Effects of high-intensity interval and continuous moderate aerobic training on fitness and health markers of older adults: A systematic review and meta-analysis.

BACKGROUND: High-intensity interval training (HIIT) promotes similar or superior gains in physical fitness and health compared to continuous moderate-intensity training (MICT) in young individuals. However, the effectiveness of HIIT in older adults is uncertain. OBJECTIVE: This meta-analysis compared the effects of HIIT and MICT on cardiorespiratory fitness, body composition, vascular, metabolic, and hormonal variables, cognitive function, and quality of life in older adults. METHODS: PubMed, Embase, Cochrane, Web of Science, Scopus, and SportDiscus databases were searched from inception until December 2023. Trials included adults ≥ 60 y. Hedge's effect sizes (g) were calculated and study quality and features of training interventions were tested as moderators. RESULTS: Twenty-nine trials including 1,227 subjects (65.4 ± 3.3 y). HIIT and MICT elicited significant (p < 0.021) and similar (p > 0.156) 'gs' for VO2max (0.722 vs. 0.490), maximal workload/peak power output ratio (0.290 vs. 0.372),% fat (-0.297 vs. -0.262), glycemia (-0.273 vs. -0.334), systolic (-0.465 vs. -0.341), and diastolic blood pressure (-0.566 vs. -2.311). HIIT (p < 0.04) but not MICT (p > 0.170) produced significant 'gs' for fat mass (-0.245 vs. -0.103), waist circumference (-0.239 vs. -0.116), testosterone (0.339 vs. 0.170), and complex Stroop test (-0.595 vs. -0.250). Increases in the VO2max occurred only in controlled trials after HIIT but not MICT (Q = 6.286, p = 0.012; HITT-g = 1.068, p < 0.0001 vs. MICT-g = 0.109, p= 0.596). CONCLUSION: HIIT and MICT produced similar changes in most of the investigated variables. In trials with greater quality (controlled vs. non-controlled trials), cardiorespiratory gains were higher in HIIT vs. MICT. These findings suggest that HIIT might be suitable for improving fitness and health in older adults.

Metabolic flexibility associated with flight time among combat pilots of the Brazilian air force.

INTRODUCTION: Fighter pilots must support the effects of many stressors, including physical and psychological exertion, circadian disturbance, jet lag, and environmental stress. Despite the rigorous selection of military pilots, those factors predispose to failures in physiological compensatory mechanisms and metabolic flexibility. OBJECTIVES: We compared through NMR-based metabolomics the metabolic profile of Brazilian F5 fighter pilots with different flight experiences vs. the control group of non-pilots. We hypothesized that combat pilots have metabolic flexibility associated with combat flight time. METHODS: We evaluated for the first time 34 Brazilian fighter pilots from Santa Cruz Air Base (Rio de Janeiro, RJ) allocated into three groups: pilots with lower total accumulated flight experience < 1,100 h (PC1, n = 7); pilots with higher total accumulated flight experience ≥ 1,100 h (PC2, n = 6); military non-pilots (CONT, n = 21). Data collection included anthropometric measurements, total blood count, lipidogram, markers of oxidative stress, and serum NMR-based metabolomics. RESULTS: In comparison with controls (p < 0.05), pilots exhibited decreased levels of white blood cells (-13%), neutrophils (-15%), lymphocytes (-20%), alfa-glucose (-13%), lactate (-26%), glutamine (-11%), histidine (-20%), and tyrosine (-11%), but higher isobutyrate (+ 10%) concentrations. Significant correlations were found between lactate vs. amino acids in CONT (r = 0.55-0.68, p < 0.001), and vs. glutamine in PC2 (r = 0.94, p = 0.01). CONCLUSION: Fighter pilots with lower experience showed a dysregulation in immune-metabolic function in comparison with controls, which seemed to be counteracted by the accumulation of flight hours. Those findings might have implications for the health preservation and operational training of fighter pilots.

Effects of Isocaloric Resistance, Aerobic, and Concurrent Exercise on Excess Postexercise Oxygen Consumption in Older Adults.

