A comparison of modelled serum cTnT and cTnI kinetics after 60 min swimming.

Post-exercise elevations of cardiac troponin T (cTnT) and I (cTnI) are often used in isolation but interpreted interchangeably. Research suggests, however, that post-exercise cTn kinetic might differ with each isoform. In this cross-sectional observational study, we collected blood samples before, immediately after (5 minutes), and at 1-, 3-, 6-, 12-, and 24-hour post-exercise in a mixed cohort of 56 participants after a distance-trial of 60 min continuous swimming (age range from 14 to 22, 57.1% female). Cardiac troponin kinetics were modelled using Bayesian mixed-effects models to estimate time to peak (TTP) and peak concentration (PC) for each isoform, while controlling for participants sex, tanner stage and average relative heart rate during the test. Exercise induced an elevation of cTnT and cTnI in 93% and 75% of the participants, respectively. Cardiac troponin T peaked earlier, at 2.9 h (CI: 2.6 - 3.2 h) post-exercise, whereas cTnI peaked later, at 4.5 h (CI: 4.2 - 4.9 h). Peak concentrations for cTnT and cTnI were 2.5 ng/L, CI: 0 - 11.2 ng/L and 2.16 ng/L, CI: 0 - 22.7 ng/L, respectively. Additionally, we did not observe a systematic effect of sex and maturational status mediating cTn responses.

Characterization of Different Forms of Kava (Piper methysticum) Products by UPLC-MS/MS.

There are several forms of kava (Piper methysticum) products available for human consumption, and many factors are known to influence their chemical compositions and therefore their pharmacological properties. Because of the increased popularity of kava intake, a rigorous characterization of their content diversity is prerequisite, particularly due to its known potential to cause hepatotoxicity. To understand the composition diversity of kavalactones and flavokavains in commercial kava products, we developed a UPLC-MS/MS-based analytical method for the quantification of six kavalactones (kavain, dihydrokavain, methysticin, dihydromethysticin, yangonin and desmethoxyyangonin) and two flavokavains (flavokavains A and B) and analyzed their contents in 28 different kava products in the form of capsules, tinctures, traditional aqueous suspensions and dried powders. Our results demonstrated a great variation in terms of the total and relative abundance of the analyzed kavalactones and flavokavains among the analyzed kava preparations. More importantly, the kavalactone abundance in the product label could differ up to 90% from our experimental measurements. Therefore, more rigorous and comprehensive quality control of kava products is required with respect to the content of individual kavalactones and flavokavains. Accurate content information is essential to understand the pharmacological properties and safety of different kava products.

COVID-19 and ethnicity: Does reduced responsiveness to glucocorticoids explain the more aggressive nature of disease among minorities?

Marked ethnic variations in complications and mortality have been noted following infection with COVID-19, with Black, Asian, and minority ethnic groups (BAME) being particularly hard hit. We hypothesise that glucocorticoid resistance stemming from several intrinsic reasons such as chronic social stress and lower circulating levels of Vitamin D may contribute to the exaggerated inflammatory response, more severe disease and poorer outcomes observed in BAME.

COVID-19 and ethnicty: Does reduced responsiveness to glucocorticiods explain the more aggressive nature of disease among minorities?

Marked ethnic variations in complications and mortality have been noted following infection with COVID-19, In the United States, the age-adjusted mortality rate among Blacks is 3.8 times, Hispanics 2.5 times, and Asians 1.5 times higher than Whites. In the United Kingdom, the age-adjusted mortality rate among Blacks is 2.9 times, Pakistani and Bangladeshi 2.2 times, and South Indians 1.8 times than that of Whites. One should consider that the increased mortality seen in BAME may be a consequence of impaired glucocorticoid sensitivity stemming from several intrinsic reasons such as chronic social stress and lower circulating levels of Vitamin D. This study aims to evaluate the effect, or lack thereof, of glucocorticoids on Black, Asian and Minority ethnic groups (BAME) when compared to White populations in the setting of COVID-19 treatment.

Kava as a Clinical Nutrient: Promises and Challenges.

