Professor Theocharis Ispoglou

1. Terry Ellapen, Lecturer, University of Kwa Zulu Natal, South Africa. The Prevalence of Acute Netball Musculoskeletal Injury among Female Adolescent Kwa Zulu Natal Players. 2. Fang-Ting Tsai, M.Sc. Student, National Yang-Ming University, Taiwan, Wei-Yi Tsu, Physical Therapist, Taichung Veterans General Hospital, Taiwan, Yin-Ju Chen, M.Sc. Student, National Yang-Ming University, Taiwan, Shwn-Jen Lee, Associate Professor, National Yang-Ming University, Taiwan & Hong-Ji Luo, Assistant Professor, National Yang-Ming University, Taiwan. Effect of Foot Orthosis and Physical Therapy on Standing Balance and Mobility in Children with Hypotonia. 3. Kubra Alpay, M.Sc. Student, Bezmialem Vakıf University, Turkey, Safinaz Albayrak Yıldız, Professor, Istanbul University, Turkey & Turker Sahinkaya, M.Sc. Student, Istanbul University, Turkey. Effects of Plyometric Exercises on Trunk and Hip Muscles in Premenopausal Women. 4. Zoran Sarcevic, Sports Medicine Specialist, Serbia. Sacroiliac Joint Dysfunction as a Cause of Scoliosis.

Background: Despite ongoing interest in anabolic therapies for sarcopenia and cachexia, pharmacological interventions are being developed to counteract age- and condition-related losses of muscle mass and strength. This systematic review and meta-analysis evaluated the effect of nandrolone decanoate on lean soft tissue (LST), fat mass, handgrip strength, knee extension strength, and bone mineral density (BMD) in adults. Methods: Following PRISMA guidelines, we searched PubMed, Scopus, Web of Science, and Cochrane Library (inception to April 2025) for randomized controlled trials (RCTs) comparing nandrolone decanoate to placebo in adults ≥ 18 years). Data were analyzed using a random-effects meta-analysis and risk of bias was assessed using the RoB2 tool. Mean differences (MD) alongside 95% confidence intervals (95%CI) were applied, while standardized MD (SMD) was used when methods or/and units of measurement were not identical (i.e., body fat mass/percentage). Results: Twenty RCTs were included in this study. Nandrolone decanoate significantly increased LST (k=11; MD: 1.59 kg, 95% CI: 1.06–2.13, p<0.01, I² = 0%) but had no effect on fat mass (k=11; SMD: -0.04, p=0.65), handgrip strength (k=12; SMD: 0.39, p=0.10), or knee extension strength (k=1; p=0.99). BMD outcomes were inconsistent, with only total proximal femur BMD showing improvement (p<0.05). No publication bias was detected. Most studies showed a low risk of bias, while GRADE assessment displayed a low certainty of evidence. Conclusion: Although nandrolone decanoate modestly increases LST, this was not accompanied by improvements in handgrip strength or consistently observed improvements in BMD, and functional outcomes were informed by limited trial data. Taken together, these findings do not support routine clinical use of nandrolone decanoate for improving musculoskeletal health. Given its limited benefit and known safety concerns, non-pharmacological approaches such as resistance training and nutritional support should remain the preferred strategy for preserving musculoskeletal health.

Background: Malnutrition is a common, yet modifiable risk factor in older surgical patients, and is associated with higher postoperative morbidity and mortality. National guidance (NICE, 2017) recommends that nutritional risk be assessed using validated tools such as the Malnutrition Universal Screening Tool (MUST) with clear care pathways for dietetic support and oral nutritional supplementation (ONS) where needed. Aim: To evaluate, through a clinical audit, how effectively MUST scores are recorded and acted upon in older patients undergoing emergency colorectal surgery. Methods: A retrospective clinical audit of patients aged ≥65 who underwent emergency laparotomy at a UK NHS teaching hospital (Jan 2021—Dec 2022). Electronic records were reviewed for MUST scores, dietetic referrals and ONS prescriptions. Results: Of 300 patients, 99% had a recorded MUST score. Among 114 patients identified as high-risk, 35% did not receive a dietetic review, and 24% received no nutritional supplementation. Conclusion: Although screening compliance was high, many high-risk patients did not receive appropriate follow-up. These findings highlight a breakdown between screening and intervention, suggesting the need for improved protocol adherence and clearer accountability in perioperative nutritional care. Improving adherence to nutritional care protocols may help reduce postoperative complications and support better recovery outcomes in older surgical patients.

BACKGROUND/AIMS: The efficacy of UK cardiac rehabilitation to improve patient outcomes has been questioned due to many programmes not prescribing a full dose of exercise as recommended by the Association of Chartered Physiotherapists in Cardiac rehabilitation. The aim of this study was to 1) evaluate whether providing digital prehabilitation to patients prescribed a lower exercise dose than Association of Chartered Physiotherapists in Cardiac Rehabilitation guidelines recommend enabled them to recall the exercise targets, and 2) to determine whether digital prehabilitation helped patients feel more familiar and prepared for participation in the cardiac rehabilitation programme.

Abstract

Purpose: To examine the ergogenic potential of creatine (Cr), sodium bicarbonate (SB),and Cr+SBafter completion of a resistance exercise bout (REB).Methods: Following recruitment,27trained males (26.8±5.7 years old) completed a one repetition maximum strength (1RM) test in the parallel squat (120.9±28.2kg). Participants then followed a standardised meal plan for 4 days whilst ingesting one of 4 supplements, and on day 5 they undertook the REB. This was a double blind randomised placebo-controlled study where participants ingested one of the following: Placebo (PLA, n=7), Cr (20g/d-1& PLA, n=8), SB (0.5 g/kg-1/d-1&PLA, n=6), andCr+SB (5 g/d-1 of Cr & 0.5 g/kg-1/d-1 SB, n=6) divided in 4 doses. The REB consisted of 4x10 repetitions (70% of 1RM, 1½ min recovery). The primary performance outcome was a 5th set (70% of 1RM) performed to volitional exhaustion.Blood glucose and lactate, heart rate, ratings of perceived exertion, sickness and stomachache scales, and time to complete each set were also recorded.Results:Participants in Cr, SB, and Cr+SB completed the required number of repetitions at 70% of 1RM however in PLA they completed the same repetitions at lower intensity (68+3.4%). Participants in PLA, Cr, SB, and Cr+SB completed 8(±1.6), 11(±5.5), 9(±3.7), and 11(±3.3) repetitions respectively during the 5th set. Despite the fact that no significant differences were observed in performance, small (SB: 0.4) and moderate effect (Cr: 0.7; Cr+SB: 1.0) sizes were observed in relation to PLA. Body mass increasedsignificantly after Cr (78.1±8.9 kg pre vs 79.1±8.9 kg post, p<0.05). No other significant differences existed in recorded variables.Conclusions: Performance gains were of higher magnitude in the Cr+SB and Cr groups. Co-ingestion of a small amount of Cr (5 g/d-1) with a standard dose ofSB (0.5 g/kg-1/d-1)appears to be equally beneficial asingestion of a standard dose of Cr (20 g/d-1). The Cr+SB was not associated with significant gains in body mass which may be beneficial in sports where size gains may negate performance. Further research is required, with larger sample size, and specific athletic populations in order to confirm the findings of the current study.

Objectives Increasing protein or amino acid intake has been promoted as a promising strategy to increase muscle mass and strength in elderly people, however, long-term intervention studies show inconsistent findings. Therefore, we aim to determine the impact of protein or amino acid supplementation compared to placebo on muscle mass and strength in older adults by combining the results from published trials in a metaanalysis and pooled individual participant data analysis. Design We searched Medline and Cochrane databases and performed a meta-analysis on eight available trials on the effect of protein or amino acid supplementation on muscle mass and strength in older adults. Furthermore, we pooled individual data of six of these randomized double-blind placebo-controlled trials. The main outcomes were change in lean body mass and change in muscle strength for both the meta-analysis and the pooled analysis. Results The meta-analysis of eight studies (n=557) showed no significant positive effects of protein or amino acid supplementation on lean body mass (mean difference: 0.014 kg: 95% CI -0.152; 0.18), leg press strength (mean difference: 2.26 kg: 95% CI -0.56; 5.08), leg extension strength (mean difference: 0.75 kg: 95% CI: -1.96, 3.47) or handgrip strength (mean difference: -0.002 kg: 95% CI -0.182; 0.179). Likewise, the pooled analysis showed no significant difference between protein and placebo treatment on lean body mass (n=412: p=0.78), leg press strength (n=121: p=0.50), leg extension strength (n=121: p=0.16) and handgrip strength (n=318: p=0.37). Conclusions There is currently no evidence to suggest that protein or amino acid supplementation without concomitant nutritional or exercise interventions increases muscle mass or strength in predominantly healthy elderly people.

Background: Potential mechanisms responsible for the ergogenic potential of Caffeine are its actions on the central nervous system (CNS) and adrenaline. Oral ingestion of caffeine 1-1½ h before exercise is a widely used ergogenic practice, however there is limited research on the effects of caffeinated chewing gum on exercise performance Aim: To investigate the acute effects of caffeinated chewing gum on sprint performance. Methods: Ten experienced track and field male athletes, aged 22.4(±2.6) years old [height 184.3(±6.9) cm, body mass 84.8(±11.5) kg], participated in this study. Following ethical approval, the participants signed a consent form and took part in a screening and a familiarisation session before they completed two trials (3x40m sprints with 4min recovery between runs) a week apart. A double-blind randomized crossover design was adopted where participants chewed for 5 min a caffeinated gum (6 mg/kg-1/BW, Stay Alert Mint flavour) or a placebo (Trident Splash Sugar-free Mint flavour) 15 min before the start of the exercise trials. Blood lactate and glucose concentration, heart rate, ratings of perceived exertion, arousal and feeling levels were recorded before and immediately after each run and 5 min after the last run. Results: Mean time to complete sprints 1, 2, and 3 were 5.05(±0.25), 5.00(±0.26), 5.03(±0.23) and 5.11(±0.25), 5.07(±0.25), 5.06(±0.25) seconds for the caffeine and placebo conditions respectively. Participants run faster in all sprints during the caffeine condition with sprint two being significantly faster than the placebo (p=0.024). In addition, blood glucose and arousal levels were significantly higher during the caffeine trial (p=0.015 and p=0.034 respectively). No other significant differences were observed between conditions. Conclusions: Our data suggests that caffeinated chewing gum can improve sprint performance when consumed approximately 15 min before exercise and this ergogenic effect is probably due to the stimulatory effect of caffeine on the CNS and release of adrenaline.

Sodium Bicarbonate (SB) or Creatine (Cr) can enhance significantly buffering capacity, but research has primarily explored their individual effects rather than combined effects. The main aim of this study was to investigate the effects of serial loading with SB, Cr, or Cr/SB on resistance exercise performance. Twenty-seven resistance-trained male volunteers aged 27 (±6) years old [height 176 (±6.) cm, body mass 77.6 (±7.2) kg] and one repetition maximum (1RM) strength in the back squat (BS) exercise 121 (±28) kg met the criteria for participation and completed all tests. Following familiarization and determination of 1RM, the participants were randomly assigned in one of 4 groups: A) Placebo (PLA, corn flour, n=7), B) SB (0.5 g/kg-1/d-1 and placebo, n=6), C) Cr (20 g/d-1 and placebo, n=8) or D) Cr/ SB (5 g/d-1 of Cr and 0.5 g/kg-1/d-1 SB, n=6). The participants ingested a relative amount to their body weight in 4 doses during the day for a period of 4 days whilst following a standardized diet plan. On the 5th day participants completed 4 setsx10 repetitions with 90 sec recovery between sets and a 5th set to exhaustion at 70% of their 1RM in the BS. Blood glucose and lactate concentration, heart rate, ratings of perceived exertion, sickness, and stomachache were also recorded. The number of repetitions completed were 8(±2), 11(±6), 9(±4) and 11(±3) in PLA, Cr, SB and Cr/SB respectively with no significant differences between groups. Cr supplementation resulted in weight gain (1.1±0.1 kg, p<0.05), but no other significant differences were observed in recorded variables. Despite the fact that Cr and Cr/SB resulted in completion of more repetitions during the 5th set significant differences did not exist between groups. Further research is needed to establish whether supplementing smaller amounts of Cr with SB can be an effective ergogenic strategy in weight bearing activities.

Validity of Telemetric-Derived Measures of Heart Rate Variability: A Systematic Review. JEPonline 2016;19(6):64-84. Heart rate variability (HRV) is a widely accepted indirect measure of autonomic function with widespread application across many settings. Although traditionally measured from the ‘gold standard’ criterion electrocardiography (ECG), the development of wireless telemetric heart rate monitors (HRMs) extends the scope of the HRV measurement. However, the validity of telemetric-derived data against the criterion ECG data is unclear. Thus, the purpose of this study was twofold: (a) to systematically review the validity of telemetric HRM devices to detect inter-beat intervals and aberrant beats; and (b) to determine the accuracy of HRV parameters computed from HRM-derived inter-beat interval time series data against criterion ECG-derived data in healthy adults aged 19 to 62 yrs. A systematic review of research evidence was conducted. Four electronic databases were accessed to obtain relevant articles (PubMed, EMBASE, MEDLINE and SPORTDiscus. Articles published in English between 1996 and 2016 were eligible for inclusion. Outcome measures included temporal and power spectral indices (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). The review confirmed that modern HRMs (Polar® V800™ and Polar® RS800CX™) accurately detected inter-beat interval time-series data. The HRV parameters computed from the HRM-derived time series data were interchangeable with the ECG-derived data. The accuracy of the automatic in-built manufacturer error detection and the HRV algorithms were not established. Notwithstanding acknowledged limitations (a single reviewer, language bias, and the restricted selection of HRV parameters), we conclude that the modern Polar® HRMs offer a valid useful alternative to the ECG for the acquisition of inter-beat interval time series data, and the HRV parameters computed from Polar® HRM-derived inter-beat interval time series data accurately reflect ECG-derived HRV metrics, when inter-beat interval data are processed and analyzed using identical protocols, validated algorithms and software, particularly under controlled and stable conditions.

Abstract

Dietary protein is a macronutrient of special importance, since it is the source of essential amino acids, which are key regulators of muscle protein synthesis and are ultimately responsible for muscle maintenance, growth and repair. Optimal muscle mass is fundamental for the promotion of health because reductions in muscle mass are associated with sarcopenia, which in turn is a contributing factor to frailty, adverse health outcomes, morbidity and mortality. Nevertheless, nutritional deficiencies are often reported in older people, resulting in undernutrition and malnutrition characterised mainly by 1) low protein and 2) low energy intake. Dietary protein and resistance exercise are important regulators of training-derived muscle mass adaptations, particular when applied in synergy. In a recent review by Morton et al (2018), it was confirmed that protein supplementation may enhance further muscle mass gains when combined with resistance training. Specifically, protein supplementation augments muscle growth when dietary protein intakes are below 1.6 g.kg.-1BM-1 on average in the young. In contrast, the impact of protein supplementation seems to reduce with advancing age. The latter is not surprising, since research findings suggest that older people have higher requirements for daily (>1 g.kg.-1BM-1) and per meal (~0.4 g.kg.-1BM-1) dietary protein. Moreover, they may also be less efficient at using dietary protein for muscle protein synthesis and require proportionally greater amounts of the essential amino acid L-Leucine to optimally stimulate muscle protein synthesis. What is most worrying is that many older adults do not even meet the current recommended daily allowance (0.8 g.kg.-1BM-1) for protein. Given that sarcopenia is exacerbated in older people with protein deficiencies, any efforts to facilitate an increase in protein intake may be effective solutions to this problem. However, simply asking older people, who often have low appetite, to eat more food containing high quality protein poses certain challenges. Enhancing dietary protein intake, which is undoubtedly crucial for optimisation of skeletal muscle adaptations through the provision of essential amino acids, typically enhances satiety resulting in decreased food consumption. Therefore, nutritional interventions that do not suppress appetite, but provide needed nutrients should be implemented. Our group's research to date has shown that in older people, supplements based on essential amino acids are palatable and do not suppress appetite; they can potentially address protein and energy deficiencies; they are easily absorbed; and can improve muscle strength and functional performance when taken alongside meals. This session will focus on our emerging research exploring alternative solutions to addressing protein deficiencies rather than just simply enhancing intakes of intact protein sources. In this manner, any negative impact upon the ability of older people to eat food can be minimised, whereas the anabolic effect of food is otherwise enhanced.

Ageing is associated with reductions in appetite and food intake leading to unintentional weight loss. Such weight loss, particularly through muscle mass reduction, is associated with muscle weakness and functional decline, which represent predictors of poor health outcomes and contribute to frailty in older adults. Exercise-induced anorexia is an established phenomenon in young adults; however appetite and energy intake (EI) responses to resistance exercise are unknown in older adults. Twenty healthy older adults (68 ± 5 years, BMI 26.2 ± 4.5 kg.m-2 ) undertook two 5-hour experimental trials. Participants rested for 30 minutes before being provided with a standardised breakfast (196 kcal, 75.2% carbohydrate, 8.9% protein and 15.9% fat). Participants then rested for 1-hour before completing: 1-hour resistance exercise bout followed by 2-hour of rest (RE) or, a control condition (CON) where participants rested for 3 hours, in a randomised crossover design. Appetite perceptions were measured throughout both trials and on cessation, an ad libitum meal was provided to assess EI. A repeated-measures ANOVA revealed no significant condition x time interaction for subjective appetite (p = 0.153). However, area under the curve for appetite was significantly lower in the RE compared with CON (49 ± 8mm•hour-1 vs. 52 ± 9mm•hour-1, p = 0.007, d = 0.27). There was no difference in EI (RE = 681 ± 246 kcal; CON = 673 ± 235 kcal; p = 0.865), suggesting that resistance exercise does not affect EI 2 hours post-exercise in older adults despite a significant but modest reduction in appetite over a 5-h period. In conclusion, resistance exercise may be an appropriate means for optimising muscle mass adaptations without attenuating acute EI of older adults.

Background Aging is a global health challenge that is associated with a decline in cognitive function. In the United States, most older adults (≥50 years) do not meet the recommended daily fiber intake, although preliminary evidence suggests that dietary fiber consumption could elicit clinical benefits on cognitive function. We investigated the associations between dietary fiber intake and cognitive function in older adults. Methods We analyzed data from the US National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014, with a study cohort of 1070 older adults (≥60 years). Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning Test (WLT), Word Recall Test (WRT) and their Intrusion Word Count Tests (WLT-IC and WRT-IC), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Multiple linear regression and cubic spline analyses were employed to examine the association between dietary fiber intake and cognitive performance on a test-by-test basis, after covariates adjustment (ie, age, sex, race, socioeconomic status, educational level, medical history, body mass index, alcohol, and energy intake). Results Participants had a mean age of 69.2 years and were primarily non-Hispanic white of middle-high socioeconomic status with a college degree at minimum. The mean dietary fiber intake was 17.3 g/d. The analysis showed that dietary fiber intake was positively associated with DSST (P = .031). No associations with CERAD WLT (P = .41), WRT (P = .68), WLT-IC (P = .07), and WRT-IC (P = .28), and AFT (P = .40) scores were observed. A plateau in DSST score was revealed at a dietary fiber intake of 34 g/d. Conclusions Higher dietary fiber intake is associated with improved specific components of cognitive function in older adults aged 60 years and older. Public health interventions that target a recommended dietary fiber intake may provide a promising strategy to combat cognitive decline in high-risk groups of older adults.

