherapy regimens and months of chemotherapy. Patients with lower VO2peak reported higher symptom burden and inferior HRQOL at baseline and during early post-HCT period. Patients with pre-HCT VO2peak <16 mL/kg/min had higher risk of mortality post HCT (entire cohort: hazard ratio (HR) 9.1 (1.75–47.0), P=0.01; allogeneic HCT patients only: HR 6.70 (1.29–34.75), P=0.02) and more hospitalized days before Day 100 (entire cohort: median 33 vs 19, P=0.003; allogeneic HCT patients only: median 33 vs 21, P=0.004). VO2peak pre-HCT is feasible and might predict symptom severity, HRQOL and mortality. Additional studies are warranted.