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Endurance exercise training (ET) is an effective treatment in heart failure with preserved ejection fraction (HFpEF), but the efficacy of resistance training in this patient population has been only scarcely evaluated. In this multicenter, randomized trial, we evaluated the effects of combined endurance and resistance training over 12 months in patients with HFpEF. The primary endpoint was a modified Packer score, including all-cause mortality, hospitalizations classified as potentially related to heart failure or exercise and changes in peak oxygen consumption ( V ̇ O 2 ), diastolic function (E/e′), New York Heart Association (NYHA) class and global self-assessment (GSA). In total, 322 patients (mean age, 70 years; 192 females (59.6%) and 130 males (40.4%)) were randomized (1:1) to ET or usual care (UC). At 12 months, the modified Packer score showed an improvement in 33 ET patients (20.5%) and in 13 UC patients (8.1%) and showed a worsening in 69 ET patients (42.9%) and in 71 UC patients (44.1%) (Kendall’s tau-b = −0.073, P  = 0.17). Although the primary endpoint was not met, clinically relevant differences favoring the ET group as compared to the UC group were observed for the following secondary endpoints: changes in peak V ̇ O 2 (mean difference, 1.3 ml kg −1  min −1 (95% confidence interval (CI): 0.4–2.1)) and NYHA class (odds ratio = 7.77 (95% CI: 3.73–16.21)). No significant between-group differences were observed for other secondary endpoints, including change in E/e′, change in GSA, time to cardiovascular hospitalization or all-cause mortality. In conclusion, 1 year of combined endurance and resistance ET did not result in a significantly better modified Packer score, but it did result in improvements in important clinical parameters, such as peak V ̇ O 2 and NYHA class, as compared to UC. ISRCTN registration: ISRCTN86879094 . In a multicenter, randomized trial, patients with heart failure with preserved ejection fraction who underwent a regimen of combined endurance and resistance exercise training over the course of 1 year did not show a statistically significant improvement in the modified Packer score—the primary efficacy endpoint—as compared to patients who received usual care, but they did show improvements in secondary endpoints for maximal oxygen consumption and NYHA heart failure class.

Abstract Context The combination of two beneficial antidiabetes interventions, regular exercise and pharmaceuticals, is intuitively appealing. However, metformin, the most commonly prescribed diabetes medication, attenuates the favorable physiological adaptations to exercise; in turn, exercise may impede the action of metformin. Objective We sought to determine the influence of an alternative diabetes treatment, sodium glucose cotransporter 2 (SGLT2) inhibition, on the response to endurance exercise training. Design, Participants, and Intervention In a randomized, double-blind, repeated measures parallel design, 30 sedentary overweight and obese men and women were assigned to 12 weeks of supervised endurance exercise training, with daily ingestion of either a placebo or SGLT2 inhibitor (dapagliflozin: ≤10 mg/day). Outcome Measurements and Results Endurance exercise training favorably modified body mass, body composition (dual-energy x-ray absorptiometry), peak oxygen uptake (graded exercise with indirect calorimetry), responses to standardized submaximal exercise (indirect calorimetry, heart rate, and blood lactate), and skeletal muscle (vastus lateralis) citrate synthase activity (main effects of exercise training, all P < 0.05); SGLT2 inhibition did not influence any of these physiological adaptations (exercise training × treatment interaction, all P > 0.05). However, after endurance exercise training, fasting blood glucose was greater with SGLT2 inhibition, and increased insulin sensitivity (oral glucose tolerance test/Matsuda index) was abrogated with SGLT2 inhibition (exercise training × treatment interaction, P < 0.01). Conclusion The efficacy of combining two beneficial antidiabetes interventions, regular endurance exercise and SGLT2 inhibition, was not supported. SGLT2 inhibition blunted endurance exercise training–induced improvements in insulin sensitivity, independent of effects on aerobic fitness or body composition. Sodium glucose cotransporter 2 inhibition attenuates some of the favorable physiological adaptations to 12 weeks of endurance exercise training in previously sedentary overweight and obese adults.

