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Consumption of ultra-processed food (UPF) has been associated with several chronic diseases and poor diet quality. It is reasonable to speculate that the consumption of UPF negatively associates with flavonoid dietary intake; however, this assumption has not been previously examined. The present study aims to assess association between the dietary contribution of UPF and flavonoid intake in the US population aged 0 years and above. We performed a cross-sectional analysis of dietary data collected by 24-h recalls from 7640 participants participating in the National Health and Nutrition Examination Survey 2017–2018. Foods were classified according to the Nova classification system. The updated US Department of Agriculture (USDA) Database for the Flavonoid Content of Selected Foods (Release 3.3) database was used to estimate total and six classes of flavonoid intakes. Flavonoid intakes were compared across quintiles of dietary contribution of UPF (% of total energy intake) using linear regression models. The total and five out of six class flavonoid intakes decreased between 50 and 70 % across extreme quintiles of the dietary contribution of UPF (P for linear trend < 0·001); only isoflavones increased by over 260 %. Our findings suggest that consumption of UPF is associated with lower total and five of six class flavonoid intakes and with higher isoflavone intakes, supporting previous evidence of the negative impact of UPF consumption on the overall quality of the diet and health outcomes. [ABSTRACT FROM AUTHOR]

Background: The hyperbolic torque-duration curve depicts critical torque (CT) and W prime (W′), with the curve's asymptote representing CT as the boundary between heavy- and severe-intensity domains. W′, the curvature constant, indicates cumulative work beyond CT. This study investigated age-related reductions in W′, CT, and gait speed, and whether W′ and CT predict gait speed independently of muscle torque. Methods: three groups (adults, middle-aged, older) totaling 131 women were studied. W′ and CT were determined using 60 maximal isometric voluntary contractions of knee extensors. The fast gait speed was calculated in walking tests at 10 m, 400 m, and six minutes (6 MWT). Results: gait speed decreased (p < 0.05) with age, as did W′ and CT. Both W′ and CT correlated positively with gait speed at different distances (10 m, 400 m, 6 MWT). Adjusted for maximum muscle torque, only W′ maintained a positive association (p < 0.05) with all gait speed tests (10 m: β = 0.201, SE = 0.086; 400 m: β = 0.262, SE = 0.085; 6 MWT: β = 0.187, SE = 0.086). Conclusions: aging led to declines in W′, CT, and gait speed. W′, not CT, remained a significant predictor of gait speed, indicating its importance for older women's mobility. [ABSTRACT FROM AUTHOR]

Background: This study sought to investigate whether different physical function tests (objective measures of physical performance) may identify a low physical resilience in breast cancer survivors (BCS). Methods: This analytical cross-sectional study evaluated 146 BCS and 69 age-matched women without breast cancer history. The different times after the end of treatment were used as criteria for group division. Participants were divided into four groups: control (CT: n = 69–women without breast cancer history); <1.0 years after the end of treatment (<1 YAT: n = 60); 1–3.9 years after the end of treatment (1–3.9 YAT: n = 45); and ≥4 years after the end of treatment (>4 YAT: n = 41). Physical function was evaluated by 4 m walk test (4-MWT), five-times-sit-to-stand test (FTSST), timed up and go test (TUG), and short physical performance battery (SPPB). Age, menopausal status, smoking, number of medications, level of physical activity, body mass index, and muscle strength were used as confounding variables in ANCOVA. Results: All groups that underwent cancer treatment (<1 YAT, 1–3.9 YAT and ≥4 YAT) had lower physical performance (p < 0.001) identified by 4 MWT, TUG, and FTSST when compared to the CT group. For the SPPB, the <1 YAT and ≥4 YAT groups had lower performance (p = 0.005) when compared to the CT. Conclusions: The different physical function tests can be used to identify a low physical resilience in BCS. [ABSTRACT FROM AUTHOR]