ABSTRACT: Pilon, R, Matos-Santos, L, Matlez, MP, Rodrigues, G, Amorim, F, Lattari, E, Farinatti, P, and Monteiro, W. Effects of isocaloric resistance, aerobic, and concurrent exercise on excess postexercise oxygen consumption in older adults. J Strength Cond Res 38(4): 755-761, 2024-Excess postexercise oxygen consumption (EPOC) is a major determinant of exercise-related caloric expenditure and metabolic adaptations. Exercise modality may influence the EPOC, but this issue has not been investigated in older adults. This study compared the EPOC after isocaloric bouts of continuous aerobic exercise (AE), resistance exercise (RE), and concurrent exercise (CE) in older individuals. Ten subjects (5 men; 73 ± 6 years) had their cardiorespiratory data assessed during AE, RE, and CE and along 30-minute postexercise recovery. Total energy expenditure (EE) during exercise was similar (p > 0.05) in AE (126.0 ± 30.7 kcal), RE (123.9 ± 30.6 kcal), and CE (130.8 ± 32.6 kcal), with different times to achieve the targeted EE (RE: 61.4 ± 1.9 minutes > CE: 43.3 ± 5.6 minutes > AE: 26.6 ± 5.7 minutes; p < 0.001). Consistently, the relative intensity during exercise was superior (p < 0.05) in AE (74 ± 15% oxygen uptake reserve [VO2R]) vs. CE (43 ± 13% VO2R) vs. RE (24 ± 9% VO2R). Despite the isocaloric conditions, average EPOC and EE were approximately 45% greater (p < 0.001) in AE (8.0 ± 2.3 L; 40.1 ± 11.7 kcal) vs. RE (5.6 ± 1.2 L; 28.1 ± 5.8 kcal) and CE (5.4 ± 2.3 L; 26.9 ± 11.5 kcal). In conclusion, the EPOC was greater after isocaloric AE vs. RE and CE performed by older adults. Exercise intensity seemed to be a more important determinant of EPOC than volume reflected by EE during exercise bouts. Moderate-intensity continuous AE was more time-efficient than RE and CE to achieve a target EE. In older individuals, AE should be preferred over RE or CE when the purpose is to increase the daily caloric expenditure.

Central and peripheral mechanisms underlying postexercise hypotension: a scoping review.

Blood pressure (BP) reduction occurs after a single bout of exercise, referred to as postexercise hypotension (PEH). The clinical importance of PEH has been advocated owing to its potential contribution to chronic BP lowering, and as a predictor of responders to exercise training as an antihypertensive therapy. However, the mechanisms underlying PEH have not been well defined. This study undertook a scoping review of research on PEH mechanisms, as disclosed in literature reviews. We searched the PubMed, Web of Science, Scopus, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Sport Discus databases until January 2023 to locate 21 reviews - 13 narrative, four systematic with 102 primary trials, and four meta-analyses with 75 primary trials involving 1566 participants. We classified PEH mechanisms according to major physiological systems, as central (autonomic nervous system, baroreflex, cardiac) or peripheral (vascular, hemodynamic, humoral, and renal). In general, PEH has been related to changes in autonomic control leading to reduced cardiac output and/or sustained vasodilation. However, the role of autonomic control in eliciting PEH has been challenged in favor of local vasodilator factors. The contribution of secondary physiological outcomes to changes in cardiac output and/or vascular resistance during PEH remains unclear, especially by exercise modality and population (normal vs. elevated BP, young vs. older adults). Further research adopting integrated approaches to investigate the potential mechanisms of PEH is warranted, particularly when the magnitude and duration of BP reductions are clinically relevant. (PROSPERO CRD42021256569).

Effects of exercise training on bone health in adults living with HIV: a systematic review with meta-analysis.

We investigated the effects of exercise training on bone mineral density (BMD) in people living with Human Immunodeficiency Virus (PLHIV). Pubmed, Scopus, Cochrane Library, and ScienceDirect databases were searched for trials investigating exercise training-induced changes in BMD of PLHIV at baseline vs. post-intervention assessed by dual-energy X-ray absorptiometry (DXA). Hedge effect sizes (ES) were calculated incorporating fixed effects for BMD variation assumptions. Disaggregated comparisons were performed for trials with more than one intervention or BMD site assessment. Seven trials included 210 PLHIV and 35 non-HIV-infected controls. Methodological quality evaluated using the Physiotherapy Evidence Database (PEDro) scale ranged from poor to moderate. Interventions applied isolated resistance, combined aerobic and resistance, and multimodal exercise protocols performed 3 d/wk for 12-to 104 week. One controlled and another uncontrolled trial presented significant effects, reporting improvements at the femoral neck and total (ES 2.14 and 0.49, respectively). Magnitude of those specific ES influenced the overall effect (controlled and uncontrolled trials), which was small but significant (k = 12, ES 0.277, 95% confidence interval 0.120-0.434). Resistance training may promote favorable adaptations in BMD of PLHIV, particularly in femur. Future research should elucidate the optimal dose-response relationship and physiological mechanisms underlying exercise-induced adaptations on the BMD of PLHIV.

Excess Postexercise Oxygen Consumption Following Isocaloric Bouts of Resistance and Aerobic Exercise in Older Adults.

