Key pointsr Cold water immersion is a popular strategy to recover from exercise. However, whether regular cold water immersion influences muscle adaptations to strength training is not well understood.r We compared the effects of cold water immersion and active recovery on changes in muscle mass and strength after 12 weeks of strength training. We also examined the effects of these two treatments on hypertrophy signalling pathways and satellite cell activity in skeletal muscle after acute strength exercise.r Cold water immersion attenuated long term gains in muscle mass and strength. It also blunted the activation of key proteins and satellite cells in skeletal muscle up to 2 days after strength exercise.r Individuals who use strength training to improve athletic performance, recover from injury or maintain their health should therefore reconsider whether to use cold water immersion as an adjuvant to their training.Abstract We investigated functional, morphological and molecular adaptations to strength training exercise and cold water immersion (CWI) through two separate studies. In one study, 21 physically active men strength trained for 12 weeks (2 days per week), with either 10 min of CWI or active recovery (ACT) after each training session. Strength and muscle mass increased more in the ACT group than in the CWI group (P < 0.05). Isokinetic work (19%), type II muscle fibre cross-sectional area (17%) and the number of myonuclei per fibre (26%) increased in the ACT group (all P < 0.05), but not the CWI group. In another study, nine active men performed a bout of single-leg strength exercises on separate days, followed by CWI or ACT. Muscle biopsies were collected before and 2, 24 and 48 h after exercise. The number of satellite cells expressing neural cell adhesion molecule (NCAM) (10−30%) and paired box protein (Pax7) (20−50%) increased 24-48 h after exercise with ACT. The number of NCAM + satellite cells increased 48 h after exercise with CWI. NCAM + -and Pax7 + -positive satellite cell numbers were greater after ACT than after CWI (P < 0.05). Phosphorylation of p70S6 kinase Thr421/Ser424 increased after exercise in both conditions but was greater after ACT (P < 0.05). These data suggest that CWI attenuates the acute changes in satellite cell numbers and activity of kinases that regulate muscle hypertrophy, which Abbreviations DAPI, 4 ,6-diamidino-2-phenylindole; ERK, extracellular regulated kinase; GAPDH, glyceraldehyde 3-phosphate dehydrogenase; MRI, magnetic resonance imaging; mTOR, mammalian target of rapamycin; NCAM, neural cell adhesion molecule; Pax7, paired box protein 7; p70S6K, p70S6 kinase; RFD, rate of force development; RIPA, radioimmunoprecipitation assay; RM, repetition maximum; rpS6, ribosomal protein S6; Ser, serine; Thr, threonine; Tyr, tyrosine; 4E-BP1, (eukaryotic translation initiation factor) 4E-binding protein1.

We investigated the effect of cold water immersion (CWI) on the recovery of muscle function and physiological responses after high-intensity resistance exercise. Using a randomized, cross-over design, 10 physically active men performed high-intensity resistance exercise followed by one of two recovery interventions: 1) 10 min of CWI at 10°C or 2) 10 min of active recovery (low-intensity cycling). After the recovery interventions, maximal muscle function was assessed after 2 and 4 h by measuring jump height and isometric squat strength. Submaximal muscle function was assessed after 6 h by measuring the average load lifted during 6 sets of 10 squats at 80% of 1 repetition maximum. Intramuscular temperature (1 cm) was also recorded, and venous blood samples were analyzed for markers of metabolism, vasoconstriction, and muscle damage. CWI did not enhance recovery of maximal muscle function. However, during the final three sets of the submaximal muscle function test, participants lifted a greater load (P < 0.05, Cohen's effect size: 1.3, 38%) after CWI compared with active recovery. During CWI, muscle temperature decreased ∼7°C below postexercise values and remained below preexercise values for another 35 min. Venous blood O2 saturation decreased below preexercise values for 1.5 h after CWI. Serum endothelin-1 concentration did not change after CWI, whereas it decreased after active recovery. Plasma myoglobin concentration was lower, whereas plasma IL-6 concentration was higher after CWI compared with active recovery. These results suggest that CWI after resistance exercise allows athletes to complete more work during subsequent training sessions, which could enhance long-term training adaptations.

