Search

Purpose: The reduced cardiorespiratory fitness (CRF) and functional capacity following surgical procedures and during cancer treatments is a major risk factor for morbidity and mortality among patients with cancer. We aimed to assess the impact of endurance and combined resistance exercise interventions during the postoperative rehabilitation period for patients with colorectal, breast, and prostate cancer., Methods: A systematic search was conducted in MEDLINE Pubmed, Web of Science, and Cochrane Library until October 2023 for randomized controlled trials that assessed exercise interventions (aerobic/endurance; resistance or combined training) on postoperative patients with cancer. The trials evaluated the change in oxygen uptake (VO 2max ), six-minute walking distance (6MWD), quality of life (QoL), and fatigue., Results: Twelve studies, including 1298 patients, were part of this systematic review, and ten studies were included in the meta-analysis. Postoperative exercise interventions led to improvements in CRF and functional capacity (VO 2max : MD 1.46 ml/kg/min; 95%-CI 0.33, 2.58; p  = 0.01; 6MWD: MD 63.47 m; 95%-CI 28.18, 98.76; p = 0.0004, respectively) as well as QoL (0.91; 95%-CI 0.06, 1.76; p = 0.04). The quality of evidence was moderate to low., Conclusion: Postoperative exercise interventions could effectively improve CRF, functional capacity and QoL as shown in this meta-analysis. However, there is a lack of high-quality trials with a higher number of participants examining the effects of postoperative exercise in patients with colorectal, breast, and prostate cancer. There is an obvious need for long-term, cancer-specific exercise therapies and their evaluation in cancer care., Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to report., (© 2024. The Author(s).)

Background: eHealth applications can support early mobilization and physical activity (PA) after surgery. This systematic review provides an overview of eHealth services to enhance or record PA after visceral surgery interventions., Methods: Two electronic databases (MEDLINE PubMed and Web of Science) were systematically searched (November 2023). Articles were considered eligible if they were controlled trials and described digital devices used to promote PA after visceral surgery. The Cochrane risk of bias (RoB-2) tool was used to determine the methodological quality of studies., Results: A total of nine randomized controlled studies (RCT) were included in this systematic review. The studies differed with respect to the interventions, surgical indications and evaluation variables. The risk of bias of the individual studies was moderate. The six studies using activity trackers (AT) predominantly showed insignificant improvements in the postoperative step count. The more complex fitness applications could partially reveal significant advantages compared to the control groups and the home-based online training also showed a significant increase in functional capacity., Conclusion: Activity tracking alone has so far failed to show clinically relevant effects. In contrast, the more complex eHealth applications revealed advantages compared to usual postoperative care. More high-quality studies are needed for evidence-based recommendations for eHealth services in conjunction with visceral surgery., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: Obesity and physical inactivity are known to affect cancer's development and prognosis. In this context, physical aerobic and resistance training as well as a Mediterranean nutrition have been proven to have many positive health effects. The aim of this study was therefore to investigate the effect of home-based training on body composition and certain metabolic laboratory parameters., Methods: Patients with breast, colorectal and prostate cancer who underwent curative surgery at stages T1N0M0-T3N3M0 were eligible for this trial and randomized to an intervention and control group. In the intervention group the patients carried out online-based strength-endurance home training during the 6-month study period. Body composition was assessed via bioelectrical impedance analysis (baseline, 3 months and 6 months). Metabolic blood parameters were also analyzed and nutrition behavior determined using the Mediterranean Diet Adherence Screener (MEDAS)., Results: The intervention group's fat mass decreased while their lean body mass increased (time effect p = 0.001 and p = 0.001, respectively). We found no interaction effect in body weight ( p = 0.19), fat mass [ p = 0.06, 6-months estimates -0.9 (95% CI -1.8 to -0.1)] and lean body mass ( p = 0.92). Blood samples also failed to show a statistically significant interaction effect between time × group for HbA1c% ( p = 0.64), Insulin ( p = 0.33), Adiponectin ( p = 0.87), Leptin ( p = 0.52) and Triglycerides ( p = 0.43). Only Adiponectin revealed significance in the time effect ( p < 0.001) and Leptin in the group effect ( p = 0.03). Dietary behavior during the study period was similar in patients in the intervention and control groups (interaction p = 0.81; group p = 0.09 and time p = 0.03)., Discussion: Individualized online-based home training in postoperative cancer patients revealed only minor changes, with no group differences in body composition or metabolic laboratory parameters, which were predominantly in the reference range at baseline. More studies investigating effects of online-based home training on body composition and nutrition behavior are needed., Trial Registration: https://drks.de/search/en/trial/DRKS00020499, DRKS-ID: DRKS00020499., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Darmochwal, Bischoff, Thieme, Gockel, Tegtbur, Hillemanns, Schulze, Voss, Falz and Busse.)