Purpose: Albeit being a major determinant of exercise-related energy expenditure (EE), there is a lack of research on the excess post-exercise oxygen consumption (EPOC) after different exercise modalities in older adults. This study compared the EPOC after isocaloric bouts of resistance (RE) and aerobic (AE) exercise. Methods: The EE during exercise was determined through telemetric indirect calorimetry in ten physically active participants aged 63 to 82 years (5 women, 73 ± 6 years, 70.5 ± 9.9 kg, 161 ± 8 cm). The target EE in AE corresponded to values achieved during RE, and the EPOC was assessed for 30 min in the supine position. Results: The EE during AE and RE were 126.0 ± 30.7 kcal and 123.9 ± 30.6 kcal, respectively. The time to achieve the target EE was 2.3 times shorter in AE vs. RE. The EPOC magnitude was greater after AE (7.9 ± 2.4 L, 40.1 ± 11.1 kcal) than RE (5.9 ± 1.8 L, 26.9 ± 11.5 kcal). Conclusion: Older adults showed greater EPOC after isocaloric sessions of AE vs. RE. Additionally, AE had better temporal efficiency than RE to elicit a given EE.

Energy Expenditure, Intensity, and Perceived Effort in Recreational Functional Training.

Background: Functional training (FT) has become popular and seems to provoke health benefits. However, there are unsubstantiated claims regarding energy expenditure (EE) vs. weight-loss and cardiorespiratory improvements linked to FT. Objective: This study quantified the EE and intensity during FT performed in a conventional fitness center. Additionally, data of FT and moderate continuous walking (WLK) were compared. Methods: Healthy individuals with no previous experience with FT [n = 25, 11 males/14 females, 38.8 ± 9.3 years; 73.9 ± 13.8 Kg; 168.5 ± 8.5 cm; 26.0 ± 4.5 Kg/m2; 16 overweight (BMI >25 Kg/m2)] performed three FT sessions interspersed with 48 h (two familiarization, one assessment). The circuit included 4 rounds of 12 exercises performed at all-out intensity for 20 s with 1-min intervals between rounds. WLK was performed for 25 min with intensity corresponding to scores 3-5 on Borg CR-10 Scale. Outcomes were EE (kcal), movement counts estimated by triaxial accelerometry, heart rate reserve (%HRR), and rate of perceived exertion (RPE). Results: On average, FT sessions lasted 24 min and EE ranged between 124 and 292 kcal (188 ± 41 kcal), corresponding to 5-8 METs (6.1 ± 0.6 METs), and 70-80%HRR (74 ± 8%). Accelerometry (counts/min) showed that vigorous predominated over moderate intensity during FT and WLK (p = .01), with similar EE. The relative intensity and RPE were higher in FT vs. WLK (74% vs. 55%HRR and Borg 5-8 vs. 3-5, respectively; p < .0001). Conclusion: FT and WLK elicited EE consistent with recommendations to reduce cardiovascular disease risk, but only FT achieved relative intensities compatible with cardiorespiratory improvement. FT should be considered an option in health-oriented exercise programs for the general population.

Biopsychosocial Effects of a Conventional Exercise Program and Culturally Relevant Activities in Older Women From Mozambique.

AIM: This randomized controlled trial compared the effects of a Conventional Exercise Program (CEP) and Culturally Relevant Activities (CRA) on body mass, cardiovascular risk, functional fitness (strength, flexibility, cardiorespiratory fitness, and agility), self-efficacy, and self-esteem in older women dwelling in Mozambique. METHODS: Fifty-seven women (67 [7] y) underwent 60-minute sessions of CEP (n = 28) or CRA (n = 29) performed 3 days per week for 12 weeks. CRA included Mozambican traditional dances and games (intensity corresponding to scores 3-4 of BORG-CR10 scale), and CEP included 20-minute stationary cycling (65%-75% heart rate reserve) and a resistance training circuit (8 exercises, 15-repetition maximum). RESULTS: CEP and CRA (P < .05) showed increased percent fat (3.4% and 5.3%), waist circumference (3.3% and 5.8%), and cardiorespiratory fitness (14.4% and 9.4%), and decreased triglycerides (-20.0% and -77.8%). In CEP (P < .05), body mass (2.9%), body mass index (3.2%), and high-density lipoprotein (10.0%) increased, while glycemia (-4.8%) and total cholesterol (-9.8%) decreased. Blood pressure slightly increased in CEP (6.2%, P > .05) and CRA (4.3%, P < .05). Self-efficacy and self-esteem increased to similar levels in both groups (15%, P < .05). CONCLUSIONS: CEP and CRA were capable to improve biopsychosocial health-related variables in Mozambican older women. Culturally referenced PA interventions should be considered as an alternative in African countries.

Neuro-Cardiovascular Responses to Sympathetic Stimulation in Fighter Pilots.