Kava beverages are typically prepared from the root of Piper methysticum. They have been consumed among Pacific Islanders for centuries. Kava extract preparations were once used as herbal drugs to treat anxiety in Europe. Kava is also marketed as a dietary supplement in the U.S. and is gaining popularity as a recreational drink in Western countries. Recent studies suggest that kava and its key phytochemicals have anti-inflammatory and anticancer effects, in addition to the well-documented neurological benefits. While its beneficial effects are widely recognized, rare hepatotoxicity had been associated with use of certain kava preparations, but there are no validations nor consistent mechanisms. Major challenges lie in the diversity of kava products and the lack of standardization, which has produced an unmet need for quality initiatives. This review aims to provide the scientific community and consumers, as well as regulatory agencies, with a broad overview on kava use and its related research. We first provide a historical background for its different uses and then discuss the current state of the research, including its chemical composition, possible mechanisms of action, and its therapeutic potential in treating inflammatory and neurological conditions, as well as cancer. We then discuss the challenges associated with kava use and research, focusing on the need for the detailed characterization of kava components and associated risks such as its reported hepatotoxicity. Lastly, given its growing popularity in clinical and recreational use, we emphasize the urgent need for quality control and quality assurance of kava products, pharmacokinetics, absorption, distribution, metabolism, excretion, and foundational pharmacology. These are essential in order to inform research into the molecular targets, cellular mechanisms, and creative use of early stage human clinical trials for designer kava modalities to inform and guide the design and execution of future randomized placebo controlled trials to maximize kava's clinical efficacy and to minimize its risks.

Oral Dosing of Dihydromethysticin Ahead of Tobacco Carcinogen NNK Effectively Prevents Lung Tumorigenesis in A/J Mice.

Our early studies demonstrated an impressive chemopreventive efficacy of dihydromethysticin (DHM), unique in kava, against tobacco carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)-induced lung tumorigenesis in A/J mice in which DHM was supplemented in the diet. The current work was carried out to validate the efficacy, optimize the dosing schedule, and further elucidate the mechanisms using oral bolus dosing of DHM. The results demonstrated a dose-dependent chemopreventive efficacy of DHM (orally administered 1 h before each of the two NNK intraperitoneal injections, 1 week apart) against NNK-induced lung adenoma formation. Temporally, DHM at 0.8 mg per dose (∼32 mg per kg body weight) exhibited 100% lung adenoma inhibition when given 3 and 8 h before each NNK injection and attained >93% inhibition when dosed at either 1 or 16 h before each NNK injection. The simultaneous treatment (0 h) or 40 h pretreatment (-40 h) decreased lung adenoma burden by 49.8% and 52.1%, respectively. However, post-NNK administration of DHM (1-8 h after each NNK injection) was ineffective against lung tumor formation. In short-term experiments for mechanistic exploration, DHM treatment reduced the formation of NNK-induced O6-methylguanine (O6-mG, a carcinogenic DNA adduct in A/J mice) in the target lung tissue and increased the urinary excretion of NNK detoxification metabolites as judged by the ratio of urinary NNAL-O-gluc to free NNAL, generally in synchrony with the tumor prevention efficacy outcomes in the dose scheduling time-course experiment. Overall, these results suggest DHM as a potential chemopreventive agent against lung tumorigenesis in smokers, with O6-mG and NNAL detoxification as possible surrogate biomarkers.

Design, synthesis, and enzymatic characterization of quinazoline-based CYP1A2 inhibitors.

Cytochrome P450 isozyme 1A2 (CYP1A2) is one main xenobiotic metabolizing enzyme in humans. It has been associated with the bioactivation of procarcinogens, including 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), a tobacco specific and potent pulmonary carcinogen. This work describes the computational design and in-silico screening of potential CYP1A2 inhibitors, their chemical synthesis, and enzymatic characterization with the ultimate aim of assessing their potential as cancer chemopreventive agents. To achieve this, a combined classifiers model was used to screen a library of quinazoline-based molecules against known CYP1A2 inhibitors, non-inhibitors, and substrates to predict which quinazoline candidates had a better probability as an inhibitor. Compounds with high probability of CYP1A2 inhibition were further computationally evaluated via Glide docking. Candidates predicted to have selectivity and high binding affinity for CYP1A2 were synthesized and assayed for their enzymatic inhibition of CYP1A2, leading to the discovery of novel and potent quinazoline-based CYP1A2 inhibitors.

Kava and its Kavalactones Inhibit Norepinephrine-induced Intracellular Calcium Influx in Lung Cancer Cells.

