This randomized controlled trial examined body mass, body composition, energy balance and performance responses of previously sedentary overweight/obese women to a circuit-type integrated neuromuscular training program with alternative modalities. Forty-nine healthy overweight or class I obese females (36.4±4.4 yrs) were randomly assigned to either a control (N = 21), training (N = 14) or training-detraining (N = 14) group. In weeks 1–20, the training groups trained three times/week using 10–12 whole-body exercises of progressively increased intensity/volume, organized in timed interval circuit form. In weeks 21–40, the training group continued training whereas the training-detraining group not. Heart rate, perceived exertion, blood lactate, exertion, oxygen consumption and excess post-exercise oxygen consumption were measured for one session/phase/person and exercise energy expenditure was calculated. Energy intake, habitual physical activity, resting metabolic rate, body composition, body mass, strength and maximal oxygen consumption were measured at baseline, mid-intervention and post-intervention. A two-way repeated measures ANOVA was used to determine differences between three time points and three groups. In C, VO2max declined (p<0.013) and body fat (p<0.008), waist (p<0.059) and hip (p<0.012) circumferences increased after 40 weeks compared to baseline. Training reduced body mass (6%, p<0.001), body fat (~5.5%, p<0.001) and increased fat-free mass (1.2–3.4%, p<0.05), strength (27.2%, p<0.001) and endurance (26.8%, p<0.001) after a 10-month implementation period using a metabolic overload of only 5–12 metabolic equivalents of task-hours per week. Training induced a long-term negative energy balance during an exercise and a non-exercise day due to an elevation of resting metabolic rate (6%-10%, p<0.05) and exercise-related energy expenditure. Training had an 8% and 94% attrition and attendance rates, respectively. Training-induced gains were attenuated but not lost following a 5-month detraining. A 10-month implementation of a high-intensity interval type training program elicited both endurance and musculoskeletal gains and resulted in a long-term negative energy balance that induced a progressive and sustained reduction of body and fat mass.Trial Registration: ClinicalTrials.gov NCT03134781

IntroductionAlthough major changes of the immune system have been described in sepsis, it has never been studied whether these may differ in relation to the type of underlying infection or not. This was studied for the first time.MethodsThe statuses of the innate and adaptive immune systems were prospectively compared in 505 patients. Whole blood was sampled within less than 24 hours of advent of sepsis; white blood cells were stained with monoclonal antibodies and analyzed though a flow cytometer.ResultsExpression of HLA-DR was significantly decreased among patients with severe sepsis/shock due to acute pyelonephritis and intraabdominal infections compared with sepsis. The rate of apoptosis of natural killer (NK) cells differed significantly among patients with severe sepsis/shock due to ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) compared with sepsis. The rate of apoptosis of NKT cells differed significantly among patients with severe sepsis/shock due to acute pyelonephritis, primary bacteremia and VAP/HAP compared with sepsis. Regarding adaptive immunity, absolute counts of CD4-lymphocytes were significantly decreased among patients with severe sepsis/shock due to community-acquired pneumonia (CAP) and intraabdominal infections compared with sepsis. Absolute counts of B-lymphocytes were significantly decreased among patients with severe sepsis/shock due to CAP compared with sepsis.ConclusionsMajor differences of the early statuses of the innate and adaptive immune systems exist between sepsis and severe sepsis/shock in relation to the underlying type of infection. These results may have a major impact on therapeutics.

BackgroundHost factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in IE.Methods and ResultsUsing a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]–Prospective Cohort Study [PCS], 2000–2006, n=4049), a model to predict 6‐month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE‐PLUS, 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the ICE‐PCS cohort and 342 of 1197 (28.6%) in the ICE‐PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left‐sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6‐month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62–0.89). A simplified risk model was developed by weight adjustment of these variables.ConclusionsSix‐month mortality after IE is ≈25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE.

Panagoulis, C, Chatzinikolaou, A, Avloniti, A, Leontsini, D, Deli, CK, Draganidis, D, Stampoulis, T, Oikonomou, T, Papanikolaou, K, Rafailakis, L, Kambas, A, Jamurtas, AZ, and Fatouros, IG. In-season integrative neuromuscular strength training improves performance of early-adolescent soccer athletes. J Strength Cond Res 34(2): 516–526, 2020—Although forms of integrative neuromuscular training (INT) are used extensively for injury prevention and treatment, no information exists about its effects on performance of adolescent athletes. We investigated the effects of an in-season INT intervention on performance of early-adolescent players using a 2-group, repeated-measures design. Twenty-eight early adolescents were randomly assigned to a control group (CG, participated only in soccer training, N = 14, 11.4 ± 0.57 years, Tanner stage 2.8 ± 0.6) or an experimental group (INT was added to conventional soccer training, N = 14, 11.2 ± 0.5 years, Tanner stage 2.6 ± 0.5). Integrative neuromuscular training (8 weeks, 3 sessions·wk−1) aimed to develop core strength, hamstrings eccentric strength, hip/knee musculature, and dynamic stability using body mass exercises, medicine balls, rocker boards, Bosu, stability balls, etc. Ball shooting speed, speed (10, 20-m), change of direction (COD), jumping performance, and strength were measured before and after training. A 2-way repeated-measures ANOVA was used to analyze data. Integrative neuromuscular training improved 10- and 20-m speed (2.52–2.13 and 3.61–3.39 seconds, respectively, p < 0.05), strength (40.1–44.4 kg, p < 0.05), jumping ability (squat jump: 16.3–17.9 cm; countermovement jump: 19.1–20.3 cm, p < 0.05), COD (18.0–17.3 seconds, p < 0.05), and shooting speed (73.8–79.0 km·h−1, p < 0.05). In the CG, soccer training caused an improvement of smaller magnitude in 10 m and shooting speed (p < 0.05), whereas COD and jumping performance remained unaffected while 20-m speed, COD, and strength deteriorated. These results indicate that an 8-week INT program may induce positive adaptations in performance of early-adolescent soccer players during in-season training, suggesting that INT may be an effective training intervention for this age group.

