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Blood-Flow Restriction Resistance Exercise Promotes Lower Pain and Ratings of Perceived Exertion Compared With Either High- or Low-Intensity Resistance Exercise Performed to Muscular Failure

Manoel E. Lixandrão, Hamilton Roschel, Carlos Ugrinowitsch, Maira Miquelini, Ieda F. Alvarez, and Cleiton Augusto Libardi

Context: Given the comparable muscle hypertrophy constantly observed between blood-flow restriction exercise (BFR-RE) and conventional resistance exercise, understanding their particular rating of perceived exertion (RPE) and pain may help to better prescribe exercise at a low-discomfort level, thus increasing its feasibility. Design: Randomized crossover study. Objective: To compare the RPE and pain response between conventional high- (HI-RE) and low-intensity resistance exercise (LI-RE) protocols to failure with a nonmuscular failure LI-RE associated with BFR-RE. Participants: A total of 12 men (age: 20 [3] y; body mass: 73.5 [9] kg; height: 174 [6] cm). Interventions: Four sets of 45° leg-press exercises in 3 different conditions: (1) BFR-RE (15 repetitions; 30% 1-repetition maximum), (2) HI-RE (80% 1-repetition maximum to muscular failure), and (3) LI-RE (30% 1-repetition maximum to muscular failure). Main Outcome Measures: RPE and pain were assessed immediately before exercise session and after the end of each of the 4 sets. Results: RPE and pain levels increased throughout the exercise sets for all RE protocols (all, Ps < .05). HI-RE and LI-RE protocols showed similar increase in RPE and pain levels during all exercise sets (P < .05); however, both protocols demonstrated higher RPE and pain response compared with BFR-RE after each of the 4 sets (all Ps < .05 between-group comparisons). Conclusions: Our results demonstrated that both HI-RE and LI-RE to muscular failure resulted in similar and significant increases in RPE and pain levels, regardless of exercise intensity. In addition, nonmuscular failure BFR-RE also increased RPE and pain response, however, to a lower extent compared with either HI-RE or LI-RE.

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Effect of Aspartate and Asparagine Supplementation on Fatigue Determinants in Intense Exercise

Marcelo Luis Marquezi, Hamilton Augusto Roschel, André dos Santos Costa, Letícia Aiko Sawada, and Antonio Herbert Lancha Jr.

Purpose: This study evaluated the effect of aspartate (ASP) and asparagine (ASG) supplementation on fatigue determinants in Wistar rats exercised to exhaustion by swimming. Methods: The animals were tested for anaerobic threshold (AT) determination and then supplemented with 350 mM ASP + 400 mM ASG · day−1 (AA group, n = 16) or 2 ml · day−1 of distillated water (PLC group, n = 16) for 7 days. On the 7th day of supplementation, the animals were divided into 4 new groups and killed at rest (RAA, n = 8; RPLC, n = 8), or immediately after the swimming exercise to exhaustion (EAA, n = 8; EPLC, n = 8). Results: No significant differences were observed between amino acids and placebo rest groups for muscle and liver glycogen, blood glucose, lactate, ala-nine, and glutamine concentrations. However, in the exhaustion groups, the EAA group showed higher exercise time (68.37+ 25.42 X 41.12 + 13.82 min, p < .05) and lower blood lactate concentration (8.57 ± 1.92 X 11.28 + 2.61 mmol · L−1, p < .05) than the EPLC group. Moreover, the ASP+ASG supplementation decreased the rate of glycogen degradation of gastrocnemius (1.00 + 0.51 X 3.43 ± 0.99 μg · 100 mg of tissue sample−1 · min−1), extensor digitorius longus (5.70 ± 2.35 X 8.11 ± 3.97 μg · 100 mg of tissue sample−1 min−1) and liver (0.51 ± 0.34 X 3.37 ± 2.31 μg · 100 mg of tissue sample−1 min−1) for EAA. Conclusion: These results suggest that ASP+ASG supplementation may increase the contribution of oxidative metabolism in energy production and delay fatigue during exercise performed above the AT.