To investigate whether long-term leucine supplementation in combination with resistance training can induce higher increases in strength and muscle mass of untrained subjects compared to a placebo group undertaking resistance training only. To investigate potential decreases in muscle mass after four weeks following the end of the supplementation period

This manuscript represents a significant contribution to our ongoing efforts to combat sarcopenia through optimisation of nutritional status in older adults with or without disease. Not only will it strengthen a potential Impact Case submission I the next REF, but it will also contribute towards gaining British National Formulary approval for the nutritional gels we have developed. This could have a major impact on the healthcare system, as these gels could be prescribed at NHS and help several patients. This is in addition to our extensive collection of publications over the past few years, which have identified effective exercise and nutritional-based interventions to address sarcopenia and improve health and quality of life in specific groups of older adults with or recovering from disease. Moreover, this manuscript is particularly significant because it contains data generated using our state-of-the-art LCMS equipment, following optimisation of a method to analyse 20 amino acids method. This showcases our enhanced capabilities to conduct high-quality research, which could generate further interest for national and international collaborations. Finally, I would like to highlight that the attached manuscript is complete and polished, with a reduced word count of less than 2000 words form almost 4000 initially. I kindly request your support in providing the necessary funding for this manuscript, as I truly believe it has the potential to make a significant impact and help us achieve our strategic research goals. Thank you for your consideration Theocharis Ispoglou Below, I am also including FYI a potential letter to the Editor “Dear Editor, Our Case Study manuscript represents a significant contribution to the literature as it sheds light on the feasibility and synergistic potential of a home-based exercise and nutrition intervention for addressing frailty and lack of physical fitness in females with multiple sclerosis. Our study aims to encourage the integration of such interventions into community-based programmes, which can potentially improve the lives of individuals with multiple sclerosis and help them achieve optimal physical fitness. We confirm that neither the manuscript nor any parts of its contents are currently under consideration or published in another journal. Thank you for considering our manuscript for publication in your journal. We eagerly await your response Sincerely yours Dr Theocharis Ispoglou” Background: Patients undergoing abdominal surgery are likely to have sarcopenia and reduced appetite, while associated energy and protein intake deficiencies can pose an issue to older surgical patients (Weimann et al, 2021). Protein enhances satiety so it has the potential to exacerbate energy deficiencies. Essential amino acid (EAA) supplements have been proposed as acceptable alternative means to address protein deficiencies since they do not suppress appetite in older adults (Ispoglou et al., 2021). However, it is not known if these supplements are acceptable to surgical patients. Objectives: To investigate the feasibility and acceptability of a nutritional supplement in two groups of surgical patients. Methods: A feasibility study was conducted in older (>60 years) postoperative elective (n=8) and emergency (n=8) abdominal surgery patients. Mean palatability scores of the supplement were obtained using visual analogue scales (Flint et al. 2000). Patients were then asked to consume the gel twice daily for four weeks. Results: Sixteen patients (5 female and 11 male) with a mean age of 68.81 (± 6.31) years completed palatability assessments. Elective patients found the gel more acceptable than the emergency patients by giving better scores in visual appeal, taste, and palatability. The aftertaste score was worse in the emergency group. Half of the elective patients complied with regime, one patient completed two weeks, two completed five and ten days and one patient withdrew. The emergency patients contrasted with elective patients where one person completed the regime. Conclusion: The acceptability of the supplement and compliance with the postoperative regime was better in the elective patients. Our data suggests that an EAA supplement could be part of nutritional support for elective patients, however, we would advise clinical trials to further test its efficacy. Postoperative taste is known to alter following colorectal surgery (Welchman et al, 2014), but it has not been previously identified that postoperative patients’ taste may differ in elective or emergency cases. Our palatability assessments suggest that a bitter aftertaste, likely due to the addition of EAAs, was more evident to the emergency patients. This further highlights the need for bespoke approaches to develop supplements to address protein deficiencies. References: Butterworth, M., Lees, M., Harlow, P., Hind, K., Duckworth, L., & Ispoglou, T. (2019). Acute effects of essential amino acid supplement-based and whey protein supplements on appetite and energy intake in older women. Appl Physiol Nutr Metab, 44 (11), pp.1141- 1149; Flint, A., Raben, A., Blundell, J. E., & Astrup, A. (2000). Reproducibility, power, and validity of visual analogue scales in assessment of appetite sensations in single test meal studies. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 24(1), 38–48; Ispoglou, T., Witard, O. C., Duckworth, L. C. & Lees, M. J. (2021). The efficacy of essential amino acid supplementation for augmenting dietary protein intake in older adults: implications for skeletal muscle mass, strength and function. Proc Nutr Soc, 80, 230-242; Weimann, A., Braga, M., Carli, F., Waltzberg, D. Bischoff, S.C. & Singer, P.. (2021) ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition 40, pp. 4745-4761; Welchman, S., Hiotis, P., Pengelly, S., Hughes, G., Halford, J., Christiansen, P., & Lewis, S. (2014). Changes in taste preference after colorectal surgery: A longitudinal study. Clinical Nutrition (Edinburgh, Scotland), 34(5), 881–884.

An invited talk to update group on findings of recently completely project

There are two arms to the study. Each participant can choose whether to take part in both arms or just one. If they choose to take part in one arm, they can also decide which arm they wish to take part in. Arm 1: Each participant attends the trial participating centre on three separate days. on each day, they take one of three tests. They do all three tests, on separate days, in a random order. These tests are: 1. Consuming an essential amino acids based nutritional bar enriched with L-leucine: oral administration of a 37.5 g nutrition bar (134.5 kcal) containing 7.5 g of essential amino acids (40% L-Leucine) 2. Consuming an essential amino acids based nutritional gel enriched with L-leucine: oral administration of a 50 ml nutrition gel (113.9 kcal) containing 7.5 g of essential amino acids (40% L-Leucine) 3. No consumption of an essential amino acids based supplement All participants then wait for an hour before consuming an ad-lib breakfast (standardised breakfast of porridge). During this hour, they are asked to complete questionnaires on hunger and opinion of the supplement consumed (if any). At the start of each of the three sessions, a phlebotomist inserts a cannulla into a vein of each participant. Blood samples are taken at a number of occasions throughout the testing session for later hormonal response analysis. Arm 2: This arm of the study is very similar to arm 1. There are again three tests that all participants take part in over three days in a random order. These tests are almost identical to those of arm 1. However, this time the ad lib breakfast is eaten at the same time as the amino acid supplements are consumed (if any). Participants are also not required to give any blood samples.

Successful management of sarcopenia: the importance of sarcopenia diagnosis, strength-promoting exercise, and protein intake

Cancer cachexia is accompanied by muscle atrophy, sharing multiple common catabolic pathways with sarcopenia, including mitochondrial dysfunction. This study investigated gene expression from skeletal muscle tissues of older healthy adults, who are at risk of age-related sarcopenia, to identify potential gene biomarkers whose dysregulated expression and protein interference were involved in non-small cell lung cancer (NSCLC). Screening of the literature resulted in 14 microarray datasets (GSE25941, GSE28392, GSE28422, GSE47881, GSE47969, GSE59880 in musculoskeletal ageing; GSE118370, GSE33532, GSE19804, GSE18842, GSE27262, GSE19188, GSE31210, GSE40791 in NSCLC). Differentially expressed genes (DEGs) were used to construct protein-protein interaction (PPI) networks and 35 retrieve clustering gene modules. Overlapping module DEGs were ranked based on 11 topological algorithms and were correlated with prognosis, tissue expression, and tumour purity in NSCLC. The analysis revealed that the dysregulated expression of the mammalian mitochondrial ribosomal proteins, MRPS26, MRPS17, MRPL18, and MRPL51 were linked to reduced survival and tumour purity in NSCLC while tissue expression of the same genes followed an opposite direction in healthy older adults. These results support a potential link between the mitochondrial microenvironment in ageing muscle and NSLC. Further studies comparing changes in sarcopenia and NSCL associated cachexia are warranted.

Probiotics have shown potential to counteract sarcopenia, although the extent to which they can influence domains of sarcopenia such as muscle mass and strength in humans is unclear. The aim of this systematic review and meta-analysis was to explore the impact of probiotic supplementation on muscle mass, total lean mass and muscle strength in human adults. A literature search of randomized controlled trials (RCTs) was conducted through PubMed, Scopus, Web of Science and Cochrane Library from inception until June 2022. Eligible RCTs compared the effect of probiotic supplementation versus placebo on muscle and total lean mass and global muscle strength (composite score of all muscle strength outcomes) in adults (>18 years). To evaluate the differences between groups, a meta-analysis was conducted using the random effects inverse-variance model by utilizing standardized mean differences. Twenty-four studies were included in the systematic review and meta-analysis exploring the effects of probiotics on muscle mass, total lean mass and global muscle strength. Our main analysis (k = 10) revealed that muscle mass was improved following probiotics compared with placebo (SMD: 0.42, 95% CI: 0.10–0.74, I2 = 57%, P = 0.009), although no changes were revealed in relation to total lean mass (k = 12; SMD: -0.03, 95% CI: −0.19 – 0.13, I2 = 0%, P = 0.69). Interestingly, a significant increase in global muscle strength was also observed among six RCTs (SMD: 0.69, 95% CI: 0.33–1.06, I2 = 64%, P = 0.0002). Probiotic supplementation enhances both muscle mass and global muscle strength; however, no beneficial effects were observed in total lean mass. Investigating the physiological mechanisms underpinning different ageing groups and elucidating appropriate probiotic strains for optimal gains in muscle mass and strength are warranted.

Low handgrip strength, a hallmark measure of whole-body strength, has been linked with greater odds of cognitive decline and dementia however conflicting findings, which could be due to population characteristics, and choice of tools, such for the assessment of handgrip strength and cognitive function domains, also exits Therefore, we examined the relationship of handgrip strength with a comprehensive list of tests to assess domains of cognitive function using a representative sample of US older men and women without neurogenerative disorders such as dementia. We analysed cross sectional data from the US National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014, with a study cohort of 777 older adults (380 men and 397 women) above 60 years of age. Handgrip strength was assessed using a handgrip dynamometer, while cognitive function was assessed through the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test (WLLT), Word List Recall Test (WLRT), Intrusion Word Count Test (WLLT-IC and WLRT-IC), the Animal Fluency Test (AFT) and the Digit Symbol Substitution Test (DSST). Sex-stratified multiple linear regression analyses were performed upon covariate adjustment for age, ethnicity, socio-economic status, education, medical history, body mass index, physical activity, energy, protein, and alcohol intake. Maximal handgrip strength was positively associated with cognitive function scores, including CERAD WLLT (P=0.009, R2=0.146) and AFT (P=0.022, R2=0.024) in older men, but not in women (CERAD WLLT: P=0.253, AFT: P=0.370). No significant associations with CERAD WLLRT (men: P=0.057, women: P=0.976), WLLT-IC (men: P=0.671, women: P=0.869), WLLRT-IC (men: P=0.111, women: P=0.861), and DSST (men: P=0.108, women: P=0.091) were observed. Dose-response curves exhibited a prominent linear relationship between all significant associations after covariate adjustment, with no indication of a plateau in these relationships. In conclusion, higher handgrip strength was independently associated with better learning ability for novel verbal information and verbal fluency in US men over the age of 60 and without dementia. Longitudinal studies are required to confirm whether muscle strength independently predicts cognitive function changes in older adults in a sex specific manner, and whether this connection is affirmed to the possibility of reverse causation due to declines in physical activity levels in the preclinical phase of dementia.

Loss of muscle mass and strength, known as sarcopenia, is a significant cause of hospitalization and loss of independence in older people. Researchers at Leeds Beckett University’s Carnegie School of Sport are on a mission to understand the effect of amino acid supplements and steroid hormones on muscle mass. We talk to them about how the adoption of Shimadzu’s LC-MS equipment has revolutionized their ability to examine levels of these small molecules in blood plasma and to monitor how they change during efforts to prevent and better manage sarcopenia.

Background: Age-associated cognitive decline may be influenced by testosterone status. However, studies evaluating the impact of bioavailable testosterone, the active, free testosterone, on cognitive function are scarce. Our study determined the relationship between calculated bioavailable testosterone and cognitive performance in older men. Methods: We used data from the US National Health and Nutrition Examination Survey (NHANES) between 2013 and 2014. This study consisted of 208 men aged ≥ 60 years. Bioavailable serum testosterone was calculated based on the total serum testosterone, sex hormone-binding globulin, and albumin levels, while cognitive performance was assessed through the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test (WLLT), Word List Recall Test (WLRT), and Intrusion Word Count Test (WLLT-IC and WLRT-IC), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Multiple linear regression analyses were performed upon adjustment for age, ethnicity, socio-economic status, education level, medical history, body mass index, energy, alcohol intake, physical activity levels and sleep duration. Results: A significant positive association between bioavailable testosterone and DSST (β: 0.049, P=0.002) score was detected, with no signs of a plateau effect. No significant associations with CERAD WLLT (P=0.132), WLRT (P=0.643), WLLT-IC (P=0.979), and WLRT-IC (P=0.387), and AFT (P=0.057) were observed. Conclusion: Calculated bioavailable testosterone presented a significant positive association with processing speed, sustained attention and working memory in older men above 60 years of age. Further research is warranted to elucidate the impact of the inevitable age-related decline in testosterone on cognitive function in older men.

The presentation aims to give an overview of how a liquid chromatography and mass spectrometry system (LCMS-8045 and Nexera X2, Shimadzu Corporation Europa GmbH, Milton Keynes, UK) has been successfully integrated into the biochemistry laboratory at the Carnegie School of Sport at Leeds Beckett University. It also provides an outline of the main concepts and goals of the overarching research project. The LCMS mass spectrometry systems have become an increasingly popular analytical tool in sports and nutritional science because of their sensitivity and specificity in identifying and quantifying compounds in complex biological matrices. Specifically, it can detect and quantify small molecules such as hormones, and several metabolites, making it a valuable tool in the analysis of sports supplements and nutritional interventions. Their use has also become widespread in doping control and forensic investigations in sports. With its capability to analyse a wide range of substances, such as nutrients, proteins, and drugs, the procurement of this equipment has enabled staff and PhD students at the Carnegie School of Sport at Leeds Beckett University to conduct analyses that support ongoing research and facilitate future aspirations. As the technology continues to advance, LCMS mass spectrometry is expected to play an even greater role in advancing our understanding of the effects of nutrition and exercise on human physiology. Furthermore, the presentation will provide a summary of two optimised methods for amino acid and steroid analyses and discuss the challenges encountered while implementing these methods. It will also provide a detailed description of the essential amino acid method, including the presentation of samples and standards, along with key findings of the completed projects. Through the optimisation of the analytical method for measuring amino acid concentrations, we were able to achieve rapid and precise quantification of 18 proteinogenic amino acids in plasma samples collected from older adults involved in research projects focusing on age-related sarcopenia. The samples were first filtered and labelled with a known quantity of standards to compensate for matrix effects and ensure accurate quantification. Chromatographic separation was performed using a specific column, and mass spectrometric detection was performed using an LCMS-8045 triple quadrupole instrument. A gradient elution was used, and the mobile phases were specified. Quality control samples were prepared to measure recovery and ensure the correct application of the method. Samples and standards were injected using an autosampler. In summary, the integration of LCMS technology in the Carnegie School of Sport has led to notable advancements in research quality and capacity. The instrument’s selection has enabled the acquisition of highly sensitive and intricate data. Our analysis of plasma amino acid levels has yielded promising findings, suggesting a possible association between decreased plasma amino acid concentrations and decreased muscle function in older adults. The implementation of this technology has the potential to foster the development of novel insights in our field.

Use of anhydrous caffeine is an established and widely used ergogenic method. In sprinting events, optimum performance is highly dependent on the simultaneous peak functioning of a host of physiological systems. Therefore, caffeine supplementation protocols need to be perfectly timed in order to achieve culmination in sprint performance parameters within a narrow time window. Typically, caffeine capsules are ingested approximately 1-hour before exercise, but absorption rates may be highly variable. An alternative mode of ingestion is through caffeinated gum where caffeine is rapidly absorbed through the buccal mucosa. Our aim was to investigate the acute effects of two distinct modes of caffeine ingestion on sprint performance. Following ethics approval, eight trained male sprinters aged 20±1 y took part in a screening and familiarisation session before they completed four trials (3x40 m sprints with 4 min recovery between runs) a week apart. A double-blind randomized crossover design was adopted where, during the trials, participants received: 1) Caffeine gum (CAFG, 6 mg.kg-1 of body weight), 2) CAFG placebo (CAFGP), 3) Caffeine capsules (CAFC, mg.kg-1 of body weight), 4) CAFC placebo (CAFCP). General and sport-specific warm-up commenced 15 minutes before sprint one. Capsules were given 45 minutes and chewing gums 15 minutes before sprint one. The gums were chewed for 5 minutes. Blood lactate and glucose concentration, heart rate, arousal and feeling levels were recorded at baseline and different time points during testing. Mean times to complete the three sprints were 5.00±0.23, 5.03±0.17, 5.10±0.15, and 5.10±0.14 s for the CAFG, CAFC, CAFGP and CAFCP conditions respectively. Participants ran faster (P<0.05) during the caffeine than the placebo conditions. Additionally, sprint two in the CAFG (2.25±0.45 % faster than CAFGP) was faster (P=0.022) than in the CAFC (1.40±0.32 % faster than CAFCP). Blood glucose and arousal levels were also higher during the caffeine trials. Our data confirm that caffeine is an effective ergogenic strategy for sprinters. Furthermore, the greater performance gains in sprint two suggest that caffeinated gum may be a more efficacious mode of ingestion than traditional methods of caffeine ingestion.

Use of anhydrous caffeine is an established and widely used ergogenic method. In sprinting events, optimum performance is highly dependent on the simultaneous peak functioning of a host of physiological systems. Therefore, caffeine supplementation protocols need to be perfectly timed in order to achieve culmination in sprint performance parameters within a narrow time window. Typically, caffeine capsules are ingested approximately 1 h before exercise however absorption rates may be highly variable. An alternative mode of ingestion is through caffeinated gum where caffeine is rapidly absorbed through the buccal mucosa. Our aim was to investigate the acute effects of two distinct modes of caffeine ingestion on sprint performance. Following ethics approval, eight trained male sprinters aged 20.2 (±0.8) took part in a screening and familiarisation session before they completed four trials (3x40 m sprints with 4 min recovery between runs) a week apart. A double-blind randomized crossover design was adopted where, during the trials, participants received: 1) Caffeine gum (CAFG, 6 mg.kg-1 of body weight), 2) CAFG placebo (CAFGP), 3) Caffeine capsules (CAFC, mg.kg-1 of body weight), 4) CAFC placebo (CAFCP). General and sport-specific warm-up commenced 15 minutes before sprint one. Capsules were given 45 minutes and chewing gums 15 minutes before sprint one. The gums were chewed for 5 minutes. Blood lactate and glucose concentration, heart rate, arousal and feeling levels were recorded at baseline and different time points during testing. Mean time to complete the three sprints were 5.00(±0.23), 5.03(±0.17), 5.10(±0.15), and 5.10(±0.14) seconds for the CAFG, CAFC, CAFGP and CAFCP conditions respectively. Participants ran significantly faster (p<0.05) during the caffeine compared to the placebo conditions. Additionally, sprint two in the CAFG (2.25±0.45 % faster than CAFGP) was significantly faster (p=0.022) than in the CAFC (1.40±0.32 % faster than CAFCP). Blood glucose and arousal levels were also significantly higher during the caffeine trials. Our data confirms that caffeine is an effective ergogenic strategy for sprinters. Furthermore, the greatest performance gains in sprint two suggests that caffeinated gum may be a more efficacious mode of ingestion than traditional methods of caffeine ingestion.

