| 1. |
- Blauenfeldt, Rolf Ankerlund, et al.
(författare)
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Remote Ischemic Conditioning for Acute Stroke : The RESIST Randomized Clinical Trial
- 2023
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Ingår i: JAMA. - 0098-7484. ; 330:13, s. 1236-1246
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Despite some promising preclinical and clinical data, it remains uncertain whether remote ischemic conditioning (RIC) with transient cycles of limb ischemia and reperfusion is an effective treatment for acute stroke. Objective: To evaluate the effect of RIC when initiated in the prehospital setting and continued in the hospital on functional outcome in patients with acute stroke. Design, Setting, and Participants: This was a randomized clinical trial conducted at 4 stroke centers in Denmark that included 1500 patients with prehospital stroke symptoms for less than 4 hours (enrolled March 16, 2018, to November 11, 2022; final follow-up, February 3, 2023). Intervention: The intervention was delivered using an inflatable cuff on 1 upper extremity (RIC cuff pressure, ≤200 mm Hg [n = 749] and sham cuff pressure, 20 mm Hg [n = 751]). Each treatment application consisted of 5 cycles of 5 minutes of cuff inflation followed by 5 minutes of cuff deflation. Treatment was started in the ambulance and repeated at least once in the hospital and then twice daily for 7 days among a subset of participants. Main Outcomes and Measures: The primary end point was improvement in functional outcome measured as a shift across the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) at 90 days in the target population with a final diagnosis of ischemic or hemorrhagic stroke. Results: Among 1500 patients who were randomized (median age, 71 years; 591 women [41%]), 1433 (96%) completed the trial. Of these, 149 patients (10%) were diagnosed with transient ischemic attack and 382 (27%) with a stroke mimic. In the remaining 902 patients with a target diagnosis of stroke (737 [82%] with ischemic stroke and 165 [18%] with intracerebral hemorrhage), 436 underwent RIC and 466 sham treatment. The median mRS score at 90 days was 2 (IQR, 1-3) in the RIC group and 1 (IQR, 1-3) in the sham group. RIC treatment was not significantly associated with improved functional outcome at 90 days (odds ratio [OR], 0.95; 95% CI, 0.75 to 1.20, P =.67; absolute difference in median mRS score, -1; -1.7 to -0.25). In all randomized patients, there were no significant differences in the number of serious adverse events: 169 patients (23.7%) in the RIC group with 1 or more serious adverse events vs 175 patients (24.3%) in the sham group (OR, 0.97; 95% CI, 0.85 to 1.11; P =.68). Upper extremity pain during treatment and/or skin petechia occurred in 54 (7.2%) in the RIC group and 11 (1.5%) in the sham group. Conclusions and Relevance: RIC initiated in the prehospital setting and continued in the hospital did not significantly improve functional outcome at 90 days in patients with acute stroke. Trial Registration: ClinicalTrials.gov Identifier: NCT03481777.
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| 2. |
- Gejl, Kasper Degn, et al.
