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International audience; While a declined physical activity level (PAL) and an increase of sedentary behaviors at all ages during the COVID-19–induced first confinement period have been unanimously observed worldwide, the lately instituted new social distancing strategies and lockdowns around the world require the formulation and dissemination of adapted and accessible recommendations to promote physical activity (PA) and limit the progression of sedentary time (SED) in the upcoming weeks. From a public health perspective, it appears imperative to encourage the adoption of healthy movementbehaviors despite the new activity restrictions imposed by governments to slow down the alarming progression of the SARS-CoV-2 pandemic.

International audience; Purpose: A decision tree based on a clinico-physiological score (SHAI score) has been developed to detect subjects susceptible to Severe High Altitude Illness (SHAI). We aimed to validate this decision tree, to rationalize the prescription of acetazolamide (ACZ) and to specify the rule for a progressive acclimatization.Methods: Data were obtained from 641 subjects in 15 European medical centers before and during a sojourn at high altitude. Depending on the value of SHAI score, advice was given and ACZ was eventually prescribed. The outcome was the occurrence of SHAI at high altitude as a function of SHAI score, ACZ prescription and use and fulfillment of the acclimatization rule.Results: The occurrence of SHAI was 22.6%, similar to what was observed 18 years before (23.7%), while life-threatening forms of SHAI (High Altitude Pulmonary and Cerebral Edema) were less frequent (2.6% to 0.8%, P=0.007). The negative predictive value of the decision tree based was 81%, suggesting that the procedure is efficient to detect subjects who will not suffer from SHAI, therefore limiting the use of ACZ. The maximal daily altitude gain that limits the occurrence of SHAI was established at 400 m. The occurrence of SHAI was reduced from 27% to 12% when the recommendations for ACZ use and 400 m daily altitude gain were respected (P

Medical prescription of physical activity. The prescription is "a therapeutic recommendation, possibly prescribed, made by a doctor". Up-to-date recommendations exist, relayed by the authorities which formalized this act of prescription by a law for long-term ailments. The medical prescription of physical activity and sports is directed to carriers of chronic pathologies for which it will have a therapeutic action and an action of prevention of the complications. It will include, at best, besides the precision of the four parameters characterizing this activity (type, intensity, duration and frequency of the sessions), advice of daily struggle against the sedentary lifestyle. It should be personalized, to consider the patient's condition and a possible risk incurred. It remains however to provide the skills to the prescribers, informed but not always trained, and to ensure the possibilities of practical realization of the exercises appearing on the medical prescription.Ordonnance de prescription de l’activité physique. La prescription est « une recommandation thérapeutique, éventuellement consignée sur ordonnance, faite par un médecin ». Des recommandations actualisées existent, relayées par les pouvoirs publics, qui ont officialisé cet acte de prescription par une loi pour les affections de longue durée. L’ordonnance de prescription d’activité physique et sportive (APS) s’adresse à des patients atteints de pathologies chroniques avec un but de prise en charge thérapeutique et un but de prévention des complications. Elle inclut, au mieux, outre la précision des quatre paramètres caractérisant cette activité (type, intensité, durée et fréquence des séances), des conseils de lutte quotidienne contre la sédentarité. Elle doit être personnalisée pour tenir compte de l’état du patient et d’un éventuel risque encouru. Il reste cependant à fournir les compétences aux prescripteurs, informés mais pas toujours formés, et à s’assurer des possibilités de réalisation pratique des exercices figurant sur l’ordonnance.

RESUME La definition precise de la prescription, est « une recommandation therapeutique, eventuellement consignee sur ordonnance, faite par le medecin ». La prescription d’activite physique et sportive (APS) dans un but de sante s’adresse donc a des porteurs de pathologies chroniques pour lesquels elle aura une action therapeutique et une action de prevention des complications. Cette prescription repose sur 4 parametres caracterisant l’APS, nature, intensite, duree et frequence des seances et devra etre personnalisee. Des recommandations actualisees existent, relayees par les pouvoirs publics qui ont recemment officialise cet acte de prescription par une loi pour les affections de longue duree. Le concept de prescription de l’activite physique associee a l’indispensable lutte quotidienne contre la sedentarite est une avancee majeure du role des APS comme facteur de sante et de la prise de conscience de la necessite de modifier les comportements. Il reste cependant a s’assurer des competences des differents acteurs, en termes de prescription medicale et de prise en charge specifique.

Pectum excavatum’s (PE) functional impact is discussed. To this day, there is no consensus despite the many studies published on that subject. This explains that there are no official guidelines regarding the evaluation of patients with PE. However, some authors suggested guidelines on the indications of corrective surgery (Nuss, or modified Ravitch) [1–3]. But the definition of functional respiratory and cardiac impairment may not be described precisely enough. Moreover, they used a radiological measure (Haller index) although several studies showed a lack of correlation with the physiological impairment of the deformity [4–6] and no impact on the patient’s quality of life [7, 8]. The aesthetic damage and its psycho-social impact were not always considered. The plastic surgery solutions were not part of the decision algorithm.

Introduction: Pectus Excavatum (PE), the most common of all congenital chest wall deformities, leads to psychosocial repercussions and seems to disturb quality of life. The impact on the cardio respiratory function and exercise abilities is debated. The aim of this study was to describe health related quality of life (HRQOL) and respiratory functions. Methods: This study involved PE patients with a project of cosmetic surgical repair by silicone implants. We evaluated pulmonary function tests (PFTs), cardio pulmonary exercise tests (CPET), HRQOL with the SF36 regarding the morphology characteristics of the deformity (CHIN classification , HALLER index, implant size). Results: 45 patients were included, the mean age was 30 years old with a 2.2 sex ratio. Only one patient (3%) described symptoms. PFTs revealed 2 obstructive syndromes and no restrictive syndrome (mean TLC: 97+/-11%). The mean peak VO2 was 85+/-13% of predicted (33+/-7 mL/min/kg). It was under 84% of the predicted value in 47% of patients (n=21), most of them were limited from deconditioning. None had cardiological, respiratory nor ventilatory limitations. Regarding HRQOL, the mean Physical Composite Score (PCS) was 88+/-10.6% and the mean Mental Composite Score (MCS) was 75.1+/-18.6%. In the patients under 24 years old, and in women with HALLER index over 5, MCS was lower (respectively 61,9% and 68.5%) than in the general population (76,27%). Conclusion: Patients had neither symptoms nor respiratory impairments, but some had a physical limitation due to deconditioning that did not impact their global quality of life. However, the younger patients and women with high HALLER index had an altered HRQOL due to psychosocial repercussions.