Introduction Acute exposure to very high altitude (>3500m) is associated with a significant suppression of appetite and energy intake, which may contribute to losses of lean mass and functional capacity. The reasons for this appetite suppression are unclear and it is unknown whether this will occur during acute exposure to moderate altitudes. This study examined the effects of exercise on appetite, appetite hormones and energy intake at moderate and very high altitudes. Methods Twelve healthy males (mean±SD; age 30±9years, body mass index 24±3kg.m-2) completed three, 305-minute experimental trials at a simulated altitude of 0m (sea level: SL), 2150m (~15.8% O2) and 4300m (~11.7% O2) in a normobaric chamber. The trials were randomised using a counterbalanced Latin Square design. Participants arrived at the laboratory after a 12h fast, entering the chamber at 8am. A standardised breakfast was consumed inside the chamber at 1h. One hour after breakfast, participants performed a 60-minute treadmill walk at 50% of altitude specific VO2max. An ad-libitum buffet meal was consumed 1.5h after exercise. Composite appetite score (CAS) ([hunger+prospective food consumption+(100–fullness)+(100–satisfaction)]/4), acylated ghrelin (AG), glucagon like peptide-1 (GLP1) and insulin were measured throughout. Results During the resting period prior to exercise there were no significant differences in any variables between conditions. During exercise, area under the curve (AUC) for CAS was significantly lower at 4,300m (33±5mm.h-1) compared with 2150m (44±5mm.h-1; p=0.024) but not compared with SL (42±4mm.h-1; p>0.05). In the post-exercise period, AUC for CAS was significantly lower at 4300m (40±19mm.h-1) compared with SL (55±15mm.h-1; p=0.004) and 2150m (60±14mm.h-1; p<0.001). During exercise, AUC for AG was significantly lower at 4300m (48±23pg.mL-1.h-1) compared with SL (69±27pg.mL-1.h-1; p=0.005) and 2150m (67±31pg.mL-1.h-1; p=0.01). During the post exercise period AUC for AG was significantly lower at 4,300m (49±31pg.mL-1.h-1) compared with SL (116±49pg.mL-1.h-1; p<0.001) and 2150m (111±62pg.mL-1.h-1; p=0.002). There were no differences in GLP1 or insulin between conditions. Mean energy intake was significantly lower at 4300m (3728±3179kJ) compared with SL (7358±1789kJ; p=0.007) and 2150m (7390±1226kJ; p=0.004). There was no difference in CAS, AG or energy intake between SL and 2150m. Discussion This study suggests that altitude-induced anorexia and a subsequent reduction in energy intake occurs with acute exposure to very high but not moderate altitudes. This effect may be explained by reduced concentrations of AG at very high altitudes. Further research should aim to identify methods of reducing appetite suppression at altitude.

Background: Sarcopenia is a major risk factor for functional decline, yet its prevalence and related changes across the lifespan remain poorly characterised in healthy female cohorts. This study examined sarcopenia prevalence and related characteristics across pre-, peri- and post-menopausal females. Methods: One hundred and fifty-one participants were categorised as pre- (n = 37), peri- (n = 41) or post-menopausal (n = 73).Body composition, appendicular lean mass index (ALMI), bone mineral density (BMD) and fat mass were assessed using DXA. Lean mass was adjusted for height in line with EWGSOP recommendations. Muscle strength and performance were measured via handgrip strength, chair stand test and gait speed. Sarcopenia prevalence was determined using EWGSOP 2010and 2019 criteria. Lifestyle data were collected through validated questionnaires. Results: Significant declines were observed in total lean mass(p < 0.001), lean mass adjusted for height (p = 0.002), ALMI(p = 0.024), handgrip strength (p = 0.002), relative handgrip strength (p = 0.006) and chair stand repetitions (p = 0.002) from pre-to post-menopause, whereas gait speed was unchanged. Fat mass increased progressively (p = 0.002), together with significant declines in total bone mass and BMD (all p < 0.001). Using EWGSOP 2019 criteria, sarcopenia prevalence was 0% across groups. In contrast, EWGSOP 2010 identified 2.4%–4.1% as pre-sarcopenic and 1.4% as sarcopenic, suggesting that earlier definitions may have been more sensitive to early changes. Protein intake (g/kg BW) was significantly lower in peri- and post-menopausal women compared with pre-menopause (p = 0.014),and leisure physical activity declined in post-menopause(p = 0.028).Conclusions: Despite no sarcopenia diagnosed by EWGSOP2019 criteria, consistent declines in strength, lean mass and bone health were evident across menopausal stages, alongside increased fat mass and lower protein intake. These findings suggest that current criteria may underestimate early risk in females. Although limited by its observational design and modest sample size, this study highlights the need for preventive strategies targeting musculoskeletal health before overt sarcopenia develops.

Background: Older adults often fail to meet protein recommendations, contributing to muscle loss and sarcopenia. Essential amino acids (EAAs) stimulate muscle protein synthesis with minimal appetite suppression, offering a practical strategy to support muscle health. However, poor palatability can limit adherence. This study compared plasma amino acid responses and palatability of two EAA supplements versus a standard protein-content breakfast placebo. Methods: In a randomised, placebo- controlled, crossover trial, 10 older adults consumed one of three supplements(Gel A, Gel B or an isocaloric placebo) before a standardised breakfast containing ~10 g protein. Gel A and Gel B both provided 7.5 g EAAs with differing relative compositions.Plasma amino acids were measured at baseline, 15 min and every 30 min for 3 h using LC-MS/MS. Palatability, appetite and food preference were assessed by visual analogue scales. Repeated measures ANOVA evaluated condition, time and interaction effects; AUC analyses compared total and individual amino acid availability. Results: The standard breakfast placebo produced only a mod-est plasma EAA rise (+19%), insufficient to sustain levels above baseline. In contrast, both Gel A and Gel B rapidly increased plasma EAAs and BCAAs within 15 min (all p < 0.001), with concentrations elevated by 102%–108% above baseline. AUC analyses confirmed greater EAA and BCAA exposure with both supplements (p < 0.001). Palatability ratings showed that Gel B was significantly less acceptable than placebo (p = 0.018), whereas Gel A did not differ. Conclusions: A standard protein-content breakfast produced negligible changes in plasma amino acid availability, highlighting the limitations of typical diets in older adults. In contrast, EAA supplementation enhanced availability, with Gel A providing better palatability. These findings support tailored EAA supplementation as a practical strategy to overcome dietary protein gaps, improve adherence and help prevent sarcopenia

Introduction: Resistance training (RT) confers significant health benefits, yet global female participation (14%–25%) re-mains lower than male participation (18%–34%). Barriers include confidence, access and perceptions of RT as a masculine domain. This is particularly concerning given the role of RT in mitigating sarcopenia, muscle wasting and age-related functional decline. This scoping review synthesised protocols and strategies designed to improve adherence and affective response to RT in adult and older females. Methods: Following PRISMA-ScR guidelines, a protocol was registered on the Open Science Framework. PubMed, Scopus and EBSCO databases were searched to August 2025. Eighty-five eligible studies were included. Data on adherence, affective response, supervision, intensity and motivational strategies were charted and synthesised thematically. Results: Over 75% of fully supervised interventions reported high adherence (> 71%), typically in programmes lasting2–3 months. Mixed supervision models sustained moderate adherence (51%–70%) in longer interventions (> 12 months).Unsupervised formats showed variable adherence but improved when combined with app-based support, reminders, follow-ups or transtheoretical model (TTM)–based strategies. Moderate-to-high intensity RT (55%–85% 1RM) was generally associated with higher adherence and more positive emotional responses, across age groups and populations. Non-conventional RT formats(functional, circuit, dyadic, Pilates and Tabata) yielded com-parable adherence and affective outcomes to traditional proto-cols, supporting flexible, preference-based design. Considerable heterogeneity in how adherence and affect were defined high-lighted the lack of standardised measures. Conclusions: Supervision, behavioural support and moderate-to-high intensity protocols appear central to sustaining adherence and enjoyment of RT in females. Flexible and non-conventional formats provide viable, personalised alternatives.Future research must prioritise standardised, theory-informed frameworks to evaluate adherence and affective response. These insights are directly relevant for designing interventions to prevent or manage sarcopenia and muscle wasting in females across the lifespan. To aid translation, a practitioner decision-support tool was developed from the findings.

Objectives This study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables. Design Observational cohort study. Setting Outpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks. Participants Sixty patients (45 male/15 female 33–86 years) were recruited following referral to local outpatient CR. Outcome measures The primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours. Results The mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p<0.001); however, blood pressure, body weight, endothelial function, arterial stiffness and habitual physical activity behaviours were unchanged following 6 weeks of CR (p>0.05). Conclusion Patients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.

Cardiac Rehabilitation (CR) is a multifaceted secondary prevention programme where nutritional education is a central component. Given the high prevalence rates of protein and energy malnutrition in clinical populations including CR patients, it is of upmost importance that current dietary interventions positively modify dietary behaviour. In the UK, the so-called “Mediterranean diet,” is distinguished by a somewhat high proportion of fruit, cereals, and vegetables and consumption of fish and poultry as the main sources of protein. Specifically, research based recommendations suggest protein intakes of up to 1.5g·kg-1 of body mass (BM) for diseased elderly populations as a means to promote recovery and good health. Therefore, this study aimed a) to investigate patients’ dietary intakes with emphasis on protein and energy intakes and b) the effectiveness of a 30-min nutritional education session provided as part of the UK standard CR provision. Following NHS ethics approval, 23 male CR patients aged (64 (± 12) years) enrolled and completed a six-week CR programme. Patients with valve replacement and heart failure were excluded from the study. Patients received a nutritional education session at the start and completed a three-day diet diary in week one and six of the CR programme. Estimated energy requirements were calculated by the updated Oxford equations (Henry, 2005) and a physical activity (PA) factor based on patients’ PA levels. Average energy intakes (EI) at week one (1871.3±583.7 kcal) and six (1674.7±500.2 kcal) were below recommendations (2098.7±329.6 kcal and 2391.4±313.1 kcal respectively) but this was only significant at week six (p=0.000). Furthermore, EI at week six was reduced compared to baseline (-7±25.3%, p=0.02). On average, for the duration of the programme, patients were consuming 0.90±0.3, 2.5±0.9, 0.7±0.3 g·kg-1·BM·d-1 protein, CHO, and fat respectively. Our data confirms that protein and energy intakes were significantly below recommendations for individuals recovering from disease. It appears that one 30-min nutritional education session received as part of the CR provision is not sufficient enough to cause positive dietary changes. Therefore, there is a real need to address the dietary deficiencies of CR patients through additional investments in nutritional education.

The efficacy of exercise-based cardiac rehabilitation (CR) to improve aerobic fitness and reduce mortality has been questioned, partly due to the insufficient exercise dose (namely frequency of exercise sessions). Lack of frequency of exercise sessions is mainly attributed to staffing and funding limitations, particularly in the UK. Despite a lack of prescribed exercise sessions, it is imperative patients adhere to the prescribed intensity and duration targets. To offset the inadequate time available to instruct CR patients, pre-CR instructional digital videos could inform patients about the prescribed exercise dose (intensity and duration). This may enhance their understanding of exercise targets when commencing CR. PURPOSE: The study evaluated the effectiveness of instructional videos in improving patient recall of targeted rating of perceived exertion (RPE) and exercise duration in a CR setting. METHODS: Fifty-five patients in North Wales, UK, were recruited. They were provided a digital video via a weblink to watch before attending CR, explaining the specific exercise duration and intensity targets. After four exercise classes, patients completed a survey about the video’s usefulness in explaining correct exercise methods, their confidence in meeting intensity and duration targets, and their recall of RPE and duration targets. Quantitative data is presented as frequency and percentage of responses. RESULTS: Of the twenty-three patients completing the survey, 47.8% (n=11) found the video extremely useful, and 34.8% (n=8) found it very useful. Overall, 21.7% (n=5) were extremely confident and 43.5% (n=10) were very confident that they were meeting the prescribed exercise targets. However, 34.8% (n=8) failed to recall the correct RPE targets for circuit-based CR exercise and 43.5% (n=10) failed to recall the correct RPE targets for gym-based CR exercise. Additionally, 60.9% (n=14) were unable to accurately recall the prescribed exercise duration targets. CONCLUSION: Despite most patients feeling confident about their understanding of exercise targets, the actual recall of RPE and exercise duration targets was limited, indicating a gap between perceived knowledge and recall. This highlights the need for more effective instructional interventions in CR programmes.

The efficacy of exercise-based cardiac rehabilitation (CR) to improve aerobic fitness and reduce mortality has been questioned, partly due to the insufficient exercise dose (namely frequency of exercise sessions). Lack of frequency of exercise sessions is mainly attributed to staffing and funding limitations, particularly in the UK. Despite a lack of prescribed exercise sessions, it is imperative patients adhere to the prescribed intensity and duration targets. To offset the inadequate time available to instruct CR patients, pre-CR instructional digital videos could inform patients about the prescribed exercise dose (intensity and duration). This may enhance their understanding of exercise targets when commencing CR. PURPOSE: The study evaluated the effectiveness of instructional videos in improving patient recall of targeted rating of perceived exertion (RPE) and exercise duration in a CR setting. METHODS: Fifty-five patients in North Wales, UK, were recruited. They were provided a digital video via a weblink to watch before attending CR, explaining the specific exercise duration and intensity targets. After four exercise classes, patients completed a survey about the video’s usefulness in explaining correct exercise methods, their confidence in meeting intensity and duration targets, and their recall of RPE and duration targets. Quantitative data is presented as frequency and percentage of responses. RESULTS: Of the twenty-three patients completing the survey, 47.8% (n = 11) found the video extremely useful, and 34.8% (n = 8) found it very useful. Overall, 21.7% (n = 5) were extremely confident and 43.5% (n = 10) were very confident that they were meeting the prescribed exercise targets. However, 34.8% (n = 8) failed to recall the correct RPE targets for circuit-based CR exercise and 43.5% (n = 10) failed to recall the correct RPE targets for gym-based CR exercise. Additionally, 60.9% (n = 14) were unable to accurately recall the prescribed exercise duration targets. CONCLUSIONS: Despite most patients feeling confident about their understanding of exercise targets, the actual recall of RPE and exercise duration targets was limited, indicating a gap between perceived knowledge and recall. This highlights the need for more effective instructional interventions in CR programmes.

Sarcopenia, once considered an inevitable consequence of ageing, is now recognised as a complex syndrome influenced by lifestyle, disease, and acute physiological stress. As global life expectancy rises, its prevalence is increasing, straining healthcare systems [1, 2] due to its association with disability, frailty, and comorbidities [3]. Prevalence estimates range from 0.2% to 86.5% depending on diagnostic criteria [4]. While typically studied in older adults, evidence suggests earlier onset, with rates between 8%-36% in those under 60 and 10%-27% in those aged 60 and older [4]. This variability partly reflects classification differences, with the European Working Group on Sarcopenia in Older People (EWGSOP2) [5] defining primary sarcopenia (ageing-related) and secondary sarcopenia (driven by disease, inactivity, or malnutrition), each posing distinct diagnostic challenges.

PURPOSE: To investigate the effects of daily oral L-leucine ingestion on strength, bone mineral-free lean tissue mass (LTM) and fat mass (FM) of free living humans during a 12-wk resistance-training program. METHODS: Twenty-six initially untrained men (n = 13 per group) ingested either 4 g/d of L-leucine (leucine group: age 28.5 ± 8.2 y, body mass index 24.9 ± 4.2 kg/m2) or a corresponding amount of lactose (placebo group: age 28.2 ± 7.3 y, body mass index 24.9 ± 4.2 kg/m2). All participants trained under supervision twice per week following a prescribed resistance training program using eight standard exercise machines. Testing took place at baseline and at the end of the supplementation period. Strength on each exercise was assessed by five repetition maximum (5-RM), and body composition was assessed by dual energy X-ray absorptiometry (DXA). RESULTS: The leucine group demonstrated significantly higher gains in total 5-RM strength (sum of 5-RM in eight exercises) and 5-RM strength in five out of the eight exercises (P < .05). The percentage total 5-RM strength gains were 40.8% (± 7.8) and 31.0% (± 4.6) for the leucine and placebo groups respectively. Significant differences did not exist between groups in either total percentage LTM gains or total percentage FM losses (LTM: 2.9% ± 2.5 vs 2.0% ± 2.1, FM: 1.6% ± 15.6 vs 1.1% ± 7.6). CONCLUSION: These results suggest that 4 g/d of L-leucine supplementation may be used as a nutritional supplement to enhance strength performance during a 12-week resistance training program of initially untrained male participants.

PURPOSE: Evidence suggests acute mountain sickness (AMS) aligns to heart rate variability (HRV) suppression at high altitude. This study explored associations between measures of autonomic cardiac function and AMS scores in normobaric hypoxia (NH) and during ascent to very high altitude in the natural environment. METHODS: Thirty participants (17 male and 13 female, aged 20-62 years) trekked from 2800m to 5350m (Himalaya, Nepal) over 14 days. Short term temporal and spectral measures of HRV were recorded at rest (paced breathing, 12 breaths per minute), in NH (FIO2=0.124, ~4100m) and in hypobaric hypoxia (HH) at 4356m and 5350m, during ascent. RMSSD and 60 second heart rate recovery (HRR60) following stepping exercise (3 min at 50-60% maximal aerobic capacity) were accepted measures of parasympathetic neural activity. The heart rate response (∆HR) to an orthostatic postural challenge (two minutes supine followed by two minutes standing), reflective of sympathetic neural activity, was measured at the same time points (∆HR = HR [peak stand] - HR [mean supine]). AMS diagnosis was confirmed for scores ≥ 5.0 (Lake Louise Survey, LLS) or ≥ 0.70 (Environmental Symptoms Questionnaire, ESQ-c) at least once during the ascent. Institutional ethical approval was gained. RESULTS: Data analysis reflects 24 participants. Eleven (46%) developed AMS. Peak LLS AMS scores ranged between 1-5, 0-10 and 2-11 units in the AMS group at 2800m, 4356m and 5350m respectively, and 0-4 for the non-AMS group. No significant interaction (P=0.161) nor a main effect for altitude (P=0.093) was observed, however a significantly greater LLS score was observed in the AMS group at 5300m (P<0.001). Peak LLS scores at 2800m correlated with RMSSD (NH) (r=.483, P=.020) and at 4300m correlated with RMSSD at 4300m (-.487, P=.025). Postural ∆HR at 2800m correlated significantly with the ESQ-c and peak LLS scores at 4300m (r=-.601, P=.002 and r=-.579, P=.004), and the ∆HR at 4300m correlated with ESQ-c and LLS scores at 4300m (r=.-570, P=.005 and r=-.471, P=.023). HRR60 (NH) correlated with LLS score at 4300 m and peak LLS score at this altitude (r=-.495, P=.026 and r=-.450, P=.047 respectively), CONCLUSION: AMS-susceptible individuals show vagal suppression at high altitude. Vagal measures may be useful indicators for AMS susceptibility at very high altitude.

