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1.  Sequential Exercise in Triathletes: Variations in GH and Water Loss 
PLoS ONE  2014;9(4):e96145.
Growth hormone (GH) may stimulate water loss during exercise by activating sweating. This study investigated GH secretion and water loss during sequential cycling and running, taking postural changes into account. The two exercise segments had similar durations and were performed at the same relative intensity to determine their respective contributions to water loss and the plasma volume variation noted in such trials. Eight elite triathletes first performed an incremental cycle test to assess maximal oxygen consumption. Then, the triathletes performed one of two trials in randomized order: constant submaximal cycling followed by treadmill running (C1-R2) or an inversed succession of running followed by cycling (R1-C2). Each segment of both trials was performed for 20 minutes at ∼75% of maximal oxygen consumption. The second trial, reversing the segment order of the first trial, took place two weeks later. During cycling, the triathletes used their own bicycles equipped with a profiled handlebar. Blood sampling (for GH concentrations, plasma viscosity and plasma volume variation) was conducted at rest and after each segment while water loss was estimated from the post- and pre-measures. GH increases were significantly lower in R2 than C2 (72.2±50.1 vs. 164.0±157 ng.ml−1.min−1, respectively; P<0.05). Water loss was significantly lower after C1-R2 than R1-C2 (1105±163 and 1235±153 ml, respectively; P<0.05). Plasma volume variation was significantly negative in C1 and R1 (−6.15±2.0 and −3.16±5.0%, respectively; P<0.05), not significant in C2, and significantly positive for seven subjects in R2 (4.05±3.1%). We concluded that the lower GH increases in R2 may have contributed to the smaller reduction in plasma volume by reducing sweating. Moreover, this lower GH response could be explained by the postural change during the transition from cycling to running. We recommend to pay particular attention to their hydration status during R1 which could limit a potential dehydration during C2.
doi:10.1371/journal.pone.0096145
PMCID: PMC3999104  PMID: 24763386
2.  Long Distance Runners Present Upregulated Sweating Responses than Sedentary Counterparts 
PLoS ONE  2014;9(4):e93976.
Relatively few studies have investigated peripheral sweating mechanisms of long-distance runners. The aim of this study was to compare peripheral sweating mechanisms in male long-distance runners, and sedentary counterparts. Thirty six subjects, including 20 sedentary controls and 16 long-distance runners (with 7–12 years of athletic training, average 9.2±2.1 years) were observed. Quantitative sudomotor axon reflex testing (QSART) with iontophoresis (2 mA for 5 min) and 10% acetylcholine (ACh) were performed to determine axon reflex-mediated and directly activated (DIR, muscarinic receptor) sweating. Sweat onset time, sweat rate, number of activated sweat glands, sweat output per gland and skin temperature were measured at rest while maximum oxygen uptake (VO2max) were measured during maximal cycling. Sweat rate, activated sweat glands, sweat output per gland, skin temperature and VO2max were significantly higher in the trained runners than in the sedentary controls. Sweat onset time was significantly shorter for the runners. In the group of long-distance runners, significant correlations were found between VO2max and sweat onset time (r2 = 0.543, P<0.01, n = 16), DIR sweat rate (r2 = 0.584, P<0.001, n = 16), sweat output per gland (r2 = 0.539, P<0.01, n = 16). There was no correlation between VO2max and activated sweat glands. These findings suggest that habitual long-distance running results in upregulation of the peripheral sweating mechanisms in humans. Additional research is needed to determine the molecular mechanism underlying these changes. These findings complement the existing sweating data in long-distance runners.
doi:10.1371/journal.pone.0093976
PMCID: PMC3977973  PMID: 24709823
3.  Workload Influence on Fatigue Related Psychological and Physiological Performance Changes of Aviators 
PLoS ONE  2014;9(2):e87121.
Objective
We evaluated a variety of non-invasive physiological technologies and a series of test approaches for examination of aviator performances under conditions of mental workload in order to provide a standard real-time test for physiological and psychological pilot fatigue assessments.
Methods
Twenty-one male aviators were selected for a simulated flight in a hypobaric cabin with artificial altitude conditions of 2400 meter above sea level. The simulated flight lasted for 1.5 h, and was repeated for two times with an intervening 0.5 h rest period outside the hypobaric cabin. Subjective criteria (a fatigue assessment instrument [FAI]) and objective criteria (a standing-position balance test as well as a critical flicker fusion frequency (CFF) test) were used for fatigue evaluations.
Results
No significant change was observed in the FAI scores before and after the simulated flight, indicating that there was no subjective fatigue feeling among the participants. However, significant differences were observed in the standing-position balance and CFF tests among the subjects, suggesting that psychophysiological indexes can reflect mental changes caused by workload to a certain extent. The CFF test was the simplest and clearly indicated the occurrence of workload influences on pilot performances after a simulated flight.
Conclusions
Results showed that the CFF test was the easiest way to detect workload caused mental changes after a simulated flight in a hypobaric cabin and reflected the psychophysiological state of aviators. We suggest that this test might be used as an effective routine method for evaluating the workload influences on mental conditions of aviators.
doi:10.1371/journal.pone.0087121
PMCID: PMC3914807  PMID: 24505277
4.  Accelerometer-Determined Physical Activity and Its Comparison with the International Physical Activity Questionnaire in a Sample of Nigerian Adults 
PLoS ONE  2014;9(1):e87233.