Background: Exercise training is beneficial in enhancing physical function and quality of life in cancer patients. Its comprehensive implementation remains challenging, and underlying cardiopulmonary adaptations are poorly investigated. This randomized controlled trial examines the implementation and effects of home-based online training on cardiopulmonary variables and physical activity., Methods: Of screened post-surgical patients with breast, prostate, or colorectal cancer, 148 were randomly assigned (1:1) to an intervention (2 × 30 min/week of strength-endurance training using video presentations) and a control group. All patients received activity feedback during the 6-month intervention period. Primary endpoint was change in oxygen uptake after 6 months. Secondary endpoints included changes in cardiac output, rate pressure product, quality of life (EORTC QoL-C30), C-reactive protein, and activity behavior., Results: One hundred twenty-two patients (62 intervention and 60 control group) completed the study period. Change in oxygen uptake between intervention and control patients was 1.8 vs. 0.66 ml/kg/min (estimated difference after 6 months: 1.24; 95% CI 0.23 to 2.55; p = 0.017). Rate pressure product was reduced in IG (estimated difference after 6 months: - 1079; 95% CI - 2157 to - 1; p = 0.05). Physical activity per week was not different in IG and CG. There were no significant interaction effects in body composition, cardiac output, C-reactive protein, or quality of life., Conclusions: Home-based online training among post-surgery cancer patients revealed an increase of oxygen uptake and a decrease of myocardial workload during exercise. The implementation of area-wide home-based training and activity feedback as an integral component in cancer care and studies investigating long-term effects are needed., Trial Registration: DRKS-ID: DRKS00020499 ; Registered 17 March 2020., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Whereas cardiopulmonary responses are well understood in endurance training, they are rarely described in strength training. This cross-over study examined acute cardiopulmonary responses in strength training. Fourteen healthy male strength training-experienced participants (age 24.5 ± 2.9 years; BMI 24.1 ± 2.0 kg/m 2 ) were randomly assigned into three strength training sessions (three sets of ten repetitions) with different intensities (50%, 62,5%, and 75% of the 3-Repetition Maximum) of squats in a smith machine. Cardiopulmonary (impedance cardiography, ergo-spirometry) responses were continuously monitored. During exercise period, heart rate (HR 143 ± 16 vs. 132 ± 15 vs. 129 ± 18 bpm, respectively; p < 0.01; η 2 p 0.54) and cardiac output (CO: 16.7 ± 3.7 vs. 14.3 ± 2.5 vs. 13.6 ± 2.4 l/min, respectively; p < 0.01; η 2 p 0.56) were higher at 75% of 3-RM compared to those at the other intensities. We noted similar stroke volume (SV: p = 0.08; η 2 p 0.18) and end-diastolic volume (EDV: p = 0.49). Ventilation (V E ) was higher at 75% compared to 62.5% and 50% (44.0 ± 8.0 vs. 39.6 ± 10.4 vs. 37.6 ± 7.7 l/min, respectively; p < 0.01; η 2 p 0.56). Respiration rate (RR; p = .16; η 2 p 0.13), tidal volume (VT: p = 0.41; η 2 p 0.07) and oxygen uptake (VO 2 : p = 0.11; η 2 p 0.16) did not differ between intensities. High systolic and diastolic blood pressure were evident (62.5% 3-RM 197 ± 22.4/108.8 ± 13.4 mmHG). During the post-exercise period (60 s), SV, CO, V E , VO 2, and VCO 2 were higher (p < 0.01) than during the exercise period, and the pulmonary parameters differed markedly between intensities (V E p < 0.01; RR p < 0.01; VT p = 0.02; VO 2 p < 0.01; VCO 2 p < 0.01). Despite the differences in strength training intensity, the cardiopulmonary response reveals significant differences predominantly during the post-exercise period. Intensity-induced breath holding induces high blood pressure peaks and cardiopulmonary recovery effects after exercise., (© 2023. The Author(s).)