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Individual Participant Data Meta-Analysis Provides No Evidence of Intervention Response Variation in Individuals Supplementing With Beta-Alanine

Gabriel Perri Esteves, Paul Swinton, Craig Sale, Ruth M. James, Guilherme Giannini Artioli, Hamilton Roschel, Bruno Gualano, Bryan Saunders, and Eimear Dolan

Currently, little is known about the extent of interindividual variability in response to beta-alanine (BA) supplementation, nor what proportion of said variability can be attributed to external factors or to the intervention itself (intervention response). To investigate this, individual participant data on the effect of BA supplementation on a high-intensity cycling capacity test (CCT110%) were meta-analyzed. Changes in time to exhaustion (TTE) and muscle carnosine were the primary and secondary outcomes. Multilevel distributional Bayesian models were used to estimate the mean and SD of BA and placebo group change scores. The relative sizes of group SDs were used to infer whether observed variation in change scores were due to intervention or non-intervention-related effects. Six eligible studies were identified, and individual data were obtained from four of these. Analyses showed a group effect of BA supplementation on TTE (7.7, 95% credible interval [CrI] [1.3, 14.3] s) and muscle carnosine (18.1, 95% CrI [14.5, 21.9] mmol/kg DM). A large intervention response variation was identified for muscle carnosine (σIR = 5.8, 95% CrI [4.2, 7.4] mmol/kg DM) while equivalent change score SDs were shown for TTE in both the placebo (16.1, 95% CrI [13.0, 21.3] s) and BA (15.9, 95% CrI [13.0, 20.0] s) conditions, with the probability that SD was greater in placebo being 0.64. In conclusion, the similarity in observed change score SDs between groups for TTE indicates the source of variation is common to both groups, and therefore unrelated to the supplement itself, likely originating instead from external factors such as nutritional intake, sleep patterns, or training status.

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Negligible Effects of β-Hydroxy-β-Methylbutyrate Free Acid and Calcium Salt on Strength and Hypertrophic Responses to Resistance Training: A Randomized, Placebo-Controlled Study

Aline C. Tritto, Salomão Bueno, Rosa M.P. Rodrigues, Bruno Gualano, Hamilton Roschel, and Guilherme G. Artioli

This study evaluated the effects of β-hydroxy-β-methylbutyrate free acid (HMB-FA) and calcium salt (HMB-Ca) on strength, hypertrophy, and markers of muscle damage. In this randomized, double-blind, placebo-controlled study, 44 resistance-trained men (age: 26 ± 4 years; body mass: 84.9 ± 12.0 kg) consuming ≥1.7 g·kg−1·day−1 of protein received HMB-FA (3 g/day; n = 14), HMB-Ca (3 g/day; n = 15), or placebo (PL; cornstarch, 3 g/day; n = 15) for 12 weeks, while performing a periodized resistance training program. Before and after intervention, lean body mass (measured with dual X-ray absorptiometry), maximal dynamic strength (one-repetition maximum), knee extension maximal isometric strength (maximal voluntary isometric contraction [MVIC]), cross-sectional area (measured with ultrasound), and muscle soreness were assessed. MVIC was also measured 48 hr after the first and the last training sessions. All groups increased lean body mass (main time effect: p < .0001; HMB-FA: 1.8 ± 1.8 kg; HMB-Ca: 0.8 ± 1.4 kg; PL: 0.9 ± 1.4 kg), cross-sectional area (main time effect: p < .0001; HMB-FA: 6.6 ± 3.8%; HMB-Ca: 4.7 ± 4.4%; PL: 6.9 ± 3.8%), one-repetition maximum bench press (main time effect: p < .0001; HMB-FA: 14.8 ± 8.4 kg; HMB-Ca: 11.8 ± 7.4 kg; PL: 11.2 ± 6.6 kg), MVIC (main time effect: p < .0001; HMB-FA: 34.4 ± 39.3%; HMB-Ca: 32.3 ± 27.4%; PL: 17.7 ± 20.9%) after the intervention, but no differences between groups were shown. HMB-FA group showed greater leg press strength after the intervention than HMB-Ca and PL groups (Group × Time interaction: p < .05; HMB-FA: 47.7 ± 31.2 kg; HMB-Ca: 43.8 ± 31.7 kg; PL: 30.2 ± 20.9 kg). MVIC measured 48 hr after the first and the last sessions showed no attenuation of force decline with supplementation. Muscle soreness following the first and last sessions was not different between groups. The authors concluded that neither HMB-Ca nor HMB-FA improved hypertrophy or reduced muscle damage in resistance-trained men undergoing resistance training ingesting optimal amounts of protein. HMB-FA but not HMB-Ca resulted in a statistically significant yet minor improvement on leg press one-repetition maximum.

