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1.
Acute Neuromuscular Response to Team Sports-Specific Running, Resistance, and Concurrent Training: A Crossover Study.
Cross, R, Lovell, R, Marshall, PW, Siegler, J
Medicine and science in sports and exercise. 2022;(3):456-465
Abstract
PURPOSE This study aimed to examine the changes in muscle contractile function, voluntary activation, and muscle damage after lower limb resistance training (RT), intermittent sprint exercise, and concurrent training (CT). METHODS Ten male, recreational team sport athletes with a history of RT participated in a randomized crossover study involving an intermittent sprint protocol (ISP), lower limb RT, and CT (ISP and RT separated by 1 h). Before (PRE), immediately after (POST), 24 h and 48 h after each exercise condition, quadriceps muscle activation, voluntary activation, muscle contractile function (evoked twitch responses), creatine kinase, muscle soreness, and Profile of Mood States (POMS)-fatigue were recorded. RESULTS Quadriceps contractile function was hampered in all conditions, with a significantly greater decline observed POST RT (58.4% ± 18.0%) and CT (54.8% ± 8.6%) compared with ISP (35.9% ± 10.7%, P < 0.05), recovering at 48 h after all exercise conditions. POMS-fatigue ratings increased at POST in all conditions with CT and ISP eliciting the greatest increase, returning to baseline 48 h after all exercise conditions. Quadriceps muscle soreness remained elevated from PRE at 48 h after all exercise conditions. No changes across time were observed for voluntary activation and quadriceps surface EMG amplitude after any exercise condition. The volume and load lifted in the RT session was unaffected by previous intermittent exercise (ISP) in CT. CONCLUSIONS RT impairs contractile function, which is not exacerbated when performed 1 h after the ISP. Contractile function after all exercise conditions displayed the same recovery profile (48 h) despite the postexercise decrement being smaller after the ISP compared with RT and CT. Previous intermittent sprint exercise does not negatively affect the volume of exercise performed in a lower limb RT session.
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The Acute Effects of Prolonged Uninterrupted Sitting on Vascular Function: A Systematic Review and Meta-analysis.
Taylor, FC, Pinto, AJ, Maniar, N, Dunstan, DW, Green, DJ
Medicine and science in sports and exercise. 2022;(1):67-76
Abstract
OBJECTIVE This study aimed to determine the dose-response relationship between prolonged sitting and vascular function in healthy individuals and those with metabolic disturbances and to investigate the acute effects, on vascular function, of interventions that target interrupting prolonged sitting. DESIGN This is a systematic review with meta-analysis. DATA SOURCES Ovid Embase, Ovid Medline, PubMed, and CINAHL were searched from inception to 4 December 2020. ELIGIBILITY CRITERIA Randomized crossover trials, quasi-randomized trials, and parallel group trials where vascular function (flow-mediated dilation [FMD]) was assessed before and after an acute period of sedentary behavior was used in this study. RESULTS Prolonged sitting resulted in a significant decrease in the standardized mean change (SMC) for lower-limb FMD at the 120-min (SMC = -0.85, 95% confidence interval [CI] = -1.32 to -0.38) and 180-min (SMC = -1.18, 95% CI = -1.69 to -0.66) time points. A similar pattern was observed for lower-limb shear rate. No significant changes were observed for any outcomes in the upper limb. Subgroup analysis indicated that prolonged sitting decreased lower-limb FMD in healthy adults (SMC = -1.33, 95% CI = -1.89 to -0.78) who had higher a priori vascular endothelial function, but not in those with metabolic and vascular dysfunction (SMC = -0.51, 95% CI = -1.18 to 0.15). Interrupting sitting with active interruptions increased the standardized mean difference for FMD, relative to prolonged sitting, but it was not statistically significant (0.13, 95% CI = -0.20 to 0.45). CONCLUSIONS Lower-limb vascular function is progressively impaired as a consequence of prolonged sitting, up to 180 min. A similar trend was not observed in upper-limb vascular function. Subgroup analysis indicated that prolonged sitting negatively affects healthy populations, a finding not observed in those with metabolic disturbances. Regularly interrupting sitting with activity may be beneficial for those with metabolic disturbances.
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The Epidemiology, Risk Factors, and Nonsurgical Treatment of Injuries Related to Endurance Running.