Kava, the extract of the roots of Piper methysticum, has been traditionally consumed in the South Pacific islands for its natural relaxing property. Epidemiological data suggests that kava consumption may reduce human cancer risk, and in vitro and in vivo models suggest chemopreventive potential against carcinogen-induced tumorigenesis. Therefore, knowledge about its molecular mechanisms and responsible ingredient(s) for these beneficial properties will better guide kava's use for the management of these disorders. Psychological stress typically results in increased production of stress hormones, such as norepinephrine (NE), which activate adrenergic receptors (ARs). Psychological stress has also been associated with increased cancer incidence and poor clinical outcomes in cancer patients. Mechanistically, binding of NE to ARs induces intracellular calcium influx, which activates downstream signaling pathways involved in both stress and cancer development. In this study, we characterized the effect of kava and its components, 3 fractions and 6 major kavalactones, on NE-induced intracellular calcium influx in H1299, a human non-small cell lung carcinoma cell line. Results show that kava extract effectively inhibits NE-mediated intracellular calcium influx in H1299 cells, potentially through antagonizing ß-AR signaling. This inhibitory activity is recapitulated by the major kavalactones in kava. Among the 6 major kavalactones, DHK demonstrated the best potency. Taken together, our study suggests a novel mechanism through which kava and its ingredients potentially offer the anxiolytic and cancer-preventive activity.

COVID-19: Social Displacement and Glucocorticoid Resistance

This study aims to evaluate the effect or lack thereof, of glucocorticoids on Black, Asian, and Minority ethnic groups (BAME) when compared to white populations in the setting of COVID-19 treatment

11ß-hydroxysteroid dehydrogenase type-II activity is affected by grapefruit juice and intense muscular work

ABSTRACT Objective The enzymatic activity of 11β-hydroxysteroid dehydrogenase-2 (11β-HSD2) is key to protecting mineral corticoid receptors from cortisol and has been implicated in blood pressure regulation. Grapefruit juice (GFJ) and acidity are thought to inhibit this enzyme in vitro. This study examines the effect of GFJ and intense exercise on 11β-HSD2 enzyme activity in vivo. Subjects and methods Eighteen subjects ingested GFJ or apple juice (CON) on separate days prior to reporting to the laboratory in a randomized order. Saliva (Sal) samples were obtained at baseline, 15 and 45 minutes post-treadmill stress test; Sal cortisone (E) and cortisol (F) levels were determined, and the Sal cortisone:cortisol (E:F) ratio was used as an index of 11β-HSD2 enzyme activity at rest and after intense muscular work. Results GFJ treatment decreased baseline 11β-HSD2 enzyme activity (44%) and Sal-E (28%) compared to CON (both, p < 0.05). Sal-E (r = 0.61, p < 0.05) and Sal-F (r = 0.66, p < 0.05) were correlated with diastolic blood pressure (DBP) in GFJ-treated individuals. Treadmill stress significantly increased Sal-E and Sal-F but did not alter 11β-HSD2 enzyme activity regardless of treatment. When treatments were examined separately, CON 11β-HSD2 enzyme activity decreased by 36% (p < 0.05) from baseline to 15 post-treadmill exercise. Conclusion Our findings suggest that GFJ and intense muscular work decrease 11β-HSD-2 activity independently, and no additive effect was noted. The association between DBP and the levels of Sal-F and Sal-E during the GFJ trial should be interpreted cautiously and warrants further investigation.

11ß-hydroxysteroid dehydrogenase type-II activity is affected by grapefruit juice and intense muscular work.