Sarcopenia and frailty share a dynamic interplay, significantly influencing the quality of life and functionality in older adults. Defined by the progressive loss of muscle mass and strength, sarcopenia often precedes and contributes to frailty—a state marked by heightened vulnerability to adverse health outcomes. Yet, sarcopenia’s progression is also exacerbated by factors associated with frailty, including inflammation, hormonal changes, and impaired nutritional status. Furthermore, the presence of additional comorbidities can amplify the impact of sarcopenia. This chapter explores the intricate relationship between these geriatric syndromes, shedding light on the bidirectional influences that intensify their effects. Importantly, potential interventions designed to mitigate these conditions are discussed. Comprehensive understanding of sarcopenia and frailty’s interconnectedness is pivotal. Such insights pave the way for interventions targeting both conditions simultaneously, aiming to enhance the quality of life and preserve functional independence during the aging process.

Introduction Heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) exhibit unique physiological pathways, influencing exercise capacity and functional performance. This systematic review and meta-analysis aimed to compare peak oxygen consumption (VO2peak), six-minute walk distance (6MWD), cardiac output (CO), and stroke volume (SV), between these phenotypes. Methods A systematic literature search of cohort studies via databases (PubMed, Web of Science, Scopus, and Cochrane Library) was conducted from inception until October 2024. A meta-analysis using a random-effects model to calculate the pooled effects was employed. Results Fourty-six studies were included. HFrEF patients demonstrated significantly greater 6MWD compared to HFpEF (k = 20; mean difference (MD): 18.09 m, 95% confidence interval (CI) 1.59–34.59, I2 = 86%, p = 0.03), though this difference became insignificant after adjusting for comorbidities. Conversely, HFpEF patients exhibited higher VO2peak (k = 20; MD: -0.78 ml/kg/min, 95%CI -1.45 – -0.11, I2 = 89%, p = 0.02), CO (k = 12; MD: -1.15 L/min, 95%CI -2.11 – -0.19, I2 = 97%, p = 0.02), and SV (k = 14; SMD: -1.00, 95%CI -1.60 – -0.39, I2 = 95%, p <0.01). Age was identified as a significant moderator of VO2peak. Conclusion HFpEF patients demonstrated superior VO2peak, CO, and SV compared to HFrEF patients, while the observed 6MWD advantage in HFrEF was likely influenced by comorbidities. Our findings emphasize the importance of tailoring rehabilitation strategies to HF phenotype-specific physiological profiles, particularly focusing on improving VO2peak and cardiac efficiency in HFpEF.

AIM Circulating endothelial progenitor cells (EPCs) are known to play an important role in vascular healing and neovascularization. Exercise is an effective means to mobilise EPCs into the circulation. However, since different modes of exercise are associated with different physiological responses, the mobilisation of EPCs could vary in response to the exercise mode undertaken. Therefore, the purpose of this study was to examine the acute effects of different exercise modalities on EPCs. MATERIAL & METHOD Ten young active healthy adults (24.6 ± 2.1 years) completed three different experimental conditions: a) high intensity interval exercise (HIIE, 4 sets x 4 min at 85-95% HRmax with 3 min recovery at 50-55% HRmax), b) moderate-intensity continuous exercise (MICON, 70-80% HRmax), and c) wholebody resistance exercise (RE), consisting of seated leg press, chest press, leg extension, lateral pull down, upright row, and shoulder press (3 sets of 10 repetitions at 70% of 1RM with 1,5 min of recovery between sets and 3 min between exercises). A venous blood sample was taken pre-exercise, at 10 min post-exercise and at 2 h post-exercise. All laboratory visits took place a week apart, in a randomised cross-over fashion. Circulating EPCs were quantified by flow cytometry and were defined as CD34+/VEGFR2+/CD45dim. After testing for normality of distribution, a Friedman test was used to determinethe differences in percentage change (%) in circulating EPCs between the exercise conditions. Cohen’s d effect sizes were calculated and reported, as appropriate. RESULTS When examining the comparison of % change from pre-exercise to 10 min post-exercise between exercise conditions, there was a moderate difference between HIIE and RE (42.4 ± 17.7% vs 13.1 ± 18.6%, d = 0.51), a small difference between HIIE and MICON (42.4 ± 17.7% vs 20.1 ± 21.2%, d = 0.36), and a trivial difference between MICON and RE (20.1 ± 21.2% vs 13.1 ± 18.6%, d = 0.11). None of these differences was significant (p > 0.05). Comparison of the % changes from pre-exercise to 2 h post-exercise showed a significant difference between the three exercise conditions (p = 0.045). There was a large statistical difference between HIIE and RE (78.5 ± 28.1 % vs –2.0 ± 21.6 %, d = 1.01, p < 0.05), a moderate difference between MICON and RE (48.2 ± 27.5 % vs –2.0 ± 21.6 %, d = 0.64), and a small difference between HIIE and MICON (78.5 ± 28.1 % vs 48.2 ± 27.5, d = 0.35). CONCLUSIONS The level of EPC mobilisation depends on the exercise modality, with more pronounced effects found after HIIE and MICON, compared to RE.

Cancer cachexia (CC) syndrome, a feature of cancer-associated muscle wasting, is particularly pronounced in older patients, and is characterised by decreased energy intake and upregulated skeletal muscle catabolic pathways. To address CC, appetite stimulants, anabolic drugs, cytokine mediators, essential amino acid supplementation, nutritional counselling, cognitive behavioural therapy, and enteral nutrition have been utilised. However, pharmacological treatments that have also shown promising results, such as megestrol acetate, anamorelin, thalidomide, and delta-9-tetrahydrocannabinol, have been associated with gastrointestinal and cardiovascular complications. Emerging evidence on the efficacy of probiotics in modulating gut microbiota also presents a promising adjunct to traditional therapies, potentially enhancing nutritional absorption and systemic inflammation control. Additionally, low-dose olanzapine has demonstrated improved appetite and weight management in older patients undergoing chemotherapy, offering a potential refinement to current therapeutic approaches. This review aims to elucidate the molecular mechanisms underpinning CC, with a particular focus on the role of anorexia in exacerbating muscle wasting, and to propose pharmacological and non-pharmacological strategies to mitigate this syndrome, particularly emphasising the needs of an older demographic. Future research targeting CC should focus on refining appetite-stimulating drugs with fewer side-effects, specifically catering to the needs of older patients, and investigating nutritional factors that can either enhance appetite or minimise suppression of appetite in individuals with CC, especially within this vulnerable group.

BACKGROUND & AIMS: Bronchiectasis is a heterogeneous, chronic respiratory condition, in which the role of nutrition remains unclear and nutritional guidance is lacking. Few studies have explored the role of nutrition in disease management, and little is known about nutritional requirements during periods of stability or metabolic stress. The aim of this study was to characterise nutritional status and intakes in a cohort of patients and identify potential associations with body composition and functional capacity. METHODS: A prospective observational cohort study was undertaken in an adult population (>17 years). Bronchiectasis was confirmed by high-resolution computerised tomography (HRCT). Anthropometric (weight, height, Body Mass Index (BMI), triceps skinfold thickness (TSF), mid upper-arm circumference (MUAC) and mid arm muscle circumference (MAMC)] lung function and nutritional intakes were measured. Results were analysed as a whole and by disease aetiology [primary ciliary dyskinesia (PCD), Idiopathic cause (IC), bronchiectasis in association with asthma and other] and associations tested. RESULTS: In total, 128 participants (65.5% female) completed the study. Median handgrip strength (HGS) in the total sample was only 66.5% (IQR 60.5-89.8) of reference population norms and was low for those with PCD [58.0% (IQR 43.5-70.0))]. Univariate regression indicated that BMI was a statistically significant predictor of lung function in the whole population with HGS and weight identified as statistically significant predictors of lung function in PCD. The total population and each sub-group failed to meet estimated average requirements for energy but exceeded the Reference nutrient intake (RNI) for protein. Vitamin D was consistently <35% of the RNI. CONCLUSION: BMI lay within normal to overweight ranges within the whole population and sub-groups, but masked important functional, body composition and nutritional deficits. This was particularly so within a younger sub-group with PCD, who had impaired muscle function, when compared to other causal and associative diseases.

The primary aim of this narrative review is to evaluate the efficacy of essential amino acid (EAA) supplementation as a strategy to increase dietary protein intake and improve muscle mass, strength and function in older adults. A sufficient daily protein intake is widely recognised to be fundamental for the successful management of sarcopenia in older undernourished adults. In practice, optimising protein intakes in older adults is complex, requiring consideration of the dose and amino acid composition (i.e. a complete EAA profile and abundant leucine content) of ingested protein on a per meal basis, alongside the age-related decline in appetite and the satiating properties of protein. Recent studies in older adults demonstrate that EAA-based supplements are non-satiating and can be administered alongside food to enhance the anabolic properties of a meal containing a suboptimal dose of protein; an effect magnified when combined with resistance exercise training. These findings support the notion that EAA supplementation could serve as an effective strategy to improve musculoskeletal health in older adults suffering from non-communicable diseases such as sarcopenia. Compliance is critical for the long-term success of complex interventions. Hence, aspects of palatability and desire to eat are important considerations regarding EAA supplementation. In conclusion, EAA-based supplements enriched with L-Leucine offer an alternative strategy to whole protein sources to assist older adults in meeting protein recommendations. In practice, EAA supplements could be administered alongside meals ofwith suboptimal protein contentintakes, or alternatively between meals on occasions when older adults achieve their per meal protein intake recommendations.

Background: Sarcopenia is characterised by losses in muscle mass, strength and function. It is a contributing factor to numerous non-communicable diseases and frailty. Screening for sarcopenia typically requires measurements of handgrip strength, functional performance, and skeletal muscle mass. However, available tools do not tend to measure strength of the lower extremities. The aim of this study was to investigate associations between these measures and lower extremity strength with skeletal muscle mass in healthy young and older adults. Methods: Fifty younger (mean ± SD age = 22.7 ± 5.4 years) and 50 older (age = 69.9 ± 4.3 years) individuals received the following measurements after an overnight fast: Skeletal Muscle Index (SMI) derived by dual-energy X-ray absorptiometry, gait speed, handgrip strength (HGS), and unilateral one-repetition maximum (1RM) leg extension strength. Muscle quality (MQ), was also determined as the ratio of grip strength to appendicular lean mass of the upper body. Results: One older female and one older male were pre-sarcopenic and sarcopenic. Upper extremity MQ was below established cutpoints in 21 older participants. SMI was positively associated with upper and lower extremity strength in all groups except older men, and negatively associated with upper extremity MQ in young males. By multiple regression analysis, dominant HGS and dominant leg extension 1RM strength predicted SMI in the complete sample, accounting for 70.3% of the variance (B = 0.469 and 0.421, respectively; P < 0.00001). The equation for SMI is as follows: 4.568 + 0.025 x dominant leg extension 1RM + 0.059 x dominant grip strength. Discussion: Since muscle mass is the foremost variable in determining sarcopenia, we support the inclusion of lower extremity strength testing in addition to that of handgrip strength to enable better prediction of SMI in both older and younger individuals. MQ determination is also recommended since established algorithms may fail to identify individuals with muscle weakness.

Endothelial dysfunction, a key contributor to atherosclerosis, begins early in life and leads to vascular damage. Endothelial progenitor cells (EPCs), primarily derived from the bone marrow, play a crucial role in endothelial repair and vascular health, while reduced EPC levels are associated with cardiometabolic diseases and elevated cardiovascular risk. Exercise is known to improve endothelial health and influence EPC mobilisation. This thesis investigates the effects of various types of exercise on circulating EPCs, and angiogenic and inflammatory responses, through systematic review approaches and analytical methods. The first systematic review focuses on the acute and chronic effects of exercise in patients with cardiovascular and metabolic diseases, showing that EPC mobilisation is influenced by exercise intensity, particularly high-intensity interval exercise (HIIE) and moderate-intensity continuous exercise (MICON), and the clinical condition. Chronic trials revealed that MICON, alone or combined with resistance exercise (RE) or HIIE, enhances resting EPC levels. The second systematic review focuses on the prospective cohort studies in healthy adults. Acute trials found that prolonged exercise, RE, and maximal exercise significantly increased EPCs, while chronic trials demonstrated improvements in both EPC mobilisation and vascular function following HIIE and MICON. The experimental chapter presents a randomised cross-over pilot study in healthy young males, comparing the effects of HIIE, RE, and MICON on EPC mobilisation, angiogenic factors, and inflammatory markers. Although no significant condition-by-time-point interactions were observed (p = 0.249, η²p = 0.145), exploratory analysis revealed a statistically significant difference, with HIIE eliciting a greater acute response in EPC mobilisation compared to RE at the two-hour time point (78.5 ± 88.7% vs. -2.02 ± 68.4%, p = 0.017). Findings should be interpreted cautiously due to the small sample size and limited blood collection points. Strong associations were observed between exercise-induced EPC responses, endothelial function, and cardiometabolic health markers. The final chapter identifies limitations and proposes future research directions, emphasising the variability of EPC responses based on exercise type and individual health status. This thesis provides valuable insights into exercise as a mechanism to enhance EPC mobilisation and supports its role in cardiovascular health interventions. Future research involving diverse populations is needed to determine optimal exercise protocols for EPC enhancement.

Rationale: Inadequate protein intake (PI), the main source of essential amino acids (EAAs), and reduced appetite are contributing factors to age-related sarcopenia. The satiating effects of dietary protein may negatively affect energy intake (EI), thus there is a need to explore alternative strategies to facilitate PI without compromising appetite and subsequent EI. Methods: Elderly women completed two experiments (EXP1&2) where they consumed either a Bar (B, 135 kcal) or a Gel (G, 114 kcal), rich in EAAs (7.5 g, 40% L-Leucine), or nothing [control (C)]. In EXP1, subjects (n=10, 68±5 years, mean±SD) consumed B, G or C with appetite sensations and appetite-related hormonal responses monitored for 1h, followed by consumption of an ad libitum breakfast (ALB). In EXP2, subjects (n=11, 69±5 years) ingested B, G or C alongside an ALB. Results: In EXP1, EI at ALB was not different (P=0.674) between conditions (282±135, 299±122, 288±131 kcal for C, B and G respectively). However, total EI was significantly higher in B and G compared to C after accounting for the energy content of the supplements (P<0.0005). Analysis revealed significantly higher appetite Area under the Curve (AUC) (P<0.007), a tendency for higher acylated ghrelin AUC (P=0.087), and significantly lower pancreatic polypeptide AUC (P=0.02) in C compared with B and G. In EXP2, EI at ALB was significantly higher (P=0.028) in C (306±122 kcal) compared to B (245±135 kcal) and G (254±118 kcal). However, total EI was significantly higher in B and G after accounting for the energy content of the supplements (P<0.007). Conclusion: Supplementation with either the bar or gel increased total energy intake whether consumed 1h before or during breakfast. This may represent an effective nutritional means for addressing protein and total energy deficiencies in elderly women.

We appreciate the opportunity to respond to the comments raised by Silva and Cipriano [1] regarding our recently published systematic review and meta-analysis on acute sarcopenia [2]. Constructive discussions such as this help clarify methodological considerations and enhance scientific understanding. Firstly, regarding knee extensor strength measurement, Silva and Cipriano [1] note that our review stated their study [3] did not assess knee extensor strength. We acknowledge that they measured strength using neuromuscular electrical stimulation to evoke peak force. However, our review excluded studies using electrically evoked contractions, as voluntary contractions are the recognised standard for sarcopenia assessments. This exclusion criterion was applied consistently across all studies, ensuring methodological alignment. Although we did not explicitly state this in our inclusion/exclusion criteria, we appreciate the opportunity to clarify this point. To further justify our stance on excluding this, we would like to highlight conclusions from Jenkins et al. [4] who acknowledged that voluntary and evoked contractions offer unique information to each other and should not be used interchangeably. Secondly, with reference to the sample size inclusion, we included only the control group from Silva et al.'s study, as per our inclusion criteria that specified that only control groups from intervention studies would be included. Although their total sample size was 60 participants, we reported only the control group (n = 30) as our review focused on muscle changes during hospitalisation independent of interventions. We acknowledge that this distinction could have been stated more clearly. We respectfully disagree with the claim that our review contains inaccuracies that could compromise the integrity of the scientific record. Our methodological decisions were carefully considered, transparent, and aligned with standard sarcopenia assessment practices. The exclusion of electrically evoked contraction measures was a deliberate methodological choice, as voluntary contractions are the established standard. Although this criterion was not explicitly outlined in our inclusion/exclusion criteria, it reflects a methodological decision rather than an inaccuracy. We appreciate the opportunity to clarify this and believe our approach remains clear to researchers familiar with standard assessment methods. We thank Silva et al. for their engagement and the opportunity to address these points.

Circulating endothelial progenitor cells (EPCs) contribute to vascular healing and neovascularisation, while exercise is an effective means to mobilise EPCs into the circulation. Objectives: to systematically examine the acute and chronic effects of different forms of exercise on circulating EPCs in healthy populations. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Results: Thirty-one articles met the inclusion criteria including 747 participants aged 19 to 76 years. All included trials used flow cytometry for identification of circulating EPCs. Eight and five different EPC phenotypes were identified in the acute and chronic trials respectively. In the acute trials, moderate intensity continuous (MICON), maximal, prolonged endurance, resistance and high intensity interval training (HIIT) exercise protocols were utilised. Prolonged endurance and resistance exercise had the most profound effect on circulating EPCs followed by maximal exercise. In the chronic trials, MICON exercise, HIIT, HIIT compared to MICON and MICON compared to exergame (exercise modality based on an interactive video game) were identified. MICON exercise had a positive effect on circulating EPCs in older sedentary individuals which was accompanied by improvements in endothelial function and arterial stiffness. Long-stage HIIT (4min bouts) appears to be an effective means and superior than MICON exercise in mobilising circulating EPCs. In conclusion, both in acute and chronic trials the degree of exercise-induced EPC mobilisation depends upon the exercise regime applied. In future, more research is warranted to examine the dose-response relationship of different exercise forms on circulating EPCs using standardised methodology and EPC phenotype.

