Yagesh Bhambhani

Cerebral oxygenation declines at exercise intensities above the respiratory compensation threshold.

During incremental exercise PaCO2 and PETCO2 begin to decline at the respiratory compensation threshold (RCT-GEX). Since PaCO2 alters cerebral blood flow it was hypothesized that there would be a systematic decline in cerebral oxygenation (Cox) measured by near infrared spectroscopy above the RCT (RCT-NIRS). Cardiorespiratory and NIRS responses were simultaneously monitored from the left frontal lobe during incremental exercise in 17 men. All subjects showed a decline in Cox above the RCT-GEX with a 20-40 s delay. Significant differences (P<0.01) were observed between the RCT-GEX and RCT-NIRS for time (9.83 versus 10.39 min), power (198 versus 212 W) and oxygen uptake (2.31 versus 2.43 L min-1). Intra-class correlations for power and absolute VO2 were 0.97 and 0.98, respectively. Bland-Altman analysis revealed no outliers for any of the variables. The results suggested that the decrease in Cox observed above the RCT was most likely due to a reduction in cerebral blood flow mediated by a decline in PaCO2. This decline in Cox could reduce neuronal activation thereby limiting maximal exercise capacity in healthy subjects.

Physiology of Wheelchair Racing in Athletes with Spinal Cord Injury

Wheelchair racing is one of the most popular sporting activities of individuals with spinal cord injury. Athletes with this impairment have unique changes in metabolic, cardiorespiratory, neuromuscular and thermoregulatory systems, which reduce their overall physiological capacity compared with able-bodied individuals or individuals with other types of impairments. This review on spinal cord injury: (i) presents the International Stoke Mandeville Games Federation classification of wheelchair athletes; (ii) describes methods commonly used to characterise anaerobic and aerobic fitness; (iii) presents the findings of physiological studies that have evaluated wheelchair racing performance; (iv) identifies the risks associated with temperature regulation when competing in wheelchair races; and (v) discusses special conditions that can influence wheelchair racing performance.Currently there is limited research that has examined the relationship between sprint or distance wheelchair racing performance and the anaerobic and aerobic components of physical fitness. Although the descriptive evidence indicates that the profiles of these athletes reflect their training and participation in these specific events, the association between their physiological profiles and real or simulated racing performance is unclear. The generally accepted concept that high values of aerobic and anaerobic power are strongly correlated with endurance and sprint racing performance, respectively, are not necessarily true in this population. Athletes with spinal cord injury have an impaired thermoregulatory capacity, because the compromised autonomic and somatic nervous system functions disrupt control of skin blood flow and sweating below the level of the lesion. As a result, they may be more susceptible to hyperthermia during distance wheelchair racing performance. Wheelchair athletes should follow recommendations advocated for able-bodied individuals to minimise their risks of heat stress during competition. Many athletes with quadriplegia voluntarily induce autonomic dysreflexia (commonly known as boosting) during distance racing events to improve performance. Experimental evidence indicates that boosting can improve performance time by 10% in elite wheelchair marathon racers during simulated racing, as a result of increased oxygen utilisation in the boosted state. However, since boosting can be dangerous to health, the International Paralympic Committee has banned athletes from voluntarily inducing it during competition. The use of antigravity suits to increase lower-body positive pressure can increase the peak oxygen uptake, cardiac output and stroke volume. However, the use of abdominal binders does not influence these physiological responses. An effect of either of these techniques on wheelchair racing performance has not been demonstrated.

Detection of ventilatory threshold using near infrared spectroscopy in men and women.

The onset of anaerobic (lactate) metabolism during incremental exercise, which may be a result of an imbalance between tissue oxygen supply and demand, has been associated with the gas exchange ventilatory threshold (VT). This study was designed to examine whether near infrared spectroscopy (NIRS) could be used to detect the VT in healthy subjects. Twenty-one men and 19 women completed incremental cycle ergometry during which NIRS measurements were obtained from the right vastus lateralis and gas exchange measurements were monitored simultaneously using a metabolic cart. The VT was identified from the metabolic data by the V-slope method and from NIRS data as the intensity at which tissue absorbency crossed the resting baseline value observed immediately prior to the initiation of exercise. Pearson correlations for the relative oxygen uptake and power output observed for the two methods of detecting VT were 0.90 and 0.88, respectively, in men and 0.89 and 0.86, respectively, in women (P < 0.01). No significant differences were observed between the two methods of detecting VT for any of the physiological responses (P > 0.05). No significant (P > 0.05) gender differences were observed in muscle oxygenation values at the VT, 32% in men and 38% in women. These results validate the use of NIRS as an alternate noninvasive method for detecting VT during cycle exercise in healthy subjects.