Carneiro, MAS, de Oliveira Júnior, GN, de Sousa, JFR, Murta, EFC, Orsatti, CL, Michelin, MA, Cyrino, ES, and Orsatti, FL. Effects of resistance training at different loads on inflammatory biomarkers, muscle mass, muscular strength, and physical performance in postmenopausal women. J Strength Cond Res 36(6): 1582–1590, 2022—It has been suggested that the effect of resistance training (RT) on circulating proinflammatory biomarkers may be dependent on muscle mass gain. A few recent studies have suggested that lower-load RT (LLRT; loads <50% of 1 repetition maximum [1RM] and repetition performed until, or close to, voluntary concentric failure) may be superior to higher-load RT (HLRT; loads >70% of 1RM) in increasing muscle mass. Hence, this study aimed to test whether LLRT is superior to HLRT for increasing muscle mass (total fat-free mass [TFFM] and leg fat-free mass [LFFM]) and improving circulating inflammatory biomarkers (interleukin [IL]-6, IL1-ra, tumor necrosis factor [TNF]-α, and extracellular heat shock protein [eHSP]70) in postmenopausal women (PW) (primary outcome). The secondary outcome was to compare the changes in muscular strength and physical performance (4-meter walking test [4-M], timed-up-and-go [TUG] test, and sit-to-stand [STS] test) between the LLRT and HLRT. The PW were randomized into 2 groups: LLRT (n = 14; loads necessary to perform 30–35 repetitions) and HLRT (n = 15; loads necessary to perform 8–12 repetitions). The greater magnitude of increase in LFFM (p = 0.033) was observed in LLRT when compared with HLRT. Moreover, there was a trend for a greater increase in TFFM in LLRT over HLRT (p = 0.070). However, there were similar improvements in TNF-α and muscular strength (p < 0.001). Furthermore, there was no significant difference between the RT schemes on IL-6, IL-1ra, and eHSP70 levels. Thus, although performing LLRT until, or close to, voluntary concentric failure seems to provide a greater stimulus for an increase in muscle mass than HLRT, it does not seem to affect the responses in circulating inflammatory biomarkers, muscular strength, and physical performance in PW. [ABSTRACT FROM AUTHOR]

Nascimento de Oliveira Júnior, G, de Freitas Rodrigues de Sousa, J, Augusto da Silva Carneiro, M, Martins, FM, Santagnello, SB, Campos Souza, MV, and Orsatti, FL. Resistance training volume enhances muscle hypertrophy, but not strength in postmenopausal women: a randomized controlled trial. J Strength Cond Res 36(5): 1216–1221, 2022—Among several possible resistance training (RT) variables to be manipulated, the training volume has been considered as a critical variable to maximize RT-induced hypertrophy. Many of the studies that compared one set of RT with 3 sets have failed to show a difference in muscle hypertrophy in older adults. However, it is not clear whether further increases in RT volume (i.e., 6 sets) would result in even greater RT-related hypertrophy than 3 sets in older adults. This study aimed to investigate whether higher-volume RT (HV-RT) maximizes gains in lean body mass and muscle strength (MS) when compared with lower-volume RT (LV-RT) in postmenopausal women (PW). Fifty-eight PW were randomized into 1 of the 3 groups: control group (CT, no exercise), HV-RT (6 sets per exercise), and LV-RT (3 sets per exercise). Volunteers took part in a supervised training program (leg press 45°, leg extension, leg curl and standing calf raises) and were assessed for leg lean mass (LLM; dual X-ray absorptiometry) and lower limb MS (leg press and leg extension; 1 repetition maximum [1RM]) before and after 12 weeks of RT. Both HV-RT and LV-RT groups increased (p < 0.05) LLM and MS when compared with the CT group. Higher increases in LLM gains were observed for the HV-RT group when compared with the LV-RT group (6.1 and 2.3%, p < 0.001). Both HV-RT and LV-RT groups similarly increased 1RM in the leg press and leg extension. Thus, there seems to be a dose-response relationship between RT volume and muscle hypertrophy, but not for MS gains in PW. [ABSTRACT FROM AUTHOR]

Background: Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID‐19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID‐19 patients. Methods: We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS‐CoV‐2 during hospitalization and were excluded from the analyses. Results: The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (±15) years, body mass index of 29.5 (±6.9) kg/m2. The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07–2.03; P = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex‐specific mean and standard deviation (1.23 [95% CI: 1.06–1.43; P = 0.007]). Mean LOS was shorter for the strongest patients (7.5 ± 6.1 days) versus others (9.2 ± 8.4 days). Evidence of associations were also present for vastus lateralis cross‐sectional area. The crude HR identified shorter hospital stay for patients with greater sex‐specific standardized values (1.20 [95% CI: 1.03–1.39; P = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross‐sectional area (0.63 [95% CI: 0.46–0.88; P = 0.006). Mean LOS for the patients with the lowest muscle cross‐sectional area was longer (10.8 ± 8.8 days) versus others (7.7 ± 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross‐sectional area remained consistent and statistically significant after adjusting for other covariates. Conclusions: Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID‐19, which stresses the value of muscle health in prognosis of this disease. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to identify the impact of whole-body resistance training (RT) at various load intensities on adipokines, adhesion molecules and extracellular heat shock proteins in postmenopausal women. It is noted that forty participants were randomized into lower-load intensity RT and it was found that higher-load intensity resistance training improves eHSP60 and 400-M in postmenopausal women.

