Prescription opioids and economic hardship in France.

This paper studies how opioid analgesic sales are empirically related to socioeconomic disparities in France, with a focus on poverty. This analysis is made possible using the OpenHealth database, which provides retail sales data for opioid analgesics available on the French market. We exploit firm-level data for each of the 94 departments in Metropolitan France between 2008 and 2017. We show that increases in the poverty rate are associated with increases in sales: a one percentage point increase in poverty is associated with approximately a 5% increase in mild opioid sales. Our analysis further shows that opioid sales are positively related to the share of middle-aged people and individuals with basic education only, while they are negatively related to population density. The granularity and longitudinal nature of these data allow us to control for a large pool of potential confounding factors. Our results suggest that additional interventions should be more intensively addressed toward the most deprived areas. We conclude that a combination of policies aimed at improving economic prospects and strictly monitoring access to opioid medications would be beneficial for reducing opioid-related harm.

Optimal whole-body vibration settings for muscle strength and power enhancement in human knee extensors.

This study compared the effects of 6-week whole-body vibration (WBV) training programs with different frequency and peak-to-peak displacement settings on knee extensor muscle strength and power. The underlying mechanisms of the expected gains were also investigated. Thirty-two physically active male subjects were randomly assigned to a high-frequency/high peak-to-peak displacement group (HH; n=12), a low-frequency/low peak-to-peak displacement group (LL; n=10) or a sham training group (SHAM; n=10). Maximal voluntary isometric, concentric and eccentric torque of the knee extensors, maximal voluntary isometric torque of the knee flexors, jump performance, voluntary muscle activation, and contractile properties of the knee extensors were assessed before and after the training period. Significant improvement in knee extensor eccentric voluntary torque (P<0.01), knee flexor isometric voluntary torque (P<0.05), and jump performance (P<0.05) was observed only for HH group. Regardless of the group, knee extensor muscle contractile properties (P<0.05) were enhanced. No modification was observed for voluntary muscle activation or electrical activity of agonist and antagonist muscles. We concluded that high-frequency/high peak-to-peak displacement was the most effective vibration setting to enhance knee extensor muscle strength and jump performance during a 6-week WBV training program and that these improvements were not mediated by central neural adaptations.

Whole-body vibration training effects on the physical performance of basketball players.

The aim of this study was to investigate the influence of 4 weeks of whole-body vibration training added to the conventional training of basketball players. Eighteen competitive basketball players (13 male symbol, 5 female symbol, 18-24 years old) were randomly assigned to a whole-body vibration group (WBVG, n = 10; 7 male symbol and 3 female symbol) or a control group (CG, n = 8; 6 male symbol and 2 female symbol). During the 4-week period, all subjects maintained their conventional basketball training program. The members of WBVG were additionally trained 3 times a week for 20 minutes on a vibration platform (10 unloaded static lower limb exercises, 40-Hz, 4-mm, Silverplate). Testing was performed before and after the 4-week period and comprised strength assessment, vertical jump performance, and a 10-m sprint test. The maximal voluntary isometric strength of the knee extensors significantly increased (p < 0.001) after vibration training, as did squat jump (SJ) height (p < 0.05), whereas performance of the countermovement jump, drop jump, 30-second rebound jump, and 10-m sprint remained unchanged. The results of the present study indicated that a 4-week whole-body vibration training program added to the conventional training of basketball players during the preseason is an effective short-term stimulus to enhance knee extensor strength and slightly SJ performance.

Neuromuscular fatigue profile in endurance-trained and power-trained athletes.

