Improved exercise performance and increased aerobic capacity after endurance training of patients with stable polymyositis and dermatomyositis

Introduction

This randomized, controlled study on patients with polymyositis or dermatomyositis was based on three hypotheses: patients display impaired endurance due to reduced aerobic capacity and muscle weakness, endurance training improves their exercise performance by increasing the aerobic capacity, and endurance training has general beneficial effects on their health status.

Methods

In the first part of this study, we compared 23 patients with polymyositis or dermatomyositis with 12 age- and gender-matched healthy controls. A subgroup of patients were randomized to perform a 12-week endurance training program (exercise group, n = 9) or to a non-exercising control group (n = 6). We measured maximal oxygen uptake (VO₂ max) and the associated power output during a progressive cycling test. Endurance was assessed as the cycling time to exhaustion at 65% of VO₂ max. Lactate levels in the vastus lateralis muscle were measured with microdialysis. Mitochondrial function was assessed by measuring citrate synthase (CS) and β-hydroxyacyl-CoA dehydrogenase (β-HAD) activities in muscle biopsies. Clinical improvement was assessed according to the International Myositis Assessment and Clinical Studies Group (IMACS) improvement criteria. All assessors were blinded to the type of intervention (that is, training or control).

Results

Exercise performance and aerobic capacity were lower in patients than in healthy controls, whereas lactate levels at exhaustion were similar. Patients in the exercise group increased their cycling time, aerobic capacity and CS and β-HAD activities, whereas lactate levels at exhaustion decreased. Six of nine patients in the exercise group met the IMACS improvement criteria. Patients in the control group did not show any consistent changes during the 12-week study.

Conclusions

Polymyositis and dermatomyositis patients have impaired endurance, which could be improved by 12 weeks of endurance training. The clinical improvement corresponds to increases in aerobic capacity and muscle mitochondrial enzyme activities. The results emphasize the importance of endurance exercise in addition to immunosuppressive treatment of patients with polymyositis or dermatomyositis.

Trial registration

ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01184625","term_id":"NCT01184625"}}NCT01184625     

Exercise training in normobaric hypoxia in endurance runners. I. Improvement in aerobic performance capacity.

This study investigates whether a 6-wk intermittent hypoxia training (IHT), designed to avoid reductions in training loads and intensities, improves the endurance performance capacity of competitive distance runners. Eighteen athletes were randomly assigned to train in normoxia [Nor group; n = 9; maximal oxygen uptake (VO2 max) = 61.5 +/- 1.1 ml x kg(-1) x min(-1)] or intermittently in hypoxia (Hyp group; n = 9; VO2 max = 64.2 +/- 1.2 ml x kg(-1) x min(-1)). Into their usual normoxic training schedule, athletes included two weekly high-intensity (second ventilatory threshold) and moderate-duration (24-40 min) training sessions, performed either in normoxia [inspired O2 fraction (FiO2) = 20.9%] or in normobaric hypoxia (FiO2) = 14.5%). Before and after training, all athletes realized 1) a normoxic and hypoxic incremental test to determine VO2 max and ventilatory thresholds (first and second ventilatory threshold), and 2) an all-out test at the pretraining minimal velocity eliciting VO2 max to determine their time to exhaustion (T(lim)) and the parameters of O2 uptake (VO2) kinetics. Only the Hyp group significantly improved VO2 max (+5% at both FiO2, P < 0.05), without changes in blood O2-carrying capacity. Moreover, T(lim) lengthened in the Hyp group only (+35%, P < 0.001), without significant modifications of VO2 kinetics. Despite similar training load, the Nor group displayed no such improvements, with unchanged VO2 max (+1%, nonsignificant), T(lim) (+10%, nonsignificant), and VO2 kinetics. In addition, T(lim) improvements in the Hyp group were not correlated with concomitant modifications of other parameters, including VO2 max or VO2 kinetics. The present IHT model, involving specific high-intensity and moderate-duration hypoxic sessions, may potentialize the metabolic stimuli of training in already trained athletes and elicit peripheral muscle adaptations, resulting in increased endurance performance capacity.     