Hypertension remains a major global public health problem as the leading modifiable risk factor for cardiovascular death worldwide, responsible for more than 10 million deaths per year. The aim of the present study was to compare the effect of strength training, based on an individual load-velocity ratio assessment, concurrent with endurance training, and endurance training on blood and metabolic biomarkers, body composition and physical fitness in adults with hypertension. A randomised, single-blind, 12-week, prospective clinical trial was conducted. The study included 75 volunteers with an average age of 54 years, all of whom were hypertensive and sedentary. The sample was randomly assigned into three groups, strength training, based on an individual load-velocity ratio assessment, concurrent with endurance training, endurance training alone group, and a control group. The concurrent training group obtained greater reductions in SBP, DBP and MAP than the endurance training group, up to 12.8 mmHg, 6.8 mmHg and 8.6 mmHg respectively. The findings of the present study indicate that performing strength training, based on an individual load-velocity ratio assessment, concurrent with endurance training 2 days per week for 12 weeks, leads to improvements in metabolic and blood biomarkers, body composition, and physical fitness, of adults with hypertension, with these adaptations being superior to those produced by endurance training alone.

Brain Endurance Training (BET) — the addition of mentally fatiguing cognitive tasks to standard physical training — could improve performance in soccer. We tested whether BET, with cognitive tasks intermixed with physical training activities, improved players' cognitive and soccer-specific technical performance compared to physical training alone when fresh and fatigued. The study employed a pre/training/midtest/training/posttest design. 31 professional male soccer players were randomly assigned to BET or control groups and completed 18 physical training sessions over 6 weeks. In between the physical training activities, the BET group completed demanding cognitive tasks, whereas the control group rested. Players completed the Loughborough soccer passing (LSPT) and shooting test (LSST) before and after completing a 30-min Stroop task. A brief psychomotor vigilance test (PVT-B), a visual analog rating of mental fatigue (MF-VAS), and rating of perceived exertion (RPE) were measured during testing and training. During testing, the 30-min Stroop task elicited a state of MF, confirmed by higher subjective ratings (P < .01). Compared to pre-testing, at mid- and post-testing, the BET group improved passing (all P < .01), shooting (all P < .01), and PVT-B performance (all P < .01) when tested after (fatigued) but not before (fresh) the Stroop task, whereas the control group did not change performance either way. During training the BET group reported higher MF (P < .01) and exhibited slower PVT-B responses (P < .01) compared to control. Intermixed BET was more effective than physical training alone at improving cognitive and soccer-specific technical performance of professional soccer players when fatigued.

This study aims to assess the effect of inspiratory muscle training (IMT) combined with endurance training (ET) on balance in patients with chronic obstructive pulmonary disease (COPD). We studied 32 male patients (62 ± 6 years) with moderate to very severe COPD. They were randomly assigned to an experimental group (IMT+ET) n = 16 or a control group (ET) n = 16 with similar characteristics. The evaluations were carried out at inclusion and after eight weeks of the training period. Functional balance was assessed by the Berg Balance Scale (BBS), the Timed-up and Go (TUG), the Single Leg Stance test (SLS), and the Activities-specific Balance Confidence (ABC) scale. The strength of the inspiratory muscles (PImax) was assessed by maximal inspiratory mouth pressure. Functional exercise performance was assessed by the 6 minutes walking test (6MWT). IMT program consists in performing two daily sets of 30 inspirations with 50% of PImax increased by 10% every two weeks. ET program consists in performing 30 min treadmill exercise at 60% to 80% of the average speed achieved during the 6MWT three days per week. After the training period, the experimental group demonstrated greater improvements in BBS (IMT+ET vs. ET; p = 0.019), and in ABC (IMT+ET vs. ET; p = 0.014). However, no significant differences between groups were observed for TUG, SLS, and 6MWT. There was a significant difference between groups in PImax (IMT+ET vs. ET; p = 0.030). Significant moderate correlations were obtained between ΔPImax and ΔBBS for both groups (IMT+ET: r = 0.624, p = 0.010; ET r = 0.550, p = 0.027) as well as for ΔABC but only in the experimental group (IMT+ET: r = 0.550, p = 0.027). Compared to ET alone, the results suggest that IMT combined with ET enhances inspiratory muscle function and functional balance according to BBS and ABC in patients with COPD. We suggest that inspiratory muscle training might be introduced as additional training to pulmonary rehabilitation programs aimed at improving balance in COPD patients. The trial registry name: Clinical Trials; Registration number: NCT04084405; URL: https://clinicaltrials.gov/ct2/show/NCT04084405.