PURPOSE: This study examined the effects of training background on the relationship between the neuromuscular fatigue profile and maximal voluntary torque production in isometric, concentric, and eccentric contraction modes. METHODS: Before and after three sets of 31 isokinetic concentric knee extensions at 60 degrees .s(-1), voluntary and electrically induced contractions were recorded in 14 endurance-trained (ENDU) men (seven cyclists: age 25 +/- 2 yr, mass 70 +/- 8 kg, height 175 +/- 5 cm; and seven triathletes: age 27 +/- 4 yr, mass 71 +/- 5 kg, height 179 +/- 6 cm) and seven explosive power-trained men (EXPLO: age 24 +/- 1 yr, mass 73 +/- 5 kg, height 179 +/- 4 cm). Maximal knee-extension torque, activation level (twitch interpolation technique), electromyographic activity of agonist and antagonist muscles, and twitch contractile properties were assessed. RESULTS: At preexercise, the maximal voluntary isometric and concentric torques of EXPLO were greater than those of ENDU (P < 0.05). After the fatiguing exercise, significant isometric (18%; P < 0.01) and concentric (25%; P < 0.05) torque decreases in EXPLO were associated with, respectively, twitch torque (Pt) and maximal rate of twitch development (+dPt/dt) reductions (P < 0.01) and with an increase in the antagonist coactivation level (P < 0.01). No modification was observed for ENDU. Interestingly, the coactivation level was also increased (P < 0.01) in eccentric contraction for EXPLO, although the maximal eccentric torque decrease (P < 0.01) could not be specifically attributed to any group. CONCLUSION: The fatiguing exercise induced central and peripheral adaptations, but the mechanisms differed regarding the contraction mode. At pre- and postfatiguing exercise, it seems that the neuromuscular profile depends on the subject's training background and the contraction modes used to assess fatigue.

Knee isometric torque and electromyographic specificities after semitendinosus and gracilis hamstrings anterior cruciate ligament reconstruction.

OBJECTIVES: Because the co-contraction of the gastrocnemius and hamstring muscles strains the anterior cruciate ligament, the role of the gastrocnemius muscle is of particular importance after semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. This study aimed to examine the neuromuscular mechanisms underlying postsurgical torque deficits during knee flexion by using surface electromyography. DESIGN: A total of 14 volunteer patients (eight men, six women; age, 32.5 +/- 9.3 yrs; height, 172.7 +/- 6 cm; weight, 69.6 +/- 10.2 kg) were enrolled in the study; all had undergone anterior cruciate ligament reconstruction performed by the same surgeon. The neuromuscular mechanisms were assessed using isometric tests and surface electromyographic recordings at 19 mos post-reconstruction. The torque deficits in the injured knee were compared with the uninjured knee, which served as control values. RESULTS: Significant differences in torque production were observed between the two limbs at specific angular positions during the extension and flexion tests (P < 0.05). The difference in the root mean square myoelectrical activity between the limbs was computed at each tested position, revealing that the gastrocnemius muscle had greater activity at 75 degrees than at 45 degrees (P < 0.05). CONCLUSIONS: In deep flexion (>70 degrees), the gastrocnemius muscle may compensate for the weakened hamstrings and thereby strain the anterior cruciate ligament graft after anterior cruciate ligament semitendinosus and gracilis tendon reconstruction.

Force steadiness in the lower extremities as an independent predictor of functional performance in older women.

The relationship between isometric force control and functional performance is unknown. Submaximal steadiness and accuracy were measured during a constant force-matching task at 50% of maximal isometric voluntary contraction (MVC) of the knee extensors in 19 older women (70-89 years). Other variables included MVC, rate of torque development, and EMG activity. Functional performance was assessed during maximal performance of walking endurance, chair rising, and stair climbing. Isometric steadiness (but not accuracy) was found to independently predict chair-rise time and stair-climbing power and explained more variance in these tasks than any other variable. Walking endurance was related to muscle strength but not steadiness. These results suggest that steadiness is an independent predictor of brief, stressful functional-performance tasks in older women with mild functional impairment. Thus, improving steadiness might help reduce functional limitations or disability in older adults.

Physiological and functional responses to low-moderate versus high-intensity progressive resistance training in frail elders.