The interplay between biarticular and monoarticular muscles of the knee and hip joints during bipedal squats (SQ BP ) requires adequate central-nervous control mechanisms to enable smooth and dynamic movements. Here, we investigated motor control between M. vastus medialis (VM), M. vastus lateralis (VL), and M. rectus femoris (RF) in 12 healthy male recreational athletes during SQ BP with three load levels (50%, 62.5%, and 75% of 3-repetition maximum) following a standardized strength training protocol (3 sets of 10 repetitions). To quantify differences in motor control mechanisms in both time and frequency domains, we analyzed (1) muscle covariation via correlation analyses, as well as (2) common neural input via intermuscular coherence (IMC) between RF, VM, and VL. Our results revealed significantly higher gamma IMC between VM-VL compared with RF-VL and RF-VM for both legs. Correlation analyses demonstrated significantly higher correlation coefficients during ascent periods compared with descent periods across all analyzed muscle pairs. However, no load-dependent modulation of motor control could be observed. Our study provides novel evidence that motor control during SQ BP is characterized by differences in common input between biarticular and monoarticular muscles. Additionally, muscle activation patterns show higher similarity during ascent compared with descent periods. Future research should aim to validate and extend our observations as insights into the underlying control mechanisms offer the possibility for practical implications to optimize training concepts in elite sports and rehabilitation., (© 2022 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Caliper and ultrasound (US) are used to measure subcutaneous fat tissue depth (SFT) and then to calculate total body fat. There is no evidence-based recommendation as to whether caliper or US are equally accurate. The aim of this paper was therefore to compare reliability of both methods. In this methodical study, 54 participants (BMI: 24.8 ± 3.5 kg/m 2 ; Age: 43.2 ± 21.7 years) were included. Using systematic body mapping, the SFT of 56 areas was measured. We also analyzed 4 body sites via MRI. A comparison between caliper and US detected clear differences in mean SFT of all areas (0.83 ± 0.33 cm vs. 1.14 ± 0.54 cm; p < 0.001) showing moderate reliability (ICC 0.669, 95%CI: 0.625-0.712). US and MRI revealed in the abdominal area a SFT twice as thick as caliper (2.43 ± 1.36 cm vs. 2.26 ± 1.32 cm vs. 1.15 ± 0.66 cm; respectively). Caliper and US revealed excellent intrarater (ICC caliper: 0.944, 95%CI: 0.926-0.963; US: 0.934, 95%CI: 0.924-0.944) and good interrater reliability (ICC caliper: 0.794, 95%CI: 0.754-0.835; US: 0.825, 95%CI: 0.794-0.857). Despite the high reliability in measuring SFT that caliper and US show, our comparison of the two methods yielded clear differences in SFT, particularly in the abdominal area. In accuracy terms, US is preferable for most mapping areas., (© 2022. The Author(s).)