Background: Cardiac output (CO) is a prognostic factor in pulmonary hypertension (PH). Right heart catheterisation using the direct Fick method or thermodilution (TD) is the reference technique for CO measurement. Impedance cardiography (IPc) is a known non-invasive method of measuring CO. Objectives: In our study, we assume that the measurement of CO by IPc using the PHYSIOFLOW® system is as accurate as TD or using the direct Fick method in patients with PH in group 1 or group 4. Methods: A total of 75 patients were enrolled in a prospective study carried out at the hypertension reference centre of Toulouse University Hospital. Right heart catheterisation was performed for the diagnosis or follow-up of the disease. CO was measured using the Fick method, TD, and IPc simultaneously. A Bland-Altman analysis was plotted. Results: CO was 5.7 ± 1.9 L/min as measured by the Fick method, 5.4 ± 1.5 L/min by TD, and 5.5 ± 1.7 L/min by IPc. The bias between CO measurements by IPc and the direct Fick method was 0.149 L/min (95% CI, –0.298 to 0.596). The bias between CO measurements by IPc and the TD method was –0.153 L/min (95% CI, –0.450 to 0.153). The correlation decreased with the more extreme CO values (< 3 L/min or > 7 L/min). A few factors changed the agreement between measurements (BMI or membership in group 4). Conclusion: To conclude, this study shows that the measurement of CO by IPc in PH patients is reliable compared to the direct Fick method and TD obtained by right heart catheterisation. This accuracy decreases for extreme CO values.

While there is no lack of evidence demonstrating the benefits of carrying out regular physical activity which is adapted to our age, our lifestyles are nevertheless too sedentary. What place does sport, a major determining element of our physical and mental health, hold today?

The fight against sedentariness and encouraging older people to exercise is a major public health objective. The aim is to preserve the health of the elderly, to avoid the excessive cost of care and to prevent the loss of autonomy.

The practice of physical and sporting activities (PSA) throughout life is now known to increase healthy life expectancy, to delay the onset of dependency, and to be an effective complementary treatment for many disorders, particularly obesity and disability. The notion of a "sedentary death syndrome " [SeDS] has been evoked on the other side of the Atlantic. Although the beneficial effects of PSA have long been known, statistical analyses have only recently confirmed at the group level what was often disputed at the individual level. Knowledge of the impacts of PSA on cellular, tissular and metabolic functions has improved considerably. PSA is no longer seen simply as a leisure activity but is now considered necessary for a healthy body and mind. PSA also has considerable social, educational and integrative implications. Can any society ignore these evident health benefits with impunity? The aims of this article are 1) to provide a quick overview of the advantages of regular, measured and reasonable PSA, as well as the potential risks of excess; 2) to discuss the quantity of PSA providing the optimal balance between benefits and risks, and the means of achieving this balance; 3) to highlight the lack of enthusiasm for PSA among the French population, and to analyze its causes, and 4) to propose a new organization designed to help more of our fellow citizens to adopt PSA, in the interests of their health and well-being.

Background Salbutamol abuse detection by athletes is based on a urinary upper threshold defined by the World Anti-Doping Agency (WADA). However, this threshold was determined in healthy, untrained individuals and after a dose of salbutamol inhaled that might not really mirror the condition of asthmatic athletes and the experts’s guidelines for asthma management. We aimed to revise this threshold in accordance with recommended clinical practice (that appear to be different from the actual WADA recommendation) and in exercise conditions. Methods For the present open-label design study, we included 12 trained male cyclists (20 to 40 y/o) with asthma. Differently from the previous pharmacokinetic study supporting the actual salbutamol urinary upper threshold, we decided to administer a close to recommended clinical practice daily dose of 3x200 μg.d−1 inhaled salbutamol (instead of 1600 μg.d−1 as authorized by the anti-doping policy). Urine salbutamol concentration was quantified by liquid chromatography-tandem ion trap mass spectrometry and corrected for urine density, at rest and after a 90-min cycling effort at 70-80 % of the maximal aerobic power. Results The maximum urine salbutamol concentration value peaked after the cycling effort and was 510 ng.mL−1. That is twice lower than the actual WADA threshold to sanction salbutamol abuse, this “legal” threshold being based on pharmacokinetic data after a daily dose that is 8 fold the total dose sequentially administrated in our study. Considering its 95 % confidence interval, this threshold value could be more stringent. Conclusion By using conditions in accordance with the experts’ clinical and safety guidelines for asthma management in athletes undergoing an intense exercise bout, our study suggests that the urine salbutamol concentration threshold could be lowered to redefine the rule supporting the decision to sanction an athlete for salbutamol abuse.

Les personnes en situation de handicap mental ou psychique ont definitivement acquis le droit a la pratique des activites physiques et sportives par la loi de fevrier 2005 ! Les bienfaits de ces activites sont demontres, sous reserve de la prise en compte au cours d’une visite medicale de certaines contre-indications ou restrictions, et de l’apport de solutions adaptees a chaque forme de handicap chez cette population tres heterogene. Les possibilites de pratiques, de plus en plus nombreuses, impliquent toutes les federations et plus particulierement la Federation francaise du sport adapte.

