Martin W. Thompson

Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss

Weight loss remains the most common therapy advocated for reducing hepatic lipid in obesity and nonalcoholic fatty liver disease. Yet, reduction of body weight by lifestyle intervention is often modest, and thus, therapies which effectively modulate the burden of fatty liver but are not contingent upon weight loss are of the highest practical significance. However, the effect of aerobic exercise on liver fat independent of weight loss has not been clarified. We assessed the effect of aerobic exercise training on hepatic, blood, abdominal and muscle lipids in 19 sedentary obese men and women using magnetic resonance imaging and proton magnetic resonance spectroscopy (1H‐MRS). Four weeks of aerobic cycling exercise, in accordance with current physical activity guidelines, significantly reduced visceral adipose tissue volume by 12% (P < 0.01) and hepatic triglyceride concentration by 21% (P < 0.05). This was associated with a significant (14%) reduction in plasma free fatty acids (P < 0.05). Exercise training did not alter body weight, vastus lateralis intramyocellular triglyceride concentration, abdominal subcutaneous adipose tissue volume, 1H‐MRS–measured hepatic lipid saturation, or HOMA‐IR (homeostasis model assessment of insulin resistance; P > 0.05). Conclusion: These data provide the first direct experimental evidence demonstrating that regular aerobic exercise reduces hepatic lipids in obesity even in the absence of body weight reduction. Physical activity should be strongly promoted for the management of fatty liver, the benefits of which are not exclusively contingent upon weight loss. (HEPATOLOGY 2009.)

The influence of menstrual cycle phase on skeletal muscle contractile characteristics in humans

1 The influence of the different phases of the menstrual cycle on skeletal muscle contractile characteristics was studied in 19 regularly menstruating women. Muscle function was measured when (i) oestrogen and progesterone concentrations were low (menstruation), (ii) oestrogen was elevated and progesterone was low (late follicular phase), and (iii) oestrogen and progesterone were both elevated (luteal phase). 2 Maximal isometric quadriceps strength, fatiguability and electrically stimulated contractile properties were measured. Isokinetic knee flexion and extension strength and fatiguability were also assessed as well as handgrip strength. Menstrual cycle phases were confirmed through measurement of oestrogen, progesterone, follicle stimulating hormone and luteinising hormone. 3 No significant changes were found in any of the muscle function parameters throughout the menstrual cycle (n = 15). The muscle function measurements showed no significant correlations with any of the female reproductive hormone concentrations. 4 These results suggest that the fluctuations in female reproductive hormone concentrations throughout the menstrual cycle do not affect muscle contractile characteristics.

Sarcoplasmic reticulum function and muscle contractile character following fatiguing exercise in humans

1 This study examined the alterations in calcium release, calcium uptake and calcium ATPase activity of skeletal muscle sarcoplasmic reticulum in response to a bout of intense dynamic knee extensor exercise, and the relationship between these changes and alterations in muscle contractile characteristics in the human quadriceps. 2 In biopsy samples taken from the vastus lateralis, sarcoplasmic reticulum calcium release and calcium uptake were significantly depressed (P < 0.01 and 0.05, respectively) immediately following the exercise with no alteration in the sarcoplasmic reticulum Ca2+‐ATPase activity. 3 A 33 % reduction in the maximum voluntary isometric torque was found following the exercise, with reduced torques from electrically evoked isometric contractions at low frequencies of stimulation (10 and 20 Hz) but not at higher frequencies (50 and 100 Hz). 4 The depressed calcium release was correlated (P < 0.05) with a decreased ratio of torques generated at 20:50 Hz, indicating an involvement in low frequency fatigue; however, no correlations between the muscle relaxation times or rates of change of torque and calcium uptake were observed.

Cardiovascular strain impairs prolonged self-paced exercise in the heat.