Objective To examine the relationship between hyperuricaemia, haemoconcentration and maternal and fetal outcomes in hypertensive pregnancies.Design Retrospective analysis of a database of hypertensive pregnancies.Setting St George Hospital, a major obstetric unit in Australia.Population A cohort of 1880 pregnant women without underlying hypertension or renal disease, referred for management of preeclampsia or gestational hypertension.Methods Demographic, clinical and biochemical data at time of referral and delivery were collected for each pregnancy. Women were grouped according to diagnosis (pre-eclampsia or gestational hypertension) and logistic regression analysis was used to determine the relationship between uric acid, haemoglobin, haematocrit and adverse outcomes; an a level of P < 0.01 was used for statistical significance.Main outcome measures Composites of adverse maternal and fetal outcomes.Results In women with 'benign' GH (without proteinuria or any other maternal clinical feature of pre-eclampsia) gestation-corrected hyperuricaemia was associated with increased risk of a small-forgestational-age infant (OR 2.5; 95% CI 1.3-4.8) and prematurity (OR 3.2; 95% CI 1.4-7.2), but not with adverse maternal outcome. In the whole cohort of hypertensive pregnant women (those with pre-eclampsia or gestational hypertension) the risk of adverse maternal outcome (OR 2.0; 95% CI 1.6-2.4) and adverse fetal outcome (OR 1.8; 95% CI 1.5-2.1) increased with increasing concentration of uric acid. Hyperuricaemia corrected for gestation provided additional strength to these associations. Haemoglobin and haematocrit were not associated with adverse pregnancy outcome.Conclusions Hyperuricaemia in hypertensive pregnancy remains an important finding because it identifies women at increased risk of adverse maternal and particularly fetal outcome; the latter, even in women with gestational hypertension without any other feature of pre-eclampsia.

Cold water immersion and active recovery are common post-exercise recovery treatments. However, little is known about whether these treatments influence inflammation and cellular stress in human skeletal muscle after exercise. We compared the effects of cold water immersion versus active recovery on inflammatory cells, pro-inflammatory cytokines, neurotrophins and heat shock proteins (HSPs) in skeletal muscle after intense resistance exercise. Nine active men performed unilateral lower-body resistance exercise on separate days, at least 1 week apart. On one day, they immersed their lower body in cold water (10°C) for 10 min after exercise. On the other day, they cycled at a low intensity for 10 min after exercise. Muscle biopsies were collected from the exercised leg before, 2, 24 and 48 h after exercise in both trials. Exercise increased intramuscular neutrophil and macrophage counts, MAC1 and CD163 mRNA expression (P < 0.05). Exercise also increased IL1β, TNF, IL6, CCL2, CCL4, CXCL2, IL8 and LIF mRNA expression (P < 0.05). As evidence of hyperalgesia, the expression of NGF and GDNF mRNA increased after exercise (P < 0.05). The cytosolic protein content of αB-crystallin and HSP70 decreased after exercise (P < 0.05). This response was accompanied by increases in the cytoskeletal protein content of αB-crystallin and the percentage of type II fibres stained for αB-crystallin. Changes in inflammatory cells, cytokines, neurotrophins and HSPs did not differ significantly between the recovery treatments. These findings indicate that cold water immersion is no more effective than active recovery for reducing inflammation or cellular stress in muscle after a bout of resistance exercise.

Muscle hypertrophy occurs following increased protein synthesis, which requires activation of the ribosomal complex. Additionally, increased translational capacity via elevated ribosomal RNA (rRNA) synthesis has also been implicated in resistance training‐induced skeletal muscle hypertrophy. The time course of ribosome biogenesis following resistance exercise (RE) and the impact exerted by differing recovery strategies remains unknown. In the present study, the activation of transcriptional regulators, the expression levels of pre‐rRNA, and mature rRNA components were measured through 48 h after a single‐bout RE. In addition, the effects of either low‐intensity cycling (active recovery, ACT) or a cold‐water immersion (CWI) recovery strategy were compared. Nine male subjects performed two bouts of high‐load RE randomized to be followed by 10 min of either ACT or CWI. Muscle biopsies were collected before RE and at 2, 24, and 48 h after RE. RE increased the phosphorylation of the p38‐MNK1‐eIF4E axis, an effect only evident with ACT recovery. Downstream, cyclin D1 protein, total eIF4E, upstream binding factor 1 (UBF1), and c‐Myc proteins were all increased only after RE with ACT. This corresponded with elevated abundance of the pre‐rRNAs (45S, ITS‐28S, ITS‐5.8S, and ETS‐18S) from 24 h after RE with ACT. In conclusion, coordinated upstream signaling and activation of transcriptional factors stimulated pre‐rRNA expression after RE. CWI, as a recovery strategy, markedly blunted these events, suggesting that suppressed ribosome biogenesis may be one factor contributing to the impaired hypertrophic response observed when CWI is used regularly after exercise.