Effects of a carbohydrate-, protein-, and ribose-containing repletion drink during 8 weeks of endurance training on aerobic capacity, endurance performance, and body composition

This study compared a carbohydrate-, protein-, and ribose-containing repletion drink vs. carbohydrates alone during 8 weeks of aerobic training. Thirty-two men (age, mean ± SD = 23 ± 3 years) performed tests for aerobic capacity (V(O2)peak), time to exhaustion (TTE) at 90% V(O2)peak, and percent body fat (%fat), and fat-free mass (FFM). Testing was conducted at pre-training (PRE), mid-training at 3 weeks (MID3), mid-training at 6 weeks (MID6), and post-training (POST). Cycle ergometry training was performed at 70% V(O2)peak for 1 hours per day, 5 days per week for 8 weeks. Participants were assigned to a test drink (TEST; 370 kcal, 76 g carbohydrate, 14 g protein, 2.2 g d-ribose; n = 15) or control drink (CON; 370 kcal, 93 g carbohydrate; n = 17) ingested immediately after training. Body weight (BW; 1.8% decrease CON; 1.3% decrease TEST from PRE to POST), %fat (5.5% decrease CON; 3.9% decrease TEST), and FFM (0.1% decrease CON; 0.6% decrease TEST) decreased (p ≤ 0.05), whereas V(O2)peak (19.1% increase CON; 15.8% increase TEST) and TTE (239.1% increase CON; 377.3% increase TEST) increased (p ≤ 0.05) throughout the 8 weeks of training. Percent decreases in %fat from PRE to MID3 and percent increases in FFM from PRE to MID3 and MID6 were greater (p ≤ 0.05) for TEST than CON. Overall, even though the TEST drink did not augment BW, V(O2)peak, or TTE beyond carbohydrates alone, it did improve body composition (%fat and FFM) within the first 3-6 weeks of supplementation, which may be helpful for practitioners to understand how carbohydrate-protein recovery drinks can and cannot improve performance in their athletes.     

The effect of variable magnesium intake on potential factors influencing endurance capacity

Rats fed a magnesium (MG) deficient diet have a lower endurance capacity than rats fed Mg adequate diets. The current study evaluates the effects of marginal, moderate, and severe Mg deficiencies on physiological and biochemical changes that may contribute to the reduced endurance capacity of Mg deficient rats. Variable levels of dietary Mg (400, 200, 100, 50 μg/g) were fed for 23 d to 5-wk-old male Osborne-Mendel rats. Indirect blood pressure and heart rate were measured during dietary treatment. Forty-eight hours after an endurance test, rats were killed and sampled for plasma glucose, insulin, and triglyceride levels. Organ weights, mineral and trace element concentrations, and carcass composition were determined. Blood pressure was lower in rats fed 50 and 100 ppm Mg during the first half of the study than in controls (400 ppm Mg). There were no significant differences in blood pressure among groups at the end of the study. Heart rate was not affected by dietary Mg intake. Plasma insulin was lowered by decreasing dietary Mg; however, plasma glucose and triglyceride concentrations were not affected by dietary Mg intake. Rats fed 100 and 50 ppm Mg diets had significantly higher calcium concentrations in plasma and gastrocnemius muscle than controls. Dietary Mg variably affected tissue trace element (iron, zinc, copper, and manganese) concentrations but did not affect Mg concentrations in any organ studied. Body composition was significantly altered by dietary Mg intake. In conclusion, variable Mg intake differentially affects the parameters evaluated. Thus, the decreased endurance capacity of the Mg deficient rat is apparently not the result of a single biochemical lesion but is likely to be multifactorial.     

Effects of eight weeks of caffeine supplementation and endurance training on aerobic fitness and body composition

The purpose of this study was to examine the effects of daily administration of a supplement that contained caffeine in conjunction with 8 weeks of aerobic training on VO(2)peak, time to running exhaustion at 90% VO(2)peak, body weight, and body composition. Thirty-six college students (14 men and 22 women; mean +/- SD, age 22.4 +/- 2.9 years) volunteered for this investigation and were randomized into either a placebo (n = 18) or supplement group (n = 18). The subjects ingested 1 dose (3 pills = 201 mg of caffeine) of the placebo or supplement per day during the study period. In addition, the subjects performed treadmill running for 45 minutes at 75% of the heart rate at VO(2)peak, three times per week for 8 weeks. All subjects were tested pretraining and posttraining for VO(2)peak, time to running exhaustion (TRE) at 90% VO(2)peak, body weight (BW), percentage body fat (%FAT), fat weight (FW), and fat-free weight (FFW). The results indicated that there were equivalent training-induced increases (p < 0.05) in VO(2)peak and TRE for the supplement and placebo groups, but no changes (p > 0.05) in BW, %FAT, FW, or FFW for either group. These findings indicated that chronic use of the caffeine-containing supplement in the present study, in conjunction with aerobic training, provided no ergogenic effects as measured by VO(2)peak and TRE, and the supplement was of no benefit for altering body weight or body composition.     