Menopause transition may impair muscle function, decreasing exercise tolerance. The torque–duration relationship (hyperbolic curve) forms a practical framework within which exercise tolerance may be explored. In this regard, resistance training (RT) increases the curvature constant of this relationship (W′). Muscle hypertrophy and strength gains have been suggested as possible mediators of RT-induced improvement in W′, however, it is unclear what the main mediator is. Higher-volume RT (HV-RT), beyond that recommended by RT-guidelines (i.e. three sets per exercise), may promote greater hypertrophy, but not higher strength gains. Hence, this study aimed to investigate whether greater hypertrophy in HV-RT maximises W′ gain when compared to LVRT in postmenopausal women (PW). Fifty-eight PW were randomised to the control group (CTRL), HV-RT (six sets per exercise) or LV-RT (three sets per exercise). They underwent a 12-week RT program and were assessed for W′, thigh lean body mass (TLBM) and maximal isometric voluntary contraction (MIVC). The TLBM gain was higher (P < 0.001) in the HV-RT (9.4%) than LV-RT (3.7%). However, both HV-RT and LV-RT similarly increased MIVC (9.7% vs. 16.5%, P = 0.063) and W′ (26.4% vs. 34.6% P = 0.163). Additionally, the changes in W′ were associated with the changes in TLBM (31%, P = 0.003) and MIVC (52%, P= <0.001). However, when the changes in TLBM and MIVC were inserted into the predictive model, only the MIVC (33%, P = 0.002) was a predictor of W′. Thus, although HV-RT promoted greater hypertrophy than LV-RT, HV-RT does not seem to maximise W′ in PW. [ABSTRACT FROM AUTHOR]

The shortage of essential medical care has become a major health concern as the coronavirus disease (COVID-19) pandemic continues to unfold. In Brazil, the universal health care system works with "community health agents", who are nonmedical personnel that could be trained to help in the surveillance of at-risk groups, such as postoperative bariatric patients, during the pandemic. The design of this study does not allow us to conclude whether the patients' overall health deteriorated as a consequence of the pandemic, but it does indicate that there are a considerable number of postsurgery patients in need of direct health care. [Extracted from the article]

This systematic review with meta-analysis aimed to compare the changes caused by exercise intervention with those provoked by usual care on physical function biomarkers in older adults immediately after hospital discharge. Two independent authors performed a systematic search (PubMed, Scopus, Web of Science, and SciELO) of studies published from database inception until August 2021. Randomized clinical trials investigating the effects of an exercise intervention compared to usual care were included. The Cochrane Collaboration assessment tool was used to analyze the risk of bias. The comparisons included handgrip strength, the short physical performance battery scale, six-minute walking test, and 10-m gait speed. Overall, the exercise intervention led to significantly greater changes compared to usual care in physical function biomarkers [standard mean difference = 0.89, 95% CI = 0.39, 1.42; P = 0.001]. However, considering the very few studies investigating each variable separately, our sub-analysis did not reveal a significant effect of the exercise intervention on handgrip strength, the short physical performance battery, six minutes walking test, and 10-m gait speed. This systematic review with meta-analysis of randomized clinical trials suggests that exercise intervention induce greater physical function biomarker alterations in older adults after hospitalization than usual care including physical activity guidance. Future trials comparing the effects of these intervention groups on physical function biomarkers in this population are needed to confirm our results. Potential mechanism involved in mitigating impairments in physiological resilience and declines in physical function biomarkers induced by exercise interventions in older adults after hospital discharge. [Display omitted] • Acute hospitalization causes an impact dramatic and permanent on physical function biomarkers during hospital-based care. • Vulnerability conferred by hospitalization in older adults leads to impairment in these biomarkers also after discharge. • Exercise intervention is better than usual care to improve physical function biomarkers in older adults after discharge. • Exercise intervention might help older adults recover from adverse effects caused by hospitalization also after discharge. [ABSTRACT FROM AUTHOR]

Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly understood. This single-center, cross-sectional study aimed to gather knowledge on this topic. Fifty-two patients with PASC recruited ∼6 mo after ICU discharge were clustered based on their need for IMV (PASC + IMV, n = 27) or noninvasive support therapy (PASC + NIS, n = 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL, n = 19) comprising individuals of both sexes with similar age, comorbidities, and physical activity levels but without a history of COVID-19 illness. Individuals with PASC, irrespective of support therapy, presented with higher rates of cardiorespiratory abnormalities than CONTROL, especially dysfunctional breathing patterns, dynamic hyperinflation, reduced oxygen uptake and oxygen pulse, and blunted heart rate recovery (all P < 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group ( P = 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all P > 0.05). These findings indicate significant involvement of both central and peripheral factors, leading to exertional intolerance in individuals with PASC previously admitted to the ICU, regardless of their need for IMV. NEW & NOTEWORTHY We found cardiorespiratory abnormalities in ICU survivors of severe-to-critical COVID-19 with PASC to be independent of IMV need. Overall, both group of patients experienced dysfunctional breathing patterns, dynamic hyperinflation, lower oxygen uptake and oxygen pulse, and blunted heart rate responses to CPX. PASC seems to impact exertional tolerance and exercise capacity due to ventilatory inefficiency, impaired aerobic metabolism, and potential systolic and autonomic dysfunction, all of these irrespective of support therapy during ICU stay.