Objectives-To examine the eVectiveness and cost-eVectiveness of two interventions based in primary care aimed at increasing uptake of breast screening. Setting-24 General practices with low uptake in the second round of screening (below 60%) in north west London and the West Midlands, UK. Participants were all women registered with these practices and eligible for screening in the third round. Methods-Pragmatic factorial cluster randomised controlled trial, with practices randomised to a systematic intervention (general practitioner letter), an opportunistic intervention (flag in women's notes prompting discussion by health professionals), neither intervention, or both. Outcome measures were attendance for screening 6 months after the practices had been screened and cost-eVectiveness of the interventions. Results-6133 Women were included: 1721 control; 1818 letter; 1232 flag; 1362 both interventions. Attendance data were obtained for 5732 (93%) women. The two interventions independently increased breast screening uptake in a logistic regression model adjusted for clustering, with the flag (odds ratio (OR) 1.43, 95% confidence interval (95% CI) 1.14 to 1.79; p=0.0019) marginally more eVective than the letter (OR 1.31, 95% CI 1.05 to 1.64; p=0.015). Health service costs per additional attendance were £26 (letter) and £41 (flag). Conclusions-Although both interventions increased attendance for breast screening, the letter was the more costeVective. Any decision to implement both interventions rather than just the letter will depend on whether the additional (£41) costs are judged worthwhile in terms of the gains in breast screening uptake. (J Med Screen 2001;8:91-98) Keywords: cluster randomised controlled trial; breast screening; uptake; primary careBreast cancer is the most common female cancer in the United Kingdom, with an estimated 33 000 newly diagnosed cases and 15 000 deaths occurring each year.1 In 1986, the Forrest Report 2 recommended the provision of a national breast screening programme in the United Kingdom for women aged 50-64 years.The National Health Service breast screening programme (NHSBSP) provides mammographic screening in specialised breast screening units which call women for screening every 3 years through their general practice using "prior notification lists" generated by health authorities. Forrest estimated that if 70% of eligible women attended for screening, a 25% reduction in mortality from breast cancer could be achieved in the United Kingdom. 2The programme as a whole is reaching current targets: in England, 75% of invited women attended for screening in 1996-7.3 However, these national figures hide considerable geographical diversity-at the time of the study, 18 out of 100 health authorities had an uptake rate less than 60%. Health promotion interventions aiming to improve uptake of breast screening often involve the primary healthcare team.4 Such interventions can be systematic, for example, a letter encouraging attendance sent from the general practitioner to all elig...

This study investigated the test-retest reliability and criterion validity of force-time curve variables collected via a portable isometric mid-thigh clean pull (IMTP) device equipped with a single-axial load cell. Fifteen males with ≥ 6 months of resistance training experience attended two testing sessions. In each session, participants performed an IMTP in two separate conditions in a randomized, counterbalanced manner. The criterion condition consisted of a closed-chain IMTP configured with a force plate (IMTPf), while the experimental test was undertaken using a portable IMTP with data acquired via a single-axial load cell (IMTPl). A very high reliability (CV = 3.10, 90% CI: 2.4 -4.6%; ICC = 0.96, 90% CI: 0.90 -0.98) and acceptable validity (CV = 9.2, 90% CI: 7 -14%; ICC = 0.88, 90% CI: 0.71-0.95) were found in the experimental condition for the measure of peak force. However, significant differences were present between the IMTPf and IMTPl (p<0.0001). Alternate force-time curve variables did not reach acceptable levels of validity or reliability in the experimental condition. The IMTPl is a valid and highly reliable method for assessing peak force. This provides evidence supporting the use of an IMTPl as a cost effective and portable alternative for those who wish to assess maximal force production in a similar fashion to a traditional IMTP. However, practitioners should be aware that these are slightly different tests.

Mobility can be defined as the ability to move or be moved freely and easily. In older adults, mobility impairments are common and associated with risk for additional loss of function. Mobility loss is particularly common in these individuals during acute illness and hospitalization, and it is associated with poor outcomes, including loss of muscle mass and strength, long hospital stays, falls, declines in activities of daily living, decline in community mobility and social participation, and nursing home placement. Thus, mobility loss can have a large effect on an older adult's health, independence, and quality of life. Nevertheless, despite its importance, loss of mobility is not a widely recognized outcome of hospital care, and few hospitals routinely assess mobility and intervene to improve mobility during hospital stays. The Quality and Performance Measurement Committee of the American Geriatrics Society has developed a white paper supporting greater focus on mobility as an outcome for hospitalized older adults. The executive summary presented here focuses on assessing and preventing mobility loss in older adults in the hospital and summarizes the recommendations from that white paper. The full version of the white paper is available as Text S1. J Am Geriatr Soc 67:11–16, 2019.