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A Systematic Review of CrossFit® Workouts and Dietary and Supplementation Interventions to Guide Nutritional Strategies and Future Research in CrossFit®

Ricardo Augusto Silva de Souza, André Guedes da Silva, Magda Ferreira de Souza, Liliana Kataryne Ferreira Souza, Hamilton Roschel, Sandro Fernandes da Silva, and Bryan Saunders

CrossFit® is a high-intensity functional training method consisting of daily workouts called “workouts of the day.” No nutritional recommendations exist for CrossFit® that are supported by scientific evidence regarding the energetic demands of this type of activity or dietary and supplement interventions. This systematic review performed in accordance with PRISMA guidelines aimed to identify studies that determined (a) the physiological and metabolic demands of CrossFit® and (b) the effects of nutritional strategies on CrossFit® performance to guide nutritional recommendations for optimal recovery, adaptations, and performance for CrossFit® athletes and direct future research in this emerging area. Three databases were searched for studies that investigated physiological responses to CrossFit® and dietary or supplementation interventions on CrossFit® performance. Various physiological measures revealed the intense nature of all CrossFit® workouts of the day, reflected in substantial muscle fatigue and damage. Dietary and supplementation studies provided an unclear insight into effective strategies to improve performance and enhance adaptations and recovery due to methodological shortcomings across studies. This systematic review showed that CrossFit® is a high-intensity sport with fairly homogenous anaerobic and aerobic characteristics, resulting in substantial metabolic stress, leading to metabolite accumulation (e.g., lactate and hydrogen ions) and increased markers of muscle damage and muscle fatigue. Limited interventional data exist on dietary and supplementation strategies to optimize CrossFit® performance, and most are moderate to very low quality with some critical methodological limitations, precluding solid conclusions on their efficacy. High-quality work is needed to confirm the ideal dietary and supplemental strategies for optimal performance and recovery for CrossFit® athletes and is an exciting avenue for further research.

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Trehalose Improved 20-min Cycling Time-Trial Performance After 100-min Cycling in Amateur Cyclists

Nathan Gobbi de Oliveira, Luana Farias de Oliveira, Rafael Pires da Silva, Tamires Nunes Oliveira, Gabriella Berwig Möller, Juliana Murasaki, Manoel Antônio Ramires, Rafael de Almeida Azevedo, Guilherme Giannini Artioli, Hamilton Roschel, Bruno Gualano, and Bryan Saunders

Carbohydrate (CHO) supplementation during endurance exercise can improve performance. However, it is unclear whether low glycemic index (GI) CHO leads to differential ergogenic and metabolic effects compared with a standard high GI CHO. This study investigated the ergogenic and metabolic effects of CHO supplementation with distinct GIs, namely, (a) trehalose (30 g/hr), (b) isomaltulose (30 g/hr), (c) maltodextrin (60 g/hr), and (d) placebo (water). In this double-blind, crossover, counterbalanced, placebo-controlled study, 13 male cyclists cycled a total of 100 min at varied exercise intensity (i.e., 10-min stages at 1.5, 2.0, and 2.5 W/kg; repeated three times plus two 5-min stages at 1.0 W/kg before and after the protocol), followed by a 20-min time trial on four separated occasions. Blood glucose and lactate (every 20 min), heart rate, and ratings of perceived exertion were collected throughout, and muscle biopsies were taken before and immediately after exercise. The results showed that trehalose improved time-trial performance compared with placebo (total work done 302 ± 39 vs. 287 ± 48 kJ; p = .01), with no other differences between sessions (all p ≥ .07). Throughout the 100-min protocol, blood glucose was higher with maltodextrin compared with the other supplements at all time points (all p < .05). Heart rate, ratings of perceived exertion, muscle glycogen content, blood glucose, and lactate were not different between conditions when considering the 20-min time trial (all p > .05). Trehalose supplementation throughout endurance exercise improved cycling performance and appears to be an appropriate CHO source for exercise tasks up to 2 hr. No ergogenic superiority between the different types of CHO was established.