Introduction
Accurate assessment of physical activity to identify current levels and changes within the population is dependent on the precision of the measurement tools. The aim of this study was to compare components of physical activity measured with an adapted version of the International Physical Activity Questionnaire (Hausa IPAQ-SF) and the accelerometer in a sample of Nigeria adults.
Methods
One hundred and forty-four participants (Mean age = 32.6±9.9 years, 40.3% women) in a cross-sectional study wore an accelerometer for seven consecutive days and completed the Hausa IPAQ-SF questionnaire on the eighth day. Total physical activity, time spent in moderate-to-vigorous activity (MVPA) and sedentary time assessed by Hausa IPAQ-SF and accelerometer were compared. The absolute and criterion- related validity of the Hausa IPAQ-SF was assessed by Bland-Altman analysis and Spearman Correlation Coefficients, respectively. Specificity and sensitivity were calculated to classify individuals according to the global standard guideline for sufficient physical activity.
Results
Compared with the accelerometer, higher time in MVPA and total physical activity were reported on the Hausa IPAQ-SF (p<0.001), while low to moderate correlations (Rs = 0.03–0.38) were found between the two methods. The 95% limits of agreement were wide between methods for total physical activity (−23019 to 20375 METmin.d−1) and sedentary time (−510 to 150 min.d−1). The sensitivity (76.2%) of Hausa IPAQ-SF to identify insufficiently active people was good, but its specificity (33.3%) to correctly classify sufficiently active people was low.
Conclusions
The Hausa IPAQ-SF overestimated components of physical activity among Nigerian adults, and demonstrated poor to moderate evidence of absolute and criterion validity. Further evaluation of IPAQ and other self-report physical activity instruments in other Africa populations could enhance accurate evaluation of physical activity data in the region countries.
doi:10.1371/journal.pone.0087233
PMCID: PMC3905026  PMID: 24489876
5.  Does an Eye-Hand Coordination Test Have Added Value as Part of Talent Identification in Table Tennis? A Validity and Reproducibility Study 
PLoS ONE  2014;9(1):e85657.
This study investigated the added value, i.e. discriminative and concurrent validity and reproducibility, of an eye-hand coordination test relevant to table tennis as part of talent identification. Forty-three table tennis players (7–12 years) from national (n = 13), regional (n = 11) and local training centres (n = 19) participated. During the eye-hand coordination test, children needed to throw a ball against a vertical positioned table tennis table with one hand and to catch the ball correctly with the other hand as frequently as possible in 30 seconds. Four different test versions were assessed varying the distance to the table (1 or 2 meter) and using a tennis or table tennis ball. ‘Within session’ reproducibility was estimated for the two attempts of the initial tests and ten youngsters were retested after 4 weeks to estimate ‘between sessions’ reproducibility. Validity analyses using age as covariate showed that players from the national and regional centres scored significantly higher than players from the local centre in all test versions (p<0.05). The tests at 1 meter demonstrated better discriminative ability than those at 2 meter. While all tests but one had a positive significant association with competition outcome, which were corrected for age influences, the version with a table tennis ball at 1 meter showed the highest association (r = 0.54; p = 0.001). Differences between the first and second attempts were comparable for all test versions (between −8 and +7 repetitions) with ICC's ranging from 0.72 to 0.87. The smallest differences were found for the test with a table tennis ball at 1 meter (between −3 and +3 repetitions). Best test version as part of talent identification appears to be the version with a table tennis ball at 1 meter regarding the psychometric characteristics evaluated. Longitudinal studies are necessary to evaluate the predictive value of this test.
doi:10.1371/journal.pone.0085657
PMCID: PMC3895002  PMID: 24465638
6.  Exercise Training Attenuates Hypertension and Cardiac Hypertrophy by Modulating Neurotransmitters and Cytokines in Hypothalamic Paraventricular Nucleus 
PLoS ONE  2014;9(1):e85481.
Aims
Regular exercise as an effective non-pharmacological antihypertensive therapy is beneficial for prevention and control of hypertension, but the central mechanisms are unclear. In this study, we hypothesized that chronic exercise training (ExT) delays the progression of hypertension and attenuates cardiac hypertrophy by up-regulating anti-inflammatory cytokines, reducing pro-inflammatory cytokines (PICs) and restoring the neurotransmitters balance in the hypothalamic paraventricular nucleus (PVN) in young spontaneously hypertensive rats (SHR). In addition, we also investigated the involvement of nuclear factor-κB (NF-κB) p65 and NAD(P)H oxidase in exercise-induced effects.
Methods and results
Moderate-intensity ExT was administrated to young normotensive Wistar-Kyoto (WKY) and SHR rats for 16 weeks. SHR rats had a significant increase in mean arterial pressure and cardiac hypertrophy. SHR rats also had higher levels of glutamate, norepinephrine (NE), phosphorylated IKKβ, NF-κB p65 activity, NAD(P)H oxidase subunit gp91phox, PICs and the monocyte chemokine protein-1 (MCP-1), and lower levels of gamma-aminobutyric acid (GABA) and interleukin-10 (IL-10) in the PVN. These SHR rats also exhibited higher renal sympathetic nerve activity (RSNA), and higher plasma levels of PICs, and lower plasma IL-10. However, ExT ameliorates all these changes in SHR rats.