Raghunandan, A, Charnoff, JN, Matsuwaka, ST
Current sports medicine reports. 2021;(6):306-311
Abstract
Running is a popular form of exercise that is easily accessible to various populations; endurance running, defined as distances beyond 5 km, continues to grow within the sport. Endurance running-related injuries are common in the lower extremities and are primarily overuse related. A multitude of risk factors for injury exist, including extrinsic factors, such as running distance and frequency, and intrinsic factors, such as biomechanics and nutrition status. Training and rehabilitation techniques vary with a general focus on strengthening and gradual increase in activity, but evidence is mixed, and it is difficult to generalize programs across different running populations. Management of specific running groups, including youth runners, is an area in which additional research is needed. New treatments, such as orthobiologics and wearable technology, have promising potential to optimize performance and recovery and minimize injury. However, they need to be further evaluated with high-quality studies.
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Long Term Survival and Limb Salvage in Patients With Non-Revascularisable Chronic Limb Threatening Ischaemia.
Verwer, MC, Wijnand, JGJ, Teraa, M, Verhaar, MC, de Borst, GJ
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2021;(2):225-232
Abstract
OBJECTIVE The aim of this study was to provide long term survival and limb salvage rates for patients with non-revascularisable (NR) chronic limb threatening ischaemia (CLTI). METHODS This was a retrospective review of prospectively collected data, derived from a randomised controlled trial (JUVENTAS) investigating the use of a regenerative cell therapy. Survival and limb salvage of the index limb in CLTI patients without viable options for revascularisation at inclusion were analysed retrospectively. The primary outcome was amputation free survival, a composite of survival and limb salvage, at five years after inclusion in the original trial. RESULTS In 150 patients with NR-CLTI, amputation free survival was 43% five years after inclusion. This outcome was driven by an equal rate of all cause mortality (35%) and amputation (33%). Amputation occurred predominantly in the first year. Furthermore, 33% of those with amputation subsequently died within the investigated period, with a median interval of 291 days. CONCLUSION Five years after the initial need for revascularisation, about half of the CLTI patients who were deemed non-revascularisable survived with salvage of the index limb. Although the prospects for these high risk patients are still poor, under optimal medical care, amputation free survival seems comparable with that of revascularisable CLTI patients, while the major amputation rate within one year, especially among NR-CLTI patients with ischaemic tissue loss, is very high.
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Lipid Optimization in Lower Extremity Peripheral Arterial Disease.
Sucharitkul, PPJ, Jones, KL, Scott, DJA, Bailey, MA
Annals of vascular surgery. 2021;:542-554
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Abstract
AIMS: This review aims to explore the current guidance and issues surrounding lipid optimisation of patients with peripheral arterial disease (PAD). METHODS A narrative review of the global PAD guidance, specifically focusing on low density lipoprotein cholesterol (LDL-C) reduction methods including; 'treating to target', 'fire and forget' and LDL-C percentage reduction. Advanced literature searches were carried out in Pubmed and Google Scholar databases comparing most recent PAD lipid guidance. RESULTS PAD lipid guidance could be improved internationally to help clinicians implement the best lipid-reduction strategies for their patients and challenge the arbitrary 1.4 mmol/L LDL-C target in line with novel proprotein convertase subtilisin/kexin type 9 inhibitors trials. By educating primary and secondary care staff on the benefits of maximal lipid-reduction therapies, we can reduce major adverse cardiovascular events and major adverse limb events. Championing PAD community clinics may lead to earlier prevention. Research comparing lipid-reduction strategies in practice is needed to improve outcomes internationally, and ongoing practice audited to understand the extent of under-prescribing in PAD. CONCLUSIONS This review highlights the current PAD lipid-reduction treatments and the clarity issues of global guidance. Further research is needed to tackle ongoing mortality and morbidity rates in PAD patients against their better off cardiovascular disease (CVD) peers. MESH KEY TERMS "Cholesterol", "Hydroxymethylglutaryl-CoA Reductase Inhibitors", "Ezetimibe", "Evolocumab", "Alirocumab", "Peripheral Arterial Disease", "Vascular Disease", "Atherosclerosis", "Secondary Prevention", "Lipoprotein, LDL".