Purpose: Functional capacity is an independent indicator of morbidity in colon and rectal cancer surgery. This systematic review describes the evaluated and synthesized effects of exercise prehabilitation depending on the duration of interventions on functional and postoperative outcomes in colon and rectal cancer surgery., Methods: Three electronic databases (MEDLINE Pubmed, Web of Sciences, and Cochrane Registry) were systematically searched (January 2022) for controlled trials that investigated the effects of prehabilitation prior to colo-rectal cancer resection., Results: Twenty-three studies were included in this systematic review and 14 in our meta-analyses assessing these outcomes: the 6 min walk distance (6MWD), postoperative overall complications, and length of stay (LOS). We observed a significant improvement in preoperative functional capacity as measured with 6MWD (mean difference: 30.8 m; 95% CI 13.3, 48.3; p = 0.0005) due to prehabilitation. No reductions in LOS (mean difference: - 0.27 days; 95% CI - 0.93, 0.40; p = 0.5) or postoperative overall complications (Odds ratio: 0.84; 95% CI 0.53, 1.31; p = 0.44) were observed. Prehabilitation lasting more than 3 weeks tended to lower overall complications (Odds ratio: 0.66; 95% CI 0.4, 1.1; p = 0.11). However, the prehabilitation time periods differed between colon and rectal carcinoma resections., Conclusion: Prehabilitation while the patient is preparing to undergo surgery for colorectal carcinoma improves functional capacity; and might reduce postoperative overall complications, but does not shorten the LOS. The studies we reviewed differ in target variables, design, and the intervention's time period. Multicenter studies with sufficient statistical power and differentiating between colon and rectal carcinoma are needed to develop implementation strategies in the health care system., Registration: PROSPERO CRD42022310532., (© 2022. The Author(s).)

Aims: Surgical and FFP2 masks are recommended to reduce transmission of SARS-CoV-2. The cardiopulmonary effects of facemasks in patients with chronic heart failure are unknown. This prospective, cross-over study quantified the effects of wearing no mask (nm), surgical mask (sm), and FFP2 mask (ffpm) in patients with stable heart failure., Methods: 12 patients with clinically stable chronic heart failure (HF) (age 63.8±12 years, left ventricular ejection fraction (LVEF) 43.8±11%, NTProBNP 573±567 pg/ml) underwent spiroergometry with and without masks in a randomized sequence. Comfort/discomfort was assessed using a standardized questionnaire., Results: Maximum power was reduced with both types of masks (nm: 108.3 W vs. sm: 101.2 W vs. ffpm: 95.6 W, p<0.01). Maximum respiratory oxygen uptake (1499ml/min vs. 1481 ml/min vs. 1300 ml/min, p = 0.95 and <0.01), peak ventilation (62.1 l/min vs. 56.4 l/min vs. 50.3 l/min, p = 0.15 and p<0.05) and O2-pulse (11.6 ml/beat vs. 11.8 ml/beat vs. 10.6 ml/beat, p = 0.87 and p<0.01) were significantly changed with ffpm but not sm. Discomfort was moderately but significantly increased (nm: 1.6 vs. sm: 3.4 vs. ffpm: 4.4, p<0.05)., Conclusion: Both surgical and FFP masks reduce exercise capacity in heart failure patients, while FFP2 masks reduce oxygen uptake and peak ventilation. This reduction in cardiopulmonary performance should be considered in heart failure patients whose daily life activities are often just as challenging as exercise is for healthy adults., Competing Interests: The authors have declared that no competing interests exist.

Background: Some studies have suggested that a mouthguard is a performance-enhancing device due to a remote voluntary contraction. The extent to which a mouthguard can induce this phenomenon, e.g., by potentially increasing biting, has not been clarified. This study's aim was to investigate the muscular activity of the maxillary and peripheral musculature and motor performance during a rest and exercise test., Methods: Our study comprised 12 active, male, professional young handball players (age 18.83 ± 0.39 years). Their performance, electromyographic (EMG) muscle activity (Σ), and lateral deviation (Δ) of the masticatory and peripheral musculature were measured during rest in a maximum bite force measurement, one-legged stand, a kettlebell swing exercise and a jump test while wearing a customized mouthguard (CMG) or not wearing one (Co)., Results: Maximum bite force measurements did not differ significantly in their mean values of muscle activity (Σ) for the masseter and temporalis muscles (Co 647.6 ± 212.8 µV vs. CMG 724.3 ± 257.1 µV p = 0.08) (Co 457.2 ± 135.5 µV vs. CMG 426.6 ± 169.3 µV p = 0.38) with versus without CMG. We found no differences in the mean activation values during a one-legged stand, the kettlebell swing, and jump test (Σ) in any of the muscles tested. Lateral deviations (Δ) wearing a CMG were significantly less in the erector spinae during the kettlebell swing (Co 5.33 ± 3.4 µV vs. CMG 2.53 ± 1.8 µV p = 0.01) and countermovement jump (Co 37.90 ± 30.6 µV vs. CMG 17.83 ± 22.3 µV p = 0.03) compared to the performance without a CMG. Jump height, rotation moment, and balance were unchanged with versus without CMG., Conclusion: Our results at rest and during specific motor stress show no differences with or without a CMG. The improved peripheral muscular balance while wearing a CMG indicates improved muscular stabilization., (© 2021. The Author(s).)