INTRODUCTION: The chronic effects of regular exposure to high acceleration levels (G-force) on the neuro-cardiovascular system are unclear. We compared the mean arterial pressure (MAP) and cardiac autonomic modulation between nonpilots (NP) vs. military fighter (FP) and transport (TP) pilots. Additionally, we correlated the cardiac autonomic indices with the cardiorespiratory fitness and flight experience of FP.METHODS: A total of 21 FP, 8 TP, and 20 NP performed a tilt test (TT), during which beat-to-beat blood pressure and heart rate were recorded.RESULTS: No difference was detected between groups for changes in MAP and heart rate variability indices during the TT. However, the analysis of areas under the curves showed a greater increase in MAP in FP vs. TP and NP. Conversely, there was a greater decrease in indices reflecting vagal modulation in TP vs. FP and NP (rMSSD, pNN50, and SDNN), and a greater increase in heart rate and sympathovagal balance in TP vs. other groups (LF/HF). The maximal oxygen uptake was strongly correlated with the vagal reserve in FP (r = -0.74). Moreover, the total flying hours of FP were positively correlated with resting HFnu (r = 0.47) and inversely correlated with resting LFnu (r = -0.55) and LF/HF (r = -0.46).CONCLUSION: FP had a higher pressor response to TT than TP and NP. Vagal withdrawal and sympathovagal increase induced by TT in FP were similar vs. NP and attenuated vs. TP. Greater cardiorespiratory fitness and accumulated flying hours in FP seemed to favor lower sympathetic and greater vagal modulation at rest.dos Santos Rangel MV, de Sá GB, Farinatti P, Borges JP. Neuro-cardiovascular responses to sympathetic stimulation in fighter pilots. Aerosp Med Hum Perform. 2023; 94(10):761-769.

Body Mass Index but not Physical Activity Level Moderates Lowered Cardiac Baroreflex Sensitivity in People Living with HIV.

Reduced cardiac baroreflex sensitivity (cBRS) is an autonomic marker associated with a worse cardiovascular prognosis. Whether cBRS is lowered in people living with HIV (PLHIV) is yet unclear, as well as potential moderator effects of body mass index (BMI) or physical activity (PA) level. The present study aims to compare the spontaneous cBRS in PLHIV vs. HIV-uninfected controls, and to determine among PLHIV the relationship between cBRS vs. body mass index (BMI) and PA level. Total, upward (cBRS+), and downward (cBRS-) cBRS gains were assessed using the sequential method from beat-to-beat blood pressure at rest in 16 PLHIV (46.5±8.4 years) under antiretroviral therapy for at least 6 months, and 16 HIV-uninfected controls (CTL; 42.1±8.0 years). PA level was assessed by the Physical Activity Questionnaire (IPAQ short version) overall score. PLHIV showed lower total cBRS (8.7±3.1 vs. 15.3±7.7 ms.mmHg-1; p < 0.01), cBRS+ (9.2±4.9 vs. 16.0±6.8 ms.mmHg-1; p < 0.01) and cBRS- (9.5±4.9 vs. 15.3±9.3 ms.mmHg-1; p < 0.01) vs. CTL. No between-group difference was found for BMI (PLHIV: 25.2±2.6 vs. CTL: 26.8±3.2 kg.m-2; p > 0.05) or IPAQ score (PLHIV: 2.4±1.0 vs. CTL: 2.0±1.4; p > 0.05). In PLHIV, total cBRS was inversely correlated vs. BMI (r = -0.44; p = 0.04), but not vs. IPAQ score (r = 0.17; p = 0.26). HIV infection may reduce spontaneous cBRS, which seemed to be moderated by higher BMI, but not PA level of PLHIV.

Self-selected or fixed: is there an optimal rest interval for controlling intensity in high-intensity interval resistance training?

PURPOSE: This study investigated the effects of different rest interval strategies during high-intensity interval resistance training (HIRT) on cardiorespiratory, perceptual, and enjoyment responses among trained young men. METHODS: Sixteen men experienced with HIRT underwent cardiopulmonary exercise testing and were familiarized with the exercises and HIRT protocol. On the subsequent three visits, interspaced 48-72 h, participants performed HIRT sessions with different rest intervals in a randomized order: 10 s and 30 s fixed rest intervals (FRI-10 and FRI-30), and self-selected rest interval (SSRI). Oxygen uptake (VO2), heart rate (HR), and recovery perception (Total Quality Recovery Scale) were measured during HIRT, while enjoyment responses (Physical Activity Enjoyment Scale) were assessed immediately after the sessions. RESULTS: The VO2 during exercise was greater in FRI-10 than FRI-30 (55% VO2max and 47% VO2max, respectively, p = 0.01), while no difference occurred between SSRI and bouts performed with fixed intervals (52% VO2max vs. FRI, p > 0.05). HR, excess post-exercise oxygen consumption (EPOC), recovery perception, and enjoyment responses were similar across conditions (p > 0.05). CONCLUSION: Exercise intensity was not affected by the rest interval strategy. High exercise intensity was maintained in sessions performed with FRI or SSRI, without negative repercussions on the duration of training sessions and enjoyment responses after exercise sessions.

