Klaus-Michael Braumann

Impact of aerobic training on immune-endocrine parameters, neurotrophic factors, quality of life and coordinative function in multiple sclerosis

In recent years it has become clear that multiple sclerosis (MS) patients benefit from physical exercise as performed in aerobic training but little is known about the effect on functional domains and physiological factors mediating these effects. We studied immunological, endocrine and neurotrophic factors as well as coordinative function and quality of life during an 8-week aerobic bicycle training in a waitlist control design. In the immune-endocrine study (1) 28 patients were included, the coordinative extension study (2) included 39 patients. Training was performed at 60% VO(2)max after determining individual exertion levels through step-by-step ergometry. Metabolic (lactate), endocrine (cortisol, adrendocortico-releasing hormone, epinephrine, norepinephrine), immune (IL-6, soluble IL-6 receptor), and neurotrophic (brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF)) parameters were compared from a prestudy and a poststudy endurance test at 60% VO(2)max for 30 min. In study (1), lowered lactate levels despite higher workload levels indicated a training effect. Disease-specific quality of life (as measured by the Hamburg Quality of Life Questionnaire for Multiple Sclerosis, HAQUAMS) significantly increased in the training group. No significant training effects were seen for endocrine and immune parameters or neurotrophins. In study (2), two out of three coordinative parameters of the lower extremities were significantly improved. In summary, low-level aerobic training in MS improves not only quality of life but also coordinative function and physical fitness.

Basal serum levels and reactivity of nerve growth factor and brain-derived neurotrophic factor to standardized acute exercise in multiple sclerosis and controls

Neurotrophins like brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are thought to play an important role in neuronal repair and plasticity. Recent experimental evidence suggests neuroprotective effects of these proteins in multiple sclerosis (MS). We investigated the response of serum NGF and BDNF concentrations to standardized acute exercise in MS patients and controls. Basal NGF levels were significantly elevated in MS. Thirty minutes of moderate exercise significantly induced BDNF production in MS patients and controls, but no differential effects were seen. We conclude that moderate exercise can be used to induce neutrophin production in humans. This may mediate beneficial effects of physical exercise in MS reported recently.

Endocrine and cytokine responses to standardized physical stress in multiple sclerosis

Since the earliest descriptions psychological and physical stress has been considered a controversial but potentially important factor in the onset and course of multiple sclerosis (MS). During recent years it has become clear that MS patients benefit from physical exercise as performed in aerobic training. As acute exercise has profound effects on immune and endocrine parameters we studied endocrine and immune response to standardized physical stress in MS within a study of aerobic training. Fifteen MS patients completed an eight-week aerobic training program, 13 patients were part of a wait-control group. Twenty healthy controls were recruited as well. A step-by-step bicycle ergometry was performed to determine individual exertion levels. For the endurance test patients exercised at 60% VO2 max for 30 min. Blood samples were drawn before, directly after and 30 min after completion of the exercise. Heart rate and lactate increased in all groups (p<.0001). We furthermore saw significant increases in endocrine parameters (epinephrine, norepinephrine, ACTH, and beta-endorphin; all p<.0001) in healthy individuals and in MS patients but without a differential effect. Whole-blood stimulated production of IFN-gamma (IFNgamma) was induced similarly in all groups (p<.01). TNF-alpha (TNFalpha) and IL-10 were less inducible in MS patients (trend). From these data we could not demonstrate a proinflammatory immune deviation in response to physical stress in MS. The observed trend of hyporesponsive TNFalpha and IL-10 responses in MS warrants further investigation.

Effects of a Physical Exercise Rehabilitation Group Program on Anxiety, Depression, Body Image, and Health-Related Quality of Life among Breast Cancer Patients

Background: Since physical exercise programs have the potential to help cancer patients regain physical fitness and may exert a range of positive consequences for recovery and psychological well-being, the impact of a physical exercise program was investigated in this prospective study. Patients and Methods: Women with primary nonmetastatic breast cancer after a minimum 4-week period post chemotherapy and/or radiotherapy completion were randomly assigned to one of 2 groups: intervention group (IG) (n = 30) and waiting group (WG) (n = 28). The 10-week twice weekly exercise group program consisted of gymnastics, movement games, relaxation, walking, and jogging. Anxiety, depression, body image, and quality of life were measured using standardized questionnaires. Maximal oxygen uptake (VO2max/kg) was assessed as a measure of physical fitness. Results: Patients in the IG improved significantly over time with regard to anxiety (p = 0.03, d = 0.45), depression (p = 0.05, d = 0.43), individual body image (p = 0.006, d = 0.44), and VO2max/kg (p < 0.001, d = 0.50), whereas no improvements were observed in the WG. However, this randomized controlled trial failed to demonstrate significant intervention effects in quality of life and social body image. Conclusions: This prospective study provided evidence for the effectiveness of a 10-week physical exercise intervention to significantly improve psychosocial wellbeing, individual body image, and physical fitness.