It has been proposed that self‐paced exercise in the heat is regulated by an anticipatory reduction in work rate based on the rate of heat storage. However, performance may be impaired by the development of hyperthermia and concomitant rise in cardiovascular strain increasing relative exercise intensity. This study evaluated the influence of thermal strain on cardiovascular function and power output during self‐paced exercise in the heat. Eight endurance‐trained cyclists performed a 40 km simulated time trial in hot (35°C) and thermoneutral conditions (20°C), while power output, mean arterial pressure, heart rate, oxygen uptake and cardiac output were measured. Time trial duration was 64.3 ± 2.8 min (242.1 W) in the hot condition and 59.8 ± 2.6 min (279.4 W) in the thermoneutral condition (P < 0.01). Power output in the heat was depressed from 20 min onwards compared with exercise in the thermoneutral condition (P < 0.05). Rectal temperature reached 39.8 ± 0.3 (hot) and 38.9 ± 0.2°C (thermoneutral; P < 0.01). From 10 min onwards, mean skin temperature was ∼7.5°C higher in the heat, and skin blood flow was significantly elevated (P < 0.01). Heart rate was ∼8 beats min−1 higher throughout hot exercise, while stroke volume, cardiac output and mean arterial pressure were significantly depressed compared with the thermoneutral condition (P < 0.05). Peak oxygen uptake measured during the final kilometre of exercise at maximal effort reached 77 (hot) and 95% (thermoneutral) of pre‐experimental control values (P < 0.01). We conclude that a thermoregulatory‐mediated rise in cardiovascular strain is associated with reductions in sustainable power output, peak oxygen uptake and maximal power output during prolonged, intense self‐paced exercise in the heat.

Methodology and Baseline Characteristics for the Sarcopenia and Hip Fracture Study: A 5-Year Prospective Study

BACKGROUND Age-related hip fractures are associated with poor functional outcomes, resulting in substantial personal and societal burden. There is a need to better identify reversible etiologic predictors of suboptimal functional recovery in this group. METHODS The Sarcopenia and Hip Fracture (SHIP) study was a 5-year prospective cohort study following community-dwelling older persons admitted to three Sydney hospitals for hip fracture. Information was collected at baseline, and 4 and 12 months, including health status, quality of life, nutritional status, body composition, muscle strength, range of motion, gait velocity, balance, walking endurance, disability, cognition, depression, fear of falling, self-efficacy, social support, physical activity level, vision, and fall-related data, with residential status, disability, and mortality reassessed at 5 years. RESULTS 193 participants enrolled (81 +/- 8 years, 72% women). High levels of activities of daily living, disability and sedentariness were present prior to fracture. At admission, the cohort had high levels of chronic disease; 38% were depressed, 38% were cognitively impaired, and 26% had heart disease. Seventy-one percent of participants were sarcopenic, 58% undernourished, and 55% vitamin D deficient. Mobility, strength, and vision were severely impaired. There was little evidence that these comorbidities were either recognized or treated during hospitalization. Disability, sedentariness, malnutrition, and walking endurance predicted acute hospitalization length of stay. CONCLUSIONS The complex comorbidity, pre-existing functional impairment, and sedentary behavior in patients with hip fracture suggest the need for thorough screening and targeting of potentially reversible impairments. Rehabilitation outcomes are likely to be highly dependent on amelioration of these highly prevalent accompaniments to hip fracture.

Effect of short‐term starvation versus high‐fat diet on intramyocellular triglyceride accumulation and insulin resistance in physically fit men