Background: Long-lasting effects of COVID-19 may include cardiovascular, respiratory, skeletal muscle, metabolic, psychological disorders and persistent symptoms that can impair health-related quality of life (HRQoL). We investigated the effects of a home-based exercise training (HBET) programme on HRQoL and health-related outcomes in survivors of severe/critical COVID-19., Methods: This was a single-centre, single-blinded, parallel-group, randomised controlled trial. Fifty survivors of severe/critical COVID-19 (5±1 months after intensive care unit discharge) were randomly allocated (1:1) to either a 3 times a week (~60-80 min/session), semi-supervised, individualised, HBET programme or standard of care (CONTROL). Changes in HRQoL were evaluated through the 36-Item Short-Form Health Survey, and physical component summary was predetermined as the primary outcome. Secondary outcomes included cardiorespiratory fitness, pulmonary function, functional capacity, body composition and persistent symptoms. Assessments were performed at baseline and after 16 weeks of intervention. Statistical analysis followed intention-to-treat principles., Results: After the intervention, HBET showed greater HRQoL score than CONTROL in the physical component summary (estimated mean difference, EMD: 16.8 points; 95% CI 5.8 to 27.9; effect size, ES: 0.74), physical functioning (EMD: 22.5 points, 95% CI 6.1 to 42.9, ES: 0.83), general health (EMD: 17.4 points, 95% CI 1.8 to 33.1, ES: 0.73) and vitality (EMD: 15.1 points, 95% CI 0.2 to 30.1, ES: 0.49) domains. 30-second sit-to-stand (EMD: 2.38 reps, 95% CI 0.01 to 4.76, ES: 0.86), and muscle weakness and myalgia were also improved in HBET compared with CONTROL (p<0.05). No significant differences were seen in the remaining variables. There were no adverse events., Conclusion: HBET is an effective and safe intervention to improve physical domains of HRQoL, functional capacity and persistent symptoms in survivors of severe/critical COVID-19., Trial Registration Number: NCT04615052., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

The post-acute phase of coronavirus disease 2019 (COVID-19) is often marked by several persistent symptoms and exertional intolerance, which compromise survivors' exercise capacity. This was a cross-sectional study aiming to investigate the impact of COVID-19 on oxygen uptake (V̇o 2 ) kinetics and cardiopulmonary function in survivors of severe COVID-19 about 3-6 mo after intensive care unit (ICU) hospitalization. Thirty-five COVID-19 survivors previously admitted to ICU (5 ± 1 mo after hospital discharge) and 18 controls matched for sex, age, comorbidities, and physical activity level with no prior history of SARS-CoV-2 infection were recruited. Subjects were submitted to a maximum-graded cardiopulmonary exercise test (CPX) with an initial 3-min period of a constant, moderate-intensity walk (i.e., below ventilatory threshold, VT). V̇o 2 kinetics was remarkably impaired in COVID-19 survivors as evidenced at the on-transient by an 85% ( P = 0.008) and 28% ( P = 0.001) greater oxygen deficit and mean response time (MRT), respectively. Furthermore, COVID-19 survivors showed an 11% longer ( P = 0.046) half-time of recovery of V̇o 2 (T 1/2 V̇o 2 ) at the off-transient. CPX also revealed cardiopulmonary impairments following COVID-19. Peak oxygen uptake (V̇o 2peak ), percent-predicted V̇o 2peak , and V̇o 2 at the ventilatory threshold (V̇o 2VT ) were reduced by 17%, 17%, and 12% in COVID-19 survivors, respectively (all P < 0.05). None of the ventilatory parameters differed between groups (all P > 0.05). In addition, COVID-19 survivors also presented with blunted chronotropic responses (i.e., chronotropic index, maximum heart rate, and heart rate recovery; all P < 0.05). These findings suggest that COVID-19 negatively affects central (chronotropic) and peripheral (metabolic) factors that impair the rate at which V̇o 2 is adjusted to changes in energy demands. NEW & NOTEWORTHY Our findings provide novel data regarding the impact of COVID-19 on submaximal and maximal cardiopulmonary responses to exercise. We showed that V̇o 2 kinetics is significantly impaired at both the onset (on-transient) and the recovery phase (off-transient) of exercise in these patients. Furthermore, our results suggest that survivors of severe COVID-19 may have a higher metabolic demand at a walking pace. These findings may partly explain the exertional intolerance frequently observed following COVID-19.