Conclusion
These findings suggest that there are the imbalances between excitatory and inhibitory neurotransmitters and between pro- and anti-inflammatory cytokines in the PVN of SHR rats, which at least partly contributing to sympathoexcitation, hypertension and cardiac hypertrophy; chronic exercise training attenuates hypertension and cardiac hypertrophy by restoring the balances between excitatory and inhibitory neurotransmitters and between pro- and anti-inflammatory cytokines in the PVN; NF-κB and oxidative stress in the PVN may be involved in these exercise-induced effects.
doi:10.1371/journal.pone.0085481
PMCID: PMC3901693  PMID: 24482680
7.  Health and Exercise-Related Medical Issues among 1,212 Ultramarathon Runners: Baseline Findings from the Ultrarunners Longitudinal TRAcking (ULTRA) Study 
PLoS ONE  2014;9(1):e83867.
Regular exercise is associated with substantial health benefits; however, little is known about the health impact of extreme levels of exercise. This study examined the prevalence of chronic diseases, health-care utilization, and risk factors for exercise-related injuries among ultramarathon runners. Retrospective, self-reported enrollment data from an ongoing longitudinal observational study of 1,212 active ultramarathon runners were analyzed. The most prevalent chronic medical conditions were allergies/hay fever (25.1%) and exercise-induced asthma (13.0%), but there was a low prevalence of serious medical issues including cancers (4.5%), coronary artery disease (0.7%), seizure disorders (0.7%), diabetes (0.7%), and human immunodeficiency virus (HIV) infection (0.2%). In the year preceding enrollment, most (64.6%) reported an exercise-related injury that resulted in lost training days (median of 14 days), but little nonattendance of work or school due to illness, injury, or exercise-related medical conditions (medians of 0 days for each). The knee was the most common area of exercise-related injury. Prior year incidence of stress fractures was 5.5% with most (44.5%) involving the foot. Ultramarathon runners who sustained exercise-related injuries were younger (p<0.001) and less experienced (p<0.01) than those without injury. Stress fractures were more common (p<0.01) among women than men. We conclude that, compared with the general population, ultramarathon runners appear healthier and report fewer missed work or school days due to illness or injury. Ultramarathon runners have a higher prevalence of asthma and allergies than the general population, and the prevalence of serious medical issues was nontrivial and should be recognized by those providing medical care to these individuals. Ultramarathon runners, compared with shorter distance runners, have a similar annual incidence of exercise-related injuries but higher proportion of stress fractures involving the foot, and it is the younger and less experienced ultramarathoners who appear most at risk for injury.
doi:10.1371/journal.pone.0083867
PMCID: PMC3885517  PMID: 24416176
8.  Influence of Prior Exercise on VO2 Kinetics Subsequent Exhaustive Rowing Performance 
PLoS ONE  2014;9(1):e84208.
Prior exercise has the potential to enhance subsequent performance by accelerating the oxygen uptake (VO2) kinetics. The present study investigated the effects of two different intensities of prior exercise on pulmonary VO2 kinetics and exercise time during subsequent exhaustive rowing exercise. It was hypothesized that in prior heavy, but not prior moderate exercise condition, overall VO2 kinetics would be faster and the VO2 primary amplitude would be higher, leading to longer exercise time at VO2max. Six subjects (mean ± SD; age: 22.9±4.5 yr; height: 181.2±7.1 cm and body mass: 75.5±3.4 kg) completed square-wave transitions to 100% of VO2max from three different conditions: without prior exercise, with prior moderate and heavy exercise. VO2 was measured using a telemetric portable gas analyser (K4b2, Cosmed, Rome, Italy) and the data were modelled using either mono or double exponential fittings. The use of prior moderate exercise resulted in a faster VO2 pulmonary kinetics response (τ1 = 13.41±3.96 s), an improved performance in the time to exhaustion (238.8±50.2 s) and similar blood lactate concentrations ([La−]) values (11.8±1.7 mmol.L−1) compared to the condition without prior exercise (16.0±5.56 s, 215.3±60.1 s and 10.7±1.2 mmol.L−1, for τ1, time sustained at VO2max and [La−], respectively). Performance of prior heavy exercise, although useful in accelerating the VO2 pulmonary kinetics response during a subsequent time to exhaustion exercise (τ1 = 9.18±1.60 s), resulted in a shorter time sustained at VO2max (155.5±46.0 s), while [La−] was similar (13.5±1.7 mmol.L−1) compared to the other two conditions. Although both prior moderate and heavy exercise resulted in a faster pulmonary VO2 kinetics response, only prior moderate exercise lead to improved rowing performance.
doi:10.1371/journal.pone.0084208
PMCID: PMC3880282  PMID: 24404156
9.  Arthroscopically Assisted Combined Anterior and Posterior Cruciate Ligament Reconstruction with Autologous Hamstring Grafts–Isokinetic Assessment with Control Group 
PLoS ONE  2013;8(12):e82462.
Objective
The aim of the study was to: 1) evaluate the differences in pre-post operative knee functioning, mechanical stability, isokinetic knee muscle strength in simultaneous arthroscopic patients after having undergone an anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) with hamstring tendons reconstruction, 2) compare the results of ACL/PCL patients with the control group.
Design
Controlled Laboratory Study.
Materials and Methods
Results of 11 ACL/PCL patients had been matched with 22 uninjured control participants (CP). Prior to surgery, and minimum 2 years after it, functional assessment (Lysholm and IKDC 2000), mechanical knee joint stability evaluation (Lachman and “drawer” test) and isokinetic tests (bilateral knee muscle examination) had been performed. Different rehabilitation exercises had been used: isometric, passive exercises, exercises increasing the range of motion and proprioception, strength exercises and specific functional exercises.
