Yiannis Koutedakis

Plasma amino acid concentrations in the overtraining syndrome: possible effects on the immune system.

Overtraining and long-term exercise are associated with an impairment of immune function. We provide evidence in support of the hypothesis that the supply of glutamine, a key fuel for cells of the immune system, is impaired in these conditions and that this may contribute to immunosuppression. Plasma glutamine concentration was decreased in overtrained athletes and after long-term exercise (marathon race) and was increased after short-term, high intensity exercise (sprinting). Branched chain amino acid supplementation during long-term exercise was shown to prevent this decrease in the plasma glutamine level. Overtraining was without effect on the rate of T-lymphocyte proliferation in vitro or on the plasma levels of interleukin-1 and -6, suggesting that immune function is not impaired in this condition. Given the proposed importance of glutamine for cells of the immune system, it is concluded that the decrease in plasma glutamine concentration in overtraining and following long-term exercise, and not an intrinsic defect in T lymphocyte function, may contribute to the immune deficiency reported in these conditions.

Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function

Abstract Context: Electronic cigarettes (e-cigarettes) are becoming increasingly popular yet their effects on health remain unknown. Objective: To conduct the first comprehensive and standardized assessment of the acute impact of active and passive e-cigarette smoking on serum cotinine and lung function, as compared to active and passive tobacco cigarette smoking. Materials and methods: Fifteen smokers (≥15 cigarettes/day; seven females; eight males) and 15 never-smokers (seven females; eight males) completed this repeated-measures controlled study. Smokers underwent a control session, an active tobacco cigarette (their favorite brand) smoking session and an active e-cigarette smoking session. Never-smokers underwent a control session, a passive tobacco cigarette smoking session and a passive e-cigarette smoking session. Serum cotinine, lung function, exhaled carbon monoxide and nitric oxide were assessed. The level of significance was set at p ≤ 0.001 to adjust for multiple comparisons. Results: e-Cigarettes and tobacco cigarettes generated similar (p > 0.001) effects on serum cotinine levels after active (60.6 ± 34.3 versus 61.3 ± 36.6 ng/ml) and passive (2.4 ± 0.9 versus 2.6 ± 0.6 ng/ml) smoking. Neither a brief session of active e-cigarette smoking (indicative: 3% reduction in FEV1/FVC) nor a 1 h passive e-cigarette smoking (indicative: 2.3% reduction in FEV1/FVC) significantly affected the lung function (p > 0.001). In contrast, active (indicative: 7.2% reduction in FEV1/FVC; p < 0.001) but not passive (indicative: 3.4% reduction in FEV1/FVC; p = 0.005) tobacco cigarette smoking undermined lung function. Conclusion: Regarding short-term usage, the studied e-cigarettes generate smaller changes in lung function but similar nicotinergic impact to tobacco cigarettes. Future research should target the health effects of long-term e-cigarette usage, including the effects of nicotine dosage.

Inspiratory muscle training improves rowing performance

PURPOSE To investigate the effects of a period of resistive inspiratory muscle training (IMT) upon rowing performance. METHODS Performance was appraised in 14 female competitive rowers at the commencement and after 11 wk of inspiratory muscle training on a rowing ergometer by using a 6-min all-out effort and a 5000-m trial. IMT consisted of 30 inspiratory efforts twice daily. Each effort required the subject to inspire against a resistance equivalent to 50% peak inspiratory mouth pressure (PImax) by using an inspiratory muscle training device. Seven of the rowers, who formed the placebo group, used the same device but performed 60 breaths once daily with an inspiratory resistance equivalent to 15% PImax. RESULTS The inspiratory muscle strength of the training group increased by 44 +/- 25 cm H2O (45.3 +/- 29.7%) compared with only 6 +/- 11 cm H2O (5.3 +/- 9.8%) of the placebo group (P < 0.05 within and between groups). The distance covered in the 6-min all-out effort increased by 3.5 +/- 1.2% in the training group compared with 1.6 +/- 1.0% in the placebo group (P < 0.05). The time in the 5000-m trial decreased by 36 +/- 9 s (3.1 +/- 0.8%) in the training group compared with only 11 +/- 8 s (0.9 +/- 0.6%) in the placebo group (P < 0.05). Furthermore, the resistance of the training group to inspiratory muscle fatigue after the 6-min all-out effort was improved from an 11.2 +/- 4.3% deficit in PImax to only 3.0 +/- 1.6% (P < 0.05) pre- and post-intervention, respectively. CONCLUSIONS IMT improves rowing performance on the 6-min all-out effort and the 5000-m trial.

The dancer as a performing athlete: physiological considerations.