OBJECTIVE: The enzymatic activity of 11ß-hydroxysteroid dehydrogenase-2 (11ß-HSD2) is key to protecting mineral corticoid receptors from cortisol and has been implicated in blood pressure regulation. Grapefruit juice (GFJ) and acidity are thought to inhibit this enzyme in vitro. This study examines the effect of GFJ and intense exercise on 11ß-HSD2 enzyme activity in vivo. SUBJECTS AND METHODS: Eighteen subjects ingested GFJ or apple juice (CON) on separate days prior to reporting to the laboratory in a randomized order. Saliva (Sal) samples were obtained at baseline, 15 and 45 minutes post-treadmill stress test; Sal cortisone (E) and cortisol (F) levels were determined, and the Sal cortisone:cortisol (E:F) ratio was used as an index of 11ß-HSD2 enzyme activity at rest and after intense muscular work. RESULTS: GFJ treatment decreased baseline 11ß-HSD2 enzyme activity (44%) and Sal-E (28%) compared to CON (both, p < 0.05). Sal-E (r = 0.61, p < 0.05) and Sal-F (r = 0.66, p < 0.05) were correlated with diastolic blood pressure (DBP) in GFJ-treated individuals. Treadmill stress significantly increased Sal-E and Sal-F but did not alter 11ß-HSD2 enzyme activity regardless of treatment. When treatments were examined separately, CON 11ß-HSD2 enzyme activity decreased by 36% (p < 0.05) from baseline to 15 post-treadmill exercise. CONCLUSION: Our findings suggest that GFJ and intense muscular work decrease 11ß-HSD-2 activity independently, and no additive effect was noted. The association between DBP and the levels of Sal-F and Sal-E during the GFJ trial should be interpreted cautiously and warrants further investigation.

Age, muscle fatigue, and walking endurance in pre-menopausal women.

Aging is associated with loss of endurance; however, aging is also associated with decreased fatigue during maximal isometric contractions. The aims of this study were to examine the relationship between age and walking endurance (WE) and maximal isometric fatigue (MIF) and to determine which metabolic/fitness components explain the expected age effects on WE and MIF. Subjects were 96 pre-menopausal women. Oxygen uptake (walking economy) was assessed during a 3-mph walk; aerobic capacity and WE by progressive treadmill test; knee extension strength by isometric contractions, MIF during a 90-s isometric plantar flexion (muscle metabolism measured by (31)P MRS). Age was related to increased walking economy (low VO(2), r = -0.19, P < 0.03) and muscle metabolic economy (force/ATP, 0.34, P = 0.01), and reduced MIF (-0.26, P < 0.03). However, age was associated with reduced WE (-0.28, P < 0.01). Multiple regression showed that muscle metabolic economy explained the age-related decrease in MIF (partial r for MIF and age -0.13, P = 0.35) whereas walking economy did not explain the age-related decrease in WE (partial r for WE and age -0.25, P < 0.02). Inclusion of VO(2max) and knee endurance strength accounted for the age-related decreased WE (partial r for WE and age = 0.03, P > 0.80). In premenopausal women, age is related to WE and MIF. In addition, these results support the hypothesis that age-related increases in metabolic economy may decrease MIF. However, decreased muscle strength and oxidative capacity are related to WE.

Dietary adherence during weight loss predicts weight regain.

This study examined the relationship between previous dietary adherence during a low-calorie diet weight loss intervention and subsequent weight change during a 2-year follow-up for weight maintenance. One hundred and sixteen healthy, recently weight reduced (lost ~12 kg, BMI 22-25 kg/m2) premenopausal women were studied. Dietary adherence was assessed by doubly labeled water (DLW) and body composition change. Comparisons were made between the upper and lower tertiles for previous dietary adherence and subsequent weight change at 1- and 2-year follow-up. Percent weight regained was significantly lower (30.9 ± 6.7% vs. 66.7 ± 9.4%; P < 0.05) in the upper compared to the lower adherence tertile for previous weight loss dietary adherence (49.9 ± 8.8% vs. 96.8 ± 12.8% P < 0.05) at 1- and 2-year follow-up, respectively. This difference was partly explained by increases in daily activity-related energy expenditure (AEE) (+95 ± 45 kcal/day vs. -44 ± 42 kcal/day, P < 0.05) and lower daily energy intake (2,066 ± 71 kcal/day vs. 2,289 ± 62 kcal/day, P < 0.05) in the higher tertile for previous dietary adherence, compared to the lower. These findings suggest that higher adherence (i.e., higher tertile) to the previous low-calorie diet predicts lower weight regain over 2-year follow-up for weight maintenance, which is explained by lower energy intake and higher physical activity. Finally, how well an individual adheres to a low-calorie diet intervention during weight loss may be a useful tool for identifying individuals who are particularly vulnerable to subsequent weight regain.

Exercise training prevents regain of visceral fat for 1 year following weight loss.