The aim of this study was to compare the effects of maximal strength training (MST), plyometric training (PT), and muscular endurance training (MET) on starting performance and swimming performance at 25- and 50-meters freestyle. A randomized parallel controlled study was conducted involving twenty-seven high-level university swimmers (Tier 2), both men and women (age: 20.2 ± 1.1 years). The training interventions lasted six weeks, with each training group participating twice a week. MST involved resistance training at 80-95% of one maximum repetition, while PT included maximal eccentric-concentric quick movements. MET, considered as a control group, consisted of free-weight exercises or light loads performed multiple times. The swimmers were assessed before, during (in the 3rd week), and after the interventions by measuring their start performance based on takeoff distance and time at the 15-meter mark. Swimming performance was assessed through the following tests: 25-meter freestyle kicking (without stroking), 25-meter freestyle stroke (without kicking), and 25-meter and 50-meter freestyle sprints. The mixed ANCOVA, using pre-evaluation scores as covariates, revealed that after the intervention, MST was significantly better than MET in start flight distance (p = 0.021), 15-meter start time (p < 0.001), 25-meter freestyle kick (p < 0.001), 25-meter freestyle stroke (p < 0.001), 25-meter freestyle (p = 0.004), and 50-meter freestyle (p < 0.001). PT was also significantly better than MET in 15-meter start time (p = 0.004), 25-meter freestyle kick (p = 0.011), 25-meter freestyle stroke (p < 0.001), and 50-meter freestyle (p = 0.014). After the intervention, no significant differences were found between MST and PT, although some differences were observed during the mid-evaluation. The conclusions reveal that, although all groups showed significant improvement in performance, MST and PT exhibited significantly better results compared to MET in enhancing sprint freestyle performance overall.

PurposePost-exercise passive heating has been reported to augment adaptations associated with endurance training. The current study evaluated the effect of a 4-week remotely administered, post-exercise passive leg heating protocol, using an electrically heated layering ensemble, on determinants of endurance performance.MethodsThirty recreationally trained participants were randomly allocated to either a post-exercise passive leg heating (PAH, n = 16) or unsupervised training only control group (CON, n = 14). The PAH group wore the passive heating ensemble for 90–120 min/day, completing a total of 20 (16 post-exercise and 4 stand-alone leg heating) sessions across 4 weeks. Whole-body (peak oxygen uptake, gas exchange threshold, gross efficiency and pulmonary oxygen uptake kinetics), single-leg exercise (critical torque and NIRS-derived muscle oxygenation), resting vascular characteristics (flow-mediated dilation) and angiogenic blood measures (nitrate, vascular endothelial growth factor and hypoxia inducible factor 1−α) were recorded to characterize the endurance phenotype. All measures were assessed before (PRE), at 2 weeks (MID) and after (POST) the intervention.ResultsThere was no effect of the intervention on test of whole-body endurance capacity, vascular function or blood markers (p > 0.05). However, oxygen kinetics were adversely affected by PAH, denoted by a slowing of the phase II time constant; τ (p = 0.02). Furthermore, critical torque–deoxygenation ratio was improved in CON relative to PAH (p = 0.03).ConclusionWe have demonstrated that PAH had no ergogenic benefit but instead elicited some unfavourable effects on sub-maximal exercise characteristics in recreationally trained individuals.