Effects of physical activity on body mass and composition of school-age children and adolescents with overweight or obesity: Systematic review focusing on intervention characteristics.

OBJECTIVE: The characteristics of physical activity (PA) interventions to improve body mass and composition in pediatric populations are unclear. This systematic review summarized the effects of PA on those outcomes in school-age children and adolescents with overweight or obesity, focusing on training components (frequency, intensity, duration, and type - FITT). METHODS: Databases were searched for controlled trials applying exclusive PA and including children (5-12 y) or adolescents (13-17 y) with overweight/obesity. RESULTS: Twenty-seven trials yielding 34 interventions were included. PA was recreational (children: k = 9, n = 478), systematized (children: k = 18, n = 565); or combined (children: k = 7, n = 205). Successful interventions were performed for 6- to 35 weeks (mostly 12-14 weeks), 2- to 5 d/wk (mostly 3 d/wk), during 8- to 60 min (mainly 60 min) with moderate to high intensity (60-90% maximal heart rate or 40-70% heart rate reserve). Half of the interventions applying recreational (4 out of 8), 59% of systematized (10 out of 17), and 57% of combined (4 out of 7) interventions reported improvements in body mass or composition, especially body fat. Benefits were more often reported for body composition (18 out of 34 interventions) than body mass (8 out of 34 interventions), irrespective of the age group. CONCLUSION: Recreational and systematized PA may improve body mass, and particularly body composition in school-age children and adolescents with overweight or obesity. Successful programs were performed for at least six weeks and applied a PA amount consistent with the minimum recommended for pediatric populations (≥60 min of moderate-to-vigorous PA at least 3 d/wk).

Can mixed circuit training elicit the recommended exercise intensity and energy expenditure in people after stroke?

PURPOSE: To investigate whether mixed circuit training (MCT) elicits the recommended exercise intensity and energy expenditure in people after stroke, and to establish the between-day reproducibility for the percentages of heart rate reserve (%HRR), oxygen uptake reserve (%VO2R), and energy expenditure elicited during two bouts of MCT. METHODS: Seven people aged 58 (12) yr, who previously had a stroke, performed a cardiopulmonary exercise test, a non-exercise control session, and two bouts of MCT. The MCT included 3 circuits of 10 resistance exercises at 15-repetition maximum intensity, with each set of resistance exercise interspersed with 45-s of walking. Expired gases were collected during the MCT and control session and for 40 min afterward. Control session was necessary to calculate the net energy expenditure associated with each bout of MCT. RESULTS: Mean %VO2R (1st MCT: 51.1%, P = .037; 2nd MCT: 54.0%, P = .009) and %HRR (1st MCT: 66.4%, P = .007; 2nd MCT: 67.9%, P = .010) exceeded the recommended minimum intensity of 40%. Both %VO2R (P = .586 and 0.987, respectively) and %HRR (P = .681 and 0.237, respectively) during the 1st and 2nd bouts of MCT were not significantly different to their corresponding gas exchange threshold values derived from cardiopulmonary exercise testing. Mean net total energy expenditure significantly exceeded the minimum recommend energy expenditure in the 1st (P = .048) and 2nd (P = .023) bouts of MCT. Between-day reproducibility for %HRR, %VO2R, and energy expenditure was excellent (ICC: 0.92-0.97). CONCLUSIONS: MCT elicited physiological strain recommended for improving health-related fitness in people after stroke and these responses demonstrated excellent between-day reproducibility.

Is postexercise hypotension a method-dependent phenomenon in chronic stroke? A crossover randomized controlled trial.