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Physical Activity: A Strategy to Improve Antibody Response to a SARS-CoV-2 Vaccine Booster Dose in Patients With Autoimmune Rheumatic Diseases

Bruno Gualano, Sofia M. Sieczkowska, Ítalo Ribeiro Lemes, Rafael Pires da Silva, Ana J. Pinto, Bruna C. Mazzolani, Fabiana I. Smaira, Nadia E. Aikawa, Leonard V.K. Kupa, Sandra G. Pasoto, Ana C. Medeiros-Ribeiro, Carla G.S. Saad, Emily F.N. Yuk, Clovis A. Silva, Paul Swinton, Pedro C. Hallal, Hamilton Roschel, and Eloisa Bonfa

Background: Physical activity associates with improved immunogenicity following a 2-dose schedule of CoronaVac (Sinovac’s inactivated SARS-CoV-2 vaccine) in patients with autoimmune rheumatic diseases (ARD). This study evaluates whether physical activity impacts vaccine-induced antibody responses to a booster dose in this population. Methods: This was a phase-4 trial conducted in São Paulo, Brazil. Patients with ARD underwent a 3-dose schedule of CoronaVac. One month after the booster, we assessed seroconversion rates of anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity. Physical activity was assessed through questionnaire. Results: Physically active (n = 362) and inactive (n = 278) patients were comparable for most characteristics; however, physically active patients were younger (P < .01) and had a lower frequency of chronic inflammatory arthritis (P < .01). Adjusted models showed that physically active patients had ∼2 times odds of seroconversion rates (OR: 2.09; 95% confidence interval, 1.22 to 3.61), ∼22% greater geometric mean titers of anti-S1/S2 IgG (22.09%; 95% confidence interval, 3.91 to 65.60), and ∼7% greater neutralizing activity (6.76%; 95% confidence interval, 2.80 to 10.72) than inactive patients. Conclusions: Patients with ARD who are physically active have greater odds of experiencing better immunogenicity to a booster dose of CoronaVac. These results support the recommendation of physical activity to improve vaccination responses, particularly for immunocompromised individuals.

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No Associations Between Physical Activity and Immunogenicity in SARS-CoV-2 Seropositive Patients With Autoimmune Rheumatic Diseases Prior to and After Vaccination

Fabiana Infante Smaira, Bruna Caruso Mazzolani, Ítalo Ribeiro Lemes, Rafael Pires da Silva, Ana J. Pinto, Sofia M. Sieczkowska, Nadia E. Aikawa, Sandra G. Pasoto, Ana C. Medeiros-Ribeiro, Carla G.S. Saad, Emily F.N. Yuk, Clovis A. Silva, Paul Swinton, Leonard de Vinci Kanda Kupa, Pedro C. Hallal, Hamilton Roschel, Bruno Gualano, and Eloisa Bonfa

Aim: To investigate the association between physical activity and immunogenicity among SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases prior to and following a 2-dose schedule of CoronaVac (Sinovac inactivated vaccine). Methods : This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial conducted in Sao Paulo, Brazil. In this substudy, only SARS-CoV-2 seropositive patients were included. Immunogenicity was assessed by seroconversion rates of total anti-SARS-CoV-2 S1/S2 immunoglobulin G (IgG), geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity before and after vaccination. Physical activity was assessed through a questionnaire. Model-based analyses were performed controlling for age (<60 or ≥60 y), sex, body mass index (<25, 25–30, and >30 kg/m2), and use of prednisone, immunosuppressants, and biologics. Results: A total of 180 seropositive autoimmune rheumatic disease patients were included. There was no association between physical activity and immunogenicity before and after vaccination. Conclusions: This study suggests that the positive association between physical activity and greater antibody responses seen in immunocompromised individuals following vaccination is overridden by previous SARS-CoV-2 infection, and does not extend to natural immunity.