Purpose: There is evidence of both the preventive effects and poor acceptance of mouthguards. There are various effects on performance depending on the type of mouthguard model. Hemodynamic responses to wearing a mouthguard have not been described. The aim of this study was to investigate the effects of self-adapted mouthguards with breathing channels (SAMG vent )., Methods: In this randomized crossover study, 17 healthy, active subjects (age 25.12 ± 2.19 years) underwent body plethysmography and performed two incremental exertion tests wearing a (SAMG vent ) and not wearing (CON) a mouthguard. Blood lactate, spirometrics, and thoracic impedance were measured during these maximum exercise tests., Results: The mean values using a SAMG vent revealed significantly greater airway resistance compared to CON (0.53 ± 0.16 kPa·L -1 vs. 0.35 ± 0.10 kPa·L -1 , respectively; p = < 0.01). At maximum load, ventilation with SAMGv ent was less than CON (118.4 ± 28.17 L min -1 vs. 128.2 ± 32.16 L min -1 , respectively; p = < 0.01). At submaximal loads, blood lactate responses with SAMG vent were higher than CON (8.68 ± 2.20 mmol·L -1 vs. 7.89 ± 1.65 mmol·L -1 , respectively; p < 0.01). Maximum performance with a SAMG vent was 265.9 ± 59.9 W, and without a mouthguard was 272.9 ± 60.8 W (p < 0.01). Maximum stroke volume was higher using a SAMG vent than without using a mouthguard (138.4 ± 29.9 mL vs. 130.2 ± 21.2 mL, respectively; p < 0.01)., Conclusion: Use of a self-adapted mouthguard led to increased metabolic effort and a significant reduction in ventilation parameters. Unchanged oxygen uptake may be the result of cardiopulmonary compensation and increased breathing efforts, which slightly affects performance. These results and the obvious preventive effects of mouthguards support their use in sports.

Background: The lockdown due to the Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has far-reaching consequences for professional sports in Germany. The aim of the present study was to investigate the impact of the eight-week lockdown on endurance capacity of elite male handball players., Methods: Ten male athletes (192±8 cm and 96±6 kg) from the first German handball league participated in the study. The effects of training on shuttle run tests between period 1 (P1: pre-season to mid-season) and period 2 (P2: mid-season to time after lockdown) were compared. The maximum oxygen uptake (VO2max) was assessed using an incremental exercise test (IET) (July 2019 and May 2020)., Results: During the COVID-19 lockdown, the athletes completed an instructed home-based strength and endurance program (52/48). The training effects were found to be reduced after the 8-weeks of COVID-19 lockdown (period 2) as compared to period 1 (mean difference 249±248 m, P=0.005). There was no significant difference in the running distance (2358±430 m vs. 2400±362 m, respectively, P=0.70) after the lockdown as compared to the pre-seasonal performance. VO2max (46.6±5.1 vs. 49.4±7.0 mL/kg/min, respectively, P=0.12) and the power output (3.13±0.36 vs. 3.13±0.43 W/kg, respectively, P=1.0) also did not differ between pre-season and after COVID-19 lockdown., Conclusions: The COVID-19 lockdown led to a reduction in endurance capacity of elite handball players without team training, despite a home-based strength and endurance program. Supervision of individual home-based training is highly recommended to avoid inadequate implementation of the training.