BACKGROUND: This study assessed the reproducibility of postexercise hypotension (PEH) detection after two bouts of mixed circuit training (MCT) using three approaches that accounts the pre-exercise values and/or a control session (CTL) to calculate PEH [i.e., ( A 1 = post - exercise - pre - exercise ${A}_{1}=\text{post}{\rm{ \mbox{-} }}\text{exercise}-\text{pre}{\rm{ \mbox{-} }}\text{exercise}$ ); ( A 2 = post - exercise - post - CTL ) $({A}_{2}=\text{post}{\rm{ \mbox{-} }}\text{exercise}-\text{post}{\rm{ \mbox{-} }}\text{CTL})$ ; A 3 = ( post - exercise - pre - exercise ) - ( post - CTL - pre - CTL ) ] ${A}_{3}=(\text{post}{\rm{ \mbox{-} }}\text{exercise}-\text{pre}{\rm{ \mbox{-} }}\text{exercise})-(\text{post}{\rm{ \mbox{-} }}\text{CTL}-\text{pre}{\rm{ \mbox{-} }}\text{CTL})]$ in chronic stroke (i.e., ≥6 months poststroke). The proportion of PEH responders determined using different cut-off values for PEH was also compared (4 mmHg vs. minimal detectable difference). METHODS: Seven participants (age: 56 ± 12 years; time post-stroke: 91 ± 55 months) performed two bouts of MCT and a CTL. The MCT involved 10 exercises with 3 sets of 15-repetition maximum, with each set interspersed with 45 s of walking. The systolic (SBP) and diastolic (DBP) blood pressures were assessed 10-min before and every 10-min along 40-min after CTL and MCT. RESULTS: The two-way random intraclass correlation coefficient for single measurements (ICC2,1 ) ranges for SBP were: A1 : 0.580-0.829, A2 : 0.937-0.994, A3 : 0.278-0.774; for DBP: A1 : 0.497-0.916, A2 : 0.133-0.969, A3 : 0.175-0.930. The proportion of PEH responders detected using 4 mmHg or the minimal detectable difference as cut-off values was not different in 97% of analyses (p > 0.05), and higher when using 4 mmHg in 3% of analyses (p = 0.031). The standard error of measurement was ≥4 mmHg in 47% of analyses for SBP, and 40% for DBP. CONCLUSIONS: The most reliable approach for determining PEH in chronic stroke was to subtract the postexercise from the post-CTL values. The proportion of PEH responders was not affected by the cut-off values applied.

Multimodal physical training combined with tDCS improves physical fitness components in people after stroke: a double-blind randomized controlled trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) seems to be a potential tool to optimize the long-term effects of multimodal physical training (MPT) on fitness components in post-stroke patients. OBJECTIVE: We investigated the effects of cortical tDCS combined with MPT on motor function reflected by strength, motor performance, and cardiorespiratory capacity in chronic stroke patients. METHODS: This double-blind randomized controlled trial included 18 volunteers (55 ± 10 y, 72 ± 13 kg), who underwent MPT preceded by either sham stimulation (SHAM) or 2 mA bi-hemispheric tDCS. MPT consisted of 24 sessions of 60-70 min performed 2 d/wk within 12-16 weeks, with individualized intensity. Outcomes were Fugl-Meyer scores for lower limbs (FM-LL), and total (FM-Total); speed in the 10-m walk test (10MWT); oxygen uptake and work output at maximal effort (VO2max and Wmax), and gas exchange threshold (VO2-GET and W-GET); peak torque of isokinetic knee extension (PT-EXT) and flexion (PT-FLEX) of paretic and non-paretic limbs; bilateral strength deficit during knee extension (DS-EXT) and flexion (DS-FLEX). RESULTS: Pre- vs. post-intervention improvements were detected in tDCS vs. SHAM (p < 0.05) for FM-total (29.6% vs. 15.9%; effect size [ES] = 0.78), FM-LL (35.9% vs. 9.0%; ES = 1.23), 10MWT (10.6% vs. 3.8%; ES = 0.67), Wmax (75.0% vs. 4.3%; ES = 1.68), W-GET (91.6% vs. 12.4%; ES = 1.62), PT-EXT (25.6% vs. -6.5%; ES = 1.94) and PT-FLEX (26.3% vs. 9.8%; ES = 0.65) of the paretic limb, and DS-EXT (-13.7% vs. 2.5; ES = 1.43). CONCLUSION: Bi-hemispheric cortical tDCS optimized the effects of MPT performed with moderate volume and intensity upon muscle strength, motor function, and cardiorespiratory performance in stroke hemiparetic survivors. (Registration number RBR-22rh3p).

Influence of HIIRT With Fixed and Self-Selected Recovery Intervals on Physiological, Affective, and Enjoyment Responses.

Purpose: Recovery-interval strategies may influence physiological and psychological responses during highintensity interval resistance training (HIIRT). This study compared the intensity, performance, and psychological outcomes during all-out effort HIIRT performed with fixed (FRI) and self-selected (SSRI) recovery intervals. Methods: Sixteen trained males (27.2 ± 4.1 years; 84.5 ± 8.9 kg; 55.8 ± 7.1 mL.kg-1.min-1) performed HIIRT bouts interspersed with FRI (10 s) and SSRI (15.3 ± 7.9 s). Results: Relative heart rate (%HRmax) and oxygen uptake (%VO2Peak), number of repetitions, and psychological responses (affection: Feeling ScaleFS; Felt Arousal ScaleFAS; enjoyment: Physical Activity Enjoyment ScalePACES) were assessed. FRI and SSRI elicited similar relative average intensity (p > .05) (%HRmax: 88.1 ± 3.5% vs. 87.6 ± 3.0%; %VO2Peak: 55.3 ± 7.4% vs. 54.1 ± 8.1%, respectively). The number of repetitions similarly decreased in SSRI and FRI from rounds 1 to 4 (~15%; p < .006), with no difference of total volume across conditions (FRI: 358.6 ± 32 reps vs. SSRI:357.5 ± 28.2; p = .89). In each round, no difference between FRI and SSRI (p > .05) was found for FS (3- to 3.5 vs. 2- to 4, respectively) or FAS (2- to 4 vs. 2- to 4, respectively), while PACES was lower in FRI than SSRI (102.8 ± 15.8 vs. 109.2 ± 13.2; p = .04). Conclusion: In conclusion, relative intensity, total repetitions, and affective perception were not influenced by the strategy of recovery intervals. On the other hand, overall enjoyment was favored in SSRI vs. FRI.