Results
After arthroscopy no significant differences had been found between the injured and uninjured leg in all isokinetic parameters in ACL/PCL patients. However, ACL/PCL patients had still shown significantly lower values of strength in relative isokinetic knee flexors (p = 0.0065) and extensors (p = 0.0171) compared to the CP. There were no differences between groups regarding absolute isokinetic strength and flexors/extensors ratio. There was statistically significant progress in IKDC 2000 (p = 0.0044) and Lysholm (p = 0.0044) scales prior to (44 and 60 points respectively) and after the reconstruction (61 for IKDC 2000 and 94 points for Lysholm).
Conclusions
Although harvesting tendons of semitendinosus and/or gracilis from the healthy extremity diminishes muscle strength of knee flexors in comparison to the CP, flexor strength had improved. Statistically significant improvement of the knee extensor function may indicate that the recreation of joint mechanical stability is required for restoring normal muscle strength. Without restoring normal muscle function and strength, surgical intervention alone may not be sufficient enough to ensure expected improvement of the articular function.
doi:10.1371/journal.pone.0082462
PMCID: PMC3875417  PMID: 24386099
10.  Neuromuscular Electrical Stimulation of the Quadriceps in Patients with Non-Small Cell Lung Cancer Receiving Palliative Chemotherapy: A Randomized Phase II Study 
PLoS ONE  2013;8(12):e86059.
Background
A reduced exercise capacity is associated with increased morbidity and mortality in patients with advanced non-small cell lung cancer (NSCLC). Therapeutic exercise can be beneficial and neuromuscular electrical stimulation (NMES) of the quadriceps muscles may represent a practical approach. The primary aim of this study was to determine the acceptability of NMES of the quadriceps to patients with NSCLC used alongside palliative chemotherapy. Secondary aims explored aspects of safety and efficacy of NMES in this setting.
Methods
Patients with advanced NSCLC due to receive first-line palliative chemotherapy were randomized to usual care with or without NMES. They were asked to undertake 30 minute sessions of NMES, ideally daily, but as a minimum, three times weekly. For NMES to be considered acceptable, it was predetermined that ≥80% of patients should achieve this minimum level of adherence. Qualitative interviews were held with a subset of patients to explore factors influencing adherence. Safety was assessed according to the Common Terminology Criteria for Adverse Events. Quadriceps muscle strength, thigh lean mass, and physical activity level were assessed at baseline and after three cycles of chemotherapy.
Results
49 patients (28 male, median (IQR) age 69 (64−75) years) participated. Of 30 randomized to NMES, 18 were eligible for the primary endpoint, of whom 9 (50% [90% CI, 29 to 71]) met the minimum level of adherence. Adherence was enhanced by incorporating sessions into a daily routine and hindered by undesirable effects of chemotherapy. There were no serious adverse events related to NMES, nor significant differences in quadriceps muscle strength, thigh lean mass or physical activity level between groups.
Conclusions
NMES is not acceptable in this setting, nor was there a suggestion of benefit. The need remains to explore NMES in patients with cancer in other settings.
Trial Registration
Current Controlled Trials ISRCTN 42944026 www.controlled-trials.com/ISRCTN42944026
doi:10.1371/journal.pone.0086059
PMCID: PMC3875585  PMID: 24386491
11.  A Predictive Model for Knee Joint Replacement in Older Women 
PLoS ONE  2013;8(12):e83665.
Knee replacement (KR) is expensive and invasive. To date no predictive algorithms have been developed to identify individuals at high risk of surgery. This study assessed whether patient self-reported risk factors predict 10-year KR in a population-based study of 1,462 women aged over 70 years recruited for the Calcium Intake Fracture Outcome Study (CAIFOS). Complete hospital records of prevalent (1980-1998) and incident (1998-2008) total knee replacement were available via the Western Australian Data Linkage System. Potential risk factors were assessed for predicative ability using a modeling approach based on a pre-planned selection of risk factors prior to model evaluation. There were 129 (8.8%) participants that underwent KR over the 10 year period. Baseline factors including; body mass index, knee pain, previous knee replacement and analgesia use for joint pain were all associated with increased risk, (P < 0.001). These factors in addition to age demonstrated good discrimination with a C-statistic of 0.79 ± 0.02 as well as calibration determined by the Hosmer-Lemeshow Goodness-of-Fit test. For clinical recommendations, three categories of risk for 10-year knee replacement were selected; low < 5%; moderate 5 to < 10% and high ≥ 10% predicted risk. The actual risk of knee replacement was; low 16 / 741 (2.2%); moderate 32 / 330 (9.7%) and high 81 / 391 (20.7%), P < 0.001. Internal validation of this 5-variable model on 6-year knee replacements yielded a similar C-statistic of 0.81 ± 0.02, comparable to the WOMAC weighted score; C-statistic 0.75 ± 0.03, P = 0.064. In conclusion 5 easily obtained patient self-reported risk factors predict 10-year KR risk well in this population. This algorithm should be considered as the basis for a patient-based risk calculator to assist in the development of treatment regimens to reduce the necessity for surgery in high risk groups such as the elderly.
doi:10.1371/journal.pone.0083665
PMCID: PMC3859639  PMID: 24349541
12.  Exercise Training in Transgenic Mice Is Associated with Attenuation of Early Breast Cancer Growth in a Dose-Dependent Manner 
PLoS ONE  2013;8(11):e80123.