The importance of using mouthguards as well as their low acceptance rate have been demonstrated. The aim of this study was to investigate the influence of customized mouthguards on hemodynamics.. This randomized crossover study used data from 13 subjects (23.5±1.4 years). The cardiopulmonary and metabolic parameters were observed during ergometer tests without mouthguard (control) in comparison to two types of mouthguards (with and normal without breathing channels). Maximum ventilation was significantly decreased with the normal mouthguard (113.3±30.00 l ∙ min -1 ) in contrast to the mouthguard with breathing channels (122.5±22.9 l ∙ min -1 ) and control (121.9±30.8 l ∙ min -1 ). Also the inspiration time was longer when using the normal mouthguard (0.70±0.11 s) compared to the mouthguard with breathing channels (0.63±0.11 s) and control (Co 0.64±0.10 s). Lactate was also increased under the influence of the mouthguard with breathing channels (10.72±1.4 mmol ∙ l -1 ) compared to the control (9.40±1.77 mmol ∙ l -1 ) and the normal mouthguard (9.02±1.67 mmol ∙ l -1 ). In addition, stroke volume kinetics (p=0.048) and maximum heart rates (p=0.01) show changes. Despite equal levels of oxygen uptake and performances under all three conditions, the use of mouthguards showed differences in cardiopulmonary parameters. The use of mouthguards during exercise does not affect physical performance and can be recommended for injury prevention., Competing Interests: The authors declare that they have no competing interests., (Thieme. All rights reserved.)

Background: The importance of mouthguards for handball players has been proven however, most players are reluctant to use it. The impact on physical capacity is assessed heterogeneously in the literature. This study aimed to investigate the influence of custom-made mouthguards (CMGs) under handball specific stress., Methods: This randomized crossover study used data from 15 youth professional handball players (age 17.0 ±0.5 years, weight 85.1±8.0 kg and height 191.2±6.9 cm) who performed a validated handball specific course and a lung function test. Pulmonary (spirometry), metabolic (blood lactate), and cortisol parameters were observed using a normal custom-made mouthguard without (nCMG) and with respiratory channels (CMGvent) in comparison to no mouthguard (Co)., Results: In resting spirometry, no differences in the parameter peak flow were observed using the CMGvent (9.57±1.59 l·s-1) and nCMG (9.17±1.03 l·s-1) in comparison to the Co (9.38±1.26 l·s-1). Under maximum stress, there were no differences in ventilation using CMGvent (151.2±15.64 L ·min-1), nCMG (148.6±12.51 l·min-1), and without mouthguard (145.8±14.32 l·min-1). Similar oxygen uptake was observed when using a CMGvent (45.51±4.14 L ·min-1·kg-1), nCMG (45.50±5.06 ml·min-1 ·kg-1), and without CMG (Co 43.90±4.02 mL ·min-1). The parameters of HR (CMGvent 185.2±11.63 bpm vs. Co 179.4±13.24 bpm p=0.46, nCMG 178.2±11.54 bpm vs. Co p=0.97; CMGvent vs. nCMG p=0.08) and in the blood lactate values (CMGvent: 9.66±2.3 mmol·l-1 vs. Co 9.07±2.1 mmol·l-1 p=0.63; nCMG 9.39±2.8 mmol·l-1 vs. Co p=0.87; CMGvent vs. nCMG p=0.91) displayed no differences. The cortisol production under stress showed no differences in the performance with the CMGvent (1.78±3.58 ng/ml), nCMG (0.74±4.52 ng/mL), and in the procedure without mouthguard (0.25. ±5.01 ng/ml)., Conclusion: The results showed that under stress, there were no differences in the cortisol, ventilation, cardiac, and metabolic responses for all three conditions. Finally, the study shows that the use of a custom-made mouthguard does not negatively affect handball specific performance. Due to the preventive aspect of the mouthguard, the use of a custom-made mouthguard in handball is strongly recommended., Competing Interests: Declaration of Competing Interest none, (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Physical training is recommended in various national and international guidelines for patients with cancer. Observational studies have shown that physical activity leads to reduced recurrence and mortality rates by 20-40% in colorectal, breast, and prostate cancer. Despite existing evidence, a systematic care structure is still lacking. The primary aim of this study is to implement and evaluate an online training platform to strengthen physical performance and patient empowerment after cancer surgery., Methods: The evaluation will be conducted as a prospective multicenter randomized controlled trial with three subgroups (colorectal-, breast-, and prostate cancer). Each group will include 100 patients (total 300 patients including dropouts; clinical stages T1-3 and/or N+; M0 after surgery intervention) and the primary endpoint (13% increase in the maximal oxygen consumption during exercise) will be examined. The intervention group will receive a 6-month home-based online training (2-3 times per week strength-endurance training using video presentations), bidirectional activity feedback information, online communication, and online counseling. The control group (usual care) will be advised lifestyle improvement. In-hospital testing will be performed before, during, and after the intervention. In addition to cardiopulmonary capacity, tumor specific diagnostics (liquid biopsy, depression and fatigue assessment, metabolic and endothelial screening) will be applied., Discussion: Due to the increasing incidence of cancer, associated with considerable mortality, morbidity and impaired quality of life, there is an imperative requirement for improved cancer care, of which structured physical training may become an integral component., Trial Registration: DRKS-ID: DRKS00020499 ; Registered 17 March 2020.