Resume Objectif Ce travail etudie les donnees recueillies (a partir des fiches d’observation) lors des entretiens realizes avec les sportifs ayant consulte l’Antenne Medicale de Prevention du Dopage (AMPD) Midi-Pyrenees entre 2002 et 2008. Methodologie Etude retrospective sur une periode de 7 ans (2002-2008). Les variables analysees ont ete les caracteristiques des sportifs, les substances consommees ainsi que les disciplines sportives concernees. Resultats Trente-cinq fiches d’observation ont ete repertoriees correspondant a 32 hommes et 3 femmes, d’âge moyen 28 ans (extremes de 18 et 47 ans, dont 10 sujets ≥ 30 ans). Le niveau de competitions etait national pour 16, international pour 8 et regional pour 7. La moyenne des annees de pratique sportive etait de 14 ans. Les sports correspondaient essentiellement au rugby (9), cyclisme (5), athletisme (3) et culturisme (3). Les substances interdites repertoriees ont ete le cannabis (15 cas), les glucocorticoides (9), les androgenes (4), les sympathicomimetiques (4), les beta-2 agonistes (2) et les antiinflammatoires non steroidiens (2). Nous avons aussi trouve des produits veterinaires (clenbuterol, boldone-veterinaire)[2]. Conclusion Cette etude permet un premier bilan des consultations cliniques dans les AMPD. Elle montre un âge relativement eleve des sportifs consultants. Les sports le plus souvent retrouves ont ete le rugby et le cyclisme. Le cannabis et les glucocorticoides paraissent les substances interdites les plus impliquees dans les situations de dopage.

Microgravity affects the different organ systems to various degrees. In particular, a thoracocephalic fluid shift occurs through suppression of the hydrostatic gradient. Sensory conflict leads to space motion sickness, which is frequent early in the flight, and the musculo-skeletal system is perturbed by the lack of stimuli. The respiratory system seems to be less affected. These changes do not seem to impair health or performance. Humans seem able to adapt to long-term exposure to microgravity, but disorders can occur on return to Earth. In-flight preventive measures need be developed.

In advanced cirrhosis, decreased lung transfer for carbon monoxide (TLCO) and increased alveolar-arterial oxygen tension difference (PA-aO2≥15 mmHg while breathing ambient air) are frequently detected. Pulmonary membrane diffusion capacity for CO (DmCO) and pulmonary capillary blood volume (Vcap) can be derived from the simultaneous measurement of TLCO and lung transfer for nitric oxide (TLNO). Measurements of single-breath TLNO and TLCO were performed in 49 cirrhotic patients with advanced liver cirrhosis and in 35 healthy controls to derive Vcap, DmCO, and TLNO:TLCO ratio. Twenty-five patients had increased PA-aO2, of whom 11 had hepatopulmonary syndrome (HPS). Compared with controls, non-HPS patients with normal PA-aO2had a significant ∼10% decrease in TLCO, DmCO, and Vcap but similar TLNO:TLCO ratios. Compared with non-HPS patients with normal PA-aO2, non-HPS patients with increased PA-aO2had lower Vcap and higher TLNO:TLCO ratio but similar DmCO. HPS patients had lower Vcap and higher TLNO:TLCO ratios than both subgroups of non-HPS patients. In cirrhotic patients, TLNO:TLCO ratios correlated positively, and TLCO (percentage of the predicted value) and Vcap (percentage of the predicted value) correlated negatively with PA-aO2( r2= 0.25, P = 0.0003, r2= 0.48, P < 0.0001 and r2= 0.57, P < 0.0001, respectively). We concluded that, in cirrhotic patients, lower TLCO and increased PA-aO2are associated with lower Vcap. In addition, high TLNO:TLCO ratios in patients with increased PA-aO2suggest a decreased thickness of the capillary blood layer in these patients.

In cirrhotic patients, alveolar nitric oxide (NO) concentration is increased. This may be secondary to increased output of NO produced by the alveoli (V'(A,NO)) and/or to decreased lung transfer factor of NO. In advanced liver cirrhosis, NO produced by the alveoli may play a role in abnormalities of pulmonary haemodynamics and gas exchanges. In cirrhotic patients, we aimed to measure V'(A,NO) and to compare V'(A,NO) with pulmonary haemodynamics and gas exchange parameters. Measurements were performed in 22 healthy controls and in 29 cirrhotic patients, of whom eight had hepatopulmonary syndrome. Exhaled NO concentrations were measured at multiple expiratory flow rates to derive alveolar NO concentration. V'(A,NO) was the product of alveolar NO concentration by single breath lung transfer factor for NO. V'(A,NO) was increased in patients (median (range) 260 (177-341) nL x min(-1)) compared with controls (79 (60-90), p0.0001). Alveolar-arterial oxygen tension difference failed to correlate with V'(A,NO). However, cardiac index correlated positively and systemic vascular resistance correlated negatively with V'(A,NO) (r = 0.56, p = 0.001 and r = -0.52, p = 0.004, respectively). In cirrhotic patients, NO was produced in excess by the alveolar compartment of the lungs. Alveolar NO production was associated with hyperdynamic circulatory syndrome but not with arterial oxygenation impairment.

Introduction: Cardiac output (CO) is one of the most important prognostic factor in PH and is required for the assessment of treatment response. CO is measured invasively by right heart catheterization by thermodilution or the Fick method. Impedance cardiography (IP) measures CO and is noninvasive, simple and provides immediate results. Objectives: The main objective of this feasibility study was to assess the accuracy of of CO measures performed IP compared to the Fick method in selected patients treated for PH (Group 1 or 4). Secondary objectives were to evaluate the accuracy of CO evaluation by IP compared to thermodilution and to determine the factors that may affect the measures. Methods: Patients were recruited from the cohort of the Competence Center PH of Midi-Pyrenees, France. The three techniques (Fick, thermodilution and IP) were realized at the same time during right heart catheterization performed in the patient follow up. All patients had confirmed PH from Group 1 or group 4. Results: We had recruited 37 subjects in the study. (31 patients group 1 and 6 patients group 4). The CO measured by IP correlates with the CO measured by the Fick method: ρ=0.62 CI 95% [0.3064; 0.8124] (P Conclusion: This pilot study validates the measurement of CO by IP in patients with PH (group 1 or 4). This suggests a potential role of the non-invasive IP in the follow up of PH patients.