Epidemiological research suggests that regular physical activity confers beneficial effects that mediate an anti-tumor response and may reduce cancer recurrence. It is unclear what amount of physical activity is necessary to exert such a protective effect and what mechanisms are involved. We investigated the effects of voluntary wheel running on tumor progression and cytokine gene expression in the transgenic polyoma middle T oncoprotein (PyMT) mouse model of invasive breast cancer. Runners showed significantly reduced tumor sizes compared with non-runners after 3 weeks of running (p≤0.01), and the greater the running distance the smaller the tumor size (Pearson's r = −0.61, p≤0.04, R2 = 0.38). Mice running greater than 150 km per week had a significantly attenuated tumor size compared with non-runners (p≤0.05). Adipose tissue mass was inversely correlated with tumor size in runners (Pearson's r = −0.77, p = 0.014) but not non-runners. Gene expression of CCL22, a cytokine associated with recruitment of immunosuppressive T regulatory cells, was decreased in tumors of runners compared to non-runners (p≤0.005). No differences in tumor burden or metastatic burden were observed between runners and non-runners after ten weeks of running when the study was completed. We conclude that voluntary wheel running in PyMT mice correlates with an attenuation in tumor progression early during the course of invasive breast cancer. This effect is absent in the later stages of overwhelming tumor burden even though cytokine signaling for immunosuppressive regulatory T cells was down regulated. These observations suggest that the initiation of moderate exercise training for adjunctive therapeutic benefit early in the course of invasive breast cancer should be considered for further investigation.
doi:10.1371/journal.pone.0080123
PMCID: PMC3842299  PMID: 24312199
13.  Classification of Forefoot Plantar Pressure Distribution in Persons with Diabetes: A Novel Perspective for the Mechanical Management of Diabetic Foot? 
PLoS ONE  2013;8(11):e79924.
Background
The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics.
Methodology/Principal Findings
Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters.
Conclusion/s Significance
There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot.
doi:10.1371/journal.pone.0079924
PMCID: PMC3838415  PMID: 24278219
14.  Oxygen and Ventilatory Output during Several Activities of Daily Living Performed by COPD Patients Stratified According to Disease Severity 
PLoS ONE  2013;8(11):e79727.
Objectives
To measure the oxygen and ventilatory output across all COPD stages performing 18 common ADL and identify the activities that present the highest metabolic and ventilatory output as well as to compare the energy expenditure within each disease severity.
Materials and Methods
Metabolic (VO2 and VCO2), ventilatory (f and VE), cardiovascular (HR) and dyspnea (Borg score) variables were assessed in one hundred COPD patients during the completion of eighteen ADL grouped into four activities domains: rest, personal care, labor activities and efforts.
Results
The activities with the highest proportional metabolic and ventilatory output (VO2/VO2max and VE/MVV) were walking with 2.5 Kg in each hand and walking with 5.0 Kg in one hand. Very severe patients presented the highest metabolic, ventilatory output and dyspnea than mild patients (p<0.05).
Conclusions
COPD patients present an increased proportion of energy expenditure while performing activities of daily living. The activities that developed the highest metabolic and ventilatory output are the ones associated to upper and lower limbs movements combined. Very severe patients present the highest proportional estimated metabolic and ventilatory output and dyspnea. Activities of daily living are mainly limited by COPD’s reduced ventilatory reserve.
doi:10.1371/journal.pone.0079727
PMCID: PMC3835796  PMID: 24278164
15.  Environment and Scheduling Effects on Sprint and Middle Distance Running Performances 
PLoS ONE  2013;8(11):e79548.
Purpose
Achievement of athletes’ performances is related to several factors including physiological, environmental and institutional cycles where physical characteristics are involved. The objective of this study is to analyse the performance achieved in professional sprint and middle-distance running events (100 m to 1500 m) depending on the organization of the annual calendar of track events and their environmental conditions.
Methods
From 2002 to 2008, all performances of the Top 50 international athletes in the 100 m to 1500 m races (men and women) are collected. The historical series of world records and the 10 best annual performances in these events, amounted to a total of 26,544 performances, are also included in the study.
Results
Two periods with a higher frequency of peak performances are observed. The first peak occurs around the 27.15th ±0.21 week (first week of July) and the second peak around 34.75th ±0.14 week (fourth week of August). The second peak tends to be the time of major international competitions (Olympic Games, World Championships, and European Championships) and could be characterized as an institutional moment. The first one, however, corresponds to an environmental optimum as measured by the narrowing of the temperature range at the highest performance around 23.25±3.26°C.
Conclusions
This is the first study to demonstrate that there are two performance peaks at a specific time of year (27th and 34th weeks) in sprint and middle distance. Both institutional and ecophysiological aspects contribute to performance in the 100 m to 1500 m best performances and define the contours of human possibilities. Sport institutions may take this into account in order to provide ideal conditions to improve the next records.
doi:10.1371/journal.pone.0079548
PMCID: PMC3868388  PMID: 24363791
16.  Influence of Age on Patellar Tendon Reflex Response 
PLoS ONE  2013;8(11):e80799.
Background
A clinical parameter commonly used to assess the neurological status of an individual is the tendon reflex response. However, the clinical method of evaluation often leads to subjective conclusions that may differ between examiners. Moreover, attempts to quantify the reflex response, especially in older age groups, have produced inconsistent results. This study aims to examine the influence of age on the magnitude of the patellar tendon reflex response.