Background: Beta-blockers are still frequently used in cardiovascular diseases but may negatively influence the exercise capacity. The aim of the study was to analyze the effect of beta-blockade on physical performance and plasma level of catecholamine during different forms of exercise., Methods: Ten prehypertensive athletes (age: 25.1±2.5 years, BMI: 24.4±2.4 kg/m2) performed repeated incremental exercise and steady-state-tests without and with the cardioselective beta-blocker bisoprolol (5mg/day). The cardiopulmonary, metabolic and the catecholamine responses were monitored., Results: Beta-blocker treatment had no effect on maximum power output (Pmax), lactate and the maximal oxygen uptake (VO2max) (Pmax: 269.0±41.5 vs. 269.0±41.5 W; lactate: 8.7±2.6 vs. 8.6±3.2 mmol/L and VO2max: 3110±482 vs. 3077±425 mL/min, respectively; P not significant). Epinephrine and norepinephrine showed a similar exponential increase to maximum load with and without beta-blockade (epinephrinemax 1.92±1.8 vs. 1.93±1.3 nmol/L; P not significant; norepinephrinemax 12.78±7.9 vs. 16.89±12.2 nmol/L; P not significant). Beta-blockade lowered heart rate (HR) and systolic blood pressure (SBP) at rest and under maximum load (ΔHRrest: 10.6±11.1 bpm, P<0.05, ΔHR-Max: 27.8±6.6 bpm, P<0.01; ΔSBPrest: 19.4±9.3 mmHg, P<0.05, ΔSBPmax: 17.7±15.3 mmHg, P<0.01). The maximum oxygen pulse was higher in the tests performed under beta-blockade (IET: ΔVO2/HR: 3.1±2.2 mL/beat, P<0.01; SST: ΔVO2/HR: 3.4±1.4 mL/beat, P<0.001)., Conclusions: Despite beta blockade and resulting differences in cardiopulmonary regulation during the exercise tests, the maximal oxygen capacity and the catecholamine concentration was similar. Higher exercise intensities (>50% Pmax) are associated with a marked increase in plasma catecholamines, which are not influenced by treatment with bisoprolol 5 mg/day.