A heuristic model for health-related autonomy based on health promotion ideas: the 'Health-Autonomy Interaction Model'.

Autonomy and health are central concepts in health promotion literature. Operational frameworks explaining their relationship are important to support health-related autonomy actions. This study presents a heuristic model describing the 'health-autonomy relationship' based on health promotion ideas, particularly Antonovsky's and Nordenfeldt's works. Central to the 'Health-Autonomy Interaction Model' is the existence of inter-related dimensions of autonomy: thought, intention and action, all influenced by negative and positive factors of physical and social environments (extrinsic factors) and personal resources to cope with life needs (intrinsic factors). Intrinsic factors comprise elements often included in definitions of negative (ill-health) and positive health (well-being and fitness), therefore establishing a bridge between conceptions of health and autonomy. Unique to this biopsychosocial framework is the differentiation between the potential for being autonomous and the degree of autonomy effectively achieved-the potential autonomy reflects the individual set of abilities to accomplish any task, while the expressed autonomy results from the extent to which this satisfies the demands of the environment and vital goals. Conceptualizing autonomy in this manner highlights that it is a multi-factorial capability referred to external conditions, reflecting a cluster of abilities to be and do things indicative of a self-empowered life. Concluding, our model moves the concept of health-related autonomy from a focus on 'disease' and 'incapacity' to a broader view in which the meaning of 'capacity' depends on the achievement of 'self-fulfillment' in given circumstances. The notion of autonomy is regarded as a precondition for health and an essential priority in health promotion.

Acute effects of exercise with blood flow restriction on endothelial function in healthy young and older populations: a systematic review / Efeitos agudos do exercício com restrição do fluxo sanguíneo na função endotelial de jovens e idosos saudáveis: uma revisão sistemática

The objective of this review is to identify the acute effects of blood flow restriction (BFR) with vs without exercise on endothelial function in healthy individuals and the changes in endothelial function in young and older adults following different levels of exclusive BFR vs free flow. Systematic searches were performed in the following databases: PubMed, Web of Science, Scopus, and Cochrane Library, from inception to July 17, 2021. The studies included healthy individuals who underwent assessments of endothelial function before and after experimental protocols through endothelium-dependent flow-mediated dilatation. In total, 4890 studies were screened, and 6 studies of moderate-to-high methodological quality (Physiotherapy Evidence Database scores 6 ­ 10) including 82 subjects (aged 24 ­ 68 years) were eligible. Overall, flow-mediated dilatation increased in the non-cuffed arm immediately and 15 minutes after exercise, with no change in the cuffed arm (BFR of 60 ­ 80 mmHg). In protocols without exercise, cuff pressures of 25 ­ 30 mmHg applied for 30 minutes did not promote changes in the endothelial function, while those > 50 mmHg induced a dose-dependent attenuation of flow-mediated dilatation only in young individuals. A moderate level of BFR appears to have no effect on endothelial function after acute exercise. In non-exercise conditions, reductions in flow-mediated dilatation seem to result from increased retrograde shear provoked by cuff pressures ≥ 50 mmHg in young but not in older adults. An exercise-related increase in antegrade shear rate leads to a greater nitric oxide-mediated vasodilator response. However, BFR appears to attenuate this effect in young but not in older individuals. (AU)