The aim of this study was to investigate whether 4 weeks of endurance training could improve tolerance to mental exertion in untrained participants. Longitudinal training study. Twenty untrained young adults (14 F, 6 M; 27.6±6.2 years) completed a 4-week training protocol in a randomised and counterbalanced order. Baseline and follow-up assessment were conducted over three sessions in the week preceding and following the training period. During session 1, participants completed an incremental maximal ramp test. During sessions 2 and 3 participants completed a 15min cycling time trial preceded by either a mental exertion or control conditions. Following baseline assessments, participants were randomised into a physical training or placebo group that completed the training intervention thrice weekly over four weeks. The physical training resulted in increase in VO2 peak relative to the placebo group (p=0.003). Linear Mixed Models utilising the control condition time trial performance as a covariate found the physical training group increased their time trial distance following the mental exertion condition to a greater extent than the placebo group (p=0.03). RPE during the time trial and perceptual measures of mental exertion did not significantly change between groups (all p>0.10) although interaction effects were observed when considering the RPE-power output relationship during the time trial. Four weeks of endurance training increased tolerance to mental exertion in untrained participants during a subsequent physical performance, but not during prolonged cognitive performance. This finding suggests that the ability to tolerate mental exertion is trainable in at least some contexts and highlights the far-reaching benefits of endurance training.

Background This study assessed the feasibility and acceptability of two common types of exercise training—high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT)—in adults with Crohn’s disease (CD). Methods In this mixed-methods pilot trial, participants with quiescent or mildly-active CD were randomly assigned 1:1:1 to HIIT, MICT or usual care control, and followed up for 6 months. The HIIT and MICT groups were offered three exercise sessions per week for the first 12 weeks. Feasibility outcomes included rates of recruitment, retention, outcome completion, and exercise attendance. Data were collected on cardiorespiratory fitness (e.g., peak oxygen uptake), disease activity, fatigue, quality of life, adverse events, and intervention acceptability (via interviews). Results Over 17 months, 53 patients were assessed for eligibility and 36 (68%) were randomised (47% male; mean age 36.9 [SD 11.2] years); 13 to HIIT, 12 to MICT, and 11 to control. The exercise session attendance rate was 62% for HIIT (288/465) and 75% for MICT (320/429), with 62% of HIIT participants (8/13) and 67% of MICT participants (8/12) completing at least 24 of 36 sessions. One participant was lost to follow-up. Outcome completion rates ranged from 89 to 97%. The mean increase in peak oxygen uptake, relative to control, was greater following HIIT than MICT (2.4 vs. 0.7 mL/kg/min). There were three non-serious exercise-related adverse events, and two exercise participants experienced disease relapse during follow-up. Conclusions The findings support the feasibility and acceptability of the exercise programmes and trial procedures. A definitive trial is warranted. Physical exercise remains a potentially useful adjunct therapy in CD. [ID: ISRCTN13021107].

PurposeAgeing is associated with increased blood pressure (BP), reduced sleep, decreased pulmonary function and exercise capacity. The main purpose of this study was to test whether respiratory muscle endurance training (RMET) improves these parameters.MethodsTwenty-four active normotensive and prehypertensive participants (age: 65.8 years) were randomized and balanced to receive either RMET (N = 12) or placebo (PLA, N = 12). RMET consisted of 30 min of volitional normocapnic hyperpnea at 60% of maximal voluntary ventilation while PLA consisted of 1 inhalation day−1 of a lactose powder. Both interventions were performed on 4–5 days week−1 for 4–5 weeks. Before and after the intervention, resting BP, pulmonary function, time to exhaustion in an incremental respiratory muscle test (incRMET), an incremental treadmill test (IT) and in a constant-load treadmill test (CLT) at 80% of peak oxygen consumption, balance, sleep at home, and body composition were assessed. Data was analyzed with 2 × 2 mixed ANOVAs.ResultsCompared to PLA, there was no change in resting BP (independent of initial resting BP), pulmonary function, IT performance, sleep, body composition or balance (all p > 0.05). Performance significantly increased in the incRMET (+ 6.3 min) and the CLT (+ 3.2 min), resulting in significant interaction effects (p < 0.05).ConclusionIn the elderly population, RMET might be used to improve respiratory and whole body endurance performance either as an adjunct to physical exercise training or as a replacement thereof for people not being able to intensively exercise even if no change in BP or sleep may be expected.