Background/aims: The primary aim of this study was to evaluate the effectiveness of two 30-minute dietary education sessions, within cardiac rehabilitation (CR), as a means to optimise nutrient and energy intakes (EI). A secondary aim was to evaluate patients’ habitual physical activity (PA) levels. Methods: Thirty patients (males: n = 24, 61.8 ± 11.2 years; females: n = 6, 66.7 ± 8.5 years) attended a six-week early outpatient CR programme in the UK and received two 30-minute dietary education sessions emphasising Mediterranean diet principles. EI and nutrient intakes were measured through completion of three-day food diaries in weeks one and six (before and after the dietary education sessions) to assess the impact of these sessions on nutrient intakes. At the same time-points, a sub-group (n = 13) of patients had their PA levels assessed via accelerometery to assess the impact of the CR programme on PA. Findings: Estimated energy requirements (EER) at week one (1988 ± 366 kcal . d -1 ) were not matched by actual EI (1785 ± 561 kcal . d -1 ) ( P = 0.047, d = -0.36). EI reduced to 1655 ± 470 kcal . d -1 at week six ( P = 0.66, d = -0.33) whereas EER increased as a function of increased activity (CR sessions). Nutrient intakes remained suboptimal, while no significant increases were observed in healthy fats and fibre, which consist core elements of a Mediterranean diet. Statistically significant increases were not observed in PA however patients decreased sedentary time by 11 ± 12% in week six compared to week one ( P = 0.009; d = -0.54). Conclusion : The present study findings suggest that two 30-minute dietary education sessions did not positively influence EI and nutrient intakes, while habitual PA levels were not significantly increased as a result of the CR programme. Future research should explore means of optimising nutrition and habitual PA within UK CR.

Background It is widely agreed that an increase in physical activity (PA) reduces mortality rates in cardiac rehabilitation (CR) patients. However, it is not known whether current standard CR training practices facilitate an increase in habitual PA. Therefore, the purpose of this study was to objectively measure PA levels in CR patients, both habitually and within structured CR sessions Design Observational study Methods Twenty patients were recruited during their CR pre assessment. Exclusion criteria included valve replacement and heart failure patients. Activity levels were assessed by waist-worn tri-axial accelerometry during the first and last week of a 6 week CR programme. Paired samples t-test and Wilcoxon signed rank tests were performed to identify changes in PA levels. Results Patients increased significantly light PA during the CR sessions compared to habitual PA levels outside CR (20 ± 11minutes versus 26 ± 8minutes, p=0.043). During week 6, patients also increased significantly the time spent in moderate and vigorous physical activity (MVPA) during the CR sessions when compared to week one (6.3 ± 6minutes versus 11 ± 7 minutes, p=<0.05) for moderate and vigorous intensities respectively. No changes were observed in PA levels outside the CR sessions. Conclusion Towards the end of the CR programme, a significant increase in the time spent in MVPA during formal CR sessions was not accompanied by an increase in habitual PA levels. Therefore, future CR programmes should place more emphasis on facilitating an increase in habitual PA.

Since the publication of the first systematic review in the late 1980s,1 the efficacy rationale for cardiac rehabilitation (CR) has evolved from a singular outcome of allcause mortality to additional multiple outcomes including cardiac mortality, quality of life, cardiorespiratory fitness (CRF), and cost savings in the form of preventing hospital readmissions.2 In the past decade, the case for the efficacy of reduced all-cause mortality has been challenged,3,4 but two questions arise around this matter: first, has some of the effective potency of exercise-based CR been lost due to modern cardiovascular health promotion and standards of medical, pharmacological, and surgical interventions being much improved5? Second, in research trials and in practice, has sufficient fidelity to an appropriate exercise dose been achieved, especially in those reports that have challenged the efficacy of CR4? In light of these questions, there has been a contemporary move to substantiate the efficacy of CR based on reduced hospital readmissions, health care costs, and quality of life.2 Given that a number of reviews, letters to editors, post hoc trials, and audit-data analyses have raised the question of exercise program dose fidelity,6,7 the aim of the current study was to investigate the influence of exercise fidelity on measures of CRF (incremental shuttle-walk test and heart rate walking speed index [HRWSI]) when patients were actively encouraged to achieve intensities >50% heart rate reserve (HRR).

Introduction: It is widely believed that ‘strength-type’ (STR) resistance training (RT) is a more effective way of improving maximal strength than ‘hypertrophy-type’ RT (HYP) however, research comparing these training methods is far from unequivocal (Nicholson et al., 2014). Furthermore, cluster training (CL) challenges the traditional way in which strength training sessions are designed although there is a paucity of research into this approach. Our main objective was to compare the adaptations resulting from STR, HYP and CL training over a 6 week period involving the back squat. Methods: 46 trained males (age: 21.8 ± 2.6 years; height: 178.0 ± 6.3cm; mass: 81.1 ± 8.8kg) were matched according to one repetition maximum [1RM] strength before being randomly assigned to one of 4 groups: a) STR: 4x6 reps, 85% 1RM, 900s total rest; b) HYP: 5x10 reps, 70% 1RM, 360s total rest; c) CL-1 4x6 reps, 85% 1RM, 1400s total rest; d) CL-2: 4x6 reps, 90% 1RM, 1400s total rest. Physiological and mechanical variables were measured before, during and after the workouts to investigate the acute training stimulus whilst similar techniques were employed before, during and after a 6 week intervention (2 sessions per week) to investigate the training effects. The findings were analysed using a two-way mixed ANOVA with significance set at p<0.05. Results: From an acute perspective, the STR and HYP workouts resulted in significantly greater reductions in repetition quality than the CL workouts (p<0.05). Furthermore, the STR and HYP workouts showed significant post-exercise elevations in blood lactate concentration (p<0.001). In terms of chronic responses, all four groups elicited significant increases (8-13%; p<0.001) in 1RM strength after training; however, the 1RM improvements were significantly greater for the STR (12.1 ± 2.8%; p<0.05) and CL-2 (13.2 ± 2.2%; p<0.001) groups than the HYP group (8.1 ± 2.5%). Increases in isometric peak force, rate of force development, muscle activity and jump height were not significantly different between groups. Discussion: The STR and CL-2 regimens represented the most favorable means of improving maximal strength. The effectiveness of the STR and CL-2 regimens underlines the importance of longer time under tension and greater impulse generation for strength development but does not support the importance of higher velocities which are often used to signify repetition quality. The findings highlight that CL regimens can offer similar performance enhancements to STR regimens so the decision as to which approach should be use lies with coaches.

It is well established that the inclusion of intra-set rest intervals during cluster-type (CL) resistance exercise enhances both repetition quality and volume-load during training sessions. Although previous CL research has been conducted into different repetition-rest combinations, no study has considered the activity of an individual during intra-set rest intervals. Since it has been shown that the prescription of active inter-set rest intervals during resistance exercise allows a greater number of repetitions (Corder et al., 2000, Journal of Strength & Conditioning Research, 14,151-156), this study examined the impact of active rest on the acute neuromuscular responses to CL resistance exercise. With institutional ethical approval, eight trained males (age: 19.38 ± 1.06 years; height 1.82 ± 0.06m; body mass: 88.1 ± 9.08kg) completed two resistance exercise sessions in a randomised cross-over design separated by at least 48 hours recovery. The passive (PASS) workout involved 3 sets of 8 5s maximal isometric knee extensions with 3 minutes of seated rest between sets and 15s of rest after every 4 repetitions. The active (ACT) workout was identical apart from participants performing active recovery on a stationary ergometer (40W) during all rest intervals. Participants completed three countermovement jumps (CMJ’s) on a force platform (Kistler; 1000 Hz) and three isometric knee extensions (100o knee flexion) attached to a force platform (1000 Hz) pre- and post-workout. A range of kinetic and performance variables were then calculated for the CMJ (e.g. jump height, peak power) and knee extension (peak force [PF], rate of force development) using Bioware software (Version 5.1.3). In addition, root mean square (RMS) activity (1000 Hz) of the knee extensors was recorded (Delsys, USA) before, during and after the workouts as well as the force output of each repetition. A repeated measures ANOVA and subsequent paired t-tests with Bonferroni correction showed a significantly greater (P < 0.01) reduction in PF at post-workout for PASS (-21.25 ± 5.45%) than ACT (-12.39 ± 3.43%). There were also significant reductions (P < 0.01) in PF throughout the PASS workout and a larger post-exercise reduction in RMS activity (45.2%) than that observed for ACT (22.2%). The findings highlight that performance during CL sessions may be further enhanced through the inclusion of active intra-set recovery. Coaches should therefore be mindful that the mode of recovery is an additional consideration when aiming to optimise repetition quality and volume-load during CL resistance exercise.

Purpose: The purpose of this study was to examine the acute and chronic training responses to strength-, hypertrophy- and cluster-type resistance training. Methods: Thirty four trained males were assigned to a strength (STR: 4 x 6 repetitions, 85% of one repetition maximum, [1RM], 900s total rest), hypertrophy (HYP: 5 x 10 repetitions, 70% 1RM, 360s total rest), cluster 1 (CL-1: 4 x 6/1 repetitions, 85% 1RM, 1400s total rest), and cluster 2 (CL-2: 4 x 6/1 repetitions, 90% 1RM, 1400s total rest) regimens which were performed twice weekly for a 6 week period. Measurements were taken before, during and following the four workouts to investigate the acute training stimulus, whilst similar measurements were employed to examine the training effects before and after the intervention. Results: The improvements in 1RM strength were significantly greater for the STR (12.09 ± 2.75%; p<0.05, d=1.106) and CL-2 (13.20 ± 2.18%; p<0.001, d=0.816) regimens than the HYP regimen (8.13 ± 2.54%, d=0.453). In terms of the acute responses, the STR and CL-2 workouts resulted in greater time under tension (TUT) and impulse generation in individual repetitions than the HYP workout (p<0.05). Furthermore, the STR (+3.65 ± 2.54mmol/L-1) and HYP (+6.02 ± 2.97mmol/L-1) workouts resulted in significantly greater elevations in blood lactate concentration (p<0.001) than the CL-1 and CL-2 workouts. Conclusion: CL regimens produced similar strength improvements to STR regimens even when volume-load was elevated (CL-2). The effectiveness of the STR and CL-2 regimens underlines the importance of high loads and impulse generation for strength development.

This study aimed to examine a wide profile of acute biochemical and neuromuscular responses to strength (STR) and hypertrophy (HYP) resistance exercise (RE). Seven trained men completed an STR workout (4 × 6 repetitions, 85% 1 repetition maximum [1RM], 5-minute rest periods), an HYP workout (4 × 10 repetitions, 70% 1RM, 90-second rest periods), and a control condition (CON) in a randomized crossover design. Peak force (PF), rate of force development (RFD), and muscle activity were quantified before and after exercise during an isometric squat protocol. Blood samples were taken 20, 10, and 0 minutes before and 0, 10, and 60 minutes after exercise to measure the concentration of blood lactate (BL), pH, and a number of electrolytes that were corrected for plasma volume changes. No differences were observed between the workouts for changes in PF, RFD, or muscle activity. Repeated contrasts revealed a greater (p ≤ 0.05) increase in BL concentration and reduction in pH after the HYP protocol than the STR or CON conditions. There were similar but significant (p ≤ 0.05) changes in the concentration of a number of electrolytes after both workouts, and a handful of these changes displayed significant correlations with the PF reductions observed after the HYP condition. Although the STR and HYP workouts were significantly different in terms of intensity, volume, and rest, these differences were only observable in the acid-base responses. The present findings reinforce the need for practitioners to look beyond the classification of RE workouts when aiming to elicit specific physiological responses.

Background: Limited empirical evidence exists which has direct translation for nutrition practitioners working with team sport athletes. Furthermore, given the lack of rugby specific nutrition recommendations, it is important to provide a framework on the requirements of players in order to enhance the standard of nutritional practice in rugby. The primary aim of this research was to develop an expert consensus on optimum nutritional practices of rugby players. Methods: To obtain expert opinion, a Delphi Poll was implemented; this survey technique allows a consensus to be established where information is currently contradictory or insufficient (1). Following ethics approval, seven expert nutrition practitioners from across the United Kingdom (UK) and Ireland were recruited for the study. Practitioners were required to have at least two years continuous experience in professional rugby clubs. All recruited practitioners had at least three years elite experience and were working with international rugby teams at the time of data collection. During the initial stage of the research, three of the UK national nutrition leads were invited to participate in standardised open-ended interviews. A total of 359 statements, divided into 20 topic areas were generated from these interviews and were included in the first round of voting in the Delphi poll. Using a 5-point likert scale, all practitioners selected their level of agreement with the statements from strongly disagree to strongly agree. For a statement to be agreed upon as good practice, 75% of the practitioners were required to vote in agreement. Statements which were not agreed upon were recirculated for the second round of voting. During the first round of voting, all practitioners were invited to provide additional statements for inclusion in the final round. Results: Following the two rounds of voting a total of 201 statements were agreed upon, an indicative sample is provided below: Practitioners encouraged estimating energy needs from lean body mass measures but recommended that caution should be exerted when using predictive equations with rugby players. Recording dietary intakes should be done so with caution with additional supporting quality control measures adopted. High protein intakes (>2 g. kg. BM-1 ) are deemed acceptable by practitioners provided other nutrient consumption is not compromised. There appears to be varied practices in carbohydrate consumption across playing positions, and often players may sacrifice carbohydrate intake for body composition goals. Body composition is a primary driver for the rugby player, however influencing factors of vanity and body image play a large role which may compromise them as a rugby player. Social media has increased interest in food and can be used as an educational tool, however sometimes players receive inappropriate information. A trackable system of supplement use should be in place and any supplementation protocols implemented should have an evidence basis. Practitioners should always have an alternative food strategy to any supplements used. All supplement strategies should be assessed throughout the season for psychological and physiological variation and it is important to be aware of the large influence senior players have over young players regarding supplement use. Finally, a key message was that even in a team sport setting it is important to acknowledge that responses to nutrition and training are highly individual and variable. Despite obtaining much agreement in appropriate practices, a relatively high level of disparity in opinion occurred in the areas of fat intake, recovery and nutrition for supporting illness. Discussion: While current research in rugby nutrition is developing, this Delphi Poll study presents a unique approach to conducting research in the field of applied sport and exercise nutrition. These statements will facilitate expert practitioners in moving towards a consensus regarding optimum nutritional strategies for the rugby player. This research can be utilised by new or developing practitioners, while an empirical evidence base is being established. Conclusion: As well as providing a consensus, the present study highlights areas where practitioners should exercise caution regarding recommendations, as more research is required to help inform their practice. References: 1. Hasson F, Keeney, S, McKenna, H. Research guidelines for the Delphi survey technique, Journal of Advanced Nursing 2000; 32 1008-1015.

Throughout a rugby league (RL) season players are exposed to a high volume of competitive fixtures. Cumulative loads and inadequate nutrition may supress immune function, which would have negative consequences for health and performance. As no study has monitored immune function and dietary intake throughout a RL season, the aim of the study was to identify the pattern of dietary intake and critical time points where immune function and selected performance monitors are compromised. Following ethics approval, 20 male volunteer professional RL players (25.4±3.2 y, 98.2±8.4 kg) were monitored the day prior to a competitive fixture for 25 weeks of the season. Weekly changes in neuromuscular function (CMJ), wellbeing (5-point questionnaire), training loads (sRPE), salivary testosterone (sTest) and immunoglobulin A (sIgA) were recorded. Dietary intake (4-day food diary) was assessed at the start, middle and end of the season. Changes from the overall mean were inferred via Cohen’s d effect sizes using means and standard deviations which were calculated from a linear mixed model to account for missing data. Moderate increases in training load occurred in weeks 3, 5, 9, 10, 12 and 20 and a very large increase occurred in week 21. Moderate decreases in CMJ flight time occurred in week 14 and small decreases occurred in weeks 6, 7, 20, 22, 24, 25. For all wellbeing parameters small decreases occurred in weeks 7 and 17 with small increases in stress, soreness and fatigue also occurring in week 20. Mean sTest was 119.8±55.5 pg.ml-1 with small declines occurring in week 7, 10, 13, 20 and 22. Overall sIgA concentrations ranged from 1.03-1.18 µg.min-1, but compared to the overall mean (1.12 ± 0.17 µg.min-1) small decreases were observed in weeks 6, 9, 16, 21, 23, 24. Dietary intakes were consistent during the recording periods with mean energy intake ranging from 2811-3149 kcal.day-1. Carbohydrate, protein, and fat intakes ranged from 2.9-3.2 g.kg.BM-1, 2.0-2.1 g.kg.BM-1, and 1.1-1.4 g.kg.BM-1 respectively. The findings suggest that a consistent intake throughout a competitive season did not prevent reductions in immune function and selected performance monitors. Further research to develop appropriate periodised nutritional strategies to maintain immune function and support player health and performance is needed.

PURPOSE: This study evaluated the impact of passive and active intermittent hypoxic (IH) exposure pre-acclimatization strategies on temporal and spectral power measures of heart rate variability (HRV) in normobaric hypoxia (NH), and natural altitude. METHODS: Thirty participants (17 male and 13 female, aged 20-62 years), matched by sex, age and maximal aerobic capacity (VO2peak), were randomly allocated to either a control, passive IH or active IH group. Experimental groups completed 10 x 2-h, passive (PIH) or active (AIH), normobaric IH exposures (FIO2 = 0.124, ~4,011 m) over the 14-day intervention period (weekends excluded). The control group received no IH exposure. During the intervention period, participants completed 20 minutes daily running training, at an individualised intensity equivalent to 80% heart rate reserve (HRR). Training workload was determined by regressing HR and running speed data from individual VO2peak tests in normal ambient conditions (control and PIH groups) or NH (AIH group, FIO2 = 0.124). AIH participants completed the exercise training sessions under supervision, during scheduled IH exposure sessions, while control and PIH groups completed training unsupervised in normal ambient conditions. Within 48 hours of completing pre-acclimatization, participants travelled by air from the UK to Nepal, a journey time of approximately 36 hours. Participants then trekked from 2800 m to 5300 m over 14 days. Temporal (RR, SDNN, RMSSD) and spectral power measures (LFnu, HFnu and LFHF ratio) of HRV were recorded, at rest with spontaneous breathing, in normal ambient conditions (FIO2 = 0.209), NH (FIO2 =0.124, ~4011 m) and in hypobaric hypoxia (HH) at 4356 m and 5350 m, during ascent. RESULTS: Two-way ANOVA (group x condition) with repeated measures revealed neither significant interactions (P>0.05), nor between-group (P>0.05) nor within-group (P>0.05) differences for temporal or power spectral HRV measures between baseline, pre-IH and post-IH. No significant interactions, between-group or within-group changes were noted between post-IH, 4300 m and 5300 m (P>0.05) natural altitude. CONCLUSION: Pre-acclimatization using active and passive intermittent hypoxic exposure did not significantly alter heart rate variability responses during ascent to very high altitude.