O objetivo desta revisão foi identificar os efeitos agudos da restrição do fluxo sanguíneo (RFS) com vs. sem exercício na função endotelial de indivíduos saudáveis, bem como as alterações na função endotelial em jovens e idosos após diferentes níveis de RFS vs. fluxo livre. Pesquisas sistemáticas foram realizadas nas bases United States National Library of Medicine (PubMed), Web of Science, Scopus e Cochrane Library até 17 de julho de 2021. Os estudos incluíram indivíduos saudáveis que avaliaram a função endotelial antes e após protocolos experimentais, por meio da dilatação mediada por fluxo. Foi selecionado o total de 4.890 estudos, e foram elegíveis seis de moderada a alta qualidade metodológica (Physioterapy Evidence Database 6 ­ 10 pontos), incluindo 82 indivíduos (24 ­ 68 anos). No geral, a dilatação mediada por fluxo aumentou no braço sem manguito, imediatamente e 15 minutos após o exercício, sem alteração no braço com manguito (RFS de 60 ­ 80 mmHg). Em protocolos sem exercício, pressões do manguito de 25 ­ 30 mmHg aplicadas por 30 minutos não promoveram alterações na função endotelial, enquanto aquelas > 50 mmHg induziram uma atenuação dose-dependente da dilatação mediada por fluxo em indivíduos jovens. Um nível moderado de RFS parece não ter efeito na função endotelial após uma sessão de exercício. Em condições sem exercício, as reduções na dilatação mediada por fluxo parecem resultar do aumento do cisalhamento retrógrado provocado por pressões do manguito ≥ 50 mmHg em jovens, mas não em idosos. O aumento da taxa de cisalhamento anterógrado relacionada ao exercício leva a maior resposta vasodilatadora mediada pelo óxido nítrico. No entanto, a RFS parece atenuar esse efeito em jovens, mas não em . (AU)

Are Self-Selected Intervals as Effective as Fixed Intervals in Controlling Acute Responses in High-Intensity Interval Resistance Training?

Physical conditioning programs often apply high-intensity resistance training (HIRT), but there is a lack of research investigating the effects of using fixed or self-selected resting intervals between exercises on the performance, relative intensity, and affective perception during this modality of training. This study compared fixed versus self-selected rest intervals in HIRT sessions on cardiorespiratory responses, number of repetitions, and enjoyment perception in trained young men. Sixteen trained males (27.1 ± 3.9 years; 56.6 ± 7.5 mL.kg-1.min-1) performed HIRT circuits with 30-s and self-selected recovery interval. The duration of resting intervals was longer in HIRT performed with fixed than self-selected intervals (14.04 ± 5.82 s; p < 0.0001; ES = 3.2). Both sessions elicited similar relative HRR (79.4 ± 6.2 % vs. 81.6 ± 4.2 %; p = 0.14), VO2R (43.0 ± 12.2% vs. 47.7 ± 9.6%; p = 0.10), and enjoyment reflected by scores in the PACES questionnaire (107.9 ± 15.1 vs. 109.2 ± 12.8; p = 0.65). The total number of repetitions (403.4 ± 45.5 vs. 353.1 ± 27.4; p < 0.01, ES = 1.3) and caloric expenditure (154.4 ± 28.6 kcal vs. 121.4 ± 21.6 kcal; p < 0.001, ES = 0.13) were greater in HIRT performed with fixed vs. self-selected intervals. In conclusion, HIRT performed with fixed and self-selected rest intervals elicited similar relative intensity and enjoyment perception. However, the number of repetitions and caloric expenditure were greater in sessions performed with fixed 30-s.

A Recreational Swimming Intervention during the Whole School Year Improves Fitness and Cardiometabolic Risk in Children and Adolescents with Overweight and Obesity.

The benefits of swimming as a treatment for overweight children are undefined. We investigated the effects of recreational swimming on cardiometabolic risk in children/adolescents with normal and excess weight. Participants (n = 49, 26 girls, 10.3 ± 1.8 y) were grouped as 'eutrophic swimming' (EU-Swim, n = 14); 'excess weight swimming' (EW-Swim, n = 20) with an 'obese swimming' subgroup (OB-Swim, n = 10); and 'excess weight sedentary' (EW-Sed, n = 15) with an 'obese sedentary' subgroup (OB-Sed, n = 11). Swimming (50 min, twice/week, moderate-vigorous intensity) was an extra activity during the school year (6 + 3 months with a 3-month school break). Nutritional status, blood pressure (BP), physical activity, cardiorespiratory fitness, biochemical variables, autonomic modulation, endothelial function, abdominal fat, and carotid thickness were assessed at baseline, 6, and 12 months. Greater improvements (p < 0.05) occurred in EW-Swim vs. EW-Sed in body mass index (z-BMI, -16%, d+ 0.52), waist-to-height ratio (W/H, -8%, d+ 0.59-0.79), physical activity (37-53%, d+ 1.8-2.2), cardiorespiratory fitness (30-40%, d+ 0.94-1.41), systolic BP (SBP, -6-8%, d+ 0.88-1.17), diastolic BP (DBP, -9-10%, d+ 0.70-0.85), leptin (-14-18%, d+ 0.29-0.41), forearm blood flow (FBF, 26-41%, d+ 0.53-0.64), subcutaneous fat (SAT, -6%, d+ 0.18), and intra-abdominal fat (VAT, -16%, d+ 0.63). OB-Swim showed improvements vs. OB-Sed in TNFα (-17%, d+ 1.15) and adiponectin (22%, d+ 0.40). Swimming improved fitness and cardiometabolic risk in children/adolescents with overweight/obesity. (TCTR20220216001).