Habitual physical activity and COVID-19.

BACKGROUND: Physical activity (PA) is known to decrease COVID-19 risk factors and can attenuate symptoms of viral infections. However, difficulty exercising and fatigue are common complaints after COVID-19. It is unknown whether prior habitual PA will improve outcomes and what the time course is until full recovery of PA after COVID-19. METHODS: Invitations were emailed to 21,933 adults who were SARS-CoV-2 positive between March 2020 and February 2021. Participants completed intake surveys and the Physical Activity History (PAH) questionnaire regarding PA during the 3-month prior to infection. Monthly thereafter, for up to 23 months, participants were emailed surveys. Scores were computed for moderate and heavy PA. Long COVID (LC) was defined as having recurring/persistent symptoms 9 months after diagnosis. RESULTS: Overall, 993 patients completed the intake survey (age 50.7±15.8 years, BMI 27.3±9.2, 58% women); 28% had been hospitalized. One-third had recovered to their pre-infection level of PA at 9 months post-infection; this increased to 65% at one year, and 90% at two years. Higher pre-diagnosis PA reduced odds of hospitalization (P<0.05) but not of LC. Factors predictive of poor PA recovery were higher pre-diagnosis PA, shortness of breath and fatigue during acute illness, and fatigue chronically. Participants who reported ongoing symptoms had consistently poorer recovery of habitual PA compared to those not reporting chronic symptoms. CONCLUSIONS: Habitual PA reduced odds of hospitalization but not of LC. Thirty-five percent had not returned to pre-COVID-19 levels of PA one year after infection, representing a major public health threat.

Incidence of concussions and helmet use in equestrians.

OBJECTIVES: Equestrians have a high risk of concussions per hospital records. However, most concussions occur in private settings where concussions are not tracked. We determined concussion incidence by self-report, expressed per 1000 h of exposure, and determined helmet usage and concussion knowledge. DESIGN: Descriptive epidemiological study. METHODS: Equestrians were recruited using a snowball method of sampling in which enrolled participants recruited more equestrians. Participants completed a survey of equestrian experience and history of concussion, symptoms and provided estimates of hours spent in various equestrian activities. From these data, incidences of concussions were calculated. In addition, they answered questions regarding helmet usage and willingness to take risks when concussed. RESULTS: 210 participants (203 women) reported 27 ±â€¯14 years of equine experience and 728 concussions, 3.47 ±â€¯5.34 per person (0-55). Incidence while riding was 0.19/1000 h which was greater than the incidence while driving (0.02/1000 h) or handling horses (0.03/1000 h). Riders were helmeted at the time of injury 85% of the time. While concussion knowledge was high, most reported willingness to risk permanent injury by continuing to work with horses while injured. CONCLUSIONS: To our knowledge this is the first study to document incidence of concussions in equestrians: incidence is higher while riding than during football or rugby training. Helmets were far more commonly worn at the time of concussion than reported in hospital data, suggesting that helmets effectively reduce concussions severe enough to warrant urgent medical care.

Effect of carbohydrate beverage ingestion on central versus peripheral fatigue: a placebo-controlled, randomized trial in cyclists.

We investigated whether carbohydrate ingestion delays fatigue in endurance-trained cyclists via peripheral or central mechanisms. Ten men (35 ± 9 years of age) and 10 women (42 ± 7 years of age) were assigned, in a double-blind, crossover design, to a sports drink (CHO) or to a placebo (PL). The following strength measures were made 3 times (before exercise, after a time trial (TT), and after a ride to exhaustion): (i) maximal voluntary contraction (MVC); (ii) MVC with superimposed femoral nerve magnetic stimulation to measure central activation ratio (CAR); and (iii) femoral nerve stimulation in a 3-s pulse train on relaxed muscle. The subjects cycled for 2 h at approximately 65% of peak oxygen consumption, with five 1-min sprints interspersed, followed by a 3-km TT. After strength testing, the cyclists remounted their bikes, performed a brief warm-up, and pedaled at approximately 85% peak oxygen consumption until unable to maintain workload. Changes in metabolic and strength measurements were analyzed with repeated-measures ANOVA. From before exercise to after the TT, MVC declined in men (17%) and women (18%) (p = 0.004), with no effect of beverage (p > 0.193); CAR decreased in both sexes with PL (p = 0.009), and the decline was attenuated by CHO in men only (time × treatment, p = 0.022); and there was no evidence of peripheral fatigue in either sex with either beverage (p > 0.122). Men rode faster in the TT with CHO (p = 0.005) but did not improve performance in the ride to exhaustion (p = 0.080). In women, CHO did not improve performance in the TT (p = 0.173) or in the ride to exhaustion (p = 0.930). We concluded that carbohydrate ingestion preserved central activation and performance in men, but not in women, during long-duration cycling.