PURPOSE: This study evaluated the impact of passive and active intermittent hypoxic (IH) exposure pre-acclimatization strategies on temporal and spectral power measures of heart rate variability (HRV) in normobaric hypoxia (NH), and natural altitude. METHODS: Thirty participants (17 male and 13 female, aged 20-62 years), matched by sex, age and maximal aerobic capacity (VO2peak), were randomly allocated to either a control, passive IH or active IH group. Experimental groups completed 10 x 2-h, passive (PIH) or active (AIH), normobaric IH exposures (FIO2 = 0.124, ~4,011 m) over the 14-day intervention period (weekends excluded). The control group received no IH exposure. During the intervention period, participants completed 20 minutes daily running training, at an individualised intensity equivalent to 80% heart rate reserve (HRR). Training workload was determined by regressing HR and running speed data from individual VO2peak tests in normal ambient conditions (control and PIH groups) or NH (AIH group, FIO2 = 0.124). AIH participants completed the exercise training sessions under supervision, during scheduled IH exposure sessions, while control and PIH groups completed training unsupervised in normal ambient conditions. Within 48 hours of completing pre-acclimatization, participants travelled by air from the UK to Nepal, a journey time of approximately 36 hours. Participants then trekked from 2800 m to 5300 m over 14 days. Temporal (RR, SDNN, RMSSD) and spectral power measures (LFnu, HFnu and LFHF ratio) of HRV were recorded, at rest with spontaneous breathing, in normal ambient conditions (FIO2 = 0.209), NH (FIO2 = 0.124, ~4011 m) and in hypobaric hypoxia (HH) at 4356 m and 5350 m, during ascent. RESULTS: Two-way ANOVA (group x condition) with repeated measures revealed neither significant interactions (P>0.05), nor between-group (P>0.05) nor within-group (P>0.05) differences for temporal or power spectral HRV measures between baseline, pre-IH and post-IH. No significant interactions, between-group or within-group changes were noted between post-IH, 4300 m and 5300 m (P>0.05) natural altitude. CONCLUSION: Pre-acclimatization using active and passive intermittent hypoxic exposure did not significantly alter heart rate variability responses during ascent to very high altitude.

Cross-sectional studies in younger adults have demonstrated a positive association between energy intake (EI) and fat-free mass (FFM), with this relationship seemingly mediated by resting metabolic rate (RMR). Establishing a causal effect longitudinally would be prudent in older adults suffering from loss of appetite. We investigated the effects of FFM on RMR, appetite and EI in 39 healthy older adults (age: 66 ± 4 years, BMI: 25.1 ± 3.5 kg·m2) assigned to either 12-week resistance training + protein supplementation group (RT + PRO) or control group (CON). Body composition, subjective appetite, leptin, insulin, RMR and laboratory-measured ad libitum EI were measured at baseline, weeks 6 and 12 of the intervention, while daily EI at baseline and week 12. FFM (+1.2 kg; p = 0.002), postprandial subjective appetite (+8 mm; p = 0.027), ad libitum EI (+119 kcal; p = 0.012) and daily EI (+133 kcal; p = 0.010) increased from baseline to week 12 in the RT + PRO. RMR, fasted subjective appetite, leptin and insulin concentrations remained unchanged (all p > 0.05). The increases ad libitum EI correlated with increases in FFM (r = 0.527, p = 0.001), with 54% of the change in EI attributed to FFM changes. In conclusion, FFM increases were associated with an increased ad libitum EI and postprandial appetite in older adults.

The objective of the study was to investigate the impact of static and dynamic stretching singularly or combined within a warm-up on a soccer-specific intermittent protocol (SSIP). Seven semi-professional players aged 21.9(±2.0) years old [height 181.5(±9.4) cm, body mass 74.8(±6.4) kg] following screening and ethical approval, completed a VO2max test and were familiarised with the SSIP. Within a 3-week period, participants undertook 3 different warm-ups, before completing the SSIP, consisting of three bouts of exercise with a 15-min recovery after the 2nd bout to simulate a soccer match. After the 3rd bout participants completed an intermittent time to exhaustion test (ITTE). Warm-ups consisted of 5-min activity, then 10-min of Static Stretches (SS), Dynamic Stretches (DS) and SS+DS (SS-DS) in a randomised-crossover order. Core temperature (Tc) and VO2 were recorded throughout. Testing took place in an environmental chamber, replicating UK conditions (9°C, 50% relative humidity). ITTE was 8.2(±2.3), 9.0(±4.6), and 10.7(±5.9) min for the SS, DS and SS-DS groups. Tc in the SS-DS (38.4±0.3°C) was higher (P<0.05) than the SS (37.9±0.4°C) during the 1st ITT bout. Tc was 38.3(±0.6)°C for the DS condition. Differences in Tc during the first two bouts disappeared in the 3rd. Participants in the DS (78±9.5%) and SS-DS (76.3±15.1%) exercised at a lower (P<0.05) %VO2max than the SS (83.0±15.4%). Combining SS and DS is more beneficial than SS alone during a warm-up, and may be more beneficial than DS alone. A second warm-up is necessary as benefits associated with the initial warm-up dissipate during the half-time break.

Aflatoxin contamination poses a significant risk to all nuts, including pistachios, during harvest, storage, and processing. Dietary exposure to aflatoxins can lead to severe toxic and carcinogenic effects in humans. To safeguard human and animal health, aflatoxin legislation sets maximum permissible levels for aflatoxins in food products, including pistachios. Consequently, imported pistachios undergo rigorous aflatoxin contamination testing. Traditional methods for measuring aflatoxin levels, such as High-Performance Liquid Chromatography (HPLC), HPLC with Mass Spectrometry, and Enzyme-Linked Immunosorbent Assay (ELISA), although precise, are destructive, costly, and time-consuming. This paper investigates the application of emerging technologies, including Hyperspectral Imaging, Chromatographic Test Strips, Luminescent Metal-Organic Frameworks, spectroscopic methods, machine vision, and advanced artificial intelligence models, to develop a non-intrusive, real-time system for aflatoxin detection in pistachio nuts. Additionally, it outlines a comprehensive strategy to protect public health, mitigate economic losses estimated at \$932 million annually, and sustain the pistachio industry.

Aflatoxin contamination in pistachios, caused by Aspergillus flavus and Aspergillus parasiticus, poses significant risks to food safety and global trade due to its carcinogenic properties. This review examines traditional detection methods such as High-Performance Liquid Chromatography and Enzyme-Linked Immunosorbent Assay. Although these techniques are highly precise, they are costly, destructive, and impractical for smallholder farmers. Emerging nondestructive technologies enable rapid, accurate detection without destroying the sample, particularly when Hyperspectral Imaging (HSI) is combined with machine learning. Regulatory thresholds such as the European Union (EU) 8 µg/kg limit for AFB1 create challenges for producers and exporters, especially since HSI methods often lack the precision required for validated quantitative regression at this level on naturally contaminated pistachio kernels. High implementation costs, limited regulatory guidance, and calibration demands hinder its adoption. Climate change heightens contamination risks, calling for predictive models that integrate HSI with environmental data. To support equitable access, especially for smallholder farmers, reducing costs, standardizing protocols, and enhancing global cooperation are essential. These measures will strengthen food safety and regulatory compliance in pistachio production.

Circulating endothelial progenitor cells (EPCs) contribute to vascular repair and their monitoring could have prognostic clinical value. Exercise is often prescribed for the management of cardiometabolic diseases, however, it is not fully understood how it regulates EPCs. Objectives: to systematically examine the acute and chronic effects of different exercise modalities on circulating EPCs in patients with cardiovascular and metabolic disease. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Results: Six electronic databases and reference lists of eligible studies were searched to April 2021. Thirty-six trials met the inclusion criteria including 1,731 participants. Acute trials: In chronic heart failure (CHF), EPC mobilisation was acutely increased after high intensity interval or moderate intensity continuous exercise training, while findings were inconclusive after a cardiopulmonary cycling exercise test. Maximal exercise tests acutely increased EPCs in ischaemic or revascularized coronary artery disease (CAD) patients. In peripheral arterial disease (PAD), EPC levels increased up to 24h post-exercise. In patients with compromised metabolic health, EPC mobilisation was blunted after a single exercise session. Chronic trials: In CHF and acute coronary syndrome, moderate intensity continuous protocols, with or without resistance exercise or calisthenics, increased EPCs irrespective of EPC identification phenotype. Findings were equivocal in CAD regardless of exercise mode, while in severe PAD disease EPCs increased. High intensity interval training increased EPCs in hypertensive metabolic syndrome and heart failure reduced ejection fraction. Conclusion: the clinical condition and exercise modality influence the degree of EPC mobilisation and magnitude of EPC increases in the long term.

BACKGROUND/OBJECTIVES: Adequate protein intake is essential to retaining muscle and maintaining physical function, especially in the elderly, and L-Leucine has received attention as an essential amino acid (EAA) that enhances protein retention. The study's aim was to compare the efficacy of EAA mixtures on lean tissue mass (LTM) and functional performance (FP) in a healthy elderly population. SUBJECTS/METHODS: Thirty-six subjects (65-75 years) volunteered to receive capsules with EAAs (Groups A and B containing 20% and 40% L-Leucine, respectively) or placebo (lactose containing 0% L-Leucine, Group C) for 12 weeks. The daily amount ranged from 11 to 21 g (0.21 g/ kg/day) and was taken in two equal dosages alongside food, morning and evening. Main outcomes measured before and after intervention were LTM and FP (30-s arm-curl test; 30-s chair-stand test (30-CST); 6-min walk test (6-WT); and handgrip strength). Secondary outcomes included dietary intakes and physical activity. RESULTS: Twenty-five subjects (11 male and 14 female) completed the study (Group A, n=8; Group B, n=8; Group C, n=9). Gains associated with medium effect sizes were noted in LTM (Group B, 1.1 ±1.1%, P=0.003) and FP (Group A in 30-CST (11.0±11.5%, P=0.02) and 6-WT (8.8±10.0%, P=0.02); Group B in 6-WT (5.8±6.6%, P=0.03) and a trend in 30-CST (13.2±16.0, P=0.06)). Significant differences between groups were not observed in secondary outcomes. CONCLUSIONS: Twice-daily supplementation of EAAs containing 20% or 40% L-Leucine improved aspects of functional status and at the higher level improved LTM. Further work to establish change in a larger sample and palatable supplemental format is now required.European Journal of Clinical Nutrition advance online publication, 17 June 2015; doi:10.1038/ejcn.2015.91.

Background: multiple sclerosis (MS) is associated with reduced bone and muscle strength and function. We aimed to investigate the effectiveness of a 24-week intervention in a 57-year-old frail female with MS. Methods: the participant completed a 2x/week exercise intervention and ingested 2x/day a supplement containing 7.5 g essential amino acids and 500IU cholecalciferol. Body composition, 6-m gait speed (GS), handgrip strength (HGS), 30-sec arm-curl test (30ACT), 6-min walking test (6MWT), 30-sec chair-stand test (30CST), and plasma concentrations of 25-hydroxyvitamin D3 [25(OH)D3], insulin-like growth factor 1 (IGF-1), and amino acids were assessed at baseline, and at weeks 12 and 24. Results: plasma 25(OH)D3 increased from 23.2 to 41.3ng/mL and IGF-1 from 131.6 to 140.7ng/mL from baseline to post-intervention. BMI, total lean tissue mass (LTM), fat mass, bone mineral content, and the sum of 17 amino acids increased by 3.8, 1.0, 3.5, 0.2, and 19% respectively at week 24. There were clinically significant increases in regional LTM (6.9% arms and 6.3% legs) and large increases in GS (67.3%), dominant HGS (31.5%), non-dominant HGS (11.8%), dominant 30ACT (100%), non-dominant 30ACT (116.7%), 6MWT (125.6%), and 30CST (44.4%). Conclusions: the current intervention was effective in improving components of physical fitness and body composition in a female with MS.

Purpose: This pilot study investigated differences in lean tissue mass, muscle strength, muscle quality (strength per unit of muscle mass; MQ), and functional performance in healthy younger and older individuals. The most robust predictors of appendicular lean mass (ALM) were then determined in each group.

Background: Acute sarcopenia is sarcopenia lasting less than six months, typically following acute illness or injury. It may impact patient recovery and quality of life, advancing to chronic sarcopenia. However, its development and assessment remain poorly understood, particularly during hospitalisation. This systematic review aimed to elucidate the incidence of acute sarcopenia and examine changes in muscle parameters during hospitalisation. Methods: Eighty-eight papers were included in the narrative synthesis; 33 provided data for meta-analyses on the effects of hospitalisation on handgrip strength (HGS), rectus femoris cross-sectional area (RFCSA) and various muscle function tests. Meta-regressions were performed for length of hospital stay (LoS) and age for all meta-analyses; sex was also considered for HGS. Results: Acute sarcopenia development was assessed in four studies with a pooled incidence of 18% during hospitalisation. Incidence was highest among trauma patients in intensive care (59%) while it was lower among medical and surgical patients (15-20%). Time of development ranged from 4-44 days. HGS remained stable during hospitalisation (SMD = 0.05, 95% CI = -0.18:0.28, P = 0.67) as did knee extensor strength. LoS affected HGS performance (θ = 0.04, 95% CI = 0.001:0.09, P = 0.045) but age (P = 0.903) and sex (P = 0.434) did not. RFCSA, reduced by 16.5% over 3 to 21 days (SMD = -0.67, 95% CI = -0.92:-0.43, P <0.001); LoS or time between scans did significantly predict the reduction (θ = -0.04, 95% CI = -0.077:-0.011, P = 0.012). Indices of muscle quality also reduced. Muscle function improved when assessed by the short physical performance battery (SMD = 0.86, 95% CI = 0.03:1.69, P = 0.046); there was no change in 6-minute walk (P = 0.22), timed up-and-go (P = 0.46) or gaitspeed tests (P = 0.98). The only significant predictor of timed up-and-go performance was age (θ = -0.11, 95% CI = -0.018:-0.005, P = 0.009). Conclusions: Assessment and understanding of acute sarcopenia in clinical settings is limited. Incidence varies between clinical conditions and muscle parameters are affected differently. HGS and muscle function tests may not be sensitive enough to identify acute changes during hospitalisation. Currently, muscle health deterioration may be underdiagnosed impacting recovery, quality of life and overall health following hospitalisation. Further evaluation is necessary to determine the suitability of existing diagnostic criteria of acute sarcopenia. Muscle mass and quality indices might need to become the primary determinants for muscle health assessment in hospitalised populations.

Rationale: Inadequate protein intake (PI), the main source of essential amino acids (EAAs), and reduced appetite are contributing factors to age-related sarcopenia. The satiating effects of dietary protein may negatively affect energy intake (EI), thus there is a need to explore alternative strategies to facilitate PI without compromising appetite and subsequent EI. Methods: Elderly women completed two experiments (EXP1&2) where they consumed either a Bar (B, 135 kcal) or a Gel (G, 114 kcal), rich in EAAs (7.5 g, 40% L-Leucine), or nothing [control (C)]. In EXP1, subjects (n=10, 68±5 years, mean±SD) consumed B, G or C with appetite sensations and appetite-related hormonal responses monitored for 1h, followed by consumption of an ad libitum breakfast (ALB). In EXP2, subjects (n=11, 69±5 years) ingested B, G or C alongside an ALB. Results: In EXP1, EI at ALB was not different (P=0.674) between conditions (282±135, 299±122, 288±131 kcal for C, B and G respectively). However, total EI was significantly higher in B and G compared to C after accounting for the energy content of the supplements (P<0.0005). Analysis revealed significantly higher appetite Area under the Curve (AUC) (P<0.007), a tendency for higher acylated ghrelin AUC (P=0.087), and significantly lower pancreatic polypeptide AUC (P=0.02) in C compared with B and G. In EXP2, EI at ALB was significantly higher (P=0.028) in C (306±122 kcal) compared to B (245±135 kcal) and G (254±118 kcal). However, total EI was significantly higher in B and G after accounting for the energy content of the supplements (P<0.007). Conclusion: Supplementation with either the bar or gel increased total energy intake whether consumed 1h before or during breakfast. This may represent an effective nutritional means for addressing protein and total energy deficiencies in elderly women.

Background: Inadequate protein intake (PI), containing a sub-optimal source of essential amino acids (EAAs), and reduced appetite are contributing factors to age-related sarcopenia. The satiating effects of dietary protein per se may negatively affect energy intake (EI), thus there is a need to explore alternative strategies to facilitate PI without compromising appetite and subsequent EI. Methods: Older women completed two experiments (EXP1 and EXP2) where they consumed either a Bar (565 kJ), a Gel (477 kJ), both rich in EAAs (7.5 g, 40% L-leucine), or nothing (Control). In EXP1, participants (n=10, 68±5 years, mean±SD) consumed Bar, Gel or Control with appetite sensations and appetite-related hormonal responses monitored for one hour, followed by consumption of an ad libitum breakfast (ALB). In EXP2, participants (n=11, 69±5 years) ingested Bar, Gel or Control alongside an ALB. Results: In EXP1, EI at ALB was not different (P=0.674) between conditions (1179±566, 1254±511, 1206±550 kJ for the Control, Bar, and Gel respectively). However, total EI was significantly higher in the Bar and Gel compared to the Control after accounting for the energy content of the supplements (P<0.0005). Analysis revealed significantly higher appetite Area under the Curve (AUC) (P<0.007), a tendency for higher acylated ghrelin AUC (P=0.087), and significantly lower pancreatic polypeptide AUC (P=0.02) in the Control compared with the Bar and Gel. In EXP2, EI at ALB was significantly higher (P=0.028) in the Control (1282±513 kJ) compared to the Bar (1026±565 kJ) and Gel (1064±495 kJ). However, total EI was significantly higher in the Bar and Gel after accounting for the energy content of the supplements (P<0.007). Conclusions: Supplementation with either the Bar or Gel increased total energy intake whether consumed one hour before or during breakfast. This may represent an effective nutritional means for addressing protein and total energy deficiencies in older women.

Acute exposure to high altitude (>3500m) is associated with marked changes in appetite regulation and substrate oxidation but the effects of lower altitudes are unclear. This study examined appetite, gut hormone, energy intake and substrate oxidation responses to breakfast ingestion and exercise at simulated moderate and severe altitudes compared with sea-level. Twelve healthy males (mean±SD; age 30±9years, body mass index 24.4±2.7kg.m-2) completed in a randomised crossover order three, 305 minute experimental trials at a simulated altitude of 0m, 2150m (~15.8% O2) and 4300m (~11.7% O2) in a normobaric chamber. Participants entered the chamber at 8am following a 12h fast. A standardised breakfast was consumed inside the chamber at 1h. One hour after breakfast, participants performed a 60 minute treadmill walk at 50% of relative V̇O2max. An ad-libitum buffet meal was consumed 1.5h after exercise. Blood samples were collected prior to altitude exposure and at 60, 135, 195, 240 and 285 minutes. No trial based differences were observed in any appetite related measure before exercise. Post-exercise area under the curve values for acylated ghrelin, pancreatic polypeptide and composite appetite score were lower (all P<0.05) at 4300m compared with sea-level and 2150m. There were no differences in glucagon-like peptide-1 between conditions (P=0.895). Mean energy intake was lower at 4300m (3728±3179kJ) compared with sea-level (7358±1789kJ; P=0.007) and 2150m (7390±1226kJ; P=0.004). Proportional reliance on carbohydrate as a fuel was higher (P=0.01) before breakfast but lower during (P=0.02) and after exercise (P=0.01) at 4300m compared with sea-level. This study suggests that altitude-induced anorexia and a subsequent reduction in energy intake occurs after exercise during exposure to severe but not moderate simulated altitude. Acylated ghrelin concentrations may contribute to this effect.