Methodology/Principal Findings
This study was conducted using the motion analysis technique with the reflex responses measured in terms of knee angles. Forty healthy subjects were selected and categorized into three different age groups. Patellar reflexes were elicited from both the left and right patellar tendons of each subject at three different tapping angles and using the Jendrassik maneuver. The findings suggested that age has a significant effect on the magnitude of the reflex response. An angle of 45° may be the ideal tapping angle at which the reflex can be elicited to detect age-related differences in reflex response. The reflex responses were also not influenced by gender and were observed to be fairly symmetrical.
Conclusions/Significance
Neurologically normal individuals will experience an age-dependent decline in patellar reflex response.
doi:10.1371/journal.pone.0080799
PMCID: PMC3832481  PMID: 24260483
17.  Association between Dietary Fiber Intake and Physical Performance in Older Adults: A Nationwide Study in Taiwan 
PLoS ONE  2013;8(11):e80209.
Background
Physical performance is a major determinant of health in older adults, and is related to lifestyle factors. Dietary fiber has multiple health benefits. It remains unclear whether fiber intake is independently linked to superior physical performance. We aimed to assess the association between dietary fiber and physical performance in older adults.
Methods
This was a cross-sectional study conducted with community-dwelling adults aged 55 years and older (n=2680) from the ongoing Healthy Aging Longitudinal Study (HALST) in Taiwan 2008-2010. Daily dietary fiber intake was assessed using a validated food frequency questionnaire. Physical performance was determined objectively by measuring gait speed, 6-minute walk distance, timed “up and go” (TUG), summary performance score, hand grip strength.
Results
Adjusting for all potential confounders, participants with higher fiber intake had significantly faster gait speed, longer 6-minute walk distance, faster TUG, higher summary performance score, and higher hand grip strength (all P <.05). Comparing with the highest quartile of fiber intake, the lowest quartile of fiber intake was significantly associated with the lowest sex-specific quartile of gait speed (adjusted OR, 2.18 in men [95% CI, 1.33-3.55] and 3.65 in women [95% CI, 2.20-6.05]), 6-minute walk distance (OR, 2.40 in men [95% CI, 1.38-4.17] and 4.32 in women [95% CI, 2.37-7.89]), TUG (OR, 2.42 in men [95% CI, 1.43-4.12] and 3.27 in women [95% CI, 1.94-5.52]), summary performance score (OR, 2.12 in men [95% CI, 1.19-3.78] and 5.47 in women [95% CI, 3.20-9.35]), and hand grip strength (OR, 2.64 in men [95% CI, 1.61-4.32] and 4.43 in women [95% CI, 2.62-7.50]).
Conclusions
Dietary fiber intake was independently associated with better physical performance.
doi:10.1371/journal.pone.0080209
PMCID: PMC3823869  PMID: 24244650
18.  Mechanical-Stretch of C2C12 Myoblasts Inhibits Expression of Toll-Like Receptor 3 (TLR3) and of Autoantigens Associated with Inflammatory Myopathies 
PLoS ONE  2013;8(11):e79930.
Recent studies in patients suffering from inflammatory autoimmune myopathies suggested that moderate exercise training improves or at least stabilizes muscle strength and function without inducing disease flares. However, the precise mechanisms involved in this beneficial effect have not been extensively studied. Here we used a model of in vitro stretched C2C12 myoblasts to investigate whether mechanical stretch could influence myoblast proliferation or the expression of proinflammatory genes. Our results demonstrated that cyclic mechanical stretch stimulated C2C12 cell cycling and early up-regulation of the molecules related to mechanical-stretch pathway in muscle (calmodulin, nNOS, MMP-2, HGF and c-Met). Unexpectedly, mechanical stretch also reduced the expression of TLR3 and of proteins known to represent autoantigens in inflammatory autoimmune myopathies (Mi-2, HRS, DNA-PKcs, U1-70). Interestingly, stimulation or inhibition of calmodulin, NOS, HGF or c-Met molecules in vitro affected the expression of autoantigens and TLR3 proteins confirming their role in the inhibition of autoantigens and TLR3 during mechanical stretch. Overall, this study demonstrates for the first time that mechanical stretch could be beneficial by reducing expression of muscle autoantigens and of pro-inflammatory TLR3 and may provide new insight to understand how resistance training can reduce the symptoms associated with myositis.
doi:10.1371/journal.pone.0079930
PMCID: PMC3817111  PMID: 24224022
19.  Fatigue Index and Fatigue Rate during an Anaerobic Performance under Hypohydrations 
PLoS ONE  2013;8(10):e77290.
Background
Since hypohydration commonly occurs in sports, studies on anaerobic exercise performance under this condition have been extensively carried out. When describing anaerobic performance, authors usually refer to a drop in anaerobic performance as fatigue index (FI) which is conventionally calculated using peak and low power data points. Meanwhile, another possible method in explaining anaerobic fatigue is using the rate constant which is derived from the exponential decline of power output known as fatigue rate (FR). Few studies have demonstrated that there was no change in anaerobic performance under mild hypohydrations.
Purpose
This study aimed to compare the kinetics of power output using FI and FR of an anaerobic performance (Wingate test) under 2, 3 and 4% state of hypohydrations.
Method
Thirty two collegiate cyclists (age  = 22±2 years; body weight  = 71.45±3.43 kg; height  = 173.23±0.04 cm) were matched using their baseline anaerobic peak power (APP) then randomly divided into 4 groups of EU (euhydrated), 2H, 3H and 4H respectively.