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Correlation between strength and skin temperature asymmetries in the lower limbs of Brazilian elite soccer players before and after a competitive season.
Rodrigues Júnior, JL, Duarte, W, Falqueto, H, Andrade, AGP, Morandi, RF, Albuquerque, MR, de Assis, MG, Serpa, TKF, Pimenta, EM
Journal of thermal biology. 2021;:102919
Abstract
This study aimed to investigate the correlation between strength and skin temperature (Tsk) asymmetries in the lower limbs of elite soccer players before and after a competitive season. The sample (n = 20) was composed of elite male soccer players. Strength asymmetry and Tsk asymmetry was measured through the countermovement jump (CMJ) test and infrared thermography, respectively. Asymmetries were quantified using the symmetry angle (SA) equation. A strong correlation was found between the SA of rate of force development (RFD) and the SA of Tsk before (baseline) (r = 0.7; r2 = 0.43; p = 0.03) and after (r = 0.6; r2 = 0.42; p = 0.04) the competitive season. Moreover, after the competitive season there were significant decreases in Peak force (p < 0.018), Impulse (p < 0.04), RFD (p = 0.0001) and CMJ height (p = 0.05), and significant increases in Tsk (p < 0.03), C-reactive protein (p = 0.03), Creatine kinase (p = 0.0001) and Cortisol (p = 0.04), even after a 3-day rest interval (no training). These results suggest that the CMJ test can be combined with infrared thermography for monitoring strength asymmetry and contribute to the prevention of muscle injuries.
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Exercise and Protein Effects on Strength and Function with Weight Loss in Older Women.
Evans, EM, Straight, CR, Reed, RA, Berg, AC, Rowe, DA, Johnson, MA
Medicine and science in sports and exercise. 2021;(1):183-191
Abstract
UNLABELLED Obesity negatively affects lower extremity physical function (LEPF) in older adults. Exercise and a higher protein diet are both known to positively and independently affect body composition, muscle strength, and LEPF during weight loss; however, their potential interactive effects have not been well characterized in older women. PURPOSE The aim of this study was to determine the relative efficacy of a higher protein diet with or without exercise to improve body composition, muscle strength, and LEPF in older inactive overweight/obese women after weight loss. METHODS Postmenopausal women (body mass index = 31.1 ± 5.1 kg·m, 69.2 ± 3.6 yr) completed a 6-month weight loss program after randomization to three groups (n = 72 randomized; 15% dropout): 1) higher protein diet (PRO, ~30% energy from protein; n = 20), 2) PRO plus exercise (PRO + EX; n = 19), or 3) a conventional protein control diet plus EX (CON + EX, ~18% energy from protein; n = 22). EX was supervised, multicomponent (aerobic, muscle strengthening, balance, and flexibility), and three sessions per week. Body composition was measured via dual-energy x-ray absorptiometry, leg strength by isokinetic dynamometry, and LEPF via 6-min walk, 8-ft up and go, and 30-s chair stand tests. RESULTS Changes in weight (-7.5 ± 4.1 kg; -9.2% ± 4.8%), fat mass, and leg lean mass did not differ among groups (all P > 0.50). Despite weight loss, muscle strength improved in the exercise groups (PRO + EX and CON + EX) but it declined in the PRO group (P = 0.008). For all LEPF measures, the PRO group had attenuated improvements compared with both PRO + EX and CON + EX (all P < 0.01). CONCLUSION Exercise during weight loss is critical to preserve strength and enhance LEPF; however, a higher protein diet does not appear to influence body composition, muscle strength, or LEPF changes when combined with multicomponent exercise.
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Antiplatelet and anticoagulation therapy after revascularization for lower extremity artery disease: a national survey and literature overview.
