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BACKGROUND: Current cardiac rehabilitation (CR) practices focus on aerobic-style exercise with minimal nutrition advice. This approach may not be optimal for CR patients with reduced muscle mass and elevated fat mass. Higher protein, Mediterranean-style diets combined with resistance exercise (RE) may improve muscle mass and reduce the risk of future cardiovascular events, although such an approach is yet to be trialed in a CR population. OBJECTIVE: We explored patient perspectives on the proposed design of a feasibility study. Patients reflected on the acceptability of a proposed high-protein Mediterranean-style diet and RE protocol, emphasizing research methodology and the acceptability of the proposed recipes and exercises. DESIGN: We applied quantitative and qualitative (mixed methods) approaches. The quantitative approach involved an online questionnaire (n = 40) regarding the proposed study methodology and relevance. A subset of participants (n = 12) received proposed recipe guides and were asked to prepare several dishes and complete an online questionnaire regarding their experience. Another subset (n = 18) received links to videos of the proposed RE and completed a questionnaire regarding their impressions of them. Finally, semi-structured interviews (n = 7) were carried out to explore participants' impressions of the proposed diet and exercise intervention. RESULTS: Quantitative data indicated a high level of understanding of the intervention protocol and its importance within the context of this research. There was a high degree of willingness to participate in all aspects of the proposed study (>90%). The trialed recipes were enjoyed and found to be easy to make by a majority of participants (79 and 92.1%, respectively). For the proposed exercises 96.5% of responses agreed they would be willing to perform them and, 75.8% of responses agreed they would enjoy them. Qualitative analysis revealed that participants viewed the research proposal, diet, and exer

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

Background COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants. Methods An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected. Results The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p < 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p < 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p < 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format. Conclusions Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics.

Item does not contain fulltext, BACKGROUND: Cardiac rehabilitation (CR) is an essential component of long-term recovery following a cardiac event. Typical CR may not be optimal for patients presenting with sarcopenic obesity (SO) who present with reduced muscle mass and elevated adipose tissue, and may indicate greater cardiovascular disease (CVD) risk. Resistance exercise and high-protein diets are known to increase muscle mass, while Mediterranean-style diets have been shown to reduce CVD risk. A high-protein Mediterranean-style diet combined with resistance exercise intervention is yet to be trialled in cardiac rehabilitation populations. OBJECTIVES: Primary outcome: to determine the feasibility of such an intervention by investigating the perceptions, acceptance and adherence to a resistance exercise protocol and high-protein Mediterranean style diet in a UK cardiac rehabilitation population with SO. Secondary outcome: to trial this protocol ahead of a fully powered clinical study. METHODS: Eligible cardiac rehabilitation patients will be randomised to one of the following: 1) a control group (standard CR), 2) high-protein Mediterranean-style diet, 3) resistance exercise group, or 4) both high-protein Mediterranean-style diet and resistance exercise group. The pilot study will last 12 weeks. Measures of body composition (dual energy x-ray absorptiometry) grip strength, CVD risk (e.g., fasting triglycerides, glucose, cholesterol) and dietary adherence will be assessed at baseline and after 12 weeks. To compare groups, a mixed model ANOVA (time x intervention) will be performed. Patient participant involvement throughout the development of this project will be used to determine the feasibility of a future, fully powered, randomised control trial. A feasibility questionnaire will help establish the proportion of eligible participants, their willingness to be randomised, response rates, and ethical considerations. Furthermore, focus groups, food tasting and telephone interviews will be conducted t

BACKGROUND: Cardiac rehabilitation (CR) is an essential component of long-term recovery following a cardiac event. Typical CR may not be optimal for patients presenting with sarcopenic obesity (SO) who present with reduced muscle mass and elevated adipose tissue, and may indicate greater cardiovascular disease (CVD) risk. Resistance exercise and high-protein diets are known to increase muscle mass, while Mediterranean-style diets have been shown to reduce CVD risk. A high-protein Mediterranean-style diet combined with resistance exercise intervention is yet to be trialled in cardiac rehabilitation populations. OBJECTIVES: Primary outcome: to determine the feasibility of such an intervention by investigating the perceptions, acceptance and adherence to a resistance exercise protocol and high-protein Mediterranean style diet in a UK cardiac rehabilitation population with SO. Secondary outcome: to trial this protocol ahead of a fully powered clinical study. METHODS: Eligible cardiac rehabilitation patients will be randomised to one of the following: 1) a control group (standard CR), 2) high-protein Mediterranean-style diet, 3) resistance exercise group, or 4) both high-protein Mediterranean-style diet and resistance exercise group. The pilot study will last 12 weeks. Measures of body composition (dual energy x-ray absorptiometry) grip strength, CVD risk (e.g., fasting triglycerides, glucose, cholesterol) and dietary adherence will be assessed at baseline and after 12 weeks. To compare groups, a mixed model ANOVA (time x intervention) will be performed. Patient participant involvement throughout the development of this project will be used to determine the feasibility of a future, fully powered, randomised control trial. A feasibility questionnaire will help establish the proportion of eligible participants, their willingness to be randomised, response rates, and ethical considerations. Furthermore, focus groups, food tasting and telephone interviews will be conducted t