The ubiquitin-proteasome system (UPS) is the main cellular proteolytic system responsible for the degradation of normal and abnormal (e.g. oxidised) proteins. Under catabolic conditions characterised by chronic inflammation, the UPS is activated resulting in proteolysis, muscle wasting and impaired muscle function. Milk proteins provide sulphur-containing amino acid and have been proposed to affect muscle inflammation. However, the response of the UPS to aseptic inflammation and protein supplementation is largely unknown. The aim of this study was to investigate how milk protein supplementation affects UPS activity and skeletal muscle function under conditions of aseptic injury induced by intense, eccentric exercise. In a double-blind, cross-over, repeated measures design, eleven men received either placebo (PLA) or milk protein concentrate (PRO, 4×20 g on exercise day and 20 g/d for the following 8 days), following an acute bout of eccentric exercise (twenty sets of fifteen eccentric contractions at 30°/s) on an isokinetic dynamometer. In each trial, muscle biopsies were obtained from the vastus lateralis muscle at baseline, as well as at 2 and 8 d post exercise, whereas blood samples were collected before exercise and at 6 h, 1 d, 2 d and 8 d post exercise. Muscle strength and soreness were assessed before exercise, 6 h post exercise and then daily for 8 consecutive days. PRO preserved chymotrypsin-like activity and attenuated the decrease of strength, facilitating its recovery. PRO also prevented the increase of NF-κB phosphorylation and HSP70 expression throughout recovery. We conclude that milk PRO supplementation following exercise-induced muscle trauma preserves proteasome activity and attenuates strength decline during the pro-inflammatory phase.

It is unclear how high-intensity, interval-type nontraditional exercise training programmes can be feasible and effective options for inactive obese individuals. This randomized controlled trial investigated the hypothesis that a 10-month high-intensity, interval-type neuromuscular training programme (DoIT) with adjunct portable modalities, performed in a small-group setting, induces improvements in psychological well-being, subjective vitality and exercise behavioural regulations in obese women. Associations between adherence, psychological and physiological indicators were also investigated. Forty-nine previously inactive obese females (36.4 ± 4.4 yrs) were randomly assigned to three groups (control; N = 21, 10-month training; N = 14, or 5-month training plus 5 month-detraining; N = 14). DoIT was a supervised, progressive, and time-efficient (<30 min) programme that used 10-12 functional/neuromotor exercises and prescribed work and rest time intervals (20-40 sec) in a circuit fashion (1-3 rounds) for 10 months. Questionnaires were used to measure psychological distress, subjective vitality, and behavioural regulations in exercise at pre-, mid-, and post-intervention. The 10-month training reduced psychological distress (72%, p = 0.001), external regulation (75%, p = 0.011) and increased vitality (53%, p = 0.001), introjected regulation (63%, p = 0.001), intrinsic regulation (33%, p = 0.004), and identified regulation (88%, p = 0.001). A moderate to strong positive relationship was found between adherence rate and identified regulation scores (r = 0.59, p = 0.001) and between VO 2 peak and identified regulation scores (r = 0.59, p = 0.001). A mild dissociation between exercise intensity and perceived exertion was also observed. Our novel findings suggest that a 10-month implementation of a high-intensity interval neuromuscular training programme promotes positive psychological adaptations provoking exercise behavioural regulation and adherence while inducing weight loss in inactive obese women.

The effects of protein supplementation on performance recovery and inflammatory responses during a simulated one-week in-season microcycle with two games (G1, G2) performed three days apart were examined. Twenty football players participated in two trials, receiving either milk protein concentrate (1.15 and 0.26 g/kg on game and training days, respectively) (PRO) or an energy-matched placebo (1.37 and 0.31 g/kg of carbohydrate on game and training days, respectively) (PLA) according to a randomized, repeated-measures, crossover, double-blind design. Each trial included two games and four daily practices. Speed, jump height, isokinetic peak torque, and muscle soreness of knee flexors (KF) and extensors (KE) were measured before G1 and daily thereafter for six days. Blood was drawn before G1 and daily thereafter. Football-specific locomotor activity and heart rate were monitored using GPS technology during games and practices. The two games resulted in reduced speed (by 3–17%), strength of knee flexors (by 12–23%), and jumping performance (by 3–10%) throughout recovery, in both trials. Average heart rate and total distance covered during games remained unchanged in PRO but not in PLA. Moreover, PRO resulted in a change of smaller magnitude in high-intensity running at the end of G2 (75–90 min vs. 0–15 min) compared to PLA (P = 0.012). KE concentric strength demonstrated a more prolonged decline in PLA (days 1 and 2 after G1, P = 0.014–0.018; days 1, 2 and 3 after G2, P = 0.016–0.037) compared to PRO (days 1 after G1, P = 0.013; days 1 and 2 after G2, P = 0.014–0.033) following both games. KF eccentric strength decreased throughout recovery after G1 (PLA: P=0.001–0.047—PRO: P =0.004–0.22) in both trials, whereas after G2 it declined throughout recovery in PLA (P = 0.000–0.013) but only during the first two days (P = 0.000–0.014) in PRO. No treatment effect was observed for delayed onset of muscle soreness, leukocyte counts, and creatine kinase activity. PRO resulted in a faster recovery of protein and lipid peroxidation markers after both games. Reduced glutathione demonstrated a more short-lived reduction after G2 in PRO compared to PLA. In summary, these results provide evidence that protein feeding may more efficiently restore football-specific performance and strength and provide antioxidant protection during a congested game fixture.

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