Physical activity in solid organ transplant recipients: organizational aspects and preliminary results of the Italian project.

Most of the difficulties when trying to realize the proposal to prescribe physical activity for transplantation patients come from patient attitudes and cultural beliefs that ignore the benefits of exercise, but there also are organizational aspects arising from the difficulties that these patients face in accessing supervised exercise facilities. To address these difficulties, the Italian study project "Transplant … and Now Sport" was developed based on a model of cooperation among transplantation specialists, sports physicians, and exercise specialists organized as a team combining their specific skills to effectively actuate the physical exercise programs. This preliminary report is based on 26 patients (16 male, 10 female; 47.8±10.0 years old; 21 kidney and 5 liver transplantations; time from transplantation 2.3±1.4 years) who performed prescribed and supervised exercises consisting of 3 sessions per week of aerobic and strengthening exercises for 1 year. Preliminary results show a significant decrease in body mass index (t=1.966; P<.05) and a significant increase in peak aerobic power (t=4.535; P<.01) and maximum workload (t=4.665; P<.01) on the incremental cycling test. Also maximum strength of knee extensors (t=2.933; P<.05) and elbow flexors (t=2.450; P<.05) and countermovement jump performance (t=2.303; P<.05) significantly increased. Creatinine and proteinuria tended to decrease, but the differences were not significant. In health-related quality of life assessed by the SF-36 questionnaire, the Bodily Pain, General Health, Vitality, Social Functioning, and Role Emotional scale scores showed a significant improvement (P<.05). Preliminary results of the study protocol "Transplant…and Now Sport" show the positive effects of the model based on cooperation among transplantation centers, sports medicine centers, and gyms in the administration of a supervised exercise prescription. These data should be considered a contribution to developing and promoting further detailed exercise protocols and to fostering improved posttransplantation health and survival, helping to ensure that physical activity becomes a safe routine medical treatment plan of patient management.

Plasma leptin and energy expenditure during prolonged, moderate intensity, treadmill exercise.

BACKGROUND: Current literature shows conflicting results regarding the possible direct role of exercise on leptin concentrations, mainly because of a non-homogeneous level of energy expenditure (EE) and the lack of standardization of energy balance. AIM: The aim of the study was to evaluate the effect of exercise duration and its corresponding EE on leptin levels, during prolonged treadmill exercise, in a well-controlled laboratory setting. MATERIALS AND METHODS: Seven young trained males underwent a 4-h treadmill exercise. The starting intensity was set at 65% of maximal oxygen consumption. At the start of the test and throughout the exercise, venous blood samples were drawn for the assays of leptin, glucose, free fatty acids (FFA), cortisol, epinephrine (E) and norepinephrine (NE). Hourly and total EE was monitored with gas analysis. RESULTS: Plasma leptin levels decreased from 1.10±0.15 to 0.85±0.26 µg/l (p<0.01) at the end of the exercise, reaching a significant reduction already after the second hour. FFA and cortisol showed a progressive significant increase, while glucose did not significantly change throughout the test. Plasma E and NE significantly increased at all sampling times compared to basal values (48.1±30.3 to 352.3±187.7 pg/ml, p<0.001 and 238.1±118.9 to 1798.7±413.5 pg/ml, p<0.001). The random-effects model for panel data analysis showed negative correlation between leptin, NE and the values of progressive EE (r2=0.745, p<0.05). CONCLUSIONS: Our data demonstrate that, during a prolonged moderate intensity exercise, leptin decrease is significantly related to the total EE. Further, NE concentrations seem to play an important role in the inhibition of leptin secretion.

Sports and arrhythmias.

Rhythm disorders represent the main challenge for the sport physician and cardiologist to grant the certificate of sports eligibility to the athletes. Arrhythmias that occur in athletes can be divided into two types. The most common are generally an expression of morphofunctional changes in the athlete's heart and are represented by certain forms of non-complex tachyarrhythmias and bradyarrhythmias. On the other hand you may encounter less frequently more complex arrhythmias that may be an epiphenomenon of cardiomyopathy can cause sudden death during sports activities. By collection of detailed medical history, careful examination, and in particular by the 12-lead electrocardiogram is already possible to understand the arrhythmic risk sporting population. After an analysis of main types of arrhythmias encountered in the athlete and the main diagnostic methods, this study focuses on the interplay between forms of arrhythmias, arrhythmogenic heart diseases and activity sports. Surely the increased adrenergic tone and anatomical and functional alterations sports-related favor the development of arrhythmia and sudden death risk in structural cardiomyopathies. But this is not yet resolved the question of whether sport is able to increase the incidence of ventricular arrhythmias in a normal heart. Dangerousness of the arrhythmia is variable depending on the sport is practiced with high intensity or not. Even if it is important considering the possibility of syncope in hazardous environments. Arrhythmias at risk impose the exclusion of the athlete from the practice of sport. In some cases it may be considered a drug treatment, ablation, and in rare and selected cases, the implantation of a pacemaker or an implantable defibrillator.

Nasal functional modifications after physical exercise: olfactory threshold and peak nasal inspiratory flow.

STATEMENT OF PROBLEM: The respiratory nasal effects of physical exercise have been extensively investigated; on the other hand there are no data regarding olfactory threshold modification after aerobic physical exercise. METHODS: The present prospective study investigated the modifications in nasal respiratory flows and olfactory thresholds after controlled aerobic physical exercise in a cohort of 15 adult, healthy volunteers. The Peak Nasal Inspiratory Flow (PNIF), and the Sniffin' Sticks olfactory threshold test were used for our determinations. MAIN RESULTS: The mean PNIF after physical exercise was significantly higher than the mean PNIF value found before physical exercise. Statistical analysis ruled out any significant difference between mean olfactory thresholds pre vs post physical exercise. PRINCIPAL CONCLUSIONS: These outcomes confirmed PNIF sensitivity and reliability also in determining the changes in nasal patency occurring after physical exercise. The active vasoconstriction of nasal mucosa associated with the reduction of blood flow to the olfactory epithelium due to physical exercise may be compensated for by the increase of olfactory molecules that reach the olfactory mucosa because of nasal mucosal shrinkage: this mechanism could explain the stability of mean olfactory threshold after physical exercise.