Exercise training improves aerobic endurance and musculoskeletal fitness in female cardiac transplant recipients

Aim

Female cardiac transplant recipients'' aerobic capacity is 60% lower than sex and age-predicted values. The effect of exercise training on restoring the impaired aerobic endurance and muscle strength in female cardiac transplant recipients is not known. This study examined the effect that aerobic and strength training have on improving aerobic endurance and muscle strength in female cardiac transplant recipients.

Methods

20 female cardiac transplant recipients (51 ± 11 years) participated in this investigation. The subjects performed a baseline six-minute walk test and a leg-press strength test when they were discharged following cardiac transplantation. The subjects then participated in a 12-week exercise program consisting of aerobic and lower extremity strength training. Baseline assessments were repeated following completion of the exercise intervention.

Results

At baseline, the cardiac transplant recipients'' aerobic endurance was 50% lower than age-matched predicted values. The training program resulted in a significant increase in aerobic endurance (pre-training: 322 ± 104 m vs. post-training: 501 ± 99 m, p < 0.05) and leg-press strength (pre-training: 48 ± 16 kg. vs. post-training: 78 ± 27 kg, p < 0.05).

Conclusion

Aerobic and strength training are effective interventions that can partially restore the impaired aerobic endurance and strength found in female cardiac transplant recipients.Exercise training is an effective intervention that can partially restore the impaired aerobic capacity and musculoskeletal fitness (i.e. muscle strength) found in cardiac transplant recipients [1,2]. However, previous reports have focused exclusively on the effects of exercise training in men. Therefore, the effect of exercise training on these outcomes in female cardiac transplant recipients is not known [2-7]. Importantly, a majority of female cardiac transplant recipients do not engage in regular physical activity leading to increased levels of fatigue, poor functional status and reduced exercise capacity [8-10]. Based on this rationale, the aim of this study is to examine the effect that exercise training has on improving aerobic endurance (i.e. distance walked in six-minutes) and lower extremity muscle strength in female cardiac transplant recipients. We hypothesized that exercise training would be a feasible and effective intervention to improve aerobic endurance and lower extremity strength in female cardiac transplant recipients.     

Obesity negatively impacts aerobic capacity improvements both acutely and 1-year following cardiac rehabilitation

Cardiac rehabilitation (CR) produces a host of health benefits related to modifiable cardiovascular risk factors. The purpose of the present investigation was to determine the influence of body weight, assessed through BMI, on acute and long-term improvements in aerobic capacity following completion of CR. Three thousand nine hundred and ninety seven subjects with coronary artery disease (CAD) participated in a 12-week multidisciplinary CR program. Subjects underwent an exercise test to determine peak estimated metabolic equivalents (eMETs) and BMI assessment at baseline, immediately following CR completion and at 1-year follow-up. Normal weight subjects at 1-year follow-up demonstrated the greatest improvement in aerobic fitness and best retention of those gains (gain in peak METs: 0.95 ± 1.1, P < 0.001). Although the improvement was significant (P < 0.001), subjects who were initially classified as obese had the lowest aerobic capacity and poorest retention in CR fitness gains at 1-year follow-up (gain in peak eMETs: 0.69 ± 1.2). Subjects initially classified as overweight by BMI had a peak eMET improvement that was also significantly better (P < 0.05) than obese subjects at 1-year follow-up (gain in peak eMETs: 0.82 ± 1.1). Significant fitness gains, one of the primary beneficial outcomes of CR, can be obtained by all subjects irrespective of BMI classification. However, obese patients have poorer baseline fitness and are more likely to "give back" fitness gains in the long term. Obese CAD patients may therefore benefit from additional interventions to enhance the positive adaptations facilitated by CR.     

4周低氧训练对男子足球运动员有氧耐力与T淋巴细胞亚群的影响

目的：探讨4周低氧训练对男子足球运动员有氧耐力相关指标与免疫系统中T淋巴细胞亚群的影响。方法：选取某体育学院及其附属竞技学校20名男子足球运动员为受试者,平均分为训练组、低氧组、低氧训练组以及对照组。训练组进行每日60 min,每周5次,持续4周的功率自行车训练,运动强度为65%~75%最大摄氧量;低氧组进行持续4周每日60 min,每周5次处于低氧环境（氧浓度为14.7%）,不进行功率自行车训练;低氧训练组在低氧环境（氧浓度为14.7%）下进行与训练组相同条件的训练;对照组不做任何影响。结果：经4周训练后,低氧训练组红细胞计数、血红蛋白含量较对照组、训练组以及低氧组均存在显著性差异（P < 0.05）;低氧训练组VO₂max水平和3 000 m跑成绩较对照组、训练组以及低氧组均存在显著性差异（P < 0.05）;低氧训练组T淋巴细胞CD3⁺水平较对照组、低氧组均存在显著性差异（P < 0.05）。结论：相比于其他方式,每日60 min,每周5日,持续4周的65%~75%最大摄氧量强度低氧训练更有利于提高男子足球运动员的有氧耐力水平,并且可能有利于运动员机体免疫功能的提高。     