The COVID-19 pandemic is an extraordinary global emergency that has led to the implementation of unprecedented measures in order to stem the spread of the infection. Internationally, governments are enforcing measures such as travel bans, quarantine, isolation, and social distancing leading to an extended period of time at home. This has resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia, a deterioration of muscle mass and function (more likely in older populations), as well as increases in body fat. These changes in body composition are associated with a number of chronic, lifestyle diseases including cardiovascular disease (CVD), diabetes, osteoporosis, frailty, cognitive decline, and depression. Furthermore, CVD, diabetes, and elevated body fat are associated with greater risk of COVID-19 infection and more severe symptomology, underscoring the importance of avoiding the development of such morbidities. Here we review mechanisms of sarcopenia and their relation to the current data on the effects of COVID-19 confinement on physical activity, dietary habits, sleep, and stress as well as extended bed rest due to COVID-19 hospitalization. The potential of these factors to lead to an increased likelihood of muscle loss and chronic disease will be discussed. By offering a number of home-based strategies including resistance exercise, higher protein intakes and supplementation, we can potentially guide public health authorities to avoid a lifestyle disease and rehabilitation crisis post-COVID-19. Such strategies may also serve as useful preventative measures for reducing the likelihood of sarcopenia in general and in the event of future periods of isolation.

Results of an extensive series of repeated load triaxial test on Dublin Brown glacial till are reported. Charts are presented relating the relevant parameters of the till to dry density and moisture content. The effect of stress history is studied. The results indicate that modifications are required to the Kirwan-Snaith nomograph and suggest that the subgrade strain design criterion should vary with the stiffness of the soil. A recently developed low cost pneumatic repeated loading test apparatus is described. Skempton's A and B pore parameters have been used to interpret the response of samples under repeated loading. A method of determining a stress-dependent resilient modulus by prepared charts from in situ tests on a subgrade is described. Results of laboratory pavement simulator tests on subgrade are compared with those obtained on undisturbed samples and with these results of the repeated loading, testing program. Modifications to DEFPAV which are required in order to include horizontally layered anisotropy are described. Initial results from a testing program to investigate the properties effecting the behaviour of natural gravels in road pavements are presented. Two computer subroutines for optimization of road pavement design are described. (Author)

A rational design procedure for flexible pavements is presented. The analysis of pavement structures is demonstrated using an improved computer program. Test tracks from other centres of research are used to test the ability of the program to predict permanent surface deformation under traffic loading. The creep characteristics of a dense bitumen macadam are analysed and a relationship suggested that links the permanent strain behavior under static and dynamic loading., See also report dated Apr 74, AD-A008 099.

A finite-element program has been developed to the stage that, given adequate material characterization, it may be used to analyse the effect of passing wheel loads on any proposed pavement structure. Until now such programs have examined the induced stresses and transient deflections of the pavement system. This program has the capability to predict the permanent strain accruing in any element of the pavement. It will then take these values and produce the surface profile of the pavement after any specified number of wheel loads has passed. To further this work a laboratory pavement simulator has been used to obtain load-deformation-time data for the program. Also the concepts of threshold and critical stresses to permanent deformation prediction have been examined together with two creep laws for boulder clays.

In the report repeated load test results for bituminous mixes, granular and cohesive soils are presented. The results of the laboratory tests were used to check theoretical predictions of stress and surface deflection of a three-layer experimental pavement. Field measurements for commercial vehicles loading were obtained over a period of nine months. A study of the impedance method of vibration testing was undertaken; the application of the method to evaluation of existing flexible pavements is reviewed. (Author)

The main objectives of the research are the elucidation of environmental factors governing the behavior of flexible pavements, as they relate to civil and military engineering construction, with the aim of producing a new design procedure. This Report is mainly concerned with two approaches, namely the dynamic method based on laboratory repeated load tests on the pavement materials, and the impulse loading technique. (Author)

The findings of a field and laboratory investigation into the causes of distress in flexible pavements are presented. Three pavements where distressed zones occurred adjacent to sound sections were tested. An attempt has been made to explain the causes of localized failures on the basis of elasticity theory. In the case of two of these roads it was found possible to predict the causes of the distress noted. The concept of threshold stress, put forward in the earlier report, is examined from the standpoint of linear viscoelastic theory. The difficulties of applying viscoelastic theory to multilayer systems where one or more layers possess a threshold stress is discussed. It is shown that viscoelasticity is a cumbersome theory to apply in practice. An alternative rate theory is developed for estimating the permanent displacements in a stress pavement. The theory is based on the formulation of a stress-strain law for clays in repeated loading. The predictions of the rate theory are shown to be in satisfactory agreement with some data obtained in the A.A.S.H.O. Road Test. The construction and instrumentation of an experimental road is described. Some experiences gained in the investigation of this full-scale experiment is presented. (Author)

Five soils, with liquid limits in the range 25 to 75, were subjected to pulsed deviator stresses applied in increments until a limiting permanent deformation was reached, or alternatively an axial stress of 18 p.s.i. was sustained without failure within 100,000 stress applications. Resilient moduli, covering a practical range of moisture contents and densities, were determined for each soil. The threshold stress, which separates the regimes of mainly elastic from the inelastic behaviour was established by an analytical procedure. The application of the threshold stress concept to flexible pavement performance is discussed. The compaction characteristics and the C.B.R. vs moisture content and density relationships were determined, and were correlated where practicable with the results of the repeated load tests. Conventional shear tests, slow undrained triaxial and unconfined compression, were performed. These test results are reported in abbreviated form. (Author)