It is currently believed that intramyocellular triglyceride (IMTG) accumulation and insulin resistance are a consequence of dietary fat ingestion and/or the elevated circulating lipid levels associated with chronic fat surplus. The purpose of this study was to compare the effect of short‐term starvation versus low‐carbohydrate (CHO)/high‐fat diet on IMTG accumulation and the development of insulin resistance in physically fit men. Intramyocellular triglyceride content, measured as intramyocellular lipid (IMCL) by proton magnetic resonance spectroscopy (1H‐MRS), and glucose tolerance/insulin sensitivity, assessed by frequently sampled intravenous glucose tolerance test (IVGTT), were determined after 67 h of: (a) water‐only starvation (S); and (b) very low‐CHO/high‐fat diet (LC). These diets had in common significant restriction of CHO availability but large differences in fat content. All results were compared with those measured after a mixed CHO diet (C). Dietary interventions were administered by cross‐over design. The level of dietary‐induced IMTG accumulation (P= 0.46), insulin resistance (P= 0.27) and glucose intolerance (P= 0.29) was not different between S and LC treatments. Intramyocellular triglyceride content and insulin sensitivity were negatively correlated (r=−0.63, P < 0.01). Therefore, whilst insulin resistance may be due to fat accumulation at a cellular level, in the integrated human organism this outcome is not exclusively a function of dietary fat intake. The comparable level of IMTG accumulation and insulin resistance following S and LC may suggest that these metabolic perturbations are largely a consequence of the increased lipolytic response associated with CHO restriction.

Muscle Triglyceride and Glycogen in Endurance Exercise Implications for Performance

The importance of muscle glycogen as a metabolic substrate in sustaining prolonged exercise is well acknowledged. Being stored in proximity to the site of contraction and able to sustain high rates of adenosine diphosphate (ADP) phosphorylation, glycogen is viewed as the primary fuel for the maintenance of exercise of a moderate to intense nature. As such, to ensure optimal exercise performance, endurance athletes are encouraged to maximise the availability of muscle glycogen through the ingestion of a high carbohydrate (CHO) diet prior to competition.The skeletal muscle cell also contains significant quantities of triglyceride. Recent improvements in the ability to measure these intramyocellular triglyceride (IMTG) stores have confirmed that IMTG acts as a significant fuel substrate during prolonged exercise. While early research of the role of muscle glycogen in endurance exercise provided clear prescriptive information for the endurance-trained athlete, no such direction for optimising exercise performance is yet apparent from research concerning IMTG.In this article, we review the processes of muscle glycogen and triglyceride storage and metabolism. Attention is given to the effects of short-term alterations in diet on muscle substrate, particularly IMTG storage, and the implications of this to endurance exercise performance and competition preparation. We demonstrate that like glycogen, IMTG formation may be relatively rapid, and its storage predominates under conditions that promote minimal glycogen formation. This observation suggests that the role of IMTG is to maintain a readily available substrate to ensure that physical activity of a moderate nature can be performed when glycogen availability is not optimal. Under these conditions, IMTG may offer a similar availability of energy as glycogen in the endurance-trained athlete. Given the potential value of this substrate, the possibility of maximising IMTG storage without compromising glycogen availability prior to competition is considered.

Central and peripheral fatigue during passive and exercise-induced hyperthermia.

PURPOSE Hyperthermia was induced during prolonged exercise (ExH) and passive heating (PaH) to isolate the influence of exercise on neuromuscular function during a maximal voluntary isometric contraction (MVC) of the quadriceps under heat stress. The influence of cardiovascular strain in limiting endurance performance in the heat was also examined. METHODS On separate days, eight males cycled to exhaustion at 60% maximal oxygen uptake or were immersed in a water bath (∼41°C) until rectal temperature (Tre) increased to 39.5°C. The ExH and PaH interventions were performed in ambient conditions of 38°C and 60% relative humidity with Tre reaching 39.8°C during exercise. Before (control) and after each intervention, voluntary activation and force production capacity were evaluated by superimposing an electrically stimulated tetanus during a 45-s MVC. RESULTS Force production decreased immediately after PaH and ExH compared with control, with the magnitude of decline being more pronounced after ExH (P < 0.01). Mean voluntary activation was also significantly depressed after both interventions (P < 0.01 vs control). However, the extent of decline in voluntary activation was maintained at ∼90% during both PaH and ExH MVC. This decline accounted for 41.5% (PaH) and 33.1% (ExH) of the decrease in force production. In addition, exhaustion coincided with a marked increase in HR (∼96% of maximum) and a decline in stroke volume (25%) and mean arterial pressure (10%) (P < 0.05). CONCLUSIONS The loss of force production capacity during hyperthermia originated from central and peripheral fatigue factors, with the combination of heat stress and previous contractile activity exacerbating the rate of decline. Thus, the observed significant rise in thermal strain in ExH and PaH impaired neuromuscular function and was associated with an exercise performance limiting increase in cardiovascular strain.