Reduced training intensities and loss of aerobic power, endurance, and cardiac growth

Twelve subjects participated in an exercise program of cycling and running 40 min/day, 6 days/wk. After 10 wk, they continued to train with either a one-third or two-thirds reduction in work rates for an additional 15 wk. Frequency and duration for the additional training remained the same as during the 10 wk of training. The average increases in maximum O2 uptake (VO2 max) were between 11 and 20% when measured during cycling and treadmill running after 10 wk of training. VO2 max was not maintained at the 6-day/wk training levels with a one-third reduction in training intensity but was still higher than pretraining levels. With a two-thirds reduction in intensity, VO2 max declined to an even greater extent than with the one-third reduction. Short-term endurance (approximately 5 min) was maintained in the one-third reduced group but was markedly reduced in the two-thirds reduced group. Long-term endurance was decreased significantly from training by 21% in the one-third reduced group (184-145 min) and by 30% in the two-thirds reduced group (202-141 min). Calculated left ventricular mass, obtained from echocardiographic measurements, increased approximately 15% after training but returned to control levels after reduced training in both groups. These results demonstrate that training intensity is an essential requirement for maintaining the increased aerobic power and cardiac enlargement with reduced training.(ABSTRACT TRUNCATED AT 250 WORDS)     

The impact of a supervised strength and aerobic training program on muscular strength and aerobic capacity in individuals with type 2 diabetes

An intervention in the clinical management of individuals with type 2 diabetes is strength and aerobic training. Limited research has been conducted that investigates the effect of a supervised strength and aerobic training program on muscular strength and aerobic capacity in people with type 2 diabetes. The purpose of this 1-group repeated-measures-designed study was to investigate the impact of a supervised strength and aerobic training program on muscular strength and aerobic capacity in subjects with type 2 diabetes. Thirteen subjects with type 2 diabetes completed the training program. Subjects met the American Diabetes Association diagnostic criteria for type 2 diabetes. For each subject, muscular strength (estimated 1 repetition maximum) and aerobic capacity (estimated maximal oxygen uptake) were measured before and after a supervised strength and aerobic training program as well as during a 6-week follow-up. Repeated-measures analysis of variance was used to compare muscular strength and aerobic capacity between pretesting, posttesting, and follow-up testing periods. Significant improvements in muscular strength (p < 0.01) and aerobic capacity (p < 0.01) were found during posttesting and follow-up testing, as compared to pretesting measures. Yet a significant loss in muscular strength (p < 0.01) and no significant change in aerobic capacity (p > 0.05) were found during follow-up testing, as compared to posttesting measures. This study indicates that a supervised strength and aerobic training program can significantly improve muscular strength and aerobic capacity in people with type 2 diabetes. Yet improvements in muscular strength due to training will not be maintained if individuals with type 2 diabetes do not adhere to a continuous training program. In addition, aerobic capacity can be improved with training, but aerobic capacity will not continue to improve if people with type 2 diabetes are not compliant with a continuous training program.     

Effect of age and training on aerobic capacity and body composition of master athletes

Maximum oxygen uptake (VO2max) and body composition have been shown to deteriorate with age. How much of the decline is attributable to aging and how much is affected by reduced physical activity is not known. The purpose of this investigation was to determine the aerobic capacity and body composition of 24 master track athletes and to evaluate the relationship to age and maintenance of training over a 10-yr period. The subjects (50-82 yr of age) were retested after a 10.1-yr follow-up (T2). All continued their aerobic training, but only 11 were still highly competitive (COMP) and continued to train at the same intensity. The other 13 athletes studied became noncompetitive (post-COMP) and reduced their training intensity. The results showed the COMP group to maintain its VO2max and maximum O2 pulse while the post-COMP group showed a significant decline (54.2-53.3 vs. 52.5-45.9 ml X kg-1 X min-1; 20.7-20.8 vs. 22.4-20.0 ml/beat from test one (T1) to T2 for the COMP vs. post-COMP groups, respectively). Maximum heart rate declined 7 beats/min for both groups. Body composition showed no difference between groups from T1 to T2. For both groups body weight declined slightly (70.0-68.9 kg), percent fat increased significantly (13.1-15.1%), and fat-free weight decreased significantly (61.0-59.0 kg). Thus, when training was maintained, aerobic capacity remained unchanged over the follow-up period. Body composition changed for both groups and may have been related to aging and/or the type of training performed.     