BACKGROUND: The purpose of this efficacy study was to measure the dose-response effect of a free weight-based resistance training program by comparing the effects of two training intensities (low-moderate and high) of the knee extensor (KE) muscles on muscle function, functional limitations, and self-reported disability. METHODS: The authors conducted a single-blinded, randomized, placebo-controlled trial. Twenty-two institutionalized elders (mean age, 81.5 years) were assigned to either high-intensity strength training (HI; n = 8), low-moderate intensity strength training (LI; n = 6), or weight-free placebo-control training (PC; n = 8). The HI group trained at 80% of their 1-repetition maximum and the LI group trained at 40%. All groups performed 3 sets of 8 repetitions, 3 times per week for 10 weeks. Outcome measures included KE maximal strength, KE endurance, and functional performance as assessed by 6-minute walking, chair-rising, and stair-climbing tests, and by self-reported disability. RESULTS: KE strength and endurance, stair-climbing power, and chair-rising time improved significantly in the HI and LI groups compared with the PC group. Six-minute walking distance improved significantly in the HI group but not in the LI group compared with the PC group. Changes observed in HI were significantly different from those observed in the LI group for KE strength and endurance and the 6-minute walking test, with a trend in the same direction for chair-rising and stair-climbing. Changes in strength were significantly related to changes in functional outcomes, explaining 37% to 61% of the variance. CONCLUSIONS: These results show strong dose-response relationships between resistance training intensity and strength gains, and between strength gains and functional improvements after resistance training. Low-moderate intensity resistance training of the KE muscles may not be sufficiently robust from a physiologic perspective to achieve optimal improvement of functional performance. Supervised HI, free weight-based training for frail elders appears to be as safe as lower intensity training but is more effective physiologically and functionally.

Strenuous exercise increases plasmatic and urinary leukotriene E4 in cyclists.

UNLABELLED: The purpose of this study was to investigate plasma and urinary levels of leukotriene (LT) and the changes in pulmonary function induced by strenuous exercise in highly trained cyclists (HT) with mild exercised-induced hypoxemia (EIH). METHOD: Nine HT and five untrained subjects (UT) performed a 30-min exercise at 78% of their VO2peak. Leukotriene E4 (LTE4) was assayed in plasma and urine. Pulmonary function tests and pulmonary diffusion capacity (DLCO) were examined before and after exercising. Ear arterialized blood gases were assessed at rest and during exercise. RESULTS: The mean drop in partial oxygen pressure was 15 mmHg in HT during exercise; and the DLCO decreased by 7.5% following exercise. No significant changes were found in forced vital capacity or forced expiratory flows. LTE4 levels increased significantly in HT following exercise: urinary LTE4 was 42.9 +/- 6.3 ng.mmol-1 creatinine at rest and 66.3 +/- 11.9 ng.mmol-1 creatinine 2 hrs after exercise, and plasma LTE4 rose from 528 +/- 91 pg.mL-1 at rest to 897 +/- 123 pg.mL-1 after exercise. By contrast, urinary LTE4 level was unchanged in the UT group. Among the HT group, there was no significant correlation between urinary LTE4 changes and PO2, air flow rates, or DLCO changes. CONCLUSION: These results suggest that strenuous exercise induces an increase of LTE4 release in highly trained cyclists with mild EIH. These changes in LTE4 levels were not related to significant impairment of lung function.

Prediction of endurance capacity of quadriceps muscles in humans using surface electromyogram spectrum analysis during submaximal voluntary isometric contractions.