Health-related fitness and trainability in children with cystic fibrosis.

The objective of this study was to examine the effects of a supervised exercise training program performed during an in patient rehabilitation course on various attributes of health‐related fitness, e.g., flexibility, balance and coordination. 286 patients with CF, age range 6–18 years (11.8 ± 3.4 years), mean forced expiratory volume in 1 sec (FEV1 82.7 ± 22.3% predicted) were included. Patients performed the modified Munich fitness test (mMFT) to assess flexibility, balance, strength and coordination. To assess aerobic capacity a 6‐min walk‐test (6MWT) was performed. In addition, some of the patients performed an incremental exercise test on a bicycle ergometer using the Godfrey protocol before and after the exercise training program. The supervised training program consisted of 4–6 weeks of different sports activities 5 times per week. After training, pulmonary function showed a significant (P < 0.05) increase. All test items of the mMFT improved significantly (P < 0.05). Compared to healthy children test scores achieved from children with CF in the mMFT were lower but within a normal range. Our children with CF had a lower walk distance in 6MWT (P < 0.05) compared to healthy. Our findings clearly demonstrated benefits of a systematic exercise training program on components of physical fitness in patients with CF, with improvements of test‐tasks to predicted normal in some cases. The results from our study suggested that an exercise training program in CF should be focused on several aspects of physical fitness including all components of physical fitness, e.g. aerobic endurance, flexibility, balance and motor skills. Pediatr Pulmonol. 2008; 43:953–964.

Changes in plasma volume and red cell formation after a marathon competition.

SummaryThe purpose of this study was to investigate middle-term influences of a marathon race on plasma volume (PV) and red cell production. We performed the following measurements in the blood of 15 male athletes: haemoglobin ([Hb]), haematocrit (Hct), plasma protein concentration ([Prot]), plasma osmolality, sodium concentration ([Na+]), potassium concentration ([K+]), aldosterone concentration ([Aldo]), haptoglobin concentration ([Hpto]), and the reticulocyte count, as well as the calculation of relative changes in PV, 3 days before and on 3-consecutive days after a marathon race. By the 2nd day of recovery PV had increased by 16%. Plasma osmolality and [K+] remained constant, whereas [Na+] had decreased slightly 2 days after the competition and [Aldo] tended to be elevated 1 day after the competition. [Hpto] was low before and 1 day after the competition and increased on the following days. Reticulocyte count was unaffected 1 day after the race, but increased by 106% on the 2nd day and was still elevated after 3 days. The causes for higher post-marathon plasma volumes and reticulocyte counts could be in the complex variations in hormonal regulation, which have not yet been sufficiently investigated.

Improved Physical Performance after Treatment of Renal Anemia with Recombinant Human Erythropoietin

The physical performance of 12 anemic patients on renal dialysis was investigated following treatment of renal anemia with recombinant human erythropoietin (rhEPO; 40-120 U/kg, 3 times a week). Exercise intensity at a heart rate of 130 beats/min (PWC130) on a bicycle ergometer was assessed before rhEPO treatment, after reaching the target hematocrit (73 +/- 18 days), and in the maintenance phase (211 +/- 53 days). Hemoglobin concentrations measured at these time points were 7.3 +/- 1.2, 11.9 +/- 1.5, and 12.1 +/- 1.4 g/dl, respectively. PWC130 rose from 77 +/- 27 to 104 +/- 37 and 104 +/- 51 W, respectively. Aerobic threshold (i.e. blood lactic acid concentration of 2 mmol/l) shifted to higher workloads indicating improved muscle oxygen supply.

Differential cognitive effects of cycling versus stretching/coordination training in middle-aged adults.