Purpose: Long-term effects of exercise training are well studied. Acute hemodynamic responses to various training modalities, in particularly strength training (ST), have only been described in a few studies. This study examines the acute responses to ST, high-intensity interval training (HIIT) and moderate-intensity continuous training (MCT)., Methods: Twelve young male subjects (age 23.4 ± 2.6 years; BMI 23.7 ± 1.5 kg/m 2 ) performed an incremental exertion test and were randomized into HIIT (4 × 4-min intervals), MCT (continuous cycling) and ST (five body-weight exercises) which were matched for training duration. The cardiopulmonary (impedance cardiography, ergo-spirometry) and metabolic response were monitored., Results: Similar peak blood lactate responses were observed after HIIT and ST (8.5 ± 2.6 and 8.1 ± 1.2 mmol/l, respectively; p = 0.83). The training impact time was 90.7 ± 8.5% for HIIT and 68.2 ± 8.5% for MCT (p < 0.0001). The mean cardiac output was significantly higher for HIIT compared to that of MCT and ST (23.2 ± 4.1 vs. 20.9 ± 2.9 vs. 12.9 ± 2.9 l/min, respectively; p < 0.0001). VO 2max was twofold higher during HIIT compared to that observed during ST (2529 ± 310 vs. 1290 ± 156 ml; p = 0.0004). Among the components of ST, squats compared with push-ups resulted in different heart rate (111 ± 13.5 vs. 125 ± 15.7 bpm, respectively; p < 0.05) and stroke volume (125 ± 23.3 vs. 104 ± 19.8 ml, respectively; p < 0.05)., Conclusions: Despite an equal training duration and a similar acute metabolic response, large differences with regard to the training impact time and the cardiopulmonary response give evident. HIIT and MCT, but less ST, induced a sufficient cardiopulmonary response, which is important for the preventive effects of training; however, large differences in intensity were apparent for ST.

Hemoglobin mass (Hbmass) and total blood volume (BV) determine the oxygen content in the blood. Varying anthropometric values are used to standardize blood volume and Hbmass. The aim of this study was to create normal values and to evaluate an anthropometric reference for Hbmass and BV. One hundred healthy young subjects participated in this study (50 women: 20.9±2.0 yr; 50 men: 23.2±2.9 yr). The Hbmass was measured twice by using a CO rebreathing method. The BV was calculated from the Hbmass, Hb concentration and hematocrit values. The lean body mass (LBM) was measured by a bio-impedance analysis. Women had a significant lower Hbmass per kg LBM compared with that of men (13.6±1.3 g vs. 16.1±1.7 g; p<0.0001). The BV per kg LBM tended to be lower in women than in men (105.3±8.4 ml vs. 108.7±9.0 ml; p=0.0548). LBM had the best correlation with Hbmass (r=0.9274) and BV (0.9233) when considering the entire study group. Normal values of Hbmass and BV could be potentially useful for fluid management and contribute to the diagnosis of blood disorders. For normalization and assessment of measured BV and Hbmass, lean body mass should be prioritized in future studies instead of body weight or body surface area., Competing Interests: The authors have no conflicts of interest to report., (© Georg Thieme Verlag KG Stuttgart · New York.)

Measuring hemoglobin mass (Hbmass) using the carbon monoxide (CO) bolus rebreathing method is frequently used in research but has yet to be widely used in the clinical practice. The estimation of an adequate CO bolus may be difficult in patients with unknown Hbmass. In the present pilot study, a progressive inhalation technique for CO that leads to a linear individual adjusted COHb increase was evaluated. Sixteen healthy test subjects participated in the study (preliminary investigation: six; main study: ten). The reliability and validity of the new method were evaluated using multiple measurements of Hbmass with and without a defined blood donation and compared to a CO bolus method. The participants inhaled a CO-air mixture (CO concentration: 1500 ppm) for a specific breathing duration. The CO uptake and COHb change were determined simultaneously. The typical error (reliability) in the repeated measurements was 2.4% (CI ± 4.7). The mean difference between the new method and the bolus method was 34 g (±41; P = 0.026). The measured hemoglobin loss in 490 mL of blood was 74 g (±35), and the calculated hemoglobin loss was 77 g (±4) (mean difference 3 g ± 34; P = 0.820). The new method was reliable and valid in a proof of concept study with healthy subjects. The total amount of CO and as a result the COHb increase is individually adjustable. Future studies in clinical settings are needed to determine if the method could be used in disease-specific pathologies associated with changes in Hbmass., (© 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.)