Entradas donde detallamos los últimos artículos publicados en revistas científicas en los que hemos participado.

SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED, CONTROLLED TRIALS ON PREOPERATIVE PHYSICAL EXERCISE INTERVENTIONS IN PATIENTS WITH NON-SMALL-CELL LUNG CANCER

Preoperative physical exercise protocols prior to cancer surgery increased in popularity over recent years; however, the beneficial effect of such protocols is not well established, with conflicting results reported. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of different modalities or combinations of preoperative exercise interventions and/or prehabilitation multicomponent training in patients with non-small-cell lung cancer (NSCLC) after surgery on the outcomes related to functional capacity, mental wellness and medical care. We searched in OVID Embase, Pubmed, Cochrane Library, CINAHL, Scopus, and Web of Science. Characteristics of studies and program results and outcome data were extracted. Changes between the intervention and control groups, from baseline to follow-up (standardized mean difference (SMD) or relative risk (RR) with 95% confidence interval (CI) for each intervention was pooled using weighted random-effects models). A total of 676 participants from 10 RCTs were included in the final analysis (aerobic training + inspiratory muscle training, n = 5; aerobic training + strength training + inspiratory muscle training, n = 2; aerobic training + strength training, n = 1; multicomponent training, n = 1; aerobic training alone, n = 1). The results showed intervention-induced improvement in walking endurance (SMD = 0.27; 95% CI, 0.11 to 0.44; I2 = 0.0%), peak exercise capacity (SMD = 0.78; 95% CI, 0.35 to 1.21; I2 = 76.7%), dyspnoea (SMD = -0.30; 95% CI, -0.51 to -0.10; I2 = 0.0%), risk of hospitalization (SMD = -0.58; 95% CI, -0.97 to -0.20; I2 = 70.7%), and postoperative pulmonary complications (relative risk (RR) = 0.50; 95% CI, 0.39 to 0.66; I2 = 0.0%). For the functional capacity and medical care parameters, preoperative combined aerobic, resistance, and inspiratory muscle training was shown to be effective if comprising one to four weeks, performing 1-3 sessions per week, with moderate intensity (50% for endurance capacity). Further studies with larger samples and higher methodological quality are needed to clarify the potential benefits of preoperative exercise training for patients with NSCLC.


REFERENCIA

  • Rosero, I. D., Ramírez-Vélez, R., Lucia, A., Martínez-Velilla, N., Santos-Lozano, A., Valenzuela, P. L., … & Izquierdo, M. (2019). Systematic Review and Meta-Analysis of Randomized, Controlled Trials on Preoperative Physical Exercise Interventions in Patients with Non-Small-Cell Lung Cancer. Cancers11(7), 944.

DOES BEEF PROTEIN SUPPLEMENTATION IMPROVE BODY COMPOSITION AND EXERCISE PERFORMANCE? A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Protein supplementation might improve body composition and exercise performance. Supplements containing whey protein (WP) have received the most attention, but other protein sources such as beef protein (BP) are gaining popularity. We conducted a systematic review and meta-analysis of randomized controlled trials that compared the effects of exercise training combined with BP, WP or no protein supplementation (NP), on body composition or exercise performance. Secondary endpoints included intervention effects on total protein intake and hematological parameters. Seven studies (n = 270 participants) were included. No differences were found between BP and WP for total protein intake (standardized mean difference (SMD) = 0.04, p = 0.892), lean body mass (LBM) (SMD = -0.01, p = 0.970) or fat mass (SMD = 0.07, p = 0.760). BP significantly increased total daily protein intake (SMD = 0.68, p < 0.001), LBM (SMD = 0.34, p = 0.049) and lower-limb muscle strength (SMD = 0.40, p = 0.014) compared to NP, but no significant differences were found between both conditions for fat mass (SMD = 0.15, p = 0.256), upper-limb muscle strength (SMD = 0.16, p = 0.536) or total iron intake (SMD = 0.29, p = 0.089). In summary, BP provides similar effects to WP on protein intake and body composition and, compared to NP, might be an effective intervention to increase total daily protein intake, LBM and lower-limb muscle strength.


REFERENCIA

  • Valenzuela, P. L., Mata, F., Morales, J. S., Castillo-García, A., & Lucia, A. (2019). Does Beef Protein Supplementation Improve Body Composition and Exercise Performance? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients11(6), 1429.