Exposure to hypoxia appears to depress appetite and energy intake, however the mechanisms are not fully understood. The aim of this review was to determine the magnitude of changes in hunger and energy intake in hypoxic compared with normoxic environments, and establish any alterations in appetite-related hormone concentrations. PubMed and The Cochrane Library as well as MEDLINE, SPORTDiscus, PsycINFO and CINAHL, via EBSCOhost, were searched through 1st April 2017 for studies that evaluated hunger, energy intake and/or appetite-related hormones in normoxia and during hypoxic exposure in a within-measures design. A total of 28 studies (comprising 54 fasted and 22 postprandial comparisons) were included. A random-effects meta-analysis was performed to establish standardised mean difference (SMD) with 95% confidence intervals. Hypoxic exposure resulted in a trivial but significant decrease in postprandial hunger scores (SMD: -0.15, 95% CI: -0.29 to -0.01; n = 14; p = 0.043) and a moderate decrease in energy intake (SMD: -0.50, 95% CI: -0.85 to -0.15; n = 8; p = 0.006). Hypoxic exposure resulted in a decrease (albeit trivial) in postprandial acylated ghrelin concentrations (SMD: -0.16, 95% CI: -0.25 to -0.08; n = 7; p < 0.0005), and a moderate increase in fasted insulin concentrations (SMD: 0.41, 95% CI: 0.17 to 0.65; n = 34; p = 0.001). Meta-regression revealed a decrease in postprandial acylated ghrelin concentrations (p = 0.010) and an increase in fasted insulin concentrations (p = 0.020) as hypoxic severity increased. Hypoxic exposure reduces hunger and energy intake, which may be mediated by decreased circulating concentrations of acylated ghrelin and elevated insulin concentrations. PROSPERO registration number: CRD42015017231.

There is a developing base of research assessing hormonal status in rugby players as a means to monitor training and performance, however to date no research has investigated the impact of dietary intake on immunity. The objectives of the study were to monitor immune responses, as well as assess dietary intake, body composition and performance of elite rugby union players. Following ethics approval, nine players (height 185.8±6.2cm, age 28.0±3.4yrs) were assessed at the start and end of a 4-week pre-season training period for dietary intake (4-day food diary), body composition (sum of 8 [Σ8] skinfold sites), one repetition maximum (1RM) strength (bench press [BP] and prone row [PR]) and endurance (1200m run). Saliva immunoglobulin A (sIgA) measures were taken at the start and end of each week (~8.30am). Mean energy intakes were 12145.9±3772.3kJ (week 1) and 12419.7±2385.5kJ (week 4). During both weeks of dietary assessment protein and carbohydrate consumption was 2.3±0.7 and 2.7±1.1g.kg.BM-1.d-1 respectively. There was a 32%, 36% and 32% contribution from protein, carbohydrate and fat to energy intake. Despite relatively low energy consumption (approximately 45% below recommendations), there was only a 0.7±2.4kg reduction in body mass (103.7±13.7 to 103±13.4kg) and a 12±2% reduction in for Σ8 skinfolds from week 1 to week 4 (106.7±44.3 to 94.17±43.6mm). Mean sIgA over the training period was 47.9±ug.min-1, with a small intra-player variability observed throughout the 4-week preseason training period (CV 5%). sIgA was strongly correlated with fat (r=0.68) and saturated fat intake (r=0.62). sIgA was also moderately correlated with protein intake (r=0.40), Σ8 skinfolds (r=0.39) and endomorphy (r=0.43). Conversely, strong and moderate negative correlations occurred between sIgA and mesomorphy (r=-0.51), and sIgA and ectomorphy (r=-0.49). Significant improvements (P<0.05) were observed for 1RM in BP (4.0 ± 4.93 kg) and 1200m (23 ± 5.27 sec) with 1200m times strongly correlating with sIgA (r=0.56). Conversely there were moderate negative correlations between improvements in strength and sIgA (r=-0.42). In summary, players with a higher dietary fat intake and endomorphic characteristics demonstrated a better immune status than leaner ectomorphic players. Those showing better immune function also produced greater gains in endurance. The negative correlations between strength and sIgA were likely due to enhanced rates of catabolism as a result of resistance training. The pre-season training period elicited improvements in body composition despite inadequate dietary intake when compared to guidelines, highlighting the potential error of applying the recommended nutrient intake guidelines to an elite rugby union population.

Mouth-rinsing with carbohydrate solutions during cycling time trials results in performance enhancements, however the majority of studies have utilised ∼6% carbohydrate solutions. Therefore, the purpose of this study was to compare the effectiveness of mouth-rinsing with 4%, 6%, and 8% carbohydrate (CHO) solutions on 1-h simulated cycling time trial performance. On four occasions, seven trained male cyclists completed at the postprandial period, a set amount of work as fast as possible in a randomised, counterbalanced order. The subjects mouth rinsed for 5-s, upon completion of each 12.5% of the trial, with 25 mL of a non-CHO placebo, 4%, 6%, and 8% CHO solutions. No additional fluids were consumed during the time trial. Heart rate (HR), ratings of perceived exertion (RPE), thirst (TH) and subjective feelings (SF) were recorded after each rinse. Further, blood samples were drawn every 25% of the trial to measure blood glucose (BG) and blood lactate (BG) concentrations, whilst whole body carbohydrate oxidation was monitored continuously. Time to completion was not significant between conditions with the placebo, 4%, 6%, and 8% conditions completing the trials in 62.0 ± 3.0, 62.8 ± 4.0, 63.4 ± 3.4, and 63 ±4.0 minutes respectively. There were no significant differences between conditions in any of the variables mentioned above however significant time effects were observed for HR, RPE, TH, and SF. Post-hoc analysis showed that TH and SF of subjects in the CHO conditions but not in the placebo were significantly increased by completion of the time trial. In conclusion, mouth-rinsing with CHO solutions did not impact 1-h cycling performance in the postprandial period and in the absence of fluid intake. Our findings suggest that there is scope for further research to explore the activation regions of the brain and whether they are receptive to CHO dose, before specific recommendations for athletic populations are established. Consequently mouth-rinsing as a practical strategy for coaches and athletes is questionable under specific conditions and should be carefully considered before its inclusion. The emphasis should be focused on appropriate dietary and fluid strategies during training and competition.

Research findings indicate that the inter-set rest interval is an important variable when prescribing resistance training (RT) programmes however, there is a growing focus of attention on the additional use of short intra-set rest intervals in the approach known as cluster set (CS) training. Despite evidence that supports the positive effects of CS configurations on the acute and chronic responses to RT, numerous challenges exist for practitioners when aiming to utilise this training concept. As such, this review aims to identify these challenges and offer recommendations in light of the contemporary research into this concept. The Discover, PubMed, Sport Discus, Research Gate and Google Scholar databases were searched in order to locate previous peer reviewed investigations which examined the acute and/or chronic responses to manipulating intra-set rest intervals. Twenty-five studies were reviewed after the inclusion criteria had been applied. Although the review highlighted that CS configurations may offer superior alternatives to traditional set configurations when seeking to emphasise specific acute or chronic responses, contrasting findings exist with regards to the chronic effects of CS configuration on various physical attributes (e.g. strength, power, hypertrophy) which presents challenges for practitioners when interpreting the literature. The contrasting findings result from a number of key methodological differences (e.g. intra-set rest duration) which practitioners need to be aware of when designing CS configurations. In terms of practical considerations, CS configurations may present challenges due to their time-consuming and monotonous nature but offer advantages in terms of reducing perceived exertion, cardiovascular demands, enhancing the performance and technique of key explosive exercises.

Introduction: Hypertrophy-type (HYP) resistance exercise (RE) is typically designed to elicit changes in fibre size whereas strength-type (STR) RE is usually employed to improve strength via mainly neural adaptations. Although previous studies have investigated the acute responses to different RE workouts (McCaulley et al., 2009), the mechanisms responsible for different long-term adaptations are still widely debated. Thus, this study examined the acute neuromuscular responses to STR and HYP workouts which utilised the back squat exercise. Methods: Seven trained males (23.6 ± 2.7 years) completed a STR workout (4x6 repetitions at 85%1RM, 5 min rest intervals), a HYP workout (4x10 repetitions at 70%1RM, 90s rest intervals) and a control condition (CON) in a randomised cross-over design separated by at least 48 hours. Subjects performed 3×4s maximal isometric back squats (100o knee flexion), by using a modified squat rack attached to a Kistler force platform (1000 Hz), immediately pre- and post- each workout. Several kinetic performance variables were determined and investigated statistically by using a two-factor within subjects ANOVA. Results: Repeated contrast tests showed a greater reduction in Peak Isometric Force following the HYP (-18.06%) than CON condition (-1.21%) (p=0.017). Also the HYP workout resulted in greater reductions in the rate of force development (RFD) during the initial 0.05s (-21%, p=0.023) and 0.1s (-29%, p=0.047) of the force-time curve as well as greater increases in the time required to produce 500N (92%, p=0.018) when compared with the CON condition. The STR workout was characterised by a greater reduction in RFD during the initial 0.2s of the force-time curve (-0.19%, p=0.034) as well as greater increases in the time required to produce 250N (28%, p=0.025) when compared to the CON condition. No significant differences were observed between the STR and HYP conditions for any variable. Discussion: Both workouts resulted in acute neuromuscular fatigue possibly via different pathways. The acute reductions in RFD following the STR workout may have resulted from central fatigue whereas the reductions in RFD and PF following the HYP workout may be indicative of central and peripheral fatigue (Hakkinen et al., 1994; McCaulley et al., 2009). Although STR and HYP workouts are typically prescribed in order to emphasise different long-term adaptations, marked differences in the acute neuromuscular responses were not observed. Such findings may question the prescription of future similar workouts when aiming to elicit distinctly different neuromuscular stimuli.

Introduction: Information on the acute metabolic responses to resistance exercise (RE) may provide valuable information regarding peripheral fatigue factors. However, most studies have examined a relatively narrow range of metabolic responses to different RE workouts. In addition, much of the research has not accounted for plasma volume (PV) changes. This study compared a wider profile of metabolic responses following strength (STR) and hypertrophy-type (HYP) back squat workouts, when corrected for PV changes. Methods: Following one repetition maximum (1RM) testing, seven trained males (23.6±2.7 years) completed a STR workout (4x6 repetitions, 85% 1RM, 5 min rest intervals), a HYP workout (4x10 repetitions, 70% 1RM, 1.5 min rest intervals) and a control condition (CON) in a randomised cross-over design separated by at least 48 hours. Capillary blood samples were taken pre- (-20min,-10min,-0min) and post-exercise (+0min,+10min,+60min) in order to measure concentration of blood lactate (BL), electrolytes, haemoglobin (Hb) and haematocrit (Hct). The samples were analysed using a blood gas CO-Oximeter and electrolyte analyser (GEM Premier 4000). Following calculation of PV changes from Hb and Hct, variables were corrected using the method of Kraemer & Brown (1986). A two-factor within subjects ANOVA was employed for statistical analysis. Results: Average PV changes were -8.05 ± (11.45%), -8.02 ± (6.54%) and -3.32 ± (6.97%) for the STR, HYP and CON conditions respectively. Repeated contrast tests revealed a significantly (p<0.05) greater increase (at +0min) in BL concentration following the HYP condition (0.83 ± 0.13 mmol/L-1 to 9.67 ± 2.45 mmol/L-1) than the STR (1.07 ± 0.38 mmol/L-1 to 6.66 ± 2.31 mmol/L-1) or CON (0.97 ± 0.48 mmol/L-1 to 1.15 ± 0.55 mmol/L-1) conditions, this was also evident at +10min. In addition, the HYP workout resulted in significantly greater (p<0.05) reductions in chloride, sodium and potassium than the CON condition whilst the STR workout also resulted in significantly greater reductions in chloride, sodium and calcium than the CON condition. Discussion: PV changes were similar to those reported previously following RE (Wallace et al., 1990). In addition, the HYP workout had a notable impact on metabolite accumulation as evidenced by significant changes in the concentration of BL and a number of electrolytes. Greater metabolic stress has been previously reported following HYP than STR workouts (McCaulley et al., 2009). However, the data highlight the need to consider a wider profile of metabolic variables when examining the acute responses to HYP workouts.

Menopause and perimenopause are natural phases of life that bring about significant physiological changes, including alterations in hormonal levels, bone density, cardiovascular health, and muscle mass. These changes directly affect women’s wellbeing and ability to maintain and benefit from physical activity. Understanding the perspectives of these women and identifying evidence-based strategies is crucial. Despite growing recognition of these health transitions, research has historically neglected the specific needs of this population, leaving a critical gap in tailored interventions and advice. The symposium showcases the recent work of the Leeds Beckett University Peri-and Post-Menopause Research Team, building on interdisciplinary expertise from the Carnegie School of Sport (CSS), the School of Humanities and Social Sciences (HSS), and the Leeds Business School (LBS). This session aims to foster a multidisciplinary dialogue on the intersection of women’s health, physical activity, and workplace experiences during these pivotal life stages.

Introduction It is well established that acute exposure to very high altitude (>3500m) is associated with a suppression of appetite, acylated ghrelin and energy intake. Ghrelin is post-translationally modified with a medium chain fatty acid and this acylation is necessary for ghrelin to exert its orexigenic effects. This novel study investigated the effects of a high-fat (HF) breakfast rich in medium chain fatty acids versus a high-carbohydrate (HC) breakfast on appetite, ghrelin constituents and energy intake at 4300m simulated altitude. Methods Twelve healthy males (mean (SD); age 26 (8) years, body mass index 23.9 (2.7) kg·m-2) completed two, 305-minute experimental trials at a simulated altitude of 4300m (~11.7% O2) in a normobaric chamber. Trials were conducted in a randomised, single blind, counter-balanced fashion. After an overnight fast, participants entered the chamber and rested until receiving breakfast at 1h. Participants consumed either an isocaloric HF (60% fat, 25% carbohydrate and 15% protein) or HC (60% carbohydrate, 25% fat and 15% protein) breakfast. One hour after breakfast, participants performed a 60-minute treadmill walk at 50% of relative V̇O2max. An ad-libitum buffet meal was consumed 1.5h after exercise. Composite appetite score (CAS) as well as acylated (AG) and de-acylated ghrelin (DG) were measured throughout. Results At baseline and during the resting period prior to exercise there were no significant differences in any variables between conditions (all P≥0.137). During exercise, area under the curve (AUC) for CAS was significantly higher following the HF breakfast (39 (12) mm·h-1) compared with the HC breakfast (30 (17) mm·h-1, P=0.036). Similarly, AUC for AG was significantly higher during exercise following the HF breakfast (152 (180) pg·mL-1·h-1) compared with the HC breakfast (101 (106) pg·mL-1·h-1, P=0.048). During the post-exercise period there was no significant difference in CAS (P=0.356) or AG (P=0.229) between conditions. No differences were observed during any time period in DG (all P≥0.207). Energy intake at the buffet did not significantly differ between conditions (P=0.384). Discussion This study suggests that, in comparison with a HC breakfast, a HF breakfast rich in medium chain fatty acids can attenuate appetite suppression during exercise at 4300m simulated altitude. However, this did not translate into increased ad-libitum energy intake when food was provided 90 minutes after exercise. It would be beneficial for further research to establish whether a prolonged HF diet can promote a positive energy balance at altitude.

Ageing is associated with reduced appetite and energy intakes. However, the mechanisms underlying this phenomenon are not fully understood. This systematic review and meta-analysis quantified differences in circulating concentrations of appetite-related hormones between healthy older and younger adults. Six databases were searched through 12th June 2018 for studies that compared appetite-related hormone concentrations between older and younger adults. Data were pooled using random-effects meta-analysis and are presented as standardised mean difference (Hedges' g) with 95% confidence intervals (95% CI). Thirty-five studies were included involving 710 older adults (mean ± SD; age: 73 ± 5 years) and 713 younger adults (age: 28 ± 7 years). Compared with younger adults, older adults exhibited higher fasted and postprandial concentrations of the anorectic hormones cholecystokinin (Fasted: SMD 0.41 (95% CI 0.24, 0.57); p < 0.001. Postprandial: SMD 0.41 (0.20, 0.62); p < 0.001), leptin [Fasted: SMD 1.23 (0.15, 2.30); p = 0.025. Postprandial: SMD 0.62 (0.23, 1.01); p = 0.002] and insulin [Fasted: SMD 0.24 (- 0.02, 0.50); p = 0.073. Postprandial: SMD 0.16 (0.01, 0.32); p = 0.043]. Higher postprandial concentrations of peptide-YY were also observed in older adults compared with younger adults [SMD 0.31 (- 0.03, 0.65); p = 0.075]. Compared with younger adults, older adults had lower energy intakes [SMD - 0.98 (- 1.74, - 0.22); p = 0.011], and lower hunger perceptions in the fasted [SMD - 1.00 (- 1.54, - 0.46); p < 0.001] and postprandial states [SMD - 0.31, (- 0.64, 0.02); p = 0.064]. Higher circulating concentrations of insulin, leptin, cholecystokinin and peptide-YY accord with reduced appetite and energy intakes in healthy older adults. Interventions to reduce circulating levels of these hormones may be beneficial for combatting the anorexia of ageing.

High-altitude exposure induces a negative energy balance by increasing resting energy expenditure and decreasing energy intake. This diminished energy intake is likely caused by altitude-induced anorexia and can have detrimental effects for those travelling to high-altitude. We aimed to investigate whether altering the macronutrient composition of breakfast could attenuate altitude-induced anorexia and augment energy intake at high-altitude. Twelve healthy men (aged 26 (8) years, body mass index 23.9 (2.7) kg·m(-2)) completed two, 305min experimental trials at 4300m simulated altitude (~11.7% O2). After an overnight fast, participants entered a normobaric hypoxic chamber and rested for one hour, before receiving either a high fat (HF; 60% fat, 25% carbohydrate) or an isocaloric high carbohydrate (HC; 60% carbohydrate, 25% fat) breakfast. One hour after breakfast, participants performed 60min of treadmill walking at 50% of relative V̇O2max. An ad-libitum buffet meal was consumed 1h 30min after exercise. Appetite perceptions, blood samples and substrate oxidation rates were measured throughout. A significantly higher area under the curve for composite appetite score was observed during exercise in HF (40 (12) mm·h(-1)) compared with HC (30 (17) mm·h(-1), P=0.036). During exercise, lower insulin concentrations (P=0.013) and elevated acylated ghrelin concentrations (P=0.048) were observed in HF compared with HC. After exercise there was no significant difference in composite appetite score (P=0.356), acylated ghrelin (P=0.229) or insulin (P=0.513) between conditions. Energy intake at the buffet did not significantly differ between conditions (P=0.384). A HF breakfast attenuated appetite suppression during exercise at 4300m simulated altitude, however ad-libitum energy intake did not increase.