L-Arginine as a Potential Ergogenic Aidin Healthy Subjects

Dietary supplements containing L-arginine, a semi-essential amino acid, are one of the latest ergogenic aids intended to enhance strength, power and muscle recovery associated with both aerobic and resistance exercise. L-arginine is claimed to promote vasodilation by increasing nitric oxide (NO) production in the active muscle during exercise, improving strength, power and muscular recovery through increased substrate utilization and metabolite removal, such as lactate and ammonia. Research on L-arginine has recently tested this hypothesis, under the assumption that it may be the active compound associated with the vasodilator effects of NO. There were only five acute studies retrieved from the literature that evaluated exercise performance after L-arginine supplementation, three of which reported significant improvements. Regarding studies on chronic effects, eight studies were encountered: four reported enhancements in exercise performance, whilst four reports showed no changes. Whether these improvements in exercise performance — regardless of the aerobic or anaerobic nature of the exercise — can be associated with increases in NO production, has yet to be demonstrated in future studies. Low oral doses (20 g) are well tolerated and clinical side effects are rare in healthy subjects. In summary, it is still premature to recommend dietary supplements containing L-arginine as an ergogenic aid for healthy physically active subjects.

THE EFFECTS OF ACUTE EXERCISE ON PULSATILE LH RELEASE IN HIGH-MILEAGE MALE RUNNERS

Evidence suggests that acute exercise and endurance training has a suppressive effect on the hypothalamic—pituitary—gonadal (HPG) axis in men and women. To determine if training and acute exercise influence the neuroendocrine regulation of the HPG axis in men we examined pulsatile LH release in six male endurance runners with a training volume of at least 80 km per week, and compared this with values in six age‐matched sedentary controls. Blood samples were obtained through an indwelling i.v. cannula from the subjects at 15‐min intervals for 6 h following 24 h without significant physical activity and again, in the runners, following 60 min of running at a speed equivalent to 5% below the anaerobic threshold. Mean LH pulse frequency and amplitude, as well as areas under the LH pulses and total LH curve, were calculated but only the mean post‐exercise area under the total LH curve area was significantly lower than basal values (P<0.05) following exercise compared with the resting values in runners. Other measures of LH release did not change with acute exercise. Basal and pre‐exercise testosterone levels were also measured and found to be at the lower end of normal men. The mean pre‐exercise serum testosterone levels were significantly higher than basal levels. Mean testosterone levels, mean pulse amplitude, and mean area under the LH curve were significantly lower in resting runners than in the controls. The data suggest that exercise induces a general lowering of LH levels but does not inhibit LH pulsatile release. An anticipatory increase in serum testosterone occurred before exercise.

Testosterone, cortisol and catecholamine responses to exercise stress and autonomic dysreflexia in elite quadriplegic athletes

Episodes of short high intensity exercise are associated with an increase in circulating total testosterone (T) in men. Mechanisms may include hemoconcentration, decreased metabolic clearance and/or increased synthesis. Beta-blockade abolishes the T response suggesting a direct beta-adrenergic effect on the testes. Some spinal cord injured (SCI) athletes deliberately induce autonomic dysreflexia (boosting) to enhance performance. Associated with this practice are elevated catecholamine (CA) levels and exaggerated responses to serum catecholamine levels. Since basal T levels are reported to be normal in the SCI male, the T response to acute high intensity exercise might be expected to be exaggerated by boosting and associated elevated CA levels. The acute exercise T response has not been examined in SCI men to date. To determine whether the increased CA values associated with boosting enhanced the exercise-induced T elevation we measured circulating levels of T, Cortisol (C), norepinephrine (NE) and epinephrine (E) before and after maximal exertion and a simulated 7.5 km race with and without boosting in eight elite quadriplegic athletes. Maximal incremental exercise and a simulated 7.5 km race resulted in a rise in T similar to able bodied men under normal exercise conditions. Under boosted conditions the rise in T was eliminated while NE levels were significantly elevated above unboosted levels. The data may suggest an inhibitory role for CA on T production or release under conditions of extreme stress. Other possible mechanisms include C induced suppression, impaired gonadotropin stimulation of the Leydig cell and CA mediated alterations in gonadal blood supply.

Cerebrovascular Reactivity Impairment after Sport-Induced Concussion

PURPOSE This study evaluated cerebrovascular reactivity (CVR) after a sport-induced concussion, also called mild traumatic brain injury (mTBI), by monitoring middle cerebral artery blood velocity (vMCA) with transcranial Doppler ultrasonography and simultaneous end-tidal carbon dioxide (PETCO(2)) measurements. METHODS Thirty-one athletes (16-25 yr old) participated in this study. The participants were divided into two groups-healthy (n = 21) and mTBI (n = 10). Participants in the mTBI group suffered an mTBI within the last 7 d (x- = 4.5 ± 1.1 d). Outcome measures included vMCA and PETCO(2) in response to breath holding (5 × 20 s, 40-s rest) and hyperventilation (5 × 20 s, 40-s rest). RESULTS Resting vMCA values between groups were not significantly different. Percentage change of vMCA was significantly different after the recovery period of the second hyperventilation (P = 0.034). mTBI subjects failed to return to resting levels after each breath hold. PETCO(2) changes mirrored the vMCA changes. CONCLUSIONS These data suggest that normal CVR responses may be disrupted in the days immediately after occurrence of mTBI. Transcranial Doppler ultrasonography combined with expired gas measurements provides a useful method for assessing CVR impairment after mTBI. Further research, including serial monitoring after mTBI and analysis of CVR response to exercise, is warranted before any firm conclusions can be drawn.