PHYSICAL EXERCISE AND MITOCHONDRIAL DISEASE: INSIGHTS FROM A MOUSE MODEL

Purpose: Mitochondrial diseases (MD) are among the most prevalent neuromuscular disorders. Unfortunately, no curative treatment is yet available. This study analyzed the effects of exercise training in an animal model of respiratory chain complex I deficiency, the Harlequin (Hqmouse, which replicates the clinical features of this condition. Methods: Male heterozygous Harlequin (Hq/Y) mice were assigned to an “exercise” (n = 10) or a “sedentary” control group (n = 11), with the former being submitted to an 8 week combined exercise training intervention (aerobic + resistance training performed five times/week). Aerobic fitness, grip strength, and balance were assessed at the beginning and at the end of the intervention period in all the Hq mice. Muscle biochemical analyses (with results expressed as percentage of reference data from age/sex-matched sedentary wild-type mice [n = 12]) were performed at the end of the aforementioned period for the assessment of major molecular signaling pathways involved in muscle anabolism (mTOR activation) and mitochondrial biogenesis (proliferator activated receptor gamma co-activator 1α [PGC-1α] levels), and enzyme activity and levels of respiratory chain complexes, and antioxidant enzyme levels. Results: Exercise training resulted in significant improvements in aerobic fitness (-33 ± 13 m and 83 ± 43 m for the difference post- vs. pre-intervention in total distance covered in the treadmill tests in control and exercise group, respectively, p = 0.014) and muscle strength (2 ± 4 g vs. 17 ± 6 g for the difference post vs. pre-intervention, p = 0.037) compared to the control group. Higher levels of ribosomal protein S6 kinase beta-1 phosphorylated at threonine 389 (156 ± 30% vs. 249 ± 30%, p = 0.028) and PGC-1α (82 ± 7% vs. 126 ± 19% p = 0.032) were observed in the exercise-trained mice compared with the control group. A higher activity of respiratory chain complexes I (75 ± 4% vs. 95 ± 6%, p = 0.019), III (79 ± 5% vs. 97 ± 4%, p = 0.031), and V (77 ± 9% vs. 105 ± 9%, p = 0.024) was also found with exercise training. Exercised mice presented with lower catalase levels (204 ± 22% vs. 141 ± 23%, p = 0.036). Conclusion: In a mouse model of MD, a training intervention combining aerobic and resistance exercise increased aerobic fitness and muscle strength, and mild improvements were found for activated signaling pathways involved in muscle mitochondrial biogenesis and anabolism, OXPHOS complex activity, and redox status in muscle tissue.


REFERENCIA

  • Fiuza-Luces, C., Valenzuela, P. L., Laine-Menéndez, S., Fernandez-de La Torre, M., Bermejo-Gómez, V., Rufián-Vázquez, L., … & Morán, M. (2019). Physical exercise and mitochondrial disease: Insights from a mouse model. Frontiers in neurology10, 790.

SUPPLEMENTS WITH PURPORTED EFFECTS ON MUSCLE MASS AND STRENGTH

PURPOSE:

Several supplements are purported to promote muscle hypertrophy and strength gains in healthy subjects, or to prevent muscle wasting in atrophying situations (e.g., ageing or disuse periods). However, their effectiveness remains unclear.

METHODS:

This review summarizes the available evidence on the beneficial impacts of several popular supplements on muscle mass or strength.

RESULTS:

Among the supplements tested, nitrate and caffeine returned sufficient evidence supporting their acute beneficial effects on muscle strength, whereas the long-term consumption of creatine, protein and polyunsaturated fatty acids seems to consistently increase or preserve muscle mass and strength (evidence level A). On the other hand, mixed or unclear evidence was found for several popular supplements including branched-chain amino acids, adenosine triphosphate, citrulline, β-Hydroxy-β-methylbutyrate, minerals, most vitamins, phosphatidic acid or arginine (evidence level B), weak or scarce evidence was found for conjugated linoleic acid, glutamine, resveratrol, tribulus terrestris or ursolic acid (evidence level C), and no evidence was found for other supplements such as ornithine or α-ketoglutarate (evidence D). Of note, although most supplements appear to be safe when consumed at typical doses, some adverse events have been reported for some of them (e.g., caffeine, vitamins, α-ketoglutarate, tribulus terrestris, arginine) after large intakes, and there is insufficient evidence to determine the safety of many frequently used supplements (e.g., ornithine, conjugated linoleic acid, ursolic acid).

CONCLUSION:

In summary, despite their popularity, there is little evidence supporting the use of most supplements, and some of them have been even proven ineffective or potentially associated with adverse effects.


REFERENCIA

  • Valenzuela, P. L., Morales, J. S., Emanuele, E., Pareja-Galeano, H., & Lucia, A. (2019). Supplements with purported effects on muscle mass and strength. European journal of nutrition, 1-26.

ATHLETIC “OLDEST-OLD”: ALIVE AND KICKING

On October 13, 2018, an 86-year-old Japanese man named Hiromu Inada, finished the Ironman Triathlon World Championship (Hawaii) in 16 hours 54 minutes. The Ironman triathlon is the paradigm of grueling endurance races, with its 2.4-mile swim, 112-mile cycle, and 26.2-mile marathon all rolled into 1 event held under extreme heat, humidity, and wind conditions. And yet this is just 1 of the many feats accomplished worldwide by the so-called oldest-old (those aged!85 years) in both endurance and more “power”-oriented sports (Figure 1).1 Instead of viewing such performances as biological exceptions, why not consider the medically relevant message they convey; that is, humans can retain remarkable functionality until the end of their life span . . . if they train for it.