OBJECTIVE Physical exercise has been linked to higher cognitive functioning and enhanced brain plasticity in aging humans. The most consistent positive effects have been reported for executive functions associated with frontal brain regions. In rodents, however, running has been shown to induce functional and structural changes in the hippocampus, a brain region known to be important for memory. It is still a matter of debate which cognitive functions are susceptible to exercise and whether an increase in cardiovascular fitness is beneficial for cognitive functioning. Moreover, little is known about the impact of exercise on cognition in middle-aged humans. METHOD Sixty-eight sedentary men and women between 40 and 56 years of age were randomly assigned to one of two training programs: aerobic endurance training (cycling) or nonendurance training (stretching/coordination). Both groups exercised twice a week for six months. Additionally, a sedentary control group was tested. At baseline and after six months, episodic memory, perceptual speed, executive functions, and spatial reasoning were assessed with standardized psychometric tests, and all participants underwent a cardiovascular fitness test. RESULTS Significant improvements in memory were observed in both the cycling and the stretching/coordination group as compared with the sedentary control group. The improvement in episodic memory correlated positively with the increase in cardiovascular fitness. The stretching/coordination training particularly improved selective attention as compared with the cycling training. CONCLUSIONS The results suggest that cardiovascular fitness has beneficial effects even in high-functioning middle-aged participants, but that these benefits are very specific to memory functions rather than a wider range of cognitive functions.

1-Set vs. 3-Set Resistance Training: A Crossover Study

This crossover study was conducted to investigate the effects of a 1-set and 3-set strength training program. The subjects were untrained men and women who were randomly signed into 1 of 3 groups: 10 subjects trained during the first 9 weeks (training period 1) with 1 set and 8–12 repetitions per set. After the break (9 weeks), they trained with 3 sets and 8–12 repetitions in training period 2. Twelve subjects started with the 3-set program and continued with the 1-set regime after the break. The control group (n = 7) did not train. The subjects were tested on 1 repetition maximum (1RM) for the biceps curl, leg press (unilateral: left and right), and bench press. Analysis of the data was done in a sampled manner for each strength training program (1-set and 3-set). The 1-set (n = 22) and 3-set (n = 22) programs led to significantly (p < 0.05) improved 1RM performances in every exercise. The relative improvements (%) for the 1RM were significantly higher during the 3-set program for the biceps curl and the bench press compared with the 1-set program. The control group exhibited no changes in any of the tested parameters over the course of this study. The design of this study allowed insight into the effects of different strength training volume without any genetical variations. The same subjects improved their 1RM during the 3-set program by 2.3 kg (biceps curl; corresponding effect size = 0.24), 8.9 kg (leg press right; 0.30), 10.9 kg (leg press left; 0.28), and 2.5 kg (bench press; 0.09) more than during the 1-set program. Depending on the goals of each trainee, these differences between the effects of different strength training volumes indicate that it may be worth spending more time on working out with a 3-set strength training regime.

Effects of footwear on treadmill running biomechanics in preadolescent children

While recent research debates the topic of natural running in adolescents and adults, little is known about the influence of footwear on running patterns in children. The purpose of this study was to compare shod and barefoot running gait biomechanics in preadolescent children. Kinematic and ground reaction force data of 36 normally developed children aged 6-9 years were collected during running on an instrumented treadmill. Running conditions were randomized for each child in order to compare barefoot running with two different shod conditions: a cushioned and a minimalistic running shoe. Primary outcome was the ankle angle at foot strike. Secondary outcomes were knee angle, maximum and impact ground reaction forces, presence of rear-foot strike, step width, step length and cadence. Ankle angle at foot strike differed with statistical significance (p < 0.001) between conditions. Running barefoot reduced the ankle angle at foot strike by 5.97° [95% CI, 4.19; 7.75] for 8 kmh(-1) and 6.18° [95% CI, 4.38; 7.97] for 10 kmh(-1) compared to the cushioned shoe condition. Compared to the minimalistic shoe condition, running barefoot reduced the angle by 1.94° [95% CI, 0.19°; 3.69°] for 8 kmh(-1) and 1.38° [95% CI, -3.14°; 0.39°] for 10 kmh(-1). Additionally, using footwear significantly increased maximum and impact ground reaction forces, step length, step width and rate of rear-foot strike. In conclusion, preadolescent running biomechanics are influenced by footwear, especially by cushioned running shoes. Health professionals and parents should keep this in mind when considering footwear for children.