The purpose of this study was to determine what effect aerobic and resistance exercise training has on gain of visceral fat during the year following weight loss. After being randomly assigned to aerobic training, resistance training, or no exercise training, 45 European-American (EA) and 52 African-American (AA) women lost 12.3 +/- 2.5 kg on a 800 kcal/day diet. Computed tomography was used to measure abdominal subcutaneous and visceral adipose tissue, whereas total fat and regional fat (leg, arm, and trunk) were measured by dual energy X-ray absorptiometry after weight loss and 1 year following the weight loss. Because not all the subjects adhered to the 2 time/week 40 min/day exercise training during the 1-year follow-up, subjects were divided into five groups for analysis: aerobic adherers, aerobic nonadherers, resistance adherers, resistance nonadherers, and no exercise. No significant differences were observed between the aerobic training and resistance training adherers for any variable. However, the aerobic (3.1 kg) and resistance (3.9 kg) exercise adherers gained less weight than any of the other three groups (all >6.2 kg). In addition, the two exercise adherence groups did not significantly increase visceral fat (<0.8%) as compared with the 38% increase for the two nonadhering exercise groups and the 25% for the nonexercise group. In conclusion, as little as 80 min/week aerobic or resistance training had modest positive effects on preventing weight regain following a diet-induced weight loss. More importantly, both aerobic and resistance training prevented regain of potentially harmful visceral fat.

Hombres violentos contra la pareja: trastornos mentales y perfiles tipológicos

Los objetivos de este artículo teórico son analizar los trastornos mentales y los déficits psicológicos más relevantes de los hombres violentos contra la pareja, así como señalar los distintos tipos de maltratadores existentes según las clasificaciones de Holtzworth-Munroe y Stuart (1994) y deFernández-Montalvo y Echeburúa (1997). Para ello se ha realizado una revisión de múltiples trabajosteóricos y empíricos. Los principales resultados indican que los agresores suelen presentar con frecuencia alteraciones psicológicas –falta de control sobre la ira, dificultades en la expresión de emociones, distorsiones cognitivas, déficits de habilidades de comunicación y de solución de problemasy baja autoestima-, y, en menor medida, cuadros clínicos bien definidos (por ejemplo, alcoholismo, trastornos de la personalidad, celos delirantes). En conclusión, existen diferentes tipos de hombres violentos -agresores limitados al ámbito familiar, agresores con características borderline/disfóricasy agresores violentos en general/antisociales- que requieren programas de tratamiento, adaptados asus características y necesidades específicas. Por último, se comentan las líneas de investigación másurgentes.

The aims of this theoretical paper are to analyze the mental disorders and the most relevant psychological deficits of intimate partner violent men, as well as to identify different types of batterers according to the classifications of Holtzworth-Munroe and Stuart (1994) and of Fernandez-Montalvo and Echeburúa (1997). A review of multiple theoretical and empirical papers has been carried out with this purpose. The main results show that the aggressors usually show psychologicaldeficits –lack of control over anger, difficulty in expressing emotions, cognitive distortions, deficit incommunication skills and problem solving, and low self-esteem-, and, not as often, well-established clinical disorders (eg, alcoholism, personality disorders, delusional jealousy). In conclusion, there are different types of violent men –family only, dysphoric/borderline and generally violent/antisocialwho require treatment programs adapted to their specific characteristics and needs. Finally, the future perspectives and the most relevant goals of research are commented on.

Os objetivos deste artigo teórico são analisar os transtornos mentais e os déficits psicológicos mais relevantes dos homens violentos contra o casal, assim como assinalar os diferentes tipos de agressores existentes segundo as classificações de Holtzworth-Munroe e Stuart (1994) e de Fernández-Montalvoe Echeburúa (1997). Para isso se realizou uma revisão de múltiplos trabalhos teóricos e empoíricos.Os principais resultados indicam que os agressores costumam apresentar com freqüência alterações psicológicas –falta de controle sobre a ira, dificuldades na expressão de emoções, distorções cognitivas, déficits de habilidades de comunicação e de solução de problemas, e baixa auto-estima-, e, em menor medida, quadros clínicos bem definidos (por exemplo, alcoolismo, transtornos da personalidade, ciúmes delirantes). Em conclusão, existem diferentes tipos de homens violentos -agressores limitadosao âmbito familiar, agressores com características “borderline/disfóricas” e agressores violentos em geral/anti-sociais- que requerem programas de tratamento adaptados a suas características e necessidades específicas. Por último, se comentam as linhas de pesquisa mais urgentes.

Effect of dietary adherence with or without exercise on weight loss: a mechanistic approach to a global problem.