Sex differences in central and peripheral mechanisms of fatigue in cyclists.

We examined peripheral versus central contributions to fatigue in men and women during prolonged cycling using a peripheral nerve magnetic stimulation-based technique. 11 men (41 ± 3 years) and 9 women (38 ± 2 years) cycled for 2 h at ventilatory threshold with 5, 1-min sprints interspersed, followed by a 3-km time trial. Quadriceps strength testing was performed isometrically in a semi-reclined position pre- and post-cycling: (1) MVC; (2) MVC with superimposed 3-s magnetic stimulation to measure central activation ratio (CAR), a measure of central fatigue; (3) peripheral magnetic stimulation (PMS) alone of the femoral nerve in a 4-s pulse train, a measure of peripheral fatigue. Data were analyzed with mixed model ANOVA. When adjusted for body mass, men and women had similar strength (p = 0.876), and changes in MVC with time were similar between sexes, declining 22 % in men and 16 % in women (p = 0.360). CAR was similar between sexes and decreased 15 % (effect of time, p < 0.001). Changes in PMS-elicited force were different between sexes: only men lost stimulated strength (6.30 to 5.21 vs. 5.48 to 5.53 N kg(-1), interaction p = 0.036). Results clearly demonstrate that quadriceps fatigue after >2 h of cycling was of both central and peripheral origin in men but solely due to central mechanisms in women.

Central fatigue after cycling evaluated using peripheral magnetic stimulation.

UNLABELLED: Central and peripheral mechanisms contribute to fatigue during exercise. Electrical and transcranial magnetic stimulation have been used to assess these fatigue mechanisms. Peripheral magnetic stimulation (PMS) of the femoral nerve is associated with very little subject discomfort and has been shown to elicit quadriceps contractions of >70% maximal voluntary contraction (MVC). PURPOSE: To examine peripheral versus central mechanisms of fatigue in men during prolonged cycling using a peripheral nerve magnetic stimulation-based technique. METHODS: Eleven men (aged 41 +/- 3 yr) cycled for 2 h at approximately 66% of VO2peak (55 +/- 2 mL x kg(-1) x min(-1)) with five 1-min sprints interspersed, followed by a 3-km time trial. Oxygen consumption was measured every 20 min to verify a constant workload. RPE were measured simultaneously and during each sprint using a Borg scale. Quadriceps isometric strength testing was performed in a seated position before and after cycling: 1) MVC, 2) MVC with superimposed magnetic stimulation to measure central activation ratio (CAR), 3) femoral nerve stimulation alone. One-minute recoveries were allowed between contractions. Changes in metabolic measurements over time were analyzed with repeated-measures ANOVA, and strength changes before to after with Student's paired t-tests. RESULTS: HR (P = 0.03) and RPE (P < 0.001) increased over time during the 2 h, and MVC declined by 22% (P = 0.001) indicating fatigue. Force elicited by PMS alone decreased 17% (P < 0.001). CAR decreased from 83% before exercise to 71% (P = 0.005) after exercise indicating a loss of central drive. PMS-induced force was > or =90% of MVC. CONCLUSIONS: Results clearly demonstrate that trained cyclists experience significant central fatigue during prolonged cycling. PMS may be a better technique for identifying central fatigue than the traditionally used interpolated twitch technique.