REFERENCIA

  • Valenzuela, P. L., García, A. C., Morales, J. S., Santos-Lozano, A., & Lucia, A. (2019). Athletic “Oldest-Old”: Alive and Kicking. Journal of the American Medical Directors Association.

MORE ON THE RECORD-BREAKING PERFORMANCE IN A 70-YEAR-OLD MARATHONER

To the Editor: Robinson et al.1 (April 11 issue) determined the physiological profile of a 70-year-old man who ran a marathon in 2:54:23, thanks to his ability to “maintain a remarkably high percentage of his maximum oxygen uptake” (approximately 95%, according to our calculations). Although persons 80 years of age reach the ventilatory threshold closer to the maximum oxygen uptake (VO2max) than do persons 20 to 30 years of age (at 85 to 90% of the VO2max vs. 60 to 70%),2 the ability to maintain approximately 95% of the VO2max for about 3 hours seems unrealistic.


REFERENCIA

  • Valenzuela, P. L., Santos-Lozano, A., & Lucia, A. (2019). More on the Record-Breaking Performance in a 70-Year-Old Marathoner. The New England journal of medicine381(3), 293.

IS HEALTH STATUS IMPAIRED IN CHILDHOOD CANCER SURVIVORS? A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND:

An increase in survival rates of childhood cancer is associated with long-term health issues in survivors.

METHODS:

We conducted a systematic review and meta-analysis comparing health status-related endpoints in childhood cancer survivors (CCS) versus controls.

RESULTS:

Eighty-six studies (n = 98,480 participants, 62% CCS) were included in the review. Of these, 73 studies (n = 96,550, 63% CCS) could be meta-analyzed. CCS showed a lower left ventricular ejection and fractional shortening (SMD=-0.59 and -0.55, respectively, both p < 0.01 [n=1,824 and 1,880]), a lower HDL-cholesterol concentration (SMD=-0.48, p<0.001, n=1,378) and a higher waist-to-hip ratio (SMD=0.61, p < 0.01, n=229) than their healthy peers. No significant differences were found for the remaining endpoints.

CONCLUSIONS:

CCS is associated with a lower left ventricular function and HDL-cholesterol level, and a higher waist-to-hip ratio than healthy controls. These findings support the need to closely monitor the cardiometabolic health status of CCS and to implement preventive lifestyle interventions for this population.


REFERENCIA

  • Morales, J. S., Valenzuela, P. L., Rincón-Castanedo, C., Santos-Lozano, A., Fiuza-Luces, C., & Lucia, A. (2019). Is health status impaired in childhood cancer survivors? A systematic review and meta-analysis. Critical Reviews in Oncology/Hematology.

INHOSPITAL EXERCISE TRAINING IN CHILDREN WITH CANCER: DOES IT WORK FOR ALL?

Purpose: Physical exercise training might counteract the weakening effects of both pediatric cancer and anti-cancer treatment. We aimed to analyze the prevalence of “responders” and “non-responders” to inhospital exercise training in children with cancer and to identify the factors that could influence responsiveness, which might help personalize exercise interventions for this patient population. Methods: We performed an ancillary analysis of the randomized controlled trial “Physical activity in Pediatric Cancer” (NCT01645436), in which 49 children with solid tumors were allocated to an inhospital exercise intervention or control group. The present study focused on the children in the former group (n = 24, 10 ± 4 years), who performed 3 weekly training sessions (aerobic + strength exercises). The intervention lasted 19 ± 8 weeks (i.e., from the start to the end of neoadjuvant chemotherapy treatment). A responder-vs-non-responder analysis was performed for physical capacity-related endpoints (five-repetition maximum strength, functional mobility tests, and cardiorespiratory fitness [CRF]). Only those participants showing improvements in a given test of a magnitude greater than both the random error and the threshold for clinically meaningful changes were considered responders. Results: Most participants improved their performance in the strength tests, with 80, 88, and 93% of total showing a positive response for seated bench press, lateral row, and leg press, respectively (p < 0.001). No significant improvements were observed for the functional mobility tests or CRF (p > 0.05, rate of responsiveness ≤ 50%). No differences between responders and non-responders were observed for sex, age, type of cancer, or treatment (i.e., including or not anthracyclines/radiotherapy). However, significant differences (p < 0.05) were observed between responders and non-responders for baseline performance in all the tests, and a significant (p < 0.05) inverse relationship was found between baseline performance and relative improvement for most endpoints. Conclusions: Although most children improved their muscle strength after the exercise intervention, a considerable individual variability was observed for the training responsiveness of functional mobility and CRF. A lower baseline performance was associated with a higher responsiveness for all the study endpoints, with the fittest children at the start of treatment showing the lowest responses. Efforts to individualize exercise prescription are needed to maximize responsiveness in pediatric cancer patients.