CONTEXT: Weight loss using low-calorie diets produces variable results, presumably due to a wide range of energy deficits and low-dietary adherence. OBJECTIVE: Our objective was to quantify the relationship between dietary adherence, weight loss, and severity of caloric restriction. DESIGN AND SETTING: Participants were randomized to diet only, diet-endurance training, or diet-resistance training until body mass index (BMI) was less than 25 kg/m(2). PARTICIPANTS: Healthy overweight (BMI 27-30) premenopausal women (n = 141) were included in the study. INTERVENTIONS: An 800-kcal/d(-1) diet was provided, and the exercise groups were engaged in three sessions per week. MAIN OUTCOMES: Dietary adherence, calculated from total energy expenditure determined by doubly labeled water measurements and dual-energy x-ray absorptiometry body composition changes, and degree of caloric restriction were determined. RESULTS: All groups had similar weight loss (approximately 12.1 +/- 2.5 kg) and length of time to reach target BMI (approximately 158 +/- 70 d). Caloric restriction averaged 59 +/- 9%, and adherence to diet was 73 +/- 34%. Adherence to diet was inversely associated to days to reach target BMI (r = -0.687; P < 0.01) and caloric restriction (r = -0.349; P < 0.01). Association between adherence to diet and percent weight lost as fat was positive for the diet-endurance training (r = 0.364; P < 0.05) but negatively correlated for the diet-only group (r = -0.387; P < 0.05). CONCLUSIONS: Dietary adherence is strongly associated with rates of weight loss and adversely affected by the severity of caloric restriction. Weight loss programs should consider moderate caloric restriction relative to estimates of energy requirements, rather than generic low-calorie diets.

Translating exercise biology into the Venezuelan medical education and health care system.

In the absence of pharmacological agents, physical exercise was widely used by physicians in the late 19th century to treat a number of maladies. In the 1950's, epidemiological evidence suggested an association between physical activity and health, and increased interest in clinical exercise biology. By the 1990's, sufficient research data was accumulated on the benefits of exercise, such that North American medical associations, government agencies, and the World Health Organization have published guidelines on exercise for public and clinical populations. Despite this, leaders in medical education have remained reluctant to incorporate exercise biology into the core medical curriculum, or to systematically implement it in graduate medical education. This work reviews Venezuelan exercise biology literature, and its medical applications. Venezuelan scientists and clinicians have invested efforts in cardiopulmonary exercise testing, skeletal muscle adaptations to training and exercise cardiovascular pharmacology in patients, sedentary subjects and athletes. It is suggested here, that there is a need to develop education and research programs in basic and clinical exercise biology in the formal training of medical students, physicians in residency programs, and allied health care professionals. Tentative steps to initiate this process are proposed.

Translating exercise biology into the Venezuelan medical education and health care system

En la ausencia de agentes farmacológicos, el ejercicio físico fue ampliamente usado por médicos a finales del siglo 19 para tratar numerosas enfermedades. Durante el siglo 20, en la década de los 50`s, la evidencia epidemiológica ya suger¡a una asociación entre la actividad física y la salud, y comenzaba un incremento en el interés en la biología del ejercicio con aplicación clínica. Ya en la década de los 90`s, suficiente investigación fue acumulada indicando el beneficio del ejercicio, en Norteamérica ya asociaciones de medicina, entes gubernamentales y la Organización Mundial de la Salud publicaron guías sobre ejercicio para poblaciones clínicas y público en general. No obstante de esto, los dirigentes de educación médica han permanecido renuentes a incorporar la biología del ejercicio al pénsum médico curricular, o a implementarlo sistématicamente en la educación médica de postgrado. Este manuscrito revisa la trayectoria de la biología del ejercicio en Venezuela y sus aplicaciones médicas. Científicos y clínicos venezolanos han hecho contribuciones en áreas tales como pruebas de evaluación cardiopulmonar, adaptaciones de músculo esquelético al enfrentamiento físico y en farmacología cardiovascular en ejercicio en pacientes, sujetos sedentarios y atletas. Se sugiere que hay la necesidad de desarrollar programas de educación e investigación en biología del ejercicio con el fín de incorporar estos conocimientos en la formación del estudiante de medicina, médicos residentes y profesionales aleados al sistema de salud. Se propone una serie de pasos tentativos para iniciar este proceso.