The effect of creatine supplementation on strength recovery after anterior cruciate ligament (ACL) reconstruction: a randomized, placebo-controlled, double-blind trial.

BACKGROUND: Creatine supplementation has been shown to augment training-induced strength gains. The purpose of this study was to examine the effect of creatine supplementation on recovery of muscle strength after anterior cruciate ligament (ACL) reconstruction. HYPOTHESIS: Creatine supplementation will facilitate strength gains after ACL reconstruction. STUDY DESIGN: Double-blind, prospective, and randomized clinical trial. METHODS: Sixty patients were randomized into creatine or placebo groups. Quadriceps and hamstring strength and power were measured isokinetically. Hip flexor, abductor, and adductor strengths were measured with a handheld dynamometer prior to surgery and at 6 weeks, 12 weeks, or 6 months after surgery. RESULTS: From 6 weeks to 12 weeks after surgery, there were significant increases in strength on the involved side for knee extension (47%), knee flexion (27%), hip flexion (20%), hip abduction (9%), and hip adduction (17%). These strength improvements were unaffected by creatine supplementation with similar effects in the creatine and placebo groups. From 6 weeks to 12 weeks after surgery, there were significant increases in power on the involved side for knee extension (46%) and knee flexion (26%), but these effects were not affected by creatine supplementation. At 6 months, creatine supplementation did not affect outcome as measured by the single leg hop test for distance or the knee outcome score. CONCLUSIONS: The results demonstrate that patients do not benefit from creatine supplementation during the first 12 weeks of rehabilitation after ACL reconstruction.

Food intake and electrolyte status of ultramarathoners competing in extreme heat.

OBJECTIVE: To relate changes in laboratory indices to dietary intake during extremely prolonged running and to determine if dietary intake influences the ability of runners to finish an 160 km trail race. METHODS: We monitored intake and serum chemistries of 26 runners competing in an 160 km foot race in temperatures which peaked at 38 degrees C. Blood was drawn pre-, mid- and post-race. Dietary intake and incidence of gastrointestinal distress or changes in mental status were determined by interview with runners approximately every 13 km. Twenty-three runners completed at least 88 kms and, of these 23 runners, 13 finished 160 km in a mean time of 26.2 +/- 3.6 hours. RESULTS: Finishers ingested nearly 30,000 J, 19.4 +/- 8.1 L of fluid and 16.4 +/- 9.5 g of sodium (Na). Sodium and fluid intake per hour was estimated to be 0.6 g/hour and 0.7 L/hour, respectively. Electrolyte intake during the first half of the race was similar between those that finished the race and those that did not. Finishers ingested fluid at a greater rate than non-finishers (p = 0.01) and tended to meet their caloric needs more closely than did non-finishers (p = 0.09). Body weight was unchanged over time (ANOVA, p = 0.52). Serum Na concentration tended to fall from 143 to 140 mEq/L during the race (p = 0.06), and was inversely correlated with weight loss (p = 0.009). Serum Na concentration was lower mid-race in runners experiencing changes in mental status than in runners without changes (p = 0.04). Fluid intake was inversely correlated with serum Na concentrations (p = 0.04). Most of the runners experienced nausea or vomiting; these symptoms were not related to serum sodium concentration. Hyponatremia (<135 mEq/L) was seen in one runner at 88 kms, but resolved by 160 km. Urinary sodium excretion decreased (p = 0.002) as serum aldosterone concentration increased pre- to post-race (p < 0.001). From start to finish of the race plasma volume increased by 12%. CONCLUSIONS: Food and fluid was ingested at a greater rate than described previously. Runners consumed adequate fluid to maintain body weight although dietary sodium fell far short of the recommended 1 g/hour. The rate of fluid intake was greater in finishers than in non-finishers, and finishers tended to more nearly meet their energy needs. Maintenance of body mass despite large exercise energy expenditures in extreme heat is consistent with fluid overload during a running event lasting more than 24 hours in hot and humid conditions.