The physical demands placed on dancers from current choreography and performance schedules make their physiology and fitness just as important as skill development. However, even at the height of their professional careers, dancers’ aerobic power, muscular strength, muscular balance, bone and joint integrity are the ‘Achilles heels’ of the dance-only selection and training system. This partly reflects the unfounded view, shared by sections of the dance world, that any exercise training that is not directly related to dance would diminish dancers’ aesthetic appearances.Given that performing dance itself elicits only limited stimuli for positive fitness adaptations, it is not surprising that professional dancers often demonstrate values similar to those obtained from healthy sedentary individuals of comparable age in key fitness-related parameters. In contrast, recent data on male and female dancers revealed that supplementary exercise training can lead to improvements of such fitness parameters and reduce incidents of dance injuries, without interfering with key artistic and aesthetic requirements. It seems, however, that strict selection and training regimens have succeeded in transforming dance to an activity practised by individuals who have selectively developed different flexibility characteristics compared with athletes. Bodyweight targets are normally met by low energy intakes, with female dance students and professional ballerinas reported to consume below 70% and 80% of the recommended daily allowance of energy intake, respectively, while the female athlete ‘triad’ of disordered eating, amenorrhoea and osteoporosis is now well recognised and is seen just as commonly in dancers.An awareness of these factors will assist dancers and their teachers to improve training techniques, to employ effective injury prevention strategies and to determine better physical conditioning. However, any change in the traditional training regimes must be approached cautiously to ensure that the aesthetic content of the dance is not affected by new training techniques. Since physiological aspects of performing dance have been viewed primarily in the context of ballet, further scientific research on all forms of dance is required.

The Effect of Muscle-Damaging Exercise on Blood and Skeletal Muscle Oxidative Stress : Magnitude and Time-Course Considerations

The aim of this article is to present the effects of acute muscle-damaging exercise on oxidative stress/damage of animal and human tissues using a quantitative approach and focusing on the time-course of exercise effects. The reviewed studies employed eccentric contractions on a dynamometer or downhill running. The statistical power of each study to detect a 20% or 40% post-exercise change compared with pre-exercise value in each oxidative stress/damage biomarker was calculated. Muscle-damaging exercise can increase free radical levels and augment oxidation of lipids, proteins, glutathione and possibly DNA in the blood. In contrast, the effect of muscle-damaging exercise on concentration of antioxidants in the blood, except for glutathione, was little. Muscle-damaging exercise induces oxidative stress/damage in skeletal muscle, even though this is not fully supported by the original statistical analysis of some studies. In contrast, muscle-damaging exercise does not appear to affect — at least to similar extent as the oxidative stress/ damage markers — the levels of antioxidants in skeletal muscle. Based on the rather limited data available, the oxidative stress response of skeletal muscle to exercise was generally independent of muscle fibre type. Most of the changes in oxidative stress/damage appeared and were sustained for days after muscledamaging exercise. The major part of the delayed oxidative stress/damage production that follows muscle-damaging exercise probably comes from phagocytic cells that are activated and recruited to the site of the initial damage. A point that emerged and potentially explains much of the lack of consensus among studies is the low statistical power of many of them. In summary, muscle-damaging exercise can increase oxidative stress/damage in blood and skeletal muscle of rats and humans that may persist for and/or appear several days after exercise.

Association of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis.

Objective Patients with rheumatoid arthritis (RA) are characterized by reduced physical activity and increased morbidity and mortality from cardiovascular disease (CVD). The aim of this study was to investigate associations between levels of physical activity and CVD risk profile in RA patients. Methods Levels of physical activity were assessed in 65 RA patients (43 females). Using the International Physical Activity Questionnaire, patients were allocated into three groups: active, moderately active and inactive. Anthropometric characteristics, RA activity/severity, multiple classical and novel CVD risk factors and 10-year CVD event probability were assessed and compared among the three groups. Results Significant differences were detected among groups in systolic blood pressure (P = 0.006), cholesterol (P < 0.001), low-density lipoprotein (P = 0.01), homeostasis model assessment (P = 0.001), type-1 plasminogen activator inhibitor antigen (P < 0.001), tissue-type plasminogen activator antigen (P = 0.019), homocysteine (P = 0.027), fibrinogen (P = 0.001), apolipoprotein B (P = 0.002) and von Willebrand Factor (P = 0.001), with a consistent deterioration from the physically active to the physically inactive group. Multivariate analysis of variance revealed that levels of physical activity were significantly associated with the differences in all of the above variables (P < 0.05) after adjustment for age, weight, sex, smoking status, as well as RA disease activity and severity. Conclusion This cross-sectional study suggests that physically inactive RA patients have significantly worse CVD risk profile compared with physically active patients. The possible beneficial impact of increased physical activity, including structured exercise, to the CVD risk of RA patients needs to be accurately assessed in prospective studies. Eur J Cardiovasc Prev Rehabil 16:188-194