Ageing is associated with reductions in appetite and food intake (1) resulting in unintentional weight loss (2). Such weight loss, particularly through muscle mass reduction is associated with muscle weakness and functional decline, which represent significant predictors of poor health outcomes (3) and are contributing factors to frailty in older people. Resistance exercise is crucial in attenuating age-induced muscle loss, whilst muscle mass gains have been proposed as a means of increasing appetite and energy intake (EI) through changes in metabolic demand (4). Exercise intensities > 60% of maximal oxygen uptake have consistently been shown to acutely supress appetite in younger adults in a variety of exercise modes (5), yet little is known about the acute effects of resistance exercise on appetite and energy intake particularly in older adults. Understanding these effects may aid exercise prescription and provide post-exercise feeding strategies to reduce age-related anorexia and ultimately attenuate age-associated reductions in muscle mass. Therefore, we investigated the effect of an acute bout of resistance exercise on appetite and EI. Twenty healthy, older adults (13 females and 7 males; 68 ± 5 years old, body mass index of 26.2 ± 4.5 kg.m-2) undertook two 5-h experimental trials. On arrival at the laboratory, participants rested for a 0.5-h period before they were given a standardised breakfast. They then rested for a 1-h period before they completed in a randomised crossover design: 1) a 1-h resistance exercise workout followed by 2-h of rest and 2) a control condition where participants rested for a subsequent 3-h period. On cessation of the trials, participants were administered an ad libitum pasta meal for the assessment of EI. Composite appetite scores (CAS) were measured throughout using visual analogue scales. A paired samples t-test revealed no difference in EI between conditions. Two-way ANOVA revealed a significant effect of condition (p = 0.007) and time (p <0.001) but no significant interaction effect (p = 0.153) for CAS, which were lower in the resistance exercise condition. Similarly, area under the curve for the entire trial was significantly different (p = 0.007) between conditions and was associated with a small effect size (Cohen’s d = 0.27). Our findings suggest that an acute resistance exercise bout does not result in EI reductions during an ad libitum meal given 2 h post-exercise, in spite of significant main condition effects in CAS. This significance can be attributed to the temporary suppression of appetite during the resistance exercise bout. Given that appetite profiles remained similar between conditions for the rest of the trial, and that feeding is likely to take place post-exercise, this mode of exercise is an appropriate means for optimising muscle mass adaptations by maintaining subsequent EI of older adults.

ORAL PRESENTATION Purpose: To evaluate and compare the acute group and individual endogenous hormone responses to three resistance exercise workouts and two load carriage workouts. Understanding hormone responses specific to military settings may enhance training optimisation in the future. Methods: Eighteen resistance exercise-trained male civilians (age: 19 to 38 y, mean 24.9 y) completed five experimental workouts and a control condition in a randomised order; three resistance exercise workouts (cluster, hypertrophy, endurance), two load carriage (90-min constant pace [CO-LC] or 6 × 8-min intervals [IT-LC], both carrying a rucksack with 25% body mass) workouts, and a control condition (60-minutes of rest). Venous blood was drawn before, immediately post workout, and 30-min and 24-h post workout. Testosterone (T), free testosterone (fT), growth hormone (GH), dehydroepiandrosterone sulphate (DHEAS), androstenedione (ANST), and insulin-like growth factor 1 (IGF-1) concentrations were subsequently analysed via liquid chromatography-mass spectrometry. Group responses were evaluated using two-way ANOVA’s with Tukey’s post-hoc analysis. The standardised standard deviations of the pre-post change scores (SDIR) were calculated to identify the presence of individual responses (Hopkins, 2015). Results: Group responses were observed despite large individual variations. T concentrations increased in response to hypertrophy (p < 0.001) and CO-LC (p = 0.02) workouts; fT concentrations increased in response to CO-LC (p < 0.001) and decreased following the hypertrophy (p = 0.035) workout; ANST concentrations increased in response to CO-LC (p = 0.007); GH increased following hypertrophy (p = 0.004), endurance (p = 0.04), IT-LC (p < 0.001), and CO-LC (p < 0.001) workouts; IGF-1 increased in response to the endurance (p = 0.018) workout. The SDIR effect size thresholds of extremely large (T, GH, DHEAS) and very large (T, GH, DHEAS, ANST, IGF-1) were achieved, representing an individualised pattern of hormone production in response to the different resistance exercise and load carriage workouts. Conclusions: The presence of within-workout variations in the hormonal responses to all workout types suggests that the mean group responses may not reflect the response experienced by all participants, and that the hormonal anabolic response differs between individuals. The group responses and within-workout variation suggest that a wide panel of endogenous hormones should be measured to provide clarity on the anabolic response to different types of training stimuli at the individual level. Military Impact: The anabolic response to training type differs between individuals. This research provides support to further investigate whether training interventions based upon an individualised anabolic hormone response to acute exercise lead to improved physical outcomes. Funding for this research was provided by Dstl MOD. References: Hopkins W. J Appl Physiol, 118:1444–1446,2015; doi:10.1152/japplphysiol.00098.2015

Age-related sarcopenia is a syndrome characterised by progressive decline in skeletal muscle mass and strength (von Haehling, Morley, & Anker, 2010). The European Working Group on Sarcopenia in Older People recommends the measurement of muscle mass and function as means of diagnosing sarcopenia (Cruz-Jentoft et al., 2010) since sole focus on measurement of muscle mass may be of limited value. The age-associated loss of muscle strength (Dynapenia) cannot be only explained by reductions in muscle size since reductions in strength are more rapid than reductions in muscle (Clark & Manini, 2012). Cawthon et al. (2014) developed cut points for appendicular lean mass (ALM) that would identify individuals with clinically significant weakness taking into account both ALM and strength. Since sarcopenia is a multifaceted syndrome with potentially modifiable factors such as dietary intakes, the aim of this pilot study was to explore the interrelationships between dietary intakes, ALM, and strength. Twenty-five healthy older adults including both female (n=15, age: 68.8 ± 2.9 years) and male (n =10, age 69.5 ± 2.5 years) participants completed a 7-day diet diary before having their handgrip strength and body composition (dual energy X-ray absorptiometry) measured. Males with ALM<19.75 kg and females with ALM<15.02 kg were defined as having low lean muscle mass, whilst cut points of <30 kg and <20 kg (Campbell & Vallis, 2014) were used to identify males and females with low strength. Participants received guidance on recording food and drink by household measures. Energy expenditure was calculated using the World Health Organization/Food and Agriculture Organization equation (Frankenfield, Roth-Yousey, & Compher, 2005) for resting energy expenditure and an activity factor of 1.5. Forty percent (40%) of the females displayed low muscle strength while their male counterparts were all above the 30 kg cut point. ALM was 25.6±3.7 and 15.9±1.7 kg for males and females respectively. Twenty-seven percent (27%) of the females were below the cut point for low lean mass whilst males were all above the equivalent cut point. Energy intake (EI) was 1753±366 kcal for males and 1376±270 kcal for females corresponding to an EI deficit of 27.8±21.7 % and 27.7±6 % for males and females respectively. EI was significantly (P<0.05) lower than recommended EI. Protein intake was 0.97±0.3 g·kg·d-1 for the males and 0.95±0.2 g·kg·d-1 for the females representing 18.8±3.1 and 17.8±2.4 % of EI for males and females respectively. Our findings suggest that females in early retirement years are at greater risk of sarcopenia and dynapenia than their male counterparts. Inadequate energy intake and protein consumption which was below current research led recommendations of 20 % suggest that females may benefit from dietary interventions that would address energy and protein deficits. References Campbell, T. M., & Vallis, L. A. (2014). Predicting fat-free mass index and sarcopenia in assisted-living older adults. Age (Dordr), 36(4), 9674. doi: 10.1007/s11357-014-9674-8 Cawthon, P. M., Peters, K. W., Shardell, M. D., McLean, R. R., Dam, T.-T. L., Kenny, A. M., . . . Guralnik, J. M. (2014). Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 69(5), 567-575. Clark, B. C., & Manini, T. M. (2012). What is dynapenia? Nutrition, 28(5), 495-503. doi: 10.1016/j.nut.2011.12.002 Cruz-Jentoft, A. J., Baeyens, J. P., Bauer, J. M., Boirie, Y., Cederholm, T., Landi, F., . . . European Working Group on Sarcopenia in Older, P. (2010). Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing, 39(4), 412-423. doi: 10.1093/ageing/afq034 Frankenfield, D., Roth-Yousey, L., & Compher, C. (2005). Comparison of predictive equations for resting metabolic rate in healthy nonobese and obese adults: a systematic review. J Am Diet Assoc, 105(5), 775-789. doi: 10.1016/j.jada.2005.02.005 Morley, J. E. (2008). Sarcopenia: diagnosis and treatment. J Nutr Health Aging, 12(7), 452-456. von Haehling, S., Morley, J. E., & Anker, S. D. (2010). An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle, 1(2), 129-133. doi: 10.1007/s13539-010-0014-2

The ultimate aim of bodybuilding is to achieve an aesthetically pleasing physique through gains in lean body mass (LBM) and reductions in fat mass (FM). Favourable blood lipid profile (BLP) adaptations have been reported but research is equivocal. Total energy intake (EI) has been suggested to be one of the biggest dietary predictors for optimum body composition with daily distribution of meals less important. However, high quality protein per meal as a means to maintain muscle protein synthesis suggests that higher daily meal frequency (MF) may be a more appropriate dietary strategy. Our aim was to investigate the interplay between habitual MF, body composition and BLP in non-competitive bodybuilders. Following ethics approval, 44 males and 10 females met participation criteria. Upper and lower 25th percentiles of response to number of eating occasions were calculated. Arranged into a low (LFG, 2.6±0.8: n=12, 28±5 years, 80.9±17.8 kg) or high (HFG, 6.6±0.8: n=12, 27±7 years, 85.2±16.8 kg) daily MF group, participants completed a 3-day diet diary, had a dual energy X-ray absorptiometry scan, and blood lipids measured. The HFG (13.9±3.8%) had lower (P=0.024) %body fat than the LFG (19.2±6.7%) but LBM in the HFG (70.2±14.4 kg) was not different from that of the LFG (62.1±14.5 kg). Blood lipids were within healthy range, while the HFG completed more (P=0.000) weekly training sessions (4.3±0.8) than the LFG (5.5±0.7). There was no difference in energy intake between the groups: HFG 2564±681 kcal; LFG 2215±533. Protein intake in the HFG was higher (P=0.054) than the LFG (2.6±1.0 vs 1.9±0.5 g/kg-1/BW/d-1). Differences were not observed in fat (1.2±0.6 and 1.4±0.6 g/kg-1/BW/d-1) or carbohydrate (2.5±1.4 and 1.9±1.1 g/kg-1/BW/d-1 in LFG and HFG respectively) intakes. In relative terms, the carbohydrate intake in the HFG (25±9%) was lower (P=0.027) than that of the LFG (35±12%). In conclusion, BLP was within the healthy range in both groups. Furthermore, higher MF was associated with better sport-specific body composition outcomes. This is potentially due to higher consumption of dietary proteins (35% of daily EI) resulting in optimisation of muscle synthetic response and training capacity.

The ultimate aim of bodybuilding is to achieve an aesthetically pleasing physique through gains in lean tissue mass (LTM) and reductions in fat mass (FM). Favourable blood lipid profile (BLP) adaptations have been reported but research is equivocal. Total energy intake (EI) has been suggested to be one of the biggest dietary predictors for optimum body composition with daily distribution of meals less important. However, high quality protein per meal as a means to maintain muscle protein synthesis suggests that higher daily meal frequency (MF) may be a more appropriate dietary strategy. Our aim was to investigate the interplay between habitual MF, body composition and BLP in non-competitive bodybuilders. Following ethical approval, 44 males and 10 females met participation criteria. Upper and lower 25th percentiles of response to number of eating occasions were calculated. Arranged into a low (LFG, 2.6±0.8) (n=12, 27.9±5.1 years, 80.9±17.8 kg) or high (HFG, 6.6±0.8) (n=12, 27.3±7.2 years, 85.2±16.8 kg) daily MF group, participants (n=24, 27.9±6.1 years, 83.0±17.1 kg), completed a 3-day diet diary, had a dual energy X-ray absorptiometry scan, blood lipids measured. The HFG (13.9±3.8%) had significantly lower (P=0.024) %body fat than the LFG (19.2±6.7%). There was a trend for higher LTM in the HFG (70.2±14.4 kg) compared to the LFG (62.1±14.5 kg). Blood lipids were within normal range, while the HFG completed significantly (P=0.000) more weekly training sessions (4.3±0.8) than the LFG (5.5±0.7). Despite the HFG consuming more energy (2564±681 kcal) than the LFG (2215±533), the difference was not significant. Protein intake in the HFG was significantly higher (P=0.54) than the LFG (2.6±1.0 vs 1.9±0.5 g/kg-1/BW/d-1). Differences were not observed in fat (1.2±0.6 and 1.4±0.6 g/kg-1/BW/d-1) or carbohydrate (2.5±1.4 and 1.9±1.1 g/kg-1/BW/d-1 in LFG and HFG respectively) intakes. In relative terms, the carbohydrate intake in the HFG (25±9.0%) was significantly lower (P=0.027) than that of the LFG (35±12%). In conclusion, BLP was within healthy range in both groups. Furthermore, higher MF was associated with optimum sport-specific body composition outcomes. This is potentially due to higher consumption of dietary proteins (35% of daily EI) resulting in optimisation of muscle synthetic response and training capacity.

Deficiencies in protein and energy intakes are partly responsible for age-related sarcopenia. We investigated the effects of supplements matched in essential amino acid (EAA) content (7.5 g) on energy intake and appetite. Ten women aged 69.2 ± 2.7 years, completed three trials in a randomised, crossover design. Composite appetite scores, peptide-YY (PYY), and insulin responses to a 200 ml whey protein isolate (WP, 275 kJ), a 50 ml EAA gel (GEL, 478 kJ) or nothing as the control condition (CON) were investigated over one hour, followed by an ad libitum breakfast. Energy intake at breakfast (CON 1957 ± 713, WP 1413 ± 623, GEL 1963 ± 611 kJ) was higher in CON and GEL than in WP (both P = 0.006). After accounting for supplement energy content, energy intake in GEL was higher than in CON (P = 0.0006) and WP (P = 0.0008). Time-averaged area under the curve for composite appetite scores (CON 74 ± 20, WP 50 ± 22, GEL 60 ± 16 mm) was higher in CON than WP (P = 0.015). Time-averaged area under the curve for PYY (CON 87 ± 13, WP 119 ± 27, GEL 97 ± 22 pg·mL-1) was higher in WP than CON (P = 0.009) and GEL (P = 0.012). In conclusion, supplementation with WP facilitated an increase in protein intake, whereas supplementation with GEL increases in both energy and protein intakes, when consumed before an ad libitum breakfast. Such findings, highlight potential gel-based EAA supplementation intake for addressing age-related sarcopenia.

We investigated the effects of ingesting a leucine-enriched essential amino acid (EAA) gel alone or combined with resistance exercise (RE) versus RE alone (control) on plasma aminoacidemia and intramyocellular anabolic signalling in healthy younger (28 ± 4 years) and older (71 ± 3 years) adults. Blood samples were obtained throughout the three trials, while muscle biopsies were collected in the postabsorptive state and 2 h following RE; following the consumption of two 50 mL EAA gels (40% leucine, 15 g total EAA); and following RE with EAA (combination; COM). Protein content and the phosphorylation status of key anabolic signalling proteins were determined via immunoblotting. Irrespective of age, during EAA and COM peak leucinemia (younger: 454 ± 32 µM and 537 ± 111 µM; older: 417 ± 99 µM and 553 ± 136 µM) occurred ~60 – 120 min post-ingestion (younger: 66 ± 6 min and 120 ± 60 min; older: 90 ± 13 min and 78 ± 12 min). In the pooled sample, area under the curve for plasma leucine and the sum of branched-chain amino acids was significantly greater in EAA and COM compared with RE. For intramyocellular signalling, significant main effects were found for condition (mTOR (Ser2481), rpS6 (Ser235/236)) and age (S6K1 (Thr421/Ser424), 4E-BP1 (Thr37/46)) in age group analyses. The phosphorylation of rpS6 was of similar magnitude (~8-fold) in pooled and age group data 2 h following COM. Our findings suggest that a gel-based, leucine-enriched EAA supplement is associated with aminoacidemia and a muscle anabolic signalling response, thus representing an effective means of stimulating muscle protein anabolism in younger and older adults following EAA and COM.

Purpose Circulating acylated ghrelin concentrations are associated with altitude-induced anorexia in laboratory environments, but have never been measured at terrestrial altitude. This study examined time course changes in appetite, energy intake, body composition, and ghrelin constituents during a high-altitude trek. Methods Twelve participants [age: 28(4) years, BMI 23.0(2.1) kg m−2] completed a 14-day trek in the Himalayas. Energy intake, appetite perceptions, body composition, and circulating acylated, des-acylated, and total ghrelin concentrations were assessed at baseline (113 m, 12 days prior to departure) and at three fixed research camps during the trek (3619 m, day 7; 4600 m, day 10; 5140 m, day 12). Results Relative to baseline, energy intake was lower at 3619 m (P = 0.038) and 5140 m (P = 0.016) and tended to be lower at 4600 m (P = 0.056). Appetite perceptions were lower at 5140 m (P = 0.027) compared with baseline. Acylated ghrelin concentrations were lower at 3619 m (P = 0.046) and 4600 m (P = 0.038), and tended to be lower at 5140 m (P = 0.070), compared with baseline. Des-acylated ghrelin concentrations did not significantly change during the trek (P = 0.177). Total ghrelin concentrations decreased from baseline to 4600 m (P = 0.045). Skinfold thickness was lower at all points during the trek compared with baseline (P ≤ 0.001) and calf girth decreased incrementally during the trek (P = 0.010). Conclusions Changes in plasma acylated and total ghrelin concentrations may contribute to the suppression of appetite and energy intake at altitude, but differences in the time course of these responses suggest that additional factors are also involved. Interventions are required to maintain appetite and energy balance during trekking at terrestrial altitudes.

This narrative review examines the mechanisms underlying the development of cardiovascular (CVD) and metabolic diseases (MDs), along with their association with sarcopenia. Furthermore, non-pharmacological interventions to address sarcopenia in patients with these conditions are being suggested. The significance of combined training in managing metabolic disease and secondary sarcopenia in type II diabetes mellitus is emphasized. Additionally, the potential benefits of resistance and aerobic training are being explored. This review emphasises the role of nutrition in addressing sarcopenia in patients with CVD or MDs, focusing on strategies such as optimising protein intake, promoting plant-based protein sources, incorporating antioxidant-rich foods and omega-3 fatty acids, and ensuring sufficient vitamin D levels. Moreover, the potential benefits of targeting gut microbiota through probiotics and prebiotic fibres in sarcopenic individuals are being considered. Multidisciplinary approaches that integrate behavioural science are explored to enhance the uptake and sustainability of behaviour-based sarcopenia interventions. Future research should prioritise high-quality randomized controlled trials to refine exercise and nutritional interventions and investigate the incorporation of behavioural science into routine practices. Ultimately, a comprehensive and multifaceted approach is essential to improve health outcomes, well-being, and quality of life in older adults with sarcopenia and coexisting cardio-vascular and metabolic diseases.