Effects of resistance versus aerobic training on coronary artery disease risk factors

Individuals exhibiting "the metabolic syndrome" have multiple coronary artery disease risk factors, including insulin resistance, hyperlipidemia, hypertension, and android obesity. We performed a randomized trial to compare the effects of aerobic and resistance training regimens on coronary risk factors. Twenty-six volunteers who exhibited android obesity and at least one other risk factor for coronary artery disease were randomized to aerobic or resistance training groups. Body mass index, waist-to-hip ratio, glucose, insulin, body composition, 24-hr urinary albumin, fibrinogen, blood pressure, and lipid profile were measured at baseline and after 10 weeks of exercise training. Both groups showed a significant reduction in waist-to-hip ratio and the resistance training group also showed a reduction in total body fat. There was no significant change in mean arterial blood pressure in either group. Fasting plasma glucose, insulin, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides were unchanged in both groups. High-density lipoprotein (HDL) cholesterol increased (13%) with aerobic training only. Plasma fibrinogen was increased (28% and 34%, P < 0.02) in both groups and both groups showed a significant decrease (34% and 28%, P < 0.03) in microalbuminuria after their respective training regimen. In conclusion, resistance training was effective in improving body composition of middle-aged obese sedentary males. Only aerobic training was effective in raising HDL cholesterol. More studies are warranted to assess the effects of exercise on plasma fibrinogen and microalbuminuria.     

Endurance training in humans: aerobic capacity and structure of skeletal muscle

The adaptation of muscle structure, power output, and mass-specific rate of maximal O2 consumption (VO2max/Mb) with endurance training on bicycle ergometers was studied for five male and five female subjects. Biopsies of vastus lateralis muscle and VO2max determinations were made at the start and end of 6 wk of training. The power output maintained on the ergometer daily for 30 min was adjusted to achieve a heart rate exceeding 85% of the maximum for two-thirds of the training session. It is proposed that the observed preferential proliferation of subsarcolemmal vs. interfibrillar mitochondria and the increase in intracellular lipid deposits are two possible mechanisms by which muscle cells adapt to an increased use of fat as a fuel. The relative increase of VO2max/Mb (14%) with training was found to be smaller by more than twofold than the relative increase in maximal maintained power (33%) and the relative change in the volume density of total mitochondria (+40%). However, the calculated VO2 required at an efficiency of 0.25 to produce the observed mass-specific increase in maximal maintained power matched the actual increase in VO2max/Mb (8.0 and 6.5 ml O2 X min-1 X kg-1, respectively). These results indicate that despite disparate relative changes the absolute change in aerobic capacity at the local level (maintained power) can account for the increase in aerobic capacity observed at the general level (VO2max).     

Thermoregulatory and aerobic changes after endurance training in a hypobaric hypoxic and warm environment.

Plasma volume (PV) expansion by endurance training and/or heat acclimatization is known to increase aerobic and thermoregulatory capacities in humans. Also, higher erythrocyte volume (EV) fractions in blood are known to improve these capacities. We tested the hypothesis that training in a hypobaric hypoxic and warm environment would increase peak aerobic power (VO(2)(peak)) and forearm skin vascular conductance (FVC) response to increased esophageal temperature (T(es)) more than training in either environment alone, by increasing both PV and EV. Twenty men were divided into four training regimens (n = 5 each): low-altitude cool (610-m altitude, 20 degrees C ambient temperature, 50% relative humidity), high-altitude cool (2,000 m, 20 degrees C), low-altitude warm (610 m, 30 degrees C), and high-altitude warm (HW; 2,000 m, 30 degrees C). They exercised on a cycle ergometer at 60% VO(2)(peak) for 1 h/day for 10 days in a climate chamber. After training, PV increased in all trials, but EV increased in only high-altitude trials (both P < 0.05). VO(2)(peak) increased in all trials (P < 0.05) but without any significant differences among trials. FVC response to increased T(es) was measured during exercise at 60% of the pretraining VO(2)(peak) at 610 m and 30 degrees C. After the training, T(es) threshold for increasing FVC decreased in warm trials (P < 0.05) but not in cool trials and was significantly lower in HW than in cool trials (P < 0.05). The slope of FVC increase/T(es) increase increased in all trials (P < 0.05) except for high-altitude cool (P > 0.4) and was significantly higher in HW than in cool trials (P < 0.05). Thus, against our hypothesis, the VO(2)(peak) for HW did not increase more than in other trials. Moreover, slope of FVC increase/T(es) increase in HW increased most, despite the similar increase in blood volume, suggesting that factors other than blood volume were involved in the highest FVC response in HW.