The measurement of endurance time ( t(lim)) is the procedure commonly used to quantify the ability of a muscle to maintain force. The relationship between surface electromyographic (sEMG) manifestations of localised muscle fatigue and t(lim) during an effort at 50% of maximal voluntary isometric torque of the knee extensors (vastus lateralis and vastus medialis) until exhaustion was studied in 14 healthy volunteers. It was carried out to test whether changes in sEMG computed over shorter periods than expected t(lim) could be used to predict t(lim). Changes in mean muscle fibre conduction velocity, mean power frequency, median frequency, root mean square ), in the relative power in the 6-30 Hz and 30-60 Hz frequency bands were monitored using linear slope and area ratio index as statistical indicators. These indicators were computed over fixed periods shorter than t(lim). The subjects were able to maintain the required force level for [mean (SD)] 78.8 (9.5) s. During the fatigue trial, it was the greatest of the increases in the 6-30 Hz frequency band, recorded for either of the two muscles investigated, that was the only variable which correlated with t(lim). Significant relationships between t(lim) and changes in this low frequency band were observed as early as the first 15-30 s of the contraction. These results suggest that sEMG frequency banding may predict mechanical endurance without the need to maintain the contraction until exhaustion. From a clinical perspective, this could be an advantage for patients who might not be able to tolerate contractions to exhaustion.

Nandrolone excretion is not increased by exhaustive exercise in trained athletes.

PURPOSE: The anabolic steroid nandrolone is widely used as a performance enhancer. Traces of its naturally occurring metabolite 19-norandrosterone (19-NA) have been found in human urine (below 0.6 ng.mL(-1)), and it has been suggested that strenuous exercise may increase urinary 19-NA. The aim of our study was to assess the effect of exhaustive exercise on the nandrolone excretion under controlled conditions in two groups of trained male athletes, one composed of judoka and the other of long-distance runners. METHODS: A Wingate test and a treadmill limited-time test (running at 85% (.)VO(2max)) were carried out on 14 judoka and 15 athletes. Hydration was controlled during each session. Urine samples were obtained before each test and 30 min, 60 min, and 24 h after each test. Urinary 19-NA concentrations were determined using gas chromatography coupled with mass spectrometry. RESULTS: Baseline urinary 19-NA concentrations varied widely across individuals, from undetectable levels to 0.250 ng.mL (-1)(mean, 0.048 +/- 0.050 ng.mL(-1)). The both exercise tests did not significantly modified urinary 19-NA levels in the two groups of subjects. CONCLUSION: Our study provides compelling evidence that endogenous nandrolone production in male athletes, during two very different types of exercise, produces urine levels far below the IOC threshold of 2 ng.mL(-1) urine. Thus, exercise does not induce endogenous nandrolone secretion.

Methods to determine aerobic endurance.

Physiological testing of elite athletes requires the correct identification and assessment of sports-specific underlying factors. It is now recognised that performance in long-distance events is determined by maximal oxygen uptake (V(2 max)), energy cost of exercise and the maximal fractional utilisation of V(2 max) in any realised performance or as a corollary a set percentage of V(2 max) that could be endured as long as possible. This later ability is defined as endurance, and more precisely aerobic endurance, since V(2 max) sets the upper limit of aerobic pathway. It should be distinguished from endurance ability or endurance performance, which are synonymous with performance in long-distance events. The present review examines methods available in the literature to assess aerobic endurance. They are numerous and can be classified into two categories, namely direct and indirect methods. Direct methods bring together all indices that allow either a complete or a partial representation of the power-duration relationship, while indirect methods revolve around the determination of the so-called anaerobic threshold (AT). With regard to direct methods, performance in a series of tests provides a more complete and presumably more valid description of the power-duration relationship than performance in a single test, even if both approaches are well correlated with each other. However, the question remains open to determine which systems model should be employed among the several available in the literature, and how to use them in the prescription of training intensities. As for indirect methods, there is quantitative accumulation of data supporting the utilisation of the AT to assess aerobic endurance and to prescribe training intensities. However, it appears that: there is no unique intensity corresponding to the AT, since criteria available in the literature provide inconsistent results; and the non-invasive determination of the AT using ventilatory and heart rate data instead of blood lactate concentration ([La(-)](b)) is not valid. Added to the fact that the AT may not represent the optimal training intensity for elite athletes, it raises doubt on the usefulness of this theory without questioning, however, the usefulness of the whole [La(-)](b)-power curve to assess aerobic endurance and predict performance in long-distance events.