A brief review of the use of near infrared spectroscopy with particular interest in resistance exercise.

There is growing interest in resistance training, but many aspects related to this type of exercise are still not fully understood. Performance varies substantially depending on how resistance training variables are manipulated. Fatigue is a complex phenomenon usually attributed to central (neuronal) and/or peripheral (muscular) origin. Cerebral oxygenation may be associated with the decision to stop exercise, and muscle oxygenation may be related to resistance training responses. Near infrared spectroscopy (NIRS) is a non-invasive optical technique used to monitor cerebral and muscle oxygenation levels. The purpose of this review is to briefly describe the NIRS technique, validation and reliability, and its application in resistance exercise. NIRS-measured oxygenation in cerebral tissue has been validated against magnetic resonance imaging during motor tasks. In muscle tissue, NIRS-measured oxygenation was shown to be highly related to venous oxygen saturation and muscle oxidative rate was closely related to phosphocreatine resynthesis, measured by 31P-magnetic resonance spectroscopy after exercise. The test-retest reliability of cerebral and muscle NIRS measurements have been established under a variety of experimental conditions, including static and dynamic exercise. Although NIRS has been used extensively to evaluate muscle oxygenation levels during aerobic exercise, only four studies have used this technique to examine these changes during typical resistance training exercises. Muscle oxygenation was influenced by different resistance exercise protocols depending on the load or duration of exercise, the number of sets and the muscle being monitored. NIRS is a promising, non-invasive technique that can be used to evaluate cerebral and muscle oxygenation levels simultaneously during exercise, thereby improving our understanding of the mechanisms influencing performance and fatigue.

Muscle oxygenation during incremental arm and leg exercise in men and women

Abstract The purpose of this study was to compare the rates of muscle deoxygenation in the exercising muscles during incremental arm cranking and leg cycling exercise in healthy men and women. Fifteen men and 10 women completed arm cranking and leg cycling tests to exhaustion in separate sessions in a counterbalanced order. Cardiorespiratory measurements were monitored using an automated metabolic cart interfaced with an electrocardiogram. Tissue absorbency was recorded continuously at 760 nm and 850 nm during incremental exercise and 6 min of recovery, with a near infrared spectrometer interfaced with a computer. Muscle oxygenation was calculated from the tissue absorbency measurements at 30%, 45%, 60%, 75% and 90% of peak oxygen uptake (V˙O2) during each exercise mode and is expressed as a percentage of the maximal range observed during exercise and recovery (%Mox). Exponential regression analysis indicated significant inverse relationships (P < 0.01) between %Mox and absolute V˙O2 during arm cranking and leg cycling in men (multiple R = −0.96 and −0.99, respectively) and women (R =−0.94 and −0.99, respectively). No significant interaction was observed for the %Mox between the two exercise modes and between the two genders. The rate of muscle deoxygenation per litre of V˙O2 was 31.1% and 26.4% during arm cranking and leg cycling, respectively, in men, and 26.3% and 37.4% respectively, in women. It was concluded that the rate of decline in %Mox for a given increase in V˙O2 between 30% and 90% of the peak V˙O2 was independent of exercise mode and gender.

Opioid prescriptions in canadian workers' compensation claimants: prescription trends and associations between early prescription and future recovery.

Study Design. Historical cohort study. Objective. We investigated the prescription of opioids in injured Canadian workers to determine recent trends in use and the association between early prescription and future recovery. Summary of Background Data. Opioid analgesia is effective for reducing chronic nonmalignant pain, and opioid prescriptions for musculoskeletal pain seem to have increased over the past years. However, recent evidence indicates early opioid use may be associated with delayed recovery in patients with back pain. Methods. Data were extracted from the Alberta Workers’ Compensation Board administrative database, and information was obtained on all time loss claims for sprains, strains, fractures, dislocations, amputations, or burns between January 1, 2000 and December 31, 2005. Information on all narcotic prescriptions was obtained along with demographic data and duration of time loss benefits. Injury severity was controlled for via nature of injury coding. Analysis included multivariable logistic and Cox regression. Results. Data were obtained for 137,175 subjects. The majority were males (∼70%) with back sprains (∼35%), and a mean age of 37 years. Between the years 2000 and 2005, all opioid prescriptions within the first year of claim decreased from 11.4% of claimants to 8.3%. Older males with fractures, dislocations, or amputations were more likely to receive narcotics. Claimants receiving early opioid prescriptions experienced delayed suspension of benefits. However, this association was also seen in claimants prescribed early non-narcotic analgesics. Discussion. Prescriptions for opioid analgesia appear to be decreasing within workers’ compensation claimants in Alberta, Canada. As expected, claimants with more severe injuries were more likely to receive opioids. An association was observed between early opioid prescription and delayed recovery, however, this is likely explained by pain severity or other unmeasured confounders.