Results
As expected the, FI, APP, anaerobic lower power (ALP) and rating of perceived exertion (RPE) did not show significant differences between and within the groups. However, the FR in 3H (0.018±0.005s−1) and 4H (0.019±0.010s−1) were significantly lower than EU (0.033±0.012s−1). Post-test FR also showed significant reduction in 3H and 4H compared to their pre-test values (p<0.05).
Conclusion
Despite the lack of changes in APP and RPE, subjects in 3H and 4H showed evidence of lower reduction of power output over time. The findings support earlier reports which showed no change in anaerobic performance under mild hypohydrations. The relatively lower FR suggests higher drive in maintaining power output under hypohydrations of 3 and 4% body weight.
doi:10.1371/journal.pone.0077290
PMCID: PMC3813710  PMID: 24204790
20.  Physical Education and Blood Lipid Concentrations in Children: The LOOK Randomized Cluster Trial 
PLoS ONE  2013;8(10):e76124.
Background and Objectives
Elevated blood lipids during childhood are predictive of dyslipidemia in adults. Although obese and inactive children have elevated values, any potentially protective role of elementary school physical education is unknown. Our objective was to determine the effect of a modern elementary school physical education (PE) program on the blood lipid concentrations in community-based children.
Methods
In this cluster-randomized controlled trial, 708 healthy children (8.1±0.3 years, 367 boys) in 29 schools were allocated to either a 4-year intervention program of specialist-taught PE (13 schools) or to a control group of the currently practiced PE conducted by generalist classroom teachers. Fasting blood lipids were measured at ages 8, 10, and 12 years and intervention and control class activities were recorded.
Results
Intervention classes included more fitness work and more moderate and vigorous physical activity than control classes (both p<0.001). With no group differences at baseline, the percentage of 12 year-old boys and girls with elevated low density lipoprotein cholesterol (LDL-C, >3.36mmol.L−1,130 mg/dL) was lower in the intervention than control group (14% vs. 23%, p = 0.02). There was also an intervention effect on mean LDL-C across all boys (reduction of 9.6% for intervention v 2.8% control, p = 0.02), but not girls (p = 0.2). The intervention effect on total cholesterol mirrored LDL-C, but there were no detectable 4-year intervention effects on high-density lipoprotein cholesterol or triglycerides.
Conclusions
The PE program delivered by specialist teachers over four years in elementary school reduced the incidence of elevated LDL-C in boys and girls, and provides a means by which early preventative practices can be offered to all children.
Trial Registration
Australia New Zealand Clinical Trial Registry ANZRN12612000027819 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347799.
doi:10.1371/journal.pone.0076124
PMCID: PMC3808412  PMID: 24204594
21.  Is Baseline Cardiac Autonomic Modulation Related to Performance and Physiological Responses Following a Supramaximal Judo Test? 
PLoS ONE  2013;8(10):e78584.
Little research exists concerning Heart Rate (HR) Variability (HRV) following supramaximal efforts focused on upper-body explosive strength-endurance. Since they may be very demanding, it seems of interest to analyse the relationship among performance, lactate and HR dynamics (i.e. HR, HRV and complexity) following them; as well as to know how baseline cardiac autonomic modulation mediates these relationships. The present study aimed to analyse associations between baseline and post-exercise HR dynamics following a supramaximal Judo test, and their relationship with lactate, in a sample of 22 highly-trained male judoists (20.70±4.56 years). A large association between the increase in HR from resting to exercise condition and performance suggests that individuals exerted a greater sympathetic response to achieve a better performance (Rating of Perceived Exertion: 20; post-exercise peak lactate: 11.57±2.24 mmol/L; 95.76±4.13 % of age-predicted HRmax). Athletes with higher vagal modulation and lower sympathetic modulation at rest achieved both a significant larger ∆HR and a faster post-exercise lactate removal. A enhanced resting parasympathetic modulation might be therefore related to a further usage of autonomic resources and a better immediate metabolic recovery during supramaximal exertions. Furthermore, analyses of variance displayed a persistent increase in α1 and a decrease in lnRMSSD along the 15 min of recovery, which are indicative of a diminished vagal modulation together with a sympathovagal balance leaning to sympathetic domination. Eventually, time-domain indices (lnRMSSD) showed no lactate correlations, while nonlinear indices (α1 and lnSaEn) appeared to be moderate to strongly correlated with it, thus pointing to shared mechanisms between neuroautonomic and metabolic regulation.
doi:10.1371/journal.pone.0078584
PMCID: PMC3799641  PMID: 24205273
22.  Toothpicking and Periodontal Disease in a Neanderthal Specimen from Cova Foradà Site (Valencia, Spain) 
PLoS ONE  2013;8(10):e76852.
We present a Neanderthal maxilla (CF-1) from Cova Foradà site (Oliva, Valencia, Spain) with periodontal disease and evidence of attempts to alleviate pain with the use of a toothpick. Two interproximal grooves have been found on the distal surfaces of the upper left Pm3 and M1 of CF-1 maxilla. The location, morphology and size of the grooves coincide with other interproximal grooves found on the teeth of other fossil specimens. Heavy dental wear and periodontal disease would have caused the Cova Foradà Neanderthal specimen pain and discomfort, which the individual attempted to mitigate using some kind of dental probe.
doi:10.1371/journal.pone.0076852
PMCID: PMC3797767  PMID: 24146934
23.  The Prevalence of and Factors Associated with the Use of Smoking Cessation Medication in Korea: Trend between 2005–2011 
PLoS ONE  2013;8(10):e74904.