Obesity in rheumatoid arthritis

Obesity is a major threat for public health and its study has attracted significant attention in the general population, predominantly due to its association with significant metabolic and cardiovascular complications. In RA research, BMI is frequently reported as a demographical variable, but obesity, as such, has received little interest. This is surprising, in view of the clear associations of obesity with other arthritides, particularly OA, but also in view of the now-clear association of RA with increased cardiovascular morbidity and mortality. In this review, we summarize the studies that have looked into obesity in the RA population, evaluate their findings, identify knowledge gaps and propose directions for future research. We also pose a question of high clinical and research significance: is the use of BMI still a valid way of assessing obesity in RA?

Greek adolescents, fitness, fatness, fat intake, activity, and coronary heart disease risk

Background: Percutaneous central venous lines (long lines) are commonly used in neonatal practice. The position of these lines is important, because incorrect placement may be associated with complications. Aims: To determine whether the addition of radio-opaque contrast material improves the localisation of long line tips over plain radiography. Methods: Radiographs taken to identify long line position were identified in two periods; 106 radiographs without contrast taken between October 1999 and August 2000, and 96 radiographs with contrast between September 2001 and July 2002. Two observers independently reviewed each radiograph to identify the position of the line tip. The formal radiology report was recorded as a third observer. Results: The use of contrast increased the proportion of radiographs in which all observers reported they could see the long line tip (53 (55%) v 41 (39%)). It also increased the proportion where they agreed on anatomical position (57 (59%) v 39 (37%)) and there was a higher kappa coefficient for agreement (0.56 v 0.33). Conclusions: The use of contrast while taking radiographs for the localisation of long line position improves the likelihood that an observer can see a long line tip and reduces inter-observer variability. Even using contrast, precise localisation of a long line tip can be difficult.

Effects of exercise and physical activity on depression

IntroductionDepression is a very prevalent mental disorder affecting 340 million people globally and is projected to become the leading cause of disability and the second leading contributor to the global burden of disease by the year 2020.AimIn this paper, we review the evidence published to date in order to determine whether exercise and physical activity can be used as therapeutic means for acute and chronic depression. Topics covered include the definition, classification criteria and treatment of depression, the link between β-endorphin and exercise, the efficacy of exercise and physical activity as treatments for depression, properties of exercise stimuli used in intervention programs, as well as the efficacy of exercise and physical activity for treating depression in diseased individuals.ConclusionsThe presented evidence suggests that exercise and physical activity have beneficial effects on depression symptoms that are comparable to those of antidepressant treatments.

Equal volumes of high and low intensity of eccentric exercise in relation to muscle damage and performance.

We examined differences in muscle damage and muscle performance perturbations in relation to the same volumes of high (HI) and low intensity (LI) of eccentric exercise. Untrained young healthy men (n = 12) underwent 2 isokinetic quadriceps eccentric exercise sessions, 1 on each randomly selected leg, separated by a 2-week interval. In the first session subjects performed HI exercise (i.e., 12 sets of 10 maximal voluntary efforts). In the second session, volunteers were subjected to continuous exercise of LI (50% of peak torque) until the total work done was approximately equal to that generated during HI. Muscle damage (serum creatine kinase concentration [CK], delayed onset of muscle soreness, and range of motion) and muscle performance (eccentric [EPT] and isometric peak torque [IPT]) indicators were assessed pre-exercise and 24, 48, 72, and 96 hours postexercise. Compared to baseline data, changes in muscle damage indicators were significantly different (p < 0.05) at almost all post-exercise time points in both conditions. However, apart from the significant elevation of CK at 24 hours after HI (p < 0.05), no other significant differences were observed between the 2 exercise conditions (p > 0.05). The main finding in relation to muscle performance was that decrements following HI exercise were significantly greater (p < 0.05) compared to LI. Compared with baseline data, the EPT values following HI and LI exercise were as follows: 24 hours, 72.1% vs. 92%; 48 hours, 81.9% vs. 94.8%; 72 hours, 77.7% vs. 100.6%; 96 hours, 86.8% vs. 107.9%. The corresponding data for IPT were as follows: 24 hours, 86.4% vs. 102.8%; 48 hours, 84.2% vs. 107%; 72 hours, 84.8% vs. 109.2%; 96 hours, 86.8% vs. 114.4%. These results indicate that matching volumes of HI and LI eccentric exercise have similar effects on muscle damage, but HI has a more prominent effect on muscle performance.