Rate and amplitude of adaptation to intermittent and continuous exercise in older men

PURPOSE This study determined the amplitude and rate of adaptation to 10 wk of continuous (CEx) and intermittent exercise (IEx) in a group of older men when the training intensity and total amount of work completed by each exercise group were the same. METHODS Ten healthy men were assigned to either a CEx (63 +/- 1 yr) or IEx (65 +/- 1 yr) group while a further five subjects (65 +/- 1 yr) acted as nonexercising controls (CON). The three groups (CEx, IEx, and CON) were matched for age, peak oxygen uptake (VO2peak), and cardiac output (Qpeak) before commencing training. The CEx group trained for 30 min at an intensity corresponding to 70-75% VO2peak, and the IEx group trained for a total exercise time of 30 min using intermittent exercise (60-s exercise, 60-s rest) at the same absolute intensity as the CEx group (CEx 112 +/- 5W; IEx 112 +/- 5W). The exercise groups trained three times per week and completed a similar amount of work during each training session (CEx, 199 +/- 9 kJ; IEx 195 +/- 9 kJ, P = 0.67). RESULTS The CEx and IEx groups had similar and significant amplitude increases in peak VO2, ventilation (VEpeak), power, Q, and SV after training. Peak VO2, Qpeak, SVpeak, and peak arteriovenous O2 difference for the CON group were unchanged. The change in VO2peak, peak ventilation, and peak power for CEx and IEx groups were best described by a linear model. Moreover, the CEx and IEx groups had the same rate of change in VO2peak (CEx: 0.02 +/- 0.00 L x min(-1) x wk(-1), IEx: 0.02 +/- 0.00 L x min(-1) x wk(-1), P = 0.32), VEpeak (CEx: 2.0 +/- 0.2 L x min(-1) x wk(-1), IEx: 1.2 +/- 0.5 L x min(-1) x wk(-1), P = 0.10), and peak power (CEx: 2.6 +/- 0.4 W x wk(-1), IEx: 2.6 +/- 0.4 W x wk(-1), P = 0.92). CONCLUSION These results suggest that the amplitude and rate of change of select adaptations in men aged 60-70 yr are independent of the mode of training (i.e., continuous or intermittent exercise) when the absolute training intensity and the total amount of work completed were similar.

Adaptations to skeletal muscle with endurance exercise training in the acutely fed versus overnight-fasted state.

Minimising carbohydrate (CHO) status in the peri-training period may accelerate the training adaptations normally observed. The aim of this study was to compare adaptations to endurance training undertaken in the acutely CHO fed and overnight-fasted states. Eight female and six male untrained, healthy participants: aged 26.6+/-5.8 years (mean+/-SD); height 174.7+/-7.6 cm; weight 75.3+/-11.4 kg; VO(2max) 3.48+/-0.67 l/min; were randomly divided into two training groups and undertook four weeks of five days per week endurance cycle ergometer training in either the overnight-fasted (FAST) or acutely fed (FED) state. FAST training had no effect on RER or plasma glucose, lactate and FFA concentrations during subsequent submaximal exercise. Training-induced changes in Vastus lateralis citrate synthase (CS) and 3-hydroxy-CoA dehydrogenase (HAD) activities were not different between training groups (P=0.655 and 0.549, respectively), but when the effect of gender was considered, men responded better to FAST and women responded better to FED. The FAST group showed a significantly greater training-induced increase in VO(2max) and resting muscle glycogen concentration than FED (P=0.014 and P=0.047 respectively), but there was no gender interaction. In conclusion, these results suggest that (a) meal ingestion prior to daily exercise can modify some of the exercise training-induced adaptations normally seen with endurance training compared to when daily exercise is undertaken in the overnight-fasted state; and (b) the extent of these adaptations in skeletal muscle differ slightly between men and women.