Background
In Korea, nicotine replacement therapy (NRT) has been widely used in government-led, public health center-based smoking cessation services since 2004 and varenicline has become available from 2007 but without reimbursement. In this study which used a series of nationwide cross-sectional surveys in Korea performed from 2005 to 2011, we examined the prevalence of smoking cessation medication use and factors associated with it.
Methods
We analyzed data from the third to fifth waves of Korean National Health and Nutrition Examination Survey (2005–2011). Prevalence of each smoking cessation method use was calculated for each year, and its secular trend was tested by multivariate logistic regression.
Results
Among smokers who made quit attempt during the previous year, 15.7% had used smoking cessation medications,15.3% had used NRT, and 0.7% had used prescription medication. There was a significant increasing trend for NRT use (P<0.001) during the study period, but use of prescription medication did not show any increase over time (P = 0.654) Education on smoking prevention and cessation was associated with smoking cessation medications use (OR 2.08, 95% CI 1.58–2.75).
Conclusions
While the use of NRT has increased over years through government-sponsored smoking cessation programs, use of prescription drugs remained very low and flat probably due to lack of reimbursement. Education of smokers about effective smoking cessation methods and change in reimbursement policy are suggested to stimulate evidence-based smoking cessation practice.
doi:10.1371/journal.pone.0074904
PMCID: PMC3794019  PMID: 24130674
24.  Are centenarians genetically predisposed to lower disease risk? 
Age  2011;34(5):1269-1283.
Our study purpose was to compare a disease-related polygenic profile that combined a total of 62 genetic variants among (i) people reaching exceptional longevity, i.e., centenarians (n = 54, 100–108 years, 48 women) and (ii) ethnically matched healthy controls (n = 87, 19–43 years, 47 women). We computed a ‘global’ genotype score (GS) for 62 genetic variants (mutations/polymorphisms) related to cardiometabolic diseases, cancer or exceptional longevity, and also specific GS for main disease categories (cardiometabolic risk and cancer risk, including 36 and 24 genetic variations, respectively) and for exceptional longevity (7 genetic variants). The ‘global’ GS was similar among groups (centenarians: 31.0 ± 0.6; controls 32.0 ± 0.5, P = 0.263). We observed that the GS for hypertension, cancer (global risk), and other types of cancer was lower in the centenarians group compared with the control group (all P < 0.05), yet the difference became non significant after adjusting for sex. We observed significant between-group differences in the frequency of GSTT1 and GSTM1 (presence/absence) genotypes after adjusting for multiple comparisons. The likelihood of having the GSTT1 low-risk (functional) allele was higher in centenarians (odds ratio [OR] 5.005; 95% confidence interval [CI], 1.810–13.839), whereas the likelihood of having the GSTMI low-risk (functional) allele was similar in both groups (OR 1.295; 95% CI, 0.868 –1.931). In conclusion, we found preliminary evidence that Spanish centenarians have a lower genetic predisposition for cancer risk. The wild-type (i.e., functional) genotype of GSTT1, which is associated with lower cancer risk, might be associated with exceptional longevity, yet further studies with larger sample sizes must confirm these findings.
doi:10.1007/s11357-011-9296-3
PMCID: PMC3448993  PMID: 21894447
Centenarians; Genetics; Exceptional longevity; Ageing
25.  SOD mRNA and MDA Expression in Rectus Femoris Muscle of Rats with Different Eccentric Exercise Programs and Time Points 
PLoS ONE  2013;8(9):e73634.
Purpose
Although superoxide dismutase (SOD) and malondialdehyde (MDA) affect Delayed Onset Muscle Soreness (DOMS), their effects are unclear in rectus femoris muscles (RFM) of rats with different eccentric exercise programs and time points. The purpose of this study is to investigate the effects of the various eccentric exercise programs at different time points on the SOD mRNA expression and MDA using rat as the animal model.
Methods
248 male rats were randomly divided into 4 groups: control group (CTL, n = 8), once-only exercise group (OEG, n = 80), continuous exercise group (CEG, n = 80), and intermittent exercise group (IEG, n = 80). Each exercise group was divided into 10 subgroups that exercised 0.5 h, 6 h, 12 h, 24 h, 48 h, 72 h, 96 h, 120 h, 144 h, or 168 h. Rats were sacrificed and their SOD mRNA expression, and MDA concentrations of skeletal muscle tissue were measured.
Results
The specimen in all eccentric exercise programs showed increased RFM SOD1 mRNA expression levels at 0.5 h (P<0.05), and decreased RFM SOD3 mRNA expression at 0.5 h (P<0.05). The continuous eccentric exercise (CE) significantly enhanced muscle SOD2 mRNA level at 0.5 h (P<0.05). After once-only eccentric exercise (OE), SOD1, SOD2, and SOD3 mRNA expression significantly increased at 96 h, whereas MDA concentrations decreased at 96 h. After CE, the correlation coefficients of SOD1, SOD2, SOD3 mRNA expression levels and MDA concentrations were −0.814, −0.763, −0.845 (all P<0.05) at 12 h.
Conclusion
Regular eccentric exercise, especially CE could enhance SOD1 and SOD2 mRNA expression in acute stage and the SOD2 mRNA expression correlates to MDA concentration in vivo, which may improve the oxidative adaption ability of skeletal muscles.
doi:10.1371/journal.pone.0073634
PMCID: PMC3772806  PMID: 24058480

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