(författare)
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Effects of Acute Exercise and Training on the Sarcoplasmic Reticulum Ca(2+)Release and Uptake Rates in Highly Trained Endurance Athletes
- 2020
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Ingår i: Frontiers in Physiology. - : Frontiers Media SA. - 1664-042X. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Little is presently known about the effects of acute high-intensity exercise or training on release and uptake of Ca(2+)by the sarcoplasmic reticulum (SR). The aims here were to characterize this regulation in highly trained athletes following (1) repeated bouts of high-intensity exercise and (2) a period of endurance training including high-intensity sessions. Eleven cross-country skiers (25 +/- 4 years, 65 +/- 4 mL O-2.kg(-1).min(-1)) performed four self-paced sprint time-trials (STT 1-4) lasting approximate to 4 min each (STT 1-4) and separated by 45 min of recovery; while 19 triathletes and road cyclists (25 +/- 4 years, 65 +/- 5 mL O-2.kg(-1).min(-1)) completed 4 weeks of endurance training in combination with three sessions of high-intensity interval cycling per week. Release (mu mol.g(-1)prot.min(-1)) and uptake [tau (s)] of Ca(2+)by SR vesicles isolated from m.triceps brachiiand m.vastus lateraliswere determined before and after STT 1 and 4 in the skiers and in m.vastus lateralisbefore and after the 4 weeks of training in the endurance athletes. The Ca(2+)release rate was reduced by 17-18% in both limbs already after STT 1 (arms: 2.52 +/- 0.74 to 2.08 +/- 0.60; legs: 2.41 +/- 0.45 to 1.98 +/- 0.51,P< 0.0001) and attenuated further following STT 4 (arms: 2.24 +/- 0.67 to 1.95 +/- 0.45; legs: 2.13 +/- 0.51 to 1.83 +/- 0.36,P< 0.0001). Also, there was a tendency toward an impairment in the SR Ca(2+)uptake from pre STT1 to post STT4 in both arms and legs (arms: from 22.0 +/- 3.7 s to 25.3 +/- 6.0 s; legs: from 22.5 +/- 4.7 s to 25.5 +/- 7.7 s,P= 0.05). Endurance training combined with high-intensity exercise increased the Ca(2+)release rate by 9% (1.76 +/- 0.38 to 1.91 +/- 0.44,P= 0.009), without altering the Ca(2+)uptake (29.6 +/- 7.0 to 29.1 +/- 8.7 s;P= 0.98). In conclusion, the Ca(2+)release and uptake rates by SR in exercising limbs of highly trained athletes declines gradually by repetitive bouts of high-intensity exercise. We also demonstrate, for the first time, that the SR Ca(2+)release rate can be enhanced by a specific program of training in highly trained athletes, which may have important implications for performance parameters.
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| 3. |
- Gejl, Kasper Degn, et al.
(författare)
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No Superior Adaptations to Carbohydrate Periodization in Elite Endurance Athletes
- 2017
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Ingår i: Medicine & Science in Sports & Exercise. - 0195-9131 .- 1530-0315. ; 49:12, s. 2486-2497
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The present study investigated the effects of periodic carbohydrate (CHO) restriction on endurance performance and metabolic markers in elite endurance athletes. Methods Twenty-six male elite endurance athletes (maximal oxygen consumption (VO2max), 65.0 mL O(2)kg(-1)min(-1)) completed 4 wk of regular endurance training while being matched and randomized into two groups training with (low) or without (high) CHO manipulation 3 dwk(-1). The CHO manipulation days consisted of a 1-h high-intensity bike session in the morning, recovery for 7 h while consuming isocaloric diets containing either high CHO (414 2.4 g) or low CHO (79.5 1.0 g), and a 2-h moderate bike session in the afternoon with or without CHO. VO2max, maximal fat oxidation, and power output during a 30-min time trial (TT) were determined before and after the training period. The TT was undertaken after 90 min of intermittent exercise with CHO provision before the training period and both CHO and placebo after the training period. Muscle biopsies were analyzed for glycogen, citrate synthase (CS) and -hydroxyacyl-coenzyme A dehydrogenase (HAD) activity, carnitine palmitoyltransferase (CPT1b), and phosphorylated acetyl-CoA carboxylase (pACC). Results The training effects were similar in both groups for all parameters. On average, VO2max and power output during the 30-min TT increased by 5% +/- 1% (P < 0.05) and TT performance was similar after CHO and placebo during the preload phase. Training promoted overall increases in glycogen content (18% +/- 5%), CS activity (11% +/- 5%), and pACC (38% +/- 19%; P < 0.05) with no differences between groups. HAD activity and CPT1b protein content remained unchanged. Conclusions Superimposing periodic CHO restriction to 4 wk of regular endurance training had no superior effects on performance and muscle adaptations in elite endurance athletes.
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