Resume Objectifs Apprecier les effets de l'exercice physique chez le sujet obese. Donnees actuelles Meme si l'exercice musculaire n'entraine qu'une faible reduction ponderale, il permet d'ameliorer le metabolisme des lipides. Cela peut etre explique par des modifications de la lipolyse du tissu adipeux et de l'oxydation lipidique. Les hormones impliquees dans la regulation de la lipolyse a court terme sont principalement les catecholamines, qui peuvent la stimuler (recepteurs β-adrenergiques) et l'inhiber (recepteurs α-adrenergiques), le peptide atrial natriuretique (ANP) qui l'active, et l'insuline qui est la principale hormone antilipolytique. L'effet inhibiteur α-adrenergique augmente avec l'IMC et le niveau de sedentarite. L'effet lipolytique β-adrenergique augmente durant l'exercice, d'autant plus qu'il est intense et se prolonge, resultant en une augmentation de la mobilisation lipidique. L'oxydation des lipides augmente avec la duree de l'exercice, et l'intensite permettant une oxydation lipidique maximale augmente avec le niveau d'entrainement d'un sujet. L'entrainement en endurance permet d'ameliorer la mobilisation lipidique en raison d'une amelioration de la sensibilite β-adrenergique et ANP-ergique et d'une diminution de l'effet α-adrenergique. Il induit egalement une augmentation des capacites d'oxydation lipidique dans le muscle. Ainsi, l'entrainement en endurance conduit a une meilleure adequation entre la mobilisation et l'oxydation des lipides, ce qui pourrait contribuer a la reduction des consequences metaboliques de l'obesite.

The aim of this study was to investigate whether endurance training improves lipid mobilization and oxidation in overweight subjects. Eleven young men (25.6 ± 1.4 yr and body mass index 27.7 ± 0.2) performed a 4-mo training program consisting of practicing aerobic exercise 5 days/wk. Before and after the training period, lipid oxidation was explored during a 60-min exercise at 50% of peak O2consumption by use of indirect calorimetry. Lipid mobilization and antilipolytic α2-adrenoceptor effect were also studied using the microdialysis method in abdominal subcutaneous adipose tissue (SCAT). After training, plasma nonesterified fatty acid (NEFA) levels, at rest and during exercise, were significantly lower than before ( P < 0.001). Lipolysis in SCAT was significantly higher after than before training. An antilipolytic α2-adrenoceptor effect in SCAT was underlined during exercise before training and disappeared after. The respiratory exchange ratio was lower after training, i.e., the percentage of lipid oxidation was higher only at rest. The amount of lipid oxidized was higher after training, at rest, and during exercise. Although exercise power was higher after training, the relative intensity was equivalent, as suggested by a similar increase in plasma catecholamine concentrations before and after training. In conclusion, 4-mo training in overweight men improved lipid mobilization through a decrease of antilipolytic α2-adrenoceptor effect in SCAT and lipid oxidation during moderate exercise. Training induced a decrease of blood NEFA, predicting better prevention of obesity.

Objective: The aim of this study was to determine how training modifies metabolic responses and lipid oxidation in overweight young male subjects. Research Methods and Procedures: Eleven overweight subjects were selected for a 4-month endurance training program. Before and after the training period, they cycled for 60 minutes at 50% of their Vo2max after an overnight fast or 3 hours after eating a standardized meal. Various metabolic and endocrine parameters, and respiratory exchange ratio values were evaluated. Results: Exercise-induced plasma norepinephrine concentration increases were similar before and after training in fasted or fed conditions. After food intake, exercise promoted a decrease in plasma glucose and a higher increase in epinephrine than in fasting conditions. The increase in epinephrine after the meal was more marked after training (264 ± 32 vs. 195 ± 35 pg/mL). Training lowered the resting plasma nonesterified fatty acids. During exercise, changes in glycerol were similar to those found before training. Lipid oxidation during exercise was higher in fasting than in fed conditions (15.5 ± 1.4 vs. 22.3 ± 1.7 g/h). Training did not significantly increase fat oxidation when exercise was performed in fed conditions, but it did in fasting conditions (18.6 ± 1.4 vs. 27.2 ± 1.8 g/h). Discussion: Endurance training decreased plasma nonesterified fatty acids, cholesterol, and insulin concentrations. Training increased lipid oxidation during exercise, in fasting conditions, and not when exercise was performed after the meal. During exercise in overweight subjects, the fasting condition seems more suited to oxidizing fat and maintaining glucose homeostasis than a 3-hour wait after a standard meal.

The aim of the study was to examine whether a moderate exercise increases the utilization of fatty acids during the recovery period in obese men. Six healthy obese participated in a randomized crossover investigation, one with exercise and one without exercise. At 8 a. m., the subjects had a standardized breakfast and they rested in a sitting position for 3 hours. The subjects were maintained in the sitting position for 4 additional hours in one session. In a second session, they exercised for 60 min at 50 % of their VO(2) max and then returned to the sitting position for 3 hours. Respiratory exchange ratio (RER) values were calculated by indirect calorimetry. During the resting session, plasma non-esterified fatty acids (NEFA) and glycerol concentrations rose progressively, whereas RER progressively decreased. During the exercise, plasma catecholamines, NEFA, glycerol, growth hormone and cortisol levels and RER increased while insulin decreased. During the recovery, plasma NEFA increased and glycerol decreased. During the first hour of recovery, RER values were lower and fatty acid utilization higher than during the same period of the resting session. The study shows that exercise induces modifications in hormonal factors promoting lipid mobilization and suggests that exercise provide substantial amounts of NEFA for muscle oxidation during recovery from an exercise bout in obese subjects.