Ipema, J, Brand, AR, DE Borst, GJ, DE Vries, JP, ÜnlÜ, Ç
The Journal of cardiovascular surgery. 2021;(1):59-70
Abstract
BACKGROUND Antiplatelet therapy (APT) after interventions for lower extremity artery disease (LEAD) is recommended. However, (inter)national guidelines vary on type and duration of APT. This report aimed to present the results of a survey on antithrombotic prescribing patterns after lower limb interventions in the Netherlands and an overview of the available literature on this topic. METHODS Vascular surgeons from the Dutch Society for Vascular Surgery and interventional radiologists from the Dutch Society for Interventional Radiology received an online survey on the type and duration of antithrombotic medication after lower limb interventions. RESULTS Surveys were completed by 139 of 285 vascular surgeons (49%) and 24 of 288 (8%) interventional radiologists. Clopidogrel was the most prescribed drug after iliac percutaneous transluminal angioplasty (PTA) (77%), femoral PTA (77%), femoral PTA with drug-coated balloon (66%), and femoropopliteal (80%) and femorocrural (51%) prosthetic bypasses. Dual APT (DAPT), consisting of aspirin and clopidogrel, was most often prescribed after femoral PTA with stenting (56%) and crural PTAs (55% without stent, 73% with stent). Vitamin K antagonists were most often prescribed after femoropopliteal (83%) and femorocrural (80%) venous bypasses. Aspirin monotherapy prescription varied from 1% to 8% after interventions. Many interventional radiologists responded that they only advise in medication prescription but do not prescribe themselves. CONCLUSIONS Prescription of antiplatelet and anticoagulation therapy in LEAD patients after femoral and crural interventions varies widely among Dutch vascular surgeons, mostly between clopidogrel and DAPT. The duration of DAPT is also highly variable. These results reflect low-level evidence and discrepancy in current guideline recommendations.
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Frequency of lower extremity artery disease in type 2 diabetic patients using pulse oximetry and the ankle-brachial index.
Abián, MF, Vanesa, BB, Diego, BG, Manuel, GS, Maria, VC, Raquel, VS, Cristina, GM
International journal of medical sciences. 2021;(13):2776-2782
Abstract
Objectives: To determine the of undiagnosed lower extremity artery disease using the pulse oximetry in a type 2 diabetic population sample. Methods: Observational, cross-sectional, descriptive study that included 594 type 2 diabetic patients, with no previous history of lower extremity artery disease. Medical history, physical examination, determination of the ankle-brachial index (portable Doppler) and measurement of oxygen saturation in upper and lower extremities (pulse oximeter) were performed. Results: Frequency of lower extremity artery disease determined by ankle-brachial index was 18.4%. No significant correlations were detected between oxygen saturation and the ankle-brachial index except for the relationship between ankle-brachial index vs. oxygen saturation at 30 cm lower limb elevation vs. the supine position at no elevation (0 cm) in subjects under the age of 40. Pulse oximetry showed little diagnostic value in the screening of lower extremity artery disease. A relationship between lower extremity artery disease and age has been found. Its diagnosis was associated with a lower body mass index and lower systolic blood pressure in the lower extremities and higher in the upper extremities. Conclusions: We conclude that pulse oximetry is not useful in the screening for asymptomatic lower extremity artery disease in type 2 diabetics.
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Neutrophil-to-lymphocyte ratio but not monocyte-to-HDL cholesterol ratio nor platelet-to-lymphocyte ratio correlates with early stages of lower extremity arterial disease: an ultrasonographic study.
Santoro, L, Ferraro, PM, Nesci, A, D'Alessandro, A, Macerola, N, Forni, F, Tartaglione, R, De Vitis, R, Gasbarrini, A, Santoliquido, A
European review for medical and pharmacological sciences. 2021;(9):3453-3459
Abstract
OBJECTIVE The role of inflammatory markers as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-high-density lipoprotein-cholesterol ratio (MHR), and platelet-to-lymphocyte ratio (PLR) in cardiovascular diseases has been widely investigated in recent years. In the context of lower extremity arterial disease (LEAD), this association has been mainly studied in the advanced stages. The aim of our study was to investigate the role of these inflammatory markers in all stages of LEAD, including early ones, using ultrasonography as diagnostic tool, together with ankle-brachial index (ABI) determination. PATIENTS AND METHODS In this cross-sectional observational study, we enrolled 240 patients undergoing ultrasonographic evaluation of the lower limb arteries and ABI determination because of symptoms suggestive of LEAD or presence of known cardiovascular risk factors. RESULTS In our study population, we found that ultrasonographic categories of LEAD were associated with NLR, but not with MHR and PLR. CONCLUSIONS These results confirm that a specific pattern of inflammation can be found in all stages of LEAD, including early ones.