REFERENCIA

  • Morales, J. S., Padilla, J. R., Valenzuela, P. L., Santana-Sosa, E., Rincón-Castanedo, C., Santos-Lozano, A., … & Lucia, A. (2018). Inhospital Exercise Training in Children With Cancer: Does It Work for All?. Frontiers in pediatrics6, 404.

RELATIONSHIP BETWEEN SKELETAL MUSCLE CONTRACTILE PROPERTIES AND POWER PRODUCTION CAPACITY IN FEMALE OLYMPIC RUGBY PLAYERS.

This study aimed to determine which contractile properties measured by tensiomyography (TMG) could better differentiate athletes with high- and low-power values, as well as to analyse the relationship between contractile properties and power production capacity. The contractile properties of the vastus medialis (VM), rectus femoris (RF) and vastus lateralis (VL) of an Olympic women’s Rugby Sevens team (n = 14) were analysed before a Wingate test in which their peak power output (PPO) was determined. Athletes were then divided into a high-power (HP) and a low-power (LP) group. HP presented an almost certainly higher PPO (9.8 ± 0.3 vs. 8.9 ± 0.4 W kg-1, ES = 3.00) than LP, as well as a very likely lower radial displacement (3.39 ± 1.16 vs. 5.65 ± 1.50 mm, ES = 1.68) and velocity of deformation (0.08 ± 0.02 vs. 0.13 ± 0.03 mm ms-1, ES = 1.87) of the VL. A likely lower time of delay was observed in HP for all analysed muscles (ES > 0.60). PPO was very largely related to the radial displacement (r = -0.75, 90% CI = -0.90 to -0.44) and velocity of deformation (r = -0.70, 90% CI = -0.87 to -0.34) of the VL. A large correlation was found between PPO and the time of delay of the VL (r = -0.61, 90% CI = -0.84 to -0.22). No correlations were found for the contractile properties of RF or VM. These results highlight the importance of VL contractile properties (but not so much those of RF and VM) for maximal power production and suggest TMG as a practical technique for its evaluation.


REFERENCIA

  • Valenzuela, P. L., Montalvo, Z., Sánchez-Martínez, G., Torrontegi, E., De La Calle-Herrero, J., Dominguez-Castells, R., … & De La Villa, P. (2018). Relationship between skeletal muscle contractile properties and power production capacity in female Olympic rugby players. European journal of sport science18(5), 677-684.

ENHANCED EXTERNAL COUNTERPULSATION AND SHORT-TERM RECOVERY FROM HIGH-INTENSITY INTERVAL TRAINING

PURPOSE:
Enhanced external counterpulsation (EECP) is a recovery strategy whose use has increased in recent years owing to the benefits observed in the clinical setting in some cardiovascular diseases (ie, improvement of cardiovascular function). However, its claimed effectiveness for the enhancement of exercise recovery has not been analyzed in athletes. The aim of this study was to determine the effectiveness of EECP on short-term recovery after a fatiguing exercise bout.

METHODS:
Twelve elite junior triathletes (16 [2] y) participated in this crossover counterbalanced study. After a high-intensity interval training session (6 bouts of 3-min duration at maximal intensity interspersed with 3-min rest periods), participants were assigned to recover during 30 min with EECP (80 mm Hg) or sham (0 mm Hg). Measures of recovery included performance (jump height and mean power during an 8-min time trial), metabolic (blood lactate concentration at several time points), autonomic (heart-rate variability at several time points), and subjective (rating of perceived exertion [RPE] and readiness to compete) outcomes.

RESULTS:
There were no differences between EECP and sham in mean RPE or power output during the high-intensity interval training session, which elicited a significant performance impairment, vagal withdrawal, and increased blood lactate and RPE in both EECP and sham conditions (all P < .05). No significant differences were found in performance, metabolic, or subjective outcomes between conditions at any time point. A significantly lower high-frequency power (P < .05, effect size = 1.06), a marker of parasympathetic activity, was observed with EECP at the end of the recovery phase.

CONCLUSION:
EECP did not enhance short-term recovery after a high-intensity interval training session in healthy, highly trained individuals.


REFERENCIA

  • Valenzuela, P. L., Sánchez-Martínez, G., Torrontegi, E., Montalvo, Z., Lucia, A., & de la Villa, P. (2018). Enhanced External Counterpulsation and Short-Term Recovery From High-Intensity Interval Training. International journal of sports physiology and performance13(8), 1100-1106.