Resume Objectifs – Mesurer le phenomene du dopage sportif chez des adolescents francais. Materiels et methodes – Notre population effective etait celle des eleves de Midi-Pyrenees en 1999 apres exclusion des sections sportives de haut niveau. Notre enquete s'est deroulee aupres d'un echantillon representatif (sur le sexe, le departement et le type d'etablissement) de 1 506 filles et 1 420 garcons âges de 13 a 20 ans, selectionnes par un sondage en grappes. Les donnees ont ete recueillies a l'aide d'un autoquestionnaire anonyme. Des estimations regionales ont ete calculees. Resultats – Plus de 80 % des eleves de notre echantillon ont declare pratiquer une activite sportive en dehors de l'education physique et sportive. Pres de 3 000 eleves de notre population effective (2 % de celle-ci) consommeraient un produit classe dopant (parfois sans le savoir) pour faire du sport, et 8,6 % des sportifs considereraient « connaitre un copain se dopant pour faire du sport ». La situation pourrait etre encore plus inquietante si l'on considere que plus de 12 000 eleves (8,7 %) de la population effective pourraient etre tentes de se doper. Les principales substances dopantes citees par les eleves etaient la cafeine sous forme de comprimes, les beta 2 mimetiques et le cannabis. Un total de neuf jeunes sportifs a egalement declare consommer de la creatine.

While there is no lack of evidence demonstrating the benefits of carrying out regular physical activity which is adapted to our age, our lifestyles are nevertheless too sedentary. What place does sport, a major determining element of our physical and mental health, hold today?

The aim of this study was to investigate the involvement of the antilipolytic α2-adrenergic receptor pathway in the regulation of lipolysis during exercise in subcutaneous abdominal adipose tissue (SCAAT). Seven trained men and 15 untrained men were studied. With the use of microdialysis, the extracellular glycerol concentration was measured in SCAAT at rest and during 60 min of exercise at 50% of maximal oxygen consumption. One microdialysis probe was perfused with Ringer solution; the other was supplemented with phentolamine (α2-adrenergic receptor antagonist). No differences in baseline extracellular or plasma glycerol concentrations were found between the two groups. The exercise-induced extracellular and plasma glycerol increase was higher in trained compared with untrained subjects ( P < 0.05). Addition of phentolamine to the perfusate enhanced the exercise-induced response of extracellular glycerol in untrained subjects but not in trained subjects. The exercise-induced increase in plasma norepinephrine and epinephrine concentrations and the decrease in plasma insulin were not different in the two groups. These in vivo findings demonstrate higher exercise-induced lipolysis in trained compared with untrained subjects and show that, in trained subjects, the α2-mediated antilipolytic action is not involved in the regulation of lipolysis in SCAAT during exercise.

In man, the major hormones controlling the lipolytic function are insulin (inhibition of lipolysis) and catecholamines (stimulation of lipolysis). Catecholamines are of major importance for the regulation of lipid mobilization in human adipose tissue and for the increase of non-esterified fatty acid supply to the working muscle. In vitro studies have shown that there are differences in the catecholaminergic control of fat cells from various fat deposits and a number of physiological and pathological alterations of catecholamine-induced lipolysis have been reported. Lipolytic resistance to catecholamines has been reported in subcutaneous adipose tissue, the major fat depot in obese subjects. Multiple alterations in catecholamine signal transduction pathways have been reported. In situ microdialysis allows a physiological exploration of adipose tissue biology. Recent data obtained on the catecholaminergic regulation of lipolysis and lipid mobilization, using microdialysis in humans, will be analysed. A potent lipolytic and lipomobilizing effect of atrial natriuretic peptide has recently been discovered; the mechanisms of action and physiological relevance will also be discussed.

With the use of the microdialysis method, exercise-induced lipolysis was investigated in subcutaneous adipose tissue (SCAT) in obese subjects and compared with lean ones, and the effect of blockade of α2-adrenergic receptors (ARs) on lipolysis during exercise was explored. Changes in extracellular glycerol concentrations and blood flow were measured in SCAT in a control microdialysis probe at rest and during 60-min exercise bouts (50% of heart rate reserve) and in a probe supplemented with the α2-AR antagonist phentolamine. At rest and during exercise, plasma norepinephrine and epinephrine concentrations were not different in obese compared with lean men. In the basal state, plasma and extracellular glycerol concentrations were higher, whereas blood flow was lower in SCAT of obese subjects. During exercise, the increase of plasma glycerol was higher in obese subjects (115 ± 35 vs. 65 ± 21 μmol/l). Oppositely, the exercise-induced increase in extracellular glycerol concentrations in SCAT was five- to sixfold lower in obese than in lean subjects (50 ± 14 vs. 318 ± 53 μmol/l). The exercise-induced increase in extracellular glycerol concentration was not significantly modified by phentolamine infusion in lean subjects but was strongly enhanced in the obese subjects and reached the concentrations found in lean sujects (297 ± 46 μmol/l). These findings demonstrate that the physiological stimulation of SCAT adipocyte α2-ARs during exercice-induced sympathetic nervous system activation contributes to the blunted lipolysis noted in obese men.

Resume Objectif. L'objectif de cette revue est de faire le point sur les connaissances concernant l'influence du sport sur l'apparition de I'arthrose femorotibiale. Actualites. De nombreux travaux suggerent que le sport peut favoriser la constitution d'une arthrose femorotibiale. Les donnees de la litterature restent cependant partielles et souvent contradictoires, cela probablement en raison des difficultes methodologiques mais aussi a cause de la complexite du probleme. Perspectives. En effet, les consequences sur l'articulation femorotibiale ne sont pas les memes en fonction du sport pratique, de l'âge de debut, de l'intensite et de la duree de l'activite. Ainsi, les consequences a long terme de la course a pied ne sont toujours pas clairement definies. En effet, bien que les coureurs de fond ne semblent pas predisposes de facon majeure a la survenue d'une gonarthrose, il apparait cependant des modifications radiologiques d'interpretation delicate. Le role deletere d'autres sports, notamment lorsqu'ils imposent des mouvements de rotation, semble beaucoup plus etabli. De meme, la duree et l'intensite de l'activite physique sont certainement deux composantes primordiales pouvant surpasser les capacites d'adaptation du cartilage femorotibial a l'exercice. Sur ces donnees, il est possible de determiner chez le sportif des facteurs qui peuvent favoriser la survenue d'une arthrose femorotibiale.

Background: -Epidemiologic studies have shown that weight loss is commonly associated with Alzheimer disease (AD) and is a manifestation of the disease itself. The etiology of weight loss in AD appears multifactorial. Hypotheses to explain the weight loss have been suggested (eg, atrophy of the mesial temporal cortex, biological disturbances, and higher energy expenditure); however, none have been proven. Objective: In the first part of this article, we describe weight loss in AD (epidemiologic data and hypotheses to explain weight loss and anorexia in AD). In the second part we report the results of a longitudinal study of the changes in nutritional variables in a cohort of patients with a probable diagnosis of AD. Design: We followed subjects with AD (based on criteria of the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association) who were recruited from the Alzheimer's Disease Center in Toulouse. All subject underwent a nutritional, neuropsychologic, and functional evaluation. The Zarit scales were used to assess caregiver burden and caregiver reactions to the patients' behavioral and autonomic disorders. Results: We showed that only results of the Burden Interview and the Memory and Behavior Problems Checklist, which explored caregiver burden, predicted weight loss in AD. It is possible that caregivers who consider themselves overburdened by the disease process are not willing to invest adequate resources to allow AD patients to properly nourish themselves. Conclusion: Nutritional education programs for the caregivers of AD patients seem to be the best way to prevent weight loss and improve the nutritional status of these patients.

The purpose of this study was to examine the effects of prolonged hypoxia on adipose tissue lipolysis, in relation to the weight loss usually observed at high altitude. Eight male subjects were exposed for 31 days to gradually increasing hypobaric hypoxia up to the equivalent altitude of 8848 m (Mt Everest) in a decompression chamber, after 7 days at 4350 m for altitude pre-acclimatization. A biopsy of subcutaneous adipose tissue was performed before and after hypoxic exposure, to study in vitro changes in adipose tissue sensitivity. Fat mass, adipocyte volume and spontaneous lipolysis were not impaired by the exposure to hypoxia. The in vitro lipolytic response to epinephrine, isoproterenol, growth hormone (GH) and parathormone (PTH) decreased significantly (P

OBJECTIVE: The aim of this study was to assess, by longitudinal follow-up, the influence of aerobic training on the in vivo lipolytic activity of adipose tissue in obese male subjects. SUBJECTS: Eleven obese non-diabetic males, aged 41.5±5.7 7 (range 27–49 y) with body mass index (BMI) 36.5±4.5 kg\m2 (range 29.4–47.1 kg\m2) participated in the study. DESIGN: Subjects took part in a 12-week aerobic training program. Before and after training, microdialysis of abdominal subcutaneous adipose tissue (SCAT) was carried out, using perfusion with graded doses of the β β-adrenergic agonist isoprenaline and a single dose of the phosphodiesterase inhibitor theophylline. In addition, the response of plasma glycerol and free fatty acids (FFAs) to intravenous infusion of graded doses of isoprenaline was tested. RESULTS: The training did not induce significant weight loss and promoted an increase in maximum aerobic capacity (P

The effect of a sustained decrease in sympathetic nervous activity, achieved through 5-day head-down bed rest (HDBR), on the beta-adrenergic lipolytic activity of s.c. adipose tissue was studied in eight healthy men. The in situ beta-adrenoceptor (AR) sensitivity was studied using the microdialysis method. Local perfusion of increasing concentrations of isoprenaline showed an increased beta-AR sensitivity to lipolysis (assessed by extracellular glycerol concentration) and to vascular tone (assessed by the ethanol clearance). The adrenergic sensitivity of isolated adipocytes was studied in vitro. Basal lipolysis and the response to nonselective (isoprenaline) or selective (dobutamine, terbutaline, and CGP 12177) beta-AR agonists were increased after HDBR as was the lipolytic effect of dibutyryl cAMP. When data were expressed as a percentage of the dibutyryl cAMP effect to rule out the postreceptor events, basal and lipolytic responses to beta-AR agonists where similar before and during HDBR. The alpha 2-AR-mediated antilipolytic effects of adrenaline were not modified. Lymphocyte beta-AR number was unchanged during HDBR. Our results demonstrate that a sustained sympathoinhibition induces an increase in the lipolytic beta-adrenergic response in adipose tissue and suggest that this hypersensitization is linked to an increase in the postreceptor steps of the lipolytic cascade in the adipocyte rather than to changes in beta-adrenoceptors.

Resume Des etudes epidemiologiques montrent que la perte de poids est frequemment associee a la maladie d'Alzheimer. Ce serait meme une manifestation de la maladie elle-meme. La perte de poids est difficilement explicable etant donne que les sujets, presentant une demence de type Alzheimer, semblent conserver des apports nutritionnels satisfaisants. Plusieurs hypotheses sont formulees : majoration des depenses energetiques, perturbations biologiques, dysfonctionnement de la regulation du poids corporel, atrophie du cortex mesial temporal. Cependant, a ce jour, aucune etude n'a permis de conclure. Il semblerait que l'amelioration des problemes nutritionnels, a l'origine d'un certain nombre de complications (infections, escarres, grabatisation), soit une des meilleures strategies permettant de diminuer le fardeau de la maladie.

The practice of physical and sporting activities (PSA) throughout life is now known to increase healthy life expectancy, to delay the onset of dependency, and to be an effective complementary treatment for many disorders, particularly obesity and disability. The notion of a "sedentary death syndrome " [SeDS] has been evoked on the other side of the Atlantic. Although the beneficial effects of PSA have long been known, statistical analyses have only recently confirmed at the group level what was often disputed at the individual level. Knowledge of the impacts of PSA on cellular, tissular and metabolic functions has improved considerably. PSA is no longer seen simply as a leisure activity but is now considered necessary for a healthy body and mind. PSA also has considerable social, educational and integrative implications. Can any society ignore these evident health benefits with impunity? The aims of this article are 1) to provide a quick overview of the advantages of regular, measured and reasonable PSA, as well as the potential risks of excess; 2) to discuss the quantity of PSA providing the optimal balance between benefits and risks, and the means of achieving this balance; 3) to highlight the lack of enthusiasm for PSA among the French population, and to analyze its causes, and 4) to propose a new organization designed to help more of our fellow citizens to adopt PSA, in the interests of their health and well-being.

Resume Une enquete exploratoire sur le dopage en milieu scolaire a ete realisee en 1991, a la suite de la publication de chiffres alarmants concernant l'utilisation de produits dopants par de jeunes scolaires et/ou sportifs aux Etats-Unis. Elle a ete conduite aupres d'un echantillon representatif de 2 425 eleves de la region Midi-Pyrenees, au moyen d'un questionnaire anonyme autoadministre. L'objectif poursuivi etait de cerner la realite du dopage en milieu scolaire, de rechercher l'existence de marqueurs de risque associes et de degager des orientations educatives dans une optique de prevention. Les resultats de cette etude ont montre qu'il existe une reelle vulnerabilite au phenomene du dopage chez les jeunes: environ 2% des eleves declarent s'etre deja dopes, tandis que 7,7% affirment avoir peut-etre deja pris un produit dopant (sans connaitre l'efficacite reelle du produit), 8,9% etre eventuellement tentes par le dopage, 7,7% avoir deja eu des propositions de produits dopants ou peut-etre dopants et 10,3% connatre un copain qui s'est deja dope. La pratique d'un sport et l'utilisation de produits dopants sont plus importantes chez les garcons que chez les filles. Les declarations de dopage ou la tentation du dopage augmentent avec le niveau et l'intensite de la pratique sportive. Certains sports comme la musculation ou les sports de combat semblent plus touches par ce phenomene.

Resume Objectifs – Evaluer l'effet d'un repas hyperglucidique sur les variations de concentration de catecholamines et sur la mobilisation des lipides lors d'un exercice. Methodes et resultats – Pendant l'exercice (1 h a 50 % du VO 2max ), les concentrations d'adrenaline augmentent 2 fois plus chez les sujets nourris que chez les sujets a jeun alors qu'il n'y a pas de difference de concentration pour la noradrenaline. A l'exercice, l'augmentation de la lipolyse est semblable dans les 2 situations. Conclusion – Chez les sujets nourris, l'augmentation importante, pendant l'exercice, des concentrations d'adrenaline compense l'effet antilipolytique de l'insuline dont la secretion a ete augmentee par la prise du repas hyperglucidique.

CCHS or Ondine9s curse is a rare autosomal dominant disease, characterized by disorders of the autonomic nervous system, with abnormal ventilatory responses to hypercapnia and hypoxemia. PHOX2B has been identified as the major disease causing gene for CCHS. It results from polyalanine repeat expansion mutations. It typically occurs in the newborn period, but some cases have been described on adults (late onset CCHS) and reflects the variable penetrance of PHOX2B mutations. A 48 year-old woman presented after an ovarian cyst surgery a severe hypoventilation requiring intubation. Arterial blood gas revealed a PO2 of 50 mmHg, a PCO2 of 80 mmHg and a pH of 7,22. Past medical history indicated poor apparent symptoms for few years. These included apneas, fitfully sleep and awakening with headaches. Physical examination and pulmonary function tests, lung tomography, magnetic resonance imaging of the brainstem were normal. Polysomnography revealed many central and obstructive apneas and hypopneas (apnea-hypopnea index of 22/h) with severe hypoxemia (SpO2 average 75%) and hypercapnia (transcutaneous CO2 85mmHg). Non invasive ventilation was initially poorly tolerated. Finally, she responded to an adaptative servo ventilation. Hypoxia and hypercapnia tests showed no adaptation of the ventilatory response. Genetic analysis showed a heterozygous five alanine expansion mutation of the 20-residue polyalanine tract in exon 3 of the PHOX2B gene. The diagnosis of late onset CCHS should be considered in patients with unexplained hypoventilation after anesthesia, and physiologic evaluations documenting abnormal ventilatory response should be completed. The presence of a PHOX2B mutation confirms the diagnosis.

Objective: To assess the prevalence of trauma injuries in triathletes and look for contributing factors involved. Method: An anonymous questionnaire about trauma history during the past season was sent by post to 788 triathletes from a French league. Results: 52.4% of triathletes responding reported having been injured at least once during the past season, for 17% of them several times. 83.5% of injuries occurred during training, mostly in running (72.5%). The tendinopathies (44.5%), and muscle injuries (35%), were the most frequently reported. The anatomical sites most frequently reported were the ankle (20.6%), knee (18.3%), thigh (15%), lumbar region (12.6%) and shoulder (8,3%). 77% of injured triathletes were able to keep training, mainly in swimming (71%) and cycling (61.5%), while running was stopped in 85.5% of cases. Injured triathletes reported devote significantly less time to warmup than uninjured triathletes (respectively 13.7 min vs. 18 min) (p < 0.01). Time devoted to stretching was also lower for injured vs. uninjured (respectively 8.3 min vs. 10.6 min) (p < 0.01). The same association was also found between time spent warming up and stretching and the prevalence of tendinopathies. The prevalence of muscle injuries was significantly associated with number of training hours per week (p < 0.05) and weekly training distance swimming, cycling and running (p < 0.05). Conclusion: Injuries encountered in amateur triathletes are musculoskeletal injuries of «overuse», occurring mainly in training, especially running. © 2011 Consell Catala de l’Esport. Generalitat de Catalunya. Published by Elsevier Espana, S.L. All rights reserved.

Background Fibromyalgia (FM) is a heterogeneous syndrome and its classification into subgroups calls for broad-based discussion. FM subgrouping, which aims to adapt treatment according to different subgroups, relies in part, on psychological and cognitive dysfunctions. Since motor control of gait is closely related to cognitive function, we hypothesized that gait markers could be of interest in the identification of FM patients' subgroups. This controlled study aimed at characterizing gait disorders in FM, and subgrouping FM patients according to gait markers such as stride frequency (SF), stride regularity (SR), and cranio-caudal power (CCP) which measures kinesia. Methods A multicentre, observational open trial enrolled patients with primary FM (44.1 ± 8.1 y), and matched controls (44.1 ± 7.3 y). Outcome measurements and gait analyses were available for 52 pairs. A 3-step statistical analysis was carried out. A preliminary single blind analysis using k-means cluster was performed as an initial validation of gait markers. Then in order to quantify FM patients according to psychometric and gait variables an open descriptive analysis comparing patients and controls were made, and correlations between gait variables and main outcomes were calculated. Finally using cluster analysis, we described subgroups for each gait variable and looked for significant differences in self-reported assessments. Results SF was the most discriminating gait variable (73% of patients and controls). SF, SR, and CCP were different between patients and controls. There was a non-significant association between SF, FIQ and physical components from Short-Form 36 (p = 0.06). SR was correlated to FIQ (p = 0.01) and catastrophizing (p = 0.05) while CCP was correlated to pain (p = 0.01). The SF cluster identified 3 subgroups with a particular one characterized by normal SF, low pain, high activity and hyperkinesia. The SR cluster identified 2 distinct subgroups: the one with a reduced SR was distinguished by high FIQ, poor coping and altered affective status. Conclusion Gait analysis may provide additional information in the identification of subgroups among fibromyalgia patients. Gait analysis provided relevant information about physical and cognitive status, and pain behavior. Further studies are needed to better understand gait analysis implications in FM.

Physical activity can be a valuable countermeasure to sarcopenia in its treatment and prevention. In considering physical training strategies for sarcopenic subjects, it is critical to consider personal and environmental obstacles to access opportunities for physical activity for any patient with chronic disease. This article presents an overview of current knowledge of the effects of physical training on muscle function and the physical activity recommended for sarcopenic patients. So that this countermeasure strategy can be applied in practice, the authors propose a standardized protocol for prescribing physical activity in chronic diseases such as sarcopenia.

hal-00680938, v1; International audience; Fat oxidation (FO) is optimized during low- to moderate-intensity exercise in lean and obese subjects, whereas high-intensity exercise induces preferential FO during the recovery period. After food intake during the postexercise period, it is unknown if FO differs according to the intensity exercise in overweight subjects. Fat oxidation was thus evaluated in overweight men after low- and high-intensity exercise during the recovery period before and after food intake as well as during a control session. Ten healthy, sedentary, overweight men (age, 27.9 +/- 5.6 years; body mass index, 27.8 +/- 1.3 kg m(-2); maximal oxygen consumption, 37 +/- 3.9 mL min(-1) kg(-1)) exercised on a cycloergometer (energy expenditure = 300 kcal) at 35% (E35) or 70% (E70) maximal oxygen consumption or rested (Cont). The subjects were fed 30 minutes after the exercise with 300 kcal (1256 kJ) more energy in the exercise sessions than in the Cont session. Respiratory quotient and FO were calculated by indirect calorimetry. Blood samples were analyzed to measure plasma glycerol, nonesterified fatty acid, glucose, and insulin. During exercise, mean respiratory quotient was lower (P < .05) and FO was higher (P < .01) in the E35 than in the E70 session (FO [in mg min(-1)]: E35 = 290 +/- 12, E70 = 256 +/- 38, and Cont = 131 +/- 7). Conversely, FO was higher in the E70 than in both the E35 session and the Cont session during the immediate recovery as well as during the postprandial recovery period (P = .005 for all; FO from the end of the exercise to the end of the session [in grams]: E70 = 45.7 +/- 8.9, E35 = 38.2 +/- 6.8, and Cont = 36.0 +/- 4.3). Blood parameters did not differ between the 3 sessions but changed according to the absorption of the nutrients. In overweight subjects, high-intensity exercise increased FO during the postexercise period even after food intake compared with the low-intensity exercise and the control session.

Resume Ces dernieres annees, de nombreuses etudes ont montre une diminution de la concentration en hemoglobine chez les sportifs entraines ainsi qu'une diminution frequente des reserves en fer, en particulier chez les athletes specialises dans les sports d'endurance et chez les femmes. La signification de ces modifications reste controversee. Sont-elles le reflet d'une carence veritable en fer ou simplement le resultat d'une adaptation physiologique de l'organisme a un exercice intense de longue duree? L'apparition progressive d'une telle carence s'explique par l'augmentation des besoins en fer secondaire a une activite physique intense et repetee, la majoration des pertes en fer en particulier par la sudation, une couverture insuffisante des besoins en fer par la ration alimentaire. S'il n'est pas certain qu'elle puisse retentir sur les performances, il est en revanche prouve qu'une diminution meme minime de la concentration en hemoglobine se repercute sur les performances en diminuant la puissance maximale aerobie. Ainsi, la surveillance biologique de ces athletes avec, en particulier, le dosage de la ferritinemie, nous semble indispensable en tenant compte bien sur de l'intrication possible des differentes etiologies. Dans le cas ou une carence en fer est retrouvee, le traitement martial nous parait necessaire tout en insistant sur la prevention et donc sur l'importance d'une ration alimentaire quantitativement et qualitativement equilibree.

Rivière Daniel. Activités sportives dans une approche préventive : de la théorie aux actions de terrain. In: Les Cahiers de l'INSEP, n°41, 2008. Le